Thursday, 2 May 2019

Relocation Fears

Our regular readers will know by now that relocation to a care setting is not something to be feared. There are several options, depending on need and finances and for many, concerns about safety, socialization, care and nutrition are quickly replaced with a new lease on life and improved health and well-being. That being said, many seniors and their families are concerned that such a significant move will prove to be a mistake.
From a family perspective, letting go of what may be a family home filled with memories and possessions can be daunting. As well, financial concerns abound especially when the choice is a private retirement setting that is without government subsidy or assistance. And finally, there is the fear that the person will decline because everything will be done for them and they will lose the will to be independent.
While its difficult to speak in generalities and everyone's experience is different, this last worry is usually completely unfounded and more often than not, with the environment in most retirement communities, people thrive and improve both mentally and physically, especially if they have been somewhat isolated and shut-in while living on their own. In addition,  the relationship between caregiver and senior will change for the better as their visits become actual visits rather than errands and household tasks that may have consumed their time together in the past.
Seniors who are relocating may share some of the same concerns as their family; downsizing can be a monumental task especially when one may have lived in the same home for decades. Financial issues often impact decision making as most are worried they will outlive their money or won't have anything left to will to their family. The other concern that often surfaces, especially if they have had regular visits from family members to assist with care or tasks, is that once they go into a care home, those visits will diminish.
In terms of the downsizing worry - it's important to separate memories from possessions - there are many ways to ease this process including, hiring a downsizing company to assist, passing down special items to loved ones (that they can 'visit') and photographing items in order to create a memory book, to name a few. Our latest edition of the Comprehensive Guide to Retirement Living available at no charge on our website at https://www.senioropolis.com/BookInfo.asp has information in Part 1 about downsizing and making the transition easier.
Finances are a common concern, especially since most seniors live on a limited budget. Often the sale of a family home is used to fund living in a private setting and the concern is that it will only last so long. For this issue, you should contact an investment advisor who can suggest ways in which to make your money last and calculate an affordable monthly budget to maximize your length of stay. Do keep in mind that if you require extra care or support in the future, the monthly costs may increase over time.
And finally, in terms of the worry a senior may have about less family visits, do everything you can to let them know that this is not the case. Visit often, take them out, involve them in family celebrations (if necessary hold celebrations at the retirement home), share information on the family and what is happening in everyone's life, take the kids to visit, stay for a meal and attend events in the home.

Monday, 15 April 2019

Private Solutions in a Public System

How do you feel about reaching out to the private sector for care or services? I think this is a question we are going to be called upon to answer more and more frequently in the coming years as our population demographic changes. It seems as if our healthcare system is already stretched and limited resources means that wait times for care and services will simply increase. For those that need or want services quickly, reaching out to the private system, for those that can afford it, seems like the next likely step.
This of course means that our system will increasingly become two-tiered but I would argue that to a certain degree, it already is. There are private medical clinics. There are private home health care services. There are retirement homes - all private. All of these services are provided for a fee outside of our public health system. They are responsive, provide quick services and resources, meet a need and fill in some significant cracks in our existing system.
Our current public system has some major holes. There are many who simply can't afford private service and must wait for what our government funded system can provide. For some this means living at risk in the community - needing care they simply can't access, until things worsen enough that they end up in hospital or in a nursing home. This is a problem that will only get worse, stretching our system further. For those on basic pension, this is truly an unfortunate scenario that there is no immediate solution to unless our government looks at innovative ways to resolve it.
But what about those who have the means to pay for extra care? There is an expectation of many that we should not have to pay for healthcare which is indeed what universal healthcare is all about. But what happens when what exists can't meet the needs? Is it fair to close the door to the private options, or simply not present them to people we help even if they can afford them? I ask this because I do know of colleagues who stand by the belief that people should not be 'told' or 'asked' to seek private solutions when our healthcare plan is meant to provide for us.
I would argue that you are doing people a disservice when you do not present all available options - public and private - allowing them to decide if they want to purchase care or services to supplement or replace what our government is able to provide. People need to be given the option of choosing for themselves, and if they can afford private care, it may indeed be their preference and a better option than waiting on the limited services our public system can provide.
When I first started visiting retirement homes many years ago, I was amazed at the stories of people who moved in needing assistance but who, over time, with proper care, nutrition, social stimulation, exercise and medication management, improved and became substantially more independent. If many of these people stayed in their homes, they would have eventually ended up in nursing homes. It speaks to the importance of retirement homes in our system on so many levels - of a private solution to a problem in our public system. So, I ask you, if an option exists that can meet a need, isn't it important to explore it, even if it is private pay?

Monday, 1 April 2019

Ontario's Changing Health Care Landscape

When I first worked as a hospital social worker close to 30 years ago, there were no LHINs, no CCACs, no central processing agency. If you needed to arrange home care for a patient, you called the home care office; if you needed to arrange for a nursing home, you completed an old photocopied form and sent it to every home you wanted and hoped it made it to the top of their pile. There was no standardized waiting list, no organized way of ensuring your patient got the same priority as someone else and no verification that the patient was competent to consent.

When CCACs were created, there was some resistance on our part without doubt. We had to do things differently. There were different forms. More forms. Capacity of an applicant became an issue and something we had to assess for. We couldn't rely on relationships we had created with long-term care homes. And our script for talking to families had to change.  Eventually, we all got on board. There was no choice but also, we eventually recognized that it did make our lives easier and it was a far more patient-centred way of doing things.

And then, about a dozen years ago, came the LHINs. The LHINs were created out of the idea that in a province as large as Ontario, health care should be decentralized. Given that different areas had different populations, it was surmised that those who live, provide services and use those services within a defined community were best equipped to determine where they needed to direct their health care dollars. The concept that one central government agency was not conducive to making decisions for the whole province was why the 14 LHINs were created. Each LHIN was a non-profit entity with a board of directors and was allotted their portion of the health budget to provide health services to their community through hospitals, CCACs, community health centres, long-term care homes, mental health and addiction services.

Another change happened again last year. it was decided that the CCACs needed to be  be disbanded as an agency because of the money spent on unnecessary management salaries, so the agencies that were once CCACs simply became the LHINs. It did not seem to disrupt patients when the transition happened though I'm certain there were jobs lost and it caused some internal agency disruption.

And now with a change in the ruling political party, our province is seeking to get rid of the LHINs completely. In fact, not just the LHINs. We are going to a 'super-agency' model that will house a host of other health care agencies including Cancer Care Ontario, eHealth, Trillium Gift of Life Network, Health Shared Services, Health Quality Ontario and Health Force Ontario Marketing and Recruitment Agency. So essentially, we are going back to 30 years ago; to a system that was flawed enough to require the creation of CCACs and LHINs. Except now we have many more seniors. And more people in general in Ontario. And an established system for some of those agencies that worked well. Yes, there are problems. And a shortage of nursing home beds. And a shortage of  staff/money for home care. And too many people in hospital emergency rooms. There are parts of the system that are broken, but not the entire system. Do they need fixing or scrapping completely? Are we 'throwing out the baby with the bathwater'? Are we really going to save money by doing this or will it cost us far more in the long run? We only seem to be hearing about what is being 'taken away', not about what we will be given to function and live better lives. Will this massive overhaul really result in better service, more service, less people waiting in hospital hallways for beds or service? How will  we transition from one system to another one seamlessly; how do we ensure that people will be adequately and properly served during this time? And what about emerging private sector services; will we end up with a two-tiered system as our public sector gets lost in the monumental changes to the way they do business?

I don't believe there is one easy solution to the flaws in the current system. It's a complex mechanism that can take years to fix, if that is even possible. But to try to fix it, really means to understand it and its complexities by living in it and talking to the people that work in it. There are many, many questions that Ontarians have about this monumental change in healthcare delivery but unfortunately, no one is giving answers to some very fundamental questions right now. I, for one, am worried about what this means for us; for our children; our seniors; and everyone in between.

Friday, 15 March 2019

Fraud Prevention Month

Did you know that March is Fraud Prevention Month? The more I read about people, especially seniors, who are duped but people who seem to think there is nothing wrong with tricking people out of their hard earned money, the more I think that every month should be Fraud Prevention Month.
We have all heard or received email scams telling us we inherited money; I've also received ones using someone's stolen email identity letting me know that they need money to get out a bad situation. And, everyone I know gets phone calls from fake CRA telling us we will go to jail unless we pay taxes that we supposedly owe. And it seems, these are all the tip of the iceberg. The list goes on... there is credit card fraud, debit card fraud, identity theft, etc.  
I do wonder if social media has resulted in an increased number of fraudsters because people put so much online that anyone searching up 'opportunity'  is able to garner a boat load of information on people just by looking at their profiles. For years there have been warnings not to post online that you are on vacation because you are setting yourself up for a house break in. Yet, we all know people who still love posting their vacation pictures all over Facebook. People let down their guard by thinking that 'only my friends' can see what I post.
I would hope that with all of the publicity out there about fraud and scams, most people are aware that this is happening and are wary of opening and responding to emails that do not sound quite right. And the same goes for those pesky CRA calls. But what about a senior who is unaware of the depth of the problem or are trusting enough to believe what they are told? 
This week in the news, there was a story of an older lady, who was tricked into sending someone thousands of dollars simply because she was under tremendous stress and didn't pay attention to the little things that would have tipped her off had she been stress-free. She had used UPS to send the money and when she realized she had been tricked, with the quick action of the staff at her local UPS depot who were able to stop the package in transit, she was able to recover the money in its entirety. She was lucky. But how many people, are not as fortunate? How many seniors are duped out of their savings by crooks who are able to find out enough details about a person to trick them into believing help is needed for someone they know and care about? 
From the plethora of articles online, it is clear that there are many people who have no problem tricking others and stealing their money. All we can do, is educate ourselves and others around us, about what is happening. If you hear of a new scam, let your network know. Let the seniors in your life know. Check out www.canada.ca/en/revenue-agency/corporate/security/protect-yourself-against-fraud.html and www.td.com/privacy-and-security/privacy-and-security/how-you-can-protect-yourself/preventing-fraud/preventing-fraud.jsp. Report fraud and scams if you know of someone who has been victimized. The only way to stop fraudsters, is to educate ourselves and others so no one falls prey to them. 

Friday, 1 March 2019

Fall Prevention in Seniors

          To say we've had a bad winter is an understatement. There have been days where going outside is treacherous and I am certain that the emergency rooms in every hospital are filled with people who have fallen on the ice. For a senior, the prospect of a fall can be disastrous, especially if a broken bone is the result. We all know a story of someone elderly who broke a hip and ended up with severely compromised mobility and/or permanent disability/dependence.
          And weather isn't always the culprit. Not all falls happen outside. Often a senior can fall inside their home as a result of a slippery floor, an unsteady gait, or tripping hazards like area rugs. I know of people who refuse to use a cane or walker; and others who only use them outside even though they need them indoors as well. Few think they will fall; and most think that if they do, they can get up without a problem and without broken bones.
          So what's the solution? I suppose prevention is always the ideal and to that end there are Fall Prevention classes that could help. However, as with most 'bad' things that 'may' happen, we are all in denial that we could be subject to a debilitating fall and, attending prevention classes means acknowledging that something could happen..... I would venture to guess that most people wouldn't attend such a class unless they or someone they know has taken a nasty spill and suffered as a result.
         If you know a senior who you are concerned about, be proactive and ask them if you can have an OT come to visit who can assess their home for hazards. At the very least, ensure there are no tripping hazards in the home; loose area rugs, wires, etc. Bathroom safety is a big issue too - install bath bars if they will allow you to, so they have some support if the floor or tub is slippery. Speak to their family doctor about your concerns and arrange for a referral to the local LHIN where they can send in an OT to do a safety assessment. Sometimes a doctor the senior trusts will have better luck getting them to accept an assessment than you might!
        In one area in Southern Ontario, when an EMT gets a call about someone who has fallen, an OT goes along to assess the situation and discuss prevention. What a great concept! And one that should be rolled out across the province. With advancing technology, I have read stories of all sorts of devices that can detect falls or provide hip padding so falling doesn't result in breaks. We can only hope that in time, prevention with be the norm rather than anecdotal stories we read in the news. 
        For seniors living alone, encourage them to get an emergency button they wear that they can press if they do fall, so help will come quickly. Encourage them to exercise - many local community or seniors centres have exercise programs for seniors. Exercise has been shown to be good for your bones, balance and fall prevention.
       The key to preventing unnecessary falls and injuries is to encourage safety and be proactive about prevention.

Friday, 1 February 2019

Eating Alone

I wonder if anyone has ever researched how many people actually make healthy, tasty, well-presented meals, when they  live alone and are only preparing food for themselves. I would venture to guess that cooking a gourmet meal for oneself when eating alone, doesn't happen very often, regardless of the age group we are talking about. I know when I lived alone, I would usually grab something quick and easy rather than taking the time to prepare and present a meal as I do for my family. And so, it comes as no surprise, that seniors living alone, may not eat very well; in some cases, they may even be malnourished.  

Its a simple fact that eating is more enjoyable when the experience is shared with others. Mealtime for many is a social event - a time to catch up with others, share conversation and enjoy company.  For a senior who is either used to preparing a meal to share with another or used to having a spouse prepare their meals for them, having to eat alone, especially if they have spent a lifetime sharing a meal with someone else, can impact nutrition in a significant, negative way. 

The perception by many is that as we get older and less active we eat less - which may be true - but it's important to still ensure that what we do eat is nutritious and a balanced diet. 

So what can we do to encourage seniors we know, who live alone, to eat well? As a first step, invite them to eat with you regularly. If you can, have a set day of the week where you see them over lunch or dinner. Look into local community agencies or seniors centres that have occasional communal dining. Suggest they create a friend group that visits over meals and perhaps rotates hosting a meal or does a weekly potluck dinner so everyone shares in the preparation. Even if there is only one other person they know in a similar situation, it would benefit both of them to share a meal once a week whether it's out in a restaurant or in one of their homes. Failing all of that, find out about their local meals on wheels agency where hot inexpensive meals are delivered daily or ,look into frozen meal delivery services (many are online allowing for easy ordering and delivery). While these last two options can ensure healthy eating for one, don't underestimate the importance of eating with others for one's social, mental and emotional health. In fact, many housing options for seniors also include a component of communal dining for this very purpose; new and innovative seniors housing solutions that are in their infancy like the co-housing model, also include a shared dining and kitchen space so no one eats alone. As housing options grow and change, I'm sure we will see even more acknowledgement of the importance of not eating alone. 

Friday, 18 January 2019

Multi-generational Living

Whenever I talk about senior housing options, I will often raise the topic of living with family. It's wonderful when families are willing to take in elder relatives but often there can be issues with the arrangement as one would expect when you amalgamate households and different living styles. As well, since many families have two working people, its often difficult to incorporate care for an elderly loved one into the mix of responsiblities. The North American lifestyle for many has forced us to move away from multi-generations living under one roof, even for those who culturally have expectations on them.
As we are seeing though,  private companies and organizations are coming up with innovative and alternate housing options as more and more people reach that 'senior' age cohort. I read recently about a builder who is designing homes specifically for multi-generational living allowing for the amalgamation of homes as two separate side-by-side private residences - one as a bugalow structure and the other as a two-storey family dwelling. Called a FlexHouz, it is a far better solution than moving loved ones into your basement or an upstairs bedroom if they are still independent and want their privacy. Keeping in mind that climbing stairs can become an issue for an older person, this allows for the senior to be all on one level and to have regular contact with family when they want or need it. As well, it does allow for aging in place if a caregiver is eventually required. It seems to be a better solution than renovating a home to accomodate two households especially if both parties currently own a property that they are willing to sell to move in together. While it appears that only one builder in Ontario is testing this concept out right now, if it catches on, I can see more and more homes being built like this as we need to consider different ways to retire and to care for our elderly. The article indicated that the builder had offered up 7 lots with this design and they sold out within 6 minutes! I'll be watching this concept with anticipation, anxious to see how many other builders pick up on the idea and how widespread it becomes.

Information for this article obtained from: www.thestar.com/business/real_estate/2019/01/02/flexhouz-is-a-home-built-for-multi-generational-living.html