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GOVERNMENT UPDATE: Failing home care system

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Our home care system is failing. The article written below perfectly expresses the significant ramifications of a poor quality home care system. Two new reports underline the need for senior care in the community.    

  • A woman goes without eating or drinking for two to three days, even though she was under the supervision of Ontario’s home care system.
  • Patients receiving palliative home care get cut off because they don’t die fast enough.
  • A patient with diabetes gets sent home after a heart attack. The expectation is that a friend will take care of her. She returns to hospital in a diabetic coma.

Those are just three tales from the trenches from personal support workers, patients, nurses, community service provider agencies and other groups involved with home care in this province.

Their testimony is contained in a two-year study, The Care We Need, released this week by the Ontario Health Coalition, an advocacy group that is rightly calling for a complete overhaul of the home care system.

If that message isn’t strong enough to be heard by the Ontario government, many of the group’s findings are reinforced by a second report on home care, made public on Thursday by a group of experts commissioned by the Ontario government.

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That report, Bringing Care Home, contains 16 recommendations to streamline and integrate services to make it easier for patients and caregivers to navigate a system that is now overly complex and unresponsive. As the experts say, the current home care system simply “fails to meet the needs of clients and families.”

The health coalition’s exhaustive study details what happens when:

  • People are forced out of hospitals to free up beds and cut costs without a coordinated, well-financed home care system in place to support them.
  • Patients end up back in expensive hospital emergency beds because they haven’t been given enough home care hours.
  • Elderly patients end up in expensive long-term nursing homes, because they can’t access the home care support they need.

What’s clear from both studies is this: the Ontario government cannot have it both ways. It can’t cut the extraordinary cost of keeping patients in hospital simply by pushing them out the door as quickly as possible without providing sufficient home care on the other end to ensure they don’t end up returning in worse shape, requiring more expensive care, than when they left.

And it can’t prevent elderly patients from accessing expensive long-term nursing home beds if it doesn’t provide the care they need at home.

The government has been warned for decades about the need to coordinate and support home care to accommodate:

The fast-growing number of Ontarians with Alzheimer’s and related dementia. There were 181,000 of them in 2011, and that number is expected to grow by 40 per cent before 2021.

The 13,042 people currently on wait lists for home care services. (This does not include those cut from the lists because Community Care Access Centres had to tighten eligibility because of a lack of funding.)

The increasing need for home care to help seniors retain their independence.

But instead of properly supporting and funding home care — to save money, never mind provide compassionate care — the current $2.4 billion budget for home care provides less per patient than in 2002/03, according to the health coalition’s calculations.

This year the Ontario government topped up the entire $4.9-billion budget for both home and community care (which includes community health centres) by $270 million and plans to increase that gradually to $750 million over the next couple of years.

Still, the Ontario Health Coalition is recommending:

  • Patient advocates or an ombudsman to help people access timely, sufficient home care.
  • Increased funding to ensure those in need are cared for.
  • More controversially, an end to the current mix of private and public health care services. (It argues the home care system should be a public, not-for-profit service)

Their report is a well-researched, well-thought-out eye-opener – backed up on many issues by the government-commissioned report. Health Minister Eric Hoskins should act on both immediately. The most vulnerable of patients – those waiting for help at home – depend on it.

March 15, 2015

(http://www.thestar.com/opinion/editorials/2015/03/12/ontarios-home-care-system-should-be-overhauled-now-editorial.html?referrer=https%3A%2F%2Fwww.google.com%2F)

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CAREGIVER: Tips For Caregivers On Dealing With Grief and Loss

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Caregiving is physically demanding, there’s no doubt about that. However, caregivers also experience emotional stress, which can be extremely draining. Whether you’re caring for a loved one, or you are a full-time caregiver in your community, you will experience loss at some point.

Grief is a normal emotion, in which we all face. It isn’t easy to lose someone close to you, but there are healthy coping strategies. It can be hard to adjust without that individual in which you were caring for. Although a loss can create the highest level of grief, many also experience anticipatory grief.

For those that care for a loved one with Alzheimer’s or Parkinson’s, it can be very hard to watch that individual’s condition worsen over time. While you are trying to manage and cope with your grief, you may also be experiencing financial or relationship difficulties. As someone that gives so much, you need to also care for yourself.

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What Exactly Is Grief?

Greif is an emotion that can sometimes make a person question life itself. Greig is an extremely strong emotion that can leave a person feeling numb, and slightly removed from the reality of their daily activities. The overwhelming sense of loss is both a universal and personal experience. This state of being can be very uncomfortable, and can sometimes be overwhelming and lead to depression, anxiety, and can lead to a disconnect between reality and sense of self. Grief is an extremely personal experience, and varies drastically from person to person.

 

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Common Symptoms of Grief

The sense of loss that is experiences through grief can affect all aspects of your being. It is important to recognize your state of being and honour where you are at physically, emotionally, spiritually, socially and mentally.

The grieving processes is an individual experience, but there are some common symptoms that are associated with the grieving process:  

1. Physical: The pituitary gland located at the base of the brain is stimulated to produce a hormone called adrenocorticotrophin hormone (ACTH). This reaction is a “protective” one and in essence makes the body ready to do battle. The ACTH (from the pituitary gland) then travels to the adrenal gland, a gland at the top of the kidneys, which causes a chemical reaction which ultimately produces cortisone. As the cortisone level increases it causes the production of ACTH to level off. When a person is in grief, they are in constant defence and the pituitary gland created extra levels of ACTH resulting in extra high levels of Cortisone in the blood. The high level of cortisone effects the thalamus which manufactures white blood cells, making you more susceptible to illness. 

2. Emotional: You will more than likely feel the largest blow to your emotional well-being. This can be hard to control, especially as you learn to adjust. Some of the most common emotional symptoms include; depression, anger, guilt, confusion, worry, anxiety, and an overall lack of control.

3. Social: It can be tough to adjust socially, especially when people do not understand the hurt you’re feeling inside. When someone experiences a loss, they can feel alone and isolated. Some begin to detach themselves from others, while others do not want to be left alone. For some, they become angry at other family members, because they are moving on with their lives.

4. Spiritual: Loss can cause people to question their faith, which can lead them to feelings of confusion and frustration. As humans, we begin searching for the meaning of life. It is hard to understand death, which can cause people to become angry. Some detach from their faith, while others grow closer, as they search for solace.

5. Mentally: Increased activity is seen along a broad network of neurons. These link areas associated not only with mood but also with memory, perception, conceptualization, and even the regulation of the heart, the digestive system, and other organs. This shows the pervasive impact loss or even disappointment can have.  Keep in mind that during these emotionally vulnerable times, we all create illusions.

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Possible Stages of Grief

You may not experience the same stages of grief as others, even those that are within your family. If you were the primary caregiver, you may take the loss of your loved one harder than everyone else. Unfortunately, there is no set map for grief. The direction you take highly depends on your situation.

The following stages are experienced by most individuals that experience loss. Remember, you may not experience these stages in the exact order listed here. You may feel anger first, but skip directly to acceptance. You may also re-visit some of these stages, during memorable times of the year (on anniversaries, birthdays, or any other special day).

1. Shock: It is normal to deny reality, especially when it is something as troubling as a loss. It is a coping mechanism, which helps us to numb the pain. Denial allows us to not feel the full extent of our emotions. This is the first stage that many experience, as they struggle to accept the facts. A new reality emerges, which can be hard to swallow.

2. Anger: You may express your feelings through anger, as you try and make sense of your loss. You could become angry at yourself, at co-workers, God, or life in general. This anger typically stems from feelings of helplessness.

3. Bargaining: Many start to think, ‘what if I did this differently…’ They start to think about what could have been. This can be a tough stage to get through, as you begin to realize that this experience is real.

4. Depression: Once you come to terms with reality, you may experience a wave of sadness. Emotions can become overwhelming, as you begin to feel lonely and lost. Depression is often paired with feelings of regret, anxiety, and fear.

5.Acceptance: This stage allows you to adjust more comfortably, as you begin to move on. You will experience a sense of healing and hope. This does not mean that you need to forget about your loved one or the individual you cared for. In fact, it’s beneficial to reflect on the good moments you had together. Think about the positive aspects of their life, not the end of their life.

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Getting Through the First Year

Experts say on average, we grieve for around a year however mourning can last for months or years. This will be less for some, or longer for others. Throughout the first year, you will more than likely experience some or all of the stages mentioned above. Majority of people find that their grief becomes less intense after the first year.

As there will be some special days that make it painful, you can plan ahead. You will want to surround yourself with people who respect your grieving process. Make sure you accept the love and support of your friends and family members.

Time will heal your emotional wounds, which will allow you to heal physically, socially, and spiritually.

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DEMENTIA: Doctors Say No To Euthanasia Requests From Dementia Patients

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Few physicians would find euthanasia and physician-assisted suicide (EAS) conceivable for patients with psychiatric disease, dementia, or those who are “tired of living,” according to a study from the Netherlands published online Feb. 18 in the Journal of Medical Ethics.

Eva Elizabeth Bolt, from the VU University Medical Center in Amsterdam, and colleagues examined whether physicians can conceive of granting requests for EAS in patients with cancer, another physical disease, psychiatric disease, dementia, or among those who are tired of living. Data were collected from a cross-sectional survey conducted among 2,269 Dutch general practitioners, elderly care physicians, and clinical specialists (response rate, 64 percent).

The researchers found that most physicians reported that it was conceivable that they would grant an EAS request for a patient with cancer (85 percent) or another physical disease (82 percent). A minority of physicians found it conceivable that they would grant this request in patients with psychiatric disease (34 percent), early-stage dementia (40 percent), advanced dementia (29 to 33 percent), or for those who were tired of living (27 percent). The likelihood of finding it conceivable that they would perform EAS was highest for general practitioners.

This study shows that a minority of Dutch physicians find it conceivable that they would grant a request for EAS from a patient with psychiatric disease, dementia, or a patient who is tired of living,” the authors write.

February 19, 2015 (http://www.physiciansnews.com/2015/02/19/doctors-say-no-to-euthanasia-requests-from-dementia-patients/)

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DEMENTIA: New Test Claims It Can Tell If You Will Develop Alzheimer’s… But Do You Want To Know?

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 “Alzheimer’s disease is the most expensive condition in the nation. The estimated cost of care for Alzheimer’s disease in the US alone exceeded $214 billion in 2014, with nearly one in every five dollars spent by Medicare on dementia.  Further, future cost estimates from the Alzheimer’s Association predict that by 2050 the disease will cost $1.2 trillion annually. The disease currently affects five million people in the US, and expected to grow to 16 million by 2050, afflicting one in nine people over the age 65, and one in three people over the age of 85. With patients, care providers, researchers and policymakers desperate for a definitive test, the world is one step closer to having results.” February 06, 2015 (http://www.forbes.com/sites/nicolefisher/2015/02/06/a-new-test-can-tell-you-if-you-will-develop-alzheimers-but-do-you-want-to-take-it/)

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Preliminary findings from a study by National Institute on Aging (NIA) scientists and colleagues showed that a blood test can measure the levels of several tau and amyloid proteins—the hallmarks of Alzheimer’s disease—in exosomes, microscopic organelles shed by brain cells.

“We now have a set of 10 proteins that can predict whether someone with early symptoms of memory loss, or mild cognitive impairment, will develop Alzheimer’s disease within a year, with a high level of accuracy.”

A blood test can help identify early stages of the disease process before the brain has been to severely affected. According to Dr. Howard Federoff, Executive Vice President for Health Sciences and Executive Dean of Georgetown University Medical Center, he is “exited there is a means by which we can test people. The excitement falls on the fact that we have failed many times in the past and spent a lot of money, as has everyone in this field. Now we can test preclinically as to enable people to take preventative measures or in the future cure it. Additionally, because a preexisting condition no longer means that you can be precluded from long-term care and life insurance, financial planning is now possible for individuals, families, employers and societies.”

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Is Ignorance Bliss?

While genetic tests are presently able to determine about 4,000 diseases and disorders, the breakthrough of predicting Alzheimer’s disease could vastly change the behaviors and costs to society, actually bending the cost curve health experts so often talk about as necessary for economic stability. Until now, official diagnosis of the disease has been reserved for the autopsy table, an unacceptable situation.

 

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Identifying blood-based biomarkers will be critical for preventative or disease modifying advances. The lipid approach has revealed mild cognitive impairment or Alzheimer’s disease within a 2-3 year timeframe with over 90% accuracy. In the near future, they are predicting the metabolomics data could test further, identifying 17 lipids proving 99% accuracy.

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GOVERNMENT UPDATE: Care homes review the right path

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A government update by Murray Mandryk featured in the Leader-Post

“REGINA — Before we again charge into Saskatchewan’s home-care fray, maybe we need to acknowledge we’ve already come a long way towards tackling this problem.

Admittedly, it likely doesn’t feel that way – especially with the looming report from provincial Ombudsman Mary McFadyen into the 2013 death of Margaret Warholm.

In releasing a progress report to Health Minister Dustin Duncan this week, McFadyen noted she has received 35 formal complaints since Nov. 20, when she began an investigation into “region-run, non-profit and for-profit long-term care facilities.”

Add this week’s court appearance by 56-year-old Tessie Weigetz – a Santa Maria employee charged last December with assaulting a resident of the facility – and one shudders at the potential depth of this problem in Saskatchewan.

After all, we’ve been hearing from the NDP Opposition since the spring 2013 session about elderly residents left to soil themselves because no care-home attendant was available to help get them to the bathroom.

So compelling was the Opposition’s case that it inspired Duncan to send out health region CEOs to tour every facility in the province in the summer of 2013. They brought back an honest assessment of inadequate meals, under-staffing and rundown facilities – stories Duncan described as “heart-breaking”but so far, Duncan has been more about words than action.

After committing $10 million for “emergency” improvements – barely half what health regions requested – there has been no additional budget funding.

Seemingly more focused on its lean agenda, delivered by a U.S. consultant specializing in privatefor-profit hospitals with little understanding of integrated long-term care in our public health system, the government is struggling to see the forest for the trees.

Seriously? Regina and Saskatoon health regions can find money to hire more six-figure lean bureaucrats or for trips to Seattle (during a supposed travel freeze, no less), but we can’t find any more money for seniors’ care? We need to invest more in our seniors and less in consultants and bureaucrats. That said, where was the NDP’s interest/investments in long-term care during its 16 years in office?
But as easy as it is to bemoan all the problems in our system or the cynical opposition/government lip service, maybe we also need to step back and look at where we are really at.

We have 155 stand-alone special care homes (plus 13 long-term care facilities that are part of hospitals or health centres) and some 8,872 beds in the province. It’s a ratio of beds-to-seniors-in-need-of-them that is enviable most everywhere else in the country and the world, where care for the aging is a faster-growing and even bigger problem. And while the focus of government and opposition has rightly been on the critical incidents that need to be eliminated, the vast majority of these 168 homes provide good food, dry beds and loving care to their residents almost all of the time. Our past eagerness to honour our pioneers has given our nursing home system a solid foundation that much of the country and world can only envy.

Around the world, there are now more people over 65 – 523 million – than have ever existed on the planet. By 2050, there will be 1.5 billion people over 65 (16 per cent) which will be 2.5 times as many as those under five years. Chalk this all up to the post-Second-World-War relative prosperity of the developed world (the source of the baby boom now producing all these seniors).

The global aging challenge is one Canada is already experiencing. With 14.77 per cent of the population over 65 (according to the 2011 census), Canada ranks 28th in the world, behind first-place Japan (at 25 per cent) and most European nations.

Of course, it’s an even bigger problem in Saskatchewan … although, not as big as it once was. This province has gone from having 15.42 per cent of its population over 65 (highest in Canada, according to the 2006 census) to 14.87 per cent over 65 in 2011 (still higher than the national average, but now seventh).

And let us understand that the vast majority of the current 154,000 Saskatchewan people over 65 will never require acute nursing home care – especially with our increasing emphasis on in-home care. Clearly, one good thing emerging out of this debate is a rethinking of future seniors’ needs.

However, the best thing of all is that we are even having this debate.
That the tragic death of one elderly woman – something that might be roundly ignored elsewhere – would incite an Ombudsman’s investigation into the entire nursing home system has clearly demonstrated a high level of caring and commitment by the opposition, government and entire province. We have far to go, but at least we seem to be on the right path.” 

January 30, 2015

(http://www.leaderpost.com/touch/story.html?id=10772702)

 

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