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.

Glad To Be A Day Older…..

by Audrey Miller on January 11, 2019

in Articles & Blogs by Audrey

Originally posted @ allaboutestates.ca
As we wind down 2018 and look forward to 2019, I always ask myself ‘where did the time go?’

I don’t really know because I am sure like many of you, I don’t feel much older than I did last year or the year before. I think we notice that someone else looks older (or has ‘aged’) when we look at them- but certainly not when we look at ourselves in the mirror. Look and feel are two different things.

A friend shared the following sentiments with me and I thought I would repost them. I am unable to ascertain who the original author is; Ms. Google dates it from 2015 from a variety of sources, so credit goes to someone, other than myself for the following 12 points below:

1. I talk to myself, because sometimes I need expert advice.
2. Sometimes I roll my eyes out loud.
3. I don’t need anger management, I need people to stop pissing me off.
4. My people skills are just fine, it’s my tolerance of idiots that need work.
5. The biggest lie I tell myself is “I don’t need to write that down, I’ll remember it.”
6. When I was a child I thought nap time was punishment. Now it’s like a mini vacation.
7. The day the world runs out of wine is just too terrible to think about.
8. Even duct tape can’t fix stupid, but it can muffle the sound.
9. Wouldn’t it be great if we could put ourselves in the dryer for ten minutes; come out wrinkle-free and three sizes smaller.
10. If God wanted me to touch my toes, he would’ve put them on my knees.
11. When the kids text me, “PLZ” which is shorter than please, I text back, “NO” which is shorter than “YES”.
12. At my age “getting lucky” means walking into a room and remembering what I came in there for.

Now, my own sentiments about getting older are slightly different. I am trying to be more thankful and appreciative of having another year. More specifically I am grateful for having another day- because truly, nothing is promised to us. Getting older is a gift and while there may be a few more grey hairs, extra pounds and extra wrinkles, the experience gained has provided me with some well earned wisdom along the way. Thank you and happy New Year.

Originally posted @allaboutestates.ca

At this time of year many of us, regardless of age, can get the flu. Unfortunately for seniors, the flu can be particularly dangerous- for a number of reasons
– Pneumonia
– Dehydration
– Greater falls risk with weakness
– Body weakness and
– Delirium- the topic of today’s blog

I had previously written about hospital acquired delirium which I believe merits reposting.
“Delirium is one of the 3 big ‘D’s that we see with our older clients. The other ‘D’’s are dementia and depression but I suppose the biggest ‘D’ out there is death. I recently came across a Reader’s Digest article while waiting at a doctor’s office that had been reprinted from The Walrus. The original title is “Why Is No One Talking About Hospital-Acquired Delirium?’” Read more about Delirium

Over this holiday period I had a number of clients get sick, enter hospital and develop delirium. The Mayo clinic shares that the ‘signs and symptoms of delirium usually begin over a few hours or a few days. They fluctuate throughout the day, and there may be periods of no symptoms. Symptoms tend to be worse during the night when it’s dark and things look less familiar. Primary signs and symptoms include:

Reduced awareness of the environment, such as:
– An inability to stay focused on a topic
– Getting stuck on an idea rather than responding to questions or conversation
– Being easily distracted by unimportant things
– Being withdrawn, with little or no activity or little response to the environment
Poor thinking skills, such as:
– Poor memory
– Disorientation
– Difficulty speaking or recalling words
– Rambling or nonsense speech
– Trouble understanding speech
– Difficulty reading or writing
Behaviour Changes and may include:
– Seeing things (hallucinations)
– Restlessness, agitation and combative behaviour
– Calling out, moaning or being quiet and withdrawn
– Slowed movement or lethargy
– Disturbed sleep and reversal of night-day-wake cycle
Emotional Disturbance such as:
– Anxiety, fear or paranoia
– Depression
– Irritability or anger
– Apathy or euphoria
– Rapid mood shifts

The risk here is that the amount of recovery can be dependent on the health and mental status of the individual before the onset of delirium.
A healthy person is more likely to recover; those who already have MCI or some degree of dementia, may not.

Lesson Learnt: If you notice any of the above symptoms, have them checked out.

Glad To Be A Day Older…

by Audrey Miller on December 31, 2018

in Articles & Blogs by Audrey, Elder Care

Originally posted @allaboutestates.ca

As we wind down 2018 and look forward to 2019, I always ask myself ‘where did the time go?’

I don’t really know because I am sure like many of you, I don’t feel much older than I did last year or the year before. I think we notice that someone else looks older (or has ‘aged’) when we look at them- but certainly not when we look at ourselves in the mirror. Look and feel are two different things.

A friend shared the following sentiments with me and I thought I would repost them. I am unable to ascertain who the original author is; Ms. Google dates it from 2015 from a variety of sources, so credit goes to someone, other than myself for the following 12 points below:

1. I talk to myself, because sometimes I need expert advice.
2. Sometimes I roll my eyes out loud.
3. I don’t need anger management, I need people to stop pissing me off.
4. My people skills are just fine, it’s my tolerance of idiots that need work.
5. The biggest lie I tell myself is “I don’t need to write that down, I’ll remember it.”
6. When I was a child I thought nap time was punishment. Now it’s like a mini vacation.
7. The day the world runs out of wine is just too terrible to think about.
8. Even duct tape can’t fix stupid, but it can muffle the sound.
9. Wouldn’t it be great if we could put ourselves in the dryer for ten minutes; come out wrinkle-free and three sizes smaller.
10. If God wanted me to touch my toes, he would’ve put them on my knees.
11. When the kids text me, “PLZ” which is shorter than please, I text back, “NO” which is shorter than “YES”.
12. At my age “getting lucky” means walking into a room and remembering what I came in there for.

Now, my own sentiments about getting older are slightly different. I am trying to be more thankful and appreciative of having another year. More specifically I am grateful for having another day- because truly, nothing is promised to us. Getting older is a gift and while there may be a few more grey hairs, extra pounds and extra wrinkles, the experience gained has provided me with some well earned wisdom along the way. Thank you and happy New Year.

The happy season is now upon us and back by popular demand I am sharing my holiday jingle. It is written with the best of intent and I hope will make you smile.

T’was the fight before Christmas, when all families know,
It’s better to forgive than tell them to F. O.,
Mom probably liked you better, if memory serves,
So while I am a P.O.A., she will get what she deserves

Come on siblings and get off your butts,
I need alittle help, ‘cause I really am going nuts,
I am pulled in many directions, with no time for my own,
Let’s hire an expert who we can speak with by phone

This Plan will save time and money and help us agree,
We can all care for Mom, in addition to me!
A Plan of Care will outline Mom’s needs,
Working together, we all will succeed

All families are strange, of this I am sure,
Now where did we put Elder Caring’s brochure?
Some guidance is needed to keep mom from harm
‘Cause with caregiver burnout, I’ve nearly bought the farm

I won’t wait this time, I will call them right now
Professional counsellors will give me know- how
I found it along with various papers
Advanced directives, wills, now finally some answers!

Meeting a counsellor, has made it much easier
I now have perspective on how to proceed
Hiring a caregiver is just what I need!
Alittle respite will go a long way
Of keeping my sanity day after day

Why did I wait? I really don’t know
We are living to 100 and there’s a long way to go
Having knowledge and resources makes it much easier
And learning when to say Yes and how to say NO!

Our government tells us, we should be aware
For those less fortunate, it may not be fair
Our society is aging and we all will need care
Live with your children? A threat or a dare?

Dementia is scary, forgetting all we know
The best is to love but how can we let go?
I too am part of the boomers, still looking ahead
One needs to be positive, no point feeling dread

We’ve had the talk and filled out the Binder
Make sure your wishes are clear- just a reminder
What’s ahead for us all, we really don’t know
I hope to have the choice when it’s my time to go

Planning ahead – my message is clear
Keep talking to your family and loving them dear

Our very best for a healthy 2019.
Audrey and the Elder Caring team