infections in senior's homes

A "new" study, 2003, Infection control at nursing homes found lacking, see the CBC news post, provides nothing new.

According to Statistics Canada data, there were a total of 2,101 residential facilities for the aged across the country in 2006-2007. CBC published a map of locations, as well as information by province and territory.

Long-term facilities-based care is not covered by the Canada Health Act. It is governed by the provinces and not the feds. Services, rules and regulations vary across the nation. In Ontario, we have a variety of profit and non-profit centres. There are a variety of staff who work in such homes.

cholesterol & depression

As a contract employee working for the Cardiovascular Health Awareness Program (CHAP), I know the importance of looking after your total health. Diagnosed with high cholesterol, I was quite surprised. It happens more often in women than previously thought. We are a group that has been left out of the research data, driven, primarily, by pharmaceutical companies.

As I surfed around, looking for information, I found a great site that gives gender-specific information on cholesterol. This is one of the contributing factors to ameliorating high risk for stroke and other cardiovascular issues. For those of us over age 50, we must recognize risks. It is estimated that 40% of Canadian have high cholesterol. For women with diabetes we have a higher risk than men (Lee, 2000). There is a relationship between depression and cardiovascular disease, too (Mussleman, 1998). I suffered from both. A simple blood test identified my high cholesterol.

There are two measures of cholesterol: good (HDL) and bad (LDL) cholesterol are present in our blood streams. Cholesterol (fats) in your blood come from the food you eat (20%) and your body produces the rest (80%). Your body needs it to function. If you have too much then plaque builds up and prevents to flow of blood through your body, robbing cells of nutrients. If arteries become narrow or blocked, your heart has to pump too hard and chest pain (angina: too little oxygen) or a heart attack (myocardial infarction) can ensue. If a clot breaks off and blocks the flow of blood to part of your brain you can have a stroke.

If your cholesterol is high you have some options:

• change your eating habits
• exercise more frequently: strength, fitness, flexibility
  
• start, switch or increase your medications
  

Your doctor may have a chart to compare the ratio to compare good to bad cholesterol to assess your risk.

Questions you doctor needs to answer about current treatment

• If I’m not at target and am already on prescription medication, will you:

  increase my dosage

  switch to another cholesterol medication

  add a new medication to what I'm currently taking

• If I’m not at target and am not already on prescription medication, should I be taking medication?
• Am I exercising enough?
• Am I eating the right quantities, of the right foods, at the right time?

Ask for help from a nutritionist for more information on healthy eating habits.
Visit the Public Health Agency of Canada for information on physical activity guides.

It is only by preventing chronic diseases that we will eliminate the ALC patients blocking access to hospital beds. You can prevent or ameliorate chronic health issues (obesity, arthritis, osteoporosis, diabetes, cancers) by eating balanced meals, exercising regularly, reducing stress, building strong muscles, by living an active life.

If you are going for a cholesterol test ask...

• When do I take my test?
• Do I need to fast?
• Do I need an appointment?
• When and how will I get my results?
• Will you phone me?

~~~~~~~~~~~~~~
References
Lee, et al. (2000). Impact of diabetes on coronary artery diesease in women and men
Musselman, DL, Evans, DL, Nemeroff, (1998). The relationship of depression to cardiovascular disease: diagnosis, biology and treatment - Arch Gen Psychiatry, 1998

Pain Management

Some health care practitioners do not understand modern pain management. My father, whose brain tumour caused him to lose his language, was unable to name his pain. I had to name it for him in a poem. It is one of the failures most regret: advocating hard enough until it was treated and managed took me months. Not a cost issue, we were paying for most of his medications, staff hesitated to manage his pain.

You can read pain symptoms in the body language and the spirit of those we love. Caregivers, professionals, need to listen to us.

Such publications as The Fundamentals of Hospice Palliative Care (2007) speak of pain as a "complex biological event that affects the person, the family, the community, and society." When a loved one suffers, we all suffer. It is up to a family member to advocate for those who cannot speak for themselves. Sometimes deep pain, as affected by psychological, biological, sociological, spiritual or practical factors, can increase without interventions.

Early intervention ameliorates pain. Prevention is a good manager. Pain experiences are related to cultural backgrounds, gender, the personal meaning of pain, and one's life experiences.

Barriers to treating pain:

• personal, preconceived prejudices on the part of the patient, health care professionals (PSW, nurse, physician, institution), caregivers, family members
• myths around pain management - that it is 'normal'
• myths around dosages
• myths around delivery of pain relief - oral vs. shots
• myths around addictions, dependence, tolerance
  

Recognizing pain early, predicting pain and preparing for it is essential. There are two kinds of pain: acute and chronic.

Chronic pain lasts for 3 - 6 months, and one has to adapt to it in various ways. It comes and goes, and endures longer than the expected time for healing or disease. It can be exacerbated by

• anticipatory pain - fear & anxiety causes the expectation of pain
• incident pain - resulting from being moved, or moving, changing positions, or dressings
• remembered pain - related to previous experiences, similar to PTSD that causes a reaction deep in the brain

Acute pain has a definite pattern of onset, caused by many physical issues. It causes the fight or flight reaction, dilation of pupils, sweating, faster heart and breathing rates. It needs to be addressed quickly and with a comprehensive approach.

No one person will have the same pain threshold as another. This is a fatal error health care professionals can make. Pain threshold can be raised by

• discomfort
• insomnia
• fatigue
• anxiety
• fear
• sadness
• depression
• boredom
• introversion
• social situation

It can be lowered by:

• symptom relief
• sleep & rest
• sympathy, understanding, companionship
• diversional activity
• elevation of mood
• anti-depressants, anxiolytics, analgesics

Complementary therapies

• acupuncture
• art
• breathing - e.g., childbirth - Lamaze training
• chanting
• dream work
• imagery
• insight therapy
• massage
• meditation
• music
• homeopathic remedies
• prayer
• reflexology
• relaxation
• therapeutic touch
• yoga
  

cuts to nursing

The Ontario government gives and it takes away. Yesterday's post, and Feb. 19th news, was a grand announcement of new health clinics staffed by Nurse Practitioners, a laudable addition to a triage in health care, especially in remote locations where doctors are scarce.

On Feb. 19 Ontario Health Minister David Caplan set targets for minor health cases and the more "complex conditions" emergency rooms face.

Today, we read that Ontario Nurses' Association Launches a Television Ad Campaign ...
In a move to cut health care costs, hospitals are cutting back nursing hours. What is the solution to the high cost of health care? I cannot think that this is it...

Prevention is the key. We know that those living in poverty are at a higher risk of health issues. Yet the poor get poorer and sicker. See: The real cost of poverty in 20 Nov 2008... For instance, this study estimates that Ontario pays $2.9 billion a year on poverty-related health care. Education, prevention, treatment and cure.

A recent report, based on 2002 data, suggests that across the board, all ages are visiting health care professionals more. This Toronto Star article says that while costs rise $76 billion, it isn't the Silver Tsunami, as has been predicted, that is to blame. A new health Council of Canada Web site, Canada Values Health.ca, features a blog, discussions and podcasts.

Recovery rooms are the barrier to having elective surgery. ALC patients, those needing beds on alternate institutions, are bed blockers who need less than a hospital, but more than home care. For those able to be sent home, family, friends and neighbours provide support, while CCAC give a few hours a day, week or month. There is a CCAC locator page for Ontarians. They can provide supports for frail and ailing adults.

Be sure you know how to access help. Check with various agencies using the 211ontario.ca website for help.

nurse practitioners

Premier McGuinty has announced the creation of 25 nurse practitioner-led health clinics. I am quite excited by this prospect. For more information visit the Ministry Web site.

This initiative is meant to help the orphan patients, those without family physicians - hundreds of thousands in Canada.

Of course, a Google search on this topic demonstrates that while nurses and patients think this a good idea, physicians do not stand up in favour of it. What a surprise. The news has even hit US-news sources.

The first such clinic opened in Sudbury in 2007. I think it a great plan.

I recall, back when I was pregnant with my daughter almost 30 years ago, that OB-GYNs proteste against midwives being given hospital rights. The battle was hard fought, but won. Now, they are finally accepted and have demonstrated that in the case of uncomplicated births, they are a valuable part of the team. These women have proven an incredible part of the pregnancy, birth and breasts-feeding process. My daughter benefitted from such a woman. She visited the mother-daughter pair daily, gave advice, supported her and educated her with practical suggestions for breast feeding and other caregiving ideas.

While the Ontario Medical Association is in favour of Family Health Teams, rather than these NP-headed clinics, I think the proof will be in the performance. With a limited cadre of physicians, we are hard pressed to find teams.

wait times

A much-lauded announcement, dulled only by the arrival in Ottawa of President Obama! A major newswire release: Ontario Health Care Wait Times. The Ontario Government is providing options to those who require health care - alternatives to crowded emergency rooms.

• Family Health Care Providers
• Family Health Teams
• Walk in Clinics
• Community HealthCentres
• Telehealth Ontario
  

I must admit to some skepticism. It remains, at best, rhetoric, as this article on Mental Health Care says. Marion Wright, of CMHA says, "Two areas need attention. First, case-management services. Second, safe, affordable, supported housing." To demand that hospitals decrease wait times, with a dearth of health care professionals at all levels from PSWs (in LTC and for Home Care) to nurses to family physicians does not seem possible. We lack human and physical resources, at this point. An emergency room doctor, in a small town, interviewed by CBC explains that wait times mean nothing if you are waiting for tests for more complex issues, i.e., cardivascular issues. The tests require repeating for certaintly. It is hospital beds that we are in desperate need of...

This chart shows the baseline data, hours spent in emergency waiting rooms, from which they will aim at improving:
It is important to establish data. But we know from education that simply testing, and demanding improved test scores (through EQAO), will not improve the delivery and mastery of curriculum. The confounding factors are too immense: language barriers, poverty: poor nutrition, lack of support services, limit the ability of a student to learn. Similarly, by simply reporting on wait times, we are not going to decrease them without interventions.

The government suggests that their proposed interventions will work: a Hospital Performance Fund, Process Improvement Programs - to increase patient flow, Dedicated Nurses to ease ambulance offloads. The latter will simply release EMS crews to go back out on the road, and will not increase the number of beds.

Also:

"Measuring and reporting the time patients spend in ERs - collecting
   information, reporting the time people spend in the ER on a public
   website, measuring and rewarding improved performance, so that
   Ontarians can see the steady progress being made."

This is the means by which the political beast can tell us that they are doing a good job. It will result in hospital shopping, such as we have seen in schools where parents shop for houses in areas where schools have good test results. It won't help those who have no choices and no options.

The most complex problem are those who require Alternate Levels of Care (ALC - or bed blockers), those who cannot go home to recuperate, who have comorbidities that preclude simple Home Care, or may not be able to recover from illnesses or diseases. Chronic care is a huge issue. One is discharged as soon as possible, with Home Care, or other supports in place. Going home may not be an option.

The government plans on spending $94 million on the Aging at Home Strategy, this is not entirely new money. This process began in 2007, on a 3-year, $13 million budget that has not transformed health care for seniors. They plan on spending more money on Personal Support Workers (PSWs), and homemaking services. In the meantime, we do not have enough trained workers to fulfill these roles. The same issue is a problem for nurses and physicians. The announced development of 1750 new LTC beds across the province will not magically appear.

With more than 500 for-profit LTC homes in Ontario, out of 640 or so, we have no assurances that these homes will be able to a) find enough employees and b) deliver the quality care that our aging population deserves. I remain skeptical! Seniors still need a basket of services from transportation, Home Nursing care, Meals on Wheels, homemaking, driveway shoveling, and many other ADL and IADLs, that simply are not available on a dependable, consistent, reliable basis from any coordinating agency. CCAC, through the LHINs cannot manage such coordination of services. When we deliver our Meals on Wheels, we do the sidewalk, phone for a snowplow, arrange for transportation to doctor's appointments. There are huge gaps across the province that remain unmet.

hospital visits & appointments

I have written previously about Alternate Levels of Care (ALC) patients. This can be termed bed blockers: patient who require a different level of service than a hospital offers. We require services that range from ICU, hospital beds, chronic care facilities, long-term care, retirement homes) for some seniors. We are short spaces in many of these facilties. Another issue arises in patients required to be in a specific hospital at a specific time for an appointment for tests, evaluation, or consultation. Discharging a frail, senior patient to home requires much in the way or preparation and assessment.

The statistics come from a joint study by U of T., Ornge Transport Medicine, Sunnybrook Hospital and ICES, 80% of patient transfer are non-urgent nature. This would imply that we need a different level of transportation. Those requiring trips to other health care facilities (larger hopsitals for MRIs, tests, to see cardiologists, diagnostic imaging ( e.g., MRI), ongoing therapy (e.g., dialysis).

This study looks at who is using ambulance crews, (see more details here) how much time it took, and how it affects missed appointments, and compromising patient care. Certainly, in the great concentration and reorganization of services in Ontario Health Care, patients are forced to go to particular institutions that deliver the specific care they need. This issue requires some examination.

They wondered why highly-trained paramedics are diverted to deliver non-urgent patients. Of course, urgent calls take priority. I know that when my father needed to go from Gravenhurst to Toronto to have an MRI, we had to take him in an ambulance - he wasn't ambulatory. Then, a week later, we had to go back and visit the oncologist, who by now had read the report and simply wanted to meet my father and let him know that his tumour was now fatal and we would not continue the radiation treatments that had so decreased his quality of life.

We sat there in the morning, and waited more than an hour until an ambulance was available, despite having booked it two weeks before. My poor father, in his dementia, could not understand what we were waiting for. In many cases, such trips waste the time of the ambulance, and concern everyone involved. It is rather an expensive taxi to drive two hours into downtown Toronto. As many of the media articles claim, politicians must examine this issue. This is a colossal waste of time, money and expertise for very poor service for these frail seniors.

~~~~~~~~~~
"Inter-facility Patient Transfers in Ontario: Do You Know What Your Local Ambulance Is Being Used For?" Victoria Robinson, Vivek Goel, Russell D. MacDonald and Doug Manuel, Healthcare Policy, Vol .4 No.3, 2009 (www.longwoods.com)

cardiovascular health awareness

I have been working on a part time contract helping with the cardiovascular awareness program (CHAP) in Muskoka. This work is sponsored, through government on Ontario grants, via McMaster University, UBC, Élisabeth Bruyère Research Institute, ICES, TIPPS, and run by to-notch researchers.

Non-profit Transfer Payment Agencies across the province, i.e.,The Friends here in Muskoka, have been assigned the task of integrating an awareness of hypertension, risks for stroke, and the benefits of a healthy diet, along with the 3 types of exercise: aerobic, stretching, and strength.

A great site for individuals to monitor their health is here at the Resource Page for CHAP. Working with the Heart & Stroke Foundation, and other non-profits, this page provides informtaion on Body Mass index, waist circumference, heart health - especially for women, stroke prevention, healthy eating guides, diabetes, smoking dependency, physical activity, stress, depression, as well as other links, i.e., HealthyOntario.com, senior's health issues, SHRTN and the Kidney Foundation.

There are on-line models to help you determine your BMI and other numerical values of the state of your health. It is government sponsored, your tax dollars at work. There are NO ADVERTISEMENTS, unlike many of the senior's sites I have complained about in a previous post, the senior's market! Canadians must be aware of the source of information for websites, since rules & regulations and different laws apply in the two countries.

Visit CHAP Resources for a ton of resources.

Home Care

In-home care is an important way to manage ill-health in the privacy and comfort of your home. What is shameful is that we do not have enough workers in the field.
The news is not usually good, about senior care. The bad news gets press. Accidentally allowing a dementia patient to be left outdoors. "Human error blamed for senior's death".

These are preventable deaths, which profoundly affect a family, senior's LTC home, community. It is very difficult to find Home Care, as well as institutional care, which may be necessary.

Home Care is delivered by for-profit or non-profit, many are Transfer Payment Agencies. All must pay fair wages to staff to retain them. There is some controversy around private agencies bidding for contracts on delivery of services to provide home care. CCAC, and other big health care providers, often puts out Requests For Proposals (RFPs). Agencies such as VON, or Red Cross can apply.

The controversy is raising its head in the legislature. The Sudbury Star's Carol Mulligan wrote: Acccent: Bidding for care, Cause for concern -- or rhetoric?
I wonder. France Gelinas, NDP MPP, has been riding the Health Minister. Concern around the competitive bidding process is well-founded. PSW workers may make anywhere from $13 - 22. There may be shift premiums, stat holiday pay, overtime, vacation pay, in lieu of pay, etc.
Their agencies, just like any other TPA, charges clients more than this. The PSWs may or may not get travel time, or mileage, which grossly takes away from their working hours and take home pay.

I cannot imagine that we are better off with competitive bidding. I think one of the most pressing issues for seniors, and anyone else getting Home Care, is continuity of services. Changing agencies from year to year is time consuming and disruptive to both care receivers, and care recipients, not to mention the paperwork involved for the agencies.

We need well-trained, able, supervised PSWs, registered at a central location to ensure that we have quality caregivers. TO SIGN A PETITION PLEASE GO TO:

http://www.gopetition.com/petitions/nursing-homes.html

Ontario Home Care Workers Speak Out

I don't often broadcast other videos on this blog. This one, however, talks about the issues that affect those working in and receiving home care.

The issues are: salary, transportation, working hours, access to services, fair wages, continuity of care, access to equipment; assistive devices: mechanical lifts, equitable delivery of services across the province, quality control, accountability of individuals and agencies, client respect and dignity.

As they say, the funding just isn't there for adequate funding, equal pay for work of equal value and to fulfil the Ontario Government's policy of enabling seniors to live well at home.

the senior's market

I am increasingly appalled by the number, the extent and the range of advertising and propoganda, and blatant manipulation of seniors as businesses, and website managers, try to earn a buck.

An interesting series by Judy Steed writes about the reality of aging in Ontario. The Toronto Star advertised it heavily, supported by an Atkinson Fellowship grant. It is a great idea. Rather than having journalists touch on stories here and there, this foundation supports journalists in researching a story over time, incorporating some expertise. For a one-year period they are paid $75,000 to write and research a topic. (Great idea, BTW, paid for by a late, former Toronto Star publisher!) There is much information on real-life stories of real seniors coping with stress. These are valuable, as there are lessons from real-life experiences. I know. I wrote one!

You will find many articles in Ms. Steed's series. Unfortunately, you will find many ads, too. One person has posed a comment, a blatant ad for her heavily Google-advertised site, that rates Ontario LTC homes. I am opposed to such sites. I am appalled that the editors would allow the comment that includes a blatant ad for a web site rating LTC homes. This is an ineffective, unreliable and undependable source of information. After all of Judy Steed's work, it is an insult to her journalistic credibility. There is no valid information on such a site where readers can vent petty and serious complaints without evidence. It is biased, anonymous, and could be posted by any idiot with an agenda. For families desperately searching for LTC it could have a very negative impact.

Ads are everywhere. On sites where one thinks one can avoid them. Why does Oprah have them? Really. A whole new industry has sprung up around this. There is a web site that promotes the "Secrets of advertising to seniors". There are ads for sites that promote advertising and try to get you to sign up! There are ads for housing, home care, pharmaceuticals, and assistance with ADLs. Now, there is a new target audience. Family members, stressed with caring for ailing parents are encouraged to buy electronic devices to monitor their parents, much like interactive baby monitors. I think we are lulled into a false sense of security. Our failing seniors want adult care, the human touch, and caring caregivers who will provide them with social interaction.

The Canadian Association of Retired Persons (affiliated with the American AARP site - with BIG bucks and research dollars) has tons of ads, with little teeny articles that provide little information, and little credibility. The Vancouver-based: Association for Active Aging Professional, charges big bucks to sign up for their organization. Hundreds of dollars to keep abreast of current issues - logically a Canadian government responsibility, free of cost and supported by those committed to helping us all age gracefully.

There is a Vancouver-based site, which I will let be nameless, that has more content in their articles, but they are too long, and are freely reprinted from (the American) WebMD. They purport to offer up to date information, and they may do so, but let's get real, they are simply providing an advertising portal.

One WebMD post discusses dementia. If you read closely, they suggest that the correct response may be a particular dementia drug, with the drug advertised down below. They get around this unethical, transparent, highly biased article disguised as an ad, by a disclaimer that you should go to your doctor for more information, and "WebMD does not endorse any specific product, service, or treatment." The banner at the top, and one on the side bar, has more ads for this drug. They have a sponsorship explanation, and claim sponsors do not influence content. May I be skeptical?

I refuse to do advertising, despite offers, for example, to put ads on for incontinence products. You just have to draw the line somewhere. We don't know where the information has come from (different legislation and rules exist in the US regarding health) and should be skeptical about its content.

You have to be careful. I blogged about debt by seniors, since this is becoming an issue with more seniors on-line and accessible to those who will prey on them emotionally and financially. Be vigilant.

Eldercare industry

It appears that the eldercare industry is increasing exponentially, the way that the childcare and educational industry has evolved. There are issues around this, in that with the increasing number of seniors in care, the risks to their safety increase, as well.

Caregiving issues that now apply to seniors in care, as in Ontario Transfer Payment Agencies (TPA) have popped up here and there. The parallel is day care, where day care centres subsidized spaces are paid for by the government, to assist low-wage income families in being able to earn a living above the poverty level. For-profit centres hire staff, some of whom may not be governed by a body that ensures that they hold accreditation, certification or ar suitable for their work.

Currently, with 533 for-profit Long-Term Care centres in Ontario, out of 640, they have different policies regarding staffing. My belief is that all staff must have certification in geriatrics*, and that specialized geriatric services must be accessible to all seniors (Lewis, 2008).

One of the big issues in elder care is abuse. This, apparently, refers to physical, financial, sexual, social, emotional abuse, or neglect. There are several agencies that concern themselves with raising awareness, raising financial support through donations, i.e., CNPEA, ACE: MAG - gov't funded, ONPEA: (Trillium Foundation funding). As I research seniors' care, I find more agencies, spreading more tax dollars across the field.

The Ontario government provides a link with a pamphlet: What you Need to Know About Elder Abuse, an information sheet: What You Need to Know About Elder Abuse, a PDF file: Safely Planning for Older Persons. These are policy measures to deal with this problem at the government level.

In a conference in June, 2008, many speakers presented concerns, methods for identification and prevention of senior abuse. According to Robinson (HRSDC, 2008), there have been 50 government-funded projects to fight elder abuse. The Feds, in a speech by Senator Marjorie Lebreton, committed $13 million over three years for this issue. In a speech by the Rt. Hon. Beverly McLachlin, Chief Justice Supreme Court of Canada, she highlights the need for us to identify and legislate around this issue.

The statistics say that 90% of abuse is committed by family members. The issue, as I see it, ought to be contained under two streams: abuse by family members or either paid or volunteer caregivers in simple assault legislation. Never mind proving abuse. Tey need to be charged at this level, in the same way that domestic assault is now heavily legislated and highly understood by professionals. In Family Violence in Canada (2008), they hint that violence and abuse against elders is unrepresented and, therefore underreported, but this is not clear.

~~~~~~~~~~~~~~~~~~~~~~
* geriatrics: from the Greek: geros: an old man, iatros: a healer

Lewis, D. (2008) Organization Design for Geriatrics: An evidence based approach. Regional Geriatric Programs of Ontario.
Gov't Canada, (208). Family Violence in Canada: A Statistical Profile, PDF file.

LTC situation in Ontario

I was asked by a journalist about the state of LTC in Ontario. We are expecting a report in March on this issue (see references below).

What is appalling is that hospital and LTC spend $18 billion of our tax dollars in the MUSH sector: municipalities, universities, schools, hospitals which includes: LHINs, LTC, Health Care & Children's Aid TPAs*, police, EMS.

In the case in most of the institutions that care for the young (Children's Aid Societies) and related organizations: non-profit Day Care, and other sectors run by municipalities, they have requisite knowledge, skills and expertise embedded in their workforce.

In the case of the old and the frail (Retirement Homes, LTC, private TPAs), many are staffed by those without necessary qualifications. For example, to work in a Day Care I need to have my ECE degree. A degree that involves training in pedagogy, sociology, psychology at the college or university level. If I work in schools with special needs students, I must have my Special Education Specialist Certificate, which I do posses!

Those who work in Retirement Homes & LTC do not require the same expertise. Day programs and activity directors may or may not have such training and may not understand their residents. Don't get me wrong, many do, but judging by, for example, resident newsletters some do not hold basic reading and writing skills. Many excellent agencies, which provide personal home care to seniors ,only hire PSWs who have a certificate. These workers often work alone, in the residents room, or in private homes - unsupervised. Nurses, and we are desperately short of this category, do not necessarily have the added geriatric certification. Physicians definitely do not have such training. The Geriatric Assessment Program of Ottawa demands that geriatric assessment by given by a qualified team to determine needs of resident, and prevent or ameliorate comorbidities and chronic health issues.

I have written previously about the need for such assessments, and the early discharge of seniors from hospital, including depression tests in both seniors and their caregivers. With early identification of these biopsychosocial health risks we can prevent seniors from landing in emergency rooms, or LTC.

Dr. Frederick Sherman (www.geri.com), of the Mnt. Sinai School of Medicine, says:

• Family Not Aware: 21% of family members fail to recognize a problem with memory in demented seniors. (JAMA, 277, 1997)
• Physicians Fail to Evaluate: 53% of seniors whose family DID recognize memory problem did NOT receive an evaluation
• Physicians Fail to Chart: 76% who screened positive for Mod/Sev D were not noted to be demented on chart review. (Ann Int Med, 109, 1995)

Dr. Michael Rachlis’s work in the area of health care calls for changes to public health policy in order to accommodate the vast numbers of seniors who will likely experience chronic care issues in the near future. Chronic diseases account for 70% of all deaths, 60% of health care costs, and 33% of deaths before the age of 65. Our health care system is not meeting the needs of those with chronic diseases; less than 30% of those with hypertension are being treated. Those with diabetes should have eye exams. Asthma is not controlled properly in 60% of our population. Sufferers of heart failure are readmitted at the rate of 20% within 60 days (Rachlis, 2006).

In The Hazards of Health Care (Heckman, 2004), warnings are given for undiagnosed dementia and delirium. We know what chronic disease does to our seniors. It reduces the quality of life for both victims and their families. There are fewer than 200 geriatricians in Canada (2003), and we need 600 to keep up with international standards for a country with our population. A Medscape article (2006) interviewed an author of a JAGS study (J. Am. Geriatr Soc. 2006;54:1453-1462), and he said,
"there are currently just under 200 geriatricians working in Canada compared with an anticipated need for between 512 and 607 geriatricians in 2006. With 4 to 9 residents entering a GM specialty training program each year, coupled with growth in the Canadian population older than 65 years and the projected retirement of many practicing geriatricians, the shortage will continue to worsen."

Ontario geriatricians say they cannot afford to practice. It is the lowest paid, and the least funded in Ontario.

What we need:

• More palliative care rooms
• More better trained staff with a wide range of expertise to manage chronic disease
• Family health teams that include PSWs, nurse practitioners, physician assistants, as well as physicians, to address issues and deliver a full range of care
• More funding for staff
• Requirements for in-service training of PSWs and medical staff, including nurses and physicians, in geriatric issues: physical and mental health issues that require specific treatments
• More continuity of care, with staffing levels that permit this to occur
• An ombudsman to assist families

~~~~~~~~~~~~~~

*TPAs (transfer payment agencies) make up for a large number of these institutions. This means that money is transferred to an agency, which has a Board of Directors, and monitors how and where our taxes are spent in caring for the young, the old, the incompetent, the incapacitated and disabled, our frail and vulnerable seniors, and those in psychological, social and emotional crisis.


References:
Barclay, L. (2006). Shortage of Geriatricians May Hinder Healthcare for Elderly, Retrieved online from http://www.medscape.com/viewarticle/544464

Check on Senior Care Urged: Both opposition parties say nursing-home neglect will be a big issue for aging electorate in Oct. 10 vote.. (Toronto Star, 2007)
Ombudsman renews call for oversight of hospitals and long-term ...(pdf report, 2008)
Ombudsman Finds Ministry Bound By Its Own Red Tape (Sept., 2005)
Rachlis, M. (2006). Seniors’ health: We can’t afford the future if we don’t repeat the past. Retrieved August 29, 2008, from www.coaottawa.ca/health_forum/DrRachlis.ppt.

depression in caregivers and seniors

What do I have to worry about? I am retired, albeit early and with a $ penalty, but my days are my own. I keep busy with volunteer activities and help out with a couple of community endeavours. I regularly keep in electronic contact with my children (phone, Wii, Skype, e-mail) and any combination of the aforementioned!

With all of these things going on, it is still easy for a caregiver or senior to gradually sink into depression. No longer are they needed for parenting issues and advice. Sometimes, some say 30% of us middle-agers are caring for family members. Many find they are burdened with caregiving issues in the sandwich generation. For some the familiar rituals of seasonal celebrations must go by the wayside, for others they are grateful to let some things go.

If stress persists, there are chemical changes in the body. I could see this happening in me as I fought for Dad in LTC. These changes are not restricted to the body; they impact one’s life psychologically and socially. In the research I did for my psychobiology course, I found that there were many signs of depression:

• Lack of interest in formerly pleasurable activities
• A change in eating patterns
• Changes in sleep patterns
• Feelings of worthlessness or guilt
• Energy level decrease
• Problems making decisions
• Thoughts of suicide

What we need is a balance of physical and cognitive activities (see this post for more information), social opportunities, family and friends around us. We need professionals who can recognize the signs of depression and treat them early, avoiding, as much as possible, unnecessary chemotherapy.

The Canadian Government offer seminars. One of them is an information package on depression.

On another site, sort of a Dear Abby for caregivers, a nurse offers some valuable insights. ary Fridley, RN, says, "Depression in caregivers is very common. Studies have shown that it affects nearly 50% of them. There are more than 40 million caregivers in America. Contrary to general belief, 80% of caregiving is done by families in the community not in institutions. Most are woman age 50 or over and at least half of them are employed."

We face huge emotional, financial and sociological implications as caregivers of spouses or aging parents. Vance, et al., said, "By providing emotionally engaging, stimulating, and, most of all, meaningful activities for adults with AD, agitation and accompanying behavioral problems may be abated, improving quality of life for patients and their caregivers."
This is so true, as long as barriers such as transportation, and ill-heath do not get in the way.

A study from Australia cites "a lack of continuity of care, multiple co-morbidities, reluctance by older people to discuss depression, negative attitudes among carers, as well as a lack of skills all contributed to a failure to detect and treat depression. (see Barriers to Care for Depressed Older People: Perceptions of Aged Care among Medical Professionals, 2009)

Of course, such findings have implications for training programs at all levels of the health care system. Prevention is such an important tool. Lack of diagnosis is a wrench in the system that negates all of the knowledge and research available to us.