Friday, 2 September 2016

Home Help

In recent years there seems to be an increasing number of companies who provide care to seniors in their own homes. For those who don't qualify for CCAC services, or for those who need more than what CCAC can provide and wish to stay in their own homes for as long as possible, this is often a very viable option (as long as it is affordable). However, as with any service geared to a vulnerable population, be it children or seniors, it is always best to take a 'buyer beware' attitude. While the large majority of companies are wonderful, well-meaning and caring organizations, there is always the possibility that a company you hire, may not be as reliable as one would expect. To this end, there are several questions one might want to ask before hiring a company to provide care for your loved one in their home. It is always smart to interview care providers before you commit to hiring them and always best to contact a few companies so you can compare what each offers.
Suggested questions include:
1. How long have they been in business?
2. Do they have any kind of accreditation (if they do, investigate them with the accrediting body)?
3. What services do the offer?
4. What qualifications do their employees have?
5. How do they screen employees (back ground checks, vulnerable person screening etc.)?
6. Do they provide extra training to their employees? If so, what kind of training?
7. How do they monitor their staff and track hours?
8. Are they licensed, insured and bonded? Is there agency liability coverage?
9. How do they share information between staff?
10. Do supervisors do surprise visits?
11. Can you interview the caregiver/s before hiring them?
12. Do the same staff visit each time?
13, What is the cost of service? Is there a minimum number of hours? How often are fees increased?
14. What emergency procedures are in place? (feel free to create scenarios of what situations you would consider an emergency)
15. Is there a contract you must sign (ask to see a copy in advance of hiring them)?
16. Can they provide references for their agency and the specific caregivers you would be using?

These are just a few questions to consider. Spend some time thinking about additional things you would like to know before making your calls. As well, you might want to speak with others who have been through this process to find out what things are important to them and what they found helpful or problematic when they hired private help. Its always best if you are prepared and do your research before a crisis hits. 

Friday, 19 August 2016

Living with Family

While it is no longer the 'norm' for children to move their elderly loved ones into there homes for a host of reasons, there are still times when families do consider this as an option when living alone is no longer possible. It is wonderful to have a family that is willing to consider this however, there are a host of factors that need to be taken into account and addressed before finalizing any plans in order to ensure the best possible outcome. It's important to keep in mind the relationship one had and continues to have with the person, any unresolved issues, care needs, home accessibility and a host of other things. Consideration needs to be given to how how a move such as this will impact the senior, family members living in the home, yourself and any extended family.  

Questions to consider include: How will the senior cope living with others especially if there are children in the home with various schedules, activity and needs? Will living in your home impact their privacy and independence? Are you close to their current social network so they can still visit with friends? How demanding is the senior? Will other family members be required to provide care? How will moving the senior into your home impact your job and/or your relationship with your spouse/children? Are there services in your community that can assist with any care if it is required now or in the future? Can you afford the extra person? Will they contribute money? If they do, will this create problems with other family members?

Inter-generational families living under one roof can be extremely rewarding for all family members involved however, for some families adding additional people to your nuclear family can be stressful and can create problems. For those struggling with a decision such as this, do keep in mind that caregiving can be difficult for even the most cohesive of families and if for whatever reason it is not feasible to move your elderly relative into your home, it's important to recognize that sometimes the best decision for all involved might be to let others provide care - even if it means relocating the person to a seniors home of some sort. It cannot and should not be viewed as any sort of failure or as a reflection of how one feels about the person. Sometimes, it is clearly the best move for everyone.

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 or for more details you may download the Emergency File Document from our site's online store at

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

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 (, 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.