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Suddenly a caregiver

Holiday nutrition survival guide

December 2016 www.homeandlongtermcare.ca

Caring for someone with an

Invisible injury SSee page 12

What is long term care insurance?


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Home & LongTerm CARE | December 2016


contents December 2016

12 Avoiding slips and falls

Nutrition: Surving the holidays

4 5 18 28 30

8

20

Cover story: Caring for someone with an invisible injury

How to de-stress the holidays

Keep Moving: Lifting properly

10

22

Editor’s Note Dementia strategy supports ports caregivers ca aregivers Family caregivers: Unsung ng hero heroes oes Help with acquired brain n injuri injuries e es Long Term Care Insurance nce

Suddenly a caregiver

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Caregiver SOS

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Editor’s Note 610 Applewood Crescent, Suite 401 Vaughan Ontario L4K 0E3 905.532.2600 www.homeandlongtermcare.ca EDITOR

KRISTIE JONES

editor@hospitalnews.com

ADVERTISING REPRESENTATIVE

DENISE HODGSON

denise@hospitalnews.com

PUBLISHER

STEFAN DREESEN CREATIVE DIRECTOR

LAUREN REID-SACHS IN THIS LAST ISSUE OF 2016 we focus on caregivers who provide care for someone with an acquired brain injury (ABI). Our cover story – Caring for someone with an invisible illness highlights the unique challenges that come with ABI and tips on how to cope. Also in this issue: Information on how to de-stress the holidays for loved ones living with dementia, as well as ways to maintain your healthy eating habits so you can stay healthy. As many of us prepare to celebrate the holidays with our families I think it’s important to step back and consider the added challenges the holiday season can often bring to those who are providing care to a loved one. If you aren’t a caregiver yourself, perhaps you know someone who is. The hustle and bustle of the holidays can be overwhelming, especially when you don’t have the time or resources to make necessary preparations for family events because of the demands of caregiving. The holiday season is a great time to offer extra help to each other or to a caregiver you know. A cooked meal, assistance in keeping the caregivers home safe in winter (see page 8), or simply an ear to listen can go a long way in easing the stress of the holidays. If you know a person receiving care, it’s a great time of year to offer to sit with them so their caregiver can run errands, get shopping done or visit with other friends and family. Small gestures can make a world of difference. Wishing you and your family all the best this holiday season!

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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: info@homeandlongtermcare.ca 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.

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Home & LongTerm CARE | December 2016


A dementia

strategy that supports care partners By David Harvey

THERE ARE OVER 220,000 ONTARIANS living with dementia and by 2020 this number will rise to a quarter of a million people. At some point in our lives, virtually all of us will be touched by dementia. Continued on page 6

December 2016 | Home & LongTerm CARE 5


Continued from page 5

A dementia strategy ategy It can happen in many ways but one likely way is that we may be called upon to serve as a care partner to someone we know who has developed dementia. That person may be our life partner, a parent, a sibling, or a friend. The demands on us may vary with the relationship but we will have a significant role to play. I sense a growing awareness of the importance of keeping up relationships as dementia develops, even though these relationships may be continuously redefined as the condition progresses. Many of us are gaining a better understanding of how dementia affects our relationships and with this, are able to adjust and discover new ways of being together. Learning to adjust to these new dynamics and demands can be challenging, in fact, research has shown that those caring for someone with dementia provide 75 per cent more care hours than other caregivers and experience nearly 20 per cent greater stress. Governments are becoming increasingly aware that care partners play the most significant role in helping people with dementia continue to live lives imbued with purpose and satisfying activities. As governments around the world (Canada being one

that lags behind) develop new policies to mitigate the impact of dementia by determining better ways to support people, policies for care partners are always in the mix. Ontario is in the midst of doing just that, the Ministry of Health and Long Term Care is currently developing a Dementia Strategy for Ontario and the Alzheimer Society is pushing for supports that work for care partners. Funds are currently being expended with the intention of supporting care partners yet stress levels among this group continue to rise. This needs to change. The Society is promoting supports that offer care partners more choice, flexibility and control over the supports and services offered to them. “Too little, too late� is a familiar phrase among care partners today. We have a window of opportunity to show Minister Hoskins that a strong and fully funded dementia strategy is needed for Ontario. Join us at www.actionfordementia.ca to stay updated on our ongoing efforts and to ensure that the dementia strategy gets the support needed to make the difference we all seek. LC

David Harvey is Chief of Public Policy and Research Officer at the Alzheimer Society of Ontario.

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Home & LongTerm CARE | December 2016


December 2016 | Home & LongTerm CARE 7


Slippery when winter Avoiding slips and falls in cold, wet weather By Pamela Stoikopoulos

WITH SUCH HARSH WINTERS, the ice and snow doesn’t just mean tough driving conditions, it’s also a hazard for slipping and falling. This is especially a worry for seniors because falling is one of the biggest health hazards faced by older adults and this risk greatly increases during the winter months. A bad fall can cause serious and long-lasting damage from an injury. Fortunately a few small adjustments can greatly reduce the chance of falling. Following the tips below can help you steer clear of slippery scenarios and lower your odds of an unwanted icy accident. • Regularly remove snow from the driveway and walkways and spread salt, sand or non-clumping kitty litter to get rid of ice. Seniors, particularly those with a history of high blood pressure or heart problems, should avoid snow shoveling because the combination of the cold air and physical exertion can be downright deadly: research 8

Home & LongTerm CARE | December 2016

suggests people 55 or older are four times more likely than younger shovellers to have heart problems while shovelling. Community services and other support agencies often provide snow removal services. • Make sure the sidewalk, driveway and steps are all well-lit. Sensor lights are a great option.


Falling is one of the biggest health hazards faced by older adults and this risk greatly increases during the winter months. • Install support railings that lead to the front door. If railings are already there, make sure they’re sturdy and secure. • Ensure you own a good pair of boots with thick, non-slip rubber soles and that you wear layers of warm winter clothing that can be easily removed if you get over-heated. Feeling cold can make you hurry or tense up which can cause you to lose your balance. • Use a walking aid such as a cane or walker if needed. Make sure it’s the right height and that the rubber grips are in good shape. Ice picks, sold at most drug stores, can also be installed at the end of a cane to offer further stability. • Provide extra treading on ice and snowy surfaces

by investing in ice-grippers or metal tracks to attach to the bottom of shoes. Make sure you can put them on and off by yourself and that you remove them when walking on smooth surfaces like tile or ceramic. • Place a winter mat at the front door so wet boots can be taken off right away. This will prevent puddles that can cause indoor slips. • Carry safety items including a cell phone, whistle and personal identification if going for a walk. It’s also a good idea to bring a small bag of salt or sand to spread on ice along the way. By making simple changes around the home and promoting safe winter practices, you can enjoy a slip and fall-free winter season. LC

Pamela Stoikopoulos is Sr. Communications and Public Relations Manager at VHA Home HealthCare.

December 2016 | Home & LongTerm CARE 9


the holidays How to de-stress

IT’S A TIME FOR CHEER, for extravagant meals, for merrymaking with friends and family. But for some of us, the holidays can also be stressful, particularly if you’re caring for someone living with dementia.

It is possible to be a full-time caregiver and still partake in the celebrations. As you get ready to tackle the holiday season this year, remember to plan early, set realistic expectations and simplify your plans. Here are 10 tips to make the holidays less stressful and more enjoyable for everyone: • Do small family get-togethers instead of day-long events. This will minimize stress and feelings of being overwhelmed, especially if the person you’re caring for is in the later stages of dementia. • Find a quiet area where the person can retreat and have someone keep them company. • Choose familiar places for gatherings to help avoid confusion. • Plan festivities on a day and time that suits the person with dementia. This article was submitted by the Alzheimer Society.

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Home & LongTerm CARE | December 2016

• Check for potentially dangerous items such as decorations that look like candy or fruit. • Decorate your home in stages so the changes are less jarring for the person with dementia. • Involve the person with dementia in preparations by giving him or her tasks they can still do or enjoy, like making holiday cards or wrapping gifts. • Prepare the person’s favourite meals, and keep in mind that too much rich food can cause them to become agitated. • Do things that have meaning such as looking at old family photos or home movies, and singing favourite songs. • Buy a thoughtful gift for the person. You can never predict how they’ll react so don’t be surprised if they’re less than enthusiastic. It’s also a good idea to make a list of doctors or walkin clinics and pharmacies that are open during the holidays in case of an emergency. And, if the person is on medication, make sure they have enough to get them through the break.


Remember, you’re not alone Call your local Alzheimer Society if you need to talk to someone who understands the stress you’re feeling. An Alzheimer Society in your community can offer a variety of support and practical advice. To find one near you, visit www.alzheimer.ca

Make time for yourself Don’t overdo it. It may be tempting to go all out or try to keep traditions from previous years going, but it’s really important to pace yourself so you don’t burn out. • Ask a friend or neighbour to help with shopping or baking – and don’t refuse help if it’s offered! • Assign specific tasks to your children and relatives.

• Adjust your priorities. How urgent is this? • Pat yourself on the back. Recognize the important work you do and how much you mean to the person you’re caring for. For more holiday tips: http://www.alzheimer.ca/en/ Living-with-dementia/Staying-connected/Holidays-andspecial-occasions LC

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Caring for someone with an

invisible injury By Lisa Levin

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Home & LongTerm CARE | December 2016


MANY FAMILY CAREGIVERS SUPPORT someone with a visible health challenge – such as frailty, or developmental and/or physical disabilities. However, many illnesses can be hard to detect with the naked eye – and that makes getting support even more challenging. This is the case for many of the 500,000 Ontarians who suffer from an acquired brain injury (ABI). It is common for those with an ABI to have difficulty obtaining a diagnosis. These individuals often fall through the cracks since health and community care agencies usually require proof of injury and a documented health condition as a requirement for service provision. Caregiving for someone with an ABI requires great stamina since most brain injuries are lifelong conditions. Layered on top of this, 86 per cent of

those with an ABI cannot return to work post-injury and their caregivers become the family’s sole income earner. It is no wonder that these family caregivers have a high rate of burn out and illness. That is what happened to Candice* whose husband Paul* was in a motor vehicle accident. It took Paul many years to realize he had sustained a brain injury. As a result, he was not able to access any benefits through his automobile insurance. Eventually Paul had to stop working – he became very anxious, socially inappropriate, and had significant issues with mental health, processing, memory and executive functioning skills. He experienced separation anxiety and needed to be with Candace at all times. Candace had to help Paul with his personal care and food preparation. She became the sole income earner, caring for Paul around the clock and advocating for his service provision. Continued on page 14

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Caring for someone with an Invisible injury Due to the absence of a diagnosis, Candice was only able to obtain a few hours of home and community support for Paul. Paul was eventually admitted to a hospital for serious mental health issues. Candice developed cancer. Despite her own illness, Candace continues to be the case manager and system navigator for both herself and Paul. There is no one to care for Candace. An ABI can result in behaviours that are a major challenge for family caregivers. Brian’s* wife Nina* suffered a significant brain injury when she was in a motor vehicle accident in the late 1990’s. This left Nina with executive functioning deficits such as impulsivity and aggression. She has no insight into her injury and feels that nothing is wrong. Nina requires full time care, so Brian had to quit his job. Nina is paranoid, and when Brian talks on the phone she screams and yells at him for cheating on her and lying. If they go out together to a restaurant Nina will accuse Paul of flirting with the waitress or other women in the restaurant. Not surprisingly, Brian has become a prisoner in his own home and is increasingly isolated from his friends and family. While there are support groups available for Brian, Nina becomes upset if he leaves the house and will obsessively call and text him. Despite her injury, Nina still has capacity, and can make her own choices about medical and financial matters. She has chosen to cut

Brian out of her medical decisions and is refusing to take her medications. Family caregivers often find that their loved ones with an ABI have poor judgement, and this may result in inappropriate and/or risky decisions. However the threshold to remove someone’s capacity for financial and medical decision-making is high. It is also important to consider for individuals to maintain control and independence whenever possible. This is a significant issue for Rebecca*, whose father Steven* has an ABI. He still has capacity to make his own decisions, however his decisions often do not appear to be in his best interest. Rebecca struggles with how to help Steven when he does not want her help. Steven lives in and out of homeless shelters, drives his electric bike on highways, and does not maintain good personal hygiene or nutrition. Rebecca has serious concerns that her father is at high risk of death or further disability, however she is powerless and cannot intervene. While each ABI is different, it is clear that caregivers of those with an ABI share an often lifelong responsibility that is complex and challenging. If you or someone you know has an Acquired Brain Injury, or is a caregiver for someone with an ABI, there are few specialized resources. The best place to go is the Ontario Brain Injury Association (OBIA). LC *Names have been changed

Their toll free support line is 1-800-263-5404 OBIA offers a peer support program, online bookstore for literature about ABI, and training programs. They can be reached toll free at 1-855-642-8877 There are 21 local associations across the province that offers a wide range of support groups. http://obia.ca/abi-associations/

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 info@lisalevinandassoc.com

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Home & LongTerm CARE | December 2016


Suddenly a caregiver By Susan C C. Jenkins

WHAT DO YOU DO when all of a sudden you find yourself the primary caregiver of a 50-year-old brother with rapidly progressing multiple sclerosis? Well, if you’re like Virginia Miles, you jump in with both feet and learn everything you can about the system. You learn what the options are, what obstacles you are likely to face, and how to overcome them. Continued on page 16

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Continued from page 15

Suddenly a caregiver Lessons learned

The challenges mount

The first lesson Virginia learned is that the further along the disability is, the greater the challenges in navigating the system. The second lesson was the importance of speaking up and never to stop asking questions. Learn all of the possible options that exist and keep pressing for more information if you aren’t satisfied with what you’re hearing.

The next hurdle she had to overcome was her brother’s day-to-day care. Because he was entitled to only three hours of home care per week, living alone wasn’t a safe option for him. Compounding the problem of being unable to care for himself was the fact that no effort was made to match the care provider’s skills and personality to her brother’s needs and temperament, making the arrangement awkward. Adding to the difficulties were the care provider’s frequent late arrivals and no shows. Clearly, Virginia had to find another option.

The first hurdle she encountered was the cost of her brother’s medications – over $30,000 a year. Her brother had no private insurance, and because he was under 65, the drugs were not covered by a government program. Virginia approached the pharmaceutical manufacturers who made the drugs her brother took and requested a discount on compassionate grounds. She got it. Next she approached the pharmacy where he filled his prescriptions and negotiated a reduced markup. She was eventually able to bring the cost of his drugs down to about $150 a month, a reduction of more than $28,000 a year.

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Home & LongTerm CARE | December 2016

While home care was inadequate to allow him to stay in his apartment, a long-term care facility didn’t seem to be right either. He didn’t need that level of care, and Virginia felt it wasn’t a good option for someone his age. Someone recommended a group home, but care at that facility proved to be inadequate as well. In fact, they weren’t even aware that her brother climbed out of the window at night to get some fresh air!


The further along the disability is, the greater the challenges in navigating the system.

Eventually, she determined that a long-term care facility was the best option, despite her initial reservations. At first, it seemed like a great place, but things went downhill pretty rapidly.

A new path Virginia’s experiences led her down a new path. She formed her own company, Compass Healthcare Solutions (www.compasshcsolutions.com) to help guide others through the crosscurrents of the healthcare system. She offers the following advice to families and caregivers who are faced with navigating the system. (see chart) Susan C. Jenkins is a freelance writer and editor specializing in medicine, pharmacy, and healthcare (linkedin.com/in/susan-jenkins-74ab0123).

Communicate • Involve close family members in the decision-making process • Be very clear with service providers and healthcare provides about the patient’s needs and wants Document • Keep track of everything – appointments, tests, results, medications, treatments • Follow up continually Plan Ahead • Get everything in place – a will, a living will, and powers of attorney • Don’t let long-term care decisions reach the crisis point. Do your research ahead of time Stay Informed • Ask lots of questions, and don’t accept anything at face value. If something doesn’t sound right, check it out. • Become an expert research all of your options. Be an Advocate • Stand up for your rights. Don’t be afraid to challenge what you hear or the people you hear it from. • Your loved one’s care is in your hands. Remember that you are in control.

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Family caregivers Unsung heroes By Ruth Wilcock

THROUGH MY WORK AT OBIA I have the opportunity to meet so many wonderful people, including survivors of brain injuries and their families. I am amazed at the commitment and dedication that families and caregivers have toward their loved ones. In my eyes, caregivers are the unsung heroes in our healthcare system.

member is unable to care for their loved one, they can experience tremendous anguish. A family member may also feel pressure to take on a caregiving role even if financially it is not possible. There are times when caregivers may feel somewhat hesitant to initially take on the caregiving role because they feel they would be expected to take on the full responsibility.

In Canada, eight million people, or 28 per cent of the population aged 15 and over, provide care to family members or friends with a long-term health condition, a disability or problems associated with aging. It is estimated that caregivers contribute more than $5 billion of unpaid labour annually to the healthcare system. Despite these incredible numbers, caregivers are often in the shadows and are not recognized for the amount of work and sometimes strain that is involved in caring for a loved one.

Meg Luxton, a sociologist in Toronto who has conducted considerable research in this area of family caregiving, cites such an example:

When a person sustains a brain injury, in an instant the family way of being can be completely turned upside down. Therefore, when a family member is called upon to take on the role of caregiver, many stressors can come into play including financial, emotional, psychological and relational, for both the caregiver and the one being cared for. The person being cared for may experience feelings of guilt and, on the other hand, if a family

My husband was injured at work. He was in the hospital for weeks and we thought that he was going to die. So I took time off work to stay with him. Then I had to go back to work. When he got out of the hospital, he needed full-time care. Everyone – the doctors, the social workers, the nurses – they all assumed I would take care of him. When I said I couldn’t, they acted like I was a monster! Surely if I was a good wife I would do anything for him. Like who was going to pay the bills? I said, he needs care, he should get it. That’s what healthcare is for. Or, he was injured at work the company should pay someone to care for him. It was a big struggle. I spent hours fighting to get him the care he needed. They really tried to make me do everything, but I said I can’t., I have to work. I felt terrible, but he understood.

Ruth Wilcock is the Executive Director, Ontario Brain Injury Association (OBIA). This article appeared in the OBIA Review, Issue 23-4 and is reprinted with permission.

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Home & LongTerm CARE | December 2016


In Canada, eight million people, or 28 per cent of the population aged 15 and over, provide care to family members or friends with a long-term health condition, a disability or problems associated with aging. I use this example because it speaks to the anguish many families face after a loved one has sustained a brain injury. Sometimes families are placed in such impossible positions, including the onerous task of trying to straddle their commitments to their loved one alongside their obligations to their paid employment. This can cause a tremendous amount of strain both at home and at the work place. With this dual role it was found that 30 per cent of caregivers were late for work or had to leave early and 29 per cent missed an average of six days of work because of caregiving responsibilities. Furthermore, many family members cannot continue to work and, therefore, become a full-time caregiver. The OBIA Impact Report found that 79 per cent of caregivers stated their family finances had been impacted as a result of their loved one sustaining a brain injury. For those of us who work in the field of ABI we need to support our family caregivers. They truly are unsung heroes. If you are a family member or you are working with someone who needs support, please feel free to call OBIA at 1-800-263-5404. Our Peer Support Program is an excellent resource that many have found helpful in this journey and we would be happy to make those Peer Support connections. LC

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Nutrition Matters

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Home & LongTerm CARE | December 2016

No matter what you may be celebrating at this time of year, the holiday season brings with it an abundance of delicious food, sweet treats and cocktails. Eating and drinking can often feel like the reason for the season.


Holiday nutrition survival guide WHILE IT’S CERTAINLY TRUE that the holidays only come once a year, that shouldn’t be an excuse to throw moderation out the window and kick-off a month-long sugar bender. Poor nutrition has been linked to a weakened immune system – perhaps that explains why the holidays coincide with flu season – and excess sugar consumption can contribute to anxiety and depression, which may already be heightened at this time of year due to tense family situations and finances. While I would never recommend that you abstain completely from the delicious delights of the holiday season, there is a way to indulge without sabotaging your health goals that will leave you feeling more like a sparkling snowflake than a lump of coal.

Become a Picky Eater Indulge in the special foods you only get at the holidays. Say you only get your Aunt Geraldine’s caramel shortbread at her tree trimming party; go ahead and enjoy every last bite. But say no thank-you to the box of Tim Horton’s doughnuts left out in the office kitchen. Don’t be fooled by the green and red sprinkles, they’re just the same old doughnuts you can get any time of year.

Eat a Balanced Breakfast Breakfast really is the most important meal of the day particularly when it comes to staying on track during the holiday season. Start your morning with protein, complex carbohydrates and some healthy fat – scrambled eggs with whole grain toast and a few slices of avocado, for example. This will help to keep you feeling full for longer and will keep your blood sugar balanced, staving off sugar cravings.

Load up on Veggies There’s always at least a couple of salads or vegetable sides on the buffet table. Vegetables are full of fiber that will help to fill you up. When navigating the buffet fill up half your plate with veggies and then once you’ve piled on the salad – go easy on the dressing – you can indulge in a little of everything else.

Get Some Sleep While a cup of coffee and a sweet treat might sound like just the thing to perk you up after a late night out celebrating, caffeine and sugar can send your energy levels soaring only to leave you crashing, a short time later. A glass of water, a little bit of exercise, or even better a good night’s sleep will help increase your energy.

Keep Moving Be sure to make exercise a priority, even when jampacked schedules make it feel like there isn’t enough time. A little bit of exercise will help boost your immune system, lift your mood and burn off some of those excess calories you’ve been indulging in. Hit the dance floor at your office party or park your car at the opposite end of the shopping mall parking lot. Better yet, bundle up the family and go for a walk to enjoy the holiday lights instead of sitting around the tree eating cookies! Don’t use the holiday season as an excuse to let go of your healthy eating and exercise efforts; you’ll only wind up feeling sick, bloated and tired when it’s all over. A little planning and strategic “picky” eating can ensure you enjoy the holidays, honour your family food traditions and still stay on track. LC

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 hello@amandalaird.ca.

December 2016 | Home & LongTerm CARE 21


Keep Moving:

paÄąn-free Best lifting practices for a

back By Barbara Grant

Caregiving is hard work. Looking after the special needs of a sick or elderly family member is stressful, mentally taxing and emotionally exhausting. It can also be extremely challenging physically, especially when the person you are caring for has limited mobility.

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BACK, SHOULDER AND KNEE INJURIES are common complaints amongst caregivers who are tasked with physically assisting their charges to get in or out of bed or stand from a seated position. Because there is often nobody to take over our job as caregivers if we get injured, when we start to feel real aches and pains we tend to ignore them and push through, blaming it on exhaustion. But eventually those aches turn into injuries and the resulting chronic pain and disability can completely derail our ability to care for our loved ones. It is imperative to do whatever we can to ensure we don’t get injured in the first place. Here are three ways you can create best practices for assisting your charges while keeping your own body safe and injury- free. 1. Learn to lift and transfer safely. You’ve heard the phrase, “Lift from your legs,” but what does that mean? It means don’t lift by bending forward! Bend at your hips and knees when you go to pick someone up and use the strength of your buttocks to straighten your legs to lift. Make sure your feet are stable, take a firm hold and keep the weight of the person close to your body. Hold onto the trunk and hips. Don’t pull the person by the arms and legs and lift as smoothly as possible. Do not try to lift above shoulder height. Avoid turning or twisting your body while lifting. Always tell the person what you are doing and give them extra time to complete the task. 2. Keep your strength up by staying physically active. The best way to ensure you stay injury free is to maintain an active lifestyle that includes strength- building exercis-

es. Encourage your loved ones to stay active as well. The stronger they are the easier everyone’s job is going to be. Walking is the ultimate stay-fit activity that can be done indoors or out by just about everyone. It’s great for cardio-vascular and full body strength and positively impacts your mental health and sense of well-being. Incorporate as much walking into you life as possible including stair walking or hills. Try these three simple exercises at home to add extra strength to your core, back and buttocks. No equipment is needed – just a carpeted floor or a mat. Spend 10-15 minutes daily on these exercises and you will start to feel a big improvement in your strength very quickly. • Toe taps Lie on your back with your arms by your side and your knees bent up in the air. Press your arms into the floor and lower one foot down to the floor as though touching your toes into a pool of water then bring the leg back up to the starting position. Alternate legs. Make sure your back stays neutral with a little curve under your waist and your abdominal muscles stay tight. Move from your hips not from your knees. Repeat 10-20 times. • Bridging Lie on your back with your knees bent and your feet flat on the floor, arms pressing into the floor beside you. Press our heels into the floor and use your buttocks to press your hips up in the air. Lower your buttocks back down on the floor with control. Keep your back neutral and move the torso in one piece reaching your knees long over your toes. You want to feel this in the lower buttocks more than in the back of the thighs. Repeat 10-20 times Continued on page 24

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

December 2016 | Home & LongTerm CARE 23


Back, shoulder and knee injuries are common complaints amongst caregivers who are tasked with physically assisting their charges to get in or out of bed or stand from a seated position.

Continued from page 23

Pain-free back • Arm and leg reach On your hands and knees reach one arm forward and up to shoulder height while you reach the opposite leg straight back and up to hip height. Keep your abdominals tight and your back long. Don’t hang your head. Hold for 3-5 seconds and return to the starting position. Alternate sides 10-20 times. 3. Make use of accessible living devices in the home. The simplest way to help your loved ones help themselves and limit the strain on your own body is to install accessible living devices in the home. Grab bars and railings at the bedside and bathroom, toilet seat raisers and transfer benches for the bath allow

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your charges to assist themselves and rely less on a caregiver’s assistance. Avoid having your charges sitting in deep chairs or couches that are difficult to stand from. Choose a firmer chair or use cushions to prop. Slip-resistant mats will help with balance. An occupational therapist can help you make some simple changes to the home environment to make mobility assistance easier. It’s always challenging to add new things into your routine. But safe lifting practices will make your life easier. Start slowly concentrating on safe lifting techniques and add strength building and assisted devices as you can. Your body and your loved ones will thank you. LC


Know a Caregiving Hero? Nominate them for the 12th annual Heart of Home Care Award! Tell us how this caregiver: • Supports an ill or disabled loved one • 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:

December 2016 | Home & LongTerm CARE 25


Caregiver SOS

behaves inappropriately When your loved one

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My dad has recently been doing sexually inappropriate things in public. I can’t cope!

environmental factors and by changes occurring in the brain.

Signed, Horrified

Try not to panic. Discuss the issue with the individuals being impacted by the behaviour, such as the nursing home staff, or the caregivers. Find a professional you can share your concerns with. Staff may be feeling they cannot bring this subject up with you, especially if they are under your employ. Determining the severity of the behaviour is a good first step.

You just wrote the most common words when someone is dealing with a relative behaving sexually inappropriately. Sexual behaviour can be affected by dementia. This is an area that families, friends and caregiving staff find most difficult to contend with. Families of people with dementia are often embarrassed by this behaviour, as it is not a topic they ever imagined dealing with. Additionally, this is not a topic that most children have discussed – or even want to discuss – in relation to a parent. What is important to remember is that sexual behaviour and interest is a normal human phenomenon. It is expressed differently in different people, but many believe that older adults are not sexual beings. This idea has been disproven time and again. We know that older adults are sexually active in their later years. However, dementia may result in damage to parts of the brain that govern sexual behaviour (frontal, temporal or limbic system) and may result in a person acting out sexually in public, with strangers or staff. A familiar-looking face can trigger an unsuitable response, such as climbing into the wrong bed, undressing or masturbating. Flirting is also not uncommon, but some find it difficult to deal with. Coming to terms with this type of behaviour in your relative is often not easy. The side effects of certain medications can be a contributing factor to the behaviours, so it is important for a physician to review the situation. More often than not, the behaviour is driven by

Sometimes, redirecting the person to the privacy of his or her own room is a sufficient solution. Closing a door or allowing the person to be alone can help, as can a firm-but-kind reminder that this activity is inappropriate in public. Assessing the triggers for the behaviour is also important. Does the man whom mom is visiting at night in an unwanted manner look similar to her husband? Scolding, anger and upset are not the way to cope, since the individual is not aware of their transgressions or their implications. Conducting staff training to deal with this issue is important, and discussions with specialists who work in nursing homes can help manage this care issue. Some staff are more affected and upset than others. Some will find the behaviour just a nuisance. Consistency is key when dealing with the messages around this issue. Medication is sometimes used, but it is not usually the first line of treatment, as it may have unwanted side effects. As a relative you may feel that this behaviour reflects on you, but supporting reasonable interventions is crucial, as is communicating and advocating for help. This is another hurdle in the difficult task of dementia caregiving. LC

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.

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Help for caregivers of loved ones with an acquired brain injury How the Ontario Brain Injury Association helps families SINCE 1986, THE ONTARIO BRAIN INJURY ASSOCIATION (OBIA) has been helping individuals whose lives have been affected by acquired brain injury through education, awareness and support. Founded by families whose children sustained severe brain injuries, OBIA has evolved into a provincial network of affiliated community brain injury associations and support groups. 28

Home & LongTerm CARE | December 2016


What is a Brain Injury (ABI)? An acquired brain injury is damage to the brain that occurs after birth from a traumatic or non-traumatic event. ABI is NOT related to a congenital disorder or degenerative disease, such as Alzheimer’s disease, Multiple Sclerosis or Parkinson’s disease. Traumatic Brain Injury (TBI) is damage to the brain caused by a traumatic event such as a blow to the head, a fall, a motor vehicle collision or a sports related injury. Non-Traumatic Brain Injury is damage to the brain caused by illness such as meningitis or encephalitis, oxygen deprivation (anoxia) or stroke.

A concussion is a brain injury A hard knock or blow to the head, neck, face or to the body or an excessive jolt is enough to cause a concussion/mild traumatic brain injury (mTBI), even when there is no loss of consciousness or external sign of injury.

You are not alone The brain controls virtually everything humans experience. Therefore, when a person sustains a brain injury some of the more common impairments can include: (see graph below) PHYSICAL

An estimated 500,000 Ontarians are living with an acquired brain injury. As you and your loved one navigate the ABI experience, there are resources that OBIA can assist with. We can help by: • Providing emotional support • Explaining the terms and language of the brain injury that you will hear from doctors, lawyers and insurance adjusters. • Advocacy as you navigate the complex system of ABI. • Connecting you to our Peer Support Program. • Providing information through our Online Bookstore • Offering educational programs for families, caregivers and professionals providing an introduction to the world of brain injury such as: e-Learning and inperson certificate training programs. • Connecting you to community resources and your local brain injury association.

What are my next steps? One of the most important things you can do for yourself and/or your family member who has sustained a brain injury is to establish a good support system as soon as possible. It is important to include a strong team of professionals with knowledge of brain injury to help you through the recovery process. LC

COGNITIVE

EMOTIONAL/BEHAVIOURAL

Dizziness or balance problems

Poor concentration

Depression

Headache

Memory problems

Anxiety

Pain

Confusion

Irritability

Fatigue/sleep disturbances

Sequencing dysfunction

Behavioural outbursts

Blurry vision or speech problems

Learning complications

Impulsivity

Sensitivity to light or sound

Initiation loss

Anger/aggression

Motor function

Communicative disorders

Self-image loss

Tinnitus (ringing in the ears)

Social dysfunction

Call: 1-800-263-5404, Visit: www.obia.ca, Email: obia@obia.on.ca, Write: PO Box 2338, St. Catharines, ON L2N 7R9

December 2016 | Home & LongTerm CARE 29


What is

long term care insurance (LTCI) I have never heard of it

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Long-term care insurance helps cover care where you wish to receive it – at home or in a care facility if necessary.

By Karen Henderson

YOU AREN’T ALONE! The product is relatively new to Canada and unknown to most Canadians. It is called a Living Benefit – because this insurance, unlike life insurance, provides benefits while you are still alive. Long-term care insurance helps cover care where you wish to receive it – at home or in a care facility if necessary. It used to be called nursing home insurance, which today it is not; statistics say 85 per cent of claims are paid to people who are being cared for at home. This insurance pays a monthly tax-free cash benefit, which you can use however you wish. Policy benefits include: • Allows you to stay in your own home as long as possible • Provides relief to family caregiver(s) • Permits care choices • Protects estate/assets

What triggers a claim? One qualifies for covered benefits when a physician states that: 1. You are unable to perform at least two of the basic Activities of Daily Living (ADLs) such as dressing, bathing, eating, toileting, continence, transferring (getting in and out of a bed or chair), and mobility 2. When you need 24/7 help/supervision because

you have a severe cognitive impairment such as Alzheimer’s disease or a related dementia

Why would someone consider buying long term care insurance? • They have a family history of dementia • They do not want to rely on family for care • They want to preserve their lifestyle/standard of living • They want care choices and control • They do not want to suffer the way a spouse/ parent suffered • They want to preserve assets for other needs • They want to keep family healthy and together • They want dignity, independence and control • They want peace of mind

How much does LTCI cost? Long term care insurance can be customized to fit almost any budget. The cost is determined by your age, health status, how much coverage you want, the length of time you wish the coverage to last, as well as the elimination period and inflation protection you choose. A licensed insurance professional can easily guide you through the decision-making process.

A word for the wise The best time to consider LTCI is in your early 50’s; at this age, the premiums will be lower and you are more likely to qualify from a health perspective. LC

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 karenh@ltcplanningnetwork.com

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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.

geriatrics.otn.ca ontariotelehomecare.ca


Home & LongTerm Care 2016 December Edition