Originally posted @allaboutestates.ca

Does her name sound familiar? Audrey was 57 years old when she died last month, by her own choice and with medical assistance. She had been diagnosed 2 years earlier with incurable cancer and had chosen to die on her own terms- except she really didn’t.

In her own words: “people like me are dying earlier than necessary because of this poorly thought out law” which requires the ‘suffering person to be competent immediately before life-ending treatment is administered’.

Ms. Parker had previously been ‘Assessed and Approved’ for assisted dying but because of the advances of her cancer and the high risk that she would lose her capacity, she opted to end her days before she actually wanted to. In my view this is a tragic story. Last week I attended a Dying with Dignity webinar highlighting some of the advances and key challenges that Canadians continue to face around Medical Assistance in Dying (MAID) and Bill C-14, the federal law on medical assistance. One of the most pressing issues of concern is around advance planning for those with dementia. An earlier polls conducted by Ipsos Reid, reported that 8 in 10 Canadians agree that individuals with a ‘grievous and irremediable medical condition, including patients with dementia, should be permitted to consent to assisted death in advance. Specifically the question is whether a ‘still competent patient with a serious degenerative illness should be allowed to make an advance request for assisted death that could be carried out when he or she is no longer competent.’ Today this issue is more prevalent than ever. As we age, more and more of us will be likely living with dementia. The question is whether we can choose to die with dementia- on our own terms. Something to think about…

Originally published @allaboutestates.ca

My fellow bloggers and I write frequently about Powers of Attorney, however my concerns are often focused on the lack of planning when it comes to making Powers of Attorney for both Personal Care and Property.
More specifically, although I do not have any statistical data, my subject matter experience tells me that people are more likely to have an attorney named solely for property than having both or only having appointed an attorney for personal care. People seem to care more about their finances than they do about they own care needs. Many times a trust or financial organization has been named as attorney for property yet there is no one named for care. Why do we continue to fool ourselves by thinking that we are going to live well and cognitively intact until we die in our sleep?

Dr. Katherine Arnup highlighted the death experience in the Vanier Institute of the Family research paper called Death, Dying and Canadian Families. I summarized her findings in a previous blog and while it is from a few years ago, I don’t believe much has changed.

The top 3 Canadian desires are:
Desire 1: We want to live forever: We are living longer with more and more of us reaching our 100th birthday.
Desire 2: We want to be fully able and then to die suddenly in our sleep: Only 10% are lucky enough to experience ‘sudden death’. The rest of us will likely linger. For many seniors’ ‘old age’ is accompanied by a progressively increasing number of ailments and chronic conditions.
Desire 3: We want to die at home: Most Canadians die in hospital.

I recently shared the death of a long time client of mine. Her last days were spent in the hospital and it was a difficult journey for her.

Part of our lack of planning, even by those who work in the health and legal fields is that of planning for when we become ill and are no longer able to make sound decisions. We ignore the inevitable and bury our heads in the sand. The message is timeless. Think about tomorrow and how you want to live UNTIL you die and choose someone who can speak for you when you can no longer speak for yourself.

by Cathy Preston, VP, Individual Markets at RBC Insurance, November 19, 2018

Read: ‘It Was 24/7′: Coping With The Stress Of Being My Mother’s Caregiver

At some point or another, most of us will have to assume a caregiver role in life, whether for a child, spouse, parent or friend. In my house, that role was taken on by my father when my mom was diagnosed with rheumatoid arthritis. But when he passed away at the age of 63, my mother’s full-time care fell to me and my sister.

In 2012, 8 million Canadians, or 28 per cent of the population aged 15 and over, provided care to family members or friends with a long-term health condition, a disability or problems associated with aging. And according to a recent survey among working Canadians, two in 10 had to take time off work to provide care for a loved one — a number that’s likely to rise given the aging boomer generation.

Whether it’s an aging parent, a sick child, spouse or friend, the emotional, mental and financial burden of a being a caregiver can be challenging at best, and potentially catastrophic without the proper supports in place. Based on my personal experience, here are five tips I can share to help better manage caregiver stress.

Don’t forget self-care
It may sound trite, but it’s truly important you look after yourself, too. In the last year of my mom’s life, I moved back into our childhood home and lived in the same room as her, while my sister’s family occupied the other rooms. It was 24/7 and all-consuming.

You can’t help others if you’re down for the count.
Caregivers can quickly become drained and exhausted, yet carry a sense of guilt if they want to escape for a bit and have some fun. It’s critical you allow time for self-care; even an hour a day to go for coffee, work out or meet a friend can help change your mindset and ease stress that can easily lead to depression or anxiety. After all, you can’t help others if you’re down for the count.

Accept help from others
Oftentimes people may feel a responsibility to handle everything on their own or believe that accepting help from others makes them appear weak. But even the most resilient or capable among us can become strained under the pressures of caregiving.

It’s perfectly acceptable to let others help, whether that’s an offer from the boss to send dinner to your house, a friend picking up groceries or running errands, or a family member coming by to help clean. And don’t necessarily wait for an offer. Decide what you are realistically capable of handling on your own, then prepare a list of things that can be delegated and let others choose which items they would like to help with.

Learn to communicate
The stress of caregiving presents itself in many ways, including irritability, anxiety and depression. Often, this can lead to caregivers becoming isolated or not feeling understood, reluctant to “burden” others with their situation. Some may argue with family members or have trouble expressing how they feel.

Reach out to a good friend, find local support groups where you can connect with others who are going through a similar situation and take advantage of any counselling services available through employee assistance plans. Being able to talk about your emotions is necessary for coping and can help create stronger bonds with loved ones.

Find support
One of the most overwhelming aspects of being a caregiver is the sheer number of responsibilities, from navigating the health care system to making decisions in times of crisis. Not to mention everyday errands, shuttling to doctor’s appointments or finding competent assisted care.

Although it may feel like it at times, remember that you are not alone
Sites like Elder Caring provide guidance, education and care management services to support patients and their families, with links to helpful resources and blogs on topics ranging from dementia to resolving family disputes. …

Shining a Spotlight on (Ontario) Caregivers

by Audrey Miller on November 19, 2018

in Uncategorized

Originally posted @allaboutestates.ca

The Change Foundation just published their findings on Ontario Caregivers- a fitting reflection for National Caregiving Awareness month. I have summarized some of their key findings based on a study involving 800 respondents across Ontario:

– Canadian family caregivers provide roughly ¾ of all patient care and their contributions to the healthcare system was estimated at 25 billion per year.
– Caregivers spend on average 11-30 hours of care per week
– 83% of carers are taking care of one person and 17% are taking care of more than one
– 46% are caring for parent or inlaw
– 15% are caring for their grandparents
– 7% are caring for children with exceptional needs
– Majority of care is provided to someone with aging issues and 17% provide care to someone with Alzheimers
– 41% of carers have been providing care for at least 3 years
– While 90% of caregivers speak English as their primary language, only 67% of those they care for speak English as their first language
– 72% of carers provide emotional support and 68% provide transportation as the two top tasks
– 42% of carers provide basic medical tasks (changing bandages, monitoring medication) and 21% take part in medical procedures such as changing G tubes, changing wound dressings and giving injections
– At least half of caregivers believe those they look after would not have the same quality of care if they were not involved
– Half of caregivers feel overwhelmed by having to organize the circle of care and a strong majority wish there was somewhere they could go for advice
– Even when providing physical care, less than one in five have received any hands on training
– 45% of caregivers say cost was the biggest barrier to getting additional support, followed by 32% who said it was lack of information
– When more information is needed, 58% of caregivers turn to the internet, 44% turn to friends and family, and 28% turn to healthcare providers. Surprisingly, only 9% approach disease-based charities for information
– Overall, most caregivers feel that being a caregiver strengthens their relationship and commitment to their loved one and makes them feel rewarded. That said, three-fifths
admitted they are doing this because they have no choice, and two-fifths feel trapped, helpless and frustrated at times.
– Three-quarters feel they are coping at least generally well with their caregiving responsibilities. However, only one-fifth feel they are coping very well. There are many aspects of caregiving they find to be stressful, particularly dealing with the declining health of their family member, meeting the needs of their family member as well as managing their own emotions
– Half of all carers have not spoken to their doctor about their ability to emotionally or physically handle the care job
– Half feel their personal time, social life and ability to care for themselves has been negatively impacted both physically and mentally
– Two-fifths have seen a negative impact on their financial situation, particularly those looking after a child or spouse
– Many have had to take time time off work for caregiving and some have lost their job
– More than half of workplaces try to make concessions to allow their employees to handles these other responsibilities, but one-third of caregivers say their workplace doesn’t even try
– Young carers (ages 16-24) tend to downplay their role, they are less likely to consider themselves as a caregivers.

I am not sure there were any big surprizes for me with this data but it certainly highlights the important (nonpaid) job that many people find themselves in. I am always glad to look at ways to better support this community as I anticipate that these numbers are only going to grow over the next few years.

The Final Goodbye

by Audrey Miller on November 5, 2018

in Articles & Blogs by Audrey

Originally posted @allaboutestates.ca

Further to my last week’s blog  on ‘getting ready for the final scene’, my lovely 94 year old client died this past Saturday.  I really can’t say it was a peaceful death as it seemed to be a very long and  difficult journey.   She could no longer eat or drink and as she was only 90 pounds when she entered the hospital, she seemed to have shrunk  considerably.  She could no longer speak but I am sure she was still able to hear me.  While her eyes were open, they did not see; yet the raise of her eyebrows and wrinkle of her  forehead  led me to believe she was able to acknowledge my words and sentiments.  She died the next day with her caregiver beside her. She was one of the lucky ones.  Her 99 year old sister was her only living relative and had said her goodbyes as well.   I say she was one of the lucky ones as she had lived very well and at home until age 94, still cognitively sharp and relatively healthy.  She and her sister lived together and they had 24 hour/ full time caregivers who encouraged them and supported them in living as fully as possible. Doris’ last words to me  a few days before, were of thanks and  gratitude for having arranged for trust services through her bank and for the wonderful attention she received from Jina, her trust officer.  It was Jina who hired Elder Caring, several years ago, after  Doris had fallen and broken her hip. I say she was one of the lucky ones as she was also able to pay for her care and able to direct it, right until the end.   As I said my final goodbyes to her,  I told her that I  was one of the lucky ones, as  it had been my honour and privilege knowing her and being considered  part of her family.

Audrey quoted in article by Catherine Harris:

Do you have clients who have aging parents? Do you know how to help these clients prepare for what may lie ahead? Although this issue is not strictly included in your mandate as a financial advisor, there’s a lot you can do.

There are many issues surrounding aging. The scariest are development of dementia; vulnerability to physical, verbal and financial abuse; stress on caregivers; and potential damage to familial relationships. Read Parental Guidance

Originally posted @allaboutestates.ca

While the majority of my work is assisting with the living process, these past few week has been occupied with planning for the dying process.

I am currently working with two wonderful ladies who have both been assigned palliative care physicians. One who is lucky enough to be home and the other is currently in the hospital. One had been recovering from a catastrophic stroke and was sent home and the other went into the hospital with stomach pain and required emergency surgery. At age 94, surgery is never elective; and while the surgery in itself was successful, her organs did not respond well and her kidneys have started to shut down.

The determination process deciding how we live until we die has now occurred with both families. The conversation was led by the palliative physicians and it was a discussion about goals and choice.

The consideration is between life determining intervention (i.e. CPR) and comfort care. The issue of signing a Do Not Resuscitate order was discussed and decided in both of these situations.

Do you remember the newspaper article last year that read: ‘A Florida man collapsed with a ‘Do Not Resuscitate’ tattoo. Doctors didn’t know what to do’.

The full article in the New England Journal of Medicine described doctors in Miami who found themselves caught in what they describe as an usual ethical dilemma. Reportedly, an unconscious man was brought to the ER with a chest tattoo that read ‘DO NOT RESUSCITATE’; his signature was underneath. He did not have any identification or family with him. The doctors initially decided not to honor his wishes ‘invoking the principle of not choosing an irreversible path when faced with uncertainty.’ The ethics team advised them to honour his tattoo as “they suggested that it was most reasonable to infer that the tattoo expressed an authentic preference, that what might be seen as caution could also be seen as standing on ceremony, and that the law is sometimes not nimble enough to support patient-centered care and respect for patients’ best interests.” The DNR order was signed. Subsequently the hospital was able to locate a copy of his Florida Department of Health, DNR order which was in keeping with the tattoo. The gentleman passed away that evening.

The NEJM article concludes “this case report neither supports nor opposes the use of tattoos to express end-of-life wishes when the person is incapacitated.”
A professor of bioethics, Dr. Arthur Caplan opined that the DNR tattoo is not substitute for an advance health-care directive. He recommends keeping the actual document in your pocket or wallet.

Most of us don’t want to think about this dying process and if we had, we do not carry this document around with us. In Ontario we do not have a central registry. I am not sure why it cannot be part of our OHIP record. Quebec is the only province that does have a central registry. I have previously blogged about the Alberta ‘Green Sleeve’ program and gains they had made in having doctors spend time with their patients reviewing and discussing issues/concerns.

It seems pretty clear to me having instructions tattooed on one’s chest should be a clear message. However, until practice, policy and the law are consistent, we can and should start with having the conversation with our loved ones.

Originally posted @allaboutestates.ca

This was the frantic call I received from a daughter this past Friday. The hospital was discharging her 90 year old mother but had omitted to confirm that services and follow up medical appointments were in place. Now in many cases, this might not be a problem- depending on the health of the patient. But in this particular case, her mom had high care needs and in addition to 24 hour private pay care (that was in place), public supports including nursing and dietary services were also required. Her mom was returning home after being treated for pneumonia. Prior to this admission she had been home for less than one week, after having spent several months as an inpatient following a severe stroke. She remained immobile and was on a feeding tube.

On this late Friday afternoon, she was sent home with a requisition for blood work to be done the next day; however it was not arranged to be done at her home. She was also sent home with new medications that had to be administered by a feeding tube, yet the community nurse (from the LHIN) was not yet in place. Even with the use of a Hoyer (mechanical) lifting device, she required 2 people to transfer her and her 90 something year old husband was not physically able assist the private PSW.

What are families to do who find themselves in this unfortunate situation?

When things are complicated, my advice is not to be discharged home on a Friday and never before a long weekend. If unavoidable, request a discharge meeting so that all team members can provide their recommendations and that any required referrals can be arranged with assurances that the gears are in motion. This is the opportunity for family to ask questions and raise any concerns that they may have. If you are fortunate to have extended family, have one person assigned as the key contact. In many cases with seniors who are in poor health, there simply is no room for error.

In the above situation, this family was fortunate as they were able to get us involved; we made the necessary calls at 7:00 pm on a Friday night to ensure that a nurse was coming to provide the night time medications. This should not have been necessary. For the majority of families that are on their own it really is important to push back, ask questions and sometimes ‘no thank you’ is the right answer.

Originally posted @allaboutestates.ca

I had the pleasure last week of being a panelist as part of the Canadian Association of Gift Planner’s mentoring & education breakfast, on the topic of Ethics. When I had previously thought of ‘Gift Planning’ I was only considering the Will component, the gift left to a particular charity, once the person had died. I had not fully appreciated all of the challenges that might be experienced when working with the older person while they are still alive. There was much discussion in relation to the donor’s capacity, and the challenges posed when large amounts of money are being gifted and bequeathed to a charity especially when the donor might exclude family from their will. Ethical practices and how to do the ‘right thing’ are certainly critical considerations for gift planners.

My contribution as a panelist was in regards to the vulnerability of many seniors and those that find themselves alone in their later years. Their vulnerability isn’t necessarily in direct relation to their capacity but rather their need for friendship and assistance when the cost for this interaction might be naming this ‘friend’ in their will as a beneficiary. I had previously blogged about this thorny topic in ‘Sharing the Caring’.

I understand that it is very hard to be and feel old and to find oneself alone. The exchange of ‘I will assist you now and you don’t have to pay me BUT you do have to leave me your house…. or your money’ does not seem fair. It is an equation that we may see in family but it is also an equation we may see between the older person and their neighbours and/or their caregivers. In some cases, it might be a reasonable exchange when there is capacity and genuine care and concern; but it can also be highly suspect and smell of elder abuse. Perhaps the best scenario would be if there is a separate bone fide attorney for property (either a person or a trust company) who has been named who can work to ensure the older person’s money is being appropriately spent- on them- the older person but even so, the issue and need to have someone trustworthy appointed as attorney for personal care is clear.

Originally posted @allaboutestates.ca

What does this mean exactly? Does it mean a greater discount at Shopper’s or at Timmy’s. I don’t think so……

It is actually a reminder to all of us to acknowledge the great contribution made by seniors every day. As boomers reach this milestone, a senior is officially defined as someone over the age of 65, but this definition in practice may vary between the ages of 55- 60 and 60- 65 years plus. This official definition may include access to provincial and and other monetary benefits( and yes Shoppers Drug Mart does offer a 20% Senior’s Day discount on the last Thursday of every month).

Our Federal government is working hard to develop strategies and policies to support ‘seniors’ to remain living as well and healthily as possible. We now have the beginnings of a Dementia Strategy-actually we have a Ministerial Advisory Board on Dementia who will advise the Minister of Health on dementia care and key issues that need to be addressed. As we know the greatest risk of developing dementia is getting older… so we have to be prepared for our ‘golden years’. With the average life span for Canadians aged 65 and above at 87 for men and 89 for women we hopefully have many years ahead.
There are a number of tools now available on the Federal website offering tips and information on aging in place and ways to balance work and caregiving- a favorite theme of mine.

So take this day to thank a senior in your life. Visit or call family members. Spend some time together, go for a meal, go for a walk together or just pick up the phone and say hello…….