Health Care Options in Ontario

The Ontario Government has popped a flyer into our mail.
As well as 211ontario.ca, we have other sources of health information. ontario.ca/healthcareoptions

In their wisdom, they are realizing that tech-savvy seniors are connecting on-line with friends, family, as well as doing research on their health care. Seniors are learning to take responsibility for their health care. They are asking questions of physicians and self-advocating.

While we still face a shortage of Primary Care staff (nurses, family physicians, geriatricians) Family Health Teams are making improvements with an holistic approach that focuses on prevention and maintenance of health living options: exercise, good eating, and a mental and physical approach to good health. It has been said the 400,000 Canadian lack a family physician. That said, we have many clinics where we can access health care.

A dietician will help you understand how to read labels and watch your sodium intake, watch for low-cholesterol foods, and ensure that your protein intake matches your weight, activity levels and body type.

The pamphlet features a handy fridge magnetic on which you can write your Health Care Provider, after hours clinics, and the telehealth number. For anyone caring for an ailing family member, this is a handy way to provide a quick resource.

Finding a health care provider

Do you not have a family doctor? By registering with Health Care Connect, you will be assigned a Care Connector to help you find family health care in your community.

Medical Services Directory

Your health Care Options Medical Services directory is a user-friendly searchable database of walk-in and after hours clinics, urgent care centres, and family health care providers.

Speak to a Nurse
Telehealth Ontario is a free, confidential telephone service you can receive health advice or information from a Registered Nurse by phone. They’ll provide you with all your health care options.

Community Care Access Centres (CCAC)

CCACs operate across the province. They are local organizations that provide access to government- funded home and community services and long-term care homes. The only way to access LTC in this province is by registering, and filling in forms with a local CCAC representative.

Newsroom
Another spot for newshounds to visit is the Newsroom, where up to date information is provided on health bulletins, legislation and news releases.

Finally, don't forget CHAP, a great reources for self-care strategies and techniques for m onitoring your blood pressure, Body Mass Index, amongst other resources.

Screening vs. diagnosis of cancer

I listened, with interest, to a CBC Ideas show on early diagnosis, or pre-disease cancerous conditions that have symptoms. In the case of pneumonia, chronic diseases, or dementia, this is true. But if you have no symptoms, the question arises: Do you do prescreening?

They were speaking of PSA and mammography test to identify prostate and breast cancers, respectively. If you have no symptoms is it a screening test. If you have symptoms, it is a diagnostic test. These are regularly scheduled tests, once you reach an age, in many cases. Now PSA screening tests are not paid for through OHIP, diagnostic tests are. One bone of contention is that mammographies are paid for through OHIP. There was some controversy with lobby groups advocating for early screening of prostrate cancer. But that is another post.
Let us deal, firstly, with PSA tests.

Screening vs. Diagnosis PSA Tests*

Dr. Perry Kendle.
Science of medicine and policy conditions, says that informed consent is important. However, in randomized trials they followed those who follow had both screenings, and those who were diagnosed following the exhibition of symptoms. At this point the jury is out. They do not know if prescreening outweighs diagnosis after symptoms for these reasons
There are downsides for being treated for prostate cancer.

• The positive test result could mean false negatives or false positive tests and over diagnosis.
• An elevated PSA may result in some other diagnostic procedure which will cause more problems.
• If cancer is present they don't know if you will find benefits from being treated in terms of mortality outcomes.
• The treatment may be worse than your current situation, emotionally it can be terribly difficult.
• Early diagnosis does not guarantee longevity.
• Prescreening may result in more or less side effects. (Impotence, urinary incontinence)
  
• Does screening find more cancer than ordinary care?

Doctor take out samples from the prostate with a needle, a biopsy the size of a wood splinter. Chances for finding prostate cancer are related to the number of times you put the needle into the prostate for a biopsy.

If you sample 6 times, for example, the results show that 20% of men develop cancer.
If you biopsy 12 times, then 40% will develop prostate cancer. The more you biopsy the likelier you develop prostate cancer. How bizarre is this?

More importantly, you need to be looking at the PSA rates in your blood stream and determine baseline data. Finding the antigen does not mean you have prostate cancer.

Randomized Trials
The difficulty is to understand the results of these randomized trials. In this way we can weigh the benefits of screening vs. diagnosis. The standard is to survive five years after a diagnosis, but does this mean a diagnosis or a screening?

They are suggesting that in the cases of these cancers and early screening when one is, say 73, does not promote longevity. If the diagnosis is made at age 75, for example, the patient in the tests still dies at age 79. This in not necessarily success. We must speak of quality of life. To live an extra two years, knowing you have cancer, does not mean a better life. Plus, many more men die with prostate cancer, after age 65, than die due to prostrate cancer. This is called 'lead time bias'.

The doctors are trained to screen and diagnose
We do not know when it is better to wait and see, rather than intervening. In some cases, in slow growing cancers, abnormal cells grow a little and then regress. In other cancers they grow quickly. My father likely lived with his brain tumour for years until it affected him. The radiation, I know, had a horrible impact on him.

Pseudodisease
Many of us have abnormalities. Many of us have lumps and bumps (nodules) found on CT Scans on liver, colons. Some will develop clinical disease. There are two sides...
Overdiagnosis can equal over treatment. My mother, having chemotherapy at her advanced stage of cancer, shortened her life. I have no doubt.

Mammography
Dr. Cornelia Baines (I went to school with her daughter!) says that the Candian National Breast Screening survey trials occured to build on what we knew. Screening reduces breast cancer deaths in people age 50 and over. This is not true for women age 40 - 49. What are the benefits of mammography over clinical breast exams?

In the case of breast cancer, they did demonstrate that after 10 - 11 years 3% decline in mortality, and any decline in mortality was small and not statistically significant. For those over age 50- 59 got a careful clinical, quality breast exam by trained nurses. Early detection did not make a difference in mortality. Stats show that there are less than 2 chances per 1000 of getting cancer. Less than 2 per 1000, a difference of .2 per 1000. For those age 50+ a difference of 1 per 1000.

CBC quoted one physician as saying that there is a 5 - 6% error rate in mammographies. For every one positive case there are 55 other women with diagnostic studies who have nothing.
(Dr. Marla Shapiro)

Mammography Risks
The risk of a false positive, is the same as in PSA false positive tests: anxiety, biopsy, and the stress entrenched in taking the path towards cancer. Our population is taught to screen, rather than to diagnose. Having nodules and lumps is quite predictable over age 50.

Popularity paradox says, the greater number of times we overdiagnosis and overtreat by screening, the more people there are who believe they owe their lives to the prescreening. If you get screening for breast cancer at age 40, she has treatment (and we know how invasive these treatments can be: surgery, radiation), if she has a false positive she will have a positive outcome. Yet, we have found that clinically, early screening does not result in a better outcome. They are the same for screening vs. diagnosis after symptoms, but quality of life is reduced.

In a previous post, once cancer has been diagnosed, I have provided some questions to ask your oncologist, but a big aspect of recent trends is to entertain screening tests. That is to say, without any symptoms, your physician sends you for a test to look for cancerous conditions.

1. Why are you suggesting this test?
2. Are there randomized trials for this test (to prove its efficacy)?
3. What are the options should the test be positive?

For example, once a man has a high level of PSA in his system, the next step is to insert a needle for a biopsy. The more one inserts the needles, the more likely it is that he contracts cancer.
~~~~~~~~~~
*You are Prediseased, by Alan Cassels on CBC IDEAS July 29 and August 5, 2009

Why wait until you are diagnosed with cancer, if you can hunt it down before it could kill you? Why not get a simple high tech CT scan to see if you are harbouring signs of pre-disease in your heart, your lungs, your breasts or your bowels?

Know your chances: Understanding health Statistics
Steven Woloshin, MD, MS, Lisa M. Schwartz, MD, MS, and H. Gilbert Welch, MD, MPH

Every day we are bombarded by television ads, public service announcements, and media reports warning of dire risks to our health and offering solutions to help us lower those risks. But many of these messages are incomplete, misleading, or exaggerated, leaving the average person misinformed and confused.

Should I Be Tested for Cancer? Maybe Not and Here's Why
H. Gilbert Welch, M.D., M.P.H.
Getting tested to detect cancer early is one of the best ways to stay healthy—or is it? In this lively, carefully researched book, a nationally recognized expert on early cancer detection challenges one of medicine's most widely accepted beliefs: that the best defense against cancer is to always try to catch it early. Read this book and you will think twice about common cancer screening tests such as total body scans, mammograms, and prostate-specific antigen (PSA) tests.
~~~~~~~~~~~~~~
*Prostate-Specific Antigen (PSA) Test - National Cancer Institute 18 Mar 2009 ... A fact sheet that describes the PSA screening test for prostate cancer and explains the benefits and limitations of the test.

See also: an excellent post by Musings of a Distractible Mind!

Daily Mail- Clinical breast exams lead to many misdiagnoses‎ -

Some went to facilities that performed only mammograms, while others went to health centres that performed both mammograms and clinical breast exams.

Seniors and Canadian Health Care - part 2

This is a follow-up to my post on our Canadian system. Seniors, and people on welfare have extra services. In addition to free medical services, my parents, for example, would only be required to pay $2.00 for new prescriptions filled.

If you are disabled, frail or ill in Ontario, you phone up the Community Care Access Centre (check the sidebar), and they will appoint a Case Manager. The Case Manager, a nurse, will asses your needs, and determine the type and amount of help you can be given.

As an example, my mother was discharged after her first cancer surgery in 2002. She had the surgery a few months after diagnosis. She had not told her physician, nor me, and put off surgery until after my August 22, 2002, wedding. She had timely surgery and good care. She had a second surgery in early 2003. I met her at the hospital. She was discharged, with a Case Manager ensuring she had a nurse to attend her for a brief visit on a daily basis. She was sent a nurse on a daily, then weekly basis, who would change her dressings, check for infection, and reassess her needs until she recovered. I was living 400 km away, and thought all was well.

Dad drove Mom home from the first two surgeries. Driving home from her 2nd one, he had a petite-mal seizure, which they only realized later. He had a massive seizure later at home. They did an MRI a month after this and found he had developed a brain tumour. Dad had surgery and the brain tumour was removed another month later. All paid for through the Ontario Health Plan. Mom could not drive, since she was quite ill recovering from her cancer surgery, and I was working full-time a five-hour drive away. Dad had had his brain tumour removed, but was not allowed to drive.

She ended up getting an infection. Later, since she had had her lymph nodes removed during surgery #3 (or 4?), her leg swelled to massive proportions. Her Case Manager sent a tensor bandage to limit the swelling.

The Canadian Cancer Society provided a volunteer driver to take Mom to radiation appointments, an hour's drive away. They had this benefit, since I lived so far away, to drive them to these government provided treatments.

Dad had MRIs every 6 months after his surgery, on the government's tab, while the Cancer Society volunteers (bless them) drove him to appointments, Mom stayed at home fretting.

After she had radiation, (2005-ish?) Mom was rather ill. She could have had a Red Cross health care aide to provide some housekeeping, and some meal preparation, but she refused it. (She was a determined, independent woman! Only old, sick people had such support!) Born in 1925, her house was her castle, and women cared for others.

Eventually, when her cancer made her bed-ridden, she accepted a Red Cross worker (4 hours per day) while I drove 62 km to work to teach. By then I had moved, found a new job close to her, and we were preparing to provide more care. She saw the nurse regularly, who made house calls. And her doctor kept in close contact. Mom died at home, on her couch, as she wished in 2006, six weeks after I moved to care for her.

When Dad's brain tumour came back, we phoned CCAC who arranged to have his name put on the list for a bed in a long-term care (LTC) home. The government pays for these home, as well as nursing care, PSW care (health care aides) and physician care within both private and publicly-funded homes. These differ from retirement homes, where the senior is a resident, not a patient as such, with the opportunity of receiving nursing support.

Another benefit in Ontario are Transfer Payment Agencies (TPAs). This is how services for children, seniors, and the disabled are managed by transferring tax dollars to such agencies. Unfortunately, many agencies, such as Hospice Muskoka, for whom I am a volunteer, also rely on fundraising. This is something that needs to be corrected. Hospices provide volunteers who will help a family when someone is in palliative care.

I worked for The Friends, a TPA that provides supportive living facilities in the Parry Sound-Muskoka area. They also provide respite services for caregivers, support groups for caregivers, as well as those with chronic health issues such as MS, cardiovascular issues, such as stroke, and they are invaluable. They have:

	Accessible Housing-with 24-hour support
	Outreach Programs
	Adult Day Away Programs
	Respite Care
	Volunteer Program
	Attendant Services

I sit on the Board of Directors for our local Family Youth and Child Services board. We arrive at a budget, and are given tax dollars to provide services to our young people. This is true for all the TPAs. A board controls tax dollars and hired staff provide services. Services are available in our province for the young and old, pregnant, frail, and those with varying health care issues.

We have Meals on Wheels clients (subsidized by the province; client pays a modest amount) to have a volunteer deliver meals a few times a week.

Another benefit of our tax dollars: agencies, such as Muskoka Victim Services, will provide social and emotional support and counselling.
Ontarians can access services through a government-run 211 phone number, or visit 211ontario.ca, for on-line information. The services are free. If you are ill, you are able to access any number of agencies to provide support. There is a broad range. Services are not parcelled out. There are wait times, which are improving, but no one is denied care - despite American anti-universal health care lobbyist claims. Some do hire private nurses and caregivers through private agencies, but much is available for those who cannot afford health care.

Community Care Access Centres Arrange in-home or school health and social services, and place people who can no longer remain in their own homes in long-term care facilities.

Community health centres Low cost, culturally sensitive health care and education for individuals, families and communities.

Developmental disabilities Services for people with developmental disabilities.

Environmental, occupational and public health Services that promote and build healthy and safe working and living environments, including public health departments.

Finding a medical professional Services that help you find a doctor, dentist, or other medical professional.

Hospitals Hospitals including hospital emergency departments.

Long-term care facilities Long term accommodation for individuals who require more nursing or personal care than can be provided through home support agencies. Includes facilities formerly known as homes for the aged and nursing homes.

Mental health Services for people with serious or chronic psychological, emotional or psychiatric problems.

Physical disabilities Services for people with physical disabilities.

Prenatal and postnatal services Services for parents before and after childbirth including breastfeeding programs.

I hope this helps my American friends, as well as others. Let me know if you have any questions!

Canadian Health Care System - part I

I was asked to write about our system in Canada, as there is much misinformation in American news about our weird ways.

Basically, health care is a Federal government responsibility, and our federal taxes are collected and dispersed to the provincial or territorial governments.

Each province and territory is responsible for looking after its health care system, they do differ province to province, and territory to territory slightly. This allows for differences withing these areas. The Canadian Government's mandate: health care is free and accessible for all. The philosophy is that we are all entitled to publicly provided health care. There are some who go to private clinics, and these people who provide extra services do so apart from the rest of the system.

This does not include drugs or dental plans, although some of us buy into private plans. As a retired teacher, I pay $200/month for my Retired Teachers of Ontario Plan. We also have Blue Cross, and various plans for particular employees, which is negotiated with our employers, e.g., federal or provincial civil servants, municipal employees, or private businesses who have collective agreements that specify this benefit. That is to say, I can privately pay or purchase insurance to pay for a private room in a hospital or long-term care (LTC - formerly a nursing home) home, rather than a 4-bed ward. I can supplement the benefits of state health care, but we are all provided with a standard of care the determines that we are equal. More about LTC and seniors and complex geriatric and palliative care in my next post!

That said, in all practicality when I go to see my family physician I take my health card with me. They swipe it at reception, the physician is reimbursed for the appointment by the government, whom they bill for their services. If s/he writes a prescription, I take it to my pharmacist, who fills it and I pay for it. Since I have a drug plan, I submit receipts and I am reimbursed. If I need a blood test for, say, cholesterol, I take a chit, signed my my physician, and the test is done in a lab and billed to the government, after swiping my little card! If I am referred to a specialist, I similarly take my health card, which is swiped, and this visit is paid for by billing the government.

My physician is part of a Family Health Team (FHT); the direction in which my province is heading. Some physicians, in fact many, collaborate if not in a FHT, then in a clinic with the benefit of both appointments and 'Walk-in' times. Some, of course, continue to work alone, although in terms of patient care, senior complex care, and the cost of providing services, many have opted in to a clinic or FHT.

The FHT is a relatively recent development. Under one roof you will find your physician, a nurse practitioner, nursing staff, dietician, and so on.
Read more here: Understanding Family Health Teams. A Family Health Team is an approach to primary health care that brings together different health care providers to co-ordinate the highest possible quality services.

Basically, the goal of the FHT: disease management and prevention, disease cure, rehabilitation, palliative care and health promotion.

If have problems with nutrition, or weight, I can book a visit with a dietician through my FHT, attend a lecture on cholesterol and carbohydrates, and learn how to prevent obesity before it is too late. This saves a great deal in terms of physician and nursing time. Many women are underdiagnosed with high blood pressure, cardiovascular issues are underdiagnosed in women. A little education in this area goes a long way. My family doctor found I had high cholesterol and I tried to manage it with diet. This did not work. I take pills, which I claim from my private plan, and I have a blood test to monitor my progress every few months.

In my situation, retiring posed many new issues. I was eating the same amounts, but not working I used fewer calories. I have increased my exercise, been given booklets on nutrition, and exercise, and I am hoping to improve. This will prevent me from developing chronic care issues. And save the system money. That is how our system works. If you have any specific questions, pleas pose them! I'll be happy to try and answer them. I did much research for my book (Living and Dying With Dignity - see the sidebar) and learned a great deal. I also worked as a Peer Health Educator with a non-profit Transfer Payment Agency, to provide education on cardiovascular issues on a contract basis.

Check out the topics on the sidebar for Cardiovascular Health supports, e.g., CHAPprogram.ca

Caregiver Abuse

An American site, which provides a place for caregivers to talk about issues, vent, and share the things they have learned. A new issue I have heard about in the USA, is false accusations of Elder Abuse! In a post entitled: 'Elders that control caregivers after their death', I read

Like many others, I really lived two lives during this time, hers and mine. I took her to multiple doctor appts, advocated for her rights, paid her bills, cooked her meals, monitored her prescriptions, arranged for any home health care, and all of the other duties that come along with this type of commitment. Also, like many caregivers, I never heard a word of thanks or comment of appreciation during this time, but rather a daily barrage of complaints about the level of my care (which she constantly told me was nonexistent) and threats of the repercussions that were to come should I not do what she wanted at the exact time and way that she wanted it done.

While in the ER, the mother complained about this treatment to the staff. The Emergency staff in the hospital reported this caregiver to authorities, who have approached this articulate, professional, adult child for neglect. The daughter goes on to say,

"My mother had a long history of anxiety and catastrophizing that would cause her to behave irrationally if her needs weren't met."

This is, unfortunately, a common story for those suffering from dementia. With the deterioration of the brain cells inhibitions, emotions conflict.

I was always worried that this issue might arise for me, since my mother refused to allow us to get people into the house to clean up. She was incontinent, as was the dog, the cat and my father. She could not stand up to make meals. She was eating small amounts each day.

If anyone came in, they would have been surprised at the condition of the house. With all the press about Elder Neglect, I worry that we are overlooking the needs of the caregiver. It is not the patient who should qualify for funds, but the family. They must be treated as a unit, and caregiver needs taken into account.

I have heard too many stories of those who suffer from dementia to believe that this is an isolated case. I remember my late father telling my 20-something daughter, "Your mother is keeping me here, you know!" He was referring to Long-Term Care (LTC) and he was incontinent, immobile, and unable to manage his Rx (8, as I recall/day). While we need to protect our elders, we need to be realistic about their emotional and psychological situations. No more sugar coating dementia-related symptoms.

dementia and break aways!

I heard another story about a retirement home. Visit Latane for her story.

I'm UPSET big time

Basically, her hubby (with dementia) escaped with another resident. What a time she had.

I know that my dad at his Manor, a retirement home,refused to go outdoors. At that point the dementia didn't affect his navigation skills. He was able to use his walker and his security button allowed him to walk around the building.

Then, about 3 weeks after trying to beg him to go out into the sweet outdoors he loved, he went out by himself. He fell, trying to go around a car improperly parked. In a minute, there were 4 people helping him.

I would rather that he had gone out and had a walk for the last time in his life, than to know he was safe in his room, staring out at the pigeon on the roof of the church.

People with dementia are clever. They manage to fool many people much of the time. This is why dementia is so undiagnosed.

The technology is fairly simple, but also fallible.

I hope you have a serious debriefing with staff to determine what went wrong.

Aren't you glad you realized how important it was to place him in a facility? I remember a woman lost her mom at the Cranberry Festival here. We had 25,000 people through town. Her dad slipped away and walked 7 km to the next town. She and the OPP found him a couple of hours later.

Don't you think it amusing that he and this woman broke free?! Makes me think of "One Flew Over the Cuckoo's Nest"!

Deep breath and many hugs!

US Health Care Reform

American Health care reformation is getting a beating. I cannot imagine how and why they think the system will fail their seniors. Our seniors are NOT being euthanized in Canada.
I think President Obama administration's goal of covering millions of uninsured is a fine one. How, in such a country as the US, could they not provide health care for all? Why can the working poor, who cannot afford to pay for health care on an income of $22,000, be denied such? The rich who can fear having their health care limited can purchase health insurance, as can anyone with money.

This is not what happens in Canada. The rich can pay for private care, should they wish to do so. Failing seniors are guaranteed support in their homes, in retirement homes, and in publicly-funded long-term care, but they can also pay to stay in privately run homes, should they choose.

We do not ration palliative care, despite shouts to the contrary. We have a terrific system of Hospice organizations which provide extra support for families. You can hire private nurses if you have money. I am really confused with the lobbying against having all persons, in such a wealthy country, being promised universal health care.

The headlines are simply shocking to someone who recently buried both of her parents. They had access to the health care they needed. We were free to hire extra nurses, or health care aides (which we did in my late father's retirement home). Mom died at home, which was her demand. She was riddled with cancer.

My father died in long-term care, where I sat with him over night. The story is in my book, Living and Dying with Dignity: A daughter's journey through Long-Term Care .

Both sides mobilize for health care town hall meetings
Milwaukee Journal Sentinel - Milwaukee,WI,USA

"I feel like this is the beginning of the end for our country!" she said. "They will start to ration senior care." She went on to complain about God being taken out American life, growing U.S. debt to China, tax increases, illegal immigrants and the lack of a national photo ID requirement."

The article goes on to quote a Dominican nun, Stella Storch:

'She expressed concern that e-mail campaigns were misleading Americans with "trigger words" such as socialism, rationing and Nazism.'

How to Cure Health-Care Reform- Fox News -video

Obama's Senior Moment Wall Street Journal - USA Virtually every European government with "universal" health care ... Or pay for a hip or knee replacement for seniors, when palliative care might cost less? ...

Palin Defends "Death Panel" Critique CBS News - New York,NY,USA Is it any wonder that senior citizens might view such consultations as attempts to convince them to help reduce health care costs by accepting minimal ...

Healthcare Reform will not meet Obama's August Deadline ...24 Jul 2009 ... A Community for Healthcare Reform ...

Lies and gossip about senior health care

I am always amazed with the information people pass on to one another!

We need prevention or early identification of chronic disease and we need more geriatricians to care for ailing seniors.
Their health care is much more complex than pediatrics. Yet, we have far fewer than we need in Canada.

The great chaos around the Shona story has been funny, in a way. But then I came across this video.

Power of Attorney

Please make it stop!
Once an ailing parents cannot manage IADLs ( e.g., banking, driving, credit cards and the other less daly, but weekly activities) you are wise to cancel credit cards and stop the nonsense.

When I phoned about Mom's Sears card they would not stop sending her the catalogues. As an environmentalist, I resented the waste of paper. But it would take a death certificate until they would close the account. The same with Dad's phone bills, credit cards, Bell, and cable TV. They were very good about cancelling them once I phoned, stated I was the Executor and could manage to send them the paperwork. The worst was the car ownership and transferring the car ownership from a dead woman (Mom) to a non-driving man sying of a brain tumour.

I wrote in my book:

Power of attorney - car ownership
Dad’s driver’s licence was rescinded because of his medications and the possibility of another seizure, and this hit his ego hard. This is the law in Ontario.

The vehicle licensing bureau would accept only my Dad’s signature or the executor’s. I had to go trucking back to Dad, find his paperwork, and figure out what to do. He could not walk to the motor vehicle bureau down the street from the Manor, so I ended up taking the papers to him to sign, returning to the bureau three times before it was all done. In the end, we had a car licensed to a man who did not possess a driver’s licence.

Loss of independence: the car transfer--March 31, 2005
Mom and Dad continued to sink into the abyss of dependence, anger, and frustration with the ravages of old age. Dad was so very upset with not being able to drive. He had Mom transfer the car ownership to her, an issue that made life difficult after her passing. Often he would state his frustration to me. It was difficult listening to Dad complain. The tumour had robbed him of his independence and any perceived control over his life. He was quite bitter about this insult.

Paperwork and estate woes--March 2, 2007
I had yet not taken Dad’s clothes to the Salvation Army store. That was a difficult task. I continued to collect my parents’ mail and dealt with that on a daily basis. Reader’s Digest thought Mom might win a billion dollars. That was the most heartbreaking mail--week after week they inundated me with large envelopes, her name boldly inscribed on them. I could not figure out how to make them stop until I finally found an address for a PR person. I wrote and demanded he make them stop. They must have killed a tree with all the paperwork they sent.

This is a familiar story. See an American story:

One Reason CitiBank Needed the Bailout

"A lady died this past January, and Citibank billed her for February and March for their annual service charges on her credit card, and added late Fees and interest on the monthly charge. The balance had been $0.00 when she Died, but now somewhere around $60.00."

Geriatric Assessments

Smart geriatric assessment and case managers interview care recipients separately from caregivers in order to get a better perspective on a case. This provides more information than an ailing senior may want to share. Many families and seniors appear to be in denial. When a senior keeps getting lost on the way home, he or she is putting everyone else on the road at risk. Since a simple driver’s test will not necessarily diagnose unsafe driving habits, family doctors, provided with information from family or caseworkers, have the authority to demand that a driver’s licence be taken away. Without the option for case managers to inform family members and ask that seniors be taken for medical diagnosis of symptoms such as dementia, the seniors and families are powerless to access more supports. Many seniors are able to exhibit “normal” behaviour and refuse supports as they convince health care professionals that they are fine. CCAC provides only limited care immediately following a hospital stay.

Dad’s driver’s licence was rescinded because of his medications and the possibility of a seizure, and this hit his ego hard. This is the law in Ontario. Family physicians have an obligation to report medical issues that affect driving ability. Mom could not travel easily, due to her colitis, and had not driven in many years. I remember her reading up on her driving manual, trying to ace the annual test for seniors. Transportation is an issue that can prove difficult for many seniors. For my Dad, it was shameful to lose this independence, another issue that contributed to his morose demeanour. Unfortunately, my mother passed the driver’s test, but required help from neighbours in navigating the minivan in and out of the driveway from time to time. I wish I had been told. This was a major sign that all was not well and that their living circumstances were not ideal for them.

It is important to determine whether dementia or delirium are present.

Here is one post about a post-operative cardiac patient.

Regulate PSWs and health care workers

We keep hearing the stories about those who provide intimate care for seniors, with little education and training.

It is crucial that we have standardised training for the women and men who change the adult incontinence products, dress, undress, wash and bathe, and toilet our frail seniors in their homes and public and private care.

The training for Personal Support Workers (PSWs) and health care aides, employed in various retirement homes, Long-Term Care (LTC), by public or private agencies, or my family members, have a grade 12 education, and, perhaps, only a certificate, if that.

Many do a fine job. Others continue to use and abuse, or neglect frail seniors. The videos prove this. And if only one senior can be prevented of this suffering it would be worth it.

Texas 'fight club' trial begins
"A former worker at a Texas state school for mentally disabled people goes on trial for organising fights between the residents."

Unregulated workers can move from company to company. They give medications to seniors, despite the fact that this cannot be part of their job. Nurses must administer Rx.
Some institutions do not even demand a health care certificate.
In the privacy of a home, seniors with dementia can be guilible, and give away their rights, precious family heirlooms, to workers who con them. Sue Grafton's 'T' is for Trespass is a perfect fictionalized example of what can happen.

PSWs who steal, abuse, or do not understand their jobs, can harm seniors. Some give medical advice to both family and patients, without medical qualificiations. This kind of thing I have seen in my late father's LTC home. PSWs diagnosing and giving other families false information regarding an infestation in the home.

Residents were suffering from rashes, which ended up being undiagnosed as scabies. And scabies is an infestation that closes a floor or a wing. An unseen pest, the symptoms are itchy rashes that become infected if not treated or identified by those unable to communicate their symptoms. However, LTC homes are not reporting these 'closures' which is illegal. They cannot close a public facility without the express written consent of the Health Officer.

For this reason, since the PSWs do most of the grunt work, it is important they be regulated, tracked, and supervised more vigilantly than ever before. They are, to their credit, overworked, underpaid and as upset as many family members, since they cannot manage the burden of care. We do not have enough of them. In Central Ontario, they are overburdened, doing extra shifts in tough times, such as flu season. The good ones go from working at a smaller agency, to the larger faclities (e.g., hospitals) that can offer higher wages and benefits.

I would call on the government to regulate and track these people. They need to be trained, given regular upgrading, and discipline to improve the standard of care we expect for our seniors.
The time is now, before the Silver Tsunami hits us. Give these workers dignity, credibility, accountability and respect, and we will, in turn, find our seniors will recieve better care.

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News item from Muskoka:

Bracebridge Ontario Provincial Police DATE: August 9, 2009

Theft from the Elderly results in Charges

(Bracebridge, Ont.) Bracebridge OPP are investigating an all too common theft. A caregiver for an elderly female Bracebridge woman has been charged with Theft under $5000.00.

The woman began working as a caregiver and companion for the elderly female in June of 2008. By November of 2008 her family had discovered cash missing from her purse. Over $1000.00 had gone missing during the 6 month period.The Police investigation has lead to Erica GRANT (33 years) of Bracebridge being charged with Theft under $5000.00. GRANT will be appearing in court in Bracebridge on Aug 11 2009.

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In the news from the US:

• Long Term Care Facility has 5 nurses and roach infestation - 6th ...
• Daughter Banned from Mom's Nursing Home After Taking Photos

Robots for healthcare?!

RI-MAN The video showas a successful carry, but one of our news shows demonstrated how difficult it is to develop such a robot.

One of my favourite Australian shows: All in the Mind

"It's all about the robots this week and next ....If you're perplexed by the prospect of robots as carers and keepers in nursing homes or childcare, I'd love to hear your thoughts here."

Catch the show here. With the Silver Tsunami (baby boomers reaching their senior years) some are hard-pressed to find care.

Abuse of Canadian health care

The plot thickens. This woman is now going after OHIP to reimburse her expenses to go to the US, while she jumped the line to get surgery earlier than others waiting in line. She went to her doctor with symptoms, including loss of vision. An MRI suggested a brain tumour, but that wasn't confirmed since she jumped the line and went to the US.

She had the money to fly to the Mayo Clinic in Scottsdale, Arizona. She had a cyst, not a brain tumour. That is a different issue. She was diagnosed with Rathke's cleft cyst (RCC) in her brain. This is not a tumor and it is not life-threatening. It does, however, threaten her vision. This kind of thing needs to be carefully done.

There is misinformation, dare we call them lies? - about wait times, on CNN. See: article by Julie Mason.

And then there's her lawsuit against OHIP saying the lack of an American type system in Canada is a violation of her Charter of Rights: www.law.utoronto.ca/healthlaw/docs/case_McCreith.pdf.
Give me a break. She is actively lobbying to not only help prevent US universal healthcare, but trying to undermine our system. Treason, in my mind! As President Obama says, if you want to keep your private plan, go ahead. For those with a household income of $37,000 a year (Kentucky) they could not afford to go to the Mayo Clinic and spend $97,000 like Ms. Holmes did. Really.

In the end, 85% of Canadians are happy. Wait times are getting shorter. Health outcomes in Canada are better. We live longer, infant mortality is lower, there are next to no medical bankruptcies. But, 18,000 Americans die every year from lack of healthcare. What a crock.

Sandwalk, a Toronto biochemist writes:

Shona Holmes and Canadian Health Care

"Shona Holmes is suing the Government of Ontario in order to force it to revise and/or dismantle public health care. The suit [Lindsay McCreith and Shona Holmes/The Attorney General for the Province of Ontario] is being supported by the Canadian Constitution Foundation, a right-wing group that's described here."

Another excellent article on healthcare reform in America by Ted Kennedy, "The Cause of My Life".

Roger J. Newell, "American health care: the view from expatriate who came home", who has lived in both the US and UK and can compare them.

Here is a piece by David Sirota - the wealthy in America are doing all they can to defeat universal healthcare.