Monday, May 18, 2015

Pilot project for self-directed home care –a dismal mistake

That is my belief.   Currently there is a cap of at-home nursing care visits per month: 120 visits. They are raising this to 150 visits per month. The Minister added $5 million in new funding for home care. The biggest barrier to getting home care is the lack of experienced, competent workers: from personal support workers (PSWs), to nurses, and physicians who will make house calls. The next barrier are the budgets that limit the number of visits. Next, the biggest barrier is the lack of regulation and training for PSWs. Poorly trained PSWs make the news. Unregulated PSWs who slip under the radar can go from employer to employer.

In the Ontario system, there is a packet of money for various home care supports: primarily PSWs who provide assistance with daily living (ADL: cleaning, housekeeping tasks, meal prep, bathing clients, keeping them dry and clean). There are also nurses who provide wound care, manage the case, and keep on top of medications. When a change is needed in medications, for those who are palliative or unable to go to the physician, they will phone the doctor and request different medications.

Families tell me that they have difficulty in coordinating care: juggling support from various
agencies, keeping on top of medications, doing errands. The agency employee (e.g., PSW or nurse) with the home care contract (e.g., Bayshore Home Health, Red Cross, VON) will phone the family and let them know when they will be over, which day and time. There is no choice, as they are swamped with work, the transportation issue, going between clients home, is complex, especially in rural Ontario. Imagine forcing client's and caregiver to phone these for-profit agencies themselves. This is what the CCAC Charge Nurse is paid for: to coordinate care.

Clients who qualify for home care are now going to have to search out an agency, and create a contract themselves. For those who qualify for nursing visits, or support with ADLs, they are still going to have a hard time finding someone to come. As it is, some families qualify for a PSW to come weekly to bathe a loved one, and hire someone to do house cleaning. This is what people with money do for themselves.

A Canadian pilot project that would give patients or their caregivers money to spend on the home health services of their choosing. Details were scant on the government’s plans for experimenting with “self-directed care,” an approach that Health Minister Eric Hoskins said is already working well for some parents of autistic children who have been given the flexibility to spend public funds on the programs they believe are best for their children. 

Pilot project to give cash to Ontario patients for 'self-directed' home ...

The Globe and Mail-May 13, 2015
In a bid to respond to a blistering report on home care in Ontario, the ... give patients or their caregivers money to spend on the home health ...

Wednesday, May 13, 2015

Ontario Liberals slammed for delayed raise for personal support workers

They blame Wynne for this, but it is the for-profit long-term care and private agencies who are avoiding raising salaries. Removing mileage is cruel. That said, PSWs need better training, and regulation, not registration.
It's not a simple process to bring sick people out of hospitals. There simply isn't the money for providing the services they need. The non-profits have very real bottom lines, with limited resources, both human and financial.
Employers more accountable to shareholders than employees and taxpayers, have gotten around this mandated pay raise by other methods.
It is less expensive to provide group care than individual home care. Bottom line. 
We are short PSWs and nurses, as well as doctors who will provide home care. Our seniors deserve the best care possible.

The investigation also found that 27 mostly non-profit health-care agencies across the province are refusing to accept the government-funded increase and pass it on to their workers, while one of the largest private-sector employers of personal support workers in Ontario cut what it pays in mileage and travel time just after the first phase of the raise kicked in last fall, leaving some employees worse off than they were before the wage-enhancement program began.

A $4-an-hour increase over three years was first promised by the Liberal government last year


Cathy Rogers dashes hopes for higher pay for home care workers
Physicians from the acute care hospitals in the Horizon Health Network ... we're spending over half our budget on the long-term care and yet if I don't do ... Rogers would like for people to remain in their homes as long as possible. ... Give extra funding to nursing homes to care for seniors with extra care ...

Other recommendations included: 

  • Give seniors with physical problems access to specialized care beds that are designed only for dementia patients. 
  • Pay personal support workers and homecare workers for their travel to seniors homes. 
  • Move the care of nursing home beds under the Department of Health. 
  • Give extra funding to nursing homes to care for seniors with extra care requirements. 
  • Have social workers on call around the clock in hospitals to work with families with complex psychosocial care needs. 
  • Provide funding for residential care hospices for patients who are in the last three months of life who can't be cared for at home, but don't require a hospital bed.

Monday, May 11, 2015

News from: Family Caregivers' Network of British Columbia

Celebrating Family Caregiver Week in BC - May 4-10
This week is an opportunity to recognize and thank the more than one million
Me and my hubby prior to his 2014 surgery
A selfie!
family caregivers across the province who devote time and energy to providing care for an adult family member or friend. During this week take time to recognize and acknowledge the hard work you do as a family caregiver and treat yourself in some way - you deserve it! Or take time to thank the people in your life who are family caregivers.
Dear Network News Subscriber,
The May 2015 issue of our Network News newsletter is now available on-line.
This issue includes:
A Caregiver Bill of Rights – As a family caregiver you have the right to…
Caregiver Self-Advocacy: Four Messages to Live By...
FCNS Annual General Meeting with Guest Speaker Jeanie Paterson, “Cultivating the Art and Practice of Being Mindful”

Sunday, May 10, 2015

Thursday, May 7, 2015

Webinar: Prostate Cancer Metastasis: circulating tumour cells

Prostate Cancer Metastasis: Tracking and Targeting an Elusive Enemy


- The majority of prostate cancer deaths are cause by the spread of tumour cells from the original prostate tumour to distant sites in the body, a process called metastasis. 
- The ability to find, track and understand metastasis in cancer patients remains one of the greatest challenges in cancer treatment. 

These are my notes from the webinar, which help me to clarify the information I learned. 
Circulating tumour cells, from prostate cancer are what causes death, not the primary cancer in most cases. Metastasis is responsible for more than 90% of all prostate cancer deaths. Prostate cancer has excellent 10-yr. survival rates. Dr. Alan studies deadly prostate cancer.

Cancer is when our own cells turn against us. The battle terminology is ridiculous, as our own bodies are going mad and creating these cells. It irks me. These are my drawings from another source. It clarifies 'cancer'.

It is fairly straightforward to remove the prostate, and hereby remove the cancerous cells. My husband had his radical prostatectomy in Jan., 2014. He has been monitored since. The key is to determine if the cells have metastasised, or spread to other parts of the body. We know his have spread, since he has a PSA (prostate-specific antigens) reading above 0.0. It has been rising slowly. I've made a graph of his results post-surgery. 
PSA reading vertical (X) axis
Time across the Y axis
Even if there are cells nearby, radiation or chemotherapy can eradicate these cells. If the cells have migrated, and/or mutated (which is likely), it is more difficult to track them and kill them off.

What determines which prostate cancer metastasizes?

This they don't know. The cancer cells can go into circulatory system or the lymphatic system.
The cells encounter the capillary bed, in distant sights, such as in the bones, liver or lungs. These cancer cells can be arrested by size restrictions in the capillaries.  Micrometastases (teeny cancer cells) may die off or remain dormant, or go on to proliferate. 

 Problem is that cancer cells do not remain the same. Metastatic cells figure out how to survive in the body and mutate. This, they call Darwinisation. They evolve, mutate, and figure out how to survive in different organs, and become moving targets for cancer therapy. 
bone scan, 2014

Part of the issue is pinpointing the cancerous cells, finding where they are and determining whether
they are still prostate cancer cells, or if they have become different. Prostate cancer can be treated with antigen therapy, removing the testosterone hormone they require to keep on living.
There are many ways to track, and tests that are available. They are tracking Circulating Tumour Cells (CTCs), through various methods. Hubby has had a CT, bone scan, two MRIs, and biopsies.

Biopsies of distant organs can be risky. Poking anything, opening it up to a needle biopsy, can be a risk for infection.  They always give him antibiotics before the biopsy. There is concern about affecting a new tumour by testing and tracking it.
Prior to surgery: Jan. 28, 2014

All metastases were different from the primary prostate tumour.
The promise of blood-based biomarkers is to find the homogeneity in cells.
Multiple or serial biopsies can be taken from blood samples and do molecular characterization of them. Track how they change, ID treatment targets.

Circulating Tumour Cells: CTC tracking them is important when giving specific therapies, to determine if therapy is working. 

As long as the metastatic tumour hasn’t Darwinised too much, it can be treated with antigen therapy. This has proven quite successful. 
They are currently doing national testing on a user-pay system. Requirement = physician cooperation. Your physician can contact them and order the tests.

Thursday, April 23, 2015

PART XXXIV: PSA Test & Colonoscopy results

I heard on CBC of a study that 1 in 7 healthcare visits are wasted when test results do not arrive.
So far, we've not had that problem in 33 visits. It happened this time. The colonoscopy report wasn't in, a failed fax (who knows where THAT report went?!) was the cause. Also, the biopsy report of the removed polyps. It's a good thing that hubby took notes in his recovery room with the doctor. I wasn't there, and couldn't take said notes. Our urologist had none of these notes. His office tracked them down that day, however.

Appt #34

9:30 left the house, took the North Gower route, Such a peaceful drive with Gillian GPS, along the backroads.

11:09 in the waiting room, fooled around with the iPad camera to pass the time. Then, I worked on my embroidery. Another patient's wife walked by and complimented me. She told me she did cross stitch, as well.
I can't read, since it's very distracting in the waiting room. One guy walked by, his Smartphone on speaker, speaking loudly into his phone as he strolled down the hallway.  Another woman complained that it was 12:15 and when would she be seen. Five minutes later they called her name, but she'd wandered over to the window and couldn't hear them. The receptionist spotted her and yelled 'Madam!'

It's important to have something to do...

11:45 closed the office reception!
closed for lunch!

Dr. Luke 

12:20 (for an 11:45 appointment!) we were ushered into the exam room.
~asked about bladder frequency.
~colonoscopy: no notes on electronic file
~We informed him that during the colonoscopy, they removed polyps for pathology, found something around prostate and wanted physical exam as well. None of this was on file.
~PSA is up to 1.1 (from 0.74 3 mos. ago)
Good doctor: he was talking to us about post-surgery therapy, high-fibre diets.
~ gave info on diet, soft bowel, high fibre cereal.
~Physical exam: feels something enlarged.

 Dr. C 

Distant recurrence, from January 2014 surgery, treatment ultimately antigen therapy. Typically the recurrence arises in the bones or lymph nodes. Curious: there are nodules around the rectum, not what we see typically. Not convincing of irregularity.
We will go to two more tests shortly: 1. MRI of pelvis, 2. Transrectal biopsy of the mucous of the rectum.

See what biopsy shows, could be post colonoscopy or prostate cancer-related, it was a COMPLETE resection Jan. 2014. ADT (hormones), could do radiotherapy. Wants to rule out what's happening in the rectum to rule out prostate cancer there.
Then come back and see Dr. C.
Off to validate the parking pass: $13.00

new bridge in Ottawa
1:25 made it to the parking lot and headed for home. We hadn't planned where to have lunch. We usually want to get out of the city by the afternoon. Hubby had taken a granola bar for a snack.

We'd have been home by 3:00, but we stopped for lunch.

Sunday, April 12, 2015

Food intake at end-of-life

Why it’s so hard to accept that the dying no longer need to eat?

This is an excellent piece. I have educated many client families about EOL care. @TheresaBrown 

Saturday, April 11, 2015

Time to move into the new millennium with Medical Marijuana

We really do. There are many ways it can help those with chronic pain. Doctors are reluctant. It's a shame. If it helps, it should be available to be used wisely.
The government has its own issues.
This is an excellent piece on it.
The government has authorized more than 50 thousand Canadians to use medical marijuana; that number is expected to grow ten-fold over the next decade. But...

Friday, April 3, 2015

Free webinars for caregivers

FREE Webinars for Family and Friend Caregivers -REGISTER NOW TO RESERVE YOUR SPOT!
Spring 2015
Guilt and Frustration: How Changing Your Expectations Leads to Emotional Wellness - April 8
Care Planning 101: A Webinar for Family Caregivers - April 14
Letting Go: A Valuable Lesson for Family Caregivers - May 27
Respite: Who Benefits? - June 15
Celebrating Family Caregiver Week in BC - May 4 - 10, 2015
What Don't I Know That I Need to Know? Effective Decision Making in Caregiving - May 5
Creating an Unhealthy Environment for Caregiver Burnout - May 7
Register by phone 1-866-396-2433 or on-line atwww.careringvoice.comWebinars are offered through your computer and telephone. If you don't have a computer, you can simply listen to the audio over your telephone. You will not be able to see the visual portion of the Power Point presentation.

Visit our website for recordings of past webinars:
For additional information or if you have any questions, please call toll-free 1-877-520-3267 or email
Please feel free to forward this email on to family, friends and co-workers who might also find the information helpful.
Glendora Scarfone
Administration and Caregiver Support
Family Caregivers' Network Society

Seniors stuck in hospital 'wastes' $170 million a year

Does this ever make me angry. Seniors 'wasting money,' as if they don't deserve the best care we can give them. If they cannot go home, they should be looked after properly. Cough up the money to find appropriate care.

Calgary Herald
Seniors stuck in hospital wastes $170 million a year, Liberals say
The rising number of patients stuck in hospitals while they wait for a ... health-care system tens of million of dollars each year, Alberta Liberals say. ... long term care spaces to reduce hospital overcrowding and contain health system ...

If those 822 people could be housed in the nursing homes beds most need instead of occupying acute care spaces that cost over four times as much to operate, Liberal Leader Dr. David Swann said they would receive more appropriate care and Alberta Health Services could save over $170 million annually.