A Good Life & A Good Death

by Audrey Miller on August 14, 2017

in Articles & Blogs by Audrey

Originally posted @allaboutestates.ca

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

 

Written by Audrey Miller and originally posted @allaboutestates.ca

Our Ontario government is short sighted. We/They have not planned well for the changing and aging of our society. There simply is no place for those of us who need care and are not fortunate enough to either have the funds to pay for it themselves or have the necessary family available who can pay for and assume this heavy burden – both in terms of financial, emotional obligation and time availability.

I have previously blogged on Alternative Level of Care (ALC) as I had a client who had been residing as an inpatient on a psychiatric floor of a busy downtown hospital for over 3 years. At that time I shared that as of June 30, 2016, there were a total of 2765 ALC patients.

The most recent data available that I could find on current numbers of ALC was from a ‘Guidance Document’ dated June 2017, titled ‘Expression of Interest for Reducing ALC Pressures through Short-Term Transitional Care Models ’. It actually is an ‘Expression of Interest’ to the LHINS ‘ to solicit local, innovative solutions that build on or develop partnerships and use existing capacity along the continuum of care to reduce ALC pressures’. Sounds good, doesn’t it?

They report as of January 31, 2017 there were 4,734 open ALC cases and patients designated as ALC had accumulated a total of 627,933 days while waiting to be transferred, typically to either a long term care facility or assisted living setting. In six month, the number of individuals with no place to go had increased by 70%.

The Ontario 2017 budget identified that over 15% of hospital beds were occupied by patients who did not need to remain in the hospital. Within the budget, new funds ($24 million) have been allocated for ‘innovative models to ensure patients are receiving care in the most appropriate care setting’ This is only one area of need and is the tip of the iceberg.

In a May 11, 2017 Globe and Mail article by Kelly Grant, titled Bad hospital discharges among top complaintsOntario watchdog finds, she wrote that ‘The Globe and Mail reported earlier this week on the case of an 88-year-old widower whose son says a Markham hospital pressured his father to leave, threatening to charge the elderly man $1,100 a day or drop him by ambulance at a homeless shelter.’

As our small company is not a LHIN and receives no public funding, we don’t have an official voice; but we do have a suggestion.  We recognize that there are a number of hospitals that have been converted to urgent care centres thereby leaving many empty floors of existing facilities.  We are wondering if those buildings could be converted to Long Term Care? Presumably there would be limited capital costs. We are aware that there are a number of such facilities in Toronto as many of the hospital amalgamations left Metro hospitals as the 9-5 urgent care centres while moving full hospital facilities outside of the city. In Etobicoke – both Queensway (now part of Trillium) and Etobicoke General (now part of William Osler) are urgent care centers. Both centres have ample space for conversion and it would greatly increase the long term care spaces.

Just saying…….

Originally posted @allaboutestates.ca

Have you been called from someone saying they are from a particular computer company and they want to fix the virus in your software program? How about the caller who identifies themselves as your granddaughter’s friend who they had their wallet stolen, is stranded and needs your help? Or the fellow who rings your door bell saying that his car broke down and his pregnant wife needs to get to the doctor and could you pay for a taxi or maybe the Nigerian prince who wants to share his inheritance?

Fraudulent scams are something that we are all at risk of succumbing to, no matter what our education, age or income. I fell for one last week to the tune of $400. The antifraudcentre shares that ‘there are many known scams, pitches and fraud types, including variations thereof, with new ones invented daily.’ These include telemarketing scams, identify theft, online scams, business scams, email and mail scams and of course, door to door scams. Navigating our daily lives is becoming more complex and the level of dishonesty ‘out there’ seems to be increasing or maybe it is our constantly changing environment that is becoming more global and technical in nature. It is particularly important that we help protect ourselves and others, who may be particularly at risk. Many seniors who are isolated are often grateful for the company- whether it be a phone sales person or a door to door caller who wants to sell something. It seems we need to be more savy and more suspicious too.

Many of us who have been victims of fraud know that there is a stigma attached to it, and often we don’t report it as we are embarrassed that this has happened to us. We also sometimes brush it off as a “less serious crime”, however, in the bigger scheme of things, these scammers are making millions off what may seem small to us. There is something we can do, as tackling this growing concern is going to take more than what law enforcement agencies can do on their own.
To report suspected fraudulent scams you can call the Canadian Anti-Fraud Call Centre at 1-888-495-8501 or report online at www.antifraudcentre.ca.
Educating ourselves and others is also very important. Information about the types of scams that impact all of us and seniors in particular, and what to do about them when they happen can be found here:
http://www.competitionbureau.gc.ca/eic/site/cb-bc.nsf/eng/04201.html
https://www.ontario.ca/page/safety-security-and-legal-matters-seniors#section-1

Remember ‘if it sounds too good to be true, it probably is’! By the way, don’t buy the ‘free sample’ of Skin Balance or Advanced Skin, because it sure wasn’t free!

Originally posted @allaboutestates.ca

by: Audrey Miller

What’s new with the CCAC? As readers know our public sector delivery system has been delivered via the Community Care Access Centres (CCAC) which are located across Ontario. The CCACs have been funded by the Ministry of Health and Long Term Care via the Local Health Integration Networks (LHIN) strategically located across 14 regions across our great Province. The latest initiative is called Patients First: Action Plan for Health Care and it is geared towards providing care at a local level. The CCACs have been integrated into the LHINs and now have sub-regions which provide for a smaller geographic planning and service delivery area. It also includes creating provincial Patient and Family Advisory Councils to ensure family carers and care recipients are involved in decision making. Additional monies for increasing home care hours and caregiver support and respite was also promised.

The Ministry website advises ‘Ontario’s Patients First Act’ includes some structural changes to the health care system that will help patients and their families access the health care they need more quickly and closer to home. The system changes will lead to a more local and integrated health care system, improving the patient experience and delivering higher-quality care. These structural changes include more localized planning of the health care system to meet the unique health needs of every community across Ontario. This means that the Local Health Integration Networks will take on a bigger role to ensure that each person in the province is receiving the care they need, tailored to the needs of their specific community.’ -Ministry website accessed July 3, 2017.

To identify your LHIN, access healthcareathome.ca and enter your postal code.
Central: [email protected]
905-895-1240
416-222-2241
Central East: [email protected]
310-2222
Central West:[email protected]
1-866-370-5446
Champlain:[email protected]
310-222
Erie St. Clair: [email protected]
1-888-447-4468
Hamilton Niagara Haldimand Brant: [email protected]
1-800-810-0000
Mississauga Halton: [email protected]
905 855 9090
North Simcoe Muskoka:[email protected]
1-866-903-5446
North East:[email protected]
310-222
North West:[email protected]
1-866-907-5446
South East:[email protected]
1-866-831-5446
South West:[email protected]
1-800-811-5146
Toronto Central:[email protected]
416-506-9888
Waterloo Wellington:Waterloowellington 1 866 306 5446

I am not exactly sure what these changes will mean to families. So far it is a name change. The CCAC case workers have a new business card.

Originally posted @allaboutestates.ca

Congratulations Canada! 150 years young and we are living longer than ever. Along with long life often comes disability and for many dementia is, in my opinion, the most threatening disease of today. Finally we have joined the ranks of the more progressive countries, those that are preparing themselves for what many have referred to as the ‘Silver Tsunami’, the tidal wave of long life. Canada is the 30th country (out of 194 World Health Organization members ) to now have a Dementia strategy. Bill C-233, An Act respecting a national strategy for Alzheimer’s disease and other dementias received Royal Assent on June 22, 2017 from the Standing Senate Committee on Social Affairs, Science and Technology.

Alzheimers Canada defines dementia as ‘an overall term for a set of symptoms that are caused by disorders affecting the brain. Symptoms may include memory loss and difficulties with thinking, problem-solving or language, severe enough to reduce a person’s ability to perform everyday activities. A person with dementia may also experience changes in mood or behaviour. Dementia is progressive, which means the symptoms will gradually get worse as more brain cells become damaged and eventually die. Dementia is not a specific disease.’ However many diseases can cause dementia and some of these conditions may be treatable.

Alzheimers is the most common form of dementia and the terms are frequently interchanged. This terrific short video describing the difference was provided on the Alzheimers website with material created by TCD, through the NEIL Programme at the Institute of Neuroscience.

What this dementia strategy will look like is still to be determined; however this is a tremendous step in the right direction. Congratulations Canada!

Congratulations Canada! 150 years young and we are living longer than ever. Along with long life often comes disability and for many dementia is, in my opinion, the most threatening disease of today. Finally we have joined the ranks of the more progressive countries, those that are preparing themselves for what many have referred to as the ‘Silver Tsunami’, the tidal wave of long life. Canada is the 30th country (out of 194 World Health Organization members ) to now have a Dementia strategy. Bill C-233, An Act respecting a national strategy for Alzheimer’s disease and other dementias received Royal Assent on June 22, 2017 from Standing Senate Committee on Social Affairs, Science and Technology.

Alzheimers Canada defines dementia as ‘an overall term for a set of symptoms that are caused by disorders affecting the brain. Symptoms may include memory loss and difficulties with thinking, problem-solving or language, severe enough to reduce a person’s ability to perform everyday activities. A person with dementia may also experience changes in mood or behaviour. Dementia is progressive, which means the symptoms will gradually get worse as more brain cells become damaged and eventually die. Dementia is not a specific disease.’  However many diseases can cause dementia and some of these conditions may be treatable.

Alzheimers is the most common form of dementia and the terms are frequently interchanged. This terrific short video describing the difference was provided on the Alzheimers website with material created by TCD, through the NEIL Programme at the Institute of Neuroscience.

What this dementia strategy will look like is still to be determined; however this is a tremendous step in the right direction. Congratulations Canada!

-Audrey Miller allrights reserved

Reposted from allaboutestates.ca

 

This original post was from a few years ago. It does seem like only yesterday because, while time has not stood still, sometimes our sentiments don’t change. The event and message is the same. It is a few years later and there is a new US golf champion. We still however miss those who are no longer around.

It was hard not to know that yesterday was Father’s Day. Signs, announcements and broadcasters made it very difficult not to acknowledge the day. Is it not odd that we need to be reminded by those organizations that typically want us to purchase something? Well maybe we do need to be reminded to spend a moment either with our fathers, if we still have one or to spend some time thinking about our fathers, for the rest of us. My father has been dead for almost 18 years and he died way too young from a ugly disease. Days do go by when I have not thought about him.The other day, I was out for lunch with a colleague and I bumped into a family friend from childhood who I had not seen for years. After briefly catching up, he was quick to remind me how close he was to my father and the impact he had made on his life. Years had passed since I had remembered the positive impact he had on others and on my friends who considered him a father figure as well. My father had an early death and there was much left undone and unsaid.

In my work with families dealing with their parents, I see those who may be flesh and blood but don’t like each other and who do not get along. In other families I am so touched by the care and respect that is shown and expressed. There is however a lot of grey in the middle. Perhaps the commercial reminder of Father’s Day can be the poke we need to reconnect and reaffirm with our own fathers so that we will not feel that there was much left undone or unsaid. Bumping into this old friend and being reminded of my father’s joie de vivre, brought a smile to my face.
Happy Father’s Day.

Keeping Memories Alive

by Audrey Miller on June 12, 2017

in Elder Care, End of Life

Originally posted @allaboutestates.ca

It is hard enough when a loved one forgets; but it is also very painful when family forget …. about who the older person is and who they were. Many times older people are seen as just that old folks- who may be wrinkled, forgetful, stooped over and hard of hearing. But what about all of their experiences, history, successes and accomplishments?

I wanted to highlight some remarkable women, whose stories today may be forgotten by almost everyone; women in the twilight of their years who may be alone having outlived family and friends. These are women who all made incredible contributions and led remarkable lives. Betty Rich is one such lady who is now in her late 90’s and only a few years ago chronicled her own story in a book called: Betty Rich: Little Girl Lost.

Mrs. Rich tells of her war experience in occupied Poland and the hardships that she faced under the Nazis. It is also her story about hope and perseverance and in her words, ‘how we deal with our fate’.
Other remarkable women whose stories may be forgotten include trailblazers in their own right. Women who pursued careers in medicine and accounting in the 1930’s and made tremendous sacrifices along the way; for several of them this meant having a career over family. Sometimes we don’t know the person for who they are on the ‘inside’ and may only see them for who they are today which sadly may be a decaying shell of their former self.

The axiom, ‘don’t judge a book by its cover’ is applicable. Lesson learnt: Get to know the person inside of the person you see.
Ps. on that note that are companies and apps that can help document someone’s story.

Elder Orphans

by Audrey Miller on June 5, 2017

in Baby Boomers, Elder Care

Originally posted @allaboutestates.ca

You may already be familiar with the terms. It refers to older individuals who do not have any family to provide care for them. They have either outlived their family or are estranged from them. With our aging demographics we are working with many single women who do not have any children.

Society has shifted and traditional models of care that were supported by nuclear and extended families and communities have changed. Our families are smaller, gender roles are shifting, more people seek full time employment to keep families financially stable. People are living longer, outliving their friends and families, and live further away from familial supports. Further, more people are choosing lifestyles other than the traditional nuclear family. This has added new challenges to caring and being cared for. Many talk about struggling to juggle the different pressures that modern life brings and how it impacts their capacity to care for those around them or to find the care that they need.

This can leave many feeling isolated and can seriously impact physical, mental and financial health of caregivers and those being cared for.

How we care for one another and planning for who cares for us is evolving. Many of us do not want to rely on the government to provide our care or make our care decisions. There is no one size fits all solution. Building communities and creative approaches will be critical. There have been several co housing initiatives that are/have started whereby like- minded individuals create their own communities.

The following articles touch on some of these challenges and solutions.
A recent Toronto Star article reflects on ‘all the single senior ladies’.

Radical Resthomes is a home grown movement out of Montreal. They have created a short documentary that outlines their plan.
Sonia Sodha considers the challenge of finding care and providing care for the childless. She suggests that “resolving the question of what the state can and ought to do is relatively easy compared with the much knottier problem of how to create a society that has an abundance of the things – love, companionship, emotional support – that the state can never hope to provide”. If you have no children, who will care for you when you’re old?

Golden Girls Here We Come!

Originally posted @allaboutestates.ca

I had the pleasure of recently attending the B’nai Brith Canada Estates and Trusts Group annual seminar, titled Power of Attorney Disputes. It was a wonderful opportunity to watch some of Ontario’s finest estate lawyers play different roles (feuding siblings and mediator) as well as hear their professional perspective on various aspects of Power of Attorney disputes regarding questionable capacity, accounting issues, estate trustees and sexual consent.
While the focus of most disputes has to do with money ( and likely the majority that proceed to trial) and the Power of Attorney for Property, my interest is with the disputes that occur on the care side and the Power of Attorney for Personal Care.

What I have seen in my many years working with caregiving families, which is paramount to the tension, is simply put, the lack of communication. The adult children’s hurt feelings of bygone years and perception seems to further cloud the situation. At the end of the day or perhaps it should really be at the beginning of the day, is the need to understand what the care issues actually are about. Understanding what the older individual actual care needs are and by having them properly assessed and documented, I believe can go a long way in reducing or maybe even eliminating the battle. Old hurts may not be resolved but the hope is that they can be put aside at least so they don’t interfere and impact the well being of the parent. Having siblings on the same page for a plan of care for their parent may be the answer.

Fellow blogger, Dr. Richard Shulman in his blog “The Psychology of Decision making by Attorneys for Personal Care – What You Won’t Learn in the Substitute Decisions Act (SDA)” shared his perspective on the psychology at play. He highlights the possibility of a previous estrangement or abandonment as well as guilt and hidden motivations (Mom loved you better or leave the money for my inheritance) that impact relationships and lead to these challenging disputes.

Understanding care needs from a medical and functional perspective is helpful at the beginning of the caregiving journey. Communicating these care needs to all involved and having an open discussion about ways to share the care or how the care will be provided and by whom and whether it will be monetarily compensated is worthy of further discussion, and may even be able to prevent an expensive trip to court.