Friday, 5 August 2016

Knowing when its time

People often ask me how they will know when it's time to start thinking about relocation. How do you know when it's time to downsize or consider a retirement home? For some, it's an easy decision and one based on health, lifestyle or even financial issues. For others, it is less clear. To this end, you might want to consider the following sorts of things:
1. Are there stairs in your house and if so, are you having difficulty with them?
2. Do you need help with household tasks, maintenance issues, cooking, shopping or any personal care?
3. Are there people that can help you with things you cannot do for yourself?
4. If you do not have people who can help, would you be willing to hire someone?
5. How do you get around and is this starting to be difficult for you? (driving, public transit, taxi)
6. Are you close to important amenities (doctor, dentist, store etc.)? 
7. Do you use any assistive devices?
8. Do you have safety or health concerns?
9. Do you feel isolated?
10. Do you get out regularly or are you in your home all the time?
11. Do you have a support network of friends and family nearby?
12. Has your family indicated any concerns about your living situation?

These questions can serve as a guide to help you determine if it's time to downsize or obtain support in the home you are currently in. While a few minor issues may not be problematic, some larger ones may suggest a need to begin considering resources and perhaps researching options to downsize with or without care services. it is far better to do your research and start discussing options with your family before you actually need the help and most certainly before crisis hits and available options become limited.

Friday, 22 July 2016

Emergency Visits

When was the last time you went to the Emergency Department of your local hospital? We all know that going to the hospital in an emergency can involve many hours waiting, and be tremendously stressful for all involved. Now imagine being elderly, perhaps with some cognitive issues, and some physical limitations and disabilities. There may be no one you know with you when you are taken there. How much more difficult is a trip to the emerg. for them?

While trips to the emergency room may be unavoidable, coping and managing the stress involved comes down to being prepared. For many years now, I have talked to people about creating an 'Emergency File' of important documents that contains any necessary information for someone to access if you are incapacitated; in recent years I have included lists in our annual book of what should be included in that file (see the article How Important are your Documents? at www.senioropolis.com/article-general.asp?ID=83 or for more details you may download the Emergency File Document from our site's online store at www.senioropolis.com/BookInfo.asp).

In addition to an Emergency File, it might be wise to create a one page document that can be taken to doctors appointments or on trips to the emergency room so you aren't scrambling to collect things when time may be of the essence. Consider, what a doctor needs to know in an emergency? Medical conditions, drugs/dosages, allergies, contact numbers of physicians, recent tests and results, health card and  insurance information and power of attorney info (if you are someone's POA for personal care, you should have it with you in case you are asked to present it). Because things may change frequently, this list should be updated regularly.

 If you are taking a senior to an Emergency Department or going with them, make sure they have any assistive devices they may require - glasses, dentures, hearing aids, walkers etc. are imperative - do keep in mind though that you don't want them to get lost in the shuffle so ensure that they stay with the person through their hospitalization or if they are admitted, label whatever you can or take home what they don't need for the moment. And for you as the caregiver, make sure you take what you need - money, food, your cell phone and a charger, phone numbers of important friends and family - you may have a long wait so it's important to have anything you might require with you.


Friday, 8 July 2016

Memory Care

As our regular followers know, we have been collecting data on retirement homes for 20 years now. Over this time, we have noticed significant changes in the industry as it has evolved into one that serves many levels of care with different needs. An example of this is care for people with memory issues. At one time, those with dementia were best (and only) served in long-term care (nursing homes). Over time, we have seen more and more retirement level homes offering this sort of care to their residents. Some will have special secure units; others will have security at the exits only. 

The benefit of having this sort of care in a retirement setting are great - firstly, if someone goes in when they are not impaired, and this care is possible, they can stay in their familiar setting with people they know and trust. It is easier on the resident and the family. Secondly, retirement homes have higher functioning people than long-term care in general so the activity and stimulation is greater for that person. This may translate into a slower decline than if they were in a home with very limited activity and programs. Thirdly, because of the cost factors involved, there may be extra resources for those with dementia in a privately funded retirement home than there is available in publicly funded long-term care homes. There are many retirement homes that have excellent care and resources for people with dementia. 

However, as beneficial as it may be, there are also potential issues if the security is not adequate to prevent wandering or the staff are not equipped to manage the resident's issues. By and large, most retirement homes are very up front with families about their abilities to manage people with various medical issues. Beyond liability issues for that one person, they need to ensure the safety of their other residents and staff. While it would be great if the options for care for those with dementia increased (which it no doubt will over time), I respect and applaud homes that recognize their limits and do not take on people who they cannot safely look after. 

All of this aside, while the setting itself might be nicer in a retirement home than a long-term care, it is not always the best place for someone with dementia. Each situation is different but one needs to carefully assess staffing, training and environment in light of the person's deficits. Clearly, for many cost is the prohibitive factor in the choice of care simply because those on government pensions alone would never be able to afford a private care setting (but that is a topic for another time). However, for those who can afford retirement or private assisted living, it is not a 'given' that it is the best place for your loved one if they have cognitive impairment. As with any sort of care for a senior, one has to take the time to look for a place that can meet their needs now and in the future at a price they can afford. Shop around, ask questions, tour, try the food, get references, etc. Because the person with memory impairment is particularly vulnerable, great care needs to be taken when choosing a home to relocate them to. As with anything, the best and most appropriate home isn't always the most expensive or fanciest. In some cases, the most suitable option for someone may indeed be long-term care. 

Friday, 24 June 2016

Ageism in 2016

A recent report released by Revera and Sheridan Centre for Elder Research has concluded that "Ageism continues to be widespread in Canada, and tops the list as the most tolerated form of social prejudice by a wide margin when compared to gender or race-based discrimination" (Revera Report on Ageism: Independence and Choice as we Age, page 8). Perhaps the reason it is so widespread is because it was never identified as discrimination until recently. We all know about sexism and racism and know both have been rallied against for many, many years. But Ageism... much less so. With an aging population and the evident vibrancy of many 'new' seniors, this has now become something we are paying attention to and identifying.

25 years ago, it was not uncommon for people to be very paternalistic when it came to care decisions for their senior loved ones. I recall many occasions as a hospital social worker when children of seniors asked if they could apply for nursing homes without telling the person directly involved. Many families just didn't understand that if someone was competent, no matter how old they were, they had the right to make their own decisions even if others didn't agree.  Those of us involved in discharge planning, breathed a sigh of relief when CCAC began managing long-term care and insisted that that senior involved be informed and signed the applications themselves.

The interesting thing about Ageism and perhaps what makes it so very pervasive, is that people who are ageist don't always realize what they are doing or saying is harmful. It is couched in a belief that one is providing 'care' or taking the burden of looking after everyday things away from someone. What many fail to recognize that in taking away someone else's ability to make decisions for themselves, you are negating their importance and value. Every human adult wants to feel independent and have dignity and control over their lives for as long as they are mentally able to.  And while children may worry about their elder parents, assuming they need guidance, assistance and direction when they have not asked for it, is discriminatory and can cause far more harm than good.  

Combating Ageism will take some time. Awareness is the first step. Change in attitudes and public policy will take some time. I suspect that with each passing year and in large part because of the 'silver tsunami'  we will be forced us to look at our perceptions of aging, care and service provision for seniors. We are entering a time of great opportunity and innovation for both seniors and those who work with them. And our well-spoken and industrious baby boomers of today will likely lead the way by insisting that maintaining one's independence and quality of life well into our senior years is both a right and a necessity.

The Revera/Sheridan Centre report can be downloaded at www.ageismore.com

Monday, 13 June 2016

Working Caregivers

I remember the years when I had young kids and was working full time an hour away from home. Every time one of them had a sniffle, I worried that the next day would mean that childcare would be an issue. Those early years involved flexibility and always being prepared. I would imagine, being a caregiver for an elderly relative is very similar in its stresses but may, in fact, create greater anxiety depending on who you are sharing caregiving with (or if you are), the medical issues you are dealing with in your loved one, and how supportive your work environment is.

Employers always know when their employees have kids, but don't always know when there are elderly relatives that one might be providing care for. It would seem to me that employers who are more in tune to the responsibilities their employees are juggling, and do their best to support them, may indeed have greater productivity and more dedicated employees. 

With the ever-increasing number of seniors on the horizon, employers will be faced with many employees balancing caregiving and work in the coming years. Being prepared for this, no matter what size company you run will make a huge difference for everyone involved.

 Ideally, a larger company that has employee benefits, may want to consider having Elder Care Counselling as part of their EAP offerings. There are many companies offering this type of counselling and referral so it would make sense for these types of services to be integrated into existing benefits. Some companies even offer lectures/workshops for employees struggling with different sorts of issues and if your company does that, do consider including elder care topics in your offerings. If you have a website with employee resources, include some related to eldercare as well. If you are able to do any or all of these things, let your employees know what is available. 

Regardless of a company's size, flexibility may be a necessity moving forward, with contingencies in place for coverage when people need to be away, or the ability to work remotely if necessary. An openness to creating options for those in a caregiving dilemma may make it easier for employees to approach a boss with some ideas for how they can make things work. If they are not worried about getting their work accomplished during traditional work hours, it may decrease their stress and increase productivity in the long run. 

While Ontario does have an unpaid family leave option for up to 8 weeks (https://www.labour.gov.on.ca/english/es/pubs/guide/caregiver.php), of concern to many is the decrease in income for that time period, especially if caregiving is impacting their finances. It would be helpful if employers could consider options for individuals requiring this sort of leave to alleviate some of this concern. Larger employers often offer a maternity 'top up'. Something similar would be helpful for those who have to take a break from work to provide care for an elderly loved one. 

 All of these initiatives will most definitely create a caring work environment, decrease the stress of employees juggling care for others, and in doing so, improve their productivity. 

Friday, 27 May 2016

Safety First

After years of working with seniors, looking for safety issues in the home has become second nature. We often think of safety issues as being outdoors - the weather, the road etc., but seniors need to be aware of risks in the home as well. With declining mobility, vision, and hearing, one needs to be more aware of their environment, both inside the home and outside. Most associate home risks with the bathroom and a need for safety bars, but there is really so much more that one needs to be aware of as well.

Are there loose throw rugs or electrical cords on the floor?
Is there anything flammable in the kitchen and if so, is it safely stored?
Is the person safe to use all kitchen appliances?
Are there working smoke detectors and CO detectors in the home on every floor?
Is the person safe in the bathroom and if not are there properly installed safety bars and non-slip flooring?
Is there adequate lighting inside and outside the home?
Are walkways and stairways clear of any tripping hazards?
Are medications safely stored and labelled?

These are just a few areas that need to be reviewed to ensure a home is safe for a senior with any impairments. There are many extensive checklists for home safety online and I would encourage you to seek them out if you are or you have a senior in your life who is living alone. Additionally, you may also want to have the home/person assessed by an Occupational Therapist who can assess functional needs and determine any necessary equipment required. For those who know that they do need some home renovations to make a home safe, the Ontario government has a program called the Healthy Homes Renovation Tax Credit where a senior who does home improvements for safety/accessibility can claim up to $10,000 on their tax return and get up to 15% back. For information on this program visit https://www.ontario.ca/page/healthy-homes-renovation-tax-credit


·      

Friday, 13 May 2016

Sorting Stuff

How do you sort through what can be a lifetime of possessions? I was speaking to a group of seniors recently and this topic came up. One lady in the group said she has been 'downsizing' for years and when it gets to the point that she is ready to move, it won't be difficult because the hard work is done. She said she doesn't get attached to 'things' so  her policy is to get rid of everything she doesn't use. Another woman in the group talked about how she had a plan over the next few months to go through her home and get rid of what she could. While she is not moving in the immediate future, she is aware that the time will come soon enough and when it does, it will be easier to move if she has less  to sort through. Yet another woman in the group talked about her memories being tied to the things she owned and how difficult a task it will be to pare down what she has when she decides to downsize to a smaller home.

This conversation got me thinking about the whole topic of downsizing and sorting possessions. For those who decide to downsize to a smaller home and have the luxury of time to do it, the tasks involved may not be too overwhelming. However, for those who for physical or medical reasons need to relocate to a retirement or long-term care setting in a short time frame, this issue can be far more difficult and emotionally draining for the person and their family.  There are many who have lived in their homes for a lifetime and everything in it is tied to memories of that life. And there is a fear that the memories will disappear with the items. The goal for all involved is to separate the memories from the possessions. So how do you do this and rid yourself of things you don't need or can't take with you?

This is a topic I can write an article several pages long on but, in a nutshell, I think you need to start with the easy things first. Start with the big stuff that you can't take with you - extra furniture, household items, kitchenware etc. You would first need to know what you have room for so it's best if you find a place first and know your space limitations. Of the 'easy' (no attachment items), decide if you want to give them away, sell them or throw them out. If you want to give something to a relative, ask them honestly if they want it - if they don't and it is in good condition, consider selling it along with other items in a garage sale, or an online or print ad. Alternately, There are many agencies that would gladly accept donations of gently used items for those less fortunate. For items that hold special meaning, offer it to family members so you can 'visit' your favourites whenever you want. Share the story behind it with them and take photos that you can keep in an album to take with you. If no one wants items that you think are of value, you can try to sell them through auction houses, estate sales or again, on through an online source.

Lastly, no one should have to do this alone. If you don't have family or friends willing to help, there are many professional downsizers and senior move managers willing and able to assist with this process.