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.

Hope you had a happy Father’s Day.

Like many of you I was watching Saturday’s  victory by our Toronto Raptors.  It is therefore completely understandable that you would not have known that the 15th episode of FinanceIsPersonal aired that same evening. Elizabeth Naumovski, CM interviews Canadian women who have important messages to share as it relates to financial issues, including financial planning, debt, estate planning and  eldercare.  I was Liz’ guest and I address many of the questions that I am asked daily by colleagues and clients including how to get started, what do I need to know, how much does care cost and how best to prepare for the caregiving journey.   As such I have taken the liberty of including a link to this episode.

Go Raptors Go……

Mom’s Day

by Audrey Miller on May 13, 2019

in Articles & Blogs by Audrey, Elder Care

Originally posted at @allaboutestates.ca

A friend sent me this Mother’s Day greeting:

“To the World

You are a Mother.

But to your Family

You are the World!”

I don’t know who wrote it, but I believe the sentiment. We all have had a mother and chances are this person shaped our lives more than any one else. For many of us, our mothers were our first loving and significant relationship. Our mothers influenced us, guided us, taught us, and loved us- unconditionally.   A mother-daughter relationship is unique.  I share many of the same traits as my own mother and  things that I may (or may not) admire in her, I can see in myself.  My mother and I look alike and I can see how I am going to age over the next several years. We also share some of those family traits and health concerns that are genetically familial.

In my day to day work with families, I see many different mother- child relationship.  Most are  loving and caring and others that seem to be so complicated and challenging, I wonder what their history was together. When frailty and dementia are evident, sometimes we have to look a little deeper to remember the happy and healthier times. My heart goes out to those who have recently lost their mother; these Hallmark holidays are difficult. I also think about those moms that are no longer able to remember some of their shared stories and this too is difficult.  I know I am one of the lucky ones as I am a mom and I still have my mom.

Thinking About Comfort Care

by Audrey Miller on May 6, 2019

in End of Life

Originally posted @allaboutestates.ca

The sun is finally shining,  we are having double digit temperatures and it is the start of the week.  While today’s blog topic on end of life treatment  may sound like a downer, thinking, talking and preparing for it,  I feel is positive.

The New York Times article, ‘How to Make Doctors Think About Death’ is a well written piece by Theresa Brown, a hospice nurse.  It discusses the need to have guidelines and best practices for families and doctors as to when comfort care measures should/could/might  be introduced.  The focus on ‘comfort care’ is on alleviating suffering and managing symptoms as best as possible,  rather than on  actively treating the patient.

The author suggests that a simple treatment guideline might include: ‘ for patients who have one terminal illness that is either resistant to treatment or can’t be safely treated, combined with a second very serious illness or complication, along with a high degree  of physiological frailty, physicians should consider comfort measures instead of cure.’

The author opines that families may not understand that true nature of their loved one’s condition.  She adds that medical staff may not have enough time to spend with families and the patient themselves and do just that- explain what is going on and what choices are available to them.  Emotion can take over and we are all so very hopeful.  The hard truth, as the author points out is that ‘every single one of us will one day reach a point where our irreparable vulnerability, and decline, cannot be denied or reversed.’  We can only hope that particular time is very far off into the future. Ultimately we make our own choices or have chosen attorneys for personal care who share our beliefs and can follow our wishes.  Thinking about advanced care planning, having guidelines on choices and comfort care, I believe is a positive step.  Happy Monday and enjoy the sunshine today.

Originally posted @allaboutestates.ca

Thank you Sally Lee for your blog last week titled ‘Pre-arranging for Personal Care’.

My colleague  has discussed such an important topic and it is one that  I feel strongly about.   I felt this blog spoke to me directly as a ‘care service provider’ and as a resource to  women such as Jane, and to advisors in the estates and wealth management worlds, I felt I had to continue the discussion.    Choosing an attorney for personal care is a topic that I have blogged extensively about and one that all of us need to address.

We are fortunate that trust companies can assume the role of attorney for property  but there are virtually no choices when it comes to appointing a corporate entity for personal care. There are a handful of lawyers who will take on this role; but typically only if they are named for both property and care.

Sally and I provide the same advice – someone ultimately needs to be identified and selected who can make decisions that are in keeping with the wishes of the person, whatever they are.

As a care provider we are often requested to work with the attorneys, to develop a plan of care or to enact a plan that has already been established.   We are not decision makers and have no legal authority but we do work on behalf of the older individual and /or their attorney for care and property to ensure the older individual is living as well as they can.  Like anything else in life,  we can either hire specialists to assist us with important decisions and to complete work that is required or we can attempt to do it ourselves.

I just completed a renovation and hired a licensed electrician and plumber and had  specialists for the tiling and painting.  I don’t know about you, but I prefer to hire the experts to do this important work, whether it is buying and selling a house, making a will or renovating my home.  Planning and assisting our older clients/family members is no less important and like anything else, hiring a professional will save time, money and aggravation.

Originally posted @allaboutestates.ca

Have you noticed that many of us may only pay attention to something when it peaks our interest OR when we are dealing with the specific topic it is addressing.  I have noticed this is the case for many when dealing with elder care concerns;  and at the time that this additional information is needed, many may already be at  a crisis point.  As such I thought I would revisit the ‘3 C’s‘ which deals with choosing an alternate living environment, most typically a retirement residence.

The first ‘C’: CARE
-Is the condition chronic, temporary, progressive or palliative?
-How is the condition being medically treated and what course of treatment and outcome can be expected?
-Will the care needs increase over time?
Experience talking: So often families don’t plan ahead and a move is made based on a poor assessment of what their needs will be tomorrow. Many retirement residences are not equipped to deal with complex medical needs from either a physical or cognitive perspective

The second ‘C’: COST
-What will be the monthly cost?
o Do you know all of the current costs that are incurred monthly? Remember that food and lodging is part of the retirement residence cost with care often being available on an incremental basis
-What is the cost of the care component by itself?
o Consider nursing costs, services of a personal support worker, other therapies
o Medication monitoring and administration
o Special equipment that may be needed and its availability in the community?
Experience talking: Fully document your current monthly expenses so that costs can be compared appropriately. It is important to compare apples to apples.

My third ‘C’: CHOICE
-What geographic location do I want to live in- what geographic boundaries are acceptable?
-Do I want to be close to family, friends, religious organization, doctors?
-Do I want to be close to public transportation?
-Are pets welcome?
-Other personal taste and traits that should be considered ie, special diets, religious affiliation or cultural group.
-What amenities are available?
Experience talking: The expression ‘don’t judge a book by its cover’ holds true for retirement and long term care settings as well. Care, staff and service are often more important than new walls or furnishings. Take time to talk to other families as to their experience.

Understanding these 3 C’s is a great starting point  as it addresses the reason for the move and the associated costs to be considered.  While there is no set formula as to when the right time is to make such a move, safety and security are key while loneliness and isolation are important factors that many seniors face. While each person’s situation is unique, it is always best to make a move by choice rather than by necessity, when time constraints may be at issue.

 

Originally posted @allaboutestates.ca

I have recently returned from a fantastic trip to Asia- which had been on my bucket list. The trip started in Japan and it was a perfect launching point to see how aging matters and learn about some of the differences and similarities in our cultures.

People live longer in Japan and in fact have the longest-living population in the world with 43% of the population predicted to be 60 or older by 2050.[1] The world’s oldest man died at age 113 on Jan 21, 2019- he was Japanese and was still living in his own home. They are already dealing with many of the problems we are now facing – a rapidly aging and childless society and not having enough caregivers generally. Japan started to address some of these problems in 1994, with an initiative to provide better childcare. More and more, both parents are working and even with increased access to daycare support, the birthrate continues to decline. Similar to North America, younger people are not getting married or having children.

One difference I did note on my sojourn was, what appeared to me, to be a greater level of respect for the older generation, this was evident in Bali and in Taiwan as well. I was in Taiwan there during the Chinese Lunar New Year, (which I learnt is a very family oriented time) and as such, the restaurants, parks, subways, were filled with families; many of whom were pushing an older parent in a wheelchair.

Japan has been focusing on encouraging healthy aging and believe that the “the key is health management and diagnostic technologies that are indispensable for heading off diseases before they strike”[2] One such initiative is further development of a new toilet that can measure urine sugar, blood pressure, body fat and body weight. Below is a photo of a standard Japanese toilet, which includes a heated seat, cleansers for the front and back, and a dryer; some offer music as well. So clever and useful! Note that is also in braille.

My appreciation for their respect toward family and services available for their older citizens has continued to grow. I will be writing and introducing a number of caregiving robots that I also had the pleasure of meeting.

[1] 2017 UN study on World Population Aging, excerpt from ‘We are Tomodachi, Winter 2019

[2] We are Tomodachi, The government of Japan, Winter 2019

Toronto Seniors Strategy 2.0

by Audrey Miller on March 4, 2019

in Caregiving, Elder Care, Health Care

Pleased to have been part of this solution. Download and read the report.

Originally posted @allaboutestates.ca

Many of us have questions/concerns about where we will live, when we are no longer able to remain in our homes and this seems to be a topic discussed regularly. I am sure over the holidays there were many similar sounding conversations had with friends either talking about their parent(s) or in planning for themselves.Most times the conversation is triggered following the death of a spouse or an admission into hospital with the realization that a return home, may not be possible.

But what about for those healthy seniors who want to remain living in their own homes but require something more. The ‘something more’ might include:
– Socialization and someone knowing if you are dead or alive
– Getting help changing a light bulb or challenges turning off the remote (yes I admit, having 3 remotes is confusing)
– Sharing a meal
– Remain in charge.

You may recall that I previously blogged on the UK having a Minister for Loneliness, so it comes as no surprise that the Public Health Agency of Canada reported that “people with adequate social relationships are at a 50% lower risk of death than those with poor or insufficient social relationships. As a risk factor for mortality, social isolation exceeds obesity and physical inactivity.” Welcome to the OASIS model that developed organically in a Kingston Ontario apartment building and is being started in a mid town Toronto apartment building.

Christine McMillan is the driving force and OASIS came to be because of her determination and hard work as well as support from community partnerships (the South East Local Health Integration Network or SELHIN) and Trillium Foundation grants. Oasis is also working with UHN OpenLab. OpenLab describes themselves as ‘a design and innovation shop dedicated to finding creative solutions that transform the way health care is delivered and experienced.’

Oasis is truly a supportive living program created for the seniors and designed by the seniors. Government monies provided for the hiring of 24/7 PSW support (which complemented what the LHIN was already providing) and other services, including exercise programs, organized social programs and entertainment. Of interest as well was that many Oasis members who were eligible for long term care chose to defer this move- which provided substantial financial savings to the LHIN and our health care system.

The apartment owners provided the party room- which became a lounge and a separate dining area so this provided space for subsidized meals to be brought in three times a week.
It seems that what was naturally occurring in Kingston is having more of a challenge in getting the required support in Toronto.

*reference: https://uhnopenlab.ca/project/oasis/

Originally posted @allaboutestates.ca

All of the writers (and presumably the readers as well) know the importance of having their ‘important paper’ work completed. For me, most importantly this means completing Powers of Attorney for both Property and Personal care as well as Advanced Care Directives. For you, perhaps the ‘most importantly’ may be the Will, but regardless we can all agree that these are all key documents for living (and for dying) well.

Many people (of all ages) don’t like to talk about these things as they feel either:
– Nothing will happen to them and/or
– If they do talk about it, something will happen.
So where does that leave them?

I had the opportunity recently to review my own documents and reviewed again, with both my husband and children, what my wishes are and where the documents are located. This conversation was easy enough.
The more challenging discussion is how to talk to your children about completing their own paperwork. What is the right age to do this, when is the right time?

For me, the incentivizing factor was a trip they were planning- which would take them out of the country on holiday. My sons are in their late 20’s, have jobs and live on their own. I felt it was time. I shared this article with my sons and found it helpful.

I am well aware of situations where there has been an accident or serious misfortune involving a young adult (over age 21) and as a result, they sustained significant brain damage. Sustaining significant brain damage and capacity are often linked so having had an attorney for both property and personal care allowed the parent to deal with financial matters (school and car loans, banking) as well as personal matters including accessing their son’s social media accounts.

I know that this is not a pleasant topic to think about, but an important one to consider AND act upon.