Ignorance is Bliss

by Audrey Miller on August 12, 2019

in Articles & Blogs by Audrey, Elder Care

Originally posted @ allaboutestates.ca

Our friend recently told us that his sister had done a DNA genetic test with one of the companies that provides ancestry and health information. What she found out was not what she was expecting at all. No, she does not have ‘royal’ roots but she does have twin half brothers that she did not know existed. It turns out that my friend’s mom had, before she married his father, given birth to twin boys that she had given up for adoption over 65 years ago.

The mom had never mentioned this to anyone and kept it her secret which would have remained as such, except for these tests results. My friend and his sister decided to track down their new found siblings. The twins had been adopted together and they believed, they had no other siblings themselves, until they received a phone call from my friend and his sister identifying themselves as close blood relations. The boys, who are now men in their late 60’s were excited to learn about their new relatives and a family reunion of sorts took place. The twins then wanted to meet their biological mother.

Unfortunately at the time of this discovery, their mother was in the late stages of dementia; as such my friend and his sister decided that it would not be a good idea for them to meet her.

Now, fast forward one year later when their mother died. Fortunately for her, she believed her secret was still hers alone; although it was no longer. My friend was the executor of his mother’s estate and the question on their minds was what was the exact wording of her will?

Did she simply indicate her estate was to be shared equally between her children or did she specifically name them? Perhaps it is a clear from a legal perspective that once someone is given up for adoption they no longer have the same rights but at that moment, it was unclear to my friend. In this case, their mother had named them (my friend and his sister) as her sole beneficiaries. From my perspective I found this to be a very interesting story. But from theirs, it is so much more……..

A few weeks ago  there was an announcement  that the Federal health minister earmarked $50 million over 5 years to support our new dementia strategy.  You may recall that the National Strategy for Alzheimer’s Disease and Other Dementias Act was passed in June 2017, which at that time, was a great birthday present for our 150th birthday.

Following several consultations, 5 principles were established to guide the process.

  1. Prioritize quality of life for people living with dementia and caregivers;
  2. Respect and value diversity to ensure an inclusive approach, with a focus on those most at risk or with distinct needs;
  3. Respect the human rights of people living with dementia to support their autonomy and dignity;
  4. Engage in evidence-informed decision making, taking a broad approach to gathering and sharing best available knowledge and data; and
  5. Maintain a results-focused approach to tracking progress, including evaluating and adjusting actions as needed.

From these principals 3 national objectives were identified including:

  1. Prevent dementia
  2. Advance therapies and find a cure
  3. Improve the quality of life of people living with dementia and caregivers.

And then, 5 underlying pillars were identified that would achieve these objectives, including:

  1. Collaboration
  2. Research and innovation
  3. Surveillance and data
  4. Information resources
  5. Skilled workforce

(excerpt from Executive Summary, A Dementia Strategy for Canada: Together We Aspire)

Our latest statistics include:

  • More than 419,000 Cdn ages 65 plus living with diagnosed dementia
  • 78,600 new cases diagnosed annually
  • 63% of those 65 plus living with dementia are women
  • 9 seniors are diagnosed every hour in Canada
  • 26 hours is the average time spent per week that friends/family provide support for someone diagnosed with dementia
  • 3 billion total health care costs and out of pocket caregiver costs in 2011
  • 6 billion is the projected total health care costs and out of pocket costs of dementia in Canada by 2031

For more detailed, please visit the Ministry website.

The groundwork has now been laid and this is a great next step as we all work together to r improve the lives of Canadians diagnosed with dementia and those living, working and caring for someone who has dementia.


Are you planning any summer holidays?  Are you travelling alone or with your family?  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 $40.24 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.

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