Middle age brings its own issues. Everything needs to be stretched and loosened much more than before. I had been a jogger since I was 15. Took it up at child #3 was born, and lost 30 -lbs., while doing a 7 km run around the block in rural Ontario!
The shin splints from my forties ball-playing years resulted in my limping for weeks.
But, those who speak of living to 100 know not whereof they speak.
We must take better care of us, the media warns, since there won't be many to provide care. But I disagree.
I know many who run or exercise and lifts weights, as I do.
Those of us with injuries have them taken care of properly. Physiotherapy is available, for those with plans, but a little attention, following doctor's orders, goes a long way.
Culture changes, attitudes change, some of us get little respect. Apparently, Aging isn't an option -- being prepared is; Good health is considered to be the 'best outcome' for retirement by Canadians about to turn 65 'This is the year when the first wave of Canada's "boomer" generation turns 65, and chances are that retirement is one of the main things on their minds -but it's also something "pre-retirees" should be thinking about too.
Don't they see seniors running marathons? We are participating. I know vets, former WW II paratroopers, delivering Meals on Wheels to those too ill to shop or cook.
We know so much more about physiotherapy, too!
Who is responsible?
Anyone who works with those who are vulnerable must be accountable.
CCAC Charge Nurses, visiting volunteers, PSWs, neighbours, family, friends...
This is a fine video from Durham Region.
Again, the emphasis is on working together, calling in police and taking it seriously.
It is not a fine line. A violent 20-something doesn't grow to be a gentle senior. These people can be tracked. Those with social and emotional issues, diagnosed conditions (e.g., schizophrenia) do not become calm seniors.
Those who are violent, who do not possess ethical standards, have a history of illegal activities, will take advantage of anyone, as much as seniors. These people must be tracked.
This is the reason for vigilant volunteer police checks.
People may encounter situations where older adults are being harmed or their rights are being violated, but they may not identify these actions as "abusive" or "neglectful". For example, if people only think of physical assaults against older adults as "senior abuse", they may not realize that there are many other forms of abuse or neglect that older adults experience, such as:
when an older man constantly belittles his wife to whom he has been married 45 years,
when a son or daughter uses a parent's money, or a son with a gambling problem uses his father's credit card without the parent's full knowledge and free consent,
when nursing home staff inappropriately restrains a resident in their care, or they ignore the resident's calls for help, or do not provide the person adequate water to drink.
Many forms of abuse are grounded in ageism. Actions that people would likely find offensive and socially unacceptable if they happened to younger persons or other groups are sometimes treated as acceptable if these are happening to an older person.
I totally disagree.
After abusing a wife for 45 years, someone should have stood up. Many women go back to abusive spouses. There are many places to go for help. The police and Victim Services are incredible about advocating with and for women (and men) who are abused. Someone has failed if it goes on for 45 years.
The credit card companies are pretty good at watching credit cards spending. It is up to the senior to review it.THis is not accepted by society, but many seniors are unwilling to take action against loved ones. Where do their rights to tell police to back off supercede the right of society to take action? This is certainly the case with Domestic Abuse. Police MUST make a charge, whether the victim wants it or not. This is something our society must discuss.
One must ensure that the senior is cognitively aware enough to determine that financial abuse is being encountered. My Dad, unable to write cheques, process numbers, use cognition, didn't understand his cheque book, and fought the bank as I tried to take Power of Attorney. To some it might look like abuse. In other situations, with seniors being preyed upon by those who would take their money, scams, phone solicitation, some are unaware that family members understand internet theft, phone con jobs and outside abuse.
Re: institutional neglect -
Our seniors deserve the BEST care
Neglect
Isn't it elder abuse when a retirement home doesn't provide extra liquids, and a hand to hold it for the resident, food supplements (e.g., Ensure)? Such a dear man. The do provide palliative client pureed sausage and sauerkraut for lunch, coffee, the same as other residents who are mobile. He is incontinent, immobile, was at 30% PPS, now at 20% Palliative Performance Scale (PPS) this week. I have spent much time trying to advocate for him. He is a vet. I'm losing sleep. PSW was giving him his pill, it was dropped, she said, 'Sh1t', like this was the worst part of her day. I don't know how to contact the family (FIPPA, PHIPA laws), I'm sure they know little of palliative care. I've been in contact with my volunteer supervisor, CCAC hasn't phoned her back. It is a battle.
There are approximately 40,000 seniors living in 700 privately run retirement homes and critics have long argued the homes must be publicly inspected and regulated. A recent Toronto Star series exposed the neglect of nearly 18 seniors in a nursing home in Toronto’s west end.
One of my favourite healthcare bloggers, Those Emergency Blues, has written a post:
'Don't tell your patient this or that'.
She writes for her colleagues, more than for the public. Her posts are insightful and deal with various healthcare issues as they pertain to the emergency room, where she works. She has dignity, respect for her colleagues, and working experiences which have taught her how to treat both peers, superiors, and civilians in her ER.
Another nurse blogger was preparing for an article, and in response, she wrote:
But the more I thought about it, the more I thought the question as posed by Reader’s Digest was curiously framed. Nurses are supposed to provide information to patients; withholding information seems like, well, unnecessary power-tripping. In fact, I will tell patients things I am not supposed to mention, like about the cosmic suckiness of hospital food (because it does) and how an ECG looks — but if I bring you in right away after doing it, you pretty well know it’s not good.
So there is very little, in the end, I won’t share. There are some things, however, that are beyond the pale. Here’s my short list of ten things I will never, ever tell you, my patient...
The list is interesting, and you can read it here.
She posited the question: At the same time, I wonder what patients really want to hear from us.
I love the positive nature of her question. What do patients want to hear? Now, I am involved heavily in healthcare, hospice work, advocating for (primarily) seniors with health issues.
Ten things patients want from their nurses
Honesty; admit what you know or don't know; 3 more patients are on their way in in an ambulance, but stay put, hang tough, you're in the queue, or the converse, you are a high priority.
Information; I didn't know that after 8 hours of reluctance to go to the ER for a trivial thumb wound, they won't sew up my thumb. Who knew? Tell me what a good death at end-of-life looks like, sounds like (choking on food and water, pain management, death rattle breathing, Cheynes-Stokes periodic respiration) and help me through it. You may have to tell me twice, as I am stressed in your work environment, afraid and in pain!
Respect; primarily for me, but also for my (sometimes embarrassing) family members, this hospital, and the entire Canadian universal healthcare system.
Good listening skills; make eye contact with me, nod when I speak, even as you write my information down; look as if you care as much about me as the dude bleeding in the waiting room.
Empathy; my pain may be 2 on a scale of 10 (compared to the woman on the stretcher in the hall) but it is pain; my GP couldn't/wouldn't see me, but you care.
Every patient matters; Every patient is important, some are more critical. But as she kindly taped up my miserable wound, eyeing the tensor bandage on my foot (tenosynovitis, not tendonitis as the ER doctor thought), I was thinking how much I missed my mom's empathy, and found it in my triage nurse!
Confidence; yes, we are overworked in ER, many are in many fields, but you are the pros; indicate that you know what to do; you have a team working and will be able to meet the needs of all.
Advocacy and Advice; speak up for me, protect me from goofy Dr. Weanus, 'take a deep breath; put your head between your legs.'
Truth; it helps, ER waiting time is 4 hours, hang tight, we care, X-ray is backed up.
Look, act, behave professionally; even if I am wearing dirty underwear, forgot to shave my legs (which I noticed when I looked at my foot), don't look as if I have a pot to piss in... I am a human being.
But then we don't have to tell all of this to the good ones!
In return, as a patient...
I promise to behave properly, not to yell at you (can't swear for my loved ones!)
I will take my turn in line, according to your triage, not mine.
Trust that the professional healthcare team are working as a team.
Understand you've been running around all day/night doing your job.
I will give you the respect you accord me.
I will listen to you, even if you have to re-explain.
I will have confidence in you.
I will be honest with you.
I will express my gratitude that you dealt with me firmly and fairly; work long shifts, dealing with nutbars and people in panic.
I'll try to smile, as I know that I am lucky to have people like you in our healthcare system.
Depression, as well as pain, is a common complaint
Dad simply could not express pain issues
due to cognitive complications of his brain tumour
This is a huge decision between the patient, the doctor and the family. It is also the reason why we all should have Advanced Care Planning. For those who research their disease, they will be able to understand the progression, if they are able to get an honest diagnosis, treatment plan, and palliative care plan. It can save family members undue emotional pain, as they juggle the needs of the patient, and can better understand their care.
Why determine palliative diagnosis?
Name it and understand it.
Healthcare access, considerations and support
Change from quantity of life to quality of life
Switch from aggressive treatment to comfort measures
Allow family to make arrangements (e.g., I quit work to provide care)
This is an important situation. In my late mother's case, the doctor visited her at home, told me she was palliative, the day before she died. I did not understand how much time she had, however.
I took off to Toronto to give some IT workshops, while she lay dying. I didn't know how ill she was. I left my brother in charge. She sent me away, and did not understand this information.
For this reason, I believe family needs to understand.
For U.S. patients they qualify for certain medical support, in Canada, with universal healthcare, not so much. But it should change our attitude towards a patient's care, and how we treat them.
The signs are there for those who are given this information. It is not complex, and I believe all patients and caregivers should have access to it. Victoria Hospice in B.C. has one of the best organizations, but other hospices exist in Canada. Who determines a palliative diagnosis?
The physician, the patient and the family. Once a patient is palliative, Ontario's Pain Management Nurses can assist with symptom management, and do pain assessment. Call your CCAC for the nurse near you.
How do we assess palliative patients?
One of the best I've found, easy for a layperson like myself, caregivers, and medical staff:
If you look at the Palliative Performance Scale (PPS), you can determine how quickly or slowly a patient is deteriorating. The patient will be at 100% in the beginning, and may gradually or quickly deteriorate. One client of mine went from 30% to 20% over a weekend, and I called the family to let them know. You want to be able to say goodbye, as I did not have that chance with my parents. Mom was at 30% two days before she died (Saturday), 20% Friday, to 10% the next day. I had no idea of the stages. On the Friday, I helped her change her adult incontinence product. This was humbling. She'd worn them for years, due to colitis, but now couldn't make it to the toilet at all.
The other reason for a diagnosis, is ER trips can be avoided as both patient and caregiver can manage at home. My brother had to leave my ill father at home, while accompanying mom to the ER. The PPS provides a common understanding, in an evidence-based approach to care. There are 5 criteria upon which the patient is assessed.
Ambulation - Full, reduced, mainly sitting, lying in bed.
Activity and evidence of disease - Normal activity, unable to do housework, hobbies, significant or extensive disease.
Self-care - Fully independent, occasional assistance, incontinent, total care.
Intake - Normal, reduced, minimal, sips, mouth care only.
Understanding where the patient fits on the PPS allows caregivers; family, friends, professionals, to be able to provide the best care. For example, getting a patient up and out of bed may or may not be indicated. My late father tired so easily, and would fall asleep in his wheelchair, falling our of it, and we had to use restraints to keep him vertical.
With a palliative diagnosis, a family member in Canada can qualify for a Compassionate Care Benefit (CCB), as long as the doctor is willing to make this diagnosis. Also, there are financial reasons in terms of an estate, to claim disability on a tax return. Unfortunately, doctors are not always willing to predict death within 26 weeks, a requirement of the CCB. This is a gross error on the part of government. This is the financial impact to the (mostly) women who care for palliative family members.
Staff who did not understand his diagnosis, and myself, would feel the need to make sure my Dad ate his veggies and meat, when all he wanted was his dessert. Also, why on earth didn't I let him have his much-loved glass of sherry before dinner? The pills he took to prevent his seizures contraindicated this, but the man was now dying. I should have made him happy.
I look back now, and realize how silly it was for the dietician to worry about his cholesterol level, when he wanted an egg every day for breakfast.
Medications change with a palliative determination. Cholesterol wasn't going to kill him. He was taking 8 pills a day, and this, too, was difficult. Nearer the end he couldn't swallow his pills, and we would try to hide them in applesauce. It was frustrating for all of us.
Treatment and symptom management protocols
Those who work in end-of-life care understand these protocols: mouth care, prevention of bed sores (e.g., turn the client every two hours, as required), the pain that comes with being in bed all day, how to change linens with the patient in the bed, keeping the patient clean, preventing aspiration pneumonia (breathing in bacteria; causing pneumonia), dental hygiene, regular attention to the body as it fights the disease.
Food and liquids
This blue veining is a sign of liver damage
It is important to listen to the patient, and food and liquid intake changes, it can be normal, or reduced. At some point my parents were simply taking a tablespoon or two at a time, several times a day. This is 'normal' in palliative care. Eventually, they couldn't tolerate any solid food. In end-of-life care, the patient cannot necessarily digest food, but you can prevent dehydration. We gave my family a liquid supplement, to keep them hydrated, dad drank lots of tea, too. But in the stage near death, the only thing you can do is to give them mouth care: moistening dry lips with ice, or a lip balm.
Pain Management
If there is pain, you must manage it. If the patient had pain before becoming ill, e.g., my father's arthritis in his knees was very painful, and it got to a point where he could not articulate it. There are signs of pain, and caregivers must be able to identify these, in conjunction with the physician, or nurse.
As a patient deteriorates, family should have a Pain Management Kit on hand. Easily administered morphine in a patch, or pills. Medications for when the patient has pain, which can be administered in the home, without the need for an ER visit.
One of my clients was clearly in pain, tearing at her clothes, moaning, grimacing, yet her (new) nurse didn't believe she was having pain. For the family, I printed out an article, 'signs of pain', and they were better able to advocate for their mother. I understand, due to litigation, why professionals are afraid of overmedicating, but we know so much more, now, about pain management.
Pain needs to be properly diagnosed, have ongoing assessment, and the healthcare professionals should be doing pain history, physical examination, social and psychosocial factors, and have an understanding of the severity and intensity of the pain.
Pain Gap Analysis Worksheet. Pain Management Guideline (PMG) Kit. The PMG Kit for Aged Care is designed to be used in conjunction with the Australian PMG
Ontario is creating a registry of personal support workers (PSWs) that will better recognize the work they do for Ontarians, while helping to better meet the needs of the people for whom they care.
Unfortunately, this registry appears to be shaped by others than taxpayers. Politicians and ministry representatives are speaking to lobby groups, such as Personal Support Network of Ontario (PSNO) and the Ontario Personal Support Network Association (OPSWA.ca).
Excellent groups, both, but governed by those who have joined these groups. OPSWA has a Board of Directors, including a nurse. PSNO is an off-shoot of OCSA, the Ontario Community Support Association. None of these groups get ministry funding, rightly so, but neither are they democratic, nor do they represent all PSWs.
Family members, and those interested in senior health, and concerned, as I am, have no voice. I believe that we need more regulation, more training, and better accountability of private, for-profit businesses, transfer payment agencies, and institutions who hire PSWs.
Across Canada, even with the Health Accord, there are varying wait times, varying standards of healthcare access. Some provinces have managed to bypass the accord, and create two-tier systems, with doctors in private practices that charge extra fees to serve fewer Canadians. It is called Concierge Healthcare.
Canadians have even less of a voice than before. Politicians are listening to lobby groups, not to family members who are doing the caregiving. These people are too busy to talk, with estimates that 20% are facing stress, due to caregiving's difficult social, emotional, and physical issues.
Personal support worker day is May 19th and recognizes the contributions of personal support workers to our health care system.
There are an estimated 90,000 personal support workers in Ontario with about 57,000 providing care in long-term care homes and 26,000 in home care through community health agencies. About 7,000 personal support workers provide care in hospitals.
The work of personal support workers ranges from assisted daily living tasks (such as personal hygiene, transferring clients between bed and chair, taking medication and doing light housework) to delegated health procedures (such as changing dressings, tube feedings and oxygen therapy).
To date, stakeholders have provided valuable input into this registry. Consultations with PSWs, their representatives and other stakeholders will begin in the summer.
The British Columbia government created a registry for first care aides
I posted a question on the PSW Facebook page.
The answers ranged from wrong and illegal, to exactly right. I believe that those who work providing intimate care of our loved ones in long-term care (LTC), home care, or in private institutions, should have much training.
No wonder we read about PSWs taking advantage of seniors. Without training that sticks, and employers that ensure that employees have ongoing PD, and monitor nurses who supervise PSWs...
No wonder many refuse to place seniors in LTC. There are many institutions that provide excellent care. Others where horrible conditions exist.
No wonder we have elder abuse.
This is why I believe we need training standards for PSWs, regulation and registration. We need 2-year programs, not a medley of 1-year compacted, or other types. I think that the larger the institution, with internal regulation standards, the safer our seniors are when many are involved in care. Those in small, private retirement homes, at home, and LTC, are susceptible to abuse.
PSWs is smaller settings are similarly subject to abuse from residents.
truly a sad story that explains other stories about neglect and abuse. Requiring PSWS to work past their limits (including too many short shifts. too many overtimes working short or working alone with known abusive clients) are..
I agree with you Jennifer, there is a fair amount of staff that are victims of abuse from residents. I know of a case where a resident punched a PSW gave them a fractured jaw for being at the wrong place at the wrong time. This resident would also chase staff where staff had to lock themselves in an area until help could arrive. This resident's uncontrolable rage was part of his condition appartenly. I've seen another resident who believed another resident was her husband and once that resident left with his wife...the female resident went into a rage and would try to hit staff with her walker when trying to calm her down. They had to call the police to restrain her. There is numours accounts of verbal abuse as well. Alot of these residents do not want to be in a LT home and will take it out on staff.
One post:
Whatever happened to the 1 year and 2 year courses for PSWs? Why are they now down 24 weeks? It's no wonder no wants to be PSW with that meager amount of training. How can it be safe for the PSW, or the people they care for? PSWs are NOT A JOKE! They are a vital part of the health care system, and are frontline workers. Most, if not all of the time, they are the first on the scene, and the last leave!
Another woman wrote:
having worked with the same company for 6 years, which i won't name. I'm almost considering switching careers after the way i have been treated. thinking i was doing the responsible thing, i notified my company the minute i was pregnant, just in case i was assigned to anything that may have put myself at risk. one occasion i was concerned when i found out that a client tested positive for tb, i called asap and explained that i wasn't comfortable going into to them, until we had further information, i was told too bad you have to, i have no one else, however they had private care that could've taken over for me. then they slowly started reducing my hours so that it was costing me money to work. when i questioned why i wasn't getting hours or going to clients that i had been with for years, they said it was the clients request, how do you dispute that? it's not like i can go and ask the clients if they did. i find it hard to believe that they would request me not to return, when they requested me to begin with. the final straw for me was when they didn't give me a raise. when i asked why, they said they didn't have too. whick they don't by law. my doctor had to sign me off on medical leave due to stress. it's been 4 weeks and i still havn't got my ROA for unemployment. my boss hasn't even called me to find out what is wrong and why i had to be signed off work, that's to me is just ignorant and rude. they did was a survey filled out that was suppose to be anonymous, to give feed back on there company and how they treat employee's so summit to CCAC, i got a phone call asking me all of the questions. what a horrible company to work for.
seniors take a wide range of meds
Jennifer Jilks asked How many PSWs are giving medications during the course of their work? In the retirement home where I volunteer with a palliative patient it seems to be the job of the PSWs.
The answers varied...
If you work in a LTC or Retirement home it is illegal for HCA/PSW to dispense any kind of oral medications. Your not even suppose to do tropical.
You must have a licensee and be registered with the college of nurses and be valid. HUGE fines....
at some of the retirement homes here in Kingston PSWS have been giving meds..they have blister packs and they pop them out..they cant give the meds to the person, they can hand them to that person and say here you go ..and when I worked in homecare i gave their meds also..
In retirement or group homes, PSWs/HCAs dispense meds and do treatments. In nursing homes, it's the job of the RPN/RN.
i work in LTC now and of course its a must for the nurses to give all meds...Let me rephrase that actually, not ALL meds, we can apply the prescribed creams..
Also, when I was doing homecare, I dispensed meds either from the bottle or a blister pack. That's the only thing I can do too. Even if a Band-Aid falls off, I am not allowed to put it back on.
Home care if different when it comes down to legislation and ministry rules. I would seriously call and ask the ministry.
PSW's do give meds in Group Homes such as Community Living. But they are not allow to give meds in other institutes. Sometimes they do with Ontario March of Dimes as well. Just one other area where there is no standard! Nothing more than risky, dangerous business! We need standardized training, and maybe regulation!!!!
In the community where i work some of the disabled cannot open their blister packs.We open and place them in a container for them.
a blister pack
we were taught in the PSW course how to pour and dispense meds now in home care were allowed to open the bottle and hand them the bottle and monitor what they take others are in the blister pack and or they are already dispensed . in hospitals and LTC RPNs and RNs do that
i have done wound care the nurses have taught me
as well as long as were trained we can basically doing anything
i wouldnt say anything, theres no way a psw can do things such as catheters, injections etc.. no matter whether a nurse trains me or not i'd say no..unless i have a license like nurses do..i wouldn't do it..
And final answer: the right one...
Just curious, doesn't anyone remember their training? and the scope of practice? you are allowed to assist with meds. that means if your putting eyedrops in for example, your hand literally has to be over their hand. yes your are trained on how to dispense medication in school, but that's for the purpose of understanding how it's dispensed. remember your not a nurse and if anything goes wrong you could hurt or potentially kill someone, your liable. it's your career it's your lively hood. the Ontario march of dimes offers a special training program for catheters, but i don't believe it's regulated by the ministry. depending on the company you work for in home care, and there policy, you have to have written permission to apply creams i.e., polysporin. and perscription, but again you can only assist. generally speaking if the home care is employed via CCAC their policy will coincide with the ministry, but if it's a private business, they will do whatever they want. so it comes down to what your choose to do, and since your not a nurse you do have the right to refuse if it's going against your training.
NICE is look for elder seniors to participate in an Elder Abuse study. They want to come up with paramaters and solutions. I think, just like domestic assault, developmental disabilities, social or emotional disabilities, there is no solution if you still have the problem in your later years. There should be a spectrum of care. Why shouldn't abuse senior women not go to a shelter and get support there. In the case of assault, why shouldn't there be arrests? Put more money into funding for specialists to prevent these issues in old age.
Do you know the difference between a retirement home and long-term care?
In a retirement home you are a tenant, and the landlord/tenant act applies to you and the residence. Most of these are for-profit residences, where you pay for services. When my late father was in a private, for-profit retirement home, we hired Red Cross PSWs to come in and give him some time and attention, especially during his Sundowner Syndrome evenings. They left us copious notes, and put kind messages in his 'guest book', actually a wedding guest book.
In long-term care (LTC - formerly called 'nursing homes') you are protected by the Ministry of Health and LTC legislation. You are a resident, but you are likely in a for-profit institution. In this case CCAC no longer comes in to assist you, as you should be receiving enough nursing and PSW care.
Retirement Home Ontario Legislation
Established in 1977, the Ontario Retirement Communities Association (ORCA) is a non-profit, voluntary professional association that represents more than 300 retirement residences province-wide.
ORCA represents approximately 65% of Ontario’s 43,380 retirement residence units. [*Source: 2009. National Seniors’ Housing Survey. Canada Mortgage and Housing Corporation (CMHC).]
sets professional operating standards
inspects and accredits Ontario-based retirement residences
has accredited homes in other provinces that do not yet have their own accrediting bodies.
New standards in Ontario
In July 2010, the provincial government passed the Retirement Homes Act, 2010, An Act to regulate retirement homes in Ontario. ORCA is committed to providing Ontario retirement homes with the tools necessary to meet the new government regulations.
Much of this is in response to the issues of ALCs. Hospital patients who require alternate levels of care (ALC patients).
This site gives you much information about Ontario retirement homes, which are NOT based on the ubiquitous senior's for-profit websites.
One of the most important issues is to be aware of how long you can stay in a retirement home. There are stories where DOCs send a resident to hospital, when a resident has a DNR order. Long-term care is better set up for palliative care.
Retirement Home Complaints
Did you know that you can make complaints about retirement homes?
This Service helps residents and family address questions or concerns about any retirement residence in Ontario, including those that are not ORCA members. This free service is funded by the Province of Ontario.
Call 1·800·361·7254 to reach an experienced Information Officer.
Older Canadians who were residing in private dwellings reported very little physical and sexual violence. In fact, only 1% of this population of seniors indicated that they had been physically or sexually assaulted by a spouse, adult child or caregiver in the five years prior to the survey.
Emotional and financial abuse infrequent
Overall, 7% of older adults experienced some form of emotional or financial abuse by an adult child, caregiver, spouse or commonlaw spouse with whom they had contact in the five years prior to the survey.
The vast majority of emotional and financial abuse was committed by spouses. This is a lifelong pattern, and how can we throw money at this issue when spouses married for umpteen years still haven't gotten help? This is something that should have been corrected much before one's senior years.
Many women go back to abusive husbands. Many due to financial reasons.
Senior men (9%) were more likely than senior women (6%) to report being victims of emotional or
financial abuse.
Emotional abuse (7%) was reported more frequently than financial abuse (1%). The
most common form of emotional abuse reported by seniors was being put down or called names
(3%), followed by limiting contact with family or friends (2%).
The incidents in the news are shocking. But they are far less common than we think.
Shortness of breath (dyspnea) that gets worse with mild activity
Fatigue
Frequent respiratory infections
Wheezing
Since the symptoms of COPD develop slowly, some people may be unaware that they are sick.
I had a friend, sat with him on a Board of Directors, and he had this cough for the two years I knew him. It just gradually got worse. It really is chronic bronchitis. Very sad to listen to and difficult to manage.
ScienceDaily (May 15, 2011) — Changes in the ability of lung cells to divide may play a role in initiating or prolonging lung tissue inflammation, a hallmark of chronic obstructive pulmonary disease (COPD), according to a study conducted by researchers in France.
During its normal life cycle, a cell will divide many times; however, its ability to divide decreases as it ages. This cellular aging process, or senescence, can vary by cell, and can also be affected by disease processes. In this study, the researchers looked specifically at endothelial cells, which border the tiny blood vessels in the lungs and create a barrier between blood and tissue. (Read more)
More research. This time by Holly Reimer, a registered dietician, and PhD candidate at uGuelph.
One of the routines involves showing residents the two meal choices. Sample plates, covered in plastic. This is part of the routine of larger institutions, as the staff can determine which meal a resident wants through body language, eye contact and more subtle gestures.
Staff need a toolbox of strategies, the author writes, in order to deal with challenging residents who refuse to eat:
Flexibility, rotating table service, individualized mealtime care, more staff education and training, recruitment of family members and volunteers at mealtimes.
sometimes his hands shook so much
he couldn't hold his mug
This is a great set of tools. Unfortunately, more staff and staff training are two of the issues that those of us involved in advocating for seniors in long-term care are finding difficult. LTC are very different from facility to facility. Most are for-profit, most are strained enough, meeting the individual needs of clients.
Also, tricking and cajoling residents into eating seems bizarre. If they had the staff, if would be better to allow the residents to eat when they wished. This makes more sense with higher staffing ratios, but this isn't going to happen. What would really be great is fresh fruit, buffet meals, the ability to make sandwiches, but we know this isn't going to happen in large institutions.
In LTC where I have volunteered, they serve food prepared by a method called 'retherm'. It is precooked, and kitchen staff only need heat the food. It is horrible, for the most part. I know. I went in every day to feed my father dinner in the last months of his life.
Dietitian researching quality mealtime for residents with dementia Preliminary findings suggest greater flexibility, more education needed
TORONTO - Having enough helpers and the flexibility to individualize care are amongst the keys to providing person-centred mealtime care for long-term care residents with Alzheimer's disease or dementia. Full Story
Read any good studies lately? Most of us don't. We have the media for this, and we know how much we can trust the media, or other groups that seek headlines, not facts.
In a new study, forewarning us about the dangerous statistics, LTC, and the Silver Tsunami, the authors cite another fear we have to face: Crowded long-term care and the dangers of for-profit residences. Now, for those unwilling or unable to read this 40-page study, several groups have been interpreting it for us. Bless them. I think.
CARP, for example, (sister lobby group for the US-based AARP), is comprised of mostly vocal senior Ontarians who don't want to pay taxes. CARP looked at this study. Not with a critical eye. CARP says, 'The authors admit, however, that there are considerable methodological challenges associated with measuring the quality of care in LTC facilities.' Then why promote the study in the first place???
The study uses references from CBC News!The study quotes 'a number of high-profile reports': CUPE? Really? A policy paper from a union/lobby group...
Here is one paragraph...
Many facility residents have dementia, and the majority are women with low incomes (Cohen et al. 2005). This population is therefore highly vulnerable and has relatively little voice. Decision-makers (Medicare 2010; Ontario MOHLTC 2009; Sharkey 2008), members of the public (CBC News 2009) and academics (Harrington 2001; Kerrison and Pollock 2001) have all expressed concerns about the quality of care in residential care facilities. A number of high-profile reports addressing the quality of care (CHA 2009; CUPE 2009; Sharkey 2008), residents’ rights and public oversight of residential care (K. Carter 2009) have been published in the last two years, reflecting Canadians’ concern for the well-being of this frail population.
However, I looked at the references. This study is a US study based on US statistics from a pretty flaky looking study.
Castle, N.G., and J. Engberg. 2005. “Staff Turnover and Quality of Care in Nursing Homes.” Medical Care 43 (6): 616-26.
'IMPLICATIONS: These findings are significant because the belief that staff turnover influences quality is pervasive. The cross-sectional results are only able to show associations, nonetheless, few empirical studies in the literature have shown this relationship.'
Long-term care in Canada is publicly funded, whether the home is public, nonprofit or for-profit. It is not so in the US. To use this data in such a report is faulty. Not only that, but most of the LTC in Ontario are for-profit. The for-profit homes operating in Canada, have head offices in the US. Scandals, lawsuits, and horrific tales of neglect - like those we have seen in Ontario, dominate the news and lead political will, and this is frightening.
Violence, Insufficient Care, and Downloading of Heavy Care Patients (PDF) An evaluation of increasing need and inadequate standards in Ontario’s nursing homes MEDIA RELEASEEXECUTIVE SUMMARYFULL REPORT (May 2008)
Keith (left) at the Remembrance Day Ceremony, 2008
A relatively small proportion of elders currently requires residential care: one in five individuals aged 85 years and older. Although making projections as to future needs based on current rates may be somewhat inaccurate [Do you think you should avoid it, then?], we estimate that by 2041, 120,000 beds will be needed in addition to the current 200,000 beds across the country (Statistics Canada 2008).
I continue to work with and see a great number of seniors helping other seniors. The paratroopers seem to be the most vibrant. My favourite is Keith Metcalfe, who was delivering Meals on Wheels at age 85, while president of his Legion.
Here is a comparison of the photo on the box, with an actual photo of my cereal. The 'fruit' is chopped up into tiny pieces, and is barely seen in my cereal.
The claims of 30% fruit are mostly the raisins. The lovely piece of peach on the box is deceptive.
It has been known since the 1920s that the repetitive brain trauma experienced by boxers sometimes led to neurologic and cognitive deterioration -- a condition that initially was termed "dementia pugilistica."
Dementia pugilistica is a syndrome characterized by motor, psychiatric, and cognitive symptoms (Morrison 1986; Guterman and Smith 1987; Mendez 1995; ... www.medlink.com/web_content/MLT00086.asp
But in 2002, after the death of Pittsburgh Steelers former star center Mike Webster, known as "Iron Mike," Omalu, who then worked in the medical examiner's office in Pittsburgh, performed an autopsy on the player, whose life ended with a heart attack after years of homelessness and destitution -- he had even sold his Super Bowl rings -- as well as depression and multiple suicide attempts.
Omalu persevered, and in special analyses of brain tissue samples, he found large deposits of tau, a protein which is part of the microskeleton of brain cells. With repeated axonal injury, tau loses its self-repairing ability, becomes hyperphosphorylated, and begins to accumulate, forming neurofibrillary tangles and neuritic threads in areas of the neocortex.
My dear friend, Kay Devlin (1916 - 2012)
Celebration of a life worth living!
It was my honour to sing Amazing Grace at Kaye's funeral. She was an amazing woman and she was well-loved. Lanark County was blessed by her energy and spirit.
Your visits mean so much. Volunteer, if you can. Consider doing a Life Review for family or friends who wonder about what to say or do during visits.
"Too often we underestimate the power of a touch, a smile, a kind word, a listening ear, an honest compliment, or the smallest act of caring, all of which have the potential to turn a life around."
-Leo Buscaglia, author (1924-1998)
Volunteer
~it's good for you. Click on the image to read about things you can do.
Pouring rain, magnolia, lilacs droop; frost tonight?
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Poor Mr. Phoebe happy with all the bugs! Yes. The forecast if for
temperatures near freezing in the night. I could have covered my potted
plants, but I was...
Groundbreaking Ceremony May 9th, 2013
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*[image: Habitat NCR Nantes St Groundbreaking Version3] *
*Celebration Time: *More than 110 people gathered for the Nantes Street
Ground-breaking...
Biography
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Jennifer Jilks, retired teacher and educational writer, moved to Muskoka to
care for her failing parents. Her intent: to write a book about teaching.
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1 year ago
Jenn Jilks: Senior's Advocate
This site is for information only, and should be used to help you navigate healthcare and finding more health information. The best source of medical information is your family physician or pharmacist.
An educator, leader and lifelong learner, Jennifer is an avid reader, writer
and blogger. She has developed expertise in working with a wide range of professionals
in education and health care. This has helped her negotiate with medical staff
while advocating for her parents. She have served on several Boards of Directors. She holds
a degree in Early Childhood Education, also, a B.Ed. and an M.Ed. in Curriculum
and Technology, with experience teaching students from Junior Kindergarten to
grade 8, and a Special Education Specialist, she worked with many special needs
students. She has delivered workshops to peers, and lectured on a part time
basis at the University of Ottawa to student teachers.
Blog posts must not be copied, distributed, or reproduced in any manner, without the express permission of the copyright owner. All content is the intellectual property of the author.
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