Who decides when you can’t?

Personal Choice. Self-determination.  Your right to decide about your own care; where you want to live; what you want to eat; who you want to look after you; where to spend your money – these choices and our ability to make them for ourselves, allow us to feel in control of our own life. They are the things most people take for granted; the things we think we will always be able to do for ourselves. But, what if one day you can’t? What if either because of an illness that gradually robs you of the ability to do these things or, an injury that does so suddenly, this is taken away from you? Who will make these decisions for you? While this is not something anyone likes to talk about, the reality is, it is a very important thing to raise and discuss this with people you care about, regardless of age or situation because none of us knows what tomorrow will bring. Planning for what you would like to happen, in the event that you need someone else to make decisions for you in the future is called “Advance Care Planning” and the legal documents that support this in Ontario are a Power of Attorney for Personal Care and a Continuing Power of Attorney for Property. Every person over 18 should have both.

A Power of Attorney for Personal Care is a legal document that appoints one or more people the right to make decisions on your behalf that specifically relate to your care or treatment if you are deemed incapable of making those decisions for yourself. Your “attorney” should be the person or persons you trust and they are your “substitute decision maker(s)”. They should be someone who knows you and what you would want in most situations.  While they may not share your values and beliefs, they should understand them and be willing and able to uphold them, in the event that they are asked to make a decision on your behalf. It would be best if you had conversations with that person (or persons) about your wishes in the event that you require care/medical intervention in the future.

A Continuing Power of Attorney for Property is a legal document that allows at least one person to act on your behalf if you become incapable of managing your financial affairs. This person can be but does not have to be, the same person as your substitute decision maker. You should trust that the person (or persons) can properly manage your financial affairs as they will have full authority to manage your money and property.

You do not need a lawyer to draft your Powers of Attorney though, it would be wise to consult one and have him/her prepare the necessary documents. There are some basic components all Powers of Attorney need to have in order to be valid, so if you choose not to have a lawyer create one for you, you may download a basic form from the Office of the Public Guardian and Trustee at www.attorneygeneral.jus.gov.on.ca/english/family/pgt/poa.pdf  that can be completed on your own.

Once you have completed your Powers of Attorney, keep the originals in a safe place and make sure that you have at least one copy that is easily accessible. Ensure those you have asked to be your attorney(s) are aware of their potential responsibilities and tell them of the whereabouts of the original documents.

Thoughts on Downsizing

Downsizing. Whether it's when the kids leave home, when we need to relocate because of health issues or any time in between, just about everyone at some point or another in their lives will have to consider how best to decrease their possessions. The task can be daunting, especially for those who have lived in the same house for a lifetime. So what is the best way to dispose of things you no longer, need, want or have space for? It would be ideal if one starts cleaning out rooms, drawers and closets over time rather than waiting until just before you must move. It's easier to gradually pare down what you own when you are not rushed or under pressure.

If  have seniors in your life that you suspect will need to downsize soon, it makes sense to help them identify what they need, what the want, and what they would like to give away. Encourage them to give their valuable, special or memorable items to family members and perhaps even let them choose what they would like. Gifting special items to loved ones provides an ideal opportunity to reminisce and share stories about the past which in turn preserves the family history. Keep in mind though that not everyone may want items that you consider special and conversely, there may be things that are not overly meaningful to you but hold special memories for a younger loved one.

If there are things that no one wants but you believe to be valuable, have them appraised so you can determine if you are best off selling them or giving them away. Consider donating items that are not valuable but still useful. So organizations may be willing to provide a tax receipt for donations which may be more beneficial than the money you can make from selling them. Many things that you think are valuable may not be and may not be worth the effort to try to sell. For large items or a large volume of items that you want to throw out, you may want to contact a junk removal company to dispose of them.  Ensure that you check all drawers in furniture and pockets in clothing that you are getting rid of to ensure you haven't put something in a 'safe' place and simply forgotten about it.

If there are family photos and mementos, entrust someone in the family to be the 'keeper of the memories'. Consider making a digital album that can be shared by everyone and perhaps even incorporate stories about the content that your elder loved ones have shared.

As difficult as downsizing can be, taking it slowly, involving your loved ones in decision making and respecting their wishes can make the task easier and far less stressful.

HomeSharing

Always looking for innovative senior housing options, I came across something interesting recently. A couple of areas are testing out HomeSharing projects. With this model, younger seniors in need of accommodation are being matched with older seniors living alone who need basic assistance or simply companionship. The younger senior helps out in exchange for reduced rent, and the older senior shares their home and has a someone to keep them company and help out around the house. As long as the two are matched well and get along, this concept seems like a wonderful idea with many benefits for all involved. 

This project,  in its infancy in both Northumberland County and the Halton Region would be worth following to see how successful it is and if it is adopted by other regions. A bit like the co-housing model but on a smaller scale, this does have potential as something communities can build on and eventually create groupings (of HomeSharing units where there are many seniors) that can also share care and assistance among them. It can be a good solution for well seniors who need a bit of assistance to remain independent but don't want to move into a retirement home setting or for those who live in smaller communities where there are not available retirement living options. 

As our senior population grows, we will be forced to look at more and more innovative ways to house them  in settings that allow for independence while providing them with a bit of assistance. This is one example of how we can do this and I look forward to following its progress.

The Gift of Music

My home is always filled with music. My eldest son is a musician. When he is home, it is rare not to hear him playing one of his many instruments. He understands a language that is foreign to me, yet he speaks a universal one. Since he chose his path, I have come to understand the gift that music truly is and how fortunate I am to be able to experience my 'private concerts'.
When I visit retirement homes and am able to witness a concert by a visiting musician, I watch the way the residents interact with the music, listen intently and allow it to fill their souls. Some move to it, others sing along or hum a familiar tune, and  still others just seem to absorb the atmosphere quietly, while feeling like an active participant in something wonderful. Music has the ability to draw people in regardless of the setting and regardless of their age.
And so, with this preamble, you will understand why I am so excited to hear of a new program in London, Ontario. Oakcrossing Retirement Living, a new retirement community, will offer an opportunity for a few music students from Western University's music program, to live in the home for free with the proviso that they spend 12 hours a week with the residents of the home. What an amazing inter-generational opportunity for both young and old!!!! I have visions of the students filling the home with music, impromptu concerts and practice sessions, perhaps even bringing classmates along to add other instruments to the mix, all while learning valuable life lessons from their neighbours, receiving guidance and support. While it is starting small scale, I can see it growing over time and perhaps even being used as a community others can learn from. I have no doubt it will be successful, I look forward to watching its progress and I applaud Oakcrossing for this innovative project which will most definitely enhance the lives of everyone living there.

Isolation

It's not uncommon to hear stories of seniors who are 'shut ins' - those who are isolated and do not leave their homes. It may happen because of physical issues and disabilities, mental health issues like depression or perhaps, a bit of both. Regardless of the cause, the outcome is never good. Isolated seniors are more at risk for both physical and mental health issues regardless of the underlying factor. It makes complete sense - human beings are social beings and need to connect with others. Without human interaction mental stimulation is diminished and so too is mental health.

So, how can one help a senior who seems to be socially isolated?  As a first step, it seems logical to address the reason for isolation especially if it is new behavior for the person. Is it because of  new physical issues for example, vision or hearing loss, incontinence, a feeling of sadness, a recent significant loss of someone close? If it is a physical issue, are there any adaptive technologies that can assist? If it's related to loss or depression, would the person be willing to speak with a doctor, clergy or therapist? If they won't are there family members or friends who can assist and speak with the person or visit more often to encourage them to go out and do things?

When we feel a sense of purpose, a reason to get up in the morning, we are more inclined to be less isolated. This can be anything from caring for someone or something else, volunteering, meeting friends or even having a hobby. Joining a seniors club where there are regular activities, perhaps congregate dining, and a place to meet others, may meet the needs of some. For others, getting a pet (as long as they are mentally competent) may ease some loneliness and in the case of a dog, may get the person outside for walks and opportunities to interact with others.

Although not as ideal as actually getting outside and meeting people in person, for those with physical issues that prevent them from leaving the house often, technology may assist with allowing them to interact with others through social media, email and phone/video type programs such as Skype.This is especially helpful if loved ones live far away and cannot visit often.

If you are concerned about a senior for whatever reason, do contact professionals involved with the person, a family doctor or a seniors support organization for suggestions and assistance.

National Dementia Strategy

Last week Canada passed "Bill C-233, An Act respecting a national strategy for Alzheimer’s disease and other dementias" (Alzheimer Society of Canada Press Release http://alz.to/wp-content/uploads/2017/06/Bill_C233_PR_EN.pdf). It is projected that by the year 2031, 1.4 million people will be effected by dementia which will translate into tremendous family stress, emotional drain, lost wages, financial burden and health care spending (http://www.alzheimer.ca/~/media/Files/national/Advocacy/SOCI_6thReport_DementiaInCanada-WEB_e.pdf).

Having personally witnessed the loss of a loved one to dementia, I can attest to the impact this disease has on families, support systems and the health care system. It is unimaginable to think that in just over a dozen years, 1.4 billion people will impacted by this horrible disease that robs the essence of a person from the body we associate with them.

Canada is the 30th country to adopt a national strategy of this sort. One would hope that the strategy will be all encompassing including, funding for research to delay, treat and one day prevent the disease, increase training and people who can provide care, support for family and unpaid caregivers, improved health care and social supports, and housing options catering to the needs of the population.

It seems that it would be both cost effective and prudent as with other aspects of senior care, that we look at what others are doing around the world. Since 29 countries have gone before us, it is not a new concept at all, and I venture to guess that we can learn a lot from the mistakes and triumphs of the other 29. There are countries with care and housing models that are innovative and work very well. There are model communities for those with dementia, caregiving communities, innovative technologies... the list goes on.

We have started the process by committing to creating a strategy; I look forward to seeing what we do with it and how Canada will build on the successes of those that have gone before us.

Buurtzorg

Regular followers of our blog will know that I often write about the need for innovative care options for seniors as our aging population increases. I recently came across an article on one such idea that is taking hold in a big way in many European and Asian countries. Buurtzorg is a Dutch model of care that has been shown to not only offer quality care that encourages independence, but also save money. 

The idea was the brain child of a nurse names Jos de Blok about 10 years ago. Teams of nurses are sent out to areas with many seniors and each team is responsible for between 40 and 60 people. A team can be up to 12 nurses and they are supported by administrators and trainers. The nurses not only assist with care but also help seniors and their families understand the importance of illness prevention.

The model is very much a 'neighbourhood care' one with latitude and independence given to the nursing teams to provide care that is necessary within a given structure. It can be adapted to different health care systems and situations as different countries do have different ways that health care is delivered and paid for. 

Its an interesting concept and one that may indeed make sense in Canada especially with the costs of current care and the limited number of nursing home beds in our system. An ongoing concern is that while there are many retirement homes in existence, the cost is often higher than basic pensions and so there are many who could benefit from the care but cannot afford it. This concept, along with perhaps co-housing models, and inter-generational housing, with a mix of funding for retirement home living, may allow us to assist people who with our current system, are not able to get the care they need because of financial limitations. 

Concerns about caring for our increasing aging population may not be so difficult to resolve if we step outside the box and take the time and initiative to look to models in other countries that are both innovative and well researched. 

To find out more about Buurtzorg visit http://www.buurtzorgusa.org

Information for this blog obtained from: https://www.theguardian.com/social-care-network/2017/may/09/buurtzorg-dutch-model-neighbourhood-care