Inside: Caregiver SOS | Wearable Therapy | Nutrition News | Innovation
May 2018 Edition
Staffing crisis in seniorsâ€™ care Page 10
Take your best shot: You’re never too old to be vaccinated By Ellen Kirk-Macri, RN, CDE and Susan C. Jenkins any Canadians think that vaccines are just for children. Too many don’t realize that the protection vaccinations give can decrease over time and a booster shot may be necessary, putting older people at greater risk for some diseases and for severe complications. According to the US National Institute of Health, adults age 60 and older are more than 2.6 times more likely to die from a vaccine-preventable disease than someone between 20 and 59 years old.
ADULT VACCINATION RECOMMENDATIONS VARY SLIGHTLY FROM PROVINCE TO PROVINCE, BUT THE CANADIAN IMMUNIZATION GUIDE OFFERS A GENERAL OVERVIEW
As a caregiver, you have an opportunity to educate your clients, their families, and visitors and to encourage them to make sure that their vaccinations are up to date. Don’t forget, healthcare providers need vaccinations, too! In addition to vaccinations for diseases that are more common among older people (e.g., herpes zoster), adults should also keep their routine vaccinations up-to-date. Don’t rely on clients’ recollections about their vaccination history; get verification whenever possible. Health Canada reported recently that while most adults believed they had received all necessary vaccinations, in fact, less than
GUIDE TO ADULT VACCINES Vaccine
Who Should Receive It
Everyone, every 10 years
People with medical, occupational, or lifestyle risks; travellers to high-risk areas
People with medical, occupational, or lifestyle risks
People 60 and older (may be administered to people age 50 and older)
HPV (human papilloma virus)
Females and males 9 to 26 years of age (may be administered to females or males 27 years and older who are at ongoing risk of exposure)
Annually, especially for people at high risk of complications
People who have not had the vaccine or the disease
People with specific medical conditions and those living in communal residences
People who have not had the vaccine or the disease
Everyone, once in adulthood
Everyone 65 and older who has a strong immune system; people younger than 65 who are living in long-term care facilities; people with specific medical conditions
People who have not had the vaccine or the disease
Everyone, every 10 years
People who have not had the vaccine or the disease
Source: Adult Immunization: What Vaccines do You Need? Immunize Canada. https://immunize.ca/adults 10 per cent were actually up to date on their immunizations. Adult vaccination recommendations vary slightly from province to province, but the Canadian Immunization Guide offers a general overview.
EASING THE PROCESS Some clients may be reluctant to get vaccinations due to fear of pain associ-
ated with the injection. Here are a few simple steps you can take to make the process easier. • Allow the person to get comfortable. Some people may prefer to sit up; others may want to lie down. • Ask the person to take a slow, deep breath and then to exhale slowly. • Try to distract the person by talking about something that interests him/
her, playing music, or putting on the television. • Topical anaesthetics such as EMLA®, AMETOPTM Gel, or Maxilene® can reduce the pain from a vaccination, but they must be applied according to the manufacturer’s instruction long enough prior to the injection so they will have time to numb the skin. LC
Ellen Kirk-Macri is a registered nurse and certified diabetes educator. Susan C. Jenkins is a freelance writer and editor specializing in medicine, pharmacy, and healthcare. She can be reached at email@example.com 2 Home and LongTerm Care News MAY 2018
contents May 2018
Cover story: A perfect storm
Looking for the next great idea
4 13 14 16 18 19 21 24 26
Healthy aging research
Managing emotions as a caregiver
Publishersâ€™s Note Wound care Caregiver SOS Improving service capacity Nutrition News Powers of Attorney Dementia Medical Aid in Dying Managing emotions
Wearable e therapy pyy
A battle with cancer
Attention Readers Dear Reader, In 2016 we were asked by many industry members to deliver more coverage on the growing home and long-term care sector. We answered that call with Home and LongTerm Care News and have been publishing ever since. We have received so many positive comments and tremendous support over the years. It is our goal to continue to provide coverage and a voice for sharing best practices, but after the May issue we will now publish this information within a special section of Hospital News. This amalgamation will allow us to bring more value and content to our readers and bring greater coverage for our advertisers. As of the June edition, the distribution of Hospital News will now include all long term care facilities in Canada. As always, we welcome your comments and suggestions. Please feel free to send to firstname.lastname@example.org Stefan Dreesen Publisher, Hospital News
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JULY 2018 ISSUE EDITORIAL: June 11 ADVERTISING: Booking and Material â€“ June 22 Home and Long Term Care News 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 News, or the publishers. Home and Long Term Care News 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. Canadian Publications mail sales product agreement number 42578518. From the publishers off Hospital News, reporting on health care news and best practices for over 30 years.
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Wearable therapy Toronto research team has created clothing with a special something inside that delivers therapy in a whole new way. The novel shirt and pants are designed to help reawaken muscles in people with upper or lower limb paralysis caused by stroke or spinal cord injury. The clothing is embedded with electrodes that deliver functional electrical stimulation (FES)—a therapy that uses low-intensity electrical pulses to generate muscle contractions and improve motor function, such as the ability to stand or grasp a cup. With AGE-WELL funding, the researchers at Toronto Rehab – University Health Network (UNH) will now
Photo courtesy of AGE-WELL.
Dr. Bastien Moineau, an AGE-WELL HQP and postdoctoral fellow at Toronto Rehab-UHN, demos a garment-based device designed to retrain motor function in people with paralysis.
THE NOVEL SHIRT AND PANTS ARE DESIGNED TO HELP REAWAKEN MUSCLES IN PEOPLE WITH UPPER OR LOWER LIMB PARALYSIS CAUSED BY STROKE OR SPINAL CORD INJURY test the shirt with people who have upper limb paralysis. The pilot trial is being conducted by project lead Dr. Milos R. Popovic and colleagues in collaboration with industry partner Myant Inc. “In hospitals, FES therapy is given to patients using an iPad-size electric stimulator,” explains Dr. Popovic. “Garment-based FES is intended for use at home to train and assist people
to do daily activities, such as standing, transferring and grasping objects. For older adults whose mobility and participation in society is limited by neurological conditions, the potential benefits are enormous.” The researchers are also holding focus groups with end users and clinicians with the goal of identifying all challenges in bringing this “e-suit” to market in the future. LC
a leader in health continuing professional education Find out more about our interactive courses designed for health professionals working in home and long-term care: • ;`i\Zkfif]:Xi\:\ik`ÔZXk\`e:c`e`ZXc Leadership Other programs of interest: • K_\Nfle[:Xi\:\ik`ÔZXk\ • K_\8[mXeZ\[Nfle[:Xi\:\ik`ÔZXk\ • :\ik`ÔZXk\`e@MXe[@e]lj`feK_\iXgp • Fundamentals of Patient Navigation Contact us for more information: 416-736-2100 ext 22170 | email@example.com hlln.info.yorku.ca/open-programs www.longtermcarenews.ca
MAY 2018 Home and LongTerm Care News 5
Looking for the next great idea By Rebecca Ihilchik solution accelerator focused on driving innovation in the aging and brain health sector, CABHI – led by Baycrest Health Sciences – supports new products, services, and best practices that address challenges associated with the aging brain, including dementia. CABHI recently announced the third round of funding available through its Spark Program. This program is an exciting opportunity for individuals working in a long-term care home or at the point of care to develop and test their innovative idea – paving the way to eventual real-world adoption of their product or service. Those caring for or working closely with older adults understand the challenges and areas for improvement in seniors’ care in an intimate way, but may not have the access, backing, or resources needed to take their ideas to a wider audience. CABHI bridges that gap by providing financial and developmental support to these ideas with the potential to affect positive change for both aging adults and the healthcare sector at large. Successful Spark applications will receive up to $50,000 CAD to support proof-of-concept testing for their projects. Up to $1 million in total funding is available.
In addition to the financial support, successful applicants also receive valuable guidance and feedback opportunities from CABHI’s innovation team. The opportunity to access this expertise in areas like business development, project management, design, and commercialization – among others – means that what starts out as a good idea stands a fighting chance at becoming a viable, successful product or service that finds its way into the hands of the people who genuinely need it. CABHI supports innovations aimed at finding solutions to four care priorities: • Aging in place: solutions that enable older adults with dementia to maximize their independence and age in the most appropriate setting of choice • Caregiver support: solutions that support caregivers in their care for older adults with dementia; • Care coordination and navigation: solutions that assist older adults, caregivers, and healthcare providers better coordinate and navigate care for older adults with dementia; • Cognitive health: solutions that improve brain/cognitive health for aging adults or support the identification and assessment of adults at risk for dementia or other cognitive impairment.
One successful Spark project is GeriMedRisk, a network of geriatric medication specialists that support clinicians involved in the primary care of older adults. When clinicians have a question about their patient’s medication, they can telephone or e-consult with GeriMedRisk and reach a specialist who is able to help. The service is meant to optimize patients’ medication plans, leading to improved cognition, mobility, and mental health – while also decreasing adverse effects caused by less-than-ideal prescriptions. The financial support and guidance from CABHI have helped to accelerate the development and adoption of the innovation. With coordination from CABHI, GeriMedRisk was tested in long-term care facilities across the Kitchener-Waterloo region, where founder Dr. Joanne Ho and her team are based. The results were overwhelmingly positive. Most recently, the Waterloo Wellington Local Health Integration Network (WWLHIN) has granted $500,000 and committed to adopting the program across the entire LHIN. GeriMedRisk is on track to become a regular fixture in clinical practice across the region, helping to improve the care provided to its older adults. “CABHI’s support through the Spark program helped us take off,”
says Dr. Ho. “To receive financial support from an organization like CABHI and to know that they support our research…carries weight.” One long-term care resident shared that “without the [GeriMedRisk] recommendation I would still be on too many medications… It’s a great service and I would recommend it highly to anybody.” Another successful Spark project is iGeriCare, a digital resource platform to which physicians can refer patients and families after a diagnosis of dementia, in order to better understand the medical and emotional journey ahead. iGeriCare offers learning modules developed with input from geriatricians, clinical staff, patients, and families. Older adults newly diagnosed with dementia and their families are able to access the resources at their own pace, which can reduce stress and increase retention and understanding of key information. They can also be
Rebecca Ihilchik is the Marketing & Communications Specialist Centre for Aging + Brain Health Innovation. 6 Home and LongTerm Care News MAY 2018
Dr. Joanne Ho and Lindsay Cox at the CAHBI Innovation Showcase 2017.
IN ADDITION TO THE FINANCIAL SUPPORT, SUCCESSFUL APPLICANTS ALSO RECEIVE VALUABLE GUIDANCE AND FEEDBACK OPPORTUNITIES FROM CABHI’S INNOVATION TEAM assured the information is coming from a trustworthy source. “The Spark catalyst is really what started everything,” says project lead Dr. Sztramko. “Once we got that award, everybody else seemed to jump on board and get really excited about iGeriCare. We used the money to build out the project, but also acquire human resources – it’s been extremely helpful.” “If I were backing up several years and was in the middle of my family member’s crises with Alzheimer’s, I www.longtermcarenews.ca
would find this very helpful,” shared a caregiver who used some of the iGeriCare modules. Post-Spark, iGeriCare received additional funding from CABHI to test the program in a real-world care setting. The project is on its way to change the way in which older adults and their families understand, and are prepared for, the realities of dementia. The deadline to apply for Spark is 5 p.m. EST on June 14, 2018. Application and full details are available online at cabhi.com. LC
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MAY 2018 Home and LongTerm Care News 7
overin funding 5.3 million for healthy aging research By Margaret Polanyi he AGE-WELL Network of Centres of Excellence recently announced funding totalling more than $5.3 million over the next two years for 27 research teams across Canada. The funding will support work on a wide array of new technologies, services and policies/practices that make life better for older adults and caregivers. The projects involve 55 network investigators at 26 universities and re-
THE FUNDING WILL SUPPORT WORK ON A WIDE ARRAY OF NEW TECHNOLOGIES, SERVICES AND POLICIES/PRACTICES THAT MAKE LIFE BETTER FOR OLDER ADULTS AND CAREGIVERS search institutes across Canada. Part of AGE-WELL’s Core Research Program, the projects have been funded by the network over the past three
8 Home and LongTerm Care News MAY 2018
years. All were rigorously evaluated by the AGE-WELL Research Management Committee before receiving the renewal funding announced today.
“These projects are now entering into a crucial new stage with a focus on commercialization, knowledge mobilization and impact,” says Dr. Alex Mihailidis, Joint Scientific Director of AGE-WELL, Canada’s technology and aging network. “The new funding will ensure that the products being developed move through the innovation pipeline to improve quality of life and deliver social and economic benefits to Canada and the world.” www.longtermcarenews.ca
NEWS This prototype virtual gym is among more than 70 products being developed by AGE-WELL investigators. The computer-guided system delivers personalized exercise instruction and feedback. It is designed for older adults who have chronic conditions, early-to-moderate dementia, mobility, accessibility or transportation challenges―and who will benefit from an exercise program where they live. Photo courtesy AGE-WELL
The wide-ranging projects include systems that can monitor people’s health at home, remote therapies, and novel ways to connect people and ease social isolation. There are other projects that look at the needs of seniors and caregivers, and inform the development of new policies and approaches to stimulate innovation and technology adoption. Dr. Andrew Sixsmith, Joint Scientific Director of AGE-WELL, stressed how much this research is needed. Canada’s 2016 census shows that Canadians 65 and older now outnumber children for the first time in the survey’s history. “The challenge is to ensure health, independence and a good quality of life
into our older years, and to support caregivers,” says Dr. Sixsmith. He said it is “an exciting time” for the AGE-WELL network. In three short years, AGE-WELL researchers have generated an “impressive range” of real-world solutions that can increase safety and security, promote independent living, enhance social participation, and support the wider economy. “AGE-WELL’s innovation extends beyond product development,” Dr. Sixsmith adds. “We are fundamentally changing the culture of research in the field of technology and aging. Knowledge mobilization and commercialization are built into every research plan. Our philosophy of co-creation means that older people and caregivers are
THE WIDE-RANGING PROJECTS INCLUDE SYSTEMS THAT CAN MONITOR PEOPLE’S HEALTH AT HOME, REMOTE THERAPIES, AND NOVEL WAYS TO CONNECT PEOPLE AND EASE SOCIAL ISOLATION
deeply involved in the research, along with our industry and community partners.” AGE-WELL is the only pan-Canadian network that brings everyone together – researchers, industry, nonfor-profits, government, academic institutions, older adults and caregivers – to develop practical solutions to support healthy aging.
Launched in 2015, AGE-WELL is funded through the federal Networks of Centres of Excellence (NCE) program. For information on projects funded through the AGE-WELL Core Research Program and other network programs, visit: http://agewell-nce. ca/research/research-themes-andprojects LC
Margaret Polanyi is the Senior Communications Manager at AGE-WELL Network of Centres of Excellence (NCE).
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MAY 2018 Home and LongTerm Care News 9
Health human resource crisis:
A ‘perfect storm’ By Lara Croll nsuring there are a sufficient number of health care workers to care for our aging population is one of the most pressing issues facing’s B.C.’s continuing care sector. A rapidly aging population, high worker injury rates, funding shortfalls, low recruitment, and the increasing acuity level of seniors are all contributing factors to the health human resource crisis facing long-term care, assisted living and home healthcare providers. The workforce is also aging and recruiting younger workers in the sector has become a challenge. Earlier this year, over 170 stakeholders came together at the 2nd An-
nual BC Continuing Care Collaborative – a partnership between BC Care Providers Association and the Ministry of Health – to address training, recruitment and retention challenges of the next generation of continuing care workers. The event brought together government and health authorities, unions, training colleges, continuing care employers and frontline workers to not only identify the most pressing HHR issues, but also seek out opportunities to tackle them. BC Care Providers Association recently released a report entitled “The Perfect Storm: A Health Human Resources Crisis in Seniors Care” highlighting the key takeaways from the
10 Home and LongTerm Care News MAY 2018
Collaborative, particularly the need for a comprehensive health human resource strategy to address the sector’s labour shortage crisis. BCCPA believes the strategy must be developed collaboratively with governments, health authorities, unions, continuing care employers, post-secondary institutions and frontline workers themselves. “The seniors care sector has identified the critical shortages of qualified frontline staff as one of our biggest challenges,” says BCCPA CEO Daniel Fontaine. “We are grateful for all of the contributions of so many stakeholders to date, and I highly recommend that ev-
eryone who is interested in the future of seniors’ care in B.C. downloads and reads the Perfect Storm report. It will serve as a useful reference handbook as we try to address the staffing crisis in seniors’ care.” Current labour shortages in the continuing care sector are creating an environment where workloads are unbalanced, contributing to worker stress and burnout, as well as increasing physical wear and tear. Continuing care employers report that staffing levels in the sector have not kept pace with the increasing acuity of residents and clients, despite recent increases to direct care hours in long-term care. www.longtermcarenews.ca
COVER It is imperative that governments provide sufficient funding for increasing staffing levels and direct care hours that support the health and safety of healthcare workers. Increasing staffing levels and increasing the number of workers in the sector would be effective strategies to address worker retention. With our aging workforce and low recruitment rates, it will be crucial to attract a younger generation of workers into the continuing care sector. Providing tuition relief and bursaries for students, as well as other financial incentives to address affordability challenges, will be effective strategies to boost recruitment into the sector. Expanding the delivery of dual credit programs will also allow career-orientated students to graduate from high school ready to work in an industry that is growing quickly and offers longterm job stability. Many young people lack awareness of job opportunities in the sector. While it is well known that sectors such as high tech will experience excellent growth, the public lacks awareness of the strong growth in the Lara Croll is BCCPA ‘s HHR Analyst.
“THE SENIORS CARE SECTOR HAS IDENTIFIED THE CRITICAL SHORTAGES OF QUALIFIED FRONTLINE STAFF AS ONE OF OUR BIGGEST CHALLENGES
healthcare sector, and in seniors’ care in particular. A comprehensive awareness building campaign, including job fairs and social media, will be needed to complement these financial incentives and advertise job opportunities in the sector. There is also a need to clear a pathway for international students and workers. Hundreds of qualified nurses and healthcare assistants enter Canada every year, only to discover that they can not start practicing in B.C. in a timely manner due to red tape and financial barriers. Similarly, international students represent an untapped pool of potential labour, but restrictive immigration policies currently discourage and block
entry into the continuing care sector. Reducing red tape, removing financial barriers, and improving access for international students and workers will be a key component of the larger strategy to address B.C.’s labour challenges. We need to better retain the workers we already have. It is well known that healthcare workers are at a high risk of occupational injury and longterm disability. High injury rates in the continuing care sector negatively affect worker retention and reduce continuity of care for residents and clients. The sector’s reputation for having high injury rates – particularly with respect to violence – prevents potentially qualified candidates from entering the sector.
Opportunities exist for continuing care employers and post-secondary institutions to work more closely to ensure that all healthcare workers have the skills necessary to stay safe at work. By committing to staff safety and investing in health and safety training, leadership teams can create organizations that have a strong culture of safety. Although labour shortages in the sector have reached a crisis point, feasible solutions that can be implemented with stakeholder collaboration over the next few years have been identified. BCCPA is confident that by implementing the solutions and strategies outlined in the Perfect Storm report, challenges and barriers experienced by continuing care providers can be overcome. However, few of these solutions can be implemented in isolation. BCCPA is committed to working in collaboration with stakeholders across the continuing care sector to secure the next generation of seniors’ care workers, and invites you, the reader, to be part of this vital work. LC
Novel muscle pump
activator device speeds wound healing
By Diana Swift ecent studies and a compelling case report show how an innovative hemodynamic add-on device (originally developed to prevent deep vein thrombosis) can reduce the healing time of new leg ulcers before they become chronic. The wireless, wearable, wristwatch-size gekoTM Wound Therapy device marshals the body’s own biomechanical mechanisms to boost blood flow and promote healing. Activating calf and foot muscle pumps through stimulation of the common peroneal nerve below the knee, the device boosts blood volume and velocity in the superficial femoral vein and artery, and systemically when worn on both legs. “That results in improved microcirculation to the skin and tissue, which is the wound bed,” explains Connie Harris, RN, a specialist in wound care and tissue repair since 1992 and a consultant for the muscle pump activator’s distributor. “In the first study to look at using the device in new leg wound patients, we found an average weekly reduction in wound
12 Home and LongTerm Care News MAY 2018
IN 2016, WOUND CARE COST THE CANADIAN HEALTHCARE SYSTEM ALMOST $4 BILLION AND CHRONIC NON-HEALING WOUNDS AFFECT AS MANY AS 500,000 CANADIANS
surface of 36.5 per cent in this group, which is really unbelievable,” Harris says. “In a prior study of patients with chronic non-healing wounds we saw a reduction of roughly nine per cent per week, which was also pretty amazing.” The costs of treating chronic wounds are enormous: in 2016, wound care cost the Canadian healthcare system almost $4 billion and chronic non-healing wounds affect as many as 500,000 Canadians. Testifying to the device’s applicability in wound healing is the 2017 case of a 74-year old woman from Cambridge, Ont., who sustained a deep laceration to her right lower leg when it was struck on the outer side by the pedal of an elliptical exercise machine at a seniors’ recreation centre. A large flap of skin and tissue was
torn away and blood and loss was significant. The flap was sutured in place in a hospital emergency room and the sutures were removed by her family doctor after 10 days. At that time, the patient received a topical antibiotic cream, but when the dressing was changed the next day, the wound edges had reopened, revealing several sutures still in place. An additional 12 sutures were removed in the ER and an antimicrobial silver dressing was applied and changed at seven and 14 days. At that time the woman entered the Waterloo Wellington Local Health Integration Network (LHIN) Home and Community Care Program. Her wound measured 6 cm long by 1.7 cm wide by 0.3 cm deep (3 cm3). After the wound was debrided of yellow slough for a second time, it
Wound on appearance day of geko™ start; and then closed at 3.5 weeks with geko™ therapy.
measured 4.5 cm by 1.5 cm by 0.5 cm (3.375 cm3), representing a 9.7 per cent per week increase in size since entering the program. The patient was then fitted with the geko™ device and taught how to apply, properly set, and remove it after each six-hour treatment, given five days a week. A strong foot twitch in response to stimulation suggested she was a good candidate and would have an optimal hemodynamic response. She was advised to turn the device off while driving in order to prevent a potentially risky involuntary movement of her pedal foot. A single-layer tubular compression stockinette of 8-10 mmHg was added to her therapy to help reduce edema and provide some surface protection. Three weeks and four days later, the wound had closed, for a rapid 100 per cent reduction in wound size at a weekly rate of about 28 per cent. “A normally healing new leg ulcer would be expected to heal by 12 to 24 weeks,” Harris says. The patient was able to go on a planned vacation and even swim in the ocean. “If it weren’t for this device, I’d still have a big hole in my leg,” she says, crediting the muscle pump
activator for the rapid resolution of her leg wound. Combined with best practices used for chronic non-healing venous leg ulcers, the device has shown benefit in other patients with new wounds. Last year, the Waterloo Wellington LIHN and Home and Community Care Program evaluated the device in 10 new wound patients, a largely elderly group that included the 74-year-old in the case study and had a total of 16 leg recent ulcers.
(range 2.29–100). In nine patients, the average time to complete wound closure was 3.03 weeks (range 5 days to 9 weeks). One obese patient with diabetes, who had developed multiple infections over time, failed to heal but did show improvement. “The device really sped up healing in people with comorbidities who looked as though they were not going to heal. One lady who was going out of the country healed in a week,” says Donna Radul, RN, wound care lead at
THE DEVICE CREATES THE SAME CIRCULATORY EFFECT AS WALKING THREE HOURS PER DAY. AND PATIENTS WHO WERE LESS MOBILE SAID THEIR LEGS FELT BETTER
With a mean Home and Community Program stay of 23 days, the patients had experienced an average weekly increase in wound size of 79.29 per cent (range 618–27.7). After the addition of geko™, wound size decreased by a weekly average of 36.5 per cent
the Cambridge LHIN clinic, adding that the device creates the same circulatory effect as walking three hours per day. “And patients who were less mobile said their legs felt better. It gives them hope they’ll get better.” The adjunctive device also increased
urine output and reduced edema and lymphedema came down within a week. The device also helped another woman who had to postpone needed surgery because of wounds. “In situations where we need to heal wounds before patients can have needed surgery I think muscle pump activators really should be considered,” says Radul. In another setting, the device was recently evaluated in a randomized controlled trial in kidney and pancreas transplant patients at Ontario’s London Health Sciences Centre. Patients were randomized either to standard care with compression stockings plus intermittent pneumatic compression pump or to the geko™ applied on each side. The results were positive and will be published in two articles, one looking at the device’s impact on wound healing and the other on prevention of edema. For Harris, with her more than 25 years’ experience in wound care, the hemodynamic approach is “truly the most exciting thing I’ve seen in all that time. I believe it can be a life changer for many patients.” LC
Diana Swift is a freelance writer in Toronto.
MAY 2018 Home and LongTerm Care News 13
has many benefits
for people with dementia Dad has been diagnosed with dementia and I notice that he is sitting around more and not active. I know that exercise is valuable for everyone, but how hard should I push him to exercise? Signed, Weighing it out 14 Home and LongTerm Care News MAY 2018
esearch tells us that there is a connection between the brain and blood flow and it is now established that there is a relationship between cardiovascular diseases and the risk of developing dementia. High blood pressure, high cholesterol and diabetes are all considered risk factors. Some studies cite that almost 80 per cent of autopsies on people who died from Alzheimer’s also show incidences of cardiovascular disease. That is one argument for the importance of exercise. We know that exercise is important as people age to ensure that their joints and muscles stay in shape, and to help maintain numerous other essential body functions. The effects of exercise are not easy to study but studies show that there are many beneficial effects for older adults. A good starting point is ensuring that the individual has been cleared medically to exercise. Discuss with the doctor what exercises the person wants to partake in. This is a particularly important conversation, especially if the person has not been active in a while. Arthritis, blood pressure or other health concerns may require a certain approach to exercise. Start slow and build up. Judy Chu, a registered geriatric Kinesiologist, tells us: “Count your exercise minutes, every one of those matter. Listen to your body and stop to rest when you are feeling discomfort in breathing rate. If you can still talk and carry on a conversation while walking or doing continuous exercise, this is a good sign for your personal intensity.” It is also important to make exercise interesting; otherwise, co-operation and involvement may be limited. Watch for any signs of dizziness, shortness of breath or any other physical difficulties and discuss with your family doctor immediately if you’re concerned. The exercise program may need to be modified. You may want to push your parent to exercise, but it is important to realize how much they can really cope with. Short workouts may be easier to do than one long session. Increase the time bit by bit. The exercises should not be too complicated as this can stress the individual
SOME STUDIES CITE THAT ALMOST 80 PER CENT OF AUTOPSIES ON PEOPLE WHO DIED FROM ALZHEIMER’S ALSO SHOW INCIDENCES OF CARDIOVASCULAR DISEASE
with cognitive issues and make it an unpleasant, and even agitating, experience. Dress the person in comfortable workout clothes and appropriate shoes that are supportive and fit properly. Dehydration is important to avoid, especially in the heat, so ensure that the individual drinks before and after their workout. Remember the exercise threshold for an older adult is different. Look back at the person’s history and try to find activities they have traditionally enjoyed. A golfer may appreciate a putting set that they can use indoors or in the backyard. Someone who liked biking may enjoy a stationary bike ride while watching a video of nature or the outdoors. There are lots of household activities that allow a person to be active. Gardening, sweeping and vacuuming are examples. Wiping counters and dusting are activities that get you moving as well. Music can also inspire people to move. There are many exercise videos set to music. Dancing is often a pleasurable task for many individuals, A lot of community centres and Alzheimer’s programs offer this as an activity. Walking is often easy to plan. A family dog can be a good mobilizer, as can any errand or outing. Ensure that the person has the appropriate aids if needed (e.g., a cane or walker). Speed is not the goal. In winter, you can find a mall, community centre or a gym to walk in. Adding some basic weight training and throwing a ball can help with coordination. Elastic resistance bands are easy to purchase and can be used while seated or standing. The key is to find someone to prompt, encourage and participate in the activity with the person. This can be used as a time to bond, socialize and interact. There are physioand occupational therapists as well
as fitness specialists who are able to formulate a program tailored to the individual. Some clients report that after being more consistent in their exercise, sleep and appetite improves. It is also a great antidote for agitation or restlessness, which occurs with dementia.
Constipation can also be relieved with exercise and activity. The social interaction helps with mood and communication. Practicing fine motor skills have also been shown to help individuals with dementia improve their daily activities (e.g., dressing, grooming etc.). Falls seem to be less likely when balance and agility are maintained through exercise. If you don’t have the time to participate, find a community program or professional to get your dad going. It is worth moving on! Search for a program near you: http://www.torontocentralhealthline. ca/listServices.aspx?id=10347 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 www.baycrest. org/dacg Email questions to caregivingwithnira@ baycrest.org This article originally appeared in the Toronto Star.
Helping people live with independence, dignity and in comfort since 1925. • Nursing • Physio and other therapies • Personal care and support • Homemaking
Also specializing in:
• Palliative support needs • Dementia care • Respite • Wound care
MAY 2018 Home and LongTerm Care News 15
Improving service capacity and care ayshore Home Care Solutions, a division of Bayshore HealthCare Ltd., has launched an innovative new project to re-invent home care service delivery, the Catalyst Project. Catalyst is streamlining the back office processes ensuring every caregiver is delivering the right
care to the right person at the right time, in a more efficient way. The new scheduling advancements go the next step to layer utilization and productivity metrics to further reduce all non-value added time, including travel time and scheduling mismatches. The reality is that every minute a caregiver is driving is a min-
16 Home and LongTerm Care News MAY 2018
ute they are not providing care to a client. Bayshore has developed new tools and processes to reduce that time by as much as 25 per cent. This reduction means clients are happier, because they get the care they need when they need it and employees are happier because they are spending less time travelling and more time doing
what they are passionate about, providing care. Bayshoreâ€™s Client Service Coordinators are using the Catalyst tools with a customized dashboard of key metrics that help them improve the client care experience and increase the rate of successful matches between clients and caregivers.
The project is being launched initially in seven government home care branches to replicate and prove early findings with a national rollout starting in the spring/summer of 2018. The Catalyst Project was developed in collaboration with a team of process engineers from Isaac Operations, a consulting firm based in Toronto, specializing in hands-on, front-line operational and financial performance improvement. “The Catalyst Project benefits our clients by improving scheduling; our government partners by improving productive capacity; and our frontline caregivers by enabling them to deliver more care with less travel – everybody
THE NEW SCHEDULING ADVANCEMENTS GO THE NEXT STEP TO LAYER UTILIZATION AND PRODUCTIVITY METRICS TO FURTHER REDUCE ALL NON-VALUE ADDED TIME, INCLUDING TRAVEL TIME AND SCHEDULING MISMATCHES wins!” says, Elissa Gamble, National Director, Bayshore Home Care Solutions. “When our caregivers are able to spend more time with clients because their busy schedules are being optimized, it reduces stress for them and provides greater quality of care for our clients. With better scheduling and less travel, we should also be able
Personalized home care services
Support is just a phone call away.
to provide services to more clients, which benefits the community as a whole.” The new scheduling tool has already reduced travel time for home support by 19 per cent overall and 25 per cent in some areas. Client scheduling time is down by 37 per cent and cancellations are down 21 per cent.
“Our caregiver and clients have been praising the new changes and job satisfaction among our service coordinators has increased significantly,” adds Gamble. “We’re looking forward to rolling it out to more communities so more people can benefit from the efficiencies. “The Catalyst Project also helps to address some of the capacity challenges in some of our tightest labour markets. In Ontario, for example we are thrilled to be able to bring our LHIN partners solutions to the problems faced by the whole sector as a result of the PSW shortage and are pleased that our work is in line with the Ontario Ministry of Health’s change initiatives,” says Gamble. LC
Personal Care Caregiver Relief Nursing Companionship Meal Preparation Medication Reminders Light Housekeeping Palliative / End of Life Care Physio & Occupational Therapy Hospital Bedside Care
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MAY 2018 Home and LongTerm Care News 17
Diabetes in longterm care By Dale Mayerson and Karen Thompson he number of people with diabetes has doubled in the past decade and continues to rise. The majority of seniors with diabetes have Type 2 diabetes, which occurs when the pancreas does not produce as much insulin as the body requires, or when the body does not respond to the insulin that is produced. When the cells cannot use the glucose, it can rise to dangerous levels in the blood and causes damage to organs and tissues.
WHY THE CONCERN? Diabetes is a progressive disease that can affect the eyes, kidneys, nerves, heart and circulatory system. Years of high blood glucose levels can impact the heart and lead to heart disease and other conditions of the heart. For older adults, there are other negative effects of ongoing high blood sugar, such as incontinence, higher risk of infection, poor healing and confusion. Diabetes has been linked to schizophrenia and dementia, as well as dental problems, hepatitis B, and hypothyroid conditions.
GOALS IN MANAGING DIABETES The goals for people with Type 2 diabetes are controlling blood glucose, reducing or maintaining a healthy body weight, and preventing complications. For people living in the community, there are diabetes education centres that provide a team approach to provide education and support to clients. Clients are taught to perform
self-monitoring at home, including blood sugar checks and symptom monitoring. The type of support for people living with diabetes in long-term care homes may be quite different. Seniors in long-term care may be physically frail, have other medical diagnoses, live with cognitive or emotional deficits, and take multiple medications. They are not able to manage their diabetes themselves and require support from healthcare professionals in the home. Medical care, meals/ snacks, activities and medications are planned according to each resident’s risks, limitations and needs. The individual condition of each resident is considered, since frailty and other health factors may preclude strict adherence to guidelines used for younger or more independent adults. These differences in meeting needs of the elderly are in place to enhance their quality of life: residents must be comfortable and safe in all possible ways. Many homes are taking a ‘liberalized diet’ approach with seniors, which allow residents with diabetes
to eat the same foods as everyone else. This improves their quality of life, and research has shown that a less restrictive diet provides more enjoyment of meals with fewer restrictions, and a better intake of nutrients for overall better health. Residents in long-term care still have their blood sugar monitored as required to improve control. Longterm care staff know that “normal” blood sugar levels may be higher for seniors, in order to avoid the risks associated with low blood sugar. Registered Dietitians in long-term care homes monitor resident progress towards their goals including checking blood glucose levels and providing individualized meal plans for residents whose blood glucose levels are not stable, or who require a special diet for complications of diabetes, such as end stage kidney disease, dialysis or other health issues. Dietitians, nurses and other healthcare professionals monitor and assess residents quarterly, or more frequently as required and develop care plans that meet residents’ individual medical and health needs.
Low blood sugar, also called hypoglycemia, can be dangerous for seniors. Frail seniors may be less aware of the symptoms of hypoglycemia. This is called “hypoglycemia unawareness”. When blood sugar falls too low, the effects can include trembling, sweating, headaches, weakness, dizziness, confusion, and fainting, all of which can further lead to falls, concussion or broken bones. These can be serious and life-altering problems for frail seniors, and therefore it is essential to ensure that blood sugar does not drop to an unsafe level. Homes should have established protocols in place for treatment of hypoglycemia. Residents in long-term care deserve the best care possible. It is important to treat seniors as individuals, and not as a homogeneous group, since their needs, desires and levels of physical and mental health are each unique. Optimal care is provided when the multidisciplinary team in a long term care home works collaboratively in providing the best possible quality of life for each resident with diabetes including monitoring and controlling blood sugar. LC
Dale Mayerson B Sc RD CDE, and Karen Thompson, B A Sc RD are Registered Dietitians with extensive experience in Long-term care. They are coauthors of “Menu Planning in Long Term Care and Retirement Homes: A Comprehensive Guide” and have participated for many years on the Ontario Long Term Care Action Group, an advocacy group of Dietitians of Canada. 18 Home and LongTerm Care News MAY 2018
Powers of Attorney are for the living By Susan Hyatt recently spent a morning in an ICU conference room at a hospital with a group of intensive care specialists, lawyers and financial advisors. We were called together to discuss the language used in Powers of Attorney for Personal Care (POAPC) documents. Many of these documents contain words and phrases that doctors find difficult to understand, or that don’t apply in today’s world of intensive care medicine. POA documents often include such terms as “heroic measures” or “do everything possible” with no real understanding about what that means when someone is critically ill. Lawyers or individuals may draft the Power of Attorney, but the family member (who is called the ‘attorney’) and doctors are left to figure out what the person really wants when they are very ill. Without having these types of discussions in advance, it can be difficult and overwhelming for the family to have it at the bedside right in the ICU. Family dynamics also bring great anguish to the situation if one sibling or another insists that Dad or Mom wants this or that. So, how do we prepare ourselves and our family members, or attorneys, who act for us? As uncomfortable as it may be, every family should have the conversation about living and dying. I call it “the what if” conversation and it goes like this. “What happens if I am in a serious car accident, become paralyzed, require extensive and risky surgery, and cannot speak for myself?” “As my Power of Attorney for Personal Care, I want to give you the responsibility and authority to make decisions about my personal care when I can’t make those decisions for myself. You will need to discuss what I might want and don’t want with the doctors and healthcare team. Simply prolonging my life is not the full answer.” Now, there are many questions for the POAPC person to ask. How do I know what you want? What are the choices that mean the most to you? What matters most to you in your life?
LAWYERS OR INDIVIDUALS MAY DRAFT THE POWER OF ATTORNEY, BUT THE FAMILY MEMBER (WHO IS CALLED THE ‘ATTORNEY’) AND DOCTORS ARE LEFT TO FIGURE OUT WHAT THE PERSON REALLY WANTS WHEN THEY ARE VERY ILL In the book Being Mortal: Medicine and What Matters in the End (Picador, 2017), Dr. Atul Gawande explores his own practice of medicine and what matters most to people at the end of life. “People with serious illness have priorities besides simply prolonging their lives,” he writes. “If your problem is fixable, we know just what to do. But if it’s not? The fact that we have had no adequate answers to this question is troubling and has caused callousness, inhumanity and extraordinary suffering.” Maybe we should turn the concept of drafting the words in the Power of Attorney for Personal Care upside down. Rather than trying to define language
around how we want to die, let’s try language around how we want to live. For example, the phrase “heroic measures” gives no guidance to attorneys or doctors. But what if your attorney knew how you wanted to live? You could say things like: • I want to be able to listen to music and play the piano, and not suffer in pain. • I want to be able to eat, to taste food, and drink. • I want to be able to wear my own choice of clothes, and have my hair washed and styled every week. • I do not want to die in a hospital, but want to stay in my home and have
monies put aside for caregivers to look after me. This type of discussion with your attorney will give some personal context as your attorney discusses the types of treatment with the medical team and what decisions need to be made. Insights on the challenge of facing death, and what makes life worth living in the face of death, can be found in The New York Times bestseller When Breath Becomes Air by Dr. Paul Kalanithi (Random House, 2016). At the age of 36, when he was about to complete his residency as a neurosurgeon, he was diagnosed with incurable lung cancer, and had to see the disease as a patient, not as a doctor. There is honesty and truth in Dr. Kalanithi’s writing that provides keen insight into this complex issue. One of my clients always reminds me that we are all going to die, and none of us is getting out of this life alive. We need to plan ahead because life happens and some of us will be facing major medical treatments. How to live in the face of death is a question we all must ask ourselves. LC
Susan Hyatt is CEO of Silver Sherpa, Inc. www.longtermcarenews.ca
MAY 2018 Home and LongTerm Care News 19
Embracing innovation: The next step in seniors care By Dr. Laurent Marcoux he pressure on the hospital system sees no sign of abating. With a health care system that’s in desperate need of refreshing, hospital administrators, physicians, nurses, allied health professionals, and others – likely find themselves frustrated with persistent overcrowding. Canada’s health care providers constantly deal with this issue, which can often lead to stress, burnout and, worst of all, patients not receiving the excellent care they’ve come to expect. The number of Canadians over 65 continues to grow, and seniors often find themselves in acute care beds as they wait for more appropriate settings such as home or residential care. As a result, they’re vulnerable to hospital-acquired illnesses and disabilities such as delirium, deconditioning and falls. We know that things need to change. We know that we can all do better – so, where do we begin? A portion of this problem is resource related. According to the Conference Board of Canada’s re-
ENSURING SENIORS HAVE THE APPROPRIATE INFRASTRUCTURE IN PLACE MEANS A MORE EFFECTIVE USE OF HEALTH CARE RESOURCES port entitled Sizing Up the Challenge, Canada will need an additional 199,000 long-term care beds by 2035, nearly doubling current long-term care capacity. This number almost seems hyperbolic – it’s hard to grasp for the average Canadian. Longterm facilities can be a more efficient means of caring for our family members, and can help relieve pressure on the hospital system. Ensuring seniors have the appropriate infrastructure in place means a more effective use of health care resources. In Ontario, according to one estimate from Northeastern Ontario Health Care Update, the daily cost of keeping a patient in acute care is $842, while in a long-term care facility the amount drops to $126. Caring for a loved one at home brings the cost
down to an estimated $42 per day, and, perhaps most importantly, it allows seniors to be amongst their loved ones. Any approach to care must be patient-centred and collaborative in nature. It’s the approach taken by the Nova Scotia Health Authority’s Care by Design program. With the support of an active and engaged group of physicians, pharmacists, nurses, paramedics and other health care professionals, Care by Design is able to offer long-term care residents access to high-quality primary health care. This program has delivered real results, including a 36 per cent reduction in transfer from long-term care to the emergency department (ED). This reduces ED resources and minimizes unnecessary stress on se-
niors. This is a powerful demonstration of how collaboration between governments, health care providers and patients can yield significant improvements in care. Care by Design is expected to be expanded across the country, with British Columbia slated to be the next province to implement this program. The time has come to embrace innovative and creative solutions to our health care dilemmas. There needs to be the right balance between adopting new technologies and developing patient centered care. Health care providers and patients share a common objective of improving care for Canadians. This must take place in the form of a national seniors plan – a comprehensive framework for improving quality of life for seniors. More than 60,000 Canadians are supporting this call to action at part of the CMA’s Demand a Plan campaign. It’s critical that we work together to push for better care for our seniors, and, as a result, improved care for all Canadians. LC
Dr. Laurent Marcoux is President, The Canadian Medical Association. 20 Home and LongTerm Care News MAY 2018
Lack of understanding, support from others when caring for a family member with dementia recent study from the Alzheimer Society reveals that one in five Canadians have experience caring for someone with Alzheimer’s disease or another form of dementia, while 87 per cent of caregivers wish that more people understood the realities of caring for someone with dementia. The results are from an online survey conducted by Leger last fall that asked 1500 Canadians aged 18 to 65 about their perceptions and attitudes towards dementia, a condition that affects over half a million Canadians today. The survey also found that a lack of understanding from friends and colleagues, inadequate services and being excluded from treatment and care decisions leave too many caregivers feeling lonely. In fact, two-thirds of caregivers feel isolated as a result of their caring role.
87 PER CENT OF CAREGIVERS WISH THAT MORE PEOPLE UNDERSTOOD THE REALITIES OF CARING FOR SOMEONE WITH DEMENTIA “Without a strong support network and people around who understand dementia and its impact, many caregivers can feel that their world is shrinking,” says Pauline Tardif, CEO at the Alzheimer Society of Canada, who has first-hand experience caring for a parent with dementia. The number of Canadians with dementia is increasing – in just 13 short years, 937,000 Canadians will have dementia, which means more of us will be providing care. Due to the progressive nature of dementia, which gradually makes it more difficult for the person to carry out day-to-day activities, care-
givers eventually become responsible 24/7 for every aspect of the person’s care. This places a tremendous toll on caregivers’ mental, emotional and financial well-being. That’s why on National Carers Day, the Alzheimer Society called on Canadians to do their part in recognizing and supporting the caregivers in their lives and communities, by checking in and lending a helping hand. The Society also encourages anyone providing care to someone with dementia to connect with their local Alzheimer Society for information, support, programs and other resources.
“Caring touches us all, but no one should feel alone as a caregiver, and it’s important that caregivers take care of their own health and well-being,” says Tardif. Learn more about Alzheimer’s disease and other forms of dementia, including our survey results, and find a local Alzheimer Society for help and support, at www.alzheimer.ca. LC
SOURCE Alzheimer Society of Canada
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22 Home and LongTerm Care News MAY 2018
From server to recreation:
A chalking tale By Amanda Paterson hen Charity Votary began working as a dining room server at Royale Place Retirement Residence in Kingston, she didn’t expect that her love of art would make its way into her everyday work. But when she saw a chalkboard menu in the dining room, she couldn’t resist the urge to add drawings around the menu items. “Eventually, I just took over and started taking up the whole board with drawings, and the residents really enjoyed it,” she says. Her drawings are often seasonally-inspired, with sunshine, flowers and birds for summer, and pumpkins, leaves and holiday images for fall. Charity’s love of art and music began at a young age. After experiencing mobility and health challenges for all of her life, she discovered art and music as a way to cope. “Art and music helped me get through it all – painting, singing, playing piano, harp and the violin have all been outlets for me.” This strong creative foundation motivated her to apply for a position as a Recreation Assistant, a role she began in September 2017. Now, she leads a broad range of art-based activities for residents. She shared that this work “is so fitting. I always wanted a career in art, but wasn’t sure I could make it. Here, I can connect with residents through art, helping them gain a new skill. They complete projects with pride, even showing off their paintings to their family.” Residents have also asked her to paint special pieces for them. A resident asked her to paint two roses intertwined, to symbolize his upcoming wedding. “He loved it so much that he placed it on his walker and took it on a tour
Charity Votary couldn’t resist adding drawings to the chalkboard menu’s at Royal Place Retirement Residence and the residents really enjoy it. around Royale, sharing it with his friends and the team members,” Charity says. She also recently painted a portrait in honour of a resident’s late wife. “It was the 1-year anniversary of my wife’s passing,” says resident Gene, “it meant a lot to me that she would create this portrait.” Charity is currently working parttime and completing a recreation
and leisure studies program. She has truly found her calling in working with seniors. “I love it. I can bond with residents because of what I’ve gone through and help them look beyond whatever health challenges they’re going through, so they can fully participate in music and art. We’re connected in that experience.” LC
Amanda Paterson is a Communications Specialist at Sienna Senior Living. www.longtermcarenews.ca
MAY 2018 Home and LongTerm Care News 23
Death’s tug of war with mystery and science
Reflecting on medical aid in dying for vulnerable persons By Al Etmanski count myself as lucky to have been born when death was still pretty much a mystery, more the prerogative of poets and other artists, philosophers and religious teachers than of scientists and doctors. I grew up surrounded by death. I served as an altar boy at dozens of funerals, attended the “wake” of my maternal grandmother in her parlour and experienced my own mother’s death at home in her bed surrounded by her six children and several grandchildren. Death may not have been welcomed, but it was not a stranger. I was reminded of death’s tug of war with mystery and science while reading the recent submission from the Vulnerable Persons Standard (VPS) team to Health Canada. They propose regulations to monitor the practice of Medical Aid in Dying (MAID) for those who are vulnerable or whose autonomy has been limited by social, psychological, economic or physical factors. MAID is a medical technology legalized in 2016 which enables Canadian adults to choose a physician assisted death. The VPS submission reminds me that Canada has been blessed by a long line of thinkers who have cautioned that all technologies promise benefits but have unanticipated consequences too, some of them harmful. Technology refers to more than machines, tools and electronic, medical or scientific devices. It includes, platforms, mediums, management techniques, commercial practices, social methodologies and protocols like MAID. Economic historian, Harold Innis was the first to chronicle the devastating impact of a technological promise in his book The History of the Fur Trade in Canada. While benefitting relatively few European capitalists, the fur trade destroyed the very culture and way of life of the Indigenous people that made that wealth possible. And for which Canada, particularly
AN OBSESSION WITH ‘PRESENT MINDEDNESS’ WIPES OUT CONCERNS ABOUT PAST OR FUTURE. – HAROLD INNIS Indigenous people, are still paying the price hundred of years later. Innis’ disciple, Marshall McLuhan observed that it’s the technology itself (TV, Facebook, i-Phones, cars) not its content that subtly and silently shifts relationships, cultural attitudes, beliefs and values over time in favour of the indispensability of the medium or tool. When you are a hammer, everything looks like and eventually becomes a nail. In her Massey lecture, The Real World of Technology, renowned University of Toronto scientist, Ursula Franklin distinguishes between two types of technologies: holistic technologies which leave “the doer
in total control of the process” and prescriptive technologies which shift control to the hands of managers or specialists. She argues that the dominance of prescriptive technologies in modern society discourages critical thinking and promotes “a culture of compliance.” Franklin, like Innis, argues that technology’s tendency is to suppress freedom and distance people from each other. Another Massey lecturer, Ronald Wright describes this as the “progress trap.” My thoughts then turn to the “Socrates of Quebec,” Jacques Dufresne, who reminds us that the loss of the soul is painless. Because technology
provides so many benefits, we start to assume that it can fix anything. Thus we fail to notice when it ceases to serve and starts to transform us in its likeness. That’s when the mysteries of the soul are reduced to problems best left to experts and their technologies to solve. And we lose our autonomy and vitality. Finally I am reminded of Nora Young, the thoughtful host of CBC radio’s Spark. She occasionally concludes her radio show with the wish that her listeners understand that all technologies come embedded with values and assumptions. She emphasizes that those values are not benign. Similar to McLuhan, she says they have an ideological bias. They amplify the dominant values of the status quo. The conclusions of these and other thinkers about culture and technology provide a useful framework to evaluate and monitor MAID. If you want technology to be your friend make sure you learn everything about it – its, values, side effects and track record. Science and medicine are not the only systems producing truth. Technology is about certainty; it doesn’t like mystery, humility, vulnerability, imperfection or tradition. Efficiency is not the dominant purpose of human relationships – interdependence, mutual respect, trust and loyalty are. The VPS submission to Health Canada stresses the importance of monitoring the practice of MAID in Canada in order to prevent harm to individuals, to minimize any potential negative impact on our culture and to preserve the benefits of MAID for those who choose it. Amidst the turbulence of the twenty first century, their recommendations help to refresh our relationship with life’s one certainty: death. I read them as an act of faith in our future. And a profession of love for our capacity to address tough moral issues together. What could be more reasonable than that? What could be more Canadian? LC
Al Etmanski has been a disability advocate since the birth of his second daughter. He co-founded Planned Lifetime Advocacy Network helping parents plan for the future well-being of their disabled child. He is an advisor to the Vulnerable Persons Standard and an expert advisor to EvidenceNetwork.ca. A version of this article first appeared in Policy Options. 24 Home and LongTerm Care News MAY 2018
Yes. I live with dementia. Let me help you understand. I was diagnosed when I was 45. I love to watch sunsets with my partner. Iâ€™m Mary Beth.
LEARN MORE AT Ilivewithdementia.ca #Ilivewithdementia MAY 2018 Home and LongTerm Care News 25
Managing emotions as a caregiver E
ffective management of feelings (also known as emotional regulation) is a part of emotional intelligence. Why is emotional intelligence so important? Most of us know someone who has very little emotional regulation, someone who has been described as a “drama queen.” This person is ruled by their emotions and expresses their feelings dramatically at every conceivable opportunity. Is this person happy? Do they seem happy to you? The answer is likely no. How are their relationships with others? The answer is likely chaotic. Allowing our feelings to dictate how we live our lives can lead to feeling out of control, anxious, and even depressed. This also leads to chaotic and negative relationships. While this “drama queen” example is an extreme one, the effective management of feelings or emotional regulation is key to both self-esteem and meaningful connections with others, such as your family or the person in your care. In the context of caregiving, there is much to be emotional about, and there will undoubtedly be moments that are painful, hard, scary, and difficult to endure. Effective processing and management of the emotional side of caregiv-
THE EFFECTIVE MANAGEMENT OF FEELINGS OR EMOTIONAL REGULATION IS KEY TO BOTH SELF-ESTEEM AND MEANINGFUL CONNECTIONS WITH OTHERS, SUCH AS YOUR FAMILY OR THE PERSON IN YOUR CARE
ing will serve not only you, but also the person you are caring for.
EMOTIONAL REGULATION STRATEGIES Identify your feelings and sensations and label them. Feelings are typically accompanied by body sensations. For example, you may notice a queasy feeling in your stomach, shakiness in your arms or legs, or dryness in your mouth. These are body sensations that typically accompany anxious feelings. Notice and name these sensations in the same way you would notice and name your emotions. Once you notice or become aware of an emotion, label or name the feeling. Labelling or naming our feelings and sensations reduces their intensity. Labelling also helps prevent over-identification and attachment to feelings. The truth is that all feelings are tem-
26 Home and LongTerm Care News MAY 2018
porary. They arise, stay for a while, and then they disappear. Feelings have been described as waves in the ocean, cresting and receding. Feelings have also been described as train cars. You can either watch the train cars go by or you can jump on and let it take you somewhere (which is the over-identification and attachment to the feeling). By labelling your feelings and sensations, you are a witness to your emotions, instead of letting them rule you. Accept your emotions and tell yourself that you can handle both the feelings and sensations. Tell yourself, “I am feeling _____ and I can handle this feeling and the accompanying sensation(s).” You may want to remember a time when you felt this particular feeling in the past and handled it well. Remind yourself that you handled it before and you can handle it now. By doing this, you are preparing yourself to effec-
tively handle your feelings and physical sensations. For example, you may say to yourself, “I am feeling this dry mouth and shakiness in my arms and legs. I can handle these sensations.” You can remind yourself of your ability to cope with the sensations. “Can I handle a dry mouth? Of course I can.” Take responsibility for your feelings and reactions. Use “I” statements rather than “you” statements. For example, “I am feeling frustrated about…” rather than “you frustrate me when….” Making “I” statements is essential to effective communication. Remember that your feelings and reactions are more of a reflection of your internal world (memories, values, experiences, and thoughts) than they are of the external world and the people around you. Explore the thought(s) that preceded the feeling. There is a thought before there is a feeling. This is such a lightning fast process that we can miss the thought that preceded the feeling. Explore the thoughts. Examine the thoughts. What were you saying to yourself before you started feeling this way? This will help you understand which thoughts trigger certain feelings and physical sensations in the body. It will also help you understand your particuwww.longtermcarenews.ca
lar triggers. Just like feelings, thoughts are not necessarily the truth. And just like feelings, thoughts are temporary. Consider taking a daily inventory of your feelings. If you write down what you feel and when, you may be able to identify patterns of feelings. From this awareness, you can then consider what you plan to do about it (if anything). For example, you notice that you have been feeling angry and resentful at your partner and your kids for a number of days in a row. Your inventory shows you that these feelings of anger and resentment start in the evening when you are tired and desperately wanting to go to sleep but you have “one more thing” to do. Now that you see the pattern, you can explore further what you would like to do about it. You can first accept responsibility for how you are feeling. That is, your partner and kids aren’t
making you angry. You are, however, having feelings of anger and resentment. Noticing this pattern may motivate you to make changes in your household. You may decide to increase your kids’ responsibilities around the house, lower your standards of both yourself and others, or reach out for additional help. The point of this exercise is for you to notice the pattern. In this case, you will likely notice that you have been so caught up in anger and resentment that you have been “dumping” or projecting it onto others. When emotions are overwhelming, try to temporarily change your state of mind. This can be done by choosing to go into a different room, going for a short walk, working in the garden, or playing a computer game for a few minutes. This allows for a change in the scenery and in your thought processes.
This is not the same as avoiding or ignoring feelings – you’re simply taking a break so you are better able to process the overwhelming and intense feelings you’re experiencing. We recommend seeking help from a health care professional or counsellor if your feelings are overwhelming or if you feel unable to manage and process them.
HOW TO PROCESS EMOTIONS Being able to effectively regulate or manage your emotions is a process that takes time and practice, but this will serve you well. You will have a sense of mastery and know that you can handle whatever emotions come up in the course of your caregiving. The process begins with: • Acknowledging and accepting feelings • Creating some distance by adopting a “witness” stance
• Examining the thoughts that precede the feelings • Being mindful of when and how to express your feelings Caregiving is an emotional journey. Processing and managing your feelings, when appropriate, will help you weave through your journey in a way that prevents your feelings from taking over and running the show. You will also be better able to respond rather than react to the emotions of the person you are caring for. Please approach these practices with self-compassion. Expect setbacks. Take note of the challenges you experience. For example, maybe you got stuck in anger or resentment and you lashed out. Learn what you can from these challenges and resume the practice. It is that simple and it is that difficult! There is no doubt that you can learn to flow easily with the emotional side of caregiving. LC
This article was reprinted from Elizz.com with permission.
Your Home Healthcare Provider of Choice INTEGRACARE a Canadian-owned company known for its exemplary service and quality care, has provided private home and healthcare services in the Greater Toronto area since 1990. Integracare is proud to announce that Sabrina V. has received the highly prestigious and coveted award as Caregiver of the Year in the Frontline Worker Category. Sabrina has been a key part of the Integracare Family as a Personal Support Worker for over 16 years and in 2017 received Integracare’s Caregiver Lifetime Achievement Award. On April 10th, 2018, Home Care Ontario and the Hon. Dr. Helena Jaczek, Minister of Health and Long Term Care awarded Sabrina with the its highest honour as the 2018 Frontline Worker of the Year based on her vast experience and excellence in care provision. Sabrina has always exceeded the expectations of Integracare, its Clients, and their Families. Sabrina is incredibly compassionate, dependable, and demonstrates great initiative and attention to detail. She strives to help her Clients achieve a more joyful living experience
during every visit, with an engaging, positive, patient and pleasant attitude. “Sabrina represents the standard of excellence for Integracare Caregivers. Sabrina is compassionate, dependable, and goes above and beyond for her Clients. Sabrina is committed to enriching the lives and fostering independence for her Clients. We are so proud of Sabrina for winning the Home Care Ontario 2018 Frontline Worker of the Year Award. The entire Integracare Family takes great pride in Sabrina’s incredible achievement.” said Lee Grunberg, President & CEO, Integracare Inc. lntegracare provides a wide range of private nursing care services to individuals in their homes, hospitals, retirement residences and long-term care facilities. Its services, while encompassing all levels of nursing care, have always included a wide range of related services that address the needs of their clients while maintaining their dignity and confidentiality.
For more information about lntegracare, visit
MAY 2018 Home and LongTerm Care News 27
Choking prevention very year thousands of people are saved by the Heimlich maneuver. What people rarely hear about are the many instances in which the Heimlich fails. Too often when this happens, the victim dies. As good as a technique the Heimlich is in emergency situations, it is far from perfect, and many times it has not worked, often resulting in death.
LIFEVAC IS A NONPOWERED DEVICE THAT COULD CLEAR THE AIRWAY OF A CHOKING VICTIM WHEN STANDARD CHOKING PROTOCOL HAS BEEN FOLLOWED WITHOUT SUCCESS There are also many diseases which make victims more prone to choking; such as with individuals who are pregnant, in wheel chairs, or who have disorders such as Dysphagia, ALS, Asthma, Cerebral Palsy, Febrile Seizure, Huntington’s Disease, Swallowing Difficulties, Stroke, Brain Injury, Multiple Sclerosis Muscular, Dystrophy, Parkinson’s Disease, Esophageal Spasm, Gastroesophageal Reflux Disease (GERD),
Esophagitis, Diffuse Spasm, Esophageal Tumors, and Neurological Disorders. Choking is a serious threat, with concerning statistics. • A leading cause of death in children and persons over the age of 65; • 4th leading cause of accidental death in children under 14 years of age; • More people die from choking than from fires or drowning; • Leading cause of brain injury in young children; • 17,000 infants and children are treated in hospital emergency rooms for choking each year. The vision of LifeVac came from a story that Arthur Lih, inventor of LifeVac, heard of a woman in a hospital weeping following the death of her young son. It was startling to him that there was nothing available that could assist in keeping someone from choking to death. Arthur went on to create LifeVac, a non-powered device that could clear the airway of a choking victim when standard choking protocol has been followed without success. Since the introduction of LifeVac in the US in 2015, the product has been delivered to thousands of homes, Fire, Police, Ambulances, Care homes, Restaurants & Schools. Arthur has worked tirelessly to create awareness of Choking Deaths and introduce LifeVac as a possible life saving device and was introduced to Canada, in October 2016.
On June 6, 2016 LifeVac saved the life of a female nursing home resident in Dyfed, Wales. The care home in Dyfed, Wales, purchased a LifeVac after a resident choked to death in January of that year. Two days after receiving their LifeVac, a female resident was choking on her lunch. An attendant used the LifeVac to successfully remove the object and clear the victim’s airway with one pull on the device. “LifeVac was developed with, and has been endorsed by, doctors, EMTs and first responders,” says Lih. “We will continue our efforts to ensure LifeVac is in every school, nursing home and anywhere a person is at a high risk of choking. LifeVac’s mission is to eliminate these tragic deaths.” LifeVac Canada Inc., based in Mississauga, Ontario, was formed to distribute LifeVac in Canada and provide awareness of choking prevention. LifeVac is a registered Medical Device with Health Canada, CE, and the FDA. LifeVac has also been peered reviewed and published in The American Journal of Emergency Medicine and The American Journal of Gastroenterology. Although a medical device, LifeVac does not require a prescription and is available for online purchase at https://lifevac.ca/ LC
Submitted by LifeVac.
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Dear Mom, You were my rock. My best friend. From the beginning it was always us. Then suddenly, I was alone. Gliding out on the ice, my legs were shaking. My heart was broken. But you steadied me. As you always did. Thousands watched... except the one I wanted most. But we did it mom. I wish you were there. Almost as much as I wish you were here.
Joannie Rochette Olympic medallist Lost her mom to heart attack â„˘ Life. We donâ€™t want you to miss it. and the heart and / Icon on its own or followed by another icon or words are trademarks of the Heart and Stroke Foundation of Canada.
Finding love and laughter in a battle with cancer By Crystal Gonder n 2014, at only 47-yearsold, Manjusha Pawagi was diagnosed with a very aggressive form of leukemia. Prior to the diagnosis, Manjusha had already led several “lives” – first as a journalist, a mother to twins, a children’s author, a lawyer, and a family court judge – before her most recent experience as a cancer survivor and author of the memoir, Love and Laughter in the Time of Chemotherapy. Fortunately, this story has a happy ending. Despite one in a million odds of finding a stem cell match and enduring the high-risk treatment, Manjusha didn’t just live to tell the tale. She lived to share her story in all of its messy, vulnerable, funny and touching glory. We were lucky to sit down with Manjusha to talk about her experience before her keynote presentation at VHA’s 13th annual Heart of Home Care Awards on April 3rd, 2018. She touched on her patient experience, the love and support that kept her going and her unique relationship with her “one in a million” donor. Why did you decide to write about your very personal experience and share it with the world? When I was sick, a friend signed me up on [the health journal website] Caring Bridge. It’s a way to keep family and friends updated and they can directly respond to you. I quickly realized that the more honest and specific I was, the more helpful their responses were. This was so energizing and therapeutic for me and it was a way to process what I was going through. These posts were like my diary quoting overheard conversations with roommates and what doctors were saying to me. Initially, it gave me something to focus my energy on and was a great way to keep in touch. Because it was so well received, my book is an extension of this hon-
esty. You know that saying when life hands you lemons, you make make lemonade. Well, what if life hands you a bag of s$%t? What can you make of out that? Turning something terrible into something good, was my way of coping. Your book includes a broad range of emotions. Even the title includes “laughter” in it, which is not really something we connect with cancer and chemotherapy. Why was it so important to include humour in the book for you? At first I thought no one wants to hear some depressing, dire tale. But in retrospect, there’s actually a lot of humour in my experience. I know some of my reactions to cancer were unusual, but people found that funny and comforting and that made me want to write about it. This isn’t traditional humour, but it’s quirky and it’s satire. I thought it would be illuminating. This is what doctors are saying, but this is what patients are hearing. If you can turn something black into something humorous, then I think you’ve succeeded. There are moments in the book of obvious vulnerability. When the fact that you are a judge and public figure are almost irrelevant. Can you talk a little bit about that and what that felt like for you? When I first started writing I was worried because of my career choice. I wondered if I should be revealing such personal information. My test was if I’d be ok with someone in my courtroom reading it? I decided it was more than ok because people want to know that the person making decisions can actually relate to them. It’s good to realize that everyone feels pain, anger and fear and I’m not just in a position of power making decisions without empathy. I thought it may be comforting for the families I work with to know that I’ve been through such heaviness and despair.
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I was reminded of a quote that I heard way before my diagnosis by an English judge a few hundred years ago. “Fill the halls of justice with good men [and women], but not so absolute in goodness as to have no understanding of human frailty.” I know that this experience has made me a better and more compassionate judge. For the most part it seems like you had very good care throughout the chemo and the stem cell transplant. What do you think makes a difference between an “okay” patient experience and a “great” patient experience? I had such amazing care. I feel so lucky to be Canadian, from Toronto, with access to the best hospitals and brightest minds. From my nurses, to hematologists, to surgeons, and to home care workers – it was incredible! It’s not just about delivering healthcare, it’s about so much more. I had a terrifying nightmare that I was dying, rushing to the light, the whole thing. I woke up gasping and horrified and a nurse put her arms around me and said, “you are not alone.” That stayed with me. One of my nurses that cared for me at home would ask for book recommendations to teach his daughter about life and love. We would chat and laugh and talk about books and that was such a joyful part of my recovery. It’s these connections that really shine! I think the major difference between an okay patient experience and a great one is constant, supportive care. It was also the hope. I remember a doctor once said, “you’ll dance at your children’s wedding.” To me this meant so many things. You’ll grow old, you’ll be healthy enough to dance, your children will be healthy and they’ll grow up and be happy. He was offering me so much in one sentence and it was everything. I clung to that. My odds weren’t good, but the optimism, hope and support (beyond the exceptional
care) I received from my team made all the difference. Can you talk about how important the people who supported you on the journey were? Namely your mother and your husband. What did they bring to your experience? I wouldn’t have survived without support from my family and friends. My husband is the real hero of this story. Knowing that my kids were so well cared for, I was able to focus on myself and my recovery. My kids didn’t miss a thing – piano lessons, sleepovers, school trips! He kept things normal and made sure they were not traumatized by the whole experience. My amazing mother came twice a day to bring me breakfast and dinner for five months. I say she gave me life twice. Once when I was born and once when I was sick with cancer. www.longtermcarenews.ca
In 2014, at only 47-years - old, Manjusha Pawagi was diagnosed with a very aggressive form of leukemia. Prior to the diagnosis, Manjusha had already led several “lives” – first as a journalist, a mother to twins, a children’s author, a lawyer, and a family court judge – before her most recent experience as a cancer survivor and author of the memoir, Love and Laughter in the Time of Chemotherapy.
Manjusha Pawagi What advice would you give to someone who has just been diagnosed with cancer? I don’t know if this is true for everyone, but I found such comfort in sharing and openness. There was a time where I know I was struggling with depression. The emotional pain of an endless recovery was worse than the physical pain I experienced in the hospital. While I knew I could technically get out of bed, I couldn’t physically do it. You need to talk openly and honestly about what you’re worried about, reach out to people and don’t sugar coat what you’re going through. Otherwise, things can get pretty dark.
On the flip side, what advice would you give friends and family who have just learned a loved one has been diagnosed? For friends and family who’s loved one has just been diagnosed, be their support. People want to help but sometimes they don’t know what to do – so ask directly! Maybe it’s a specific book, fresh fruit, (which is hard to find in hospitals) or a relaxing play list. The most amazing thing that my community did was set up a dinner schedule. My husband and children didn’t have to cook for the entire five months I was in the hospital. Another friend wrapped 30 little gifts for me to open each day. Just know that every gesture counts and
matters. After my recovery, some people said I’m sorry I didn’t reach out, I didn’t know what to say. So send a card and say just that! While cancer can’t be cured by encouraging thoughts, support and positive thinking make the days bearable. After your recovery, you were able to meet your stem cell donor in person. What was that like and how do you describe the connection you feel with him? We are family. Literally. The stem cells that made his blood have also made all of mine. His blood is circulating through my body. It’s miraculous! One year after the transplant, we both agreed to meet each other. I couldn’t
compensate, match or make up for what he did. All I could do was say thank you and I wanted to do that in person. But, what do you say to someone, what do you give them? Then I decided on a framed photo of my family in Mexico in the pool, smiling and happy. When he has bad times he can look at this picture and say, “This is the family I saved. See how happy they look!” It’s not just one life. He saved my husband, my children, my parents and my friends. What an impact. I feel like I gave him something too. I know he feels so lucky and blessed that he was able to save my life. The connection is deep. I didn’t just get my life back, I got a whole other family out of it. LC
Crystal Gonder works in communications at VHA Home HealthCare. www.longtermcarenews.ca
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