MD Whistleblower: U.S. Preventive Services Task Force and Mammography: Evidence-Based Medicine or Medical Rationing?

MD Whistleblower: U.S. Preventive Services Task Force and Mammography: Evidence-Based Medicine or Medical Rationing?

The theories abound out there! They recommend not to check your breasts yourself. I disagree, as you must be familiar with what is normal for you and your body.

Yet, we see the research: 1 in 2000 women will be diagnosed through a mammography with breast cancer. 1 in 1000 are given false positives.
In Canada, 20 % of the screenings are in error. You be the judge.
Your age is the important factor. If you are in your forties, your breasts are too dense for an accurate reading. Once you hit age 50, they say to have mammographies every two years.

Scoot out of the way!

I regularly spot these fabulous transportation vehicles. I recall how difficult it was to persuade Dad to even use the a walker, let alone a wheel chair. Then, when he was confined to a wheelchair, it drove him crazy. 

Imagine the senior with limited mobility, having the freedom of zipping around town. Muskoka towns are populated with these scooters. With modern batteries, they can manage our hills and roads.

These little scooters are just a great transportation vehicle, but there have been accidents. I have had students with disabilities have to learn that their wheelchair is now an extension of their personal space. As the article says, those driving a scooter need to understand how much space they take up, and to avoid rolling over toes.

I have previously posted about the signs to watch for in senior drivers. It is difficult to be told that your skills are not what they have been.

Senior Drivers in the news tell us a story of dangerous driving, as response times increase, mobility is decreased, and age takes its toll on our bodies.

I spotted this gentleman on our way up to Lake Superior Park! Obviously, having a good time...he waved at every driver that passed by.

As I wrote previously in, Senior Drivers in Ontario, Transport Canada warns of seniors having car accidents in intersections. Current stats, in the recent Ontario move to more severely curtail teen drivers, reveals statistics that demonstrate seniors are more risky than newbie teen drivers.

I read a really sad, startling and funny article in Macleans.ca.

Beware of seniors driving scooters
Macleans.ca - Toronto,Ontario,Canada
He recalls one elderly man who gave up his licence “on the premise he could drive this thing like a car.” Repeatedly, police urged the man and his scooter onto the sidewalk.

“You are to yield to vehicles and bicycles,” he booms. “You can’t pull into traffic. Use the crosswalks. Wear bright clothing. Remember! You are a pedestrian!” 

I can't imagine telling such seniors what to do! Like teenagers, they take their new freedom for granted and the ones in the news story have been acting like hooligans. Rather a 2nd wind, methinks. 
Many new contraptions provide seniors with more opportunities for freedom and transportation. One man sold his father's car, invested the money and arranged for a taxi company to look after all of his transportation needs. This makes a lot of sense.


Col. Potter Cairn Rescue Network: Wheelchair riders often lose out ...
Last month, a 43-year-old Yucaipa man was left in critical condition after being struck by a truck while he crossed Yucaipa Boulevard in a motorized wheelchair. The truck was driven by a 16-year-old boy, who police said was not speeding and tried to stop before plowing into Wayne Swanson's wheelchair.

Patients need advocates

This is the kind of story that makes all of Canada look bad. One hospital with questionable, dangerous, illogical practices. My Dad had a brain tumour removed. He wasn't capable of much. This man, blind, with heart problems, was released after two day. On the way home he had a stroke and the Emergency crew did not want to readmit him without an EMS crew bringing him in. It is shameful treatment to leave him there for the 3 minutes they said the Emergency staff were arguing with the man's brother.

Stroke victim had trouble getting back into hospital

For more info, read the article.

This is the same hospital where Brian Sinclair died...

The Health Sciences Centre is the same hospital where Brian Sinclair, a 45-year-old double amputee with a speech problem, was found dead in his wheelchair after spending 34 hours in the emergency department waiting room in September 2008.

This really addresses the point that family members must advocate for patients. With underlying heart issues, hospital stays are risky for some. There are many Superbugs out there, and they thrive in hospital, but for someone with a heart condition to be sent home? 

What do you do if you do go home? In Ontario you are eligible for CCAC to send people to your home to give you care. In some instances, people are sent home without enough support in place. In this situation, there are groups who advocate for seniors, for example, to ensure that you have the right level of care. If you need a long-term care home, not a retirement home with little in the way of nursing care, it is your right to stay put. 

Women in my generation are faced with not just one, but potentially two parents or in-laws being home, ill and unable to care for themselves. The stories abound.

WHERE THE WOMEN WENT

This is a powerful documentary. I watched it previously on The Fifth Estate: "Where the Women Went". A sad tale of women trying to make ends meet. With the fishing industry collapsing, these women do what they have always done, worked hard at making a living wherever they can find it.

 Watch Where the Women Went online

They leave Newfoundland, to go across the water  to work in Nova Scotia. 

See the Google map: Newfoundland to Halifax

Scathing audit says Newfoundland ferry service fails to offer ...‎

HALIFAX, NS — The Crown corporation operating the ferry service that links Nova Scotia with Newfoundland is ineffective, inefficient and plagued with serious problems, the federal auditor general says in a report released Thursday.

 See "How the Women Get There"

Untrained workers, they work as live-in caregivers for the elderly, the sick, and the dying. This is a difficult issue for those who do not live in the cities or rural areas. Or for those without access to support services. The barriers to Aging at Home are immense for many people.

They have many issues, the first is getting from Newfoundland, going by ferry to North Sydney. Taking shuttle buses for another 6 hours to Halifax. One woman, a paraplegic, is cared for by these women, staying for days at a time. Another woman, with early Altzeimer's Disease, is cared for for two weeks at a time. This is a similar issue to the women brought in from foreign countries, to live with a family and provide care.

We know how difficult caregiving is when we care for our own loved ones. I cannot imagine how difficult it is to leave friends and family to work off of the island. 

Elder care is a huge issue in the world. We are not the only ones with problems. But what are we going to do about it?

H1N1 - on-line resources

The human brain is hardwired to be visual. I find maps and graphics of great help. Who knew we'd be tracking a pandemic in this day and age?

Google Maps has one of outbreaks. It appears to be Wiki-based, added to by users, and so take it with a grain of salt. They have maps on many other topics, too. At first blush, it appears out-of-date, since they cite Canada as having 53 cases, when, in fact Ontario alone had 79 deaths (according to TV media sources). Can you blame me for being dubious?!

Go to the nearest hospital emergency department or call 911 right away if you or your child has any of the following symptoms:

• Difficulty breathing / shortness of breath when doing very little or resting
• Continuous vomiting or severe diarrhea with signs of dehydration such as dry tongue, dry mouth, decreased peeing (no urine for the past 6-8 hours), or very yellow/ orange urine
• Stiff neck, sensitive to light
• Seizures or convulsions
• Confusion or disorientation

In Ontario you can phone Telehealth. Or, Ontario's Ministry of Health has created a self-assessment tool to help determine whether you or someone else has signs of H1N1. 

Influenza assessment for children UNDER 5 years of age 

Influenza assessment for adults and children OVER 5 years of age  

Download printable self-assessment charts for adults and children [PDF]


you are best to work with your provincial or territorial health care system, or contact your family physician, barring that, there are some H1N1 Regional Flu Assessment Centres, like those in Toronto, that are far preferable.


And then, there is helpful Microsoft, who wants to help you self-diagnose. I am leery of such, except that they do say to stay at home if you can manage your symptoms. For those in the USA: 

'Tis an American website, and they state: "This self-assessment is intended for residents of the United States only." You are required to put in your US Postal Code. It is interactive, and they are collecting data from this location. Interesting data, if it can be relied upon.

For More Information in Ontario

For information about seasonal flu, H1N1 and pandemic preparedness call ServiceOntario, INFOline at 1-800-476-9708 (Toll-free in Ontario only)
TTY 1-800-387-5559. In Toronto, TTY 416-327-4282
Hours of operation : 8:30am - 5:00pm

Telehealth Ontario at 1-866-797-0000
TTY: 1-866-797-0007
Hours of operation : 24 hours, 7 days a week

Do you glow in the dark?

The Globe published an article:

Experts urge tracking of X-rays, CT scans

X-ray technology has been around for decades, but the issue of radiation has been heating up as new research considers the health risks

 This is something I have pondered, but not for long. I am of an age when they recommend mammograms, but have not yet had one. I am unconvinced that, without symptoms or signs (e.g., lumps) that it is necessary and will detect cancer early.

There is radiation in X-rays mammograms and computed axial tomography (CAT or CT) scans. By the way, there is no radiation in Magnetic resonance imaging (MRI) or an ultrasound.

The Canadian Association of Radiologists(CAR) Estimates that up to 30 per cent of CT scans are inappropriate or contribute no useful information to help the patient.

Do You Need That CAT Scan? (PDF - CAR pamphlet)

The radiation dose from a CT scan is 100 - 500 times more than from a conventional X-ray. 

 I have written previously [See: Screening vs. diagnosis of cancer] about the concerns some physicians have with over diagnosis, or  prediagnosis of lumps, a normal part of aging. The statistics around this issue are scary. CBC quoted one physician as saying that there is a 5 - 6% error rate in mammographies. 
--For every one positive case there are 55 other women with diagnostic studies who have nothing wrong with them. (Dr. Marla Shapiro) 
Now, we have to worry about excessive radiation, too. 
The suggestion from the CAR, is to be your own advocate:

• Question your physician [see Questions to ask your doctors   |   Questions to Ask the Doctor | Cancer.Net ]
  
• Ask if it is medically necessary - e.g., do the risks provide a benefit?
• Do not have X-rays or scans 'just in case'
• If you have a scan done, ensure that it will be available for a consultation, or appointment with a specialist. You should not have multiple scans and unnecessary radiation.
• Ask if the scanner is using 'reduced radiation techniques'. This is your right. Let them know what you know!
• If you end up in emergency and they want to give a CAT scan, question them. You should have a diagnosis by a physician or a conference with a radiologist. 
  

The use of CAT scans have increased 8 times since 1980, and is growing by 10% per year. KNow what you need, vs. what you do not need for diagnosis. Ensure that the tests you have are necessary and correct. The use of CAT scans for children and pregnant women are dangerous. Children are growing, and their cells are sensitive. In the last 10 years, radiation imaging of pregnant women has increased 100%. These can be gene-altering X-rays.

Comfort measures

End-of-life care means that we look after the needs of our client, and him him/her comfortable.

This means controlling the environment, having a Pain Management Kit on hand, feeding the patient as s/he indicates, providing physical comfort measure for skin, mouth, preventing bed sores by moving the patient every two hours or so.

Dr. Mike Harlos warns that common end-of-life complications include pneumonia, exacerbated by other physical issue: dementia, malignancy, and neurodegenterative, respiratory, and rheumatic conditions.

Quality of life Bill of Rights

Quality of life and end-of-life care policies in Canada are clear. The Canadian Bill of Rights guarantees the dignity and worth of every human being. The Government of Canada (2000) in its policy statement said the key mechanisms for improving the care of the dying include:
• Service delivery by interdisciplinary teams
• Access to services in the most appropriate location
• Availability of services when needed, whether for a few hours or around the clock
• Availability of services before death is imminent
• Services for a broad-based clientele, both with respect to cultural background and type of illness
• Awareness and skill in pain and symptom management
• Support for caregivers and family members

Symptom Management In Comfort End-Of-Life Care Of Pneumonia
I have learned that it is important to give regular doses of pain medication, to achieve, or quickly 'reclaim comfort', as Dr. Harlos says.

Often, patients are given oxygen to relieve breathing issues. It keeps them calmer, as they fight a little less to get a breath.
Typical symptoms may include, but are not limited to:

• Dyspnea (shortness of breath)
• Tachypnea (rapid breathing)
• Agitated delirium (80% or more in the final days)
• Pain
• An agitated state of paranoia
• dry lips since the patient breathes by mouth  (use a sterile mouth creme)

The mistake many caregivers make is in feeding the patient when s/he isn't hungry. The body begins to shut down, organ by organ, and food with compromise the client's comfort as i tries to digest food.
Patients, one nurse told me, can go two weeks without food, two days without water and two minutes without air.

My mother was eating about a tablespoon of food, three times a day in her last two weeks. This is entirely normal. My father, similarly, reduced his food intake slowly. It was only sweets he loved!

If you are choosing to remain at home, caregivers should be given a Pain Management Kit, to be used in the event of severe pain in the wee hours. Ensure that you advocate for this. It is well within the patient's End-of-life Bill of Rights (Gov't, 2000) , no matter where you live, and how many health care support workers are available to you.

Deaths

• In 2006, 228,079 Canadians died (Statcan.ca*)
• 75% of all deaths occur in people over 65 years of age.
• 75% of the deaths take place in hospitals and long-term care facilities.
• Each death potentially affects the well being of an average of five other people.

• An estimated 5% of dying Canadians receive integrated and interdisciplinary palliative care.
• About one quarter of the total deaths in Canada are related to cancer, but cancer patients account for more than 90% of those receiving palliative care.
• The number of institutional palliative care beds has been cut as result of health care restructuring.
• Few provinces have designated palliative care as a core service with a specific budget.

Palliative Care

• People are receiving significantly different treatment in various institutions across the country.
• People over 65 years of age are less likely than younger people to want to die at home.
• Rural residents have considerably less access to palliative care than the residents of large urban areas.
• Most of the costs and other burdens of homecare are assumed by the family.
• Palliative care relies disproportionately on charitable donations for survival.

(from: Government of Canada. 2000. Quality end-of-life-care: The right of every Canadian. )

Palliative Care(PPT)

Bereavement Care. End of Life Care. Terminal phase. Current Model .

The Dying Person's Bill of Rights (PDF)

Canadian Hospice Palliative Care Association
National association provides leadership in hospice palliative care in Canada. 

See also:

• Palliative Care available from Community Care Access Centres
• Palliative Care - information, reports and related links
• Advanced Care Planning Guide
• Life Care Transition Life Event - information from Seniors Canada On-Line
• Locate a hospice
• Directory of Hospice Palliative Care Services

Assistive Devices for seniors - part 2

The Ontario government provides assistance in renting or purchasing assistive devices for those without the finances to purchase special equipment Assistive Devices Program (ADP). There are agencies which provide money for  things such as wheelchair ramps, and other needs. 

If you suffer from a particular disorder, you are wise to contact their organization, as most have great plans in place. While agencies do much fundraising for research, we must ensure that financial support is there for those who need a wheelchair, a ramp, or a walker.

There are many sources of funding for the client's share of the cost, if you go through ADP, including :

• voluntary/charitable organizations e.g. March of Dimes, The Easter Seals Society, Kiwanis, Lions Clubs, 
• Canadian Cancer Society, WarAmps
• social assistance
• Department of Veterans Affairs
• insurance companies.

What bothers me are concerns with clients who are emotionally or psychologically unable to determine funding sources. The CCAC in Ontario should provide simple equipment such as mattress pads, bandage changes, etc., or lack of knowledge of needs on the part of a case manager who does not understand a client. My mother avoided telling the truth to her case manager, as she was afraid of us forcing into another living arrangement. It was frustrating! She refused help from Red Cross, homecare support that would have made her life easier. She spent energy vacuuming, rather than fighting her cancer, leaning on the sink in pain as she made my father's lunchtime sandwiches, shaking with pain or fatigue?

Another issue that shocks me, is that at the time of Dad's diagnosis of being terminal, funding ceased for his walker and his wheelchair. They do not want to provide funding if they have less that 6 months to live. I guess it wasn't worth the paperwork for them.

Dad had a great walker, but CCAC also installed devices in the shower: a large handle to prevent him falling, and a wonderful seat that spanned the bathtub to allow him to sit and be showered, once he was unable to get in and out and have his daily bath.

Much research has been done in this area, especially in the large US market:

Assistive Devices: MedlinePlus (USA)

25 Sep 2009 ... The primary NIH organization for research on Assistive Devices is the National Institute on Deafness and Other Communication Disorders

1. 
   
   
   Many companies offer workers to help, but we were hard-pressed to get any help figuring out something simple like back support.
   
2. 1. 
      
      Now, you would think that a company, like Obus, would have PK seminars for the many companies that specialize in Assistive Devices. NOT. We were looking for back supports. I have a chronic back issue, as does hubby, and sitting on the sofa, or in the car, is difficult. We phoned a large pharmacy chain, which offers many such devices. No one there knew if these products would help.
      
      We spoke to the physiotherapist. His comment: take them home, try them and see if they work. Of course, he doesn't know. I am amazed, in this day and age, that Obus would not provide enough information in Product Knowledge  seminars. I know that when our son worked in a small outdoor equipment store, they would have monthly PK sessions, in which they learned about various products (sleeping bags for subzero weather, hiking shoes( and such issues as foot pronation or suppornation, which affect product choice.
      
      
      Next call: to Obus International. Fortunately, an 800 number. The sales rep did not have a clue about her product. She read out the specifications, which we had found on their webpage, and added no new information. We bought it and will try it.
      ~~~~~~~~~~~~~~
      Footwear, Pronation, and Knee Pain
      Arch height is a major factor in determining the amount of foot pronation. Flat feet often cause overpronation but not all overpronators have flat feet.
      
      
      
      

      Assistive Devices for Independent Living for Seniors, the ...

      
      
      Disability Products offers secure shopping for assistive devices that support independent living for seniors, the handicapped and disabled,
      
      
      
      
      
      
      

      Industry Sector Office: Assistive Technology/Assistive Devices

      
      
      16 Sep 2009 ... The Canadian Assistive Technology (AT) and Assistive Devices (AD) industry is tracked and supported by Industry Canada.
      
      
      
      
      

      1. 
         
         
         

         Assistive Devices / Seniors Canada

         
         
         Seniors Canada On-line provides single-window access to Web based information and services that are relevant to seniors 55+, their families, caregivers
         

         
         

         
         

         Ontario Ministry of Health and Long-Term Care - Public Information ...

         
         

         The objective of the Assistive Devices Program (ADP) is to provide consumer centered support and funding to Ontario residents who have long-term physical ...
         

         
         
      
      

   
   
   
   

Assistive Devices for seniors - Superphone

There are a lot available! There are things that lift, technology to help with hearing and clothing to make dressing and undressing easier.

We have ramps on a lot of homes in My Muskoka. In my book, I wrote about hubby's search for a Superphone for my Dad. Dad had a hearing loss in both ears. He was unable to make them work properly, his ears filled with wax, and he kept turning up the hearing aids until they screamed and whined,  and broke.

Book excerpt:

After his tumour was removed in 2003, he could not hear much. Brian did a great deal of research to find this phone. Dad’s “superphone” blinked when there was voice mail, and it upset him terribly. The problem was that when there was a phone message waiting, the huge, bright red light flashed and Dad could not figure out how to get access to the messages. They had never had voice mail.


Hubby ended up going to the various phone stores around Ottawa. Why not speak to a representative and find out the kind of phone that would boost hearing for Dad, and allow us to talk to him when, for example, Mom was having surgery or radiation and Dad was alone at the house?

At the first store, Bell, they all knew the ins and outs of every cell phone, and could find one for all needs. They had no idea what Brian was talking about when it came to a phone for the hearing impaired.

These young people, who had had PK seminars up the yin yang, and could navigate their way through Bell's computer, 'Emily', at the speed of a button push, had no product knowledge in this area.

What next? The Internet. Sure. After research, we knew more about these products than those who sold them. This is what we ended up with. Superphone. With the aging population and the Silver Tsunami, you'd wonder why on earth they do not know about these things.

This phone can be turned up, or turned to 'normal', and I could sit the receiver on the floor and still hear the conversation.

It has bells and whistles I had not heard of, nor had the 3 phone store reps in the various outlets Brian visited. This phone increases decibels by an exponential factor. As we queried the reps, they did not know what a dB was!

Decibel - Wikipedia, the free encyclopedia

The decibel (dB) is a logarithmic unit of measurement that expresses the magnitude of a physical quantity (usually power or intensity).

I was amazed. You'd think with cell phones, and cordless phones, this might be a number worth understanding. We wanted Dad's phone to amplify sound for him. We seldom talked to him on the phone.

This phone has large buttons, as many of us need reading glasses!

With a push button, you can go from 'normal' to a higher decibel ("amplify") in an instant, so that anyone in the house can answer it. I loved it. But Mom and Dad hated it. Another $300 down the drain. They did not like the light that indicated a call. They were not amused. Once Dad's brain tumour caused dementia, he accepted it a bit more. But, in the long run, he was unable to figure out the function of things like the phone or TV clicker, and we had to take the phone away. He was calling all sorts of people in town, and calling us at 2:00 in the morning.

Scared sleeveless - H1N1

Yes, kids are afraid. "No, your friend, home sick from school, is NOT going to die, honey."
Schools are teaching kids about good hygiene, as they have always done. But fearmongering has them scared. You ask, and they now know the rules: sneeze into a sleeve, wash your hands, use tissues.

We have always taught these measures, but the fear is hitting home. Kids share spoons, snacks, eat off of their desks over which others have sneezed.

One clever civilian commenter said,
Nov 7 - My research - check for yourself - no warranty :) :

H1N1 Deaths - 115 (Public Health Agency of Canada)
Murders per year - 594 (2007 -Statscan)
Car Accident Deaths - 2900 (Transportation Safety Board)
Seasonal Flu Deaths - Around 5,000 (Globe and Mail -depends on year)
Cancer Deaths - 37,000 (Canadian Cancer Society)
Heart and related deaths - 71,000 (Heart and Stroke Foundation)

To delay dying our best strategy is to as much as possible:

-quit smoking,
-lose 10 lbs,
-monitor and control your cholesterol and blood pressure,
-get some exercise,
-eat green leafy vegetables,
-drink in moderation,
-never drink and drive,
-slow down while driving,
-refrain from criminal activity and avoid choosing violent spouses
-wash your hands,
-get the vaccine when you are eligible
-learn to relax and have fun.

Statistically speaking, the Media has caught this one and like the touchdown dance, hold up the ball - if it bleeds it leads. We told you so, they dance and prance.

 CTV news reported in April: According to a recent U.S. Centers for Disease Control and Prevention's weekly report, more than 13,000 Americans have died from seasonal flu in 2009 alone.

The worldwide total for seasonal flu related deaths is generally between 250,000 and 500,000 a year. We are at about 5,000 at this point. 

Swine flu death rate similar to seasonal flu-expert

 It has a death rate of less than 0.1 percent. I have been teaching in a middle school during flu season, and have notice 100 kids absent in a school of 600 one year. This is fairly normal, but goes unreported, except in local papers.

Numbers for H1N1 are totally inaccurate because so many cases go undiagnosed, and it is the deaths of young people that capture the headlines. It is impossible to test every patient and because people with mild cases may never be diagnosed.

Media outlets are jumping on the bandwagon: Yet the Globe reports, for example:

Tips for Parents

How to spot swine flu in kids, when to treat it at home and when to call your doctor.

Call 911 right away if your child:

• has severe trouble breathing and it is not caused by a stuffy nose
• has blue lips or hands, suddenly becomes pale, or has cold legs up to their knees
• is so sleepy that he doesn't respond when you try to get him up, or isn't able to move
• seems confused
• has a seizure

This is a normal flu in most cases, but if you have medical conditions:

• lung or heart disease
• any chronic health problem that requires regular medical attention, including obesity
• an illness that might affect their immune systems, such as diabetes, cancer, or HIV/AIDS
• is pregnant

and you develop flu symptoms then call your doctor. Pneumonia is the killer in this disease.
The key is to keep fluids in, ensuring that you are getting better, but watch for flu symptoms improving, then suddenly worsening. Do not stay alone.
~~~~~~~~~~~~~~~~~~

CTV News | Seasonal flu killing more people than 'swine flu'

29 Apr 2009 ... Canada AM: Dr. Neil Rau, infections disease expert ...

Euthenasia Bill C-384

Update:
 Jan. 14 Progration does not affect this important bill

Prorogation of parliament "means that Bill C-384 will receive its second hour of debate on March 12 or 15, at the earliest, and be voted on March 17 or 24, depending on whether or not they take a March break (a break was scheduled on the previous parliamentary calendar between March 15 - 19)," Schadenberg explained.

"Lalonde has traded-backwards in the order of precedence 3 times to delay the second hour of debate and vote on her bill, probably because she knew it was going to be defeated."

I am following, with interest, the debate on the bill in the House on euthanasia*. Palliative care is a horribly confusing term. As a Hospice Vounteer, everyone has access to the care afford by our volunteers across the province. The discussions is hear are right: we undermanage pain and there are many myths around pain, health care, and its management. In Muskoka, health care is hampered by a lack of health care staff (doctors, nurses, and personal support workers) to maintain adequate standards of care.

Consider my case study

Elder Self-abuse Case #1

Palliative care is a process in the caregiving continuum, it is not a style of care in my mind. There are decisions to be made and no longer are doctors making choices for you.

The goal, for all clients, is to have managed care with treatment goals, treatment options and a plan with eyes wide open. This is what I wrote about in my book, when my father's doctor was inaccessible and unresponsive to our needs for pain management. Many seniors suffer depression - the statistics are clear and predictable, and would be susceptible to choosing death over living.

Hospice care is an option, if he is able to sign on to the program. They are not just there for those dying, but aging, failing seniors will benefit from care and support. Volunteers provide care and will visit homes receiving mileage for their effort. Yet, he needs a care manager who can ensure that there are people checking in on him regularly; a difficult proposition since many are afraid of the dog and many shudder in the dirt, grime and mess of the place.

The health department could be called. The sewer back up in the spring was followed by a refrigerator that remained unplugged for days. He did not appear to notice, although uneaten MoW deliveries had been placed there by some one.

The police can take responsibility for those who abuse elders. They have specific specialists who deal with those living in poverty and squalor, blissfully unaware of acceptable standards of cleanliness and sanitary conditions. But who is at fault here? No one knows who enters the home. No one can see what his daily life is like. No one seems to care. This is the depth of despair for those who are old and alone.

At some point, if he cannot manage to make decisions for himself, and without Power of Attorney for an Alternate Decision Maker, the government will appoint an Attorney for Personal Care, according to the Public Guardian and Trustee Act.

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

Global

Steven Fletcher: Make life the first choice, but not the only choice

National Post - ‎Nov 2, 2009‎

Should euthanasia be legal in some circumstances? This is the question that a Private Member's Bill, C-384, is forcing parliamentarians to consider.

Euthanasia supporters worry about misuse: poll

National Post - ‎Nov 3, 2009‎

The poll comes as Bill C-384, which would legalize euthanasia for those in physical or mental distress, is undergoing second reading in Parliament

Power of Attorney - advance care planning

In Canada, it is important to get the facts about the legal requirements of ensuring that you get the medical care that you want and the protection of your property. I was at the Muskoka Elder Abuse Network* workshop. In a presentation by JoAnn Boulding, who is the Executive Director of the Muskoka Legal Aide Clinic.

Power of Attorney(POA) The Office of the Public Guardian and Trustee has produced a Power of Attorney Kit that will help you appoint the person you want to make decisions for you when you are no longer able to do so for yourself.

What is a Power of Attorney (POA)?

It is a signed, witnessed document in which you set out your wishes for the protection of you or your property.

Currently, there are two main purposes of a POA. One is for Property and the other for Personal Care. You may wish to name different people for these two separate issues.

Continuing Power of Attorney for Property

This legal document is called 'continuing' because it takes effect when you specify in the document, or when your doctor, or someone else you appointment, determines you are incapable of making decisions. Many seniors choose to give this to their children when they are unable to navigate their way to the bank, or when bill paying becomes too difficult for them. Some choose to open a joint account, if they trust that their adult child will keep their best interests at heart. Of course, in situations in the news, you will find that Elder Abuse occurs when an adult child is not making decisions in the best interests of their parent. This situation is further compounded if a parent has dementia, prohibiting them from making any rational decisions. This was my case!

I had POA both financial and personal, and the bank manager refused to accept it. Instead, she approached my father, by now exhibiting the signs of dementia: agitated, confused, unable to process numbers, or keep track of his accounts. Cognitive functioning had ceased in this area, and yet since she could not coax him into signing her bank forms, they would not grant this to me. In this situation, I should have gone to my lawyer to direct the bank manager. Their forms are not necessary. I spent hours writing his cheques for him and then dealing with the bank.

See also: Continuing Powers of Attorney for Property

Power of Attorney for Personal Care

A legal document that gives another person the authority to make personal care decisions based on your wishes. This includes health care, nutrition, shelter, clothing, hygiene and safety. This does not mean that they can do what they want if you are incapable, but it does mean that you and your Attorney have spoken on such issues as "Do Not Resuscitate" (DNR) orders, and when to start or stop treatment.

See also: Duties of Guardians of the Person and Attorneys for Personal Care

Why do you need a POA?

Firstly, if you have an underlying condition, and extreme wishes to stay off of a ventilator, for example, you need a POA for Personal Care in order to ensure your wishes are met.

In the US it is called a 'Living Will', but this has no power in Canada. You must have prepared a POA in which you determine who would act as your Attorney, should you be unable to make decisions on your behalf.

An one site says, "Important questions that you will want to decide now, is whether you wish to prolong your life with medical treatments offered by your physician, even if such treatments may include an array of medications, surgery, or feeding tubes."

If you do not have a POA for Personal Care, and decisions need to be made, theSubstitute Decisions Act, 1992, S.O. 1992, c. 30, will be in force. This act specifies the various relatives from your spouse/partner, to adult children, to more distant relatives, upon whom Primary Care staff will turn to in order to create a treatment plan. That said, if you have no relatives, they will turn to the government will appoint a Public Guardian Trustee for you.

I have written of Quality of Life and End-of-life care concerns previously. Read up on what could happen. In my case, my father had unnecessary radiation and my mother's chemotherapy treatments killed her! You need to have this talk with your family, especially if you have a chronic illness, or one that threatens you on an immediate basis.

JoAnne recommends getting 6 certified copies of your POA. Also, if your children do not get along, do not appoint them together! Give the role of POA Personal Care to the one who will respect your wishes. The one who can manage money appoint them Attorney for Property. Or, appoint POA for the relative who lives the nearest to you.

Do tell your bank and your doctor about your POA. Make your decisions now, while you are able. Take control of your life and your finances. If you suspect you are being neglected, abused, or otherwise being taken advantage of, talk to the police, or your local Elder Abuse hotline.

See also my post on Advance Care Planning
If you begin caregiving for an ill family member the Ontario Government has Labour Code that provides for Employment Insurance (EI) Compassionate Care Benefits. Family members must be at risk of dying within 6 months, which is a little bizarre, since physicians do not like to predict death timelines and a doctor's certificate is required. But maybe that is just me!

A Guide to Advance Care Planning

by the Ontario Government 

• Introduction
• Why Do Advance Care Planning
• Making Personal Care Choices
• Communicating Your Choices
• When Advance Care Choices Take Effect
• Choosing Your Substitute Decision-Maker
• How to Give Your Substitute Decision-Maker Power to Act for You
• Carrying Out Your Care Choices
• If You Don't Appoint a Substitute Decision-Maker
• Steps in Advance Care Planning
• Your Substitute Decision-Maker Wallet Card
• Where to Get More Information
• Summary of Steps in Advance Care Planning
• Alphabetical Listing of Contacts

• Power of Attorney Kit
• Power of Attorney and "Living Wills" - Some Questions and Answers
• Advance Care Planning: what you need, and why you need it!
• International Association for the Study of Pain: Pain Terminology

Euthanasia would hurt doctors
Ottawa Citizen
... the first debate on Bill C-384, "CMA's policy on this matter is clear: 'Canadian physicians should not participate in euthanasia or assisted suicide'.

*Contact: Karen Boyer, Coordinator
E-mail: caregive@muskoka.com