Caregiving from a Distance

For family members whose aging loved ones live far away decision making can often be difficult, from stress to financial worries on top of time spent trying to sort things out. 
If you live in another city, province, or even country from your aging loved one, chances are you won’t be there yourself every time to address any sudden health changes or changes in daily needs. Whether it’s gathering information about care needs, or coordinating alternate care and medical services, caregiving from a distance involves a substantial investment of resources.

The Challenges of Taking Care of Aging Parents from a Distance
Plan ahead 
Find out what resources are available in your loved one’s community. Establish contacts with a doctor, faith leader, social worker, hospital discharge planner and if in Ontario, your local LHIN.

Arrange a meeting
Include your parent (s), your family members and professionals who are helping. Think and talk about all the options. Be sure to talk about what role each family member might play when dealing with an aging parent or loved one. 

Work together 
If your sibling (s) or another relative is nearby, work together to arrange for help. Give emotional support for when you are not able to be there. It really is stressful and emotional. We will Blog on the importance of support shortly. 

Arrange for a regular check
Ask a friend or neighbour to look in on your parent or loved one and let you know if problems arise.

Breakdown:
Schedule family meetings via conference call or Skype to discuss decisions ahead of time, make sure to organize documents and paperwork before you need them, and gather all necessary contact information for concerned parties, including friends, family, neighbours and care providers.
In particular, seeking help from knowledgeable parties can be invaluable. 

We are here to support you and families, because we know you can’t always be there. But we can. 

Burlington

Sunrise Remembrance Day Service
November 11, 2018, 9 a.m.
This 30-minute ceremony will take place at the Naval Ships Memorial Monument in Spencer Smith Park.
www.burloaknavalveterans.org/parades-ceremonies/

Remembrance Day Parade
November 11, 2019, 10:30 a.m.
The parade starts at Central Public School.
www.burlington.ca/en/live-and-play/Remembrance-Day.asp

Remembrance Day Service
November 11, 2018, 11 a.m.
Held at the Cenotaph, on the north side of City Hall.

Hamilton

Hamilton Street Railway (HSR) will offer free rides to veterans in uniform on November 4, and 11, 2018 for bus travel to and from Remembrance Day services.
For further info please visit:
www.hamilton.ca/attractions/festivals-events/remembrance-day-services

Glanbrook Remembrance Day Service
Sunday, November 4, 2018
2:00 pm to 4:00 pm
Glanbrook Cenotaph at the Glanbrook Arena, 4300 Binbrook Road, Binbrook
View event

Ancaster Remembrance Day Service
Sunday, November 11, 2018
10:30 am to 12:30 pm
Ancaster Old Town Hall, 310 Wilson Street East, Ancaster
View event

Dundas Remembrance Day Parade and Service
Sunday, November 11, 2018
10:30 am to 12:30 pm
Dundas Cenotaph at the Dundas Lions Memorial Community Centre, 10 Market Street South, Hamilton
View event

Lynden Remembrance Day Service
Sunday, November 11, 2018
10:30 am to 12:30 pm
Royal Canadian Legion - Beverly Branch 500, 206 Lynden Road, Lynden
View event

Mount Hope Remembrance Day Service
Sunday, November 11, 2018
10:30 am to 12:30 pm
Canadian Warplane Heritage Museum, 9280 Airport Road, Mount Hope
View event

Royal Canadian Legion Branch 163 Remembrance Day Service
Sunday, November 11, 2018
10:30 am to 12:30 pm
Royal Canadian Legion - Branch 163, 435 Limeridge Road East, Hamilton
View event

Stoney Creek Remembrance Day Parade and Service
Sunday, November 11, 2018
10:30 am to 12:30 pm
Stoney Creek Cenotaph, King Street & Highway 8, Hamilton
View event

West Hamilton Remembrance Day Service
Sunday, November 11, 2018
10:30 am to 12:30 pm
West Hamilton Cenotaph at St. George's Reformed Episcopal Church, 134 Emerson Street, Hamilton
View event

Hamilton Remembrance Day Service and Parade
Sunday, November 11, 2018
10:45 am to 12:45 pm
Veterans’ Place at Gore Park, 64 King Street East, Hamilton
View event

Waterdown Remembrance Day Service
Sunday, November 11, 2018
10:45 am to 12:45 pm
Royal Canadian Legion - Waterdown Branch 55, 79 Hamilton Street North, Waterdown

Oakville
For further info please visit:
www.oakville.ca/events/remembrance-day.html

Bronte Village
November 4, 2018, 10 a.m.
The Royal Canadian Legion parade will proceed west along Lakeshore Road from 79 Jones St. to the Cenotaph for the Ceremony of Remembrance, hosted by the Royal Canadian Legion.

George’s Square Ceremony
November 11, 2018, 11 a.m.
The Veterans Parade will proceed east along Lakeshore Road to Trafalgar Road and north on Trafalgar Road into George’s Square for the Ceremony of Remembrance, hosted by Oakville Legion Branch 114.

Trafalgar Memorial
A Ceremony of Remembrance will take place on November 11, 2018, 11 a.m.

They say dog is man’s best friend, but for stroke survivors, a dog can mean even more than that. Dogs tend to respond well to training and have the temperaments to be good companions. For this reason, more and more stroke survivors are finding comfort, support, and assistance during recovery in the form of pet therapy dogs. 
These animals are not just the pets you’ll find at the pet store; they go through special training to become service animals ready to help in a multitude of ways. And by simply caring for a dog (brushing, feeding, walking), survivors experience therapeutic effects.

What is Pet Therapy?

Pet therapy is not just a fancy term for having a pet. Pet therapy, also known as animal-assisted therapy or AAT, uses trained animals as a form of treatment. While almost any kind of domesticated animal can be a part of pet therapy, canine therapy is the most common and most popular. Dogs are ideal therapy animals because they are comforting and non-judgemental, and therapy dogs undergo extensive training before working with a patient.
In pet therapy sessions, the patient normally works with a licensed therapist, a trained animal, and the animal’s handler to help with their recovery. In these sessions, the animal can assist the patient with a variety of symptoms, including aphasia, spasticity, hemiparesis, and depression. Here are some of the benefits pet therapy can have for stroke patients:


How Pet Therapy Can Help Stroke Patients

Loneliness One great benefit of pet therapy is how it can make stroke survivors feel less lonely. Having a stroke can be an isolating experience. If the survivor suffers from aphasia, it may be difficult for them to communicate with others. If they are unable to walk, they will likely spend most of their time at home. An animal provides company and stimulation, allowing a stroke survivor to have a more varied lifestyle.


Provide Motivation to Walk A dog can provide an incentive for a stroke survivor to want to work on gait training and rebuilding their walking ability. Christi Dudzik, an animal assisted therapy provider, has seen patients when working with a therapy dog walk twice as far as they did the day before. The reason behind this, she says, is that “they are distracted by the dog and aren’t aware they’re walking twice as far.”


Help With Aphasia Pets encourage stroke survivors with aphasia to try to communicate. Dogs are able to pick up on nonverbal cues, like hand signals and sounds, and may respond to just one word, making it easier for someone with aphasia to practice communicating. When out and about with a dog, the pet is also a great conversation starter, giving the stroke survivor more opportunities to practice talking with strangers.


Lessening Depression Stroke recovery and rehabilitation can be difficult, and it can take an emotional toll on the survivor. Pets offer the acceptance, love, and motivation that a stroke survivor may struggle to find in themselves. Even just petting an animal can provide a calming and comforting effect that can help with a survivor’s mental health.


Assist With Stroke Exercises Therapy dogs can assist a stroke survivor with their stroke recovery exercises. A simple activity like brushing the dog’s fur can act as a hand exercise and help decrease spasticity and increase motor recovery. They can also practice motor tasks by doing things like snapping the dog’s leash on and off, tying a bandana around their neck, and feeding them treats.


Pets Give Purpose For stroke survivors, an animal could be the missing link in their recovery efforts. Dogs are common therapy pets, and there are many benefits to having one. They can provide the comfort and motivation a stroke survivor needs to power through their recovery and improve their mental health. Caring for a dog may also improve confidence in survivors because it makes it easier for them to meet people and be social. 


Content written by Saebo
​ www.saebo.com/benefits-pet-therapy-stroke-survivors/

A recent visit and tour of a Pioneer Elder Care Home in St. Catharines showed us an alternative to caring for people with Alzheimer's Disease.
At the door we were welcomed by some of the residents and Mary Ellen guided Karla and myself through the home.

The home has 10 bedrooms in a residential neighbourhood, with 5 bedrooms on either side of the building. In the centre of two wide hallways are spacious tub rooms and washroom facilities along with a laundry room, where laundry is done daily.

The hallways flow to the back of the house to the open concept kitchen, dining and living room area. In addition, there are two outside areas where residents can enjoy the outdoors when weather permits. There were residents sitting in the living room area relaxing, chatting and watching television, we were welcomed by them as well.

It is refreshing and heart warming to see people with dementia living in a place which is really a home environment, quiet, calm and serene.
Pioneer Homes has 4 such homes in the Niagara area and currently have a waiting list.

This is a fresh alternative to Long Term Care options. Please take a quick look at the video to see one of the homes. 

pioneereldercare.com/

When it comes to exploring care options it can often be overwhelming for families or clients.
We have briefly explained some of the different options available to the community for those in need of some extra support.                                                                         
 
Types of Support-LHIN, Live In, Private Care
 
LHIN funded Home Care
 

• Anyone can call the LHIN for an assessment to determine if they qualify for government funded home support services.
• A needs assessment may take one to weeks to be completed.
• The number of hours of service are limited and you will be advised as to the service available to you.
• There may be no continuity of caregiver.
  

 
Private Live-in Caregiver
 

• You must do your own hiring and screening of the caregiver.
• It is important that you are involved in the case management aspect to schedule staff.
• You are then considered to be an employer and as such are responsible to pay WSIB premiums and source remissions.
• If you decide not to pay remissions, you may still be held liable for any work related injuries.
• If the case is not closely managed, you may find that the caregiver and client relationship boundaries could crossed, and the client be at risk for exploitation.

 
Hiring a Health Care Agency
 

• Private agencies respond quickly to calls.
  
• Consultation to determine needs can be done on the same day or at a time that is convenient for you or your loved one.
  
• There is an individualized, personal care plan done, with the client and family input to ensure that your needs are met. 
• Flexible scheduling to meet your needs.
• 3-24 hours of service a day for as long as the service is required.
• A caregiver can provide support in any care setting such as hospital, long term care, retirement home, assisted living or in home.
• Staff can transition with the client from setting to setting.
  
• Staff are bonded, insured, and certified with a thorough background check and references completed. Source deductions and WSIB are all in place through the agency.
  

 
FAMILIES CAN’T ALWAYS BE THERE, BUT WE CAN
 
 Yvonne Griggs 
 
Alert Best Nursing and Home Care

What's the Dollar Cost of Caring for a Loved One With Alzheimer's?
By Steven Reinberg
HealthDay Reporter

Latest Alzheimer's News
WEDNESDAY, Sept. 26, 2018 (HealthDay News) -- Almost $200,000 over the course of two years. That is the cost of the care that a family member typically gives a loved one with Alzheimer's disease.
 
That's according to a new study that attempted to put a price tag on the burden of the day-to-day help that millions of folks with the memory-robbing disease need for shopping, cooking, cleaning, eating, taking medicine and looking after their well-being. 
 
"The costs of caregiving depend on the needs of the [patient], and median costs range between $144,000 to over $200,000 over the course of two years," said study author Norma Coe. She's an associate professor of medical ethics and health policy at the University of Pennsylvania in Philadelphia.
 
More than 35 million Americans provided care to someone aged 50 or older in 2015, but the real costs of this so-called informal care aren't really clear, the researchers said.
 
When these costs are usually taken into account, researchers multiply the hours of care by the wage that paid home health care workers would earn. But this falls short of the real-world costs of care given by family members.
That's because family caregivers often give up activities such as leisure time or jobs, the study authors explained.
 
These costs totaled at least $277 billion in 2011, Coe said. "As baby boomers age and policies shift long-term care towards the community, these costs will likely rise substantially," she added. 
 
For this study, Coe and her colleagues looked at the costs to daughters between the ages of 40 and 70 who would be taking care of their mother in the near future.
 
The researchers specifically studied different scenarios of the mothers' health. These included mothers who were healthy, those who had difficulty with daily activities, those with memory loss, those who had difficulty with daily activities and had memory loss, and moms who needed constant care.
 
For mothers who had memory loss but no difficulty preforming daily activities the researchers estimated the cost over two years at $163,000.
 
The costs of caring for someone who had difficulty with daily activities was $167,000 over the same period.
 
When memory problems were combined with difficulty with daily activities, however, the costs of caregiving actually dropped to $144,000, the researchers found. 
 
But when a mother cannot be left alone for more than one hour, costs increased to more than $200,000, Coe's team reported.
 
The average cost of a semi-private bed in a nursing home in 2017 was $85,775, which suggests that two years of nursing home care would cost $171,550, the study authors explained.
 
"As we move away from institutional care, it is important to remember the costs to the family and informal caregivers," Coe said. "Caregiving involves significant costs, in line with the costs of a nursing home."
 
Keith Fargo, director of scientific programs and outreach at the Alzheimer's Association, said Alzheimer's diseaseis exceptionally demanding for caregivers and the scope of the problem is likely to get worse. 
 
"Our best estimate is that there are 5 million Americans with Alzheimer'sand lots of caregivers for those folks," Fargo said. "And when you project out to 2050, that's going to increase to 13.8 million."
 
People caring for someone with Alzheimer's need training and time off from giving care, he said. Support can include adult daycare and workplace policies that can help caregivers continue to work while they're providing care, Fargo said. 
Giving care can go on for many years, and caregiving can become more demanding over time, he said. 
People need to start thinking about the cost of caring for someone with Alzheimer's and how to manage before it happens, Fargo said. They should consider long-term care insurance and options for care in their community, he suggested.
"People should look at these options before it's too late," he said. "No matter how you slice it or dice it, it's very expensive."
In the study, Coe and colleagues used data from the Health and Retirement Study, conducted by the University of Michigan.

The report was published online recently in the Journal of the American Geriatrics Society. 

POSSIBLE CAUSES:
 
PHYSIOLOGICAL OR MEDICAL CAUSES:

• Fatigue at time of request, activity or event.
• Disruption of sleep pattern (day and night reversal) causing sleep deprivation.
• Physical discomfort, such as pain, fever, illness, constipation, fecal impaction,

expressed as anger.

• Loss of control over behaviours due to physical changes in the brain.
• Adverse side effects of medication such as phychotropics, sedatives or tranquilizers.
• Impaired vision or hearing causing person to misinterpret sights and sounds.
• Hallucinations.

 
ENVIRONMENTAL CAUSES:

• Sensory overload – too much noise, activity, or clutter, or too many people in

environment.

• Unfamiliar people, place, or sounds.
• Sudden movements, startling noises.
• Feeling lost, insecure, forgotten. When familiar person is out of sight, impaired

person may feel abandoned.

• Difficulty adjusting to darkness from well-lighted area and vice versa.

 
OTHER CAUSES:

• Being asked to respond to several questions or statements at once.
• Responding to arguments between other people
• Response to caregiver’s impatience, stress, irritability.
• Person scolded, confronted, contradicted.
• Surprised by unexpected physical contact.
• Inability to perform what was once a simple task, e.g., buttoning clothes.
• Instructions unclear or too complicated.
• Change in schedule or routine.
• Attention span too short for task.
• Task not broken down into manageable steps.
• Activity perceived as too childlike, insulting.

 
COPING STRATEGIES
 
Begin with medical evaluation to rule out physical and/or medication problems.
 
Discuss possible adverse side effects of current medications with physician.
 
Have vision and hearing checked.
 
Alternate quiet times with more active periods.
 
Plan outings, activities when person is rested.
 
Make sure person is comfortable – clothes are not tight, person is not too hot or too cold.
 
Simplify environment by reducing noise, number of people, and clutter.
 
Keep daily routine as consistent as possible.  Avoid changes and surprises.  For some people
with dementia, the slightest change may lead to confusion and disorientation.  Try scheduling
meals, bathing, and walks, for example, at the same time everyday.
 
Determine an appropriate amount of time to accept change in routine when rescheduling is
necessary. For example, if a new caregiver is to be introduced, or day care is being tried, 
accustom the person to the new place or caregiver as gradually as possible.
 
Keep furniture and objects in the same place at all times.
 
Orient person to time by using calendars and large numeral clocks, as the person may lose a
sense of time because of the disease.
 
Make sure the person is protected from hurting him/herself.  Remove sharp utensils, tools, 
and objects from environment.
 
Remove the person from stressful situation, person(s), or place.  Gently guide the person 
from environment while speaking in a calm and reassuring voice.
 
Distract the person with a favourite food or activity. This may reduce agitated feeling.
Distraction and avoidance are often the most useful approaches to handling agitated or angry
behaviours.
 
Exercise regularly to help in reducing stress.  Try walking or dancing.
 
Try music, massage, quiet reading as way to calm person.
 
Use gentle physical touch to calm person.  Holding hands and hugging may be comforting
for some persons living with dementia, but perceived as restraining by others.

This afternoon we were graciously hosted by the wonderful team of staff and volunteers at Dr. Bob Kemp Hospice for their Lunch & Learn on Music Therapy Experiences in Hospice and Bereavement Care. 

The 10 bed Hospice, located on the Hamilton Mountain has been a great resource to families and the community for over 25 years. We can't thank them enough for a very moving hour in our day today.

What we learned this afternoon was invaluable and below is some general insight, with thanks to the Association for the information: 

First of all, who is the Canadian Association of Music Therapists? 
The Canadian Association of Music Therapists  (CAMT) is a not-for-profit organization that works to promote the practice and research of music therapy; increase national awareness on the topic and increase the opportunities for clients to access high quality music therapy services. 

What is Music Therapy? 
Music therapy is a discipline in which credentialed professionals use music purposefully within therapeutic relationships to support development, health, and well-being. Music therapists use music safely and ethically to address human needs within cognitive, communicative, emotional, musical, physical, social and spiritual domains.  

Where can you find Music Therapists? 
Hospitals, long-term care facilities, hospice, correctional centres, mental health facilities, schools, community programs and addiction centres. 

What are the benefits? 
-Improve communication skills
-Improve self esteem
-Facilitate learning and processing of complex emotional issues
-Promote independent mobility
-Provide alternate forms of self expression 
-Decrease agitation 
-Manage pain
-Facilitate rehabilitation 

The room was moved to tears more than a few times during the presentation by Sara Klinck and Andrea whom are both so incredible and have such passion and talent.

We have included a short YouTube video from the Hospice, please do check it out.

​ 

With the current waiting lists for Long Term Care and the increase in costs of living in Retirement Communities we are looking for other housing options.
The goal is to provide options that are cost effective and provide choices for Seniors. 
Now a days there are definitely more Senior living options than in the past.  Many depend on what you are willing and able to pay for.  

Home Care

•There are many home care providers that can provide assistance for clients in their homes, retirement homes, long term care and in hospital
•Their services include: personal care, meal preparation, homemaking, companionship and safety supervision, up to and including end of life care
•Costs vary slightly but range from $28.00 to $32.00 hourly depending on the level of care and distance required to travel.

•Retirement Homes

•There are a number of retirement residences available for residents that are still independent and provide self-care
•Meals and housekeeping are provided
•If a resident becomes ill or declines in abilities, they may be asked to move unless they purchase additional support services
•Costs can range from $2500.00 to $6000.00 monthly or more.

•Nursing Home

•There are approximately 650 Nursing Homes in Ontario
•Wait Lists in most communities are around 450 persons, many of whom are in ALC beds in hospitals
•There is a tremendous shortage of LTC beds due the increase in the Senior population
•Once a client is deemed an ALC client, the client is charged $2600.00 monthly for the bed
•Part of the emergency room backup crisis is a result of bed shortages related to ALC bed usage.

•Co-op Housing

•Individuals purchase a share of the building
•Provides ownership
•Shared expenses, shared care, shared household duties•Shared decision making regarding new owners, maintenance decisions,purchases
•Property becomes part of the estate
•Example: SolterraCo-housing

•Shared Housing

•A home owner rents part of their home
•To off set income  
•Help with home maintenance
•Provides socialization and prevents Isolation and Loneliness.

The Eden Project, The Green House Project

•A new concept of care homes where people live in a home-like setting of 8-10 persons
•There is a large common shared kitchen DR area, with family room.
•These homes are situated in neighbourhoodsrather Senior Communities, or institutions
•When asked where people want to live as they age, they say they want to remain in their homes
•This alternative gives a feeling of home.

•Other Alternatives

•Reverse Mortgages- those that need cash can use the equity in their home to enjoy retirement.  You receive up to 50% of the equity in your home.  There are interest charges which you do not pay until your home is sold.
•Sell your home, rent it back, use the cash to invest and use funds to care for yourself or your spouse. Maintenance is looked after by the new owner, with a flexible lease in the event of an illness or death

                                                                                                         Yvonne Griggs

By: Julie Corliss

If you’re confused by the terms used to describe heart attacks, you’re not alone. They’re often described as “mild” or “massive,” or even the ominous-sounding “widow maker.” But these terms are not necessarily helpful, and they may create confusion and anxiety.
The good news: most people who have a heart attack survive. The bad news? “Any heart attack can be fatal, no matter how big, how small, or where it occurs in the heart,” says Dr. James Januzzi, a cardiologist at Harvard-affiliated Massachusetts General Hospital. “Furthermore, there’s a lot of misunderstanding among the general public about what a heart attack actually is,” he says.

The connection between heart attack vs. cardiac arrest
Perhaps the most common source of confusion is the difference between a heart attack and cardiac arrest. A heart attack (what doctors call a myocardial infarction or MI) is defined as damage to part of the heart muscle caused by inadequate blood flow to that area. Most of the time, this happens due to a blockage in one of the heart’s arteries. Known as a type 1 heart attack, such blockages typically occur when cholesterol-laden plaque lining an artery ruptures. A clot forms, obstructing the vessel.
While a heart attack is a plumbing problem, a cardiac arrest is an electrical problem. Cardiac arrest happens when the heart’s electrical system malfunctions, causing it to beat rapidly and chaotically — or to stop beating altogether. Without blood circulating to the brain, lungs, and other organs, the person gasps or stops breathing and becomes unresponsive within seconds.
A heart attack is a common cause of cardiac arrest, but most heart attacks do not lead to cardiac arrest. Other possible causes of cardiac arrest include heart failure, a clot in the lungs, a serious imbalance of potassium, magnesium, or other minerals in the blood, a drug overdose, or a blow to the chest.

Does size matter?
Some heart attacks cause more harm than others. During a heart attack, blood levels of a protein released by damaged muscle (troponin) give some sense of severity. Afterwards, an ultrasound of the heart (echocardiogram) can reveal the extent of the damage. “A large heart attack will significantly reduce the squeezing strength of the heart muscle,” says Dr. Januzzi.
The term “widow maker” refers to a heart attack caused by a blockage near the top of the left anterior descending (LAD) artery, the main artery that supplies blood to the front of the heart. However, heart attacks that involve the LAD are not necessarily fatal, and those involving other arteries can be deadly, too.

What to do
Call 911 right away if you or someone near you has symptoms of a heart attack or cardiac arrest. Common heart attack symptoms include:
•    uncomfortable pressure, squeezing, or pain in the chest
•    pain or other uncomfortable sensations in an arm, the back, neck, jaw, or stomach
•    shortness of breath
•    sudden nausea or vomiting
•    lightheadedness or dizziness
•    unusual fatigue.
Signs of cardiac arrest are a sudden loss of responsiveness and abnormal breathing (either not breathing or only gasping). Give hands-only cardiopulmonary resuscitation (CPR) until help arrives.