Tomorrow is GivingTuesday

by Audrey Miller on December 2, 2019

in Articles & Blogs by Audrey

This past weekend was the American Thanksgiving.  In Canada we knew it was their Thanksgiving because advertising for  Black Friday sales was everywhere.   First it was on Friday, then it included Saturday and Sunday and now we have Cyber Monday.  What a concept!  While I tried not to be taken in by the advertising, I failed.  Our 10 year old television finally died and Best Buy was advertising some good prices…… so, I succumbed.  But sadly it did not stop there.  Some of the sales were very enticing and, in a cognitive dissonance sort of way, I thought about all the money I would be saving if I purchased the online specials that kept popping up on my browser.  And save I did!

Fortunately there is penance to be had with Giving Tuesday tomorrow.  I can dissuade any guilt by giving to those less fortunate.   According to givingtuesday.ca, this is “a global movement for giving and volunteering, taking place each year after Black Friday.  The ‘Opening day of the giving season,’ it’s a time when charities, companies and individuals join together and rally for favourite causes.  In the same way that retailers take part in Black Friday, the giving community comes together for GivingTuesday.”

GivingTuesday was originally started in the US in 2012.  Last year in Canada,  6500 partners came together for GivingTuesday, impressively $15 M was donated on line.  It is a targeted day of  giving back.

Regardless of where you are in Canada, some special ‘giving events’ have been organized. 

Philanthropy within the estates’  world includes pre planning and  bequeathing monies to charities and organizations as part of one’s estate. While this is a fantastic way to support your favorite cause, you don’t need to wait until you have passed to see your monies being spent on a worthy cause- other than yourself.

What are you going to do tomorrow?

 

Originally posted @allaboutestates.ca

Remembrance Day is a significant day in the lives of many who endured the challenges of living during war times. As benefactors of their sacrifice, we sometimes forget that peace is a gift and the high price that was paid for it. Today we have young soldiers who are returning from war, many of whom are returning with a disability. “Centres of Excellence’ across our country will be opening to provide short and long term rehabilitation treatment for our returning soldiers. I remain hopeful that funding will be available in order to meet their life long needs, including retraining, reintegration into society, accessible accommodation and counselling support. It is not only remembering their sacrifice but also ensuring that they have full funding and timely access to goods and services for their rehabilitation and integration in to their communities. They deserve no less.

Veterans Independence Program

The Veterans Independence Program (VIP), developed in 1981, is a National Program that assists veterans to remain independent in their own homes. The primary caregivers (including a spouse, common-law partner, adult child or another individual) who were taking care of the veteran at the time of their death or admission to long-term care can also qualify to receive these benefits.

Eligible survivors may receive housekeeping and/or grounds maintenance benefits. As well, housekeeping services may include: vacuuming; laundry; making and changing beds; cleaning floors;dusting and general picking up; kitchen and bathroom cleaning; meal preparation; appliance cleaning;washing and changing windows; and errand services to purchase food, do banking, pay bills.  Ability to access the services is dependent on health needs and whether these services are available to the veteran through some other governmental program.

Lest We Forget…..

  • Tips for Keeping Your Brain Young: Get enough sleep. Older adults don’t need less sleep than younger adults.
  • Getting less than 7 or 8 hours of sleep at night can make it harder to concentrate and remember.
  • Get rid of stress.  Over time, stress can make it hard to get a good night’s rest. Stress can also make it harder to concentrate, learn and remember.
  • Exercise, prayer and meditation are good stress relievers.
  • Think, think, think. The more you use your brain, the better it’ll work. Read.
  • Do that crossword puzzle. Play bridge. Join a discussion group at a senior center or church. Take a class at your local community college. Learn to play the piano or speak another language.
  • Socialize.  Spending time with other people also seems to give your brain a boost. Find ways to meet and get to know others. Join a club.
  • Volunteer. Try a part-time job.
  • Eat right. A diet that is low in saturated fat (the kind found in fried foods,butter, cheese, beef and pork) but rich in fruits and vegetables and B vitamins is good for your brain. Your diet should also include a couple of servings of fish, especially salmon, tuna, sardines, and mackerel, each week. These fish are high in omega-3 fatty acids, which are good fats that your brain needs. Ask your doctor or nurse if you should also take multiple vitamin daily.

Source: Foundation for Health in Aging
Established by the American Geriatrics Society

Dementia and MAID

by Audrey Miller on November 3, 2019

in Articles & Blogs by Audrey, Dementia, Uncategorized

Originally posted @allaboutestates.ca

Medically assistance in dying (MAID= Bill C14) for eligible Canadians was passed by federal legislation in June 2016.  To recap, eligibility includes:

  • Being 18 years and older and mentally competent
  • Having a grievous and irremediable medical condition
  • Making a voluntary request for MAID that is not the result of outside pressure or influence
  • Providing informed consent.

Grievous and irremediable has been defined as:

  • Having a serious illness, disease or disability
  • Being in an advanced state of decline that cannot be reversed
  • Experiencing unbearable physical or mental suffering from your illness, disease, disability or state of decline that cannot be relieved under conditions that you consider acceptable
  • Being at a point where your natural death has become reasonably foreseeable which takes into account all of your medical circumstances and does not require a specific prognosis as to how long you have left to live

One does not have to a fatal or terminal condition to be eligible for medical assistance in dying.

Informed consent means receiving all of the information required to make a decision at the time of your request AND immediately before medical assistance in dying is provided.[1]

Given the above criteria, for those individuals who have been diagnosed with a dementia and have indicated that when in the future, they have declined to a point when they no longer (recognize family/ communicate/ feed themselves/ respond  to those around them/able to get out of bed/breath on their own) have not been eligible to request MAID.

This past August 2019, a Victoria man became one of the first Canadians with a dementia diagnosis to have received MAID.  Dr. Stefanie Green is the physician who provided the medical assistance.  In a recent interview she shared:  “His care ‘seemed very much on the edge….The risk of not meeting the eligibility criteria, or not being found to have done so properly, is a criminal offence, which leaves me liable to go to jail for up to 14 year.’”[2]

Dr. Green expressed: “This is not an expansion of our law….This is a maturing of the understanding of what we’re doing.”

This is a difficult and very important topic.  A team of Canadian experts recently authored a paper to provide guidance to clinicians who assess and provide MAID in Canada.  Their report is linked here  https://camapcanada.ca/wp-content/uploads/2019/05/CPG-dementia.pdf.

I found the examples in the Appendix reflected the medical status of many clients with whom I have worked over the years and I wonder how many wanted a different ending.

 

 

 

 

[1] https://www.canada.ca/en/health-canada/services/medical-assistance-dying.html

[2] https://www.cbc.ca/radio/thesundayedition/the-sunday-edition-for-october-27-2019-1.5335017/b-c-man-is-one-of-the-first-canadians-with-dementia-to-die-with-medical-assistance-1.5335025

November 2019 Newsletter

by Audrey Miller on November 3, 2019

in Newsletter, Uncategorized

The gusty wind and leafs on the ground tell us that another season has passed and we are heading into cold months ahead. As a younger person, winter was enjoyable, but now I would prefer warmer days with more daylight. But wishing doesn’t make it so, at least in Canada, so how best to prepare? In addition to November being Falls Prevention Month (which is the focus of this update), it is also known as ‘National Nachos Day and National Bittersweet Chocolate Almonds Day (yup in the US); Movember (Men’s Health Awareness Month) and Make a Will Month. Given our forecast for snow, I thought I would share some information that I hope keeps you steady on your feet.

The Seniors Health Knowledge Network shares their research that provides tips, exercise and information. Nobody expects to fall but unintentional falls are the leading cause of injury for Canadians aged 65 and older and 81% for seniors admitted into hospital were as a result of a fall. Many sustain a brain injury and/or a broken pelvis. Prevention is the best we have to offer. I hope this information is helpful.

Originally posted @allaboutestates.ca

I had a wonderful opportunity last week to be part of panel discussion on CTV Your Morning to discuss issues that are critical for seniors. Certainly an important topic as we approach election day.

The National Seniors Strategy is really the document that outlines what needs to be done. I cannot comment on what the parties promise or what they will implement, but I know that much work has gone into a solid document that outlines a number of key issues. The research and report were written in Jan 2016, with Dr. Samir Sinha taking a lead role. They identified 12 policy issues under ‘four overarching pillars or themes; and supported by five core principles essential to understanding the needs of Canada’s ageing population.” The principles identified are:

1. Independent, Productive & Engaged Citizens (remaining independent and productive)
Making addressing ageism, elder abuse and social isolation a national priority
Ensuring older Canadians do not live in poverty (increasing CPP for example)
Ensuring access to affordable housing and transportation
Enabling age friendly physical environment and spaces

2.Health And Active Lives
Ensuring older Canadians are supported to engage in wellness and prevention activities that enable healthy aging ( ie falls prevention)
Improving access to medically necessary and appropriate medications
Ensuring older Canadians and their caregivers are enable to participate in informed health decision – making and advance care planning

3. Care Closer To Home (person- centered, high quality, integrated care close to home provided by those with knowledge and skill)
Ensuring access to appropriate high quality home and community care, long term care, palliative and end of life services
Ensuring access to care providers that are trained to specifically provide the care they need ( there are under 300 geriatricians in Canada)
Developing standardized metrics and accountability standards to enable a National Senior’s Strategy

4. Support For Caregivers (acknowledge and support the family and friends who provide unpaid care)
It is estimated that unpaid caregivers provided care that would have cost our system around $30 Billion
Ensuring older Canadians are supported in the workplace (does your company offer Elder Care as part of its Employee Assistance program?)
Ensuring caregivers are not penalized when taking on caregiving roles (caregiver tax credits, caregiver allowances, greater flexibility in the workplace)

The ground work has been laid, now it is up to the parties to outline how they are going to achieve and implement these recommendations.

Originally posted @ allaboutestates.ca

Last week I had a pleasure of attending the 100th birthday of one of my (favourite) clients. She is one of the lucky ones as she still lives in her own home and is able to afford 24/7 care. She has a wonderful care team who have been consistently providing care to her for over 4 years. They were initially providing a few hours a day and over the years, as her needs changed, they increased to 24/7.

I first met Audrey (yes that is her name) in 2015 after her younger sister fell and was admitted into hospital for hip surgery. I was referred to ‘the sisters’ by her long time trust officer who was handling their finances for them. She knew that the sisters could use some assistance and I was invited to meet them at the rehabilitation facility.

Audrey was 96 at the time and was fiercely independent. Neither used any mobility aids nor received any caregiving or housekeeping assistance. They did everything themselves. Neither had married and they had always lived together- looking after each other.

Since her sister’s fall, Audrey would take a taxi to visit her daily, who was then an in- patient at a rehabilitation facility. A few days after first meeting them, I received a call from her sister to tell me that Audrey had not shown up to visit her, as she had routinely done every afternoon since the fall. Long story short and several hours after receiving this concerned call, I was able to track Audrey who was at the emergency department of a nearby hospital. She had fallen on the slippery walk way outside her apartment building and lay there until a neighbour called 911.

The GEM (Geriatric Emergency Nurse) nurse told me that she had cut her forehead very badly and had received over 25 stitches. It was 9:00 pm and they were about to send her home in a taxi- alone. That very evening was the first time a caregiver started working with them, I arranged to have a PSW meet her at the ER and accompany her home and remain with her overnight.

It is now almost 5 years later, her younger sister has passed away and Audrey continues to live well in her own home. She wanted a tea to celebrate her birthday and together we ordered some new clothes, chose the foods she wanted to serve and the type of birthday cake and decided on the few guests who would be invited. I was able to arrange birthday greetings from the Queen as well as from our Governor General and from her local Longos where she had been a long time customer since they first opened their doors over 20 years ago. With her permission I am sharing her 100th birthday celebration photo. Ziggy was number # 1 on her guest list. Audrey is one of the lucky ones. With thanks to her very caring trust advisor, Audrey has been able to live the life she wanted- remaining in her own home and being well looked after.

Originally posted @allaboutestates.ca

My colleague Dr. Shulman in his July 30, 2019 blog “What an Attorney for Personal Care Can Do” described the roles of the substitute decision maker and the very important part they play in ensuring their loved one’s wellbeing. I have used ‘loved one’ but actually in many cases, the individual chosen is not a family member and love may not be part of the equation at all. It is a very big responsibility to become someone else’s decision maker and many times, some very tough decisions are required. I think the duties that are stipulated in the SDA act should be shared prior to someone agreeing to be another’s attorney for personal care (and property as well). I have always stated that the care decision should dictate what is needed first and foremost and it needs to be supported by the attorney for property. For example, the individual requires care (decision #1); how much care and how much money there is available to pay for said care is decision # 2.

I am now working with a single women who never married, has no close friends and has some relatives who live out of town. She had appointed these relatives to be her attorney for care. Fortunately, she had the foresight to have chosen a trust company to be her attorney for property. They now need to work together to decide how much care she can actually afford. At over $25,000 a month for the care that is currently in place, it cannot be sustained for very long. The attorney for care now needs to explore alternate care and living accommodations as her monies cannot sustain that monthly expenditure indefinitely. Not an easy decision to make for extended family members who don’t live in the same city and have had limited contact with their relative. Fortunately, they now have our firm’s guidance to help them understand their choices and explore alternatives and costs so that this lady’s quality of life can be maintained and she can continue to get the care that she needs.

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.