Planning for doctor visits
June 2017 www.homeandlongtermcare.ca
goals See page 8
Financial help for caregivers
Letter to the Editor
Re: The alternative cancer treatment industry IN JULY 2015 my mother was diagnosed with metastatic ovarian cancer. We had no idea she was sick, yet the left ovarian mass had grown so large that it was obstructing her bowel. Emergency surgery at St. Joseph’s Hospital in Toronto saved my mother’s life, but to all appearances it was only a temporary reprieve. The cancer was very aggressive, had spread throughout her abdomen and pelvis, and could not be surgically removed. The CA 125 test, used to measure a protein (cancer antigen 125) produced by ovarian cancer cells, yielded truly grim data. A normal CA 125 value is less than 35 units per millilitre. My mother’s CA 125 value measured 1395 in mid-July and 2194 three weeks later. We were told my mother would likely be dead within a year. Not wanting to give up without a fight, my sister and I asked my mother’s gynecologist for a referral to Princess Margaret Hospital. He kindly obliged and my mother was entrusted to the care of an oncologist who was prepared to try chemotherapy. There were eight chemo treatments, roughly three weeks apart, throughout the autumn and winter. After the first treatment, my mother’s CA 125 value had dropped to 235. After the eighth and final treatment, it was 3. A CT scan in June 2016 showed “no measurable disease.” Not all cancer treatments will be successful, of course, and my mother’s chemo treatments were not without side effects. Twice she had to be rushed to emergency with excruciatingly painful
Home & LongTerm CARE | June 2017
bowel obstructions, and on one of those occasions she remained a guest of Toronto General Hospital for a week. Many aspects of her life have been changed forever, and a year and a half later we’ve been told the cancer cells are beginning to grow again. More chemotherapy is necessary. My mother is alive thanks to the mainstream cancer therapy she received at Princess Margaret (and OHIP, which covered the cost of it). I feel the need to state that emphatically because her illness has made me aware of a sprawling netherworld of pseudo-scientific cancer treatments that many people tragically mistake for effective. Friends, relatives, and well-meaning strangers have touted the cancer-fighting power of asparagus, Laetrile, vitamin C, macrobiotics, juicing, cannabis (as a cure, not merely a palliative), kombucha and other teas, high-alkaline diets, hydrogen peroxide, and others. I’m grateful for the suggestions I received, and I understand the desperation that would lead cancer patients and their loved ones to consider anything that might help, but none of the natural treatments listed above have been shown in clinical studies to cure or meaningfully fight cancer in humans. The supporting data that exist for them are typically anecdotal or misinterpreted. Some of these treatments, for example ingesting hydrogen peroxide or Laetrile, can cause serious harm. Yet a vast number of websites, books, and videos enthusiastically promote them. Some advocates of natural therapies discourage conventional medical treatments. Continued on page 6
contents June 2017
8 Caregiver resources
Palliative care and dementia
Cover story: Setting caregiver goals
Financial help for caregivers
From cure to care
2 4 22
Letter to Editor Editorâ€™s Note Senior debt
Editor’s Note 610 Applewood Crescent, Suite 401 Vaughan Ontario L4K 0E3 905.532.2600 www.homeandlongtermcare.ca
I AM A PLANNER – always have been. I love checklists, my paper agenda and nothing brings me more pleasure than checking things off that checklist. Unfortunately, I often set unrealistic goals and my checklist ends up being unachievable. So instead of feeling good about all that I have checked off I end up beating myself up about all of the things that weren’t checked off. Caregivers have many demands on their time and often feel as if they are juggling four or five balls at a time. This month’s cover story focuses on helping caregiver’s set goals using the S.M.A.R.T method. According to this method, goals should be specific, measureable, attainable, realistic and timely. When goal setting, caregivers need to ensure that some of these goals include self-care, like getting in better shape, eating better or planning a vacation. Too often caregivers are so focused on the needs of their loved one, their goals and subsequent checklists don’t include anything for themselves. It’s important to keep in mind that setting goals for yourself, to take time for you and improve yourself will only make you a better caregiver.
STEFAN DREESEN email@example.com
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: firstname.lastname@example.org Subscription rates in Canada for single copies is $35.00 per year.
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Home & LongTerm CARE | June 2017
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Perhaps it’s too much to ask that we be perfectly informed and entirely rational when it comes to healthcare
Letter to the Editor Continued from page 2 Others promote the idea that medical professionals are aware of one or more natural cancer cures, but are actively suppressing the truth to protect their multi-billion dollar cancer treatment industry. These claims are absurd, and not just because quackery itself is a multi-billion dollar industry. Conventional cancer treatments are supported by science and are becoming safer and more effective every year. Thanks to advances made in research and treatment, many cancers such as leukemia, Hodgkin’s lymphoma, and breast cancer have seen dramatic increases in survival rates in recent years.
We hardly live in rational times. We are inundated daily with obfuscation of the truth, fake news, and other bald-faced lies. So perhaps it’s too much to ask that we be perfectly informed and entirely rational when it comes to healthcare. But cancer treatment is literally a question of life and death, and it’s sad to see so many well-meaning people, who in other domains may well embrace the conclusions of science, turn their back on those conclusions in this instance and be seduced by ineffective nostrums that should be the real targets of their skepticism. Anthony Minna
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Caregivers know that while every caregiving experience is unique, there are many common issues. We can learn from each other and from resource agencies. This list cannot be exhaustive, but further information can found on the agency links.
resources Provincial Resources: 211 Ontario has a central community information line that can provide you with a wealth of information about resources in your community. Dial 211 or visit www.211ontario.ca Alzheimer Society provides supports to caregivers across Canada and has developed a range of informative brochures and publications. For programs and services, contact your local Alzheimer Society. www.alzheimer.ca BrainXchange provides caregiver resources as a network of people dedicated to improving quality of life and supports for persons with or at risk of having brain-health needs related to dementia, mental health and neurological conditions related to aging or have experienced brain health changes earlier in life that are now more complex with aging. brainxchange.ca Caregiver Exchange offers a complete listing of support services across Ontario. It also provides tips and insights for family caregivers (updated weekly). www.caregiverexchange.ca 6
Home & LongTerm CARE | June 2017
Community Care Access Centres Ontario’s 14 Community Care Access Centres (CCACs), located across the province, assist people in getting the home and community care they need in their region. healthcareathome.ca Elder Caring Inc provides families with the necessary information, guidance and support to plan and care for the older individual and family members. Registered social workers/care managers/ occupational therapists assist the family caregiver by providing advocacy, system navigation and will assess and develop a Plan of Care. Identification of appropriate resources and retirement residences is also part of their personalized service. www.eldercaring.ca Fall Prevention month occurs in November with the slogan. It takes a community to prevent a fall: We all have a role to play. The free Loop website contains archived webinars such as “Practical advice for caring safely: “The ergonomics of providing care for a frail older adult”, “Resources for low income seniors”, “Nutrition and frailty screening” The toolkit provide useful resources for older adults and their caregivers. www.fallsloop.com
Home Care Ontario Home Care Ontario is a member-based organization representing providers of quality home care services from across Ontario. www.homecareontario.ca
Carers Canada is a virtual alliance of diverse partner organizations that work collectively, and autonomously, to identify and respond to the needs of caregivers in Canada. www.carerscanada.ca
Ontario Caregiver Coalition (OCC) is open to organizations and individuals who share common caregiver support objectives. This website also features an extensive list of caregiver resources. www.ontariocaregivercoalition.ca
The Powerhouse Project The Powerhouse Project offers online resources and articles for Ontario’s young carers – youth and young adults, who are in a caregiving role for a family member needing assistance with their daily-lived experience. www.powerhouseproject.ca
Ontario Community Support Association OCSA is the voice of home and community support, representing hundreds of agencies, 25,000 staff, and 100,000 volunteers across Ontario. www.ocsa.on.ca Ontario Ministry of Labour – Family Caregiver Leave Family caregiver leave is unpaid, job-protected leave of up to eight weeks per calendar year per specified family member. www.labour.gov.on.ca Saint Elizabeth is a not-for-profit charitable organization, powered by people who are dedicated to changing lives, health care and society for the better. Learn more about their many services and programs. www.saintelizabeth.com
Service Canada – EI Compassionate Care Benefit Service Canada provides some links to supports and other resources provided by the Federal Government. www.canada.ca Veterans Affairs Canada Check out eligibility for the family caregiver relief benefit. www.veterans.gc.ca Caregiving is a time limited journey. Enjoy what you can, seek help when you need to, and be kind to yourself. LC These resources were compiled by Marguerite Thomas, RN., BScN., Coordinator, Fall Prevention Community of Practice, Consultant, Ontario Neurotrauma Foundation.
thehealthline.ca Find community services in your area of Ontario using the name of your community, postal code, or by map. thehealthline.ca
Canada Revenue Agency (CRA) – Family Caregiver Tax Credit For 2014 and subsequent years, if you have a dependent with an impairment in physical or mental functions, you may be eligible for the Family Caregiver Tax Credit. www.cra-arc.gc.ca Canadian Virtual Hospice provides support and personalized information about palliative and endof-life care to patients, family members, healthcare providers, researchers, and educators. www.virtualhospice.ca Caregiving Matters Caregiving Matters is an internet-based registered charity offering education and support to family caregivers. www.caregivingmatters.ca
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Set caregiver goals using the
S.M.A.R.T method By Melanie Ramos
GOAL SETTING IS A TOOL that you can apply to caregiving, no matter what stage of caregiving you’re at. Using the SMART method of goal setting will help you to become more likely to achieve anything you desire or put your mind to. S.M.A.R.T. stands for Specific, Measurable, Attainable, Realistic, and Timely. In short, when setting caregiver goals: • Be specific and clearly define your objectives about what you want to target and achieve. • It’s okay to aim high, but establish a set of criteria for measuring your progress towards your caregiver goal. This enables you to track your progress as you get closer to achieving your end goal. • Develop a plan with a purpose and clear steps to help you attain your goal. • Be realistic about your ambitions and what you’re willing and able to work on towards achieving your goal. • And finally, set a timeframe for fulfilling your dream and to give you a sense of urgency that will drive you towards completing your goal.
Home & LongTerm CARE | June 2017
Here are some goals that you can set to achieve even more success in your caregiving. Apply the S.M.A.R.T. method to these and other goals you may have, and you will see a roadmap to completion starting to develop.
Take a vacation Believe it or not, taking a vacation can help you become an even better caregiver. A change of scenery is a great way to relax and de-stress from the daily grind of your work and personal life, and help you come back to your caregiving activities with a refreshed outlook. Whether you’re going abroad or staying within the country, travelling anywhere as a caregiver requires careful planning and coordination between you, the person you’re caring for, and other people in your care network. Continued on page 10
Using the SMART method of goal setting will help you to become more likely to achieve anything you desire or put your mind to.
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S.M.A.R.T. method Continued from page 8 If you’re vacationing with the person in your care, learn why it’s important to get additional travel health insurance for yourself and the person in your care.
Get in shape Having a fitness objective to regularly exercise can help your body stay in optimal shape so you can keep up with everything that life throws at you. Exercise improves your stamina, energy, and strength – all things that you need to have when caregiving. You may also want to include the one you’re caring for in your fitness plan to ensure that they are getting the right amount of daily physical activity they need to stay healthy. Remember to track your progress and set a target date for meeting your goal.
Be a better communicator Communication plays a large factor in all of your day-to-day interactions. As a caregiver, having good communication skills is vital to supporting the physical and emotional needs of the person you’re taking care of, as well as your own needs.
Get organized If you haven’t already helped the person you’re taking care of create an advanced care plan, perhaps this is the year to do it. Creating an advanced care plan with the person you’re taking care of is the best way to ensure that their wishes regarding end 10
Home & LongTerm CARE | June 2017
of life care are met, in the event that they’re no longer able to make their own decisions.
Grow your network If Canadian caregivers formed an exclusive club, there would be 8.1 million members. With so many caregiving members, why do 74 per cent of caregivers feel that they don’t have access to caregiving resources and services? Reaching out to fellow caregivers is a way of sharing the knowledge you’ve acquired during your time as a caregiver, and it gives you an outlet to share your emotions, thoughts, highs and lows, and experiences with people who understand where you’re coming from.
Plan for ongoing self-care It’s important to look after yourself in order to prevent caregiver burnout. Even the most fuel-efficient car needs to refuel at some point or risk running out of gas, and caregivers are no different. Even if it’s only for a few minutes per day, make sure you take a break to focus on your needs. Try to pick an activity that’s outside of your caregiving role, whether it’s reading a book, watching a favourite TV show, socializing with your friends, meditating, or even running personal errands. At first it may be difficult to get used to the concept of adding a little “me time” into your schedule, but in time you’ll find that self-awareness
(taking care of yourself) is one of the best ways to take care of someone else.
Caregiver action plan A caregiver action plan can help you maintain and improve your caregiver experience. A caregiver action plan will help you achieve clarity and focus, optimize your resources, improve the use of your time, find peace of mind, fulfill your dreams, and many more. It will also help you maintain and improve your caregiver experience. LC
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Melanie Ramos is a writer for Elizz.com. This article was reprinted with permission.
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Doctor’s visits require a well-made plan My dad has physical and cognitive problems. I go with him to medical appointments, but I can’t speak freely in front of him and the visit is often not as helpful as I want. Signed, Can’t win
Your dad’s care is crucial to you. As the primary caregiver you are the linchpin of his caregiving team, helping dad with all his needs. The family doctor should be the other key part of this team. In fact, many times it is the doctor who first becomes aware of subtle changes in a patient’s health status. Hopefully, your family doctor is someone you like, trust and can rely on. Experience with the elderly is important, but good bedside manner and overall medical skills are essential. It is important to share dad’s needs and care plans, and to make all healthcare providers aware of the type of person your parent was – and is. The doctor’s role is to care for your dad; and if dad is still able to understand and make decisions for himself, then questions and concerns should be directed to him. This can become more complex if dad cannot follow information as well and your help is required. The doctor – and any of your dad’s other health-care team members – are able to receive any information from you as a caregiver, but
unless your father has given legal consent to have you involved, the doctor cannot share information with you. Dr. Lina Giancola, a family doctor, says that this is a key issue and should be addressed early on with all healthcare practitioners. You will likely be asked to sign a form to this effect, so calls and other medically related actions can occur. This highlights the need to have legal documents such as a power of attorney handy. Start and maintain a health file of all relevant information. Keep business cards, feedback, directions and suggestions. An up-to-date list of medications must also be accessible. One of the key things is to be prepared and ready for is a doctor’s appointment. Prepare updates and questions. In some practices, these can be faxed or emailed in advance, thus giving the opportunity for the doctor to prepare as well. Talk to family members ahead of time and ensure that everyone’s concerns are being covered. Multiple players making calls and reporting in can muddle things, and most professionals find it confusing and untenable with busy workloads. Another option is to book a separate appointment for you as a caregiver to go over issues and concerns with the doctor personally. That way, concerns can be dealt with efficiently. This can be done periodically as the condition and needs of your dad change.
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 firstname.lastname@example.org. This article originally appeared in The Star.
Home & LongTerm CARE | June 2017
One of the key things is to be prepared and ready for is a doctorâ€™s appointment.
Often, family doctors are aware of community resources for caregivers; but if not, there are other agencies and supports you can use. The family doctor should be your â€œquarterbackâ€? to care. Coordination and information should funnel through their office, even if you are seeing other specialists. Be sure that you share that expectation with other members of the team who see your parent. This can help ensure the doctor is aware to look for any medical issues that can arise from other conditions. Medical appointments can be confusing. Having an agenda or other administrative support to care for your dad, or another set of ears, can sometimes help. Encourage dadâ€™s physician to provide written lifestyle prescriptions as cues, (especially if they value their doctorâ€™s opinion), e.g., â€œgo to the exercise program three times weekly.â€? This is a technique that often makes your work easier. Remember that each of you has a unique role and you must maintain mutual respect for the expertise that you each bring to your relativeâ€™s care. LC
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Financial help for caregivers in Canada
By Christine Stewart
AS CAREGIVERS, life is continuously throwing us curveballs so it can be hard to stay on top of the programs, tax benefits, and caregiver financial support that is available, especially if someone were to get sick or have an accident. Heather Haddon is a self-employed financial planner (CFP, CHS) who runs three successful businesses – financial planning, Heather Haddon Tax Prep, and SWAN Connection. ection. She explains some of the optionss available when it comes to financial ncial help for caregivers in Canada. a.
Caregiver tax benefits Heather explains, “If the person you are caring for lives with you, you can work with your financial planner to claim various amounts on your annual taxes – similar to claims ms for dependent children. Your income comes off of these amounts. mounts. While they are not monthly ly benefits, they help to generate a tax refund refund.”” You may be eligible to: • Claim an amount or an additional $2,093 on your taxes through the Family Caregiver Amount (FCA). The additional amount changes each year • Claim the person’s medical expenses • Claim rebates for any renovations you’ve made to your house 14
Home & LongTerm CARE | June 2017
Canada pension plan disability /Quebec pension plan disability This plan provides financial assistance to people who have been working up until the age of 60, but who are unable to work due to illness or disability. The CPP Disability Benefits are paid monthly to eligible applicants and their dependent children.
Disability ttax credit (DTC) The Disabil Disability Tax Credit is not age restricted. Similar or income inco to the Canada Pension Plan Disability, eligible condiDisa tions need to be severe tio and prolonged. an H Heather explains, “For eexample, Alzheimer’s o or loss of other menta tal capacities - these are no not going to get better. The They will also become more expensive for caregivers.” El Eligibility also doesn’t need to be for a condition that comes on later in life. Heather recommends filling out the form early on. Depending on the medical condition, take the application form to your family doctor or health practitioner (e.g., optometrist, audiologist, occupational therapist, physiotherapist, psychologist, or speech/language pathologist.) You may need to pay for this.
As caregivers, life is continuously throwing us curveballs so it can be hard to stay on top of the programs, tax benefits, and caregiver financial support that is available. “It’s important to know that the application often gets denied the first time,” Heather cautions. “Don’t give up – you can appeal it, and it may get approved.” Benefits can be retroactive to the year of diagnosis. Again, it is not a monthly credit, but it can provide a big annual refund on your taxes.
Compassionate care leave Juggling work and caregiving is hard. You can receive compassionate care benefits up to a maximum of 26 weeks if you have to be away from work to provide care or support to a family member with a life threatening illness. If you are unemployed and already receiving EI benefits, you can also apply for compassionate care benefits. “This is an underused benefit right now,” says Heather. “But similar to EI, it can give you up to 60 per cent of your income.”
No matter what stage of caregiving you may be in, it’s important to have a good financial planner. A professional financial planner will take a holistic look at your family’s entire situation and help you build a solid future. To support family and friends with significant medical costs, many people have recently used online crowdfunding sites like GoFundMe. It’s a great platform to rally help, generate cash flow, and share updates. It’s also worth noting that GoFundMe collects a small percentage of the money raised, and is not a registered charity, and therefore does not provide a tax deduction. LC Christine Stewart is a writer for Elizz.com. This article is reprinted with permission.
Registered disability savings plans A registered disability savings plan (RDSP) is a savings plan that is intended to help parents and others save for the long term financial security of a person who is eligible for the disability tax credit (DTC). Contributions can be made until the beneficiary turns 59. “Government grants go with it, but this is a longer term proposition that you want to start younger; for example, supporting a child with Down syndrome or cystic fibrosis.”
Beyond government support programs If your employer benefits include a disability plan, speak with your family doctor about a stress leave. Collecting benefits though your employer can mean the difference between keeping or quitting your job,” says Heather. Caregiver stress and burnout is real and a risk to your physical and mental health. “Stress leave is often needed and don’t be embarrassed to ask for it.” June 2017 | Home & LongTerm CARE 15
Palliative care and dementia WHAT COMES TO MIND when you hear the words ‘palliative care?’ If you’re like most people, you probably think the person is going to die soon and there isn’t anything that can be done. Or, you may think the person’s care team has given up. Misconceptions abound. What is palliative care? It’s about providing the best possible quality of life for people facing lifethreatening illnesses like dementia, right up to and through their final days. 16
Home & LongTerm CARE | June 2017
Dementia and its many forms, including Alzheimer’s disease, have a terminal phase. Some dementias will worsen over time and the person will eventually die of related complications or another condition they may have. Regardless of when focuses on comfort care helps manage symptoms, as well as pneumonia.
death occurs, palliative care – not cure. Good palliative the person’s pain and other as treatable conditions such
Good palliative care helps manage the person’s pain and other symptoms, as well as treatable conditions such as pneumonia.
Spiritual and social support is also critical, not only to ensure the person’s quality of life, but also to provide emotional support to their family after death occurs.
their goals of care. These will differ for each of us, and palliative care should address these.
According to the Canadian Hospice Palliative Care Association, 74 per cent of Canadians think about end-of-life, yet we don’t easily talk about death and dementia.
For me, I may want to listen to my favourite music when I’m feeling agitated. For you, it may mean looking at family photos. This is what we call person-centred care – knowing each person as a unique individual helps the person with dementia live with dignity.
Palliative care opens the door for these conversations and raises awareness about care options that can help those who have dementia live comfortably and contentedly as their disease progresses.
Palliative care is about healthcare teams working together and never giving up on the person, always treating them as a whole person, and thinking about their comfort.
When we talk about providing palliative care to someone with dementia, it’s important to discuss
We all want and deserve good palliative care. People with dementia are no different. LC
This article was submitted by The Alzheimer Society of Canada.
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Five ways to
lighten up for spring SPRING IS FINALLY HERE. The sun is shining, the blossoms are peaking and the promise of summer is in the air. The streets are coming alive as the warm weather draws us out of our homes and onto patios and into parks. Suddenly we are shedding layers. The parkas are gone and even light jackets and sweaters are being discarded. Boots give way to shoes, leggings to bare legs, dark, heavy fabrics to floaty colours and florals. Lunches get a little longer and bedtimes come a little later as the light lingers into the evening. 18
Home & LongTerm CARE | June 2017
Spring is always a great time for cleaning and clearing the clutter. Get rid of the heavy wet grime of winter and be ready to start anew with a purged closet or a pruned garden. Cleaning things out, washing windows and getting into the corners of basements and garages allows us to get a fresh start. We too need some care and attention to clear out the winter debris and heaviness and get a fresh start. As we shed our outer layers let us also consider shedding some inner layers with these five easy ways to lighten up for spring.
1. Choose restorative exercise. You have been working hard all winter. Give yourself a break with some restorative Pilates or other exercise to focus on releasing muscle and joint pains and restoring nervous system equilibrium. 2. Choose fresh fruits and vegetables. It is recommended that we eat 10 servings per day of fresh fruits and vegetables. Most Canadians don’t come close to that. Forget micro-nutrients! Load up on fresh produce at your local market. 3. Choose mindfulness. It’s easy to miss the beauty of budding flowers and returning birds when we are constantly rushing from place to place. Slow down and be conscious of the sites and
sounds around you. Just a few times a day focus on your breath and be mindful of your environment and your impact on it. 4. Choose outdoor transportation. Not everyone can walk or ride their bike to work. But we can all spend a part of each day getting around outdoors – walking, running, cycling, skateboarding, pole-walking, whatever you choose. If you can, do it in a park. It’s even better! 5. Choose kindness. Grudges and petty grievances weigh us down. Lighten your load by choosing to be kind regardless of how others behave. You might find that kindness is more often than not, met with kindness, especially when it is not expected. 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
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From cure to care By Susan Jenkins
LEARNING THAT A LOVED ONE has a life-limiting illness can be a shock. So many questions come to mind. What is likely to happen? When will it happen? What decisions will have to be made? How will it affect your relationship with the person? How can you help? This can be an emotionally-charged time with raw emotions and uncertainty about the future. Only time will ease the pain, but understanding what is to come can make it easier to deal with the situation.
What is palliative care? When someone is diagnosed with a life-limiting illness, at some point a health professional may bring up the subject of palliative care. To put it simply, palliative care is end-of-life care. It is when the focus shifts from trying to cure a disease to caring for the person’s comfort. This can include pain control, nausea relief, emotional counselling, and a variety of other therapies. The aim of palliative care is to provide the best possible quality of life for someone who is dealing with a life-limiting illness. Respect and dignity are essential to palliative care. For a caregiver who is not part of the family, this can mean learning about the person’s culture, beliefs, and values.
Decisions One of the first decisions that will have to be made is where the person wants to be at the end-of-life. Options include at home, in a hospital or long-term care facility, or in a hospice. 20
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If the person wishes to pass away at home, you will need to determine the type of care that will be needed, and appropriate arrangements will have to be made. The family doctor will be able to explain what is likely to occur and what preparations will need to be made. It is important to find out if the person would like to pass in solitude or would prefer to be surrounded by family and friends. If he or she would like company, it is important to determine ahead of time who the person would like to see and who should be kept away. Another thing to consider is whether the person would welcome a visit from the clergy. Don’t assume that someone who hasn’t been an active member of a faith-based group would not welcome such a visit. Don’t be afraid to ask gently about this.
Providing comfort As the end approaches, the person may not be able to attend to basic needs, even simple hygiene. This can provide the caregiver with an opportunity to provide both physical and emotional comfort. As you help the person with these simple personal tasks, you can touch and hold your loved one. Talk comfortingly, but make sure you listen attentively when he or she wants to do the talking.
the person’s doctor to see if anything more can be done. Other things you can do to make the person comfortable include: • Checking the amount of light, the temperature, and the air circulation regularly and making adjustments when necessary • Making sure the bedding is changed regularly • Offering liquids periodically to prevent dehydration or, if the person has difficulty swallowing, moisten the lips and mouth with a wet cloth or mouth swabs
Saying good-bye This can be a highly emotional time, but it can be a chance to remember good times with loved ones, put old wounds to rest, and embrace the memory of happy days and love shared. LC If the person takes medication for pain, make sure he or she gets the medicine on time and takes it properly. If you don’t think the medication is controlling the pain well enough, consult
Susan C. Jenkins is a freelance writer and editor specializing in medicine, pharmacy, and healthcare. She can be reached at email@example.com.
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Are you a senior
drowning in debt? By Caryl Newbery-Mitchell & Mary Plahouras
AFTER A LIFETIME OF HARD WORK, seniors should now be at a stage in their lives where they can slow down, retire and enjoy their golden years. Unfortunately for many seniors, this is not the case. Insufficient income from government pension plans and savings, combined with the high cost of living, health issues, relationship breakdown and often providing financial assistance to adult children are some of the main reasons seniors find themselves in debt in their retirement years. As a result, Licensed Insolvency Trustees (“LIT”) are seeing a greater number of individuals in their retirement years looking to understand the options available to them under the Bankruptcy and Insolvency Act (“BIA”). The primary purpose of the BIA is to allow an honest but unfortunate debtor to obtain a release from their debts and make a fresh start. Under the BIA, an individual debtor may be able to file an assignment in bankruptcy or a Consumer Proposal in order to obtain a release from their debts and start fresh again. But to many seniors, the thought of filing a bankruptcy, often after many years of successfully managing their finances and maintaining a good credit history, is devastating. On the other hand, many seniors are also at a stage in their lives where they will not require the use of credit going forward, 22
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such as for obtaining a mortgage or credit cards and are in a good position to use a proceeding under the BIA to get out of debt. Usually the two most significant factors for seniors when considering filing a bankruptcy or a Consumer Proposal are: • Assets owned by the debtor; and, • If there is any excess cash available once all monthly expenses have been paid. If the debtor owns assets that would be realizable in a bankruptcy (such as equity in real property), they may be able to sell that asset in order to pay off their debts and avoid a filing under the BIA. However, if they have no realizable assets and most don’t as they have already exhausted all of their sources of cash by the time they meet with a LIT, then a filing under the BIA may be their only option for dealing with their debt. When choosing between filing a bankruptcy or Consumer Proposal, a Consumer Proposal will usually require there to be an excess of cash once all monthly expenses have been paid. If the individual’s income barely covers their monthly expenses, as is often the case with seniors living on a fixed income, there may be no alternative but to file an assignment in bankruptcy to deal with their debt.
LIT’s are also seeing more seniors with income tax debt owing to the Canada Revenue Agency (CRA). This often happens in circumstances where the individual has elected for income taxes not to be taken off their pension payments. This means that come tax filing time they will owe taxes. After one or two years of non-payment, the seemingly small amount of taxes owing can become an insurmountable debt. We also see this in circumstances where an individual is not earning enough income from pensions or savings and chooses to supplement their income by working on a self-employed basis after retirement, but do not deduct taxes at source. The accrual of income tax debt can result in garnishments being placed on an individual’s pension payments, other income sources and bank accounts by the CRA. A garnishment almost always has the effect of further exacerbating an already difficult financial situation. Filing an assignment in bankruptcy or a Consumer Proposal will put in place a stay of proceedings which will allow the garnishment to be lifted and ordinary payments to resume. Going forward, the individual can request the government take taxes off of their pension payments in order to avoid future tax liability. In circumstances where an individual has little or no realizable assets and no excess income to be able to afford to pay the fee to file a bankruptcy, the Office of the Superintendent of Bankruptcy (OSB)
offers the Bankruptcy Assistance Program (BAP). This program is available to any individual that cannot afford to pay the regular LIT’s fee. The BAP process works as follows: • The OSB keeps a list of LIT’s who participate in the BAP by offering their services at a reduced rate. Contact the Office of the OSB to request a BAP registration form and a list of LIT’s participating in the BAP in your locality. • Once you receive the BAP registration form, contact two LITs from the list and schedule an initial consultation meeting with each for an assessment and to obtain the LIT’s signature attesting to your inability to pay the LIT’s regular fees. • Submit the completed BAP registration form to the OSB. The OSB will review the information and if warranted, designate a LIT to administer your bankruptcy estate. Taking the initiative to deal with a difficult financial situation is often the hardest part of the process for an individual, especially when they are finding themselves in financial difficulty at a later stage in their lives. A LIT is in the best position to discuss their financial situation and to review the options available, whether it is to make use of a proceeding under the BIA or another option that would avoid the use of a formal proceeding. LC
Caryl Newbery-Mitchell is a Licensed Insolvency Trustee in the Greater Toronto Area and Mary Plahouras holds a Master of Laws in Bankruptcy and Insolvency Law from Osgoode Hall Law School and is an Estate Manager at MNP’s Toronto and Markham locations. For more information visit www.mnpdebt.ca.
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