The Role Played by the Family Caregiver

by Audrey Miller on October 21, 2017

in Caregiving

Originally published on October 16, 2017

The family caregiver plays a key role in supporting the very fabric of Canadian society. The most recent Census data tells us that 28% of all Canadians provide unpaid care to a family member or friend. If you are reading this article, chances are you are or know someone close to you who is a family carer.

Today there are more seniors over age 65 than children under age 14. Not only are we living longer, but adults over 100 years of age are also the fastest growing age group. Today’s life expectancy is 80 years for men and 84 years for women. Women are living longer and many find themselves widowed after looking after their partner. Continue reading: The Role Played by the Family Caregiver

The family caregiver plays a key role in supporting the very fabric of Canadian society. The most recent Census data tells us that 28% of all Canadians provide unpaid care to a family member or friend. If you are reading this article, chances are you are or know someone close to you who is a family carer.

Today there are more seniors over age 65 than children under age 14. Not only are we living longer, but adults over 100 years of age are also the fastest growing age group. Today’s life expectancy is 80 years for men and 84 years for women. Women are living longer and many find themselves widowed after looking after their partner.  Read The Role Played by the Family Caregiver October 16, 2017

Originally posted

If you ask anyone where they would like to live when older, most would say that they want to remain living in their own homes- for as long as possible. What does ‘for as long as possible’ mean? Most times in means that the older individual is able to remain living safely and is able to afford whatever care may be needed to help them maintain their independence and safety. Other times it means that the necessary care is not only affordable but is available and that any necessary home adaptations are possible; for example an older home may not be able to accommodate a stair glide and the installation of an elevator is cost prohibitive.

However, there are some of the ‘softer’ accommodation devices that help an older individuals maintain their comfort and independence. Money Watch highlighted in their October 10, 2017 post a number of ‘smart home’ devices, ranging from controlling thermostats and lighting, to playing music and placing telephone calls and being able to view who is ringing their doorbell. Reminders for medication administration and automatic stove controls are also available.

Some recent start up companies have widened their ‘help with independence net’ and have developed some very interesting apps and resources including: Uber for seniors, companies that will ensure timely bill payment and management, visual monitoring aids and my own personal favorite, a UK company specializing in aids and devices for those with memory loss. Closer to home a Toronto start up has developed a ‘steadiglove’ which reduces hand tremors, a common symptom of Parkinson’s Disease. The Dementia Hackathon in which I was a mentor/judge last March, provided a wonderful first hand and up close look at technology that will be a life saver and life changer for many. Every day there are new developments and I look forward to having affordable access to them.

The Randomness of Life

by Audrey Miller on October 2, 2017

in Articles & Blogs by Audrey, End of Life

Originally posted

On Wednesday, September 27th, Ken Chung, a 39 year old academic Philosopher died of Stage IV Pancreatic Cancer. Diagnosed in March 2016, Ken blogged about his experience up until his very last days, providing a unique and important perspective on what it means to both live and die. Ken wrote with exceptional clarity about his experience; he shared his hopes, his fears, about the randomness of getting sick, and mostly, how fortunate he was to do good deeds, spend time with his family, and to live the life he had.

Ken wrote his own memoriam: “Ken Chung died on Wednesday, September 27, 2017, eighteen months after being diagnosed with terminal pancreatic cancer. He wished he had more time to think, to write, to read, to figure out what life was all about. But mostly he wanted to more time to spend with his wonderful wife, Emma Abman, and to hang out with his family and friends. He considered himself to be, on the whole, a lucky man. He was 39 years old.”

Ken’s final blog, written one week before his passing, discusses the nature of a struggle. Ken writes that in life, struggling is typically accompanied by some possibility of success which makes all of the struggling, all of the failure, worth it. Ken notes with terminal cancer, it is different; there is no possibility of success. Ken finishes the article by writing about his own struggle with cancer:
“So this is a struggle without a reward. Is this why I find it so f*king hard?
I know, though, that the struggle itself is not all dark. It’s still up to me to make an extra effort to enjoy what I can — to take an extra second to enjoy my coffee, to taste the sweet freshness in the fruits I can still eat, to cherish the warmth of friends and family, to write a word here and there.”

Life is too short.

Originally posted

September 21 was World Alzheimer’s Day.

The Public Health Agency of Canada notes that more than 402,000 seniors (65 years and older) are living with dementia and this a number that will continue to grow.

Dementia is the plague of the 21st century and we don’t yet have a cure. It will impact all of us and countries around the world are developing Dementia strategies to address this growing health crisis. Canada’s national strategy, Bill C-233 is still in its infancy.

Other important initiatives include the establishment of the  Centre for Aging and Brain Health Innovation located at Baycrest to address areas of research as well as improvements for the individual with the disease and their caregivers. Themes included aging in place, caregiver support, care coordination and navigation and cognitive health. We are so fortunate to have this world leader as our own and the projects that they are working on, are simply incredible.

The Alzheimer’s Society shares 5 ways you can make a difference this month:
1. Learn more about the disease: What are the risks, what prevention is available and how to support those living with the disease
2. Spread the Word: Talk about it. Become a Champion for Dementia
3. Host or attend a Coffee Break: A ‘Coffee Break’ is the Alzheimer’s Society Nationwide annual fundraiser. Give a donation and get a cup of coffee!
4. Make a donation
5. Leave a gift in your will through the Alzheimer’s Society Legacy Giving program.

Please try not to forget: this is so important that the Alzheimer’s Awareness campaign will continue all month.

By: Audrey Miller, originally published

While the New Year starts in January, Jews around the world celebrate another New Year, the birth of the universe, 5778 years ago based on the Hebrew calendar. While it is the first of the High Holidays, for many who may not attend synagogue, it may still be recognized and celebrated with family sitting down together for a festive dinner.

When there has been a death of a loved one over the previous year, it is during the holidays when I believe their absence is felt stronger than ever. I know it is for me. For feuding families perhaps it is also time to put differences aside as we recognize how important family is.

The Jewish New Year (Rosh Hashanah) will be celebrated this week, closely followed by the 10 days of Awe leading to Yom Kippur, the Day of Atonement. It is the time for prayer and atonement so as to be inscribed in the Book of Life and to have another year of ‘peace, property and blessing’. The Book of Life is then sealed, on Yom Kippur.

A well known poem called Unetaneh Tokef—Let Us Cede Power- was written over 1000 years ago continues to be sung every year in synagogues around the world. Many of us may know the revised version of this poem by the late Leonard Cohen, which follows below the traditional chant.

Unataneh Tokef: 
How many shall die and how many shall be born
Who shall live and who shall die
Who at the measure of days and who before
Who by fire and who by water
Who by the sword and who by wild beasts
Who by hunger and who by thirst
Who by earthquake and who by plague
Who by strangling and who by stoning
Who shall have rest and who shall go wandering
Who will be tranquil and who shall be harassed
Who shall be at ease and who shall be afflicted
Who shall become poor and who shall become rich
Who shall be brought low and who shall be raised high.

Who By Fire by Leonard Cohen:
“And who by fire, who by water,
Who in the sunshine, who in the night time,
Who by high ordeal, who by common trial,
Who in your merry merry month of May,
Who by very slow decay,
And who shall I say is calling?
And who in her lonely slip, who by barbiturate,
Who in these realms of love, who by something blunt,
And who by avalanche, who by powder,
Who for his greed, who for his hunger,
And who shall I say is calling?
And who by brave assent, who by accident,
Who in solitude, who in this mirror,
Who by his lady’s command, who by his own hand,
Who in mortal chains, who in power,
And who shall I say is calling?”

Regardless of which version you sing, it is a powerful poem timeless in its ability to make us reflect on our past and hope for the future.  Happy New Year/Shana Tova

The Balancing Act Continues

by Audrey Miller on September 11, 2017

in Articles & Blogs by Audrey, Caregiving

Labour Day signifies back to school and for many parents, having their children return to school is a great relief. However for many of those ‘sandwiched’ between working full time and providing caregiving assistance to older family members, a return to school may mean less time for themselves. Helping with homework, driving to afterschool activities, getting lunches made and dinner on the table makes me appreciate how many roles and responsibilities that we all juggle.

I reread an earlier blog that I wrote in September 2014 that concludes with a quote from Sherri Torjman from the Caledon Institute of Social Policy. In her essay titled They’re informal, but these workers are essential, she writes: “On Labour Day, we need to pay attention to this huge group of essential workers: the millions of informal caregivers who show up nowhere in the employment numbers, but figure so prominently in real life.”

The Conference Board of Canada last month released their paper titled: The Juggling Act. Balancing Work and Eldercare in Canada. They summarized that the “total spending on continuing care supports for seniors was $28.2 billion in 2011. Of this amount, $10.2 billion was estimated to have been paid by individuals out of pocket or through private insurance. Clearly, unpaid caregivers are shouldering a large part of the cost of eldercare.” They reviewed that the types of care provided by employed Canadians included emotional support (checking in); assistance with health and daily living- (such as shopping, going to appointments) and case management (scheduling and organizing appointments). (Reference: Duxbury and Higgins, Balancing Work, Childcare, and Eldercare.)

The Conference Board estimate that eldercare obligations cost business $1.28 billion per year. They reviewed that direct costs include:
– training new personnel to replace those that leave because of caregiving responsibilities
-Wages paid to absent workers
-Overtime pay and wages for temporary replacement workers
-Additional health care claims and benefit costs related to stress and short term and long term disability leave and that the Indirect Costs included reduced performance and loss of knowledge (from both an institutional, procedural perspective).

Their paper looked at the cost to business, let’s not forget however the emotional and financial cost and toll it takes on the employees themselves and of course, their families. 35% of employed Canadians are caregivers.

It seems to me that it would make good sense for companies to support their caregiving employees. There are a number of different ways for organizations to offer this support, ranging from a paid leave of absence which perhaps is the most expensive option, to offering a flexible work schedule and work from home option that would presumably be less expensive.

Sadly, the Conference Board survey found that formal elder care programs were uncommon among Canadian organizations. However, south of the Border, according to a 2016 study by AARP and ReACT, “for every dollar invested in flexible work arrangements, businesses can expect a return ranging from $1.70 to $4.34. Telecommuting, meanwhile, delivers a return of between $2.46 and $4.45 for each dollar invested.” (Reference: AARP and ReACT. “Determining the Return on Investment: Supportive Policies for Employee Caregivers.” (2016).

There are many other options such as ensuring that Employee Assistance Providers include an elder care component that can either offer resource identification or 1:1 counselling which might also be covered through extended health care benefits (ie social work services are frequently covered by insurance plans). Lunch and learn and other educational programs are also a great resource and can help support employees by providing important and helpful information before they reach a complete burnout requiring a formal leave.

We are an aging society and we need to continue to talk and find ways to support one another as our caregiving journey continues. Our government clearly cannot do it alone and we need business to be part of the dialogue. Question for the day, is your company part of the solution?

Originally posted @

With Labour Day fast approaching I thought it would be fitting to highlight the role that young caregivers have in providing care to another person.

Since the creation of Lucky, The Young Carer Rap,

which was a partnership with the Vanier Institute of the Family based on research conducted by Dr. Grant Charles, the numbers of young carers has grown.  At that time 12% of young people surveyed in Vancouver high schools were in a primary caregiving role.  The care recipient was a parent, grandparent, sibling or other relative.  Their responsibilities could include practical, personal and emotional caregiving tasks as well as a wider range of household task such as shopping, laundry and cooking. Some are also providing hands on assistance with activities of daily living.

The purpose of Lucky, The Young Carer video was to raise awareness and raise awareness we did!  Action Canada completed a Task Force Report and identified a number of steps to improve conditions for Young Carers across the country, including: increased awareness, improved data collection and research and a multi-sector effort to support Young Cares in their communities.

Statistics Canada in 2014 provided data on Young Carers and found that  one in four young Canadians were providing care to a family member or friend and were typically spending three hours a week in this role. However 5% were spending more than 30 hours per week caring for others. Mostly these young people were looking after their grandparents (40%), parents (27%), friends and neighbours (14%) and siblings or extended family members (11%). {Data from “It’s Time to Care for Our (Young) Carers” by Andrea Breen for the Vanier Institute}.

More recently The Change Foundation  identified that within Ontario, 17% of Ontario Caregivers are youth. Again these are young people between the ages of 15 and 24. However there are many young carers who are under 15 and some are still in elementary school. In August 2016, a number of these young people share their stories in some  wonderful videos.

While Labour Day typically signifies the end of summer vacation and a return to school, please remember that for many young carers, their caregiving responsibilities did not take the summer off.  Recognizing and becoming more aware of what these young people do, is the first step in supporting them.

If you would like more information, please contact:

The Young Carers Initiative  and the Young Carers Project 


If an older individual was brought to your law office by a non family member and they wanted to appoint the individual as POA for Property and Personal Care, would you be suspicious?  Or what about if the request was to either change a will or to make a will, naming this individual as a beneficiary? Would you be concerned then; and if so, what can you do?

Would you be less worried if the older person wanted to appoint this individual for only Personal Care?

All of these scenarios lead me to the issue of capacity and whether the lawyers who are completing these documents do make a thorough determination whether capacity is evident at that time.  This question of course excludes readers of this blog who practice within the estates bar and perhaps it is better directed to general practitioners.

In terms of elders with whom we work that have chosen to appoint non family members, we see a variety of situations including: those who have appointed the same person for both Personal Care and Finance; those who appointed more than one non family member for both POAs (usually friends) and those who have appointed non family only for Personal Care and a financial institution or PGT has been named for Finance.  I am less suspicious and prefer when this latter option is in place, – however it seems it may not be the chosen route but rather the route defined post mediation/litigation. With our aging population and the rate of dementia anticipated, I wonder if there a place to review these options with our clients when drafting POA’s rather than after something has gone amiss.  I welcome your feedback.

A Good Life & A Good Death

by Audrey Miller on August 14, 2017

in Articles & Blogs by Audrey

Originally posted

A long time client of ours passed away last week.  She was able to remain at her own home and die in her own bed.  So many of us wish, when the time comes, that we could do the same.  We know this is not the ending place that most experience.

This blog is about the community team that came together to support her.

Mary (not her real name) was widowed many years ago and was not particularly close with her two children.  For many many years, Mary had a wonderful neighbour who  she viewed as a surrogate daughter and this younger neighbour viewed Mary as a mother figure.  So much so that Mary named this younger friend, Nathalie, as her POA for both care and property. This younger friend happened to also be a lawyer and acted in her attorney capacity  with commitment, care, consideration and respect towards her friend. By the time we were retained by her attorney, Mary was already living with dementia and needed care supports at home.  Mary’s wish was to remain at home.  In order to  meet this goal, Lori, our care manager worked with a team of  caregivers selected and hired from a local home health care company. Tom, the owner of this agency went above and beyond what is typically  provided by most home care agencies.  He visited, connected with, met with and maintained open and regular communication with both Nathalie, her POA and Lori.  As Mary’s health failed, her additional requirements included making the home accessible for her, which included the installation of a stair glide, porch lift, renovations to the bathroom, obtaining the needed mobility devices and other assistive devices to allowher to maintain her independence for as long as possible.  Her medical and treatment team now included her family doctor who visited her at home and an excellent palliative care team  from the CCAC  (now the LHIN).

The excellent care she received from her caregivers and treatment team allowed her to maintain her dignity and have her final wishes carried out. A memorial tea was held last week at Mary’s home to celebrate her life- with all of the care providers  and treatment team members who had the privilege of knowing and working with her.  It is truly an honour to be able to assist and support our clients in carrying out their wishes.  PS.  At the memorial tea, one of her  favorite caregivers prepared and cooked all of Mary’s favorite foods.   A truly fine ending for a truly lovely lady.

-Audrey Miller