Fact sheets on End of Life Care by Nurses

In my searches for information while being caregiver for my Mom and Dad, there was little available. No one talked about death and dying.

No one would share information. Physicians, especially, kept it all to themselves, death being equal to failure in their minds, I suppose.

In this day and age, while talk of end-of-life is usually limited to the professionals, there is much more information available to the non-pros, like me.

Registered Nurses' Association of Ontario
RNAO

Related Downloadable Files

	End of Life Care Fact Sheet
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	End-of-Life Care During the Last Days and Hours
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The limits of treatment and the need to plan for the end

Here is an excellent article on dying with dignity.

Why Doctors Die Differently

Careers in medicine have taught them the limits of treatment and the need to plan for the end

Charlie, 68 years old, diagnosed with cancer, was uninterested in a treatment that would give him  more months. He went home the next day, closed his practice and never set foot in a hospital again. He focused on spending time with his family. Several months later, he died at home. He got no chemotherapy, radiation or surgical treatment. Medicare didn't spend much on him.

In a 2003 article, Joseph J. Gallo and others looked at what physicians want when it comes to end-of-life decisions. In a survey of 765 doctors, they found that 64% had created an advanced directive—specifying what steps should and should not be taken to save their lives should they become incapacitated. That compares to only about 20% for the general public.

In reality, a 2010 study of more than 95,000 cases of CPR found that only 8% of patients survived for more than one month. Of these, only about 3% could lead a mostly normal life.

At risk for falls - aren't we all?

Did you know…?

Susan Hocking @hockings

Need to Bring Frailty into focus Caregeriatricresearch.medicine.dal.ca/pdf/Clinical%2…

• One-third of people aged 65 and over will fall at least once each year.
• Falls are the most common cause of injury and the sixth leading cause of death for seniors.
• Canadians spend about $3 billion a year on medical care for fall-related injuries to seniors.
• Women are three times more likely than men to be hospitalized for a fall-related injury.
• 40 per cent of falls that require hospitalization involve hip fractures.
• Half of the people who have a hip fracture never regain their pre-fall level of functioning.
• Almost half of admissions to long-term care facilities are fall-related.
• Most falls occur in seniors' own homes, while doing their usual daily activities. However, up to 40 per cent happen outdoors and in public places.
• Falls usually happen because of the combined effects of a number of factors, such as a loss of balance, side effects of medicine, impaired vision or mobility, and environmental hazards.
• Many seniors are afraid of falling and restrict their activities. This can increase their risk of falling because of muscle weakness, joint stiffness and poor balance.

As some one in her 50s, I've been noticing that I have been more susceptible to slipping than in the past. I hurry down the stairs for the phone. Rush in floppy slippers. Glasses askew, I misstep.

Here is one post that tells us what happens when seniors fall:
Mr. CD, 88, took a little tumble (you must read this ER Charge Nurse Blog!)

• a scalp laceration the length of Q-tip on his temple, 
• bled like a stuck pig, 
• transported by EMS, triaged, assessed by both MD and RN, x-rayed, CT’d, 
• deblooded, stapled, tetanus’d, acquired a head dressing worthy of a maharajah, and finally sent back to the nursing via a private ambulance and their ill-paid yet (hopefully) competent attendants.

As seniors age they take themselves for granted. Age brings a decrease in flexibility, reflexes, poor eyesight, poor hearing, a reduced sense of touch and proprioception, which is the ability to know the position or movement of a body part without looking.

Most of us are not debilitated by a fall. 

Sometimes chronic falls indicate frailty and should mean that the senior needs to do more exercise to build muscles. Unfortunately, it is hard to convince seniors that they are at risk and should take steps to rectify the situation.

How do you convince someone they are engaging in risky behaviour?
A hard call, this one. I usually use myself as an example, rushing, talking about a misstep, or a near-accident.
We can prevent falls, using environmental actions: loose rugs, and the like.
Ensuring that the senior has enough calcium in their diet to decrease frailty.

Regular exercise, which is a great social activity, as well!
Checking their medications, using Medscheck in Ontario.

Falls are the leading cause of death due to injury for those over 80.
In the case of seniors, falling leads to hospitalisation and there is an impact on all of us from this institutionalisation: physically, socially, emotionally for family and friends. I have written about the dangers of this previously, both hospitalization and readmission risks.

Factors known to increase the risk of falls
and fall-related injuries in seniors include:

• Advanced age
• Gender (females are at higher risk)
• Chronic and acute illnesses, such as the effects of a stroke, Parkinson's disease, arthritis, heart disease, incontinence or acute infection
• Mobility problems, including slower reflexes, muscle weakness, poor balance and poor posture
• Changes in mental alertness caused by cognitive impairments, depression, delirium, side effects of medications, alcohol use, poor nutrition, dehydration or lack of sleep
• Taking multiple medications, particularly those known to increase your risk of falling such as antidepressants, tranquilizers and antihypertensives.

Other risks can predict dangers: the Dalhousie Frailty Scale is a good assessment tool (PDF). Also,

• living alone, climbing ladders alone, too much alcohol, refusing to use walkers, misuse of canes or walkers, poor diet, lack of access to healthcare.

The environment adds to the situation:

• stairs without handrails, poor lighting indoors and out, inattention to curbs, crosswalks. 

Falls are not the only risks, obviously, but they are highly preventable.

Risk taking – can mean climbing up on unstable furniture, climbing up too high, or reaching for something out of your reach, lifting things that are too heavy, not paying attention or underestimating your surroundings. Know your limitations and think before taking that risk.

Footwear – non slip soles, and shoes that fit properly are important.

Blood pressure – Have your doctor check you for postural hypotension (an excessive drop in blood pressure that occurs when a person stands up or is in an upright position). This causes dizziness, light-headedness and loss of consciousness.  You need to rise slowly from a seated or laying down position. If you get up in the middle of the night to use the bathroom take your time.

Medications – Polypharmacy - four or more, puts you at risk for a fall. Ask your pharmacist for a Medscheck, a comprehensive review of all your medications including over-the-counter drugs. This service is covered by OHIP. The pharmacist will check the dosages, and drug interactions. The pharmacist may make some recommendations to reduce your risk.

Vision – have your eyes checked every 2 years. If you need glasses, get them. Poor vision has been blamed for many falls. If you wear bifocals consider changing your prescription and using reading glasses. Bifocals cause problems when walking and trying to look at the ground.

Home Safety – The most common are scatter rugs, clutter on the stairs, extension cords (even pets) underfoot also can become trip hazards. Clear snow and ice from your walkways, or ask a neighbour to help. Many local community home support offices will help with this. Check out 211.ca in Ontario

Bathroom – put a night light in the bathroom and hall. Installing grab bars in the bathroom gives you more independence. You want them there when you are slipping or dizzy so you can prevent a fall. Put a non-slip mat in your shower stall, and be careful in the bathroom.

Leg Strength – Regular walking will keep your legs strong. Stairs are a great way to exercise. Put on some music, and do step-ups. Do a series of ten leading with your right leg, another ten leading with your right. Stand up firmly on the step, placing both feet together.

Bones – Osteoporosis leads to weak bones, which break very easily. Ensure get get enough calcium. Know your bones: ask your doctor for a bone density test.

Nutrition – Drink water throughout the day, as dehydration makes you dizzy. Make sure you take in enough vitamin D to maintain bone health.

Incontinence – There is help. Ask your doctor to refer you to the appropriate services.

~ Alberta Centre for Injury Control & Research. Edmonton: Alberta Centre for Injury Control & Research; 2010. (PDF) 

Dementia behind bars - California pilot program

I read a fascinating article about the US prison system; California, to be precise.

Happy times in LTC

They have trained convicts in prison to help care for other convicts with dementia. Some want these prisoners paroled and sent to long-term care, but that is no solution.

For those with a history of violence, to be placed with grampa who has had a stroke, and loves to dance, WOULD be criminal.

The US philosophy 'getting tough on crime' has been adopted in Canada, and while we do not have the California three strikes law, prisons are getting crowded. It would be criminal to release these men with violent histories to be cared for by personal support workers (PSWs) with little training in handling violent offenders.

Those in prison age faster than the rest of us. They are at-risk, due to their backgrounds: limited education, hypertension, diabetes, smoking, depression, substance abuse, even head injuries from fights and other violence.

Dementia makes people paranoid and confused.
If you visit the NY Times piece you will be able to watch a video of these men. It is a loving, caring story. Not only that, but these violent offenders, trained to care for their peers with dementia, are finding an opportunity to discover their humanity with these fragile dementia sufferers.

They are paid $50 per month to provide this care, as the state is unable to pay for extra support for these prisoners 24/7.
They seem to be well-trained, and care about their charges.

To quote Secel Montgomery Sr., regarding his client,
"If I go and tell him what to do, he won't follow. He's real independent.
I have to let him tell me when he is ready to make his bed, because it's about him, not me.
You've got to be friends with these guys.
I got a job to do and I'm gonna do it. It don't work like that.
If they don't trust you it's not gonna work."

Life, With Dementia

Secel Montgomery Sr., and other convicted killers at the California Men’s Colony, help care for prisoners with Alzheimer’s disease and other types of dementia, assisting ailing inmates with the most intimate tasks: showering, shaving, applying deodorant, even changing adult diapers.

Dementia in prison is an underreported but fast-growing phenomenon, one that many prisons are desperately unprepared to handle. It is an unforeseen consequence of get-tough-on-crime policies — long sentences that have created a large population of aging prisoners. About 10 percent of the 1.6 million inmates in America’s prisons are serving life sentences; another 11 percent are serving over 20 years.

Many states consider over-50 prisoners elderly, saying they age up to 15 years faster.

This isn't elder abuse - this is more complex

If a child asks for money, is this abuse?
It depends.
If a stranger weasels money from a senior, it is fraud. Plain and simple.
Terming it Elder Abuse takes away from the sheer horror and the law that states that theft and fraud are criminal acts. I find a difference between fraud, in the case of strangers, e.g. cold calls from those claiming to be a grandson in trouble needing money.

There isn't enough data on senior fraud, nor elder abuse, as they are lumped together. Too many seniors are silent on this issue.
Elder abuse, when an adult child begs, coerces or steals money, can be a difficult situation.

In my experience, my clients know it is wrong to give away the precious little money that they have, but they do!
Out of guilt, or wanting to buy their adult children's love and attention, they will dig deep and transfer funds. How do we, as strangers, come to a conclusion without knowing the circumstances.

My late mother created this embroidery for me,
 after the birth of my three children (Dec. 26, 1988).

I have been working with a client to give her the language to stand up for herself. She know it is wrong, but when a son phones and says he has no food, a mother feels guilt. Is this Elder Abuse? I'm not sure.

We can teach and educate, however. You see it all the time on shows that feature those with addictions. It is often grandparents who will give in and give money to grandkids.


Roots and Wings
I told this client about the deer in our backyard. In July or August, whenever fawns are weaned, they continue to nudge the momma, who gives them a good head butt.
I assured my client that we need to give our children roots and wings.

If a child, on welfare, is unable to make ends meet, has a partner or a relationship or a child, but manages a trip to Kenya, you've got to think that there is something wrong.
A child who refuses to give contact information, while you collect their mail, including summons and parking tickets, you've got to be suspicious.
A relationship is a two-way street, and if seniors depend upon the child needing money for them to have a relationship, then you know there is something wrong. That said, we must respect their desire to give a child what they think they want, even if it isn't what they need.

Broken Record or Stonewalling
I talk to my clients, and register my doubt that it is wise to give a child money repeatedly, especially when the senior is on fixed-income herself.


I sugest she create some strong messages, and simply repeat them. Do not argue, cajole, barter, or bargain for love and attention. Do respond with anything other than one or two fixed messages that you repeat, like a broken record.


Write them down on a recipe card, if needs be:
I love you but I cannot afford to support you.
You need to get a job and to learn how to support yourself.
I will be hear to listen, but I will not send you any more money.

Please Note:

Taking advantage: Elder financial abuse on the rise. In the majority of elder financial abuse cases, abusers have a close connection to the victim and exploit this connection. Family members, friends, neighbours and caregivers are often the ones committing these crimes.

Signs of financial abuse
· irregular patterns of spending
· frequent withdrawals from bank accounts
· unusual credit card activity
· missing personal belongings or cash
· purchasing inappropriate items
· unpaid bills
· a new “best friend”
· unexplained debt

Forms of financial abuse
Do not be pressured, forced or tricked into:
· lending or giving away money, property or possessions
· selling or moving from your home
· making or changing your will or power of attorney
· signing legal or financial documents you don’t understand
· working for little or no money, including caring for children or grandchildren
· making a purchase you don’t want or need
· providing food and shelter to others without being paid

Resources

Ontario Network for the Prevention of Elder Abuse senior safety line: 1-866-299-1011
Canadian Anti-Fraud Centre: 1-888-654-9426
Crime Stoppers: 1-800-222-8477
York Regional Police seniors’ support liaison officer: 1-866-876-5423, ext. 6697

Taking advantage: Elder financial abuse on the rise

In November 2011, police announced a 33-year-old Markham man had been arrested in connection with a fraud investigation. Employed as a personal live-in caregiver, he was accused of defrauding an 84-year-old man who has Alzheimer’s disease. In just under a year of employment, he is alleged to have stolen more than $100,000 from his charge by accessing the man’s bank accounts. Police believe there may be more victims.

THE Ontario Heath Study INSIDER – FEBRUARY 2012

The Ontario Health Study approaches a major milestone!

Thanks to each and every one of you, we are now very close to reaching the milestone of 100,000 participants with completed questionnaires. This is an amazing way to head into the new year! As of Feb. 14, more than 95,000 participants have completed the OHS questionnaire. We’ll be in touch when we reach this incredible milestone.

Such a large number of participants makes the Ontario Health Study one of the biggest and most successful health research studies in the world. The OHS is already the largest health study in Canadian history. So congratulations for being a part of something big – and thank you!

If you’re interested in becoming an OHS Community Champion and helping us to recruit even more Ontarians into the Study, please visit the Community page at OntarioHealthStudy.ca.

What’s new at OntarioHealthStudy.ca

We have a couple of new videos for you to check out at OntarioHealthStudy.ca. The first is an "OHS on the Street" video, where Ontarians tell us why health matters to them. The other new video is the inaugural profile in our series of "Meet the Researchers" videos. Our first researcher profiled is Dr. Lorraine Lipscombe, a physician at Women’s College Hospital who co-chairs our Diabetes Working Group. You can find these videos on our Community page.


What's Next

The Ontario Health Study has always enjoyed the support of physicians who work in hospitals and clinics across Ontario. So it was a natural progression for the OHS to look to hospital clinics and medical facilities as good venues for telling potential participants about the Study. We’re happy to report that recruitment efforts undertaken by Women’s College Hospital, Sunnybrook Hospital’s Odette Cancer Centre and the STOP Study (the Centre for Addiction and Mental Health’s anti-smoking program) have proven successful.

The next phase of the Study’s clinic-based recruitment is set to take place at Women’s College Hospital (WCH). Currently in the Osteoporosis Clinic, OHS recruitment will expand to the After Cancer Treatment Transition (ACTT) Clinic and other clinics within the hospital’s department of Medicine.

Senior drivers in the news

We wouldn't let this guy drive, either!

Ontario considers new rules for senior drivers, says transport minister, Chiarelli

The number of elderly drivers who are cognitively impaired has risen significantly in recent years...

It is not surprising. But I truly wonder if it is that physicians are correctly reporting cognitively impaired drivers, more seniors are being tested, or family members are stepping up to the plate.
In fact, since Ontario instituted mandatory testing for those 80+, collision rates have fallen 45% since 2000.

Physicians have begun to follow the law, reporting impaired drivers from 30,000 a year in 2006, to 50,000 in 2010. Of these, 70% had licences suspended immediately.

Drivers like this put us all at risk.

From my work with dementia clients, we know how devious they are at covering up their impairments! As human beings, we have a long history of self-preservation. Dementia commonly affects the prefrontal cortex, where higher level thinking takes place. Yet, my mother covered up her hearing impairments, and chose to pick up driving when Dad's licence was taken away.

My father chose not to disclose that he would get lost going home, a classic sign of dementia. His doctor chose to ignore the information until Dad had a petite-mal seizure while driving, then a grand-mal seizure in his kitchen. This, to my mind, is criminal. Mom had not driven in 30 years, and that a VW Beetle. She had many problems driving their mini-van. The neighbours would rescue her, a park the car for her. None told me about this.

A man, undiagnosed, who was found shoveling the snow in his backyard in June, still drove to meetings that did not exist. Someone needs to step in.

As with many issues, 'it takes a village to raise a child.' All of us must take responsibility to identify and report anyone with biological, physiological and cognitive issues that impact on our driving abilities. They are our loved ones; those they can kill, in a moment, when they forget, or cannot check a blind spot, cannot react quickly in self-defense, or drive too slowly on highways.

Pick a lane, any lane.
He just hauled off into traffic.

In my experience, physicians are loathe to test at-risk seniors, family members are loathe to piss off a parent, and society refuses to report dangerous drivers. In small communities, people recognize when a person with dementia fails to look both ways before pulling into traffic. They do not tell far-off extended family, out of, I think, some sense of loyalty. This must change.

There are many quick, 10-minute, cognitive tests physicians may administer in their offices.
There is no excuse for this lack of testing by either Transportation Departments, who test vision, rules of the road and knowledge of road signs. But this may not be enough.

Do we become better drivers, the older we get?

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:

• 6.4 % of fatal accidents caused by those less than 20 years of age
• 7.3 % caused by those over age 65 (with fewer km traveled).
• While 16 - 19 yr. olds have accident rates of 2.47 per 10,000
• Adults over the age of 65: 2.9 per 10,000

It is not ageism. It is a fact that as we age we are less limber, less aware, take driving for granted, we have more vision, flexibility, attention, hearing, mobility and reflex issues. Driving habits deteriorate. No question.

Federal Highway Administration data

SLower drivers piss off everyone.

• drivers 75 years and older have higher rates of fatal motor vehicle crashes than any other age group except teenagers.

Insurance Institute for Highway Safety

• drivers 85 and older have nearly twice the number of fatal accidents as those 16 to 19.

Collisions and traffic violations in the elderly population reflect:

• errors of inattention
• failure to yield
• difficulty maneuvering
• driving too slowly



Dangerous decisions are made every day on the highway

• left-hand turns are dangerous. 

It is not about our dignity, our inadequacy, or ageism.
We do not target senior drivers. We target those who prove a risk.
How old is too old to drive? This is the wrong question. How frail is too frail to drive?

I reported this driver (below), as well as another who continued to drive 20 km under the speed limit on 80km/hour highways. An incident waiting to happen. Drivers would pass impatiently, unsafely, to avoid this man, along this 30 km stretch of Ontario's highway.

They're just getting faster and faster out there.

For more reading: How to tell your parents they cannot drive

Palliative Care – be in the present moment

When my mother was dying, in 2006, I was unable to find much information. As I sat in Ottawa, waiting to phone her after an appointment, or waiting for her call after an appointment in a far off town.
One of our Canadian resources provides support to those dealing with death and dying.
They answer questions and provide information for many facing the most important time of their lives. Here is a sample:

Emotions and Spirituality How can I support my husband who’s been diagnosed with cancer and is waiting for test results?

Waiting can add stress to an already uncertain situation. Some people say that waiting for health and treatment information is one of the most stressful aspects of being ill. There’s the frustration of waiting, and for some people there’s also fear of what the test results may be. The waiting period can be equally difficult for family and friends. They have the added frustration of wanting to help, but not knowing what to say or do...read more.
~~~~~~~~~~
I felt that I could add to this answer.
I was desperate for information, while I waited to hear the next bout of bad news from my late mother's latest results and appointments.
What bothers me in the news, and on Social Media, are all of these requests for support for causes.
'Send a tweet to cure cancer', or 'Walk for the cure'. Very little Social Media is devoted to real people making a real difference: to need transportation to appointments, a listening ear, someone to walk the dog, bring over a meal, rake the lawn, shovel the snow.
Those dealing with the reality of death and dying need to be recognized and supported in the present moment. Those waiting for test results can be helped. Those waiting with them can learn to find realistic hope.

I counsel my clients to live in the now. There was yesterday, there is today. This we know for sure. We can plan and prepare for the worst tomorrow, but wasting energy on what might be drains the care recipient and the caregiver of precious time. I once knew someone who spent 3 or 4 hours each night researching breast cancer cures for his late wife. These were hours he did not spend with his wife, or his now motherless children.

The "What If" Train

That 'what if' train comes barreling in the door, runs us down, and distracts us from our loved ones.
We know how much mind = body = spirit are connected. We know that biology (physiology), psychology, (thoughts, emotions and behaviours) and sociology (family, traditions, culture) have a profound influence on us all. So much so, that there are courses in biopsychological development. I know I've taken one!

“The secret of health for both mind and body is not to mourn for the past, worry about the future, but to live in the present moment wisely and earnestly.” – Buddha


Keep your power
If you give worry your power, it will gladly take it from you. Your power should be centred in the heart of your being. Your power should be centred in living.

There are ways and means and ancient and modern techniques to get around this worry factor.

Some suggestions to help
1. Recognize worry - do not discount it, as it tells us we are in fear. Fear is a normal emotion. Be aware of times when worry is apt to derail you.
2. Practice mindfulness: Let your worry go. Acknowledge it, witness it as a normal reaction to stress. Then, let it go.
3.  Practice meditation. Buy some audiotapes to help you learn. Simply sitting, paying attention to your breathe as it flows into your body, into your lungs, and back out your mouth, is a very basic quiet meditation. Another strategy: breathe in on 4 counts, hold your breathe for 7, exhale for 8 counts.

4. Music soothes. Simply using music will help us in many ways. Music to relax by, to move by, to escape into. A wonderful Canadian resource is Room 217. I exchanged one of my books for a CD by Bev Foster. She was similarly presenting at a conference where I spoke in 2010. They now have relaxation DVDs, as well as music to play for those in a palliative condition.
5. Laud your hopes and dreams. Perhaps they change with a diagnosis of a palliative condition, then look for things on a daily basis to fulfill your dreams. The wish to share a laugh, see a favourite person, or caregiver, and
6. Write an abundance journal. For what are you grateful today? Specifically today. Do not mourn that which will not be. Celebrate that which is today. Take out family photos and celebrate the good times.
7. Draw into your life positive people. You have the right to limit your visitors, and control the type of energy present in your life. You need not tolerate angry, miserable visitors or hired caregivers. Speak to their supervisors.
8. Smile. Simply smile. Sit with a friend and create a smile. Find something to laugh over.
9. Forgive the past. Many of my clients dredge up past grudges. They spend their days harping over family fights, long-insignificant incidents and situations.
10. Become a minimalist. Many in palliative conditions push away the frills and trappings of their outer lives to focus on their inner lives. Accept this as a caregiver. Make each object in your space speak to you. Let go the which is unimportant. Draw unto you artifacts that celebrate good moments in your life. Do less. Focus on one task at a time.

Deaths by injury

~ Alberta Centre for Injury Control & Research. Edmonton: Alberta Centre for Injury Control & Research; 2010.

Injury Deaths - Alberta statistics (1999-2008)
• Suicides were the leading cause of injury death
for seniors between 65 and 69 years of age.
• Motor vehicle collisions were the leading cause
of injury death for seniors between 70 and
79 years of age.
Falls were the leading cause of injury death for
seniors 80 years of age and older.

Physicians and end-of-life care – an oxymoron?

A busy life, doting grandmother

The family sits by her bedside. Mother, with Parkinson's Disease, has had it bad lately. Fighting for independence, they fought adult children who tried to find the best living conditions for them.

With a range in services, from Adult Day Away Programs, respite care, Home Care support, to long-term care and hospitalisation, caregiving  decisions must be made with clarity and all information possible.

With several siblings, near and far, they took turns advocating for Mother and Father. With many happy memories of cottage life, embracing the outdoors and healthy living, they enjoyed their large family.

Yesterday morning, Father met them at the hospital. Mother had had a stroke. She was in bed, unresponsive. Life had been hard for him lately. With each new medical complication, this pair married over 60 years, kept telling one another 'once we get over this, things will be the way they were.' But Parkinson's takes its toll. Father was a healthy man, was downhill skiing in his 80s.

The children gathered in the city hospital.
Father had brought in a change of clothes for Mother, for when she would soon leave the hospital. Unfortunately, no one had told him the prognosis. Hooked up to an IV, with paralysis on one side, she would never leave this hospital. Even the layman knew this. Unfortunately, physicians refuse to deal with reality in these cases.

How can physicians be so cold? Whether it be those in the ER, or the GP, they still refrain from using their experiences to educate patients. Life is like a hotel. We all check in but we all check out at some point. Better in our twilight years, with a good life behind us. But this is not always the case.

She had slept on this side of the bed for 60 years.
He rested.

We know they cannot predict timelines for end-of-life, but they need to be honest about the signs and the significance of particular trauma, like a stroke, in an elderly or frail patient.

It is beyond the Scope of Practice for nurses, yet they are the ones who develop a rapport as they provide intimate daily care for loved ones. Perhaps the nurses should be more involved.
For failing seniors facing this issue, the loss of a spouse of six decades, of shaping a life through marriage, careers, raising children, enjoying grandchildren, is still a complete shock.
Do they not deserve honesty, truth, and the truth that experience gives a wise physician? Patients with multiple co-morbidities may or may not be able emotionally and cognitively to face truth. Spouses and family members need to know.

The family demanded the physician sit down with them, and Father, and lay it out. Goodbyes had to be said, arrangements made. Father would need a new plan.

Sadly, it was the next day that Mother passed over. Father was better prepared with the intervention of his adult children.
The day of death should not be mourned. They celebrate a life well-lived; a woman well-loved.
Physicians must learn honesty, transparency, and know that we only rent these bodies. Families who pregrieve, who come together in anticipatory grief, are better prepared for what the future will bring.

Top health video picks for February by Howdini

How to lower your risk of heart disease

How to stay on a diet

How lifestyle changes can help you avoid heartburn

How to recognize women’s heart attack symptoms

How to maintain heart health with herbs and supplements

How to relieve stress

For a good chuckle, Senior Moments

Costs of Ontario Health Insurance Plans

The recent Drummond Report suggests that are many places where Ontario needs to cut back.
Healthcare, schools, amalgamating hospitals, capping doctor's salaries.
Full-day kindergarten, rather than more affordable and kid-friendly subsidized day care, costs $1.4 billion.

Full-day kindergarten on chopping block: Drummond report ...

There were 105 recommendations on health alone!
Ontario is spending $47 billion on health in 2011-2012 and that is 42 per cent of its total spending on programs. Of that, operating hospitals accounted for nearly 35 per cent of health-care spending.


The commission wants Ontario’s 2,500 separately funded health agencies — including hospitals — streamlined under local health networks. That would "involve further amalgamating hospitals and reducing the number of boards".

There is not so much waste in healthcare, as funding for those things that appear unnecessary, while we face wait lists for long-term care, a shortage of nurses and personal support workers. Too many unnecessary tests, wait times for specialists, back-up in ERs, since physicians are difficult to access 9-5.

While seniors in Ontario are fighting cutbacks in all aspects of Home Care: from the range, the amount of time, the length of time services are covered, OHIP pays for those without serious health issues to undergo expensive IVF treatments. I was shocked.
OHIP-Funded IVF Patients:
If you are applying to undergo artificial inseminations (IUI), and you are an Ontario resident with an Ontario Health Insurance card, you are a funded patient. All of the medical services (i.e.: physician consultations/visits/blood tests/ultrasounds, etc.) are billable to OHIP. 

Description	Funded	Non-Funded
Administrative  Fee non-refundable		$ 250.00
CONSULTATION FEE *(physician referral letter)	OHIP*	$ 225.00
Repeat Consultation *(physician referral letter)	OHIP*	$ 175.00
Specific Assessment	OHIP	$ 75.00
Office Visit	OHIP	$ 50.00

***ALL FEES QUOTED EXCLUDE DRUG COSTS****

Description	Funded	Non-Funded
IUI - Intrauterine Insemination	$ 500.00	$ 3,000.00
IUI - Intrauterine Insemination (Hepatitis Patients)	$ 625.00	$ 3,125.00
BASIC IVF CYCLE(PER CYCLE) *OUT OF PROVINCE/COUNTRY PATIENTS	$ 3,500.00	$ 6,000.00 $ 7,000.00
BASIC IVF TREATMENT - HEPATITIS PATIENTS	$ 4,000.00	$ 6,500.00
BASIC IVM TREATMENT (In Vitro Maturation) (Includes ICSI)		$ 6,750.00
BASIC IVM TREATMENT - HEPATITIS PATIENTS		$ 7,250.00
FROZEN EMBRYO TRANSFER Physician Fee/Lab Fee Additional: Hormonal Assays (each) Additional: Ultrasounds (each)	$ 1,260.00 OHIP OHIP	$ 1,610.00 $ 35.00 $ 125.00
FROZEN EMBRYO TRANSFER HEPATITIS POSITIVE PATIENTS Physician Fee/Lab Fee Additional: Hormonal Assays (each) Additional: Ultrasounds (each)	$ 1,535.00 OHIP OHIP	$ 1,885.00 $ 35.00 $ 125.00
EGG FREEZING TREATMENT CYCLE Annual maintenance frozen eggs Return for thaw of eggs, sperm insemination with ICSI, embryo culture & embryo transfer Freezing of extra embryos		$ 5,000.00 $ 300.00 $ 4,500.00 $ 550.00

Social media in healthcare

Social Media

Social

(adjective) of or relating to society or its organization, human society, being in the company of others, living in companionship with others or in a community.

ORIGIN late Middle English : from Old French, or from Latin socialis ‘allied,’ from socius ‘friend.’

Media 

the main means of mass communication (esp. television, radio, newspapers, and the Internet)

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I think it important to put up professional boundaries. Many of us have no interest in talking to strangers on Twitter, let alone our health care providers.
That said, some physicians encourage professional SM interactions:

1. It encourages communication.
2. It allows us to address issues that we would otherwise have a hard time addressing.
3. Other patients will benefit by reading the discussions.
4. We get an opportunity to show how we handle different situations.

There are those interested in discussing and debating healthcare issues. Believing in discourse, I participate in Twitter chats on healthcare topics. Unfortunately, many do not wish to to look at other points of view. If you do – you are blocked.

Patient-centered care is all important to all of us on both sides of the Canada/US border.

This is something many advocate for on the part of those dissatisfied with current healthcare practices. Social Media is a good place to make a difference.

Via: PowerDMS

Expressive Arts Bereavement Groups at Community Home Support – Lanark County

Community Home Support-Lanark County is once again offering expressive arts bereavement groups for children, teens and adults beginning in March 2012.   These groups run for 8 weeks at the Perth office free of charge and are facilitated by Julie McIntyre, an experienced art therapist, and trained hospice volunteers who are also professionals. 

In the fall of 2011 three groups were successfully completed for bereaved children (7 to 12), teens (13-17) and adults using expressive arts modalities including visual arts, poetry, drama, movement, games, journaling, mask and doll making and storytelling.  Comments from teens included: “an amazing output of emotions”, “I never realized how I felt until I looked at my own art”, “everything in life is just another obstacle to overcome, another journey for our life and art helps us understand and made sense of it”, “so much better than I imagined it would be”, and “even though you are going through a tough time just remember you will always have someone to talk to and talking about it makes you feel better even though you may seem uneasy about it at first it makes you feel braver and ready to face the world”.  Participants indicated that being in a safe environment where they could share their own experience of loss and connect to others who understood was a great opportunity to feel supported.  One new aspect of the program will be to use teens who have experienced this group to become co-facilitators and mentors in other groups.

Expressive therapy, also known as creative arts therapy, uses creative arts such as music, dance, drama, and writing as a form of therapy. The most important concept behind the use of expressive therapy is that using the imagination to create art helps promote mental and physical healing. When this type of therapy is used as treatment, the act of creating is given more importance than producing a completed work of art.

The creative arts are a powerful tool for us to restore, repair and renew.  Expressive arts therapy is also about experiencing the natural capacity of creative expression and creative community for healing.  Working in the arts allows expressions of feelings that there may be no words for or where there have already been too many words such as discussion of a loss.  It is the process of the art making that is the true healing experience.

Children have always used art and play as a means of coping with events and emotions beyond their control. Adults may find it more difficult to engage in the creative process so freely. But when we do let go, we are assuming an active role rather than a passive one over our experience. When art is made in response to a grief experience, a person learns to practice control over the experience that may be otherwise difficult to accept. This active response is empowering as it increases a sense of control, hopefully providing a realization that you have a choice in how you relate to your experience. Having choices is empowering! This freedom of choice as well as the experience of sharing with others in a similar situation can boost self-esteem and self-confidence as well as form connections that help integrate the experience of loss as a journey that others are also sharing.

What are the benefits of expressive art therapy?

• Art can make the invisible (such as painful emotions and experiences) visible through external expression.
• Experiences in art creation validate our connection to the whole of life, which increases self-esteem, self-validation, and self-awareness.
• Encourages self-control through working with art materials.
• Metaphorical language and story can emerge through the art, giving voice to that which is often difficult to express.
• Emergent and re-occurring symbols bridge our conscious and unconscious awareness.
• Discovery of one’s strengths and authenticity.
• Learning the skill of self-observation through one’s art creations.
• Art making engages the whole brain and can stimulate integration of cognitive, feeling and sensory processes.
• Art and emotions are closely linked and therefore art-making can help to positively alter one's mood.
• Energy and vitality can be increased by a visible expression of suppressed thoughts and memories.
• Provides an experience of relaxation, reducing stress, anxiety and worry.
• Art therapy offers a hands-on, active, fun, and productive form of therapy.

The use of expressive arts in grief and bereavement work has many beneficial effects and can promote healing, integration and connection in a group setting.  No artistic talent is required or expected and there is no judgement on the work completed.  Everyone is encouraged to use the art making within the group for their own healing and to continue the process at home after the completion of the group.

For more information or to register for an upcoming group, please contact Rebecca Bowie at 613-267-6400 orrebeccab@chslc.ca.  Community Home Support-Lanark County is supported by the South East LHIN, the United Way of Lanark County and community donations.

Rebecca Bowie

Coordinator, Volunteer Hospice Visiting Service

Community Home Support - Lanark County

40 Sunset Blvd., Suite 100

Perth, Ontario  K7H 2Y4

Phone: 613-267-6400 ext. 28 or Fax: 613-267-3497

www.chslc.ca