Sunday, April 29, 2012 | Categories: Episodes
On Cross Country Checkup: caring for seniors
As Canada's baby boomers jog and rollerblade into their senior years, some experts are warning of a looming demographic time bomb. It's something Canada's health ministers will have to address in the new health accord. But before then, are seniors today getting the care they need now?
With host Rex Murphy.
Health Council of Canada
I think we all know that seniors' needs are becoming more complex. Instead of saying can we meet seniors' needs, I think we should be focusing on managing the expectations of seniors and families. I think families and health care practitioners need to have adult conversations with aging family members about what they want in their final phase of life. We already know that aggressive treatments are not leading to better outcomes for many seniors. The focus can't be on "if only we had" - it has to be to give dignity to seniors in the final phase of their life.
Our family are caregivers for a 91 old women with advanced dementia. Her 1.5 year hospital stay 10 years ago was the contributing factor to her illness. She has many changing and complex care needs - but managing our expectations has been our survival strategy.
My mother is 80 years old with Alzheimers. She is in a retirement home with Alzheimer care facilities. She is approaching the time when she will need to get into a long term care facility to handle her increasing needs.
In Ontario, she must apply for a place in a long term care facility understanding that she will be on a waiting list for anywhere from one to three years! Who can predict an elderly patient's care needs accurately three years in advance? If you err on the side of caution and put the patient on the list too soon, expecting perhaps the 3 year wait, and the patient's name comes to the top of the list before they are deteriorated sufficiently to need that spot, then you go back to the bottom of the list to wait another one to three years. It's a vicious, vindictive policy that forces families to choose between putting a person in that kind of a facility before it's necessary, or risking having them unable to get a space in a suitable facility when they finally need it.
It's a bureaucratic protocol that ignores the patient as a human being, and this kind of ageist policy making is rampant in our society.
Try finding a bench for an elderly person to rest on at a bus stop in Toronto, or any where on the city's sidewalks. The state of our overcrowded transit systems, and our pedestrian-unfriendly sidewalks makes getting around impossible for anyone who is not in robust health.
Again and again, the elderly are treated with indifference when it comes to the nuts and bolts of necessary infrastructure.
My father's full life was suddenly and then agonizinly slowly cut short by vascular dementia. In our rural area of Manitoba the system is that when the patient is panelled for care you must wait for a bed in the local personal care home (you are placed in first available) away from familiar doctors, neighbors, etc.The bed was 60 km from my home and my father died there two years later. A bed never did come available in our home town. I am a nurse who knows how to navigate the system, advocate for acceptable care, and not take no for an answer. I feel very sorry for all families who have to figure out an unfamiliar system that really is very broken.
I am a social worker at Community and Home Assistance to Seniors and I was also a caregiver for my mother. I hear a great deal of stories from seniors caring from seniors, adult children caring for seniors and friends looking out for their older adult friends.
I find that older adults are having difficulty accessing services because there isn't a great deal of awareness out there of services that are needed for seniors. Family member and older adults have to navigate through the system and they are finding that there is a lot of red tape where there is a great deal of assessments in order to receive services and the services that are to be offered through the government is time limited and limited to only specific conditions and abilities.
It is difficult for seniors to remove themselves from their own home and let alone be introduce strangers in their own home to provide personal services like bathing, toileting and making meals. Seniors may feel that their privacy is invaded and because of the lack of awareness and conditioning seniors have about the future of their care, it is awkward and anxiety ridden to accept personal care from a stranger.
Adult children and older adult family caregivers find themselves having to compensate their own lives work, caring for their own children and their own personal lives in order to offer care for their aging family member. Not all of these caregivers have formal training or awareness of the services and the system. This is becoming more stressful for families and it impacts other generations beyond the aging parent or person.
Richmond Hill, Ontario
I am 82 years of age. What I need is supportive connection around me, we live near each other but we are not aware of each other or each other's needs.
There could be an agency that helps us to connect, a trustworthy agency that reveals what we need and discerns what we can do for each other. I could easily walk the dog of the elderly lady across the street when she goes into hospital, I could deliver groceries to anyone near me, drive someone to a medical appointment or pick them up after an eye operation, etc. The problem is that we do not know each other year after year. I would like to be able to call up a neighbor when I need a drive from the hospital or some cleaning that I cannot manage by myself because of the stiffness that comes with arthritis (my three children are thousands of miles away and it would not be appropriate to bring them here to do those small things, I want to save them for a serious crisis when it comes, I do not want to go into assisted living just because of small needs). Life has made us too independent, we need to learn again how to help each other. We elderly do not want everything to be done by doctors, nurses, institutions, care homes, so long as, with a little help from our immediate neighbors, we could do so much of it all for ourselves. But we need an agency to be set up to allow and encourage this neighborliness to happen to help us.
Victoria, British Columbia
I am 65 years old. I, and my baby-boomer contemporaries, have been heading for old age for over half a century. Why has no government had the foresight to see us coming, and to prepare for it? We aren't exactly invisible.
I feel like a complete fool for not waking up earlier to the prospect of government inaction on good elder care. Of course, I did not think I would be facing old age entirely alone, and on a very, very low income, either.
From what I have seen so far with my own parents, and with contemporaries, I think low income seniors like myself are heading for a truly horrible experience.
My parents, Mom in particular, cared for both my grandmothers, one severely debilitated by a stroke, in the 1970-1980's for several years. As a result, they both have no desire to be kept living by medical means as they age. Ideally, they will go quickly and suddenly. Watching Mom care for my gransmothers was an intense experience, one they expressely do not wish on my brother or me. I have to say I agree. I'm at the tail end of the baby boon, cognicient that life is lived in the present and with no desire to spend my last days in a home or as a burden on society.
The time to live is now and it's important to do it well. Is medical treatment always the right way to go?
In my openion the only solution to this problem is to encourage and facilitate small, private nursing homes, taking care of 5 to 10 seniors. More seniors will get help and many younger people will get jobs.
Sydney, Nova Scotia
As a senior in my late 80's living in Alberta and still on my own. I was dismayed to hear that our new Premier wants to get the private sectorinvolved in building and operating new nursing homes. Alberta has not been keeping up with new homes despite our burgeoning population.
Privately-run nursing homes can cut corners in order to maximize profits. They can raise rates, serve mediocre meals and cut staff, etc. I am not in favour of privately-run nursing homes.
I think one of the biggest issues is that we have 'medicalized' aging, as we are so afraid of aging, we often look at it in and of itself as 'illness', which I think makes people afraid of planning for their later years, and as such, often older adults end up needing care urgently as they are reacting to a crisis.
If we put our collective ageism aside and took a page from the book of some of the Eastern cultures, we may be able to gain a respect for aging and the aging process, and as such be able to look ahead at our and our loved ones' lives, and make decisions based on personal choice and plan which would allow both ourselves and the system to prepare for our later years.
The problem with the health care system is that we treat our publicly funded health care system as a business and not a service paid for by taxpaying citizens. We have changed the rhetoric in how we talk about it, in how it has managed and in so doing have changed the way we look at this system. Instead of hospital administrators and hospital boards based in the community we now have way over paid CEO's many of whom do not know anything about the practice of medicine, we now have case managers and presidents of nursing care with community care access headed by executives. None of these people should have these titles. Our system is a public service. Yes, we want it to be accountable and well managed but business gurus who know only profit and loss, how to cut cut cut are not the people we need running our health care. Oh and the one I like best? We are stakeholders. Give me a break. We are patients who need to use this service when we are sick. There are too many executives and not enough troops doing the work.
With regards to senior care a lot of this problem could be solved by bringing seniors and home care into the Canada Health Act. Community Care Access contracts out home care to the lowest bidder a strategy which to me is tantamount to slavery for the people who are caring for seniors in their homes. Sadly we seem to have an attitude in this country that anyone who looks after people who are ill are somehow not entitled to a decent wage for the work they do. Their work is difficult often dealing with very difficult patients (oops clients) and most often done by immigrant women and men who take the courses and are guaranteed a job when they finish the course. But wages of $12.75 per hour is not good enough.
We have had experience with seniors care over the last year and a half with two terminally ill parents and can only say that it is time to look at these services and do a thorough evaluation of how they are delivered and who delivers them.
One cannot discuss senior health care without touching on the topic of end of life decisions. It is time seniors have the right to decide when and how they exit this world. As a daughter who had to watch her 89 year old mother starve to death over a period of 10 days in hospital due to pneumonia that was unresponsive to medication, I spent every evening wishing there was a way I could increase her morphine to allow her to die with dignity. Instead, I was told by the shocked nurse "no, we can't increase her morphine, she might stop breathing". Um, yes, that was my point.
New Westminster, British Columbia
It's important to understand that there is no one solution for folks. My mother is in an assisted living arrangement and it's the best thing that could have happened for her. We are fortunate that she can afford it. But her opportunity to interact with others and healthy meals has extended her life. The care is wonderful. Yes she didn't want to go when this option was first presented but now is so very content with the arrangements.
Today older adults want to live at home. To do so we need help with home-making such as meal planning, vacuuming and companionship, all social issues. However in Ontario you need to have a medical service before you can get any of these services. The focus needs to switch from medical to social to make this happen.
Older adults go into hospital with issues that can often be treated in a short period of time yet, once that occurs, they are immediately placed in Alternative Level of Care beds awaiting Long Term Care that are referred to as bed-blockers. What should happen when older adults have been treated, they should go into rehabilitation, restoration program that focuses on going home where they truly want to be with social supports listed above. Hospitals need to address such issues now.
Today's older adults are healthier, more fit and financially able to afford additional care not covered by our present system. It is those who are financially struggling whose needs are not being met. The idea of a senior tsunami is a myth. Dr. Michael Rachlis, a policy maker says they system needs to change from a hospital model to a home-support one but that means political intervention. Unfortunately politicians are only there to get re-elected so are reluctant to make any changes.
My husband is 81 and I am 72. We live in our Aging in Place bungalow meaning everything is accessible. In our basement we have a one bedroom apt. Where we could have a carer live should we need one. It is not perfect but it is a solution for us.