Portraits of Home Care Report

CHCA releases Portraits of Home Care 2008
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>Tue 24 Jun 2008
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>Dateline: OTTAWA, June 24

Interesting report. Not exactly an unbiased Board of Directors, though! It's a government report that costs $200! They say we have 900,000 people who get home care in Canada. We knew that, didn't we?

It seems to be a report advocating for more Federal involvement, rather than more LHIN control over regional needs anc concerns.

I found working on Aging at Home that such folks, i.e. LHIN employees, were conservative followers of Ministry policy. What we need are health care practitioners prepared to push the envelope and make home care work for us.

We do not evalulate as assess frail seniors enough. GPs need to pass on frail seniors to geriatricians (although those are the lowest paid physicians with the most complex cases involving polypharmacy, multipe health issues and comorbidities!) FHT do not seem to be doing their jobs in prevention. We are short-staffed. Every week our local rag advertises for RNs and PSWs. We do not provide enough resources. Telehealth in Ontario tells folks to go to emergency.

I question the report. On p. 20 of the executive summary (I can’t afford to buy the entire report!) says that MOHLTC is going to fund End-of-Life care by 2007/8.

Where has that happened? I was unaware of hospice associations that might provide me with moral support living 415 km away from my husband and adult children in order to provide support to my parents. My brother sat alone with my mother the morning she died after being sent home from the Emergency room. He had no idea how to cope, what to do, nor what to expect. The CCAC did not recommend even support services, let alone be able to afford to provide them. My mother refused to admit she was dying. When that happens they are helpless to intervene as they do not assess cognitive processes nor the needs of the family members for support. CCAC sent a caregiver for 4 hours a day. I was not given information on life expectancy nor signs of death. I did not know what to expect and we did not realize how close to death she was. I sat alone with my father in LTC when he died. The PSWs popped in hourly.

This report provides no new news. It is an ongoing situation that will worsen with tightened budgets and taxpayers who are not inclined to help pay for increased social services with increased taxation. It is an untenable position as taxpayers clamour for more care and yet demand lower taxes. These are people with decent pensions but no sense of the cost of doing business in this day and age.

Ontario drownings: seniors

Up here in cottage country our seniors keep taking risks that others will not. Drowning deaths in the highest risk group (18 - 24 year olds) have gone down in numbers, but still remain a current risk. Often alcohol is a factor, as demonstrated in June, 2008. Common sense flees with young men (formerly the highest risk group) exhibiting grandiose gestures and showing off their high-powered machines. Just watching them they seem to put street racing into a whole new context. Snowmobiles fall into this same category. In the meantime, our seniors are quietly jumping in a canoe or the lake without a life jacket or a spotter. As a child the rule was that we never swam alone. With far too may seniors living alone, they are continuing to jump into the lake and not emerge.

The new report from the Lifesaving Society provides statistics from 2004, the latest StatsCan data on drowning risks.

Last year, on our small lake, a 90-year old man went into the water alone for a swim. No one found him for three days. I pity the person that found him. More recently, May 23, 2008, a 90 year old man went to sort out his dock in the high, cold, spring water. The police report says the empty canoe was found 2 km away, his body 100 m from the canoe. His wife of 65 years, alone and, no doubt, bereft. I know of an 88-year old neighbour who swims alone daily. She is frail, wobbly on her legs, and has trouble getting in and out of the water. I have suggested she is at risk, but have made no progress in convincing her that the cold water and the effects of hypothermia, can be lethal. Heart attacks and other physiological issues arise rendering the senior unable to save themselves. Two-thirds of victims over 50 years of age were alone.

For those who do not live in cottage country, and our beloved elders and seniors cannot walk out their front door and pop into a canoe, this seems like a useless report. However, it does demonstrate the risks that seniors will take with their lives. As risky as behaviours that we have seen in teens who act as if they are immortal. Our seniors live alone, without proper support services, and are failing to meet their Activities of Daily Living (ADL) and IADL needs. We have seniors with undiagnosed dementia, behaviours that seem odd are not reported to family members and I feel they should. As a family member, and concerned citizen, it breaks my heart to see our seniors without the simple supports, or a kind caregiver to check in on them periodically, someone who will help them stay in their own homes with moderate supervision. On the other hand, it is up to neighbours to report dangerous behaviours that put seniors at great risk, such as swimming alone. For those living as independent adults they must make adult-like choices. Their choices impact their family members, neighbours, society, the health care system and tax payers. Swimming alone, and living in isolation in the north, has not proven to be a good option. It is family members who must pick up the pieces and neighbours who find the bodies.

Open Letter to Norm Miller, MPP

Dear Mr. Miller,
norm.millerco@pc.ola.org

I have great concerns around the Aging at Home project that seems to be now defunct. The LHIN promised to provide services for seniors. The role has fallen back to CCAC,and they are inadequately funded.

Regarding CCAC, they only help people when they are discharged from hospital or need to get into LTC. They are a short term request for service. Once the person is in LTC they do not get any more service from CCAC. I cannot tell you how serious this is for our seniors.

I am publishing a book on dying with dignity and have done extensive research.

They do not have enough of a budget, PSW or RNs to provide enough care for all the seniors who need it. Our LTC homes are short-staffed for all of these workers, too. The local non-profits cannot hire and retain their workers, as they are poached to LTC or the hospitals. The PSWs are poorly trained, or their 14 modules they are given cannot provide them enough in education. Most of these people are 40-something, high school educated women up here. There are still issues in the city.

CCAC only provides respite up to 4 hours per day of care. When my mother was dying, and I was trying to get help and working full time in Parry SOund, they didn't even refer me to a hospice organization. From the point of view of a family member it is most frustrating.

I sat on the LHIN 12 Aging at Home project and we determined that a basket of services would be appropriate. Some seniors need transportation (like my friend) and they have to go to the Red Cross. My friend gets 2 1/2 hours help per week. They drive her into town, she gets her mail and groceries. These contracts have been signed and have not been fulfilled.

Our Meals on Wheels program is very poorly organized. Volunteers don't have contact info. If someone falls ill and they find them, they have to run around looking for information on them. This is another service that ought to be run by the Family Health Teams, but is not. Meals on Wheels has folded in Gravenhurst due to lack of volunteers. My husband works as a volunteer on Wed., but he is the youngest person. Another person doing it is getting chemo and in ill health. Another volunteer forgets to do it, or is late. It is truly a sad state of affairs.

Jennifer Jilks
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Update:
My response from Mr. Miller is that many of these contracts are now being fulfilled, but were held back due to legislative barriers that prohibited some of the work that needs to be done. Some of the projects, as of January, 2009, are now being put into place. We need sustained work to help seniors stay at home, release those from hospital who require Alternate Levels of Care.

Seniors Issues in Muskoka

The price of gas must be difficult for those who have chosen to retire in Cottage Country. While housing costs are similar, if you are not on the water, I know that many seniors have transportation issues. Many travel 35 km to get health care, or shop, many more should not be driving at all. I shudder to think about the proposed Carbon Tax. Incomes are $15,000 below the provincial average here in Central Ontario. This kind of tax takes a big chunk out of a pensioner's income.

Of course, income disparities between men and women are more severe at this age. Women earn an average of $34, 752 per year compared to men. For retired seniors, on fixed income, costs increase rapidly. There are no transportation systems in Central and northern Ontario. A taxi to the nearest town, 35 km away, is $60. Volunteers are few and far between and face health issues of their own. In our town, fortunate to still have Meals on Wheels, is delivered by those who now cannot travel the roads to deliver these meals.

Transfer payments to organizations such as health care and social services, standard across the province do not take into account the higher costs in Central and Northern Ontario. In terms of meeting with clients: travel, travel time, and the time to get to and visit with clients, is an onerous amount of our budgets. It is more difficult finding volunteers and getting clients to and from appointments (from seniors, Meels on Wheels, to mental health care appointments) the costs are too dear. The Ministry needs to keep this in mind as they prepare budgets to transfer payment agencies.
Our North Simcoe LHIN covers a deep and wide territory. The map, found on the Ontario Local Health Integration network website, demonstrates the huge area they just serve, including 10,000 residents.

Primary Health Care

There are 400,000 Ontarians who do not have access to a physician (Primary Care). They are called orphan patients. The complications of old age: nutritional issues, comorbidities (other health issues that could lead to further deterioration of health), access to physiotherapy, pharacological support, dementia and many other factors contribute to inadequate delivery of Primary Care for our seniors.

What is even more difficult for seniors is that they often have many complications that compound their access to Primary Care: transportation, for example. Frail seniors are not always given enough time by their health care team. They need patient advocates or navigators to help them through an already stressed system. For those who face polypharmacy they may be weakened by a complicated cocktail of chemicals designed by those not on a health care team.

My parents' physician was an age peer and did not have up to date facilities and access to technology that would have given them some benefit in their access to Primary Care.
The ravages of radiation and chemotherapy took their toll on their already frail psychological and physical bodies. Wait times in already crowded emergency room exacorbated their issues. The lack of nursing staff in Long-Term Care (LTC) homes meant that my father's care was less than ideal. An already burdened staff does not have time to reviews medications and check on residents of LTC. We are incredibly short-staffed in Central Ontario and it does not seem to be getting better.

Aging At Home projects have not seen fulfillment. We drive an 88 year old to the library, grocery store, and Post Office. In her winter home she had access to volunteers/Red Cross personnel who took her three times a week to the store and out to take care of her IADLs. She is a brilliant, well-educated, retired teacher whose physical frailties belie her mental acuities. She cannot drive, nor stand for long periods of time. With a home care worker she could manage. She is not a candidate for a retirement home, nor does she need one, but she does need more help than the system can afford to provide for her.

*Primary care – basic or general health care from the medical system

Mechanical Lift

The PSW told me that he quite enjoyed caring for my dad. He told me he gave dad pain pills as needed on those nights that dad was loudly vocal, some days they could hear him singing down the hall and around the corner in the nurse’s office. They made sure that they gave him the pills before they moved him. I was grateful. Dad appeared uncomfortable every time they had put him into the swing lift for several weeks now.

The mechanical lift is a marvel, as long as a resident/patient wants to be moved. It is difficult watching this process as your father used to be your tall, strong protector.


What to expect?--February 7, 2007
Dad was not putting sentences together very well--he could draw up many nonsensical words. He was napping every few minutes. He had some of his lunch still in his mouth. He was gesturing towards the bed and I knew he wanted to sleep. We pushed the call button and Cynthia came to our aid. She told us she would get Sharon to come and put Dad into bed. Sharon had a lovely sense of nonsense! Dad always smiled when he saw her. She is an attractive woman, perhaps in her thirties or forties, with dark hair and a winning smile. She always made a point of bending over, or kneeling down, and getting at his eye level. She told him she was going to get him into bed. I loved it when they treated him like a person and someone who might be sentient, even though all indicators pointed to the other end of the spectrum.

They brought in the big mechanical lift. This was a piece of equipment about five feet high that was plugged in to charge its batteries when not being used. On wheels, it could be rolled and moved around the room easily. Sharon made Dad lean forward. They put the jacket around his shoulders and up under his legs. She told me that he really did not like it. She apologized to him, even though he couldn’t hear her, for having to use the lift. It was a touching gesture and I think it helped. It certainly helped me. I remember one time that he enjoyed it and was laughing and smiling at me as he was being lifted. Once he was in bed, he was asleep in thirty seconds. We tucked him in. I kissed him goodbye and left. He would pass away on February 16, not long after.

I adored Sharon’s bedside manner. She was always respectful, kind, and caring at a level that went beyond her training. Her spirit embodied that of the PSW: she treated Dad with such dignity and respect at all times. Despite his inability to hear her, she always explained what she was doing. Jill Bolte Taylor, in her book My Stroke of Insight, demonstrated the respect, or lack thereof, that some staff members or visitors display to those who are perceived to be ill. Dr. Bolte Taylor suffered a life-threatening blood clot in her brain and wrote of her experiences. Since she had moments of clarity, with little brain function on the left side of her brain, she was able to understand emotions and feelings without having the language to articulate them at the time. She reminds caregivers and staff members that the best way to help those who are ill is to let them sleep.

Beyond that, a caregiver’s respectful attitude is perceived on a deeper psychosocial level even by those with brain injuries and apparent dementia. She found that those who came in to visit her, if they possessed a positive attitude, and brought energy and a strong spirit into her room, gave her added energy. So many burned-out workers in LTC are hard-pressed to keep their energy up. So many of our RNs and RPNs, and suport staff are stressed-out beyond their abilities to cope due to lack of staff, and other issues. This has a profound effect on those in care. They can read your emotions and it affects them, too.

Entering Long Term Care

To pack for LTC
He needed his toiletries, a housecoat, slippers, a pair of running shoes, four pair of pajamas, and six changes of clothes, i.e. six undershirts, six shirts, six pair of pants or jogging suits. All of these places offer laundry services and this was all that would be need. Also, a sun hat, a winter hat, and a couple of sweaters, and a seasonal coat.

Gifts for those in LTC
The literature suggests that appropriate gifts include toiletries, greeting cards, costume jewelry, washable housecoats or sweaters, non-slip slippers, jogging suits, leg warmers, candies, fruit or cookies in containers. Bringing them recent newspapers, photos of home and the ‘old days’, a thermos of tea to share, and talk about the old days were called for and quite welcomed.

picking up mail

6/1/06

Dad had an infection still. We find that he still needs much care. He continues to urinate frequently. He is becoming increasingly difficult. Little do we realize how ill he is. I continue to do his bills, collect his mail, and try to look after his affairs. He cannot write checks, I fill them in, but had just enough energy to sign them.

I picked up the mail today. This is to prove the most difficult and long-lasting issues of the grieving process. My parents continually received mail from organizations to which they had made donations. It took me more than a year to get mom's names off of the Reader's Digest list. I finally found the name of the PR person, wrote him a scathing letter, and we made it so.

Soon I will receive a letter from my mother’s best friend since her childhood. She had moved to the United States and they hadn’t visited in many, many years. I did not recognize her name in Mom’s address book. She wrote to Mom asking what is going on as she had phone twice and hadn’t heard from her. I had no idea that Mom had kept up with her, nor did I know her married name or recognized the foreign address.

I find her phone number in Mom’s obtuse address book and make the call. There is no answer. I leave a message saying that I am Joan’s daughter and wanted to talk to her. She does not phone for a couple of days and I phone back. This time Betty is home. I explained to her what had happened and feel so very sick at heart. Having gotten in touch with a couple of bereaved spouses in trying to contact all of Mom’s friends, I am reluctant to do so again. We spoke for a half hour. Mom had phoned her and said her good-byes, although Betty did not know it at the time. This is a story I heard several times over.

One issue that concerns me is knowing who is visiting Dad and keeping track of his caregivers. We are promised, by CCAC, that he will continue to receive extra care. I bought a Guest Book, in a silver (manly!) book cover with a silver fine pen for Dad’s room. Some people are most kind in signing it for us. It frustrated him no end when he cannot recall the names of visitors. It is a great investment.