Caregiving

The economic news requires digesting. No question. Something I think we miss in this busy day and age, is settin' on the porch, thinkin' time. This is allowed. This is a gift you can give yourself. Judy's blog, "Every Day is a Gift", is a good one. This is the time to regroup, rethink and process what is going on.

Some days you just have to give yourself permission to "let go and let God", or the Universe, Spirit, or whatever your spirituality point, to take over. This is the time to let that 'still, small voice' enter your mind, body, spirit and soul. Women are very good at feeling guilt. We need to let it go. We put food in the freezer to preserve it. Sometimes we need to do this for our souls.

When I was giving palliative care to my father I was so numb, as well as being in a depression. I gave myself permission to just 'be' on days when I needed it. I gave myself permission to let my husband look after me: meals, housekeeping, dishes, while I concentrated on simply feeding dad one meal a day. I left the LTC home crying most days. It was awfully difficult. But I made it through by only solving problems and carrying out the activities I felt like doing. That was the gift I gave myself.

One thing I did not do well was to reach out and accept help from agencies that could be there for me. I found the Cancer Society peer program too late. I could have phoned a spiritual advisor, but did not. I was weak, fragile, tired and stressed. Accepting such help is a gift you can allow others to make. It is a gift that friends and family can give to so many who are fulfilling a role as a caregiver.

seniors and infections

The more I read, the more relieved I am that my parents were no in a hospital. What with Clostridium difficile Associated Disease (C. Difficile) ,a deadly form of infectious diarrhea, on the loose, if you excuse the pun. Transferred from bowel movements to hands and surfaces is can be fatal to thos without strong immune systems. A Scarborough hospital had 319 cases of C. difficile this past August (2008). You can check on the rates in Ontario hospitals here go to the "Hospital Reports" button on the left.

One infection is associated with hospitals: methicillin-resistant Staphylococcus aureus (MRSA) infections, E. coli is another. Our seniors are most at risk for issues like listeriosis, with 19 deaths, and these mostly seniors. The timelines for the testing, identification and product recalls were very slow.

Unfortunately, those visiting retirement homes, senior's residences, Long-Term Care, hospitals and aging relatives, do not understand the need for sanitary practices. You would have thought that SARS would have taught Torontonians something. Hand washing is crucial for every residents, staff member, volunteer and visitor. This .pdf file contains proper handwashing techniques. Infection control can be done with simple but thorough precautions.

caring for aging parents

The ravages of age were familiar to me. My elderly aunts and uncles had passed on. Listening to my parent’s aches and pains in their seventies, I had realized aches and pains of middle age in my forties. Getting up in the morning can be slower than before. Mom and Dad, since their 50s had fought arthritis, cholesterol, and weight issues, and were pretty careful with their health. They would work long hours at events in town, supporting the volunteer network. They slowed down in their sixties and I began to monitor them more and more during this time. There were clues that their visits to the pharmacist were becoming more serious by the sheer volume of drugs. Mom had lactose intolerance, and debilitating colitis: a stress-induced diarrhea. She was an extreme worrier and it resulted in her having to wear adult diapers when driving a long way or going into church or choir practice. The smallest stress would send her off to the toilet. Dad was taking 8 pills a day, polypharmacy that put him at great risk.

In my mind I had already looked ahead to the last chapter in my parent’s lives after my first husband’s mother contracted lung cancer. She was heavy smoker and it was not a surprise. I read all I could at that time and began to understand the philosophy of Elizabeth Kübler-Ross’ five stages of grief. With the strong bonds I had developed with my mother, I knew that we could honour that past, while grieving in the present. I could foresee that time as my parents began recognizing and showing signs of the aging process. Slowly they began giving up the physical activities they could not longer manage: mowing the lawn, shovelling snow, raking snow off of the roof, stacking the cords of wood they needed for their wood stove, and they began to hire people for those purposes.

I worry about adult children, like myself, who must help frail parents die with dignity in a relationship that is less than whole. I was adopted into a loving family by parents who always let me know that I was loved and supported me through marriage, divorce and a stressful career in education. I laud those who work with ailing seniors. It is a difficult job, especially for Personal Support Workers (PSW) with little training and low pay. There is a great myth that revolves around seniors: benign grey-haired men and women who sip tea in their retirement homes. Such people do exist, mind you, but they are the minority on Long-Term Care (LTC) homes.
Those in LTC can be angry, anxst-ridden people who would prefer to remain in their own homes but cannot due to their inabilities to manage the Activities of Daily Living (ADL). ADL include daily bathing, grooming, dressing, eating, mobility and pain management needs. How difficult it must be to be placed in an institution with “a lot of old, sick people”, to quote my late father (stricken, at the time, with a recurring brain tumour).

Caregiving in the Home

For family caregivers responsible for seniors: remember to breathe. You are no good to anyone if you cannot breathe. Caregivers need quality of life assessments, especially for the frail spouse. Demand that your doctors provide assessments and consider home support. Reassess the polypharmacies, contact your pharmacist for help in ensuring that prescriptions are necessary as often some may be contraindicated.

Another issue arises for seniors cared for in their own homes by outside agencies or hired professionals. They are at risk from workers, such as PSWs who can prey on them physically, emotionally and financially. The recent (2007) Sue Grafton novel, T is for Trespass, is a mystery novel about an ailing senior at home. It demonstrates the vulnerability of seniors to those who may prey on them. Our society has moved from a nursing model of care (Nursing Homes) in which the majority of staff were highly trained nurses with experience in dealing with seniors who have resistance, denial, anger, chronic diseases and exhibit mobility and lifting issues, as well as complex pharmacologies. It is only nursing staff, or those with special certificates, who are legally able to administer medications.

There are agencies that recruit caregivers from other countries. Some caregivers may be 'nannies' with little experience in eldercare. The agencies can placement fees to a caregiver, and the Federal Government supports a Live-in Caregiver Program. The Toronto Star quotes $4500 for one agency, with 34,000 caregivers in Canada - we're talking big bucks). It is important to encourage worker programs, but I question Temporary Worker Programs. It is a difficult situation, as we are desperate for health care professionals, and standard vary around the world.

Eldercare in Canada is currently an unregulated industry. The majority of staff in what we now call Long-Term Care, has many workers who are unregistered and untracked and may or may not have PSW qualifications. Whether a PSW works in the home or in a profit or non-profit agency workers can move from employer to employer if they are fired or prove to be inadequate or abusive. No controls are in place, as there are for preschool, home caregivers for children, i.e. nannies. Those applying from other countries can forge documents and recommendations, which an unsuspecting family or agency could not explore. Other countries do not provide the kind of training that we find in, for example, the British system of training nannies. Some are not necessarily trained in the ways of physical therapy, chronic diseases, mobility and lifting issues.

With a fourteen-module PSW course in Canada there is standardization of practices and ethics, but agencies do not have a way of knowing about the type of education a worker has received in other countries. Canadian agencies continue to hire and recruit absolute strangers to live and work closely in Canadian homes with our loved ones. This is an industry that needs to be regulated. Youtube is filled with violent incidents recorded by suspicious family members in the United States. This is a situation that must be prevented from occurring in Canada.

If you are thinking about hiring caregivers in the home ensure that their references are accurate. Check out their education, experiences, qualifications and reasons for termination of employment, if applicable. Pop in or phone frequently to ensure that there is a quality of care in the home. Set up a contract with a professional agency to determine standards of care. YouTube shows startling (American) videos of Alternate Decision-Makers who have been suspicious of their hired caregivers. A wise person ensures the safety of their loved ones by thoroughly checking out employees. American College recruitment videos show the dignity that can be accorded to keeping seniors in their homes. This is an honourable profession and one which must be respected. Our elders deserve it.

Health Care & Privacy Laws

For Family Members of Ailing Seniors:
It is clear that family members face severe and potentially profound issues when caring or advocating for family members. Unfortunately, many health care providers do not understand the various Health Care acts that apply to both their clients and their families. Some of these include: Mental Health Act, Public Hospitals Act, Health Protection and Promotion Act, Long-Term Care Act, Occupational Health and Safety Act, Child and Family Services Act. Workers in health care continue to cite the Freedom of Information and Protection of Privacy Act (FIPPA) Legislation when refusing to communicate serious and crucial safety information regarding those in their care. The Personal Health Information Protection Act (PHIPA) governs such workers. Yet, workers fail to communicate with adult children to inform them of the status of their frail parents’ health. Health Care providers and professionals have an obligation to inform family when they feel that seniors may be facing dementia, for example, which might put seniors at risk in their homes. This risk has an impact on the seniors, their neighbours, and the community, in that those who fall end up in hospital. Those who accidentally leave pots on the boil cause fires that tie up emergency services. Those who leave a tap on in an apartment cause flood damage to other residents’ ceilings.

Dr. Ann Cavoukian, Information and Privacy Commissioner for Ontario, is on a personal mission to inform health-care providers and professionals about their responsibility to include family members among those who are privy to the mental and physical health conditions of patients and clients. Health information custodians who collect, use, and disclose personal information can tell them to exercise judgment. In a conflict, PHIPA prevails over other Acts. This includes FIPPA. Health information custodians include professionals: licenced and non-licenced practitioners such as social workers, those working in LTC, or operate health facilities, pharmacies, laboratories, ambulance services, centres, programs, or services for community or mental health purposes.

Disclosure can be made for the purpose of contacting a relative, friends or substitute decision-maker of an individual who is incapacitated, injured, or ill, and unable to consent (PHIPA, sect. 38(1)(c), p. 38) if it becomes necessary to eliminate or reduce a significant risk of serious bodily harm to a person or group (PHIPA, sect. 40, p. 40).

Frail seniors living on their own may be incapable of taking their medications at the right time. This is a serious risk to a senior. It is up to a health-care provider to make the decision to inform family. Many family members may not understand that their ailing relatives are incapable of ADL or IADL when friends and neighbours are covering these duties. The risk of such enabling actions is great to both the senior and his or her family. Disclosure must be forthcoming to protect one and all.

Gulli and Lunau (2008) suggest that while the trend towards collaborative care is a positive one with Family Health Teams in Ontario and Alberta, there simply are not enough health-care practitioners to fill the need. Physicians are no longer willing to work the long hours or to make the house calls that used to be the norm in my parents’ generation. Burnout is a huge problem, as much as the dearth of practitioners.

Symptoms and biological consequences of dementia

The person with dementia is frail: premorbid, at risk for biopsychosocial issues; there is an inability to maintain physical, social, and emotional needs.

Twaddle et al. (2007) believe that prompt referrals with planned admissions to the best settings ameliorate the need for placements in facilities such as intensive care units and promote early discussions in situations such as palliative care for greater clarification of treatment goals. They found that palliative care study patients were more likely to access medical care through emergency departments. These patients were discharged from American academic/university hospitals at a rate of 42% without follow-up home care services, despite histories of severe illnesses.

This model of crisis intervention is replicated amongst the friends that I know. My father’s discharge from the ER with a urinary tract infection after radiation therapy with no diagnosis in July, 2006, is a prime example of this situation.

Seniors do not like this term, yet “frail” paints a very complex and complete picture for family members and caregivers. Dementia can be caused by trauma (falls, broken hips) due to frailty, leaving the senior unable to meet ADL. Nutritional issues can then worsen an already frail senior. (An empty refrigerator is an eighty-percent predictor of problems with dementia.)

Dementia leads to an inability to communicate, and comorbidities such as infections, infarctions, or subcortical issues, such as plaque and damaged brain cells, will remain undiagnosed. For some seniors, aphasia (language disturbance), apraxia (impairment in motor activities), agnosia (failure to recognize objects), or affective disorders such as depression, Alzheimer’s disease, or sleep disorders (insomnia or hypersomnia) can result in those who must receive more support than might be obvious to outside observers or even close neighbours. For some, impairment of the senses (hearing, vision, olfactory, touch, taste) results in a quality of life that creates frustrations to both care recipients and caregivers.

A frail senior who has had surgery will have a higher risk of infections due to the immune system that is compromised, as well as to the frailty of skin and tissue. For those with delirium, drugs are purported to be responsible for eleven to thirty percent of hospitalized patients (Feil, et al., 2007). Nutritional inadequacies, such as a lack vitamins or minerals, can result in dementia, and can be identified or prevented with liver function tests, calcium, and glucose tests (Wenger, et al., 2007).

For those seniors who live in their own homes, it is my belief that family members must be contacted to provide them with information. My friend Kristin said to me, “Geriatrics or pediatrics: the only difference is body mass.” We have the right as well as the responsibility as parents to care for our children. We regulate workers in day care and nursery schools. We must protect them and advocate for them. Why is this not the same for seniors? Why do we not regulate long-term and private home care? Once an outside agency becomes involved in the care of a senior, privacy laws should not supercede the rights of adult children to ensure that their parent’s needs are being met.

Seniors are often placed in LTC due to dementia. Of those with dementia, fifty-five to seventy-seven percent have Alzheimer’s disease. There is a high correlation with depression (and caregivers as well are at high risk for depression). It can be ameliorated with improved social outcomes with cognitive screening tests, and medical, behavioural, and social interventions. It can be prevented or lessened by these measures, but it will not be cured. It must be diagnosed by medical professionals who take a history of the resident within two weeks of entering LTC (Feil, et al., 2007).

Quality indicators for medication use in seniors demonstrate that seniors fill an average of twenty prescriptions per year (Shrank, et al., 2007). Once a senior has a need for hospitalization, he/she may be sent home with an additional prescription and might not think to ask his/her GP if he/she really needs these medications. In addition, those in LTC do not always have the benefit of seeing a doctor. An RPN may simply phone a doctor without any assessment or review of other medications. There are some lucky institutions with Nurse Practitioners who have the ability to prescribe medications, but health care is so closely guarded by self-serving physicians that many health-care providers are finding it hard to access clients. Government legislation controls many providers of services: pharmacists, midwives, and providers of holistic services such as massage and reflexology.

Wenger, et al. (2007) recommends the clock drawing test, Beck’s depression test, and medication reviews and adjustments, as well as other measures they call Assessing Care of Vulnerable Elders (ACOVE). The impact on seniors, their families, and friends in an aging population requires that we seek to identify more of the signs, symptoms, and causes of dementia, as well as other infirmities of the aging body.

Caregiving in Canada

Caregiving has been related to both physical and mental health issues and an increase in depression in several studies (Gallagher–Thompson and Coon, 2007; O’Rourke, Cappeliez, and Neufeld, 2007). Depression rates in caregivers of terminally ill cancer patients ranges from 18% to 55% (Tang, Li, and Liao, 2007), with other studies reporting high rates for various morbidities between 20% and 30% (Grov et al., 2005; Kim et al., 2005). To promote the well being of caregivers, interventions should address improving social supports for caregivers. Lack of social supports, such as counselling and respite care, have been associated with increased levels of depression among caregivers (Redinbaugh, MacCallum, and Kiecott–Glaser, 1995).

The stress involved in caregiving relationships is exacerbated by the age and health of the caregiver, the degree of illness or disability in the care recipient, and the supports and outside resources available to the caregiver; the effects can be: arthritis, hypertension, insomnia, pain, stiffness, headaches, and hearing problems (Emick and Hayslip, 1999). There are limits to the ability of a caregiver to look after both herself and her loved one.

Pagel and Becker (1978) studied the impacts of social supports and self-esteem on depressive thinking in caregivers, finding that caregivers with high levels of depressive cognition had high levels of depression only if social supports were low. They found a need for interventions with caregivers to alleviate stress by addressing social supports and controllable life stressors (see also Redinbaugh, MacCallum, and Kiecott–Glaser, 1995).

Caregivers tend to have work responsibilities (two-thirds work outside the home, according to the Women’s Healthcare Network (1998). They tend to have problems with being absent from work, which impact their rates of pay, career advancement, physical and spiritual health, pensions, and long-term financial security.

Caring for ailing or disabled kin is an international situation. Schreiner and Morimoto (2003), in a Japanese study, found that persons with a higher sense of mastery, the degree to which caregivers believe they are not governed by forces outside their control, and their sense of efficacy, agency, and autonomy affect their sense of control, and they have less stress and strain and depressive symptoms in contrast to Western caregivers (Morimoto, Schreiner, and Asano, 2001; Magai and Cohen, 1998).

With neighbours enabling my parents’ transition from independent, self-directed individuals to totally dependent patients, my parents began to call upon friends, family, and neighbours to meet their IADL and ADL. The health care system failed us as my parents managed, in denial, to continue to live in a small town where they could not get their mail, mow their lawn, shovel snow, shop for groceries, or meet many other needs. When my mother was dying at home, no one gave me suggestions or support in finding respite care, hospice care, or any other resources that would help me help my mother. I ended up “retiring” early, with a huge cut in my anticipated pension, so I could look after these needs. I am not the only daughter or daughter-in-law who has had to change her life for this reason.

I would like to see the statistics that support an argument in favour of this approach. It is a faulty one. My parents did not want help from me; my mother stopped me from attending doctors’ appointments, including those with the oncologist and the surgeon. She did not hear well, misunderstood what she was hearing, and avoided allowing me to help her and share the burden of her health care.

[Excerpt from my book: Living and Dying With Dignity]

Caregiver Recovery

It has been over two years (May, 2006) since my mother passed away from cancerous lumps #6 & 7. Dad's brain tumour, originally excised in early 2003, came back at the time of my mother's death, until he finally succumbed in February, 2007. Once he passed over the grieving began.

As a grieving daughter I have found there are many things that help in my recovery. As a caregiver I was stressed beyond belief. I would go into the LTC home every other day or so, every day when I could, to assist dad with his ADL as the LTC homes are understaffed and I felt useful. It was a strain, however, to see him deteriorate and my health suffered. I know I was not alone, but there were days that I felt a deep burden. I began to feel stress. I experienced panic attacks when, for example, hearing very loud noises, or parking on a hill. My startle reflex was horribly affected. The least noise (fireworks, car horns, people yelling) would create a sense of insecurity and I would have to turn inwards. My 'fight or flight' reflex was in full panic mode.

As caregivers we need to look after ourselves. There are basics things we can do: good nutrition, exercise, meditation, relaxation, talking to others in the same passage of life, writing a memoir, researching, and generally looking after our well-being. I have read ever thing I could find about caregiver stress (research) and other's stories (autobiographies). The latest was Simone de Beauvoir's A Very Easy Death (1965). I concluded from this book that the more things change...the more they stay the same. Beauvoir had issues with understaffing in Paris health care, over-treatment of her failing mother, lack of respect for the frail, and access to caregiver support. When my late in-laws passed away I read everything I could of Elisabeth Kübler-Ross' work. It helped understanding the Five Stage of Grief.

One day at a time I began to eschew excess food and wine. We cut back the number of times we ate out since after feeding my dad dinner almost every night I really wouldn't feel like cooking. My depression was severe. Eventually, I have cut out alcohol weekdays. I allow myself a treat on weekends. At one point I used food and drink to soothe my troubled body and soul and to help me sleep. I realised that my weight gain was a result of these addictions.

I kept up my daily exercise - as this releases endorphins that help in relaxation. I now manage 30 minutes per day on a very regular basis. I have to get up and do it first thing in the morning, or I do not tend to get to it. So many other thing in life get in the way.

I have realised that while recovery is slow, I am making progress. I have lost 11 lbs. and have been feeling much better. My workouts have become more effective and I have more energy than ever before. I have come to terms with the means by which my mother chose her death. I know that I did look after my father as best I could at the time. Once he lost the ability to figure out the function of things he couldn't feed himself very well. Staff at the LTC home told me he would ask for me and that is comforting. (Mind you he asked for my late mother, too, but that is another story!)

I have taken one day at a time. My adult children continue to support me. My grandbaby I have taken pride and joy in; the cycle of life. I have begun to feel fewer panic attacks. My body feels more fit. My mind feels more alert. I have experienced more joy and appreciation of life, nature, and people. One day at a time...

Signs of Pain

There are many signs of pain. Bizarre behaviour proved to be one of the. One day Dad wandered down the hall, still in his wheelchair. He could not walk on his own and had lost the ability to move around independently. He ended up pulling the fire alarm. I was mortified! At least I knew they cannot kick him out of this Long-Term Care home. In the retirement home I was always worried.

I worry about having to restrain him. He is terribly confused and groaning a lot. We did not know if he is in pain or what we could do about it. The staff gave him some Tylenol to ease his pain. It might simply have been his knees that agonized him, but, again, we did not know. He could not communicate this to us.

Pain is not a normal part of aging. It is fairly common in Long-Term Care Homes, and ought to be addressed. Chronic pain is pain that persists for 3 to 6 months after it is expected to, after healing from something. Persistent pain is pain that lasts longer than a month. Dad has always had persistent pain, due to the arthritis in his knees, and this has never been adequately addressed. All of us tried many things but did not find relief – or he give up. He bought the magnetic wraps that are supposed to help, but gave those up. In the summer we put some topical ointments on his knees. After the radiation treatments on his forehead he put some of this, accidentally, on his forehead when he isn’t thinking straight. In the past Dad indicated pain, but he is beyond that now. A great resource regarding pain is at BP Blogger's monthly newsletters. This one, on pain (click here: for PDF) is excellent. They have many others covering a variety of issues.

There are non-specific signs of pain: frowning, grimacing, grinding of teeth, fidgeting, bracing, rubbing, striking out, increasing or recurring agitation, poor eating or sleeping habits, sighing, moaning, groaning, decreasing activity levels, resisting particular movement, change in gait or behaviour or loss of function. Dad had all of these and, in hindsight, was clearly undermedicated.

Hearing Aids Cleaned

Dad had been so frustrated with his hearing or lack thereof. He had been having his ears cleaned weekly, after much muss and fuss. In the Long Term Care Home, however, this service isn’t available as far as we know. His retirement home took him by mini-bus to the doctor, who will do this for us. Funding allocations for LTC residences in 2006 include staff funding of 2.5 to 2.6 hours per resident to get them up and ready and into the dining room for meals, washing them, meeting their needs and giving them snacks. It is barely enough and less than other provinces deem minimal.

For each resident in BC, Alberta, Manitoba and Saskatchewan they have a minimum funding per client of 3 hours per day. Recently, pre-election posturing in August, 2006, included a political announcement of 1200 new nurses in the province and funding announcements that will not be in enacted until 2008, and we won’t see a result until 2009. Funding for housekeeping, laundry and other services are running less than inflation. Wages and utilities have increased by 3 % and inflation is increased by 1.6 %. The 3rd floor, for example, with the flight risk residents and Alzheimer’s patients, absolutely needs 3 hours per resident.

While we met the doctor on his intake day, he only visits weekly and they do not have enough time to see each patient during this visit. The government only provides funding for one physician per floor. This will later prove a difficult obstacle. Right now it isn’t too much of an issue. It is the nursing staff that determines his needs, along with our advice, support and guidance.

Brian took dad’s hearing aid to have it cleaned at the store. It is a bit of money, but worth it. Dad’s ear is raw with scratching it. Everyone says that they have never seen such wax build up and so small an ear canal. I wonder if Dad can focus on this problem since he cannot face his other issues: grieving over his wife, dog, old life and old home. Dying is a complex issue.

Meals on Wheels

Jack Hutton, an legend in Bala, gives Brian his list for the day. Jack is the president of the Meals on Wheels Project in Bala. Sue Gurr is the coordinator who manages the list and divides up the 3 delivery days offered (M/W/F) between various religious groups, legions, senior's groups and other volunteers, who feel good about contributing their time and energy to the project.

Jack says, "Meals on Wheels was started in Bala about 23 years ago by Linda and a girl friend. They were concerned about an older friend who obviously needed that assistance and approached the appropriate government agencies."

A Google search found 1,950,000 English pages on this topic. What a wonderful community endeavour in which people help other people. Meals on Wheels is a program by which volunteers organize, plan and coordinate the delivery of meals to those who would benefit from hot meals delivered to their homes. Some groups, like the one here and in Nepean, ON, charge for meals as part of their requirements. The Ministry, which funds these groups, have obtuse rules about its governance!

MoW, as we call it at home, is reported to have begun in Great Britain during the 2nd World War, and spread to many places. Many small and large communities provide this service from right across Canada, and in the U.S. and other countries, such as Australia. Meals on Wheels in the GTA, is a highly organized system. The referral process is easy.

The purpose is to provide a hot meal to adults living alone, or who are unable to make a hot, nourishing meal on a regular basis for themselves or their spouses. The meals are made in a variety of places, and the programs are delivered in a variety of means for a variety of reasons. Frail seniors, adults with physical disabilities, or elderly people convalescing from surgery/illness, can qualify for this program. Unfortunately, from my research on my book, and personal conversations, it seems as if many are reluctant to participate in the program.

This is a popular program much eschewed by those who purport not to need it. My parents, both fighting cancer, or or should say my mother, refused the program. I recall seeing her stand at the counter and leaning heavily on it, her hands shook fiercely as she determinedly made a sandwich for my father. She was in very bad condition but refused our help, as well as that of others. This was in April, and she died in mid-May. I patiently (OK not so much!) explained that she needed to save her energy for healing. There is much that caregivers receive as they try to give back to society. It took me weeks to make my point - but I made it eventually. Family members have to be strong in demanding that our seniors avail themselves of these programs. One of the signs of dementia is an empty refrigerator. A great predictor of ill-health is an empty refrigerator (Lancet 2000). In this study 31% of those with empty refrigerators were admitted to hospital in four weeks, compared with 8% of those with filled refrigerators. Some seniors cannot be bothered cooking, and some husbands of my parent's generation have never learned to cook. There are many reasons to participate in this program!

In Muskoka we have programs in Bala, and Bracebridge, but the Gravenhurst program had to stop due to the lack of volunteers in 2007. Many volunteers are suffering donor fatigue. It is said that 95% of the volunteering is undertaken by 5% of the population.

The risk to such programs, of course, is the rising cost of gas, and the fewer and fewer numbers of volunteers who can afford to spend the time, money and energy to look after these types of programs.
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(Photos printed with permission from happy participants in Meals on Wheels!)