Pain Management

I went to a lecture last night on pain management. It focussed mostly on palliative care. But it was very evident that the speaker was aware of how pain is managed, or not, in care facilities. I imagine it is the same how pain in the elderly is managed in the community.

Pain management is probably highly undertreated or mistreated, if not un- or misdiagnosed in care facilities.

Pain is complex. It is psychological, physical, cultural.

Treatment is changing, improving. Knowledge is increasing. Techniques are different than even a few years ago.

The problem is the knowledge gap-- that space between where things are discovered, used, and evaluated, and then become the new standard, and the spreading and use of that standard among those whose professional responsibilities include utilizing that knowledge.

So what do you do? Like everything else, if you are a caregiver: define the problem, and find the solutions that are available, and then advocate for them.

If you are unable to, that is what a Geriatric Care Manager does--we advocate, and problem solve. We are there when you are not, or supporting you when you are. Senior Care, Eldercare, whatever you call it--that is our expertise.

O.K. so the last paragraph was an advertisement. I prefer to think of it as "product placement. " Why not? It works for Coca-Cola. (Was that more product placement? )

Now You See 'Em, Now You Don't

The B.C. Government is trying to buy back beds. That means that beds they closed, they are now opening. They are offering some facilities thousands of dollars to reopen or take on funded spaces. Some are saying no. The government is also contracting beds from the private sector. One facility was just funded for thirty beds. At the same timek,places continue to be closed. Richmond's Lions Manor is scheduled to be closed (that's a rumour, but o.k., so I admit it, I'm a gossip).

What does this all mean?

Well, in a nutshell, it means a couple of things. One, it means they ( or someone) are finally getting it that the beds should never have been closed in the first place.

Two, it means that we are not getting the resources that we were promised--but the government gets to look like they are keeping their promises. Here's the thing: If they said they would build 500 beds, and the private sector is building/built 500 then we would have 1000 beds. But if the government builds 300 beds, but contracts 200 from the private sector, then we only have 800. The resources have not gone up so much, they have simply been shifted around. It still means more people are competing for resources that were supposed to be added to more than they did.

Third, since beds and facilities are still being closed, there continues to be a net decrease. Ít strikes me that it would be cheaper to renovate Lion's Manor than close it and build something new. But, oh yeah, I forgot--the government is not building the new places.

So who wins here? Well, the private, for sector profit, as their risk is lower for one thing.

In some ways, some people who need housing win because there are some nice new spaces available that they would not have been able to access previously.

And of course, all those people in Victoria win because they can talk about all the new beds they build.

Did you win?

If not, don't be discouraged. We can't all be winners.

Let's Make A Few Changes Around Here...

Caring for Caregivers

Peter Silin, Special to the Vancouver Sun

Published: Tuesday, March 21, 2006

Sometimes tragedy is the impetus to review and remake a system. With commitment, we can take what we learn and make things better. Perhaps the legacy of the deaths of Frances and Alfred Albo a few weeks ago will lead British Columbia's health authorities to do just that in our system of eldercare.

Over the past few years, significant changes in resources for and policies concerning our older citizens have taken place. They include decreasing the amount and type of home support available to people living at home, increasing the frailty level required before someone is eligible for complex nursing home care, reducing rehabilitation opportunities and a focus on reducing hospital bed occupancy days.
Care and planning policy for seniors focuses on the individual, not on the couple or family.

The result of these policies and changes is myriad. The most subtle one is that it increases the burden on caregivers to fill the gap left in services. The lectures on eldercare I give to businesses and employee groups are filled with stressed and depressed caregivers who are pulled between work responsibilities and aging parents or spouses.

These problems have been exacerbated by the closure of hospital and care facility beds before others were ready to take their place. Hundreds of beds have been closed; especially in rural areas, which means no facilities in communities that once had them. The remaining ones are strained because of higher demand.
There are several solutions to the problems we are encountering.

First, discharge planning and placement policies need refocusing to "target" the couple or the family. Such policies would automatically keep couples together, and would take into account natural support and emotional networks. This shift from planning for the individual to planning for a family unit is a fundamental shift. We also need to commit to adequate planning for discharge, and discharge only to the appropriate space.

Discharge planning needs to provide education and support to families through the crisis that results from becoming caregivers. Family members who understand the process and have a sense of confidence are better caregivers than ones who feel they are lost.

Second, we need to look at different housing models, especially in rural areas. In B.C., we already have Folkstone Family Homes. Folkstone is a non-profit agency that seeks out families who wish to care for someone in their own homes. They train and support them to do so. This is a cost-effective model of providing services over a wide area, without capital building costs. Following and expanding the Folkstone model, we should be developing small group homes for two or three people. These are community -based, non-profit models that are replicable anywhere.

Third, we need to reinstate some of the home support services that were demolished, a decision that was most likely "penny-wise and pound foolish."

Fourth, we need to look at utilizing other resources in more creative ways. Nursing home rooms could be used half a week by one resident, half by another. Co-op programs run by churches or families and supported by the province can develop adult day centres or small socialization programs, home meal programs, or recreational opportunities. With adequate provisions for privacy, people might be monitored by computer or camcorders in their homes.

Fifth, we need to look beyond the care system. We need to encourage businesses to support their staff. Can new developments receive added density if they put in services for seniors, or a floor of housing? Can we stimulate neighbourhoods to provide for their elderly, similar to Neighbourhood Watch or Block Parents programs? Networks can be developed along the lines of those advocated by the Planned Lifetime Advocacy Network (PLAN). When the False Creek lands are developed, can we combine the day care for children with daily programs for adults?

Oh, and let's also get those additional 5,000 beds (the ones the Liberals promised several years ago) up and running soon.

Peter Silin is principal of Diamond Geriatrics, an eldercare consulting and geriatric care management company in Vancouver and the author of Nursing Homes: The Family's Journey.

www.diamondgeriatrics.com

© The Vancouver Sun 2006

If This Doesn't Make You Feel Guilty...

Someone sent this to me. It may be politically incorrect, but I can't tell.

An elderly woman decided to prepare her will and told her preacher she had two final requests. First, she wanted to be cremated, and second, she wanted her ashes scattered over Wal-Mart.

"Wal-Mart?" the preacher exclaimed. "Why Wal-Mart?"

"Then I'll be sure my daughters visit me twice a week."

When Life Kicks, Get a Kick Out of Life

Sadie will be ninety-nine in less than three months. A couple of weeks ago, she had a colostomy. At her age, many people wouldn't survive the surgery. When I saw her this week, she was lying in her bed; the sheets covered up to her neck. She smiled when she saw me, a large smile, of clean white dentures. I asked her how she was.

"Better than last week," she answered.

"How do you know?" I asked her.

"I feel more energy, more life in me. I think I will make it to 100."

"What do you want?"

She stopped to think a minute, then said, "I want to make it further than that."

"Sadie, " I asked her, "Why is it that some people at your age are just waiting to go and you are wanting to stay? What makes it different for you?"

"I still get a kick out of life," she told me.

"What gives you that kick?"

"I like it when people come in to visit me, and we have things to talk about."

"Just visitors coming in?"

She smiled again, "I like having people come in to talk."

We spoke a few more minutes, and then I told her I would be on my way.

"Come see me again, " she said.

This time I smiled. "You can be sure of that," I told her.

When life kicks, kick back.

"If Grandparents Were Flowers..."

I came to see her a few days after her 88th birthday. There was a huge bouquet of flowers on her dresser. Hanging down, almost hidden among the blooms, was a sign. It said, " If Grandparents were flowers, I'd pick you first."

It's the Policies, Stupid

91 year old Mrs. Albo died after being separated from her husband while both were in hospital. Her husband just died yesterday, at 96.

The British Columbia government did a review and came up with several recommendations, some good, some not so good. Some will create, I fear, more bureaucracy, and not much more care.

But there was no acknowledgement in the Ballem report recommendations that some basic policies need to be changed. We need policies that dictate a primary objective is keeping couples together. We need policies that take into account family abilities to care for relatives and be available. We need policies that do not limit access to care because of differing care levels. We need policies that do not pressure hospital staff to make harsh and rash decisions because of bed shortages in the hospital.

Why has this come about? Many reasons. The Province closed too many beds and didn't build enough fast enough, despite whatever promises they made. They have made it harder for people to be eligible for care, and harder for them to receive home care. That creates a wide gap in terms of safety and care, which somehow, families are supposed to fill. Often they cannot because they have their own work or child commitments.

The building of new care beds and assisted living has not happened fast enough. It is also not well thought out--what happens when all of those people in assisted living need more help? Then they move again, and we end up with relocation stress, family crisis, and sometimes, death.

It's the policies, stupid.