Tuesday, September 27, 2005

This Is Not The Time to Worry About Your Shoes

In last week's Vancouver Sun, there was an article about a Vancouver Island couple, who were about to be separated because of differing care needs, and the Health Authority's impending actions which would have placed them in separate facilities.

Out of exasperation, the family contacted the Vancuver Sun. After one phone call to the Health Authority from a Sun reporter, a decision was made that they would be placed together.

Coincidence?
Sheer good luck?

It is hard to know what was really happening, the details were not made public, the Health Authority didn't say in the article what they had planned.

But I believe what it says, because I have seen the same problem with the results before. What does it tell you? Families need to be good advocates. Sometimes they need to be great advocates. Sometimes you have to stop worrying about what it will look like, or whether someone will like you, or whatever, and just do what you have to do.

This is not the time to worry about your shoes.

Consumers are not equal in this game--you don't know the rules ( and they keep changing), you do not know the players, you do not know the system, and most of the time, you do not know what constitutes really good care.

You do know how to ask questions. So ask them. Demand answers. If you don't get them, go higher up in the hierarchy. Look for a consumer group. Hire a Care Manager

Sometimes there really are limits--there may not be a bed available; the system will not fund you for twenty four hour care in your home; sometimes no amount of rehabilitation services will help someone walk again.

But sometiimes there is and sometimes they will.

Monday, September 19, 2005

More on Financial Abuse of the Elderly

I just got another issue of Elderlaw News, the e letter put out by elderlawanswers.com and it mentioned articles on financial abuse of the elderly published in the San Mateo Times under a series "Preying on the Elderly," and done in conjunction with National Public Radio in the U.S. Very good articles, radio programmes, and very good newsletter. Check them out .

NPR site: http://www.npr.org/templates/story/story.php?storyId=4667720

and San Mateo Times article: http://www.insidebayarea.com/sanmateocountytimes/elderly

Monday, September 12, 2005

On Financial Abuse

Writing the last post on Private Care Agreements, made me finally write something about financial abuse because I have seen a lot of it lately. But subtle financial abuse (or, as you might call it SFA, although nobody that I know calls it that yet, but if you start then they might).

Where was I. Oh yeah.

There have been several instances in which a caregiver has had power of attorney for an elderly person who has become cognitively impaired due to dementia of some sort, and they have not really considered all of the options available for the person they are taking care of. For instance--using the equity in the house to get a loan or reverse mortgage to allow the person to stay in their home. Instead, they have gone right to having their relative go into care. Or they have told me, "but --wanted to leave the money to us/the children/grandchildren." That is the reason they do not go the extra mile.

The problem is that ethically, the person's money and assets should be spent on them first. Unless you have said to them, "What if you need to go into a nursing home--would you want to do that to make sure the house goes to little Johnny?" then you need to assume that in this case they would want to have their needs met first.

If you don't have the time to manage their affairs so that they can stay in their home or do what they would have wished, that is when you bring in a Geriatric Care Manager. That is what we do--we manage things for them so that they can stay home. We will hire and monitor caregivers, we will get them to appointments, make sure medications are taken, etc., etc.

Yes,there may be times when for health or safety, a care facility is the best choice. But it should be a choice based on consideration of all the options.

This is also, by the way, why you have those icky conversations that you hav been avoiding that ask what your mother/father/husband/whomever would want in various situations. Living wills are the beginning, but also only the beginning.

Look at all the circumstances and possibilities, then ask what if?

Care Agreements

I recently had a meeting with Laura Watts, of the Canadian Centre for Elder Law Studies (CCELS). They are doing some remarkable work, including a brochure on "Care Agreements." Care Agreements are (usually informal) agreeements between an older person and a caregiver. The deal goes something like, "I will live in your house and take care of you in return for (inheritance money/ the house when you die/you signing over the house to me now). "

The problem is that these agreements leave the older person at risk for abuse, and it can leave the caregiver at risk for not getting what they think they are entitled to. The caregiver can sell the house once it is theirs. On the death of the older person, the caregiver's siblings can come out of the woodwork, even though they did not do any work.

The CCELS has written a great booklet, called "What If" in which it asks people to think about what could happen during the course of this informal agreement. For instance: What if:

--the caregiver pre-decesaes the care recipient?
--the caregiver becomes disabled and can't look after the property
--the care recipient lives for thirty more years?

The CCELS has also written a full report and proposed legislation on Private Care Agreements, as they call them. It is well worth reading and some sober thought.

For the brochure, or to find out move about what they are doing: www.ccels.ca

Monday, September 05, 2005

Doctors For The Elderly

Well, I know they are called Geriatricians, but it seems to me sometimes it helps to remind ourselves about basics. Like , Geriatricians are people who provide medical services to the elderly. (Well, actually I suppose they are specialists, but wouldn't it be nice if the doctors treating the elderly were specialists, like those who treat children ).

Anyway, Doctors For The Elderly need to be able to do it in a way that makes sense for their clients (patients).

So we need to support a model of care which allows them to do that. This means paying them an adequate amount so that they can do home visits, so that they can get to nursing homes to see their clients, so that they are encouraged to want to have the elderly as patients.

So that they want to be geriatricians.

As things stand in B.C., none of those so thats are really happening. It does not pay for doctors to do home visits, go to nursing homes, etc.

Oftentimes elderly people do not have the ability to get to their physician. Sometimes they have friends or families who will take them. This means taking time off of work. If the elderly person has multiple medical problems, this can mean a lot of time off work. We already know that the costs to business of workers taking time on eldercare is enormous.

One response is organize the medical system response so that it functions in a way which meets the needs of their clients.

If I may get in a personal plug here, this is also one reason why people hire Geiatric Care Managers. We do things like make sure your relative gets to the physician. We will call the physician when something goes wrong. We may use a nurse consultant (if we are not nurses) who can do a preliminary check out at home. We will make sure their prescriptions are filled and refilled, and re-examined to make sure they are still necessary, and consult with the pharmacist to make sure they are appropriate not interacting in conflicting ways with each other.

I can't pretend to understand the recent deal from the B.C. government that was rejected by the British Columbia Medical Association. However, there were questions about doctors spending time in nursing homes, which is like doing a home visit to someone's home, they just happen to live with a ton of other people.

Any deal that they come up with must encourage proper medical care, and recognize the needs, abilities, and circumstances of the elderly.

And before anyone gets on my case, let me say that I know there are many, many, many doctors who are not considered certified Geriatricians or whatever it takes, who have large elderly populations, and are fantastic with them, have a real interest and knowledge of geriatric medicine, and so on. I know tons of you personally. I'm trying to help you here ( as well as the people we both work with) , and make sure you get what you deserve and are encouraged to do what you already do out of compassion, even though you don't get rewarded for it monetarily. Okay?

Sunday, September 04, 2005

Creature Comforts

Well, this doesn't have anything to do with aging or seniors or anything but..............

I was camping a couple weekends ago and it struck me, as I was sitting in my tent at night, that for a couple of hundred thousand years or so, people have struggled to leave their cave homes and cooking over an open fire, and have created a society of comfort, with (some of us) rain and cold and wind resistant houses and ten different ways to cook our food.

So what do some of us do for "vacation?" We go live in a cave cook over an open fire.

Hurricanes Make Heros Too

Amid all the focus on looting and shooting in the aftermath of Hurricane Katrina, what struck me were the pictures of those people whose humanity and compassion came out way on top. In the past few days I noted several pictures of care workers who had an elderly man or woman they had been taking care of, and whose agony showed in their desperation for their charge; and who had been unwilling to desert them for their own safety and health.

I know that these are not the pictures that sell the news, but certainly there are thousands of these people, and others, who shared what little they had and risked their lives for others. I am far away from you, but thank you for showing all of us around the world that we have choices about who we are and what we do.