Preparing your home for winter
November 2016 www.homeandlongtermcare.ca
The forgotten caregiver See page 16
Hidden risks of influenza
If you remember when
rock was young, there’s a ﬂu vaccine specially designed for you.
As you get older, your immune response to inﬂuenza vaccines decreases. FLUZONE® High-Dose improves your immune response to inﬂuenza (also known as the ﬂu) and has demonstrated better protection of adults over 65 against the ﬂu than our standard dose ﬂu vaccine. In fact, FLUZONE® High-Dose vaccine is signiﬁcantly more effective than our standard dose vaccine in preventing the ﬂu – 24.2% more effective.
For more information, visit www.fluhd.ca FLUZONE® High-Dose is a vaccine used to prevent inﬂuenza in adults 65 years of age and older. Inﬂuenza (or ﬂu) is an infection caused by the inﬂuenza virus. Annual vaccination using the current vaccine is recommended for prevention against inﬂuenza as immunity declines in the year following vaccination. Persons with a history of severe allergic reaction to eggs or egg products or any component of FLUZONE® High-Dose should not receive the vaccine. FLUZONE® High-Dose will only protect against the strains of inﬂuenza virus contained in the vaccine or those that are closely related. FLUZONE® High-Dose will not protect against any other strains of inﬂuenza virus. FLUZONE® High-Dose is not indicated for the prevention of hospitalization or death after the onset of disease. As with all vaccines, FLUZONE® High-Dose does not protect 100% of people immunized. Allergic reactions can occur. The most common side effects are pain at the injection site and muscle ache. Contact your healthcare provider to see if this vaccine is right for you. For more information, visit www.sanoﬁpasteur.ca. FLUZONE ® is a trademark of Sanoﬁ Pasteur. Sanoﬁ Pasteur 1755 Steeles Avenue West, Toronto, Ontario M2R 3T4 © 2016 Sanoﬁ Pasteur Limited. All rights reserved. DIN : 02445646 372-012c E 09/16
Home & LongTerm CARE | November 2016
contents November 2016
Cover story: The forgotten caregiver
Preparing your home for winter
Flu vaccination makes sense
Choosing a home
4 Editorâ€™s Note 10 Caregiver SOS 23 Spotlight on wound care nurse 24 Keep moving 28 Getting parents to accept help 30 Nutrition Column
Working through grief and loss
Seeing beyond disability
Editor’s Note 610 Applewood Crescent, Suite 401 Vaughan Ontario L4K 0E3 905.532.2600 www.homeandlongtermcare.ca EDITOR
STEFAN DREESEN CREATIVE DIRECTOR
LAUREN REID-SACHS THERE ARE PRESENTLY over half a million Canadians (564,000) living with dementia and that number is expected to rise to 937,000 in the next 15 years. That means many of us will at some point be caring for a loved one with some form of dementia. This month’s cover story – The forgotten caregiver – highlights some of the challenges caregivers face when their loved one has been diagnosed with dementia (any disorder of the brain). In addition to providing care, these caregivers often grapple with having to watch their loved deteriorate into someone unrecognizable. With the progressive nature of dementia, it is not uncommon for people with dementia to ‘forget’ who their caregiver is. Ultimately, many caregivers are unable to provide the level of care their loved one requires and have to find a long-term care home. We also provide some information on how to go through this selection process in the article Choosing a home for someone with dementia. You will also find an article on how to get your aging loved one to accept help (at the request of one of our readers), information about the flu shot for seniors and much more. We hope these articles assist you on your caregiving journey.
SENIOR GRAPHIC DESIGNER
JOHANNAH LORENZO GRAPHIC DESIGNERS
ANGEL EVANGELISTA, NICK MCGRAW, ARUN PRASHAD, ALICESA PULLAN, KATHLEEN WALKER, STEPHANIE GIAMMARCO BILLING AND RECEIVABLES
MATTHEW PICCOTTI, PHIL GIAMMARCO
Home and Long Term Care is published for consumers who are supporting and/ or involved in home care or long term care. It is available free of charge from distribution racks in hospitals across Ontario. The statements, opinions and viewpoints made or expressed by the writers do not necessarily represent the opinions and views of Home and Long Term Care, or the publishers. Home and Long Term Care and Members of the Advisory Board assume no responsibility or liability for claims, statements, opinions or views, written or reported by its contributing writers, including product or service information that is advertised. Changes of address, notices, subscription orders and undeliverable address notifications, and inquiries can be sent to: email@example.com
Kristie Jones Editor Home & Long Term Care firstname.lastname@example.org
Home & LongTerm CARE | November 2016
Subscription rates in Canada for single copies is $35.00 per year. Canadian Publications mail sales product agreement number 40065412. From the publishers of Hospital News, reporting on health care news and best practices for over 25 years.
Tips for caregivers:
Preparing your home for winter By Melanie Ramos
EVEN IF IT DOESN’T FEEL LIKE IT, when summer officially comes to an end the slow transition from summer to fall is happening. Especially lately, when we wake up to cooler mornings that look as dark as when we went to bed. Fall and winter can be a difficult time of the year for house-bound seniors, those who live with a physical disability, or those who are recovering from a prolonged illness or surgical procedure.
sidewalk in front of the home are cleared of ice and snow. Invest in a snow thrower or blower, or have a service come in to do it for you if you can’t manage this task on your own. If a neighbour has a snow blower, ask if they would be willing to do your driveway as well. Continued on page 6
Winter is just around the corner which, according to the Farmer’s Almanac, will be a brutal one for Canadians this year. This period of transition between Canadian seasons, when the weather’s still warm enough to be considered summer weather, is the perfect time for caregivers to assess the home of the person they’re caring for, both inside and out. Besides getting ready for fall, it’s time to also determine what needs to be done to get ready for the colder winter season ahead.
Outdoor winter preparations
Save up to 50% vs. tradional agencies
Roof – Worn out shingles and eaves troughs that are full of leaves and other debris can lead to a bigger mess inside the home. Address these issues before the autumn rains start and you end up with a leaky roof on your hands.
Find the Best Local caregivers Caregivers are Veriﬁed & Insured Easily Coordinate Care online
Walkways – Make sure that all walkways are well lit, and that cracks and uneven pavement are fixed to prevent tripping or falls. During winter, always make sure that walkways, driveways, and the
Join Free Today: www.eadvocate.com 1.888.992.1575 November 2016 | Home & LongTerm CARE 5
“Winter is just around the corner which, according to the Farmer’s Almanac, will be a brutal one for Canadians this year.” Continued from page 5 Waterproofing – Look for areas around the outside of the home where water tends to pool when it rains. These areas will get icy during winter so it’s a good idea to have them fixed before temperatures dip or it snows. Front Door – Keep some sand or salt nearby to spread on driveways and walkways after a snowfall. Car – Have the car inspected by a qualified mechanic to make sure it’s winter-ready. Yardwork – While some plants are hardy enough to last through the fall, it’s time to gradually start getting the garden ready for winter. Rake the leaves on a regular basis (wet leaves can pose a slipping hazard), cut back perennials and protect them with a layer of mulch, and protect shrubs and trees with wire or burlap screening.
Indoor winter preparations Alarms – Make sure that all smoke detectors, carbon monoxide detectors and house alarms are in good working condition. Test the units to make sure that the batteries are still working.
Home & LongTerm CARE | November 2016
Ducts – If you haven’t had the air ducts cleaned in the last 3-4 years now may be a good time to do so. Furnace – Check to see if the furnace is still in good working condition before winter sets in. The worst time to find out that you need to replace your furnace is when you need it the most. Also, make sure that the filter is clean and the area around the furnace is clear of obstructions. Failing to maintain a clean furnace puts everyone in the home at risk for carbon monoxide poisoning. Windows – Check for drafts around windows and seal them. Pipes – To prevent frozen pipes, remove and drain hoses used outdoors, and close inside valves that supply water to outdoor faucets. Check that all water supply lines inside the home are insulated.
Emergency preparedness for caregivers If you are a family caregiver for someone with major health issues and a major winter storm knocks out your power or
closes access roads, you and the person you are caring for may be facing some major challenges. Here are some helpful tips on emergency preparedness for caregivers: • Keep your electronics and cell phones fully charged at all times • Make sure batteries in a portable radio and flashlights are in good working order • Keep plenty of bottled drinking water on hand • Consider acquiring a propane heater or some alternate source of heating • Consider a generator if the person you are caring for is oxygen-dependent • Your vehicle should have good winter tires and always have a full tank of gas but only drive if it’s necessary • Have important phone numbers ready including the healthcare team, fire department, etc.
Ask for help There’s no need to feel like you have to take on all of these tasks on your own all at once. Ask your family and friends for help in preparing your home for winter, especially areas where you lack the required skill set (such as plumbing, auto repair, or gardening). Or, ask for a referral to someone you can hire on a contract basis. Fall and winter can be a difficult time of the year for house-bound seniors, those who live with a physical disability, or those who are recovering from a prolonged illness or surgical procedure. It’s important to make their home as comfortable – and as safe – for them as possible. LC Melanie Ramos is a writer for Elizz.com. This article is reprinted with permission.
November 2016 | Home & LongTerm CARE 7
Choosing a home for a person with dementia This article was submitted by the Alzheimer Society.
Due to the progressive nature of the disease, there will eventually come a time when you can no longer care for the person with dementia at home. Planning ahead for that moment will make it easier for both you and the person you care for.
10 tips for choosing a home: 1. Think about your priorities and expectations. Are you looking for a private room or a shared room? A private or publicly funded home? Remember, a more expensive room doesn’t necessarily mean that the person will receive better care.
Next, familiarize yourself with the long-term care homes in your area and ask questions about the services, policies, and costs so you’re ready to make a decision quickly when a room becomes available. A printable checklist of questions to ask is available at alzheimer.ca/LTCquestions.
2. Do your research. Contact your local community health centre for information about the long-term care application process in your area. It may differ in various regions, or even within your own province.
3. Make a list. Once you’ve done your research, make a list of long-term care home options and then narrow it down to those you would like to visit.
Home & LongTerm CARE | November 2016
4. Schedule a tour. Bring your list of priorities, expectations, and questions to the visit so that you don’t leave out anything important. Bring along a friend or family member for input and support. 5. Involve the person with dementia. Depending on the stage of the disease and if appropriate, arrange for the person to visit the homes that you’re considering for them. Some long-term care homes make their day programs or respite services public, allowing the person with dementia to visit the home ahead of time and become familiar with it. 6. Talk to current residents and their families. Some long-term care homes provide tours led by family volunteers, giving you a chance to speak with them and ask questions. 7. Understand waiting lists. Room availability is based on priority needs, such as the person with dementia’s condition, how much support the person currently has, and your condition as the caregiver. If
you urgently need to relocate the person to a home and a room becomes available that is not your first choice, you can stay on the waiting list for your first choice and transfer the person as soon as a room becomes available. 8. Trust your gut. Your instincts can be very helpful in determining if a home is appropriate for the person you’re caring for. 9. Be prepared for the move. The wait for a room may be long, but the move is often sudden. When a room becomes available, you will need to decide quickly if you would like to take it, and often the moving date is within the next couple of days. There are stiff penalties if you decide not to take it, such as being put at the bottom of the waiting list. 10. You’re not alone. If you have any questions, contact your local community care office or the healthcare professional that you are working with. Your local Alzheimer Society is also a great resource to help you through this process. LC
This article was submitted by the Alzheimer Society.
Imagine! You can chose the best ever caregiver… professional, highly trained, experienced, engaging, Trusted, compatible, compassionate and wonderfully caring! • Personal care–bathing, dressing, hygiene, laundry, light housekeeping • Medication supervision • Joyful companionship • Mobile hair care • Foot care • Escorting to appointments; shopping • Referral for solutions for mobility needs • RN/RPN supervised care
• Veteran’s care • Physiotherapy & occupational therapy • Nutritional planning; meal preparation • Chronic disease care: cancer, Alzheimer’s, Parkinson’s, etc. • Direct CCAC referrals • Hospital and retirement home care • Live In/Out 3-24 hours; or 24/7 care
• Convalescence and respite
Veterans Affairs Canada
Celebrating 16 years of service
Tel: 416.483.0070 Toll Free: 1.855.483.2273 www.LAServices.ca November 2016 | Home & LongTerm CARE 9
The family cottage can also have an impact on parental care and has been noted to affect adult children making decisions for their parents’ future needs.
Arguing with siblings about the future We just had the nastiest argument my sibs and I have ever had, and it was about the future of our family cottage. My parents are old and their care needs are increasing. This cottage discussion got complicated and ugly. I’m distraught by what happened. Signed, Northern Mess
The cottage is a place that most of my older adult patients cite as bringing up good memories of family time, thoughts of kids grow-
ing up and social gatherings. Sadly, the cottage is also a topic that many times leads to some of the most awful and controversial family disputes. This often arises from a hurt child or siblings who are watching their parents’ plans unravel. It can result in family members not talking to each other and ultimately, the family being ripped apart. The family cottage can also have an impact on parental care and has been noted to affect adult children making decisions for their parents’ future needs. This often happens, whether purposely or inadvertently, as sibling conflicts are acted out in the parents care plan.
Nira Rittenberg is an occupational therapist who specializes in geriatrics and dementia care at Baycrest Health Sciences Centre and in private practice. She is co-author of Dementia: A Caregiver’s Guide, available at baycrest.org/dacg Email questions to caregivingwithnira@ baycrest.org. This article originally appeared in The Star.
Home & LongTerm CARE | November 2016
You are in a good situation if your parent is able cognitively to do some planning and organizing in advance. The most common mistake that parents make is in trying to avoid planning and leaving it to the kids to work out instead. A good estate lawyer can help plan what is needed and how to best avoid unwanted complications. Meeting as a family and good communication are often invaluable. Succession planning and frank discussion can facilitate the process. If your parent is cognitively intact, encourage them to do this planning for you and your siblings, even if they don’t feel they need to. A good lawyer will encourage them not to pick one sibling over another, settle scores or make complicated and possibly poor tax choices. Many families that end up in “cottage wars” have told me they wished they had sold the cottage earlier and that all the “ugliness” could have been avoided. They talk about how the cash that each of them would have received would have made everybody happy ultimately. Emotions, ideals and
the hopes of recreating good family times are what most people wish for, but on a practical level this might not be easy as families grow. If you are already in this difficult situation with siblings, it is imperative that you separate your parents’ needs from the cottage drama at hand. Much like a divorce, you may need to learn to do what is best for mom and/or dad, and work with siblings that have hurt your feelings or you do not respect. Although the backdrop of a dispute is hard to forget, the overlying question should always be: how you can be a helpful caregiver to your parents in their time of need. Try to deal with your pain, anger and disappointment with a skilled health professional. They can help you determine what is really important in eldercare. If you and your siblings ultimately cannot move forward with what is in your parents’ best interests, maybe you can find someone who can. Ultimately, don’t double the hurt for your parents. It will only complicate your situation. LC
WHEN YOU NEED QUALIFIED CARE
WE WILL BE THERE! waiting for your next call
Nurses PSWs - Alzheimers HCA - Sick Kids Massage Therapy Homemakers Companions Sitters Foot Care Nurses Drivers Live in Caregivers Denture Services at home Palliative Care
Serving all of Ontario including HAMILTON • TORONTO • OTTAWA
7 DAYS A WEEK
Royal Canadian Health Services Inc.
November 2016 | Home & LongTerm CARE 11
MyGrief.ca Understanding and working through grief and loss
“I am at the h epicentre i t of this earthquake.” –Bonnie When Bonnie’s husband of 41 years, Ray, died in 2013, she likened the experience to an earthquake. As his wife, she was at its epicentre and her life needed the most rebuilding. Their three children, friends and others grieved, but they experienced the tremors and were less intensely affected.
“I miss her sso much… Sometimes I feel guilty wondering if this is how a mother takes care of a child? But I’m not a mother, I’m a father.” –Hamayun When Hamayun’s wife died in 2014, he grieved her loss while adjusting to his new role as single parent to their teenage daughter and 2-year-old son.
GRIEF SUPPORT is an unmet need for too many Canadians. To help address this need, the Canadian Virtual Hospice developed MyGrief.ca in collaboration with national and international grief experts including Dr. Robert Neimeyer, family members who have “been there” and pan-Canadian partners. Funding to develop MyGrief.ca was provided by the Canadian Partnership Against Cancer. 12
Home & LongTerm CARE | November 2016
This online resource helps people understand and work through their loss from the comfort of their home and at their own pace. MyGrief.ca is free to Canadian users. Out of country residents pay $25 USD for six months unlimited use. Bonnie, Hamayun and others share their very personal stories of loss and healing after the death of a spouse, partner, child, parent or sibling. They offer practical advice, insights and describe finding their way through grief to acceptance, peace, and newfound strengths. Divided into nine sections, MyGrief.ca enables people to find the information they are seeking quickly. Its topics include recognizing how grief affects you before and after death; facing emotions such as sadness, loneliness, anger, guilt and fear; managing situations that trigger grief; managing family dynamics; dealing with unhelpful comments and unwanted advice; and re-engaging with life after a death.
MyGrief.ca answers common questions such as “When will I be over my grief?” and “What’s the right way to grieve?” (Answers: You never get over loss; you learn to live with it. There is no single “right” way to grieve.) It explains the difference between grief and depression and the signs that someone might be stuck in their grief. It recognizes that sometimes death comes as a relief when the relationship was difficult or the dying process long and hard. Virtual Hospice plans to expand MyGrief.ca. New sections on how to support a grieving child will be launched in Spring 2017. Canadian Virtual Hospice (virtualhospice.ca and portailpalliatif.ca) is the most comprehensive online source of evidence-based information on advanced illness, palliative care, loss and grief in the world. It serves people living with advanced illness, family members, health providers, educators and researchers. LC
For information, contact: Marissa Ambalina, Communications Specialist Marissa@virtualhospice.ca (204) 478-1758
Our Respite & Recuperative Program provides individuals the time they need to rest and recover after an illness, treatments or surgery. Private furnished accommodation, daily meals, nursing and personal care.
DAY 129 PER *Prices subject to change
2339 Dufferin Street Toronto, Ontario M6E 4Z5 November 2016 | Home & LongTerm CARE 13
Influenza The hidden risks of
Why vaccination makes sense By Dr. Brian Aw
Did you know elderly adults make up only 15 per cent of the Canadian population yet they account for up to 70 per cent of influenza-related hospitalizations and 90 per cent of influenza-related deaths? What if I told you that influenza can result in a host of possible serious health consequences such as heart attacks, hospitalization, and even death?
Home & LongTerm CARE | November 2016
INFLUENZA IS A HIGHLY CONTAGIOUS viral illness of the nose, sinuses, throat and lungs. A common misconception is the perceived harmlessness of influenza. Although many people may shake off the infection, some will continue to experience the ill effects of influenza for the rest of their lives. In reality, the dangers of influenza are hidden and extend well beyond the symptoms, such as fever, cough and headaches that we would normally associate with the “flu”.
For those 65 years of age and older, there is now a high-dose influenza vaccine available in Canada. Both Health Canada and NACI have recognized this vaccine as having shown improved efficacy for preventing influenza illness that is generally safe and well-tolerated when compared to the standard influenza vaccine. It’s time to consider the high-dose influenza vaccine to help better protect older adults in Canada. Ask your doctor today if the high-dose vaccine is right for you.
Older adults (65 years of age and older) are at the highest risk of complications due to influenza. Unlike the common cold, studies have shown influenza can lead to serious and potentially fatal health problems such as pneumonia and may be associated with the worsening of pre-existing kidney or lung disease, and can even trigger heart attacks or strokes. Consequently, influenza illness can be especially debilitating for older adults as these complications can lead to disability and a loss of independence. Given the impact that influenza can have among older adults, Canada’s National Advisory Committee for Immunization (NACI) highly recommends annual vaccination of adults 65 years of age and older as well as those with various chronic conditions.
Remember to protect yourselves and your loved ones by getting your annual flu shot against influenza. Empower yourselves to prevent one of the top 10 leading causes of death in Canada! LC Dr. Brian Aw has been practicing Travel Medicine and Family Practice for over two decades. He is one of the leading local educators in Travel Medicine and Vaccination and regularly lectures to nurses, pharmacists and doctors across Ontario. He sits on the Examination Committee as the primary Canadian representative for the International Society of Travel Medicine.
As we get older, our immune system naturally and progressively weakens which makes it more difficult for the body to fight off infections. To make matters worse, older adults typically have underlying diseases such as diabetes, heart problems, and kidney disease which can be worsened by influenza. As a result, the repercussions of influenza among older adults may be long lasting if not permanent. While influenza vaccination remains among the best ways to prevent influenza, vaccination tends to be less effective in older adults compared to younger adults. Vaccines work by training your body’s defenses to identify and fight off foreign invaders. However, when older adults and other people with weakened immune systems are given a vaccine, the immune response often just isn’t as robust so they’re more vulnerable to infection and the severe consequences of influenza compared to younger adults. November 2016 | Home & LongTerm CARE 15
forgotten caregiver By Lisa Lipkin
Home & LongTerm CARE | November 2016
ONE SUNNY FALL DAY, my grandpa was driving me home. I think I was around six years old. As we were driving over a winding overpass, grandpa became disoriented and got lost. I had to give him directions to my home. It was my first encounter with Alzheimer’s disease and I was truly shocked. I could not understand how Grandpa, a brilliant scientist who had studied at Harvard, and done ground-breaking research at Johns Hopkins University, could get lost in my neighborhood. Over half a million Canadians are now living with dementia and each year, 25,000 more Canadians are diagnosed with this illness. With the aging population, an estimated 937,000 Canadians will have dementia by 2031. That is more than the current population of the City of Ottawa. Many articles focus on individuals who have Alzheimer’s and other dementias – detailing the slow torture of losing one’s memory and one’s ability to independently undertake daily activities. What is often excluded from the conversation is the heavy toll their unpaid caregivers face after years of unrelenting stress and exhaustion. They experience what some call the “long goodbye” as their loved ones slowly become incapacitated, piece by piece, over a period of time that can be as long as 10 to 15 years, or more. The care recipients may transform into volatile or even violent individuals, some suffer from hallucinations, and many eventually lose the ability to walk and talk. Caregivers will often tell you it took years for their loved ones to actually be diagnosed with dementia. In the meantime, both caregiver and care recipient suffer in silence with little or no support. It took seven years for Mary’s* husband Jack to be diagnosed with Vascular Dementia that was brought on by a series of mini-strokes. Jack had his PhD in Chemistry and Physics and took great pride in his
vast knowledge of science. However, he soon began to forget even the simplest of things – like how to take a picture with his much beloved camera. Once a diagnosis was made, Mary and Jack received excellent support at Mount Sinai Hospital in Toronto where Mary attended the CARERS program at the Cyril and Dorothy, Joel and Jill Reitman Centre. The program helped Mary cope with Jack’s new and challenging behaviours. However, CCAC home care was minimal. Mary only had three hours a week of CCAC support for most of the seven years she took care of Jack at home. This was particularly stressful since Jack was a wanderer. Despite his poor balance, Mary never knew when Jack would take off, with or without his walker. It could happen in the middle of the day or the middle of the night. She was always on high alert. Mary finally had to place Jack in long-term care. One of the most devastating moments was when Mary bent over to kiss Jack goodbye at the end of one of her daily visits. Although Jack was non-verbal by that point, words were not necessary for Mary to know that her husband had no idea who was trying to kiss him on the lips. He did not “pucker up” as usual. Rather he was offended, upset and turned away. Joy* began caring for her 93 year old mother Phyllis who suffers from Alzheimer’s and Lewy Body dementia two years ago.
Lisa Levin is Chair of the Ontario Caregiver Coalition and is also the Principal Consultant for Lisa Levin and Associates where she provides services including strategic planning, marketing and communications and accreditation project management. She also provides Care Management services to help families navigate the home and community care system. She can be reached at email@example.com
November 2016 | Home & LongTerm CARE 17
Over half a million Canadians are now living with dementia and each year, 25,000 more Canadians are diagnosed with this illness.
Continued from page 17 Phyllis was a strong and proud woman who had worked as a cook, and loved to make food. She hid her dementia from her children for many years. However, complaints started to come from the neighbors that Phyllis was burning her food on a regular basis. This was becoming a safety hazard for the whole building. Joy gave up her own apartment, career, privacy and independence, to move into her mother’s condo and care for her full time. Phyllis was able to get free home care from the CCAC - but for only half an hour each day. One wonders how Phyllis would have coped on her own had Joy not moved in. Once Joy began living with her mom, she realized Phyllis was having auditory and visual hallucinations. Phyllis would see imaginary people and bugs in her condo, and hear music that was not playing. Caregiving for someone with dementia requires great creativity and patience. When Joy first proposed that Phyllis have a Personal Support worker
come and bathe her, Phyllis was adamant that she did not want help. Joy finally got a Personal Support Worker to come in, despite her mother’s objections. The minute the worker arrived, Phyllis’s natural warmth and hospitality took over and she welcomed her with open arms. In Mary’s situation, her good nature and patience helped her deal with Jack, when he would put on his coat and take off on an unexpected walk. Mary would chase after him, catch up and pretend the stroll was a naturally planned part of the day. Jack has since passed away and Mary is rebuilding her life. Joy is preparing to go back to work, and move back out on her own. She is under immense stress, and is transferring the responsibility for now, back to her siblings. Whatever your caregiving journey, it is important to acknowledge your limitations and seek help. The more support you get for yourself, the longer you can care for your loved one. LC *Names have been changed upon request of the interviewees
Where you can go for support: Your local Alzheimer’s Society has many supports including g support groups for people with all forms of dementia, caregivers, and family ly members; educational sessions; day programs for people with dementia; ntia; and respite www.alzheimer.ca. d people with First Link – a referral service that connects newly diagnosed g their local dementia to local health and community services, including elp/ Alzheimer Society. http://www.alzheimer.ca/en/We-can-help/ Resources/For-health-care-professionals/first-link e.ca/ Your local CCAC for home care - http://healthcareathome.ca/ In Toronto: Sinai Health System - Reitman centre firstname.lastname@example.org
Home & LongTerm CARE | November 2016
Know a Caregiving Hero? Nominate them for the 12th annual Heart of Home Care Award! Tell us how this caregiver: â€˘ Supports an ill or disabled loved one â€˘ Has improved a life with their super-human dedication and care Visit www.vha.ca and click on
DEADLINE IS JANUARY 17TH 2017 2016 Event Sponsored by:
2017 Media Sponsor:
November 2016 | Home & LongTerm CARE 19
Tips for hiring
homecare professionals By Janet Balfour
Home & LongTerm CARE | November 2016
ACCORDING TO A ROYAL BANK of Canada (2013) survey, 83 per cent of baby boomers hope to remain in their homes as they age. For a growing number of these seniors, their spouses, and concerned families, aging at home is often possible with the help of qualified homecare professionals. The number of seniors receiving homecare in Canada grew by 51 per cent in the 10 years from 2002 to 2012, but in most provinces, public home care supports cannot keep up with demand (RBC, 2013), leaving many families to seek private pay options. Some families may choose to hire help through an agency, while others may opt to hire caregivers directly. Some people may be daunted with the task of hiring and managing a caregiver directly, but should also see the tremendous value of having more choice and control to find the best caring professional to meet your needs. If this is what you decide to do, here are some important tips and interview questions to ask.
How to find qualified homecare professionals? Some people may opt to ask friends, neighbors, coworkers or other caregivers you know for referrals. Post on a bulletin board ad at the library or at a nearby senior centre, adult day centre, or through a student college/university program. Others may choose to go online to find a qualified caring professional through a reputable marketplace, such as www.eadvocate.com, where you can review verified professional profiles of local caregivers in your area.
Checking credentials Be sure that you always begin your search for the best caregiver by asking to review the candidateâ€™s education, training and certifications. You can require that the candidate bring originals of all documents to an interview and/or give you permission to contact the appropriate educational institutions to verify these details.
Check professional standing You should also check if any candidate you are considering is a member of a professional associa-
tion and/or college, to be sure that they are in good standing and not subject to any practice restrictions or disciplinary action. You can contact these professional bodies to seek this information.
Check insurance coverage You will want to be sure that any caregivers coming into your home to care for your loved ones are verified and insured. It is extremely important to discuss how you, your loved ones and the caregiver are covered for any liability issues. Many freelance caregivers may not be covered, so you might choose to hire a caregiver from an online marketplace that offers professional liability coverage.
Background checks You will only want to hire caregivers that have a clear criminal background check. You should ask any candidate to provide you with photo identification and an original copy of a recent criminal background check. Another advantage to using a marketplace when hiring, is that they often require all caring professionals to complete a background check as a condition of work.
Meeting diverse needs One advantage of hiring a caregiver directly is that you can outline the specific and personal needs of your family and/or loved ones. You are able to express preferences related to location, schedule, gender, language, and other needs. Finding the right fit with a caregiver often supports better quality care and better health outcomes. Continued on page 22
Janet Balfour, PhD is the President eAdvocate.com â€“ the Caring Marketplace and Part-time Instructor, School of Social Work, Ryerson University.
November 2016 | Home & LongTerm CARE 21
Some families may choose to hire help through an agency, while others may opt to hire caregivers directly.
homecare professionals Continued from page 21
Contracting your care
Once you have shortlisted the best caregiver to meet your needs, you can also ask them a series of qualifying questions to help determine fit. It is also a great idea to include, whenever possible, the person requiring care in the interview process. Ask them to:
It is important to be very upfront and clear about your expectations when contracting with a caregiver. Setting clear and accountable guidelines for care, scheduling and compensation are central to developing a respectful, professional relationship when hiring caregivers. Another advantage of working through an online marketplace is that they often provide supportive tools to help you create a care plan, manage scheduling, outline daily task lists, as well as completing time sheets, budgeting or tax forms and have secure online payment platforms that help protect everyone involved.
• Describe where they may have had similar caregiving experiences in the past? What specific credentials and/or training they offer? This helps identify relevant experience in caregiving, companionship, and working with people with a diverse range of care needs, as well as knowledge about specific training in areas such as CPR/First Aid, dementia or memory care, mindfulness, mobility, medication management, etc. • Describe how they feel they can best support and meet the needs you require? Candidate responses to these questions offer critical insights into whether you feel this person is well suited to offer care that meets the specific health, emotional, social or household needs of your loved one. • Describe their philosophy and approach to care? Explain why they decided to become caregivers? Who their most memorable client was and/or place to work? You are looking for someone who is not only qualified but enjoys working as a caregiver, is sociable and nurturing.
Home & LongTerm CARE | November 2016
Being an advocate It is important to also negotiate with caregivers how you wish to receive care updates and all emergency contact information has been shared. Using online resources to share real-time updates and information about your loved one, can be the best way to ensure that everyone is reassured and well informed. With a growing number of Canadian families now seeking private homecare, there is a growing need to empower healthcare consumers with safer guidelines and new innovative ways to directly find the caregivers they need. Often going direct, as opposed to through an agency could mean a little more time but also means much more choice, control and savings. LC
A wound care nurse MY NAME: Nicole McGrath MY JOB: Wound Care Nurse
What I do: I identify and treat the challenging, often chronic wounds that can really impact a person’s quality of life. This includes surgical wounds, and wounds caused by poor circulation (caused by diabetes or high blood pressure). As part of our Wound Resource Team, when a care coordinator or visiting nurse would like more ideas in order to support and manage a complex wound, I’m here to help. In reviewing a complex client, I ask the care team what has happened so far, and I will often visit clients at home to speak with them in order to make recommendations that are tailored to their needs. I also collaborate with doctors and other members of a client’s care team to ensure everyone is aware of and using best-practice wound care. For instance, we know that the use of daily dressing changes using gauze is not the best way to heal wounds, especially ones that are complex and are taking a long time to heal. New wound care dressings are reducing healing time, which means less discomfort and risk of infection for our clients.
The best part of my job: I love my job. I get to be part of an amazing team that helps our clients meet their wound care goals and improve their quality of life. I also have an opportunity to do some health teaching with clients, which is really rewarding. When we talk to our clients about what is most important to them, many want to return to independence and manage their own care; we give them the knowledge and the tools they need to care for their wounds and improve their overall health, including recommendations for diet and exercise. Reassuring them that they can improve their quality of life and helping motivate them to meet their goals is a great feeling. LC
Nicole McGrath is a wound care nurse with the Wound Resource Team at Toronto Central CCAC (Community Care Access Centre).
November 2016 | Home & LongTerm CARE 23
In the stressful, fast-paced, rushing-from-here-to-there lives that most of us lead, itâ€™s important to remember to do one simple thing: Breathe.
for better health and happiness
Home & LongTerm CARE | November 2016
FOR JUST ONE MOMENT, listen to the sound of your breath entering your body. Now, listen to the sound of your breath exiting your body. Feel better? If there is one thing that almost all adults and even most kids in the modern world share, it’s a sense of feeling continually stressed. The constant demands on our time, financial resources and energy seem to multiply daily. Add to this the often unrelenting demands of caring for an aging parent, a sick child or a spouse in recovery from an accident that it’s no surprise that our stress levels are through the roof. Stress elicits the “fight or flight” response in our body. It speeds up our heart rate, boosts our adrenalin levels and prepares us to either fight the enemy or to flee from a dangerous situation. This is very useful when we are fighting off sabre-tooth tigers or running from an invading clan. In our modern world, the stress response can be elicited by everyday events such as waiting in line or searching for a parking spot. This response is not only not useful, it’s actually harmful to our health. Chronic untreated stress can contribute to a host of health problems including: • High blood pressure and heart disease • Obesity and diabetes • Mental health issues such as anxiety and depression • Fatigue and sleep disorders • Headache, muscle and chest pain • Eating disorders and stomach problems • Substance abuse Everyone experiences stress differently and the way it impacts your life and health is unique to every individual. If you are concerned about your stress levels or are experiencing some of these symptoms it is important that you speak to your doctor. Help is available. Many people find mind-body techniques helpful in managing stress. Techniques such as mindfulness, meditation, guided imagery, prayer and mind-body exercise such as Pilates, yoga and Tai Chi elicit the relaxation response, a profound state of rest that is the opposite of the stress response.
A simple way to develop a healthier way of responding to stress is through the use of mindful breathing techniques. Deep breathing encourages the full exchange of incoming oxygen for outgoing carbon dioxide. This exchange can slow the heart rate and lower or stabilize blood pressure. The following exercises can be used everyday and in any situation to ease the immediate impact of stress. Do one or all of them. Do them for two minutes for up to 20 minutes. They are great to try when you are waiting quietly somewhere or just before bed when you are trying to fall asleep. Practiced consistently over time, mindful breathing techniques can have a profound effect on your stress levels and bring much needed mind-body freedom to your life. 1. Belly breathing: Place one hand on your chest and one hand on your belly. Breath in and out through your nose focusing on the exhalation. Breathe in for a count of four and out for a count of six. After several repetitions breathe out for a count of eight. Allow your belly to expand more than your chest when you inhale. 2. Imagine your breath as a colour: Imagine breathing in through the soles of your feet and watch the colour move up your legs and torso and out the top of your head. Next, imagine breathing in through the palms of your hands and watch the colour move up your arms and neck and out the front of your face. Alternate hands and feet on each breath and change colours whenever you want. 3. Imagine you are laying on a warm sandy beach at the waters edge: With each inhalation imagine the water lapping up over your body. First to your ankles, then knees, then hips, tummy, chest, shoulders and finally just to the back of your head. With each exhalation imagine the wave receding and dragging with it bits of the sand under your body While we are living in a world that is filled with external stressors, there are some simple ways of managing the daily challenges we all face. By using any or all of these suggested techniques, you can successfully live each day happier, healthier and stress-free. LC
Barbara Grant is the Founder and Director of Retrofit Pilates in Toronto. She can be seen weekly on Rogers television as the host of Shape Up with Barbara Grant. http://www.retrofit.ca/barbs-blog
November 2016 | Home & LongTerm CARE 25
Getting parents to accept
the care they need By Karen Henderson
AS PARENTS AGE, we walk a fine line between wanting them to be independent, and wanting them to be safe. It’s too often the same old story; no matter what you do to try and help a parent remain independent, they refuse any outside help. All they want is you, in some cases for as many hours a day in their home as possible. War can break out.
How can you approach this situation, which I shall warn you, will only get worse? It’s worth spending a few words here on adult psychology. All our lives we are taught to be independent, that asking for help was ‘weak’. All of a sudden, an older person realizes she needs help, but now won’t ask for it, because she has learned not to. Also as we age, we start to lose control – over our health, over the death of family and friends. Anger can then set in, and the senior starts to rage at the world to get back any control that may be possible. For example, a parent may refuse to disclose his financial situation to his children; it’s his money, and one of the last things he can control. The best thing always is to continually communicate with parents about the future. Ask the ‘what if’ questions like: “What if something happens to mom and she can’t care for you dad? What if something happens to me,
your daughter/caregiver?” You are planting the seeds for change. Ask your parent(s) to humour you, and visit some facilities, have a meal, chat with other residents. This can entirely change a parent’s perspective on facility care. In the mean time, here is a plan of action when the situation is fairly calm. 1. Start bringing outside help in early in the game – I cannot emphasize this enough. As soon as you see things going off-track, sit down over a cup of tea and explain to mom that ‘Susan’ will be coming over tomorrow to have tea with her several times a week. That’s it… just tea. Don’t let mom refuse. Let her get used to Susan over time (Susan is not to leave, even when told to!) The longer you leave introducing others into the home, the more difficult it will be – until it becomes impossible. 2. Work with Susan yourself off-line, and gradually get her to help mom, with preparing the tea, cleaning up etc. Hopefully over these gentle, nonthreatening visits, mom will become used to Susan in her home, start to trust her, see she is not losing control, and ultimately ask her for assistance. Obviously the key here is to find the ‘right’ Susan who understands older people, and is very patient – and persistent!
Karen Henderson, founder of the Long Term Care Planning Network is an independent aging and long term care planning specialist. Karen has worked with many families to help them make care decisions. You can reach Karen at 416.526.1090 or email@example.com
Home & LongTerm CARE | November 2016
This article has been written in response to a question from one of our readers:
How can I get my parents to accept outside help or move to a care facility if necessary?
3. If mom continues to complain for no apparent reason, ask yourself: Does she really need me, or just want me? Remind her that Susan is enabling her to stay independent in her own home
things have to get worse before they get better. It may take a fall/broken hip or other incident for the parent to fully understand he cannot remain alone at home any longer.
4. Continue on with the plan; do not give in. Remind mom that you love her, but have a life of your own. Would she want you, her daughter, to ignore her grandchildren?
If a parent has been diagnosed with dementia, and refuses to move, but will accept help, try to keep him at home with supports as long as possible. If things continue to deteriorate, you hopefully have Power of Attorney for Personal Care so you can take legal action to remove him from his home to a safer environment. Obviously, this is the last thing most of us want to do. Also, try bringing in a third party – doctor, minister/priest – to help with the move, so you won’t be ‘the bad guy’.
If a parent is cognizant, accepts no help and a state of war exists, sometimes all that’s left to do is state clearly and calmly: “Dad, I have done all I can to help you remain happy and safe in your own home. But you refuse all outside help, send away anyone I arrange for, then scream at me that I am a ‘bad daughter’ for not spending more time with you. I love you very much, but cannot go on like this – the stress is making me ill, and very unhappy, and I know you don’t want that. So I am going to leave you on your own for a while”. And you leave. At first the anger in you prevails, but then the guilt takes over. Don’t let it. You are doing what both of you need. This approach is called “Dignity of risk”; you are allowing the parent to live in dignity, but perhaps at physical risk. This is, however, his right as a rational human being. Sometimes a parent will come around and realize they really do need help. Or sometimes
But if you have communicated from the very beginning, as indicated above, the move may not be so traumatic. Unfortunately, every care situation is different; there is no one solution. The one constant, though, is this: When a parent is moved, he may feel he is being abandoned. It is critical that you, the caregiver, constantly say: “Dad; please know that I love you and will always be here for you, no matter what.” Moving a loved one into care is one of the toughest things a caregiver will ever do. After it’s done, take the time to remind yourself that you are doing your best – and that’s all anyone can do. LC
November 2016 | Home & LongTerm CARE 27
Christopher loves Pokemon Go!, hanging out at the mall and the recent Ghostbusters movie.
Seeing beyond disability
By Pamela Stoikopoulos
IF YOU SAW CHRISTOPHER’S PROFILE on a social media site he’d seem just like an average 15-year-old boy: his favourite game is Pokemon Go!, he loves to hang out at the mall and, as of August, he was really into the latest in the Ghostbusters franchise. Once described as a “sensitive kid,” Christopher is getting better at jumping into typical high school banter. “This is going to sound bad,” says his mom Joanne Barker, “but he eggs the other kids on. He gives it right back to them,” she notes with a hint of pride. One suspects that Christopher’s feistiness and mischievous grin are largely due to his mother’s passionate personality. “I can rub people the wrong way,” she confesses. It’s clear though, that her resiliency and insistence on bucking the system is why Christopher continues to surpass doctors’ expectations as someone who lives with severe dystonic Cerebral Palsy (CP). Doctors insisted he’d need a g-tube (but he’s able to eat) and that he’d never be able to speak (he now has 28
Home & LongTerm CARE | November 2016
a vocabulary of a robust 5000 words). The condition, however, still makes it hard for Christopher to control the movement of his limbs and impossible for him to perform simple tasks like dressing or feeding himself. “I hate that!” exclaims Christopher.
Sharing to shed light “His brain is perfectly fine,” adds Joanne. And while it’s clear from the sparkle in his eye and his laughter at my jokes that Joanne is telling the truth, it can still be a struggle to get people to look beyond Christopher’s disability and see the artist, the comedian and, yes, even the hormone-driven teen that lies within. It was one of the motivations behind Christopher launching his very own blog, Living with a Disability. His description of himself in the blog captures it best: Hi I’m Christopher! I’m not your average teenager, I have the regular teenager problems: nagging parents, too old to do some things and too young to do others,
Christopher continues to surpass doctors’ expectations as someone who lives with severe dystonic Cerebral Palsy
Christopher with his mother, Joanne.
I have to keep my room clean, I worry about girls liking me and being invited to parties – all the regular crap. BUT I also have cerebral palsy which makes it a little harder because I have to work harder to do everything and even to make other teenagers see me.
A different ballgame: Parenting a teen with CP Joanne, who won VHA’s Heart of Home Care Award in 2015 for her incredible dedication to Christopher as a single working mom, is reluctant to give sweeping advice on raising a kid with CP. “Every child is unique,” she says. “Making sure that, above anything, they can talk to you about anything is essential – because for them it’s a different ballgame. The other kids aren’t going to understand because they’re not going through the same thing.” His bedroom is considered his safe space. “He can go into his room and say, ‘I want to talk,’” she adds. Joanne also notes that depression for teens with CP is a common problem. And while it can take a terrible mental toll, it can also wreak havoc on Christopher’s already-fragile physical state. Joanne insists on a proactive, ear-to-the-ground approach that encourages open communication at all times. She also makes sure Christopher has lots of opportunities for social interaction. Aside from hanging out with his neighbourhood buddies daily, Christopher regularly connects with two teens he met through March of Dimes and Grandview Children’s Centre respectively, many years back. “They need that,” says Joanne thoughtfully. “They have to have a peer that walks the walk they walk.” She cautions parents to be thorough in their investigation of educational options for their teen living with a
disability. Joanne, who is confident that Christopher is able to complete the standard academic curriculum that will allow him to enter college or university, discovered that, without advocacy, he might have been put on a different path. “We’re looking at Trent University because they have a program for people with disabilities and provide facilitation when you need it.” They are also looking a little closer to home at Durham College. “There’s no reason he can’t work in IT (information technology),” notes Joanne. For now though, Christopher, like most teenagers, is focused on getting through the ups and downs of high school – the first loves, the bullying, the laughter and the homework. In a world where “fitting in” is paramount, Christopher confronts being different on a daily basis. His aim as a blogger and advocate for those living with a disability is for the able-bodied world to dig a little deeper to see the film and video game-loving prankster on the inside and “not to see the wheelchair,” Christopher says emphatically. LC
Pamela Stoikopoulos is Sr. Communications and Public Relations Manager at VHA Home HealthCare. For more information visit: www.familycaregiving.ca
November 2016 | Home & LongTerm CARE 29
Eat well, feel well
WINTER IS COMING and you know what that means: Cold and flu season is also on it’s way. But that doesn’t mean getting sick is inevitable; a healthy diet provides a solid foundation for a strong immune system. The immune system is made up of cells, tissues and organs that work together to fight off viruses and bacteria. In short, it’s what keeps you healthy. Supporting your immune system is particularly important for caregivers of elderly people or those with underlying medical conditions who may be at higher risk for complications or hospitalizations from illnesses such as the flu. Here are a few immune supporting superstars that you want to make a regular part of your diet through the colder months.
Fresh vegetables and fruits Vitamin C gets all the press for being a powerful antioxidant that can be helpful in warding off colds and flu, but there are a number of other vitamins such as A, D and E that are just as vital for your immune system.
The best way to ensure that you are getting these important nutrients is to eat fruits and vegetables! Choose a wide variety of colourful veggies and fruits at every meal. In Canada it can be difficult to find high quality produce in the colder months and it’s perfectly fine to opt for frozen. Look for flash-frozen varieties that don’t include any added salt or sugar.
Garlic This immunity superstar isn’t just a powerhouse in the flavour department; it’s also anti-viral, anti-bacterial and anti-fungal, and has been shown to reduce cold and flu symptoms. Load up on fresh garlic and use it liberally in your kitchen. Add it in at the end of your cooking when making soups, stews, or sauces as garlic’s immune-enhancing powers work best when it’s raw.
Probiotic foods Fermented foods such as kimchi are a hot food trend at the moment and for good reason – they are delicious and incredibly good for you! And not just for your gut – the probiotics in fermented foods also support your immune system.
Amanda Laird is a Toronto-based registered holistic nutritionist, writer and speaker who believes that delicious food and healthy food aren’t separate concepts. Visit her website at www.amandalaird.ca and send your nutrition questions to firstname.lastname@example.org.
Home & LongTerm CARE | November 2016
What to eat to ward off cold and flu season Sauerkraut, kimchi, miso and kombucha are becoming more mainstream and are readily available in many grocery stores. While fermented foods might be more of an acquired taste, there are hundreds of varieties from food cultures around the world so try them all until you find what you like!
vegetables, whole grains and proteins and taking care of our overall wellness may help improve your chances of dodging a winter cold this year. LC
It’s not just about what you eat A healthy diet may give you a solid foundation for a strong immune system, but you can’t out-eat bad habits. Other lifestyle factors are just as important when it comes to staying well this winter: • Sleep is vital to all aspects of your health, including the immune system, so make a good night’s rest a priority. • A recent study showed that even a daily brisk walk was enough exercise to reduce sick days by as much as half! So bundle up and get outside to get moving. • Stress doesn’t just bring down your mood it can make you sick. This winter be mindful about managing the stress in your life and make room in your busy calendar for some downtime. While it’s important to have a healthy immune system all year round, it’s essential to pay special attention to your immunity in the winter months when we’re spending more time indoors and natural sunlight is low. Eating a whole foods diet based on good quality fruits, November 2016 | Home & LongTerm CARE 31
MARTHA DIDN’T HAVE TO GO TO THE HOSPITAL TODAY.
With Telehomecare and other virtual healthcare programs, like the Ontario Geriatrics Learning Centre, the Ontario Telemedicine Network supports home and community care. OTN is a nonproﬁt organization supported by the Ontario Ministry of Health and Long-Term Care and Canada Health Infoway.