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"Ask Nurse Kris" Blog

Our CEO and Clinical Director, Kris Stewart is a respected columnist, and routinely publishes articles related to seniors and their families in various regional publications. These articles deal with matters close to the heart of families, and those they love. We hope you find these informative. 

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Dementia Care at Home?

Posted on 30 January, 2015 at 10:20 Comments comments (0)

Dear Nurse Kris;

 

My siblings and I live a long distance away from my mom. Seeing her means a full day of flying or driving, time off work etc. My mom is recently widowed, lives alone in her large home, has Alzheimers and we worry about her forgetfulness. She says she’s taking her daily medications and eating and showering, but I don’t have any way of knowing for sure. We promised her we would never move her to a nursing home. When we call, she’s forgetful about the day's events, and she’s growing lonely. When we visit, the house is neat, and her story sounds good, but still I feel uncomfortable. I spoke with the government nurse, and she recommends we consider placing mom in Assisted Living. I made a promise to her I would never do this. Mom has always said she would stay in the house until the day she died, and she made all of us promise to honour her wishes. Can you make any suggestions?

 

Thomas…Trying to sort things out from Alberta

 

 

Dear Thomas;

 

 

Photo: Thinkstock.com

You are in a tough spot…you are appropriately concerned about your mom and want to do what’s best for her, and you want to honour her wishes by keeping her at home.

 

Basically, there are two main components you’ll want to be thinking about; her physical wellness, and her mental wellness.

 

Let’s talk about her physical wellness for a moment. Cash strapped government health authorities often can only put short periods of care in, up to several times per day. These services can include attention to personal hygiene, bathing, grooming, dressing, meal preparation and medication reminders or assistance or a bath once a week. The costs for this will be based on your mom’s income level, and for some folks, the costs will be high. At times, they exceed the health authority’s grid and they then recommend to families that they seek outside private care services. Your mom may also need more ‘life management’ interventions than the health authority can provide, and if this is the case, then yes, they will recommend Assisted Living as a first step.

 

Once her needs escalate beyond needing two services in the Assisted Living home, choices will be few and a recommendation would be made to place her in Residential Care (there is no more “Intermediate Care”).

In a recent local case, the health authority nurse found that for an elderly couple living at home and needing extensive services, the cost was essentially the same for both the health authority rates and the private agency. But the difference was that the private care agency could offer many more services for the same price. The private agency service workers could assist the client with paying bills, personal laundry, making breakfast and lunch, taking on outing or to appointments, minor housekeeping, transporting to doctors and other appointments in the caregivers vehicle…something the health authority care givers were not allowed to do. In this particular case, the couple - who met Assisted Living criteria - decided to go with the private agency caregivers, because they could do twice as much for the same price as the health authority was offering.

 

Let’s talk about your mom’s mental health. Declining cognitive function is common in 10% of adults aged 65 and older, and more than 50% of adults older than 85 have some form of cognitive impairment. Many families are concerned about what to do. Essentially, there is no magic bullet for stopping or reversing the disease, but there are medications to slow the disease progression, and there are tools to provide quality interactions with families, support persons and caregivers.

 

I’ve just recently discovered such a tool which address the five aspects that are the most significant aspects of Dementia: communication, remembering, coordination and motor skills, visual and audio sensory perception, and critical thinking and problem solving. Whether you are a caregiver, family member, or friend, this tool should help folks with diminishing cognitive functioning, not only maintain their dignity, but get the most of out every interaction with their loved ones. They have reported feeling a sense of accomplishment and were meaningfully engaged for hours; this activity sparked their creativity and imagination, starts conversations around reminiscing, and basically prevented boredom from setting in. It enhanced their quality of life.

 

In short Thomas, there is a lot you can do to honour your mom’s wishes. It sounds like Assisted Living is the only option your local health authority can offer, thus if you want to honour your mom’s wishes, you’ll need to go directly to a private agency. Choose one with Registered Nurses who can oversee your mom’s care. Some private agencies offer 24/7 support hours for families and client as well as professional geriatric care management services for folks with dementia.

 

Good Luck Thomas!

 

Nurse Kris

"No, I DON'T want you to call an Ambulance!"

Posted on 30 January, 2015 at 10:20 Comments comments (0)

Dear Nurse Kris:

 

Recently my wife fell, I couldn’t get her up off of the floor, she refused to let me call the ambulance, and she told me to stand in our building’s hallway until I saw someone who could help. So I did. When my neighbour came to help the two of us couldn’t move her either. We finally did call the ambulance. Now my wife is upset with me. What should I have done?”

 

Frank S, tired caregiver of ailing wife

 

 

 

Photo: Thinkstock.com

Dear Frank:

 

I am sorry you experienced this. It sounds like you are trying hard to do the best you can and be responsive to your wife’s requests. You are in a tough predicament. You mention your wife is ailing, and with her recent fall it leads me to suspect you have been in the caregiver role for her, for at least a little while.

 

In health care, there is a phenomenon called “caregiver exhaustion”. This is what happens when caregivers ‘overhelp’. When one spouse cares for the other, it can be difficult to retain your objectivity. Being the sole care provider to your spouse, means dual roles for you. You are both husband, AND, caregiver.

 

There are a few sticking points with this dual role. You either cease being a husband, while you become your wife’s primary caregiver, or, you become over absorbed with the infinite details of your wife’s care needs and cease being a husband. Martyrdom is the next plane for you.

 

Being a Martyr, means you think you are the only person who can do things right for your wife, and the only one who really knows how to care for her. You will know when you’ve reached this point when your friends ask you how you are doing, and you respond with “Mary had a great BM today, wow, am I thrilled”.

 

Frank, the message here, is that you cannot be everything, to everyone. The reason your lovely gal married you, is because she likes you for the man you are. Marriage vows do not mean, that you must do everything yourself for your gal. Marriage vows and partnerships mean you ensure your loved ones needs are anticipated, met and carried through as best as you can possibly provide for.

 

Your goal here is to be the loving person you are, and ensure your wife’s needs are properly met. You want to give the best of yourself to your wife do you not? It’s difficult if not improbable to achieve, if you are also her primary and solitary provider of care.

 

As your wife’s needs increase, you’ll need to put in place more a more formal care giving structure. When an individual can’t move about comfortably or safely or can no longer perform all of their Personal Care, outside services (formal care) are there to help you and your lovely gal.

 

In Canada, each regional health authority, or equivalent, has the responsibility for assessing clients in need and determining what level of care can be provided. Interior Health authority, uses an income means test to determine what level of care and the associated cost if any, can be provided to you.

 

Some clients bypass the Health Authority entirely to avail themselves of the services of non-government personal care agencies which have the ability to schedule staff to arrive at specific times, the ability to match caregivers to clients, and keep that same caregiver for consistency in care.

 

For more information Frank, you should first speak to your local Interior Health Community Care office at 250-980-1400 to inquire about an assessment of your wife. Other options to explore would be any Veterans Benefits you or your spouse might have, or insurance products such as Long Term Care, Extended Health Benefits or Critical Illness Insurance which you may have been paying for all these years.

 

Frank, you sound like a caring spouse. Enjoy your role as a spouse more, and find others to help with care giving. I hope these suggestions help you and your wife.

 

Best,

 

Nurse Kris

 

 

Suffering from Caregiver Burnout?

Posted on 30 January, 2015 at 10:20 Comments comments (0)

If you’re a caregiver to a parent or disabled person, you know how much work is involved! And you also know how many other parts of your life are begging for attention: family, friends, work, the gym… the list goes on.

 

 

Photo: Contributed

You may be providing home care, personal care, housekeeping, taking them to medical appointments, grocery shopping and maybe even meal preparation, checking to make sure they have taken their medications… the list is never ending but your time and energy do have a limit.

 

You may feel you’ve almost reached that limit. You’re exhausted trying to get everything done. You may even feel guilty about not spending quality time with your parent or your family. You’re concerned that your parent’s care is becoming more demanding and you’re running out of ideas and resources to help. You may even be fearful that if you don’t get some respite care soon, the other parts of your life may start to fall apart.

 

What can you do?

 

If you’re a caregiver how do YOU find respite care staff whom YOU can trust with your loved one? And what happens if you live in another city and can’t commute to your parent’s home on a regular basis?

 

Sandra L., one of our clients, lives in Calgary and was concerned about her father. She wanted us to provide services for him and keep her informed about his condition. Kris Stewart, our Clinical Director did a nursing assessment and provided Sandra with a report on what he needed and what services Advanced Home Care Solutions could provide.

 

Sandra immediately engaged Advanced Home Care Solutions to provide that assistance. In a letter she wrote to us later on she said, “I was very impressed with Kris’s service for my father. She went far beyond expectation. She worked closely with my family’s needs and requests and her team delivered compassionate, responsible care. I would recommend Kris and her team to anyone looking for a trustworthy service for an aging parent or loved one.”

 

We were able to replace her fears about her father’s care with confidence that he was being well looked after. The guilt she felt living in Calgary and not being able to be here on a regular basis was replaced with relief that our team of home care and health care professionals were looking after her father.

 

Sandra received regular reports from our Clinical Director on how her dad was doing. When she talked with him she didn't have to do the ‘parent care dance’; instead she could talk with him about what was going on in the world and her life. She could share a laugh or a joke. She became a daughter, not a caregiver, and this role helped strengthen her relationship with her father.

 

We are proud to have helped Sandra and her dad feel comfortable and safe about him living independently. We thoroughly enjoy providing him with our health and home care services.

 

 

Medicare: is it our Medieval Groaning Board?

Posted on 30 January, 2015 at 10:20 Comments comments (0)

Dear Nurse Kris;

My dad had an unsettling experience recently in a nearby hospital. He’s been living at home alone since Mom died last year. I’ve been noticing that he’s been getting less nimble. So of course the inevitable happened. He fell one day while sweeping his porch - a neighbour found him there a few hours later and called the ambulance. He went to the emergency room and was told he had a broken hip. If that isn’t bad enough, they didn’t put him in a real bed, they put him in a stretcher in the hallway. I was really shocked when I arrived there later that day.

 

He said he couldn’t get any rest because the lights from the nursing station kept him from sleeping and the staff were noisy. He said he had wet the bed once because no one came to help with a bedpan. This really upsets me! I talked to the nurses and they said they were at “overcapacity” and unfortunately dad would remain on the stretcher until a bed came open, or surgery…whichever came first.

 

What has our health care system come to??

 

Signed, “Dealing with Dad and this Disastrous thing called a Health Care System”, BC City.

 

 

Dear Dealing:

 

Your Dad is considered a “Frail Senior”. His experience is not unusual of patients in hospitals in BC, and in many places across Canada. Being a "hallway" patient is not uncommon to hear about. Hospitals in BC are usually at overcapacity, which correlates to sick patients like Jonathon sleeping on stretchers in the hallways; often without privacy, or the capability to readily summon help for pain control, or the wants of nature.

 

Canadians have claimed for five decades that we have the best health care system in the world. It may have been true at one point, it is true no longer. Canada spends 12% of its GDP on health care; it ties for first place with Iceland, yet has only mediocre health care outcomes in the 32 country OECD {Organization for Economic Development}. Canada is the only country in the world to outlaw the private purchase of health care services that are publicly administered, as per the tenents of the Canada Health Act. No other country in the OECD has replicated our single payer system. Our health care is not ‘free’, it is expensive to procure and manage. Its cost is hidden in our high taxes; free it is not.

 

When Medicare was developed in the 1950s it was designed to meet the acute care needs of a relatively young population, not keeping the elderly safe at home or housed in facilities. As such, the health care system can be compared to the Medieval Groaning Board; the health care system is buckling under the weight of the burden of caring for its aging citizenry.

 

As Dr. Simpson, new leader of the Canadian Medical Association said, “Canada’s health system ranks next to last (after the US) on virtually every measure of quality and access to care.” He continues on to say that no one would ever create a health care system like this today. (Andre Picard, 2014)1. Dr Simpson maintains that caring for people in their own homes to the extent safely possible would save the health care system in Canada, $2.3B per year.

 

Many seniors across Canada, tired of dismal, ever-so-cold winters in the East, turn to BC for easier winters. The unpredicted costs are great socially and financially. Not only do they leave their families behind, but they leave their support systems too. This means when they age in place in their new BC home they require more resources. They increasingly face social isolation as opportunities to mix with their peers, and families become more limited.

 

Our health care system needs to provide more home based care to people like Jonathon to help prevent misfortunes that necessitated his untimely visit to the Emergency Room. In 2011, BC hospitals spent $7.4 B providing care to hospital patients, $1.7 B to Residential Care patients (nursing homes), and only $943 M to clients who live on their own in the community. (John Doyle, Auditor General of BC, 2013)2.

 

BC and Canadian families are aging and Medicare struggles to meet their increasing health care requirements. These same families feel that there is a looming crisis regarding the ability of the health care system to continue to fund needed care.

 

Health care funding is a complex matter to be sure; there are a few tools that BC Ministry of Health uses that helps for funding allocation, called “Population Based Funding”. BC spends the least amount except for Quebec on health care per capita. We cannot argue that older adults require more resources. With BC having more older adults per capita than other province, why do we spend so little on health care? These are questions for others to answer, who are in positions to provide answers.

 

Jonathon can ask the health authority for home care support to stay safe and well in his own home. However, should he have a high retirement income - which many seniors do who move here from other areas - he will have to pay full price for home support services, either to the Health Authority, or to private service providers.

 

Health Authorities in BC have set important strategies and goals to change this dilemma but it will not happen overnight. Until the way that home care is funded and delivered (i.e cost shifting from acute care to community care) older adults and their families should not rely exclusively on a broken patriarchal health care system that is buckling under the weight of this Medieval Groaning Board. They should not be deluded into thinking that the current health care system will meet all of their needs at a level they expect. Instead, families and their loved ones should be proactive and ensure home support services are in place to protect the safety and dignity of their loved ones.

 

‘Dealing’, I suggest you talk to your local MLA, Ombudsperson for Seniors, and call the Patient Quality of Care office in the hospital your Dad is in. Share your story and be part of the voice that helps create change. I wish you both the very best in health and hope your Dad’s recover is a success.

 

Best,

 

Nurse Kris

 

 

1. Andre Picard. (2014). CMA slams Ottaws' inaction on medicare. Globe and Mail, A5.

 

2. John Doyle, Auditor General of BC. (2013). Health Funding Explained. Vancouver, BC: Office of the Auditor General.

 

 

Do your love ones' need help?

Posted on 30 January, 2015 at 10:20 Comments comments (0)

Do your loved ones need help?

by Contributed | Story: 124404 - Oct 14, 2014 / 5:00 am

1

As we grow and age ourselves, we often don’t notice the gradual physical, social, or mental changes that are happening to our parents, aunts and uncles and even our grandparents. If we don’t see our loved ones on a regular basis, we may be shocked at the decline when do see them.

 

“Why didn't’ they tell me they needed help?” is the most common expression vented in frustration. “I could have arranged for someone to come in and help!”

 

Many parents of baby boomers don’t want to burden us with their troubles. Most of all, most seniors do NOT want to move out of their home to a ‘nursing’ home. They do everything in their power to avoid hearing the words, ‘nursing home’.

 

The telephone conversation may go something like this, “I’m fine, dear. Don’t you worry about me. Now tell me all about…”.

 

So how can we tell if our loved one needs home care or help to live independently?

 

 

1. If possible, visit with your loved one as often as you can. When visiting, look for telltale signals such as: dishes in the cupboard that still have food particles on them (poor eyesight can’t tell the dishes are still dirty); dusty knick knacks (especially if the senior was a good housekeeper in their earlier years); floors look like they need to be washed or carpets vacuumed.

 

2. As you’re visiting listen carefully. Your loved one may say that they don’t use the oven because they can’t lift the pot or the pan into or out of the oven; or perhaps they mention casually that they aren’t taking a bath or shower anymore because it’s too hard to get in and out of the tub or don’t go to the dentist ‘because it’s too expensive’. (Too expensive often means that they have to take a cab there and back, not that the dental services are too expensive!)

 

3. If you’re unable to visit and your loved one doesn’t have other family in the area, check with a neighbour and ask them how your loved one is doing. Ask how your loved one gets their groceries or gets to the appointments. If your loved one lives in a condo or apartment, call the building superintendent or resident caretaker and ask how your loved one is making out on their own.

 

 

Now what?

 

Explain to your loved one that you can arrange for caregivers to come in and help with whatever is required… once a day, once a week or more, is a good place to start. Your loved one will likely appreciate that you are trying to help them stay in their home, instead of forcing them to a nursing home.

 

It’s always a good idea BEFORE introducing the topic of home care to your loved one, to check out the various services that are available in your community and their prices.

 

You may wish to choose an agency that can send one staff member to do a variety of different functions (personal care, housekeeping and meal preparation for example). If you see the need for progressive care for your loved one select an agency who can supply the different levels of care you feel your loved one may need.

 

We hope these ideas help you help your loved one live independently.

 

Medication Counselling for Seniors

Posted on 30 January, 2015 at 10:15 Comments comments (0)

Dear Nurse Kris,

 

My dad gets so confused when he visits his doctor. He’s hard of hearing and even with hearing aides he

doesn’t understand what the doctor is always saying. The pharmacist he gets his tablets from tries to

explain things to him, but by the time he gets home he’s forgotten instructions. I know he has a good

memory, but it’s almost as though he needs one to one assistance in understanding medication

instructions. I live in the same town as he does, but I work all day and cannot get time off of work to go

with him. By the time I’m off work, the pharmacy he uses, has closed.

 

Signed, Carol in Kelowna

 

 

Dear Carol,

 

I empathize with you and your dad. Busy health care professionals sometimes assume patients have the

information they need, or will ask for clarification if needed. Unless your Dad asks for more information,

they’ll assume he understands everything. Perhaps I can steer you towards one of Kelowna’s best kept

secrets. "Prescription Health Studio” at 540 West Avenue, is owned and managed by Esther Simmons

Foot, a pharmacist. From time to time, when I need further information about a medication that my

client is on, I call Esther. She has been immeasurably helpful to me.

 

How I think she might be able to help your dad is that she will sit down with him, and spend thirty

minutes counselling him on his medications. She is compensated for this time, by billing BC Medical, for

this consultation. It is free to your dad, and anyone who wants to avail themselves of this. It is called a

“medication review”.

 

Given your dad's hearing difficulty, this might be the best solution. Esther can be reached at (778) 478-

1303 or [email protected] An appointment is required for this.

 


 

Dealing with Declining Health

Posted on 30 January, 2015 at 10:15 Comments comments (0)

Dear Nurse Kris;

 

My parents are on a limited income, and my mom needs help with getting up and around for the day. It’s taxing Dad immensely to help mom out. He is struggling to take on the household tasks, the cooking, the shopping etc. He wasn’t brought up to know how to do these things; he has had to learn how to do them, as mom has become sicker and less capable. What kind of help is out there for Dad? I see him getting more tired as time goes on. He’s very devoted to mom, and I wish I could help but I only can on the weekends. I am helping my own kids through college, so I’m financially not able to really contribute to helping. What do I do?

 

Signed, Concerned in Kelowna

 

 

Dear Concerned;

 

You and your parents are facing a very common problem. Many seniors struggle with activities of daily living. Our wonderful geographic location and fabulous weather make it a mecca for older adults to retire to, from other parts of Canada. Statistics indicate there is a higher population of older adults in Kelowna than in any other city of similar or larger size in Canada. It is said that Kelowna is now, what the rest of Canada will look like in 15 years time.

 

A very good system is in place for identifying the needs of folks of any age, who live in the community, who are struggling with day to day personal care and household responsibilities. Interior Health Authority has primary responsibility for assessing folks and identifying if they can live at home safely, and if they need help or support at home. They can also determine if any cognitive decline is present… a little is usually okay, but at a certain point, if a person cannot make safe decisions about their day, or how to function in ways that are safe (ie. not opening the door to strangers, or leaving the stove on), then alternate housing needs to be considered.

 

If they do require assistance with personal care, meals, housekeeping etc, the Interior Health Authority assessing nurse will identify how much help is required, how much help they can provide, and the costs of this care to your parents. For folks with a high retirement income, the cost of receiving household and personal support services will be roughly the same as caregivers from a private agency. (Advanced Home Care Solutions is an example of one of these agencies).

 

Interior Health has a special program in place called “Home First”. It is intended for folks living at home in the community, who meet the criteria and have agreed to have their name on a wait list for Assisted Living. The program is designed to keep older adults living at home safely, who are at risk for falls, and who are wait listed for Interior Health funded Assisted Living apartments. There can be lengthy waits for these.

 

If your parents have a low income, I highly recommend you call Interior Health Authority, Community Care division at (250) 980-1400 and ask for Central Intake. Have your parents’ postal code ready, and then you’ll be directed to the appropriate nurse, who has responsibility for the area your parents live in.

 

The benefit to using Health Authority caregivers, is that it can be a low cost solution. Others, not so much. The detractor to using the Health Authority, is that the arrival time of the caregivers is not set in stone. The client is given a window of time (between 8 AM and 10 AM for example). There will be many different caregivers, who will all ask the client the same questions as they orientate to the client's home and preferences. For clients who prefer consistency, this may not be the best solution.

 

A private agency can also send a Nurse to assess your parents. The agency caregivers will have a wider breadth of tasks they are allowed to perform than the Interior Health Authority caregivers. Only the necessary few are assigned to the client so that warm, therapeutic relationships can quickly be built and the clients routine and preferences quickly known. They arrive at the exact minute they are scheduled for. For those with higher retirement incomes, the costs can be quite similar to Health Authority caregiver costs.

 

Interior Health is the gatekeeper for all funded Assisted Living and Residential Care (nursing home) beds. A family member cannot just call up the care facility to place mom or dad in a funded bed. Private pay beds are an option at most facilities if you choose to go this route, however. As I’ve stated many times before, folks have much better quality of life if they receive care in their own home, as long as safety issues are not a deterrent (risk of falls, leaving the stove on, letting strangers in the house).

 

Your parents may also benefit from having a Professional Care Manager (a nurse with advanced education), look in on them on a regular basis. Check around with different agencies, or Google “Professional Geriatric Care Manager” to check this out.

 

I hope I’ve given you some helpful information.

 

Nurse Kris

 

"No Nursing Home" Promise?

Posted on 30 January, 2015 at 10:15 Comments comments (0)

Dear Nurse Kris:

 

My siblings and I live a long distance away from my mom. Seeing her means a full day of flying or driving, time off work, etc. My mom is recently widowed, lives alone in her large home, has Alzheimer's and we worry about her forgetfulness.

 

She says she's taking her daily medications and eating and showering, but I don't have any way of knowing for sure. We promised her we would never move her to a nursing home. However, when we call, she's forgetful about the day's events, and she's growing lonely. When we visit, once or twice a year, the house is neat and her story sounds good, but still I feel uncomfortable.

 

I spoke with the government nurse and she recommends we consider placing mom in assisted living. The problem is, we made a promise to her we would never put her in a nursing home.

 

Mom has always said she would stay in the house until the day she died and she made all of us promise to honour her wishes. Can you make any suggestions?

 

Thomas- Trying to sort things out from Alberta

 

 

Dear Thomas: You are in a tough spot - you are appropriately concerned about your mom and want to do what's best for her, and you want to honour her wishes by keeping her at home.

 

Basically, there are two main components you'll want to be thinking about - her physical wellness and her mental wellness.

 

Let's talk about her physical wellness for a moment. Cash-strapped government health authorities often allow workers to come in for short periods of care up to several times per day. These services can include attention to personal hygiene, bathing, grooming, dressing, meal preparation and medication reminders or assistance. They also may book a personal care service for a bath for her, once or twice a week. The costs for this will be based on your mom's income level and the costs could be high. At times, those costs exceed the health authority's grid and the recommendation is the family seek outside private care services.

 

Your mom may need more "life management" interventions than the health authority can provide. If this is the case, then yes, they will recommend assisted living as a first step.

 

Once your mom's needs escalate beyond needing two services in the assisted living home, choices will be fewer and a recommendation would be made to place her in residential care (there is no more intermediate care).

 

In a recent local case, the health authority nurse found that for an elderly couple living at home and needing extensive services, the cost was essentially the same for both the health authority rates and the private agency. However, the difference was that the private care agency could offer more services for the same price.

The private agency service workers could assist the client with paying bills, personal laundry, making breakfast and lunch, going on an outing or to appointments, minor housekeeping, transporting to doctors and other appointments in the caregiver's vehicle - something the health authority care givers were not allowed to do. In this particular case, the couple - who met assisted living criteria - decided to go with the private agency caregivers, because they could do twice as much work for the same price as the health authority was charging.

 

Let's talk about your mom's mental health. Recent research published in the Archives of Gerontology and Geriatrics shows declining cognitive function is common in 10 per cent of adults aged 65 and older, and in 50 per cent of adults older than 85 there is some form of cognitive impairment.

 

Many families are concerned about what to do. Essentially, there is no magic bullet for stopping or reversing the disease, but there are medications to slow the disease progression, and there are activities to provide quality interactions with families, support persons, and caregivers. Whether you are a caregiver, family member or friend, these activities should help folks with diminishing cognitive functioning, not only maintain their dignity, but get the most of out every interaction with their loved ones.

 

Seniors report feeling a sense of accomplishment and were meaningfully engaged for hours - this activity sparked their creativity and imagination, started conversations around reminiscing, and basically prevented boredom from setting in. It enhanced their quality of life.

 

In short, there is a lot you can do to honour your mom's wishes. It sounds like assisted living is the only option your local health authority can offer, thus if you want to honour your mom's wishes, you'll need to go directly to a private agency. Choose one with registered nurses who can oversee your mom's care. Some private agencies offer 24/7 support hours for families and clients, as well as professional geriatric care management services for folks with dementia.

 

Good luck, Thomas!

 

 

Relocate to Kelowna?

Posted on 30 January, 2015 at 10:15 Comments comments (0)

Dear Nurse Kris;

My parents live in Newfoundland, and I live in Summerland, BC. They are strongly considering moving to Kelowna. I’ve always thought of Kelowna as a pretty "spendy" place to live. What should I be telling my parents to look into? I don’t have a lot of time to help them as I’m busy with my own kids and their problems and I work and look after my own house. Can you give me any ideas to advise them about?

Sarah in Summerland, BC

Dear Sarah;

Kelowna consistently ranks near the top in UN-affordability of housing in all of Canada. While the winters out East are brutish, the cost of living in Kelowna is similarly brutish.

I have come across a great study recently done by a Master of Arts - Interdisciplinary Studies student at UBC-O, by the name of Heather Catherine Brown (Brown, 2013). In her thesis called “Aging Gracefully: A case Study of Seniors in Kelowna’s Housing Market”, she finds that seniors already living here do say that Kelowna’s housing market is expensive and that these seniors recommend that the location of the new home be close to amenities. They also recommend that a senior/senior couple, rent first for one year before deciding to buy a home. These study participants all recommend that the City of Kelowna add more affordable housing options. Recommendations were also made by these seniors that the three levels of government do more to make housing more affordable for seniors.

The main keys to success for your parents, according to this thesis (Brown, 2013), is maintaining social connections, having a good sense of personal well-being, and having available home support services.

Many respondents to this study said that they incorporated the help of realtors, family members and friends as well as doing on line research and enquiries in making decisions about what kind of housing would best suit their needs. Many seniors feel that it is their ‘right’ to stay in their own homes for as long as possible (and in most cases, they are right about that).

Sarah, I think your parents should investigate the housing market with the assistance of someone they trust, to make non-conflict recommendations to them. There is a lot to keep in mind to be sure. Your parents should think of the things that are important to them (access to medical services, golf courses nearby, values around privacy and space, proximity to family etc), determine what their funds are and plan what the best living and housing situation is, based on the answers to those questions.

In Kelowna, there are a wide range of options; from living in an owned detached home, to apartments that are subsidized, to ‘campuses of care’ which have both Assisted Living condos and residential care beds, in the same large building. Or, supportive housing, where most meals are taken in a common dining room, and some also have a variety of specialized purpose rooms such as a wood working shop, a movie theatre, a hair salon, a general store, a gift shop etc. Housing affordability will determine where your mom and dad can live. The cost of housing should be no more than 30% of their available income (Brown, 2013).

Kelowna also has one or two professional geriatric care managers who know the seniors housing industry well. They could be contacted and asked for assistance as they know the seniors housing market well and have no conflict of interest in deciding which housing option is best.

Best of luck Sarah,

Nurse Kris

Bibliography

Brown, H. C. (2013, March). Aging Gracefully: A case study of seniors in Kelowna's Housing Market. Masters Thesis, The Unversity of British Columbia, Kelowna.

 

 

Are Extended Care Homes Safe?

Posted on 30 January, 2015 at 10:15 Comments comments (0)

Dear Nurse Kris:

 

I know you help families who are dealing with putting a parent in a facility, so I thought I would run our situation by you. Our problem is, I just heard a couple of really negative comments about the facility we going to place our mom in. We thought it would be okay to put her in a large extended care facility near one of our family members, but now we are having some second thoughts because of these comments. I thought all facilities had to meet certain standards of care, so what I heard about this one really shocked me.

 

How do we know if these extended care homes are safe?

 

Signed,

 

Tom from Vancouver

 

 

Dear Tom:

 

I'm not an expert but have done some research recently on the topic of safety of extended care homes.

 

Care homes are either Assisted Living (for clients who are more independent and direct their own care) or Extended Care (for clients who need 24 hour care and assistance). They are licensed by different licensing entities, and each have different criteria for admission.

 

A care home bed will either be a 'funded' bed, or a 'private pay' bed. A 'funded' bed simply means the patient's stay is primarily funded by the health authority. All clients who need placement in funded bed, need to have an assessment performed by a health authority nurse from the Community or Long Term Care department. A private bed, means the client or their family privately pay for these beds. A nursing assessment is usually not necessary.

 

Many regulations are in place to promote the health, safety, and dignity of residents. It is important to stay involved with your family member’s life after they have moved into a facility. Be sure your visiting family member asks questions and observe any changes in your mom. Other ways to be involved include participating in the resident and family council and taking part in your mom's routine care planning meetings.

 

Health authorities post summary inspection reports on their websites for routine and follow-up inspections of facilities licensed under the Community Care and Assisted Living Act or licensed or designated under the Hospital Act. The reports include information relating to substantiated complaints and inspections. Only since 2012 have substantiated reports been available in our health authority in the Interior of BC.

 

To determine if the comments you heard have any basis, go to the health authority website where the facility is and look for the tab which discusses Senior Care or housing, or Residential care. Search the menu for "Inspection Reports" and "Substantiated Complaints". As well, you can search these websites inspection reports for Food Inspection reports. I advise you to read these as well.

 

I would also recommend you perform an internet search with key word "senior abuse in care home" or the like. This will turn up media reports. Remember, a media report is simply a news story until allegations are founded and substantiated.

 

From my experience working as a Registered Nurse and Residential Care Manager in a health authority facility in the Interior of BC, we always appreciate it when we have family involvement. Having family involved and visiting means resident advocacy is enhanced, which generally means improved understanding for the preferences and needs of the resident.

 

I also recommend you or your family members attend a family support group targeted to families with parents in care. This will give you a good opportunity to connect with other families with similar situations. Ask questions about the responsiveness of management at various facilities. Facilities with a high turnover of management or staff denotes a problem at higher levels of management. Inconsistent or constantly changing key leaders means changes that are implemented may not be followed through with and staff performance issues may not be fully addressed. This results in care practices that may not be supervised or addressed.

 

I hope I've given you a place to start. Good Luck Tom!

 

Nurse Kris

 

 


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