A Feel Good Story

by Audrey Miller on August 13, 2018

in Articles & Blogs by Audrey, Dementia, Elder Care

Originally posted @allaboutestates.ca

I am one of the lucky ones. I like what I do and I enjoy my work very much. The counsellors who work with me say the same thing and while we do deal with much sadness, we always try and find the positive in our daily work. This is one such story.

Mark is a 90 plus year old gentleman who was a very accomplished executive. We met Mark recently; he was living on a secure memory floor in a retirement residence. His history of how things came to be, are still unknown to us; but what we do know was that he had not been managing well in the community and had been subsequently placed there by the Office of the Public Guardian and Trustee. The referral came to us from his trust officer who recently became involved when Mark’s paperwork and their appointment as his Attorney for Property became known. Our counsellor met with Mark who was withdrawn, quiet and distrustful. She also met with the resident care team to understand his needs and status. He had severe memory issues but was relatively well physically. His room was stark without any personal belongings. We were told that his condo had just been sold and that a moving company was going to clear out the unit in the next few weeks.

Our past experience told us that we needed to get to the unit quickly and identify and choose some personal items, such as photographs, family pictures, artwork and furniture that could decorate his new setting. We know that having familiar items around us can assist with memory recall and comfort and we felt that this would be important for Mark. Fast forward to this past week when my colleague went to visit him and found him in his room sitting in his favorite leather chair with a huge smile on his face. He invited her to sit down and have a cup of tea with him.

Mark was alone yet he wasn’t. He had the foresight to assign an attorney for property who was a pro active advisor. His attorney wanted to ensure his client was managing well and as such we were invited to make a difference in his life, which provided great satisfaction for all of us. This small step is just the beginning in getting to know Mark and working together to ensure he is living as well as he can with the appropriate resources and supports available to him.

 

I Didn’t Want To Wake You

by Audrey Miller on July 30, 2018

in Uncategorized

Originally posted @allaboutestates.ca

A story I heard…..

Last week Zoey had the pleasure of visiting her aunt and uncle (in celebration of a 90th bday) who live in the States.  Zoey and her husband accompanied her mother who took the train in (by herself) from Montreal so that we could fly together.  Zoey’s mom used a wheelchair  transport for the airport, which greatly accelerated their wait in security, customs and boarding the plane (tip # 1: book a wheelchair and only take carry on luggage).  Fortunately the travel and trip went well.

Their return flight home was delayed; they arrived home in the very early hours in the morning (tip # 2: pre book transportation).     Zoey walked her mother to the guest room and said goodnight.  The next morning Zoey went into her mother’s room to find her sitting in bed holding a bloody tissue to her forehead, with blood on her, her bedding and clothing.  When asked what happened, she replied that when getting into bed, she tripped, fell and hit her head on the wall. She had spent the entire night sleeping fitfully, with a gash on her forehead that was still bleeding.  When asked why she did not call out for assistance, she simply said: ‘ I did not want to wake you’.

Now as you can appreciate Zoey was not thrilled with her response  and told her so,  and professionally I will share that  her response is more common than one would think (tip # 3: make sure the night lights are ON).

Upon assessment, Zoey and her mom agreed that the situation did not require a trip to the emergency room but Zoey did want to have her checked out by a physician.  The steps taken included:

  • Checking internet for closest urgent care centre: she was not able to enter her postal code to determine proximity,
  • Calling the closest family health team office: office closed, message connected to telehealth Ontario, left message with the return cell phone number,
  • Looking up walk in medical clinics and eureka, she was able to enter her postal code, she called the closest clinic, they were open and  had parking available,
  • They attended the clinic, had a short wait to meet the doctor who assessed her mom and applied sterri strips to the forehead wound and cleared her to continue her return trip home scheduled for later in the day,
  • Zoey received a return call from telehealth (abount 1.5 hours after leaving a message).

Zoey’s  mom was lucky.  Tip # 4: Consider yourselves fortunate. Zoey had a complete list of her mom’s medications and medical history as she had a  Wellness Binder (although it needed to be updated) and  was grateful that the fall was not more serious than it was.    For her mom the fall was not a big deal but for Zoey, it was……

 

 

 

 

Originally posted @allaboutestates.ca

This past week I met with two new clients who were both single women in their mid- 70’s. They both lived alone in their own condos and had retired from well-paying jobs. There were reaching out to EC to help guide them in thinking about and planning for a time when they would be less capable (both mentally and physically) of managing their own day to day needs. Thankfully, they are both planners and were being proactive.

Neither of these women had children nor close blood relatives on whom they could rely. Our conversation soon focused on the important paperwork particularly the need for powers of attorney for both property and personal care. My particular interest of course is in relation to the attorney for personal care and the importance of identifying a key individual (or individuals) who could make decision on their behalf when they were no longer capable of doing so for themselves.
This was problematic for both and neither felt that there was anyone who stood out, who could or would assume this role. There were concerned that their friends were the same age and many were struggling with their own health challenges and they did not want to add to their load.

Over the last many years, we have worked with many older single women and like these two ladies, the issue of who to name as their attorney for personal care had been of concern. Fortunately a trust company can be named for property and this can alleviate a lot of worry and apprehension. However, for personal care, this is not an option. In several cases the older individual contracted with a neighbor to fill the role as attorney for personal care with the understanding that the neighbor would be named in their will as a major beneficiary. This had not worked out well for them. Other times, there was no one named and the Office of the Public Guardian and Trustee had to step in. This did not always work out well either.

Other times I have seen several friends appointed who could share the responsibility and I think that ‘sharing the caring’ among friends may be the route more frequently chosen. EC is often asked to work with the attorney (attorneys) and be their eyes and legs. Knowledgeable and professional care managers are doing the groundwork, navigating the health care systems, identifying resources and helping the attorneys to make an informed choice once they know the options available. I believe this is of great assistance and through continued education we are seeing more and more proactive individuals getting their important paperwork in place and feeling confident about their futures.

Originally posted @allaboutestates.ca

Grey area: The fragile frontier of dementia, intimacy and sexual consent was the Saturday July 14, 2018 front page headline in the Globe and Mail.

Seniors and sexuality finally makes the front page of a national newspaper. However It is much more than that and the focus of the article is on consent and how it is (not) defined for those whose capacity may be questionable and the challenges faced by both families and residential settings.

As a society we have our share of hangups- especially when it comes to sexuality. Our parent’s generation didn’t talk about sex and we don’t really want to ask them questions about it either. For many, intimacy is about closeness, love and connectedness with another; sexual activity may or may not be part of the equation. Not all of our equipment may work as well as it once did either.

The issue regarding sexuality and seniors comes to the fore for those who reside in facilities, particularly those who reside in publicly funded long term care/nursing homes. Privacy is almost non existent and there is no such as thing as ‘behind closed doors’ due to safety concerns. For those seniors with dementia ( and appreciate that this is 1 in 3 over age 85) the issue is about capacity and understanding and consenting to sexual activity.

The Criminal Code indicates that consent can be ‘spoken or unspoken, but it needs to be affirmative and happen in the moment; passivity cannot be construed as a “yes,” and nobody can consent (or dissent) on anyone else’s behalf, not even with the power of attorney.’ This definition applies to all of us.
What is defined as capacity to consent for sexual activity for those living with dementia is not clear. Does the individual understand what they are doing and any consequences that may follow and can they change their mind and say no? This is even more complicated when one party is still married to another individual.

While Long Term Care settings would like to be considered as the person’s home, they really are not. They facilities are regulated by the Provincial Ministry, front line staff are Personal Support Workers; safety is supposed to be paramount and staff are to treat all residents with respect and dignity. However staff hold their own values and there is no policy on how to respond to physical intimacy between residents. Policy makers, researchers, advocates and involved, invested and interested individuals are discussing this issue and hopefully very soon we will have some best practices as we boomers age gracefully into ‘seniorhood’.

At least 54 people in Quebec have died over the last 2 weeks due to this current heat wave; the majority were seniors. Summer has hit us hard and although all winter long we look forward to warmer weather, the heat can actually cause harm- especially to the elderly.

Those of us 65 years and older, are more prone to heat stress, commonly referred to as heat stroke because our bodies do not adjust as well to the heat as younger individuals and certain medications may interact with the sun which can cause an adverse reaction.

Heat stroke occurs when we are unable to control our body temperature and our temperature rises very rapidly without being able to cool itself down. The following are signs and symptoms of heat stroke:

– An extremely high body temperature
– Nausea
– Dizziness
– Red, hot, and dry skin (meaning no sweating)
– Throbbing and unbearable headache

Heat exhaustion is another heat-related illness although not life threatening. Heat exhaustion can occur if exposed to high temperatures over several days or by not consuming enough fluids throughout the day.

The following are signs and symptoms of heat exhaustion:

– Paleness
– Muscle cramping
– Tiredness and weakness
– Dizziness and fainting
– Headache
– Nausea and vomiting
– Pulse rate may be fast or weak
– Breathing may be fast or shallow
– Skin is cool and moist

Dehydration occurs when one’s electrolytes are depleted, one’s body temperature is normal but the heart rate and respiratory rate increases. Often those with dehydration will feel lightheaded especially when standing.

Some ways to safeguard against the perils of too much heat are:

– Drink cool beverages (non-alcoholic)
– Rest
– Take a cool bath or shower
– Stay in an air-conditioned environment
– Wear light clothing
– Start drinking fluids 30 minutes before going outside
– Do not wait until you are thirsty to start drinking
– Do not drink liquids that contain caffeine, alcohol or large amounts of sugar.

If you are caring for an older individual you can assist them by keeping an eye open for the symptoms or signs of heat stroke or dehydration. If at all possible encourage older folks to remain in an air-conditioned location or provide an electric fan to keep them cool. Most importantly make sure they are drinking enough fluids to keep them hydrated. If they are showing any sign of symptoms, the person can be cooled down by applying wet cool towels or by having a cool bath.

The hot and humid weather is particularly difficult for those who have asthma, emphysema or bronchitis. It is advisable for the elderly and their family members to make sure that they have their medications on hand, they are well hydrated and that the older adults remain in a cool and shaded environment. If leaving the home or an air-conditioned environment, make sure that you bring food/snacks and plenty to drink. Also consider:

– Using a sunscreen with an SPF of 30 or higher
– Drinking lots of water and natural fruit juices
Avoiding going out in the blazing sun or heat when possible
– Going to air conditioned or cool places such as shopping malls, libraries, community centres or a friend’s place
– Keeping lights off or turned down low
– Seeking shade under trees, umbrellas or awnings whenever possible
– Wearing loose, lightweight clothing that covers as much of the body as possible, whenever possible.

Many of us like to take summer holidays and for caregivers, this brings some extra things to consider.

Should you decide to vacation with your older parent, there are some pre planning tips that can make this journey more enjoyable for both of you. Firstly, know what type of holiday would be best for everyone. Extensive touring, outings, or excursions can be tiring for older individuals. There are some senior friendly travel agencies which can also provide guidance for more ‘senior friendly’ destinations.

By Air or Train: If possible, try to set up a direct flight for your parents; call the airline in advance to know what special arrangements must be made. This may include ordering special foods/meals or use of a wheelchair. Some airlines allow companions/aides to travel either at a reduced rate or at no additional cost. I recently flew to San Francisco with my mother and arranging for a wheelchair for her, was especially helpful, as the distances in the airport are long. It also saved us all time getting through security and customs (win- win)!

If taking a vacation does not include your parents, then there are several options to ensure that they will be well taken care of during your absence. If there is an option for another family member to take over for you, then wonderful, as maintaining the older person’s routine as much as possible is recommended. If not, then there are still a few options.

Hiring an agency to provide care is a preferred route for many. If there is an extra bedroom available, a caregiver can move temporarily into the home and sleep there. If there is no private bedroom, then typically the staff remains ‘awake’ overnight. This route is more expensive but may provide necessary peace of mind. Although hiring from an agency is more expensive than hiring privately, there are checks and balances in place, which include coverage and supervision that all bring peace of mind. If this is your preferred route, have the caregiver start a few days early at least for a few hours, so that they can become familiar with your parent’s routine.
Another option chosen by many are short-term stays at retirement residences. Furnished suites are available, with personal care and full meal options as part of the daily rate. Costs start at about $120.00 per night

Alternatively, some choose to book respite stays at Long Term Care facilities. Again full care and meals are provided. The Ontario Ministry rate is $39.34 per day. This option must be booked well in advance and applications are made based on the the older person’s address and Local Health Integration Network (LHIN) office. Regardless of choice of location, make sure that all emergency contact information is provided.

Whether your parents are traveling with you or the decision is that they remain at home, it is important that you plan ahead to make sure all arrangements are in place.

Written by Jessica Rochman Fowler:

The tech industry is no stranger to age bias in employment practices. Several articles have been written over the past few years about ageist assumptions that permeate the tech world, including that older people can’t keep up with improving technology, or that older employees should “let the younger people do it,” with “it” referring to any number of tasks. The fact is, employing older people is often labeled (incorrectly) as a bad return on investment, an investment employers will find subtle ways to avoid.

Recently, an article was written titled “Cutting Old Heads at IBM,” which detailed the recent firing of thousands of IBM workers that targeted predominately senior employees and contradicted rules against age bias in the process.

According to the article, “ProPublica estimates that in the past five years alone, IBM has eliminated more than 20,000 American employees ages 40 and over, about 60 percent of its estimated total U.S. job cuts during those years.”

Finding a tech job doesn’t hold much more promise – simply put, says the Newstack, “for Baby Boomers, the chances of being hired are 60 percent less than their workforce representation.” And age bias doesn’t just mean being fired or not being hired, it can mean being passed over for promotions, being assigned work well below your pay grade, or being pushed out of your job in some other way as a result of your age.

Yet, an op-ed in WIRED magazine noted that those most affected by ageism in the workplace often don’t want to bring it up for fear of being labeled “old.” Which brings me to a broader question – when will our society address our collective fear of being “old” and acknowledge that this fear can result in unpunished acts of discrimination?

The Vanier Institute reports that 13.4% of seniors participated in the paid labour market in 2015, up from 9.2% in 1976. As people live and work longer, ageism is an issue that begs to be addressed. It’s time we start valuing the variety of skills displayed across generations and enable older people to continue participating in the workforce for as long as they’re able. This includes recognizing that ageism isn’t just a problem in the tech world, but one that resonates in many employment settings.

Referenced:

https://hiring.monster.ca/hr/hr-best-practices/recruiting-hiring-advice/strategic-workforce-planning/ageism-workplace-canada.aspx

Originally posted @allaboutestates.ca

The events over the last few weeks highlight how fragile life is. Anyone of us could have been walking on that sidewalk on that fateful day; we just never know what life has in store for us. This blog isn’t about being prepared, which is a concept I endorse but as I was never a girl guide, I may not be as well prepared as some. Rather today’s blog is about dealing with ‘a series of unfortunate events’ (thank you Lemony Snicket) and the need to recognize that we are all impacted, one way or another; some very directly and others not as much. Good mental health is our goal and getting assistance to deal with trauma and negative stress is important.

Employee Assistance Providers (EAP) are often the go-to resource for those companies that subscribe and while I do not have the statistics readily available, I hope that more and more companies see the value. Dealing with loss, witnessing a tragedy, being involved in an accident, are events that we cannot plan for and we may not know how we will react until, if and when, that situation presents itself. Working with a social worker or counsellor can be very beneficial whether dealing with post traumatic stress or loss. If you don’t have access to EAP resources, check out your extended health benefit provider as the services of a registered social worker are frequently covered, as well as possibly massage, physio or psychological counselling. Elder Care services are also more common today and can provide direction and support to employed carers before they burn out.

Failing access to either of these employer programs, the Canadian Mental Health Association offers a wide range of support programs. So, as per Bell Canada’s slogan, ‘Let’s Talk’.

* http://checkupfromtheneckup.ca/

Originally publised @allaboutestates.ca

I was intrigued by the following headline “How a stationary bike, paired with Google Street View, helps seniors with dementia” so decided that this would be the start of this morning’s blog. One of my preferred themes is dementia and the impact it has on everyone. No surprise as “dementia is the greatest global challenge for health and social care in the 21st century: around 50 million people worldwide have dementia and this number is predicted to triple by 2050. ” I have written about the need for services and about both Canada’s Dementia Strategy and the Ontario Senior’s Strategy. It continues to impact almost all of my clients so when new discoveries are made or new technology used to improve the lives of these individuals, I am interested. While there is no cure, the Lancet Commission on dementia, identified potentially modifiable health and lifestyle factors, that they indicate, if eliminated, might prevent dementia. This evidence suggests that if we change our lifestyle, we may be able to delay the onset of symptoms or maybe even prevent them. The Alzheimer’s Society provides the following health habits worthy of consideration:

1. Break a sweat- studies have found an association between physical activity and reduced risk of cognitive decline
2. Hit the books- formal education, at any stage of life, will help reduce the risk
3. Butt out- stop smoking. Evidence shows smoking increases risk of cognitive decline
4. Follow your heart- Risk factors for cardiovascular disease and stroke (obesity, high blood pressure and diabetes) negatively impacts cognitive health
5. Heads up!- Reduce risk of brain injury- “Wear A Helmet” Chicken Little was right.
6. Fuel up right- Eat a healthy and balanced diet. The DASH diet may help.
7. Catch some Zzz’z- Not getting enough sleep (insomnia or sleep apnea) may result in problems with memory and thinking
8. Take care of your mental health- studies have linked depression with an increased risk of cognitive decline
9. Buddy up- Stay social and engaged
10. Stump yourself- challenge your mind
All excellent advice for maintain good health, mentally, physically and cognitively.
Now back to the article of interest which describes how Carriage House Retirement Residence is using ‘The BikeAround’ which originated in Stockholm. Seniors ride a stationary bike and through the miracle of technology and Google Maps, can visit their favorite places, which bring back memories and provides both mental and physical stimulation. The BikeAround originates from Sweden and will hopefully be available more widely in Canada soon.

Originally posted @allaboutestates.ca

Case Example 1:   John was a 93 year old, well -to -do gentleman, never married  and had no known family.   He lived in his own home in a nice part of the city.  His next door neighbor had kept an eye out and assisted him over the years by shoveling his walkway and offering to get groceries for him on an occasional basis.  John had a ‘Friend’ who he met while playing Bingo. The ‘Friend’ spent more and more time at the house and soon appeared to be living at the house with John.  A short time thereafter, his neighbour noticed that  there were contractors at John’s house.  He went over to talk with John and the ‘Friend’ answered  the door and said that John was sleeping. The neighbour noticed a new roof, new windows and a fancy new car in driveway.  The bank noticed large withdrawals from his checking account and his  financial advisor started to receive emails signed by John (although John never sent an email previously) asking that  large sums of money be transferred out of his account .

Q: What could his neighbour have done? What could his bank have done?   If there was a signed Power Of Attorney for  both Property and Personal Care held at the bank could this have been avoided?

Case Example 2:  Frank was a 85 year old widower, estranged from his two sons.  He lived on a large property in the country. He always kept to himself and was largely independent.  After his wife died, he did engage a trust company to act as his Attorney for Property.  No one was named as Attorney for Personal Care.   After some troubling calls from Frank to his bank,   the trust officer called a community care manager to assess how he was doing and ensure his health and care needs were being well met.   Frank’s care needs continued to increase to a point at which 24 hour care was required.  His behaviours escalated and he started to have violent outbursts.  His caregivers began to fear for their safety.  After a subsequent fall, he was admitted to hospital and was found not be capable of making his own treatment decisions. At the point that he was ready to be discharged, the hospital did not feel he was safe to return home. He was subsequently referred to the OPGT and subsequently sent to live in a Long Term Care facility.  The bank was not in a position to make health care decisions on his behalf.

In this scenario, the financial institution had its hands tied as there was no Attorney for Personal Care to make health care decisions on Frank’s behalf.  While Frank may have had the necessary funds to live in a setting other than LTC or may have preferred to remain at home or live in a dementia specific retirement residence, this did not occur.  If there was a signed Power Of Attorney for Personal Care, could this have been avoided?

Note: both of these situations are fictitious.

There have been two recent papers  discussing prevention of financial abuse amongst seniors including the Ontario Securities Commission “Seniors Strategy”   and the “Report on Vulnerable Investors: Elder Abuse, Financial Exploitation, Undue Influence and Diminished Mental Capacity”   by the Canadian Foundation for the Advancement of Investor Rights (“FAIR Canada”).

They both make excellent and similar recommendations regarding steps to develop best practices to safeguard vulnerable seniors from financial abuse.   However, neither organization recommends that an Attorney for Personal Care be designated at the same time an Attorney for Property is named.

Just asking…..

Originally published @ allaboutestates.ca

This weekend we celebrated the first nights of Passover and Good Friday and Easter Sunday. Two major holidays that coincided, along with a statutory holiday enjoyed.

For me and perhaps for many of you, these holy days have a traditional familial connection rather than a religious one. The foods eaten, or perhaps the foods not eaten, while symbolic of a religious theme, also provide a cultural comfort and familial custom. It is this connection and the lifelong memories associated with these annual holiday celebrations, which I believe remain with us. For me, it is the family gathering, the specialty foods and singing of songs that stay. I think for many with memory decline, this holds true as well. For those who lost a loved one, an empty seat at the holiday table can be particularly difficult. For the many families that are in conflict with one another and may not be talking, this too can prove challenging.

Every year I take comfort in making my late grandmother’s friend turkey recipe, which is one of my family’s favorite meals. This is a recipe handed down to my mother and then to me, which one day I hope my sons will be making. However you celebrated and whatever foods you enjoyed, I hope you too had a special holiday long weekend.