Originally posted @allaboutestates.ca

While I was enjoying the Florida sunshine last week, a Washington Post article caught my eye ‘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 does 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 all start with having the conversation with our loved ones.

Originally posted @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.

Last week’s blog regarding the Aging With Confidence: Ontario’s Action Plan for Seniors reported that “Ontario will invest 1 million over three years in a public education campaign to raise awareness among seniors on how important- and easy- it is to set up Powers of Attorney and to encourage them to choose who can make personal care and financial decisions on their behalf, if necessary.” This is good news.

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.

Originally posted for @allaboutestates.ca

Last January 2017 the Ontario government recognized that Seniors in Ontario  are a growing force that needs to be better serviced and recognized and created its own stand alone Ministry, namely the Ministry of Senior Affairs. It has previously been housed within the Ministry of Infrastructure.  Yes I thought they were strange bedfellows too.  While Statistics Canada advises that there are more seniors over age 65 than children under 15 years of age, Ontario has recognized  that within the next 25 years, the number of seniors in Ontario will double to 4.6 million.

So, last week, the Wynn government released: Aging With Confidence:  Ontario’s Action Plan for Seniors:  which I hope is the start of something wonderful.

It is an exciting announcement  advising that the government will spend 550 Million$$ over 4 years for  the building of 5,000 new Long Term Care beds and another  $155 million over 3 years for community based services. In an attempt to support seniors at all ages, the Action Plan divides resource allocation into a few different areas.

Firstly, to all seniors, regardless of age and health status.  These initiatives included things such as:

  1. Free ‘high-does flu vaccines
  2. One Stop Website: www.ontario.ca/agingwell or call 211
  3. Better community transportation option
  4. More age friendly communities- accessibility (Community Planning Grant)
  5. Elder Abuse Prevention
  6. Expansion of consumer protection
  7. Strengthening elder abuse prevention (public education, service provider training, research and improved community response)
  8. Provide education about powers of attorney (Ontario.ca/agingwell)

The second area is directed towards supporting seniors living independently in the community.  These initiatives include funding for:

  1. More senior active living centres (community hub provide social, recreational program)
  2. More community engagement opportunities: funding more projects
  3. Staying physically strong (active for life recreation stream under Ontario Sport and Rec Communities Fund)
  4. Engaging seniors through arts programs
  5. Helping seniors with technology – linking youth volunteers with seniors
  6. Supporting seniors to become mentors- will fund 20-30 more projects

The third area is directed towards Supporting Seniors Requiring Enhanced Supports at Home.  This includes:

  1. Support for more naturally occurring retirement communities- providing more onsite support with focus on ethno-cultural services- OASIS model
  2. Increasing access to in home health care- access to house calls.
  3. Increased access to geriatric care- increasing training opportunities for health care providers and psw.
  4. Providing more home care hours (PSW , nursing and pt)
  5. Expanding seniors supportive housing new transitional care spaces (between hospital to home) and providing 200 new subsidies to access affordable housing
  6. Increase support for caregivers: will provide a single point of access for information?
  7. Making the quality of care more consistent: better consistency from region to region and better understand how need relates to hours provided.
  8. Helping people with dementia- expanding programs (investing $100 million over 3 years)
  9. Enhancing self-directed care- new- self directed care models –( new personal support services organization by 2018)

The last group is directed towards Supporting Seniors Requiring Intensive Supports.   These include:

  1. Modernizing long term care homes- eliminating 4 bed ward.
  2. Reduce the wait time for LTC – will create 5,000 new beds by 2022 and will create 30,000 more over next decade
  3. More staffing and support in LTC- increase in nursing hours, PSW hours and specialized behaviourial training and end of life care. Increase to 4 hours PSW care daily
  4. Promoting innovation- virtual consultation?
  5. Culturally appropriate LTC (meals and language)
  6. Strengthening safety in LTC
  7. Strengthen office of the OPGT
  8. Improved end of life care- more hospice beds closer to home

Some great initiatives ahead.  There are many that I am excited to learn more about.   Let’s see how things unfold….

originally published @allaboutestates.ca

I had the pleasure of attending last week’s Society of Trust and Estate Practitioners’ conference, titled “Elder Abuse and Manners of Protecting the Elderly”. It focused on financial abuse which is the most common form of elder abuse. It provided an excellent overview with a panel discussion presented and moderated by lawyers (Craig Vander Zee, Kim Whaley and Albert Oosterhoff), the Toronto Police Vulnerable Persons Coordinator (PC Jason Peddle) and the Ombudsperson for Banking Services and Investments (Sarah Bradley). I learnt a lot- primarily about what happens after the (alleged) offence occurs from the legal perspective both from the civil and criminal courts. Ms. Bradley highlighted the investigation and dispute resolution mechanism when a financial institution/investment firm is involved and PC Peddle shared the police process/response after receiving a call of complaint.

What was missing for me was more information on how to prevent financial abuse, especially when the primary abuser is family or the older person’s attorney for finance. It is not that the information was missed or omitted but rather I am not sure it exists at all. Can this crime can be prevented before there is a victim? The incidents vary widely- from the younger caregiver and older (rich) client; the new internet love interest who wants to move in and be added to the bank accounts; the neighbor who assists and buys the older person’s groceries (as well as their own) to the son in law who wants to invest all of your money and then some…..

My fellow bloggers and I have written previously on this topic the repeated question is asking what can be done to prevent financial abuse? Awareness and education have been the key messages to date in terms of preventative measures, but sadly it may not be enough. We know these crimes are under reported, often due to shame and stigma felt by the older victim. Many times we may have a suspicion but without the theft occurring the authorities are unable to get involved. Do you think there are ways that this abuse can be stopped before there is a victim?

I would love to hear your suggestions and here are few to get us started:
– Attorney workshops on what it means to be an attorney for property and personal care
– Provincial POA registry 
– Use of consistent best practices within the financial and trust institutions
– Citizen led (and police supported) watch group that can say to possible perpetrators that ’we have eyes on you’ and
– Easier way to investigate potential scammers

Here’s hoping we can make a difference……

The Role Played by the Family Caregiver

by Audrey Miller on October 21, 2017

in Caregiving

Originally published @agecomfort.com 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

AgeComfort.com October 16, 2017

Originally posted @allaboutestates.ca

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 @allaboutestates.ca

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 @allaboutestates.ca

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 @allaboutestates.ca

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