Things you need to know about talking to your ageing parents

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Having the Talk? Here’s a few tips.

If you have not had “the talk” with your ageing parent/s, don’t put it off any longer. While mom and dad are cognitively intact the process is pretty straight forward… albeit, it can be somewhat uncomfortable for both parties. It needs to be approached from the same angle as if the conversation was to be had with you by your own grown children.

IOC The talk1Talking about the future can be hard. Such discussion will invoke anxiety in even the most calm of us when we start to think about all the unknowns in our futures and those of our loved ones. These discussions can get even harder when it’s not our future we’re talking about, but rather someone else’s. However, as difficult as it may be, there are some questions that we need to have answers to when it comes to our ageing parents and it is wise to have these conversations sooner rather than later. On that note, here are 7 basic questions that you should include in the “talk” with your ageing parent/s… as soon as you can.

1. How do they feel about getting older or having to get help to sustain their independence?

A parent/s can have all the legal stuff taken care of, but that doesn’t tell you how they feel. To really understand your ageing parents, it’s important to talk about how they feel about the situations that might happen.  Allow them to talk about their fears, their wishes, how they envision things unfolding in the event of a medical situation, and so on.  This is the type of conversation that will tell you if they have made decisions based on what they think will be easiest for others or what they really want.  This is the type of conversation that will allow you to make sure that the legal documents accurately represent your loved one’s wishes.  Most importantly, it is the type of conversation that will allow your ageing parent/s to know how much you support and love them and want what is best for them.

2. Do they have a will? Is the Will is safe keeping and up-to-date?

Bringing up a will can seem like you only care about what you’re getting, but a will contains so much more than just ‘who gets what’ and is essential to the process of handling matters when a loved one passes. This is your parent’s opportunity to dictate how they would like their affairs to be handled and who they want to handle things.  It is equally important for our parent/s to ensure their will is up-to-date so that loved ones don’t end up in bureaucratic chaos trying to simply execute the wishes of a loved one while simultaneously trying to mourn. Importantly, the same questions pertain to life insurance, which is separate from a will and requires the beneficiaries to be named to the life insurance company directly.

3. Do they have a living will?

Although many people plan for their deaths, many forget to also plan for any situation that might render them incapable of making their own decisions while still living.  Your parent/s may assume that the “right” decision will be made for them, by those in charge. This is not always how it plays out. Taking the time to decide what they want and making sure those wishes are legally noted is the only way to ensure your parents will be cared for in that way.

4. Do they have a Power of Attorney?

This can be one of the trickier topics to discuss if there are multiple children or individuals who might expect to be “chosen”.  Parents sometimes put this off because they simply don’t want to be seen as picking favourites, but it’s an essential document to have.  For this reason it is important that children (and any other interested individual) are respectful of whatever decision the elder makes.  No offense should be noted to the parent/s and if there are concerns about a selection, it would be wise to make sure all parties are involved in discussing this instead of trying to quietly bring it up to the parent. By involving everyone, the right decision for your aging parent can be made.

5. Do you have long-term care insurance?

Not all people have invested in long-term care insurance and with the costs of long-term care. This is something your parents may want to consider if it’s not too late to invest. If they have invested, being aware of what is covered, who to contact to initiate the insurance claim, and what services your parent will want to take advantage of is important to know ahead of time and can save money and hassles if/when the time comes.

6. What kind of care situation do you want?

Does your parent have a retirement or assisted living home in mind?  Do they want to stay at home as long as possible, focusing on ageing in-place (Home Care)? What nursing homes are they comfortable with if the situation were to become necessary? Having these discussions before a decision needs to be made ensures that people can look for the right care, make any needed arrangements, and not scramble at the last minute and have to take whatever is available.

7. What are your wishes for a funeral/memorial?

IOC-The talk2Sometimes there’s a lot of pressure to do things in a “traditional” way when it comes to how we remember our loved ones, but that’s not always what they want.  Although funerals/memorials need to reflect both the person that is gone and those who are left behind, having a discussion ahead of time can mean that all sides get their voices heard.  When a decision is reached beforehand, our loved ones know their wishes will be respected and those of us left behind can know we’re memorializing our parents in a way that they accept as well. This means no guilt for anyone and that’s a much-needed relief at a time of sorrow.

However hard it may be, please take the time to talk to your loved ones about these issues.  It’s also not too late to start thinking about them for yourself as well. The more prepared you are, the easier it is for those around us and the more open we are, the more likely we are to respect everyone’s wishes and know that ours will be respected too.

Elder Abuse – Know it, Report it, Stop it

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Elder Abuse – Have you heard about it?

Know it, Report it, Stop it!Abuse and Neglect

Canada’s population demographics is shift, the number of seniors in Canada has increasing by 57.6% between 1992 and 2012. Within the same period, the number of children dropped by 3.6%. This shift hypotheses that an increasing number of people will be put into a position of caregiver for their parents/grandparents even as they are caregivers to their own families. Juggling these dual care giving roles & responsibilities can bring on a great deal of stress, anxiety, and despair.

While no one underestimates the level of responsibility, accountability and stress levels associated with caregiving, caring for an older senior can present a number of new challenges. Caring for an adult is much different than caring for child yet the level of patience and compassion required must be the same. An untrained person can easily become overwhelmed with the demands required to effectively manage, care for, and delivered care… in a caring manner. With that being said, there’s a real potential for frustration levels to escalate, setting the stage for elder abuse. Unfortunately, it does not happen quite like that. If that were the case, it would be so easy to intervene and resolve it. Elder abuse is far more complex and widespread than just the physical abuse. Not to say that it does not begin there.

So. What is Elder Abuse?

Although elder abuse includes the types of behaviours attributed to domestic violence, it also includes additional types of abuse such as neglect and financial exploitation. It also occurs in a wider range of settings and relationships. Perpetrators of elder abuse cases can be spouses but can also be children, grandchildren, other relations, friends, fellow residents in an institution and personal caregivers. Issues related to individual cognitive and physical functioning are central concerns in elder abuse and consequently frail older people have become identified with this perspective.

The World Health Organization defines elder abuse as, “Single or repeated acts, or lack of appropriate action, occurring within a relationship where there is an expectation of trust, which causes harm or distress to an older person.”

Fast facts:

  • Among seniors who’ve been physically abused, 68% report the assault was committed by a family member (Source: Ministry of Citizenship and Immigration)
  • 96% of Canadians think most of the abuse experienced by older adults is hidden or goes undetected (Source: Environics poll for Human Resources and Social Development Canada)
  • Female seniors (38%) are more likely to be abused than male seniors (18%). (Source: Ministry of Citizenship and Immigration)

Under-reporting

Some studies suggest that women and men differ in their tendency to report abuse and may interpret questions about abuse differently. For example, women seem to be more willing than men to identify themselves as perpetrators of emotional abuse. However, as is the case in all surveys about sensitive issues, respondents may also be reluctant to disclose their experiences due to shame, fear or lack of trust. Older women may have fewer resources and less independence than men and may be less inclined to report abuse due to fear of leaving their home or accusing someone who provides for their daily needs. Older men, on the other hand, may be embarrassed or ashamed that they are no longer in a position of control in their home. There may be a shift in this with the aging of the baby boomers as the stigma associated with masculine need for help lessens.

There is a huge under-recognition of abuse of seniors in Canada. I would say this field is 20 years behind where we were when we were trying to raise awareness about violence against women and, before that, how to prevent and respond to abuse of children.”

Elder abuse is often referred to as ‘the hidden crime.’ It can take many forms, including physical abuse, sexual abuse, financial abuse, mental abuse and neglect.

Fortunately, there is no better time than now to tackle the issue because seniors are by far the fastest growing segment of the population. Statistics Canada predicts that by 2026 seniors, aged 65 and older, who now account for 13% of the Canadian population, will grow to 21%.

A closer look at Elder Abuse:

  • Elder abuse is an issue that may affect seniors in all walks of life. However, some seniors may be at greater risk of experiencing some type of abuse: those who are older, female, isolated, dependent on others, cared for by someone with an addiction, and seniors living in institutional settings.
  • Those who are frail, who have a cognitive impairment or a physical disability.
  • In most cases, the person being abused knows and trusts the abuser and relies on him/her in some way, which makes it even worse. It might be a child, another family member, another senior, a fellow resident in an institution, a paid caregiver or even a spouse.
  • Unfortunately, seniors can make easy targets. Many live alone and are socially isolated, which increases their vulnerability. Others are dependent on their abuser for care. Some suffer from dementia or other health issues that may prevent them from responding to the abuse or reporting it. Some may feel it’s impossible to get away from the abuser if the relationship has been long standing. And many seniors who simply are not as physically strong as they once were are unable to defend themselves.

Forms of Elder Abuse:

The Ontario Network for the Prevention of Elder Abuse (ONPEA) uses the following descriptions:

Financial Abuse – One of the most common forms of elder abuse. It often refers to the theft or misuse of money or property such as household goods, clothes or jewelry. It also includes forcing the sale of property or possessions, misusing power of attorney responsibilities, coercing changes in a will, withholding funds and/or fraud.

Physical Abuse – Is any physical pain or injury that’s willfully inflicted upon a senior. It includes unreasonable confinement or punishment resulting in physical harm, as well as hitting, slapping, pinching, pushing, burning, pulling hair, shaking, physical restraint, physical coercion, forced feeding or withholding physical necessities.

Sexual Abuse – Is any sexual activity that occurs when one or both parties cannot or do not give consent. It includes, but is not limited to, assault, rape, sexual harassment, intercourse, fondling, intimate touching during bathing, exposing oneself, and inappropriate sexual comments.

Psychological (Emotional) Abuse – Is the willful infliction of mental anguish or the provocation of fear of violence or isolation. This kind of abuse diminishes the identity, dignity and self-worth of the senior. It can include name-calling, yelling, ignoring the person, scolding or shouting, insults, threats, intimidation or humiliation, treating as a child, emotional deprivation, isolation, and the removal of decision-making power.

Neglect – Can be intentional or unintentional. It happens when the caregiver of a dependent senior fails to meet his/her needs. Forms of neglect include not providing adequate food, housing, medicine, clothing or physical aids, as well as inadequate hygiene, supervision and safety precautions. It also includes withholding medical services and medications, overmedicating, allowing a senior to live in unsanitary or poorly heated conditions, and denying access to necessary services, such as homemaking, nursing, and social work. For a variety of reasons seniors themselves, may fail to provide adequate care for their own needs, and this is known as self-neglect.

Older women who’ve been abused have been socialized to believe this is not something they’re supposed to talk about. This is a historical problem and their mothers and grandmothers, who may also have also been victims of abuse, probably didn’t talk about it either. To go specifically to an agency that serves abused women is very difficult for them and there’s a stigma attached to it. We need to be able to reach these women wherever they are – and we need to let them know it’s okay to talk about and it’s okay to get some help.

Recognizing the signs of elder abuse

Sometimes it can be difficult to determine if an elder is actually being abused since there may be other explanations for the signs, such as a fall, self-neglect or poor personal choices. Other times it’s more obvious abuse is going on. One thing experts agree on is the longer the abuse goes on, the worse it tends to get.

The following are possible signs an elder is being abused:

Financial Abuse/fraud:

  • Significant withdrawals from the elder’s accounts
  • Sudden changes in the elder’s financial condition
  • Items or cash missing from the senior’s household
  • Suspicious changes in wills, power of attorney
  • Unpaid bills, even when the elder has enough money to pay
  • Financial activity the senior couldn’t have done, such as an ATM withdrawal when the account holder is bedridden
  • Unnecessary services, goods, or subscriptions
  • Paying far more for work/service than others would be charged
  • Large advance payments with nothing to show for it

Physical Abuse:

  • Unexplained signs of injury such as bruises, welts, or scars, especially if they appear symmetrically on two sides of the body
  • Broken bones, sprains, or dislocations
  • Reports of drug overdose or apparent failure to take medication
  • Regularly (a prescription has more remaining than it should have)
  • Broken eyeglasses or frames
  • Signs of being restrained, such as rope marks on wrists
  • Caregiver’s refusal to allow you to see the elder alone

Sexual Abuse:

  • Bruises around breasts or genitals
  • Unexplained venereal disease or genital infections
  • Unexplained vaginal or anal bleeding
  • Torn, stained, or bloody underclothing

 

Psychological/Emotional Abuse:

  • Threatening, belittling, or controlling caregiver behavior witnessed by others
  • Behaviour from the elder that mimics dementia, such as rocking, sucking, or mumbling to oneself

Neglect: (By caregivers and/or self)

  • Unusual weight loss, malnutrition, dehydration
  • Untreated physical problems, such as bed sores
  • Unsanitary living conditions: dirt, bugs, soiled bedding and clothes
  • Being left dirty or unbathed
  • Unsuitable clothing for the weather
  • Unsafe living conditions (no heat or running water; faulty electrical wiring, other fire hazards)
  • Desertion of the elder at a public place

Addressing the growing concern over elder abuse

Some jurisdictions have designated resources to deal exclusively with elder abuse.

On April 17, 2009, the Ontario Network for Prevention of Elder Abuse launched a province-wide toll-free hotline for at-risk seniors (1-866-299-1011), which is part of an elder abuse strategy funded by the provincial government at a cost of nearly $900,000 a year.

On June 15, 2009 the Government of Canada launched a nation-wide elder abuse awareness campaign, including an advertising campaign dubbed Elder Abuse – It’s Time to Face the Reality. The 2008 federal budget also earmarked $13 million over three years to help seniors and others recognize the signs and symptoms of elder abuse and to provide information on available supports.

The challenges in detecting and preventing elder abuse in long-term care facilities and retirement homes are compounded by the number of people providing care, the often high ratio of residents to workers, the various cognitive and physical impairments of residents, and by the demands and expectations of family members. Enhanced non-abuse training and increased staffing levels are critical to minimizing the chances of elder abuse occurring.

The Bill of Rights for People Living in Ontario Long-Term Care Homes was published in September 2008 by the Advocacy Centre for the Elder and Community Legal Education Ontario. It outlines 19 fundamental rights for long-term care residents and most long-term care facilities post these rights so staff, residents and family members are all aware of them. Knowing these rights is especially important given the increasing number of media reports about elder abuse in institutions.

Most of the cases of elder abuse that are reported to police tend to involve fraud, the most common form of elder abuse.

“To address elder abuse, it is imperative that action take place at the community level and that resources be allocated to this. Participants delivered a unanimous message:
that without adequate and sustainable funding, efforts to combat elder abuse in local communities are compromised.”

Fast facts:

  • The greater the impairment of a senior or the more severe the illness, the more likely it is that he/she will be abused. (Source: Canadian Mental Health Association)
  • Male seniors (9%) are more likely to report financial or emotional abuse, compared to female seniors (5%). (Source: Ministry of Citizenship and Immigration)
  • A study involving 31 nursing homes reported that 36% of nursing home staff had witnessed the physical abuse of an older adult and 81% had witnessed some
    form of psychological abuse. (Source: Canadian Mental Health Association)

Risk Factors for Elder Abuse

Some of the risk factors for elder abuse apply to the abuser, others the victim. Caregiver stress, for example, is a key factor in abuse in both the home and in institutional settings. That stress is intensified if the senior has mental health issues or physical care needs the caregiver is incapable of providing. Caring for a senior with multiple needs can be overwhelming and eventually lead to depression.

Even caregivers in institutions can experience stress levels that can lead to abuse. Excessive responsibilities, poor working conditions, long hours and inadequate training can all be contributing factors.

Sometimes family caregivers are poorly informed and lack the education and support required to properly care for an elder at home.

“When it comes to neglect, we see some families who aren’t providing appropriate care for their elderly loved ones, but it’s not necessarily because there’s any ill intent; sometimes it’s because they don’t know how to care for someone who’s sick, debilitated and has Alzheimer’s.”

Other risk factors include a history of family violence. If there has been abusive behaviour within the family in the past, there’s a greater likelihood an elder will be abused at some point in the future.

There are also the personal problems and personalities of the abusers themselves. According to the Canadian Mental Health Association, abusers are more likely to have mental health problems, substance abuse issues and/or financial problems.

Signs that a caregiver may be abusing an elder may include:

  • Being aggressive, insulting or threatening behaviour
  • Speaks for the elder and doesn’t allow him/her to make decisions
  • Reluctant to leave the elder alone with a professional.

Signs that an elder may be a victim of abuse:

  • Is anxious, withdrawn, agitated, evasive, depressed or suicidal.
  • Shows fear of caregiver; behaviour changes when care giver enters/leaves room.
  • Is frail or cognitively impaired and presenting for emergency treatment alone or without regular caregiver.
  • Has low self-esteem.

Habits:

  • Sudden/unexpected change in social habits.
  • Sudden/unexpected change in residence or living arrangements.
  • Unexplained or sudden inability to pay bills, account withdrawals, changes in his will or Power of Attorney, or disappearance of possessions.
  • Refusal to spend money without consulting caregiver.
  • Claims of being “accident-prone”.
  • Missed/cancelled appointments, especially medical appointments.

Some people say, “I wonder why I’ve never come across a case of physical elder abuse, especially when you know the statistics”. I think this really speaks to the fact that elder abuse is so hidden and it reminds us how vigilant we all need to be in looking for the signs.

Health & Well-Being:

  • Sudden/unexpected decline in health or cognitive ability.
  • Poor/decline in personal hygiene; skin ulcers.
  • Dehydration or malnutrition; sudden/rapid weight loss.
  • Signs of over/under-medication.
  • Suspicious injuries: bruising in various stages of healing; on the face or eye area, the inner part of the thighs or arms, or around the wrists or ankles.
  • Sexually transmitted disease; itching, pain or bleeding in genital area; difficulty sitting or walking.
  • Explanation of injury or condition: inappropriate to type/degree; vague or bizarre; conflicting information from elder and care giver.
  • Unexplained delay in seeking treatment.
  • Denial in view of obvious injury.
  • Previous reports of similar injury.

Environment:

  • Poor living conditions in comparison to assets.
  • Inappropriate or inadequate clothing.
  • Lack of food.
  • Lack of required medical aids, functional aids, or medications.
  • Evidence of locks or restraints.
  • Living in worse conditions than others in the home.
  • Involuntary separation from others in home, friends or other family members.

Fast Facts:

“Sometimes our role becomes helping the adult children realize their parent still has the ability to make his or her own choices and that they have that right. Just because someone is 80 doesn’t mean they can’t think clearly or make decisions.”

  • 12% of Canadians have sought out information about a situation or suspected situation of elder abuse or about elder abuse in general.
    (Source: Environics poll for Human Resources and Social Development Canada.)
  • There are almost 300,000 seniors living in institutions in Canada. (Source: Statistics Canada)
  • Fewer than one in five situations of abuse actually come to the attention of any public agency, and fewer still come to the attention of a public agency operating in the criminal justice system. (Source: Canada’s Aging Population: Seizing the Opportunity, Special Senate Committee on Aging, 2009)

Taking Action: What to do if elder abuse is suspected

It’s a job for police when a crime has been committed under the Criminal Code of Canada. These offences include assault, forcible confinement, sexual assault, extortion, fraud, forgery, theft, (including theft by a person with power of attorney), uttering threats, criminal harassment, criminal negligence and failure to prove the basic necessities of life. If in doubt, people are advised to call police, who will help determine what to do next.

There are no quick fixes or simple solutions in addressing the issue of elder abuse. The challenges in raising awareness, responding to elder abuse and ultimately mitigating and eliminating it are many, but the energy, commitment and expertise already exists among those who have taken on this task across the country.

There is also a toll-free, confidential elder abuse hotline in Ontario that provides information, support and referrals to services 24 hours a day, seven days a week at 1-866-299-1011. In emergency situations dialing 911 is the best option.

Even though there are no legal requirements to report suspected elder abuse of people living in their own private residences, anyone who witnesses harm being done to an elder in a long-term care facility is required by law to report it to the Ministry of Health and Long-Term Care. This can be done by calling the toll-free Action Line at 1-866-434-0144.

“The field of prevention of abuse and neglect of older adults in Canada is lagging behind other areas of family
violence prevention. It is largely the case that multiple small-scale projects and a few noteworthy larger programs exist in a patchwork of service delivery and under- coordinated effort. It is also far from being able to use practice standards that are available for other fields.”

The Canadian Network for the Prevention of Elder Abuse suggests the following as the best steps to take for seniors who are being abused:

For seniors living in the community:

  • Tell someone what’s happening to you.
  • Ask others for help if you need it.
  • If someone is hurting or threatening you, or if it is not safe where you are, call police.
  • Find out more from community resources about your options to take care of your financial security and personal needs.
  • Call for counselling and support.
  • Make a safety plan in case you have to leave quickly and contact Optimism Place, Victim Services or the Emily Murphy Centre for help developing a plan that’s right for you.

You might also:

  • Set aside an extra set of keys, I.D., glasses, bank card, money, address book, medication, and important papers. Keep this outside of your home.
  • Find a safe place with friends and family so you have a place to go to in an emergency.
  • Consider obtaining a restraining order to protect yourself.

“We believe that when people learn about victims who’ve had the strength to come forward and reach out for help it encourages others to do the same.”

For seniors living in a nursing home or other kind of assisted living facility:

  • Tell someone what is happening to you.
  • Ask others for help if you need it. Staff members have a responsibility to see that abuse stops and that you get the help you need.
  • If someone is hurting or threatening you, or if it is not safe for you where you are, call the police.

“Most people working in Home Care Services, including those in long-term care are in the field because they choose to be. They love the elderly and are committed to their care and wellbeing.

“The elderly in our community need to know it’s okay to ask for help. Too often they’re too nervous or they don’t want to bother the police; they don’t even know if what’s happening to them is a crime. They don’t realize there are other organizations they can turn to for help – and which would put them in contact with the police if need be.”

A Summary of Canada’s Aging Population

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Group of SeniorsA Summary of Canada’s Aging Population

An aging Canadian population is expected to present significant social, economic and political challenges over the next decades. Understanding the needs of seniors and addressing the barriers they face can promote successful aging and ensure that Canadian society benefits from the numerous contributions seniors can provide as engaged citizens and voters.

This research note is the first in a two-part series on seniors, defined as those aged 65 and older. This note provides a demographic profile of this age group, including information about their geographical distribution, lifestyles and socio-economic status. It also addresses some of the challenges that they face in various areas of life. The second note will focus on the electoral participation of seniors, including turnout in federal elections, barriers to voting and initiatives that can be put forward to reduce these barriers.

The qualifying age for seniors is generally 65 in developed countries. However, seniors do not represent a homogenous group, and there is significant variation in the circumstances of those aged 65 to 74, 75 to 84, and 85 and older. Therefore, each one of these three age categories will be treated as distinct where possible.

The Aging Population
A sustained decline in mortality and fertility rates during the twentieth century has resulted in a shift towards older populations worldwide. Canada, while somewhat younger than the average among developed countries, still has an all-time high proportion of seniors. According to Statistics Canada, between 1981 and 2011, the number of Canadians increased significantly amongst the three age groups:

  • For those aged 65 to 74, from 1.5 million (6% of the total population) to 2 million (8%)
  • For those between 75 and 84, from 695,000 (2.8%) to 1.6 million (4.9%)
  • For those aged 85 and older, from 196,000 (0.8%) to 492,000 (2%)

The number of seniors in all age groups is expected to continue to rise, and by 2041, seniors are projected to comprise nearly a quarter (24.5%) of the Canadian population, as compared to 14.8% today. Those aged 85 and over are expected to nearly triple to 5.8% of the total population by 2041.

The chart below illustrates the growth of the older population since 1921.

Aging Population Chart-CanadaGeography
Canada’s senior population is distributed unevenly across the provinces, with the highest concentration in the Atlantic provinces. Nova Scotia has the highest proportion of seniors, at 16.6% of its population, followed by New Brunswick (16.5%) and Prince Edward Island (16.3%). Alberta has the lowest proportion of seniors at 11.1% of the population, while Nunavut has the youngest population overall, with only 3.3% over 65. Some regions are aging more rapidly than others. The Atlantic Provinces are expected to see the highest increase in their proportion of seniors by 2026, while Ontario has the lowest projected increase. Most older seniors (61%) live in metropolitan areas, reflecting the overall trend towards urbanization in Canada, while 23% reside in rural areas.

Gender and Ethnicity
Since women have a longer life expectancy, the majority of seniors are women, with the gender discrepancy increasing with age. In 2011, women made up 52% of seniors aged 65 to 74, 56% of seniors aged 75 to 84, and 68% aged 85 or older. This gap is narrowing, however, and the next decades are expected to see a relative increase in the number of older men as they catch up in terms of life expectancy.

Approximately 28% of seniors are immigrants, the majority of whom were born in Western Europe and Asia. Most immigrant seniors moved at a relatively young age and have been living in Canada for several decades. The proportion of Aboriginal seniors is low, with only 5% of the Aboriginal population over 65, and 1% over 75.

Living Arrangements
As shown in table 1: Most people over 65 reside at home, either with a spouse or alone. According to a study released in 2002 by Health Canada, three quarters of seniors enjoyed housing considered to be affordable, adequately sized and in good condition.

A small percentage of seniors live in institutions, including long-term care facilities and hospitals, though rates of institutionalization rise sharply with age. Reasons cited for institutionalization include increasing frailty and care needs that exceed the capacity of family or friends. In many cases, family and friends continue to provide care even after institutionalization.

Table 1: Where Seniors Live

Living Arrangements
% Of Seniors
Aged 65–74
% Of Seniors
Aged 74–85
% Of Seniors
Aged 85+
Institution
2.2
8.2
31.6
With Spouse
54.4
39.9
16.2
With Children or Grandchildren
18.9
16.0
15.8
Alone
21.5
33.0
33.7
Other
2.9
2.8
2.6

Employment and Income
As of 2006, nearly 15% of men and 5% of women over 65 were participating in the workforce. A smaller percentage of seniors in the 75+ age group were still working, with labour force participation rates of 7.5% for men and 2.4% for women. Self-employment and higher levels of education are associated with a higher likelihood that a person will continue to work after 65.

Post-retirement sources of income among retired seniors include transfers (such as CPP/QPP, OAS, EI, GIS), pensions, RSP withdrawals and investment income. Older seniors are often mischaracterized as impoverished. While they generally have only half the income of working-age households, they are often able to support a similar standard of living. This is likely due to lower expenses (for example, no mortgage or expenses related to child provision) and higher savings from which to draw.

Consumption and spending remain steady through the working years up to age 70, and then begin to decline. It is likely that this decline is voluntary, as gift giving and savings remain unchanged. Older seniors may be less willing or able to spend money; they may be saving for anticipated health care costs or to leave money behind for relatives.

Income aside, work is also important in defining personal identity. The loss of full-time employment, therefore, may present challenges to retired seniors, including lowered confidence, loss of perceived prestige and loss of purpose. Participation in various groups or organizations can ease the transition, and new challenges like volunteer activities may restore a sense of purpose.

Health and Quality of Life
Improved medical technology and public health measures have provided Canadians with a longer life expectancy and quality of life than in the past. Nonetheless, chronic health conditions are widespread among seniors, with four out of five seniors residing at home having a chronic health condition of some kind. The most common of these conditions are arthritis or rheumatism, hypertension, (non-arthritic) back pain, heart disease and cataracts. Alzheimer’s disease and other forms of dementia also affect significant numbers of older seniors and are expected to present a major social and public health problem as the population ages. In 2008, 480,600 people, or 1.5% of Canada’s population, suffered from some form of dementia. This number is expected to rise to 1.13 million (or 2.8% of the Canadian population) by 2038. Most dementia sufferers are 75 years of age or older.

Many seniors also have a disability or activity restriction that requires them to seek assistance with various activities. One quarter of older seniors require help with housework, while one in ten need help with personal care activities, such as washing, dressing or eating. Most assistance is provided by immediate family members, although friends and professional caregivers may help as well. Limitations increase sharply after 85, with mobility, sight, hearing and cognition becoming more restricted.

Despite the prevalence of chronic conditions and activity limitations, seniors generally perceive themselves to be in good health. As of 2011, 46% of men and women over 65 rated their own health as very good or excellent. Higher levels of educational attainment are strongly related to better self-reported health, as are greater independence, the absence of pain or barriers to communication, and the presence of strong social networks. Even seniors residing in long-term care facilities generally rate their health fairly highly, suggesting that they adjust their expectations for health relative to their circumstances and those of their peers.

Victimization, Abuse and Ageism
Elder abuse is gaining increasing recognition as an important issue. Abuse can be physical, psychological/emotional, sexual or financial in nature, or involve intentional or unintentional neglect. A random survey of seniors in Canada found that 4% reported experiencing maltreatment since turning 65. Older women and sponsored immigrant seniors are particularly vulnerable to elder abuse. This could be due to increased financial dependency, social isolation, cultural norms, familial status, disadvantage or disability.

Fraud against older people is also common. Seniors may be particularly vulnerable due to isolation and, in some cases, cognitive decline. Types of scams may include mail or telephone fraud, charity or lottery scams, or fake business opportunities.

Older seniors may also experience a type of discrimination referred to as ageism, defined as a “process of systematic stereotyping or discrimination against people because they are old, just as racism and sexism accomplish with skin colour and gender.” Ageism may be positive (for example, the belief that all seniors are wise or caring) or negative (one study shows that younger Canadians overwhelmingly assume that most seniors reside in an institution, suffer from dementia and are responsible for a large proportion of traffic accidents). Ageism can have implications for individuals whose competencies and merits are not acknowledged, and for society as a whole, which, operating under the assumption that everyone is young, fails to meet the varied needs of all of its citizens.

What Older Seniors Fear The Most
A recent study looked at some of the fears that seniors experience as they age. Losing their personal independence and going into a Nursing Home were among the their greatest fears… more so than death.What Seniors Fear Most

Social and Civic Participation
It is important for seniors to remain active in social networks, as this fosters a sense of belonging and connectedness, and is associated with better health and quality of life outcomes. Seniors who are socially involved are less isolated and tend to have more close friends.

As of 2003, 54% of seniors were involved in groups or organizations, such as social clubs, service clubs, sports leagues and religious organizations. This proportion is similar to that of adults under 65. For seniors over 75, the rate of group involvement dropped to 46%. Seniors with higher levels of education and those with a previous history of involvement are more likely to participate in a group or organization.

Many seniors also volunteer for charities or non-profit organizations. While they are somewhat less likely to volunteer than younger retirees or working people, they tend to contribute more hours when they do volunteer. In 2004, 39% of seniors between 65 and 74 volunteered, contributing an average of 250 hours of volunteer work – 100 hours more than the average for adults between 25 and 54. Volunteering decreases somewhat after age 75, health being the most widely reported reason for non-volunteering seniors.

Conclusion
The role of seniors in society warrants increased consideration as their share of the population grows. Currently, seniors have a good quality of life in Canada. Most enjoy good living conditions, adequate financial resources, and generally rate their health highly. While the majority of seniors are retired, many remain socially involved through participation in organizations or volunteer work. Nonetheless, seniors continue to face certain challenges and barriers. These include physical and cognitive health conditions, a lack of independence and negative attitudes.

Understanding the needs of seniors and addressing the barriers they face can promote successful aging and bring benefit to Canadian society from the numerous contributions older people can provide, including their participation in the electoral process.

Please contact us today, to discuss any challenges you may be facing and how our services can help you remain independent, protected, safe, and in you home / community.

You got questions, we have answers: (905) 785-2341 or email us at homecare@inourcareservices.com

 

Alzheimer’s & Dementia Care… The road ahead

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Alzheimer's & Dementia Article1Alzheimer’s and Dementia Care… The road ahead

Caring for a loved one with Alzheimer’s disease and other types of dementia can be a challenge, not only for the person diagnosed but also for their spouses and family members. Although caring for someone with Alzheimer’s or dementia can seem overwhelming at times, the more information & support you have, the better you will handle the demands and determine the long-term care options that are best suited to you and your loved one.

 

 

THIS ARTICLE WILL DEAL WITH:

  • Preparing yourself for the care
  • Developing routines
  • Engaging your loved one in activities
  • Planning activities with your loved one
  • Handling challenges as they present themselves
  • Considering long term care
  • Assessing assisted living or nursing homes

Preparing yourself for Alzheimer’s & dementia care

You may be dealing with a whole range of emotions and concerns, as you come to grips with an Alzheimer’s or other dementia diagnosis. There’s no doubt you will be worried about how your loved one will change, how you will keep him or her safe & comfortable, and how much your life will change in order to sustain it. Emotions such as anger, grief, and shock will be likely to be experienced. Adjusting to this new reality is neither, easy or immediate. It is critically important to give yourself some time, process the road ahead and reach out for help and support from a number of resources available. The more support you have, the better you will be able to help and manage your loved one, care.

While some of these tips are aimed specifically for people with Alzheimer’s, they can equally apply to persons suffering with other types of dementia.

Early-stage Alzheimer’s care preparations

Some Alzheimer’s & Dementia care preparations that are best done sooner rather than later. It’s hard to consider these questions at first, as it means thinking about a time when you or your loved one is already well down the road of his or her Alzheimer’s journey. However, putting such preparations in place early helps a smoother transition for everyone later on. Depending on the stage of diagnosis, include the person with Alzheimer’s & Dementia in the decision-making process as much as possible. If the person is at a more advanced stage of dementia, at least try to act on what their wishes would be.

Questions to consider in preparing for Alzheimer’s and dementia care:

▪   Who will make healthcare and financial decisions when the person is no longer able to do so?

While this is difficult topic to raise, if your loved one is still lucid enough, getting their wishes down on paper means they’ll be preserved and respected by all members of the family. Consider having a family meeting involving the person and those who may be impacted with the decisions being made (all children, and or grandchildren who may have to ultimately step up and take on a role in their care). In most cases such family meetings can go smoothly as it pertains to respecting the affected person’s wish. However, do not hesitate to involve an elder law attorney to best understand your options. You’ll need to consider power of attorney, both for finances and for healthcare. If the person has already lost capacity, you may need to apply for guardianship/conservatorship. Last but not least, their Personal Will if one is not in place already.

▪   How will care needs be met?

It is not uncommon that some family members assume that a spouse or nearest family member can take on the role of caregiver, but this assumption is not always the case or even possible. Caregiving is a rather a large commitment, and one that becomes greater over time. The person with Alzheimer’s and or advanced Dementia will eventually need round-the-clock personal care. Although family members are more than willing to take this challenge on, many family members may have their own health issues, jobs, and other roles & responsibilities. Communication is essential to ensure that the needs of the affected person are known & met, and that the caregiver has all the support in place to meet those needs.

▪   Where will the person live?

Knowing their wishes ahead of time will certainly ease the process in making this decision. Their own home will more than likely be their first wish. However, before concluding that home care is the final decision, consider a home assessment to determine the appropriateness of the home to meet their care needs. An assessment can be performed free of cost and determine the care needs and client’s challenges for today and moving forward. This way you will know if perhaps the home is fine for now, but difficult to access or make safe for later. On the other hand, the home could be fully suitable for their care… now and to meet future challenges. This is the type of information that will be invaluable to make informed decisions. If the person is currently living alone, for example, or far from any family, it may be necessary to relocate or consider care options that best suits their need, care, wishes… or a facility with more support.

Find out what assistance your medical team can provide in these areas. In some countries, you can also hire a care manager privately. Geriatric care managers can provide an initial assessment as well as assistance with managing your case, including crisis management, interviewing in-home help, or assisting with placement in an assisted living facility or nursing home.

Developing day-to-day routines

Having a daily routine in Alzheimer’s & Dementia care helps caregiving run smoothly. These routines won’t be set in stone, but they give a sense of consistency, which is beneficial to the Alzheimer’s patient even if they can’t communicate it.

While every family will have their own unique routine, you can get some great ideas from your medical team or Alzheimer’s support group, especially regarding establishing routines to handle the most challenging times of day, such as evenings.

  • Keep a sense of structure and familiarity. Try to keep consistent daily times for activities such as waking up, mealtimes, bathing, dressing, receiving visitors, and bedtime. Keeping these things at the same time and place can help orientate the person.
  • Let the person know what to expect even if you are not sure that he or she completely understands. You can use cues to establish the different times of day. For example, in the morning you can open the curtains to let sunlight in. In the evening, you can put on quiet music to indicate it’s bedtime.
  • Involve the person in daily activities as much as they are able. For example, a person may not be able to tie their shoes, but may be able to put clothes in the hamper. Clipping plants outside may not be safe, but the person may be able to weed, plant, or water. Use your best judgment as to what is safe and what the person can handle.

Communication tips

As your loved one’s Alzheimer’s progresses, you will notice changes in communication. Trouble finding words, increased hand gestures, easy confusion, even inappropriate outbursts are all normal. Here are some tips, do’s and don’ts on communicating:

Communication Do’s and Don’ts?
Do
Avoid becoming frustrated by empathizing and remembering the person can’t help their condition. Making the person feel safe rather than stressed will make communication easier. Take a short break if you feel your fuse getting short.
Keep communication short, simple and clear. Give one direction or ask one question at a time.
Tell the person who you are if there appears to be any doubt.
Call the person by name.    
Speak slowly. The person may take longer to process what’s being said.
Use closed-ended questions, which can be answered as “yes” or “no.” For example, ask, “Did you enjoy the beef at dinner?” instead of “What did you have for dinner?”
Find a different way to say the same thing if it wasn’t understood.Try a simpler statement with fewer words.
Use distraction or fibs if telling the whole truth will upset the person with dementia. For example, to answer the question, “Where is my mother?” it may be better to say, “She’s not here right now” instead of “She died 20 years ago.”
Use repetition as much as necessary. We prepared to say the same things over and over as the person can’t recall them for more than a few minutes at a time.
Use techniques to attract and maintain the person’s attention. Smile, and make eye contact, use gestures, touch, and other body language.
Don’t
Ever say things like: “Do you remember?” “Try to remember!” “Did you forget?” “How could you not know that?!”
Ask questions that challenge short-term memory, such as “Do you remember what we did last night?” The answer will likely be “no,” which may be humiliating for the person with dementia.
Talk in paragraphs. Instead, offer one idea at a time.
Point out the person’s memory difficulty. Avoid remarks such as “I just told you that.” Instead, just repeat it over and over.
Talk in front of the person as if he or she were not present. Always include the person in any conversation when they are physically present.
Use lots of pronouns such as “there, that, those, him, her, it.” Use nouns instead. For example, instead of “sit there” say “sit in the blue chair.”
Use slang or unfamiliar words. The person may not understand the latest terms or phrases.
Use patronizing language or “baby talk”. A person with dementia will feel angry or hurt at being talked down to.
Use sarcasm or irony, even if meant humorously. Again, it can cause hurt or confusion.

Planning activities and visitors

As you develop daily routines, it’s important to include activities and visitors into their life. You want to make sure that the Alzheimer’s patient is getting sensory experiences and socialization, but not to the point of getting over-stimulated and stressed. Here are some suggestions for activities:

  • Start with the person’s interests.
  • Ask family and friends for memories of interests the person used to have. You’ll want to tailor the interests to the current level of ability so the person doesn’t get frustrated.
  • Vary activities to stimulate different senses of sight, smell, hearing, and touch. For example, you can try singing songs, telling stories, movement such as dance, walking, or swimming, tactile activities such as painting, working with clay, gardening, or interacting with pets.
  • Planning time outdoors can be very therapeutic. You can go for a drive, visit a park, or take a short walk. Even sitting on a balcony or in the backyard can be relaxing.
  • Consider outside group activities designed for those with Alzheimer’s. Senior centers or community centers may host these types of activities. You can also look into adult day care programs, which are partial or full days at a facility catering to older adults and/or dementia patients.

Visitors and social events

Visitors can be a rich part of the day for a person with Alzheimer’s disease. It can also provide an opportunity for you as the caregiver to socialize or take a break. Plan visitors at a time of day when your loved one can best handle them. Brief visitors on communication tips if they are uncertain and suggest they bring memorabilia your loved one may like, such as a favorite old song or book. Family and social events may also be appropriate, as long as the Alzheimer’s patient is comfortable. Focus on events that won’t overwhelm the person; excessive activity or stimulation at the wrong time of day might be too much to handle.

Handling challenges in Alzheimer’s and dementia care

One of the painful parts of Alzheimer’s disease is watching your loved one, display behaviours you never would have thought possible. Alzheimer’s can cause substantial changes in how a person acts. This can range from the embarrassing, such as inappropriate outbursts, to wandering, hallucinations, and even violent behaviour. Everyday tasks like eating, bathing, and dressing can become major challenges.

As painful as some behaviours are, it’s critical not to blame yourself or try to handle all the changes in behaviour alone. As the challenging behaviour progresses, you may find yourself too embarrassed to go out, for example, or to seek respite care. Unfortunately, difficult behaviour is part and parcel of Alzheimer’s disease. Don’t isolate yourself. Ask for help from the medical team and reach out to caregiver groups for support. There are ways to modify or better accommodate problem behaviours. Both the environment you create at home and the way you communicate with your loved one can make a substantial difference.

Considering long-term Alzheimer’s and dementia care

It’s the nature of Alzheimer’s disease to progressively get worse as memory deteriorates. In the advanced stages of Alzheimer’s, your loved one will likely need round-the-clock care. Thinking ahead to these possibilities can help make decisions easier.

Care at home

There are several options for extending care at home:

  • In-home help refers to caregivers that you can hire to provide assistance for your loved one. In-home help ranges from a few hours a week of assistance to live-in help, depending on your needs. You’ll want to evaluate what sort of tasks you’d like help with, how much you can afford to spend, and what hours you need. Getting help with basic tasks like housekeeping, shopping, or other errands can also help you provide more focused care for your loved one. Be sure to look for a service provider who has extensive Geriatric Care experience.
  • Day programs, also called adult day care, are programs that typically operate weekdays and offer a variety of activities and socialization opportunities. They also provide the chance for you as the caregiver to continue working or attend to other needs. There are some programs that specialize in dementia care. Alternatively, you can hire a caregiver for the days you need it for without any time commitment. This may alleviate some stress on the part of the patient, as they do not have to leave their familiar surroundings.
  • Respite care. Respite care is short-term care where your loved one stays in a facility temporarily. This gives you a block of time to rest, travel, or attend to other things. Of course, you can hire a caregiver for the block of time desired. This may alleviate some stress on the part of the patient, as they do not have to leave their familiar surroundings.

Is it time to move?

As Alzheimer’s progresses, the physical and mental demands on you as caregiver can gradually become overwhelming. Each day can bring new additional challenges. The patient may require total assistance with physical tasks like bathing, dressing, and toileting, as well as greater overall supervision. At some point, you won’t be able to leave your loved one alone. Nighttime behaviours may not allow you to sleep, and with some patients, belligerent or aggressive behaviours may exceed your ability to cope or feel safe. Every situation is different. Sometimes, you can bridge the gap by bringing in additional assistance, such as in-home help or other family members to share the caregiving burden. However, it is not a sign of weakness if moving to your loved one to a facility seems like the best plan of care. It’s never an easy decision to make, but when you’re overwhelmed by stress and fatigue, it’s difficult to maintain your caregiving standards. If the person with Alzheimer’s is living alone, or you as the primary caregiver have health problems, this option may need to be considered sooner rather than later.

When considering your caregiving options, it’s important to consider whether you are able to balance your other obligations, either financial or to other family members. Will you be able to afford appropriate in-home coverage if you can’t continue caregiving? Talk to your loved one’s medical care team for their perspective as well.

Evaluating an assisted living facility or nursing home

If the best choice is to move the Alzheimer’s patient to a facility, it doesn’t mean you will no longer be involved in their care. You can still visit regularly and ensure your loved one gets the care he or she needs. Even if you are not yet ready to make that step, doing some initial legwork might save a lot of heartache in the case of a crisis where you have to move quickly. The first step is finding the right place for your loved one.

Choosing a facility

There are two main types of facilities that you will most likely have to evaluate for a loved one with Alzheimer’s: an assisted living facility or a nursing home.

Assisted Living

Assisted living is an option for those who need help with some activities of daily living. Some facilities provide minor help with medications as well. Staff are available twenty-four hours a day, but you will want to make sure they have experience handling residents with Alzheimer’s disease. Also be clear about what stage your loved one is at, as he / she may need to move to a higher level of care.

Nursing Home

Nursing homes provide assistance in both activities of daily living and a high level of medical care. A licensed physician supervises each resident’s care and a nurse or other medical professional is almost always on the premises. Skilled nursing care providers and medical professionals such as occupational or physical therapists are also available.

How do I choose a facility?

Once you’ve determined the appropriate level of care, you’ll want to visit the facility announced and unannounced—to meet with the staff and otherwise evaluate the home. You will also want to evaluate the facility based on their experience with Alzheimer’s residents. Facilities that cater specifically for Alzheimer’s patients should have a designated area, for residents with dementia.

Questions to ask such a facility include:

  • Policy and procedures – Does the unit mix Alzheimer’s patients with those with mental illness, which can be dangerous? Does the program require the family to supply a detailed social history of the resident (a good sign)?
  • Environment – Is the unit clean? Is the dining area large enough for all residents to use it comfortably? Are the doors alarmed or on a delayed opening system to prevent wandering? Is the unit too noisy?
  • Staffing – What is the ratio of residents to staff? (5 to 1 during the day, 9 to 1 at night is normal). What is staff turnover like? How do they handle meals and ensure adequate hydration, since the person can often forget to eat or drink? How do they assess unexpressed pain—if the Alzheimer’s resident has pain but cannot communicate it?
  • Staff training – What training for Alzheimer’s care do they have? Does the facility provide staff with monthly in-service training on Alzheimer’s care?
  • Activities – Is there an activity plan for each resident based on the person’s interests and remaining cognitive strengths? Are residents escorted outside on a daily basis? Are regular outings planned for residents?
  • Services – Does the unit provide hospice services? What were the findings in the most recent Ministry conducted inspection? What are the rates of infectious outbreaks? What is the resident rate of injury incidences?

What to expect during a transition

Moving is a big adjustment both for the person with Alzheimer’s and you as their caregiver. Your loved one is moving to a new home environment with new faces and places. You are adjusting from being the person providing hands-on care to being an advocate. Remember to give yourself and the Alzheimer’s patient time to adjust. If you’re expecting to move, try to have essentials packed and ready to go, and as many administrative details taken care of as possible, as sometimes beds can come up quickly. Work closely with staff regarding your loved one’s needs and preferences. An extra familiar face during moving day, such as another relative or close friend, can also help.

Each person adjusts differently to this transition. Depending on your loved one’s needs, you may either need to visit more frequently or give your loved one their own space to adjust. As the adjustment period eases, you can settle into the visiting pattern that is best for both of you.

Please contact us today, to discuss any challenges you may be facing and how our services can help you remain independent, protected, safe, and in you home / community.

You got questions, we have answers: (905) 785-2341 or email us at 

 

Dollars & Sense

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Personal FinancesPersonal Finances – An Overview:

This is never an easy topic, but one that has to be embraced at some time in our lives… sometimes twice or three times.

  • Planning for our own retirement
  • Engaging our ageing parents financial plan into action
  • Engaging our own retirement financial plan

The article is powerful in part because it deals with an issue that — if we’re lucky — most of us will face. Despite the fact that the experience is almost universally shared, too few of us are prepared to deal with the financial challenges that tend to arise as our parents reach old age, it is now more important than ever to prepare for this stage of life.

Dealing with aging parents can clearly be trying — emotionally and financially — but you can make the process much easier if you begin to prepare before your parents face serious health problems. To get you started, here’s a look at six basic steps you’ll need to take.

Have a financial plan of your own

The first thing an adult child needs to do is protect his own financial security, to avoid serious financial difficulties while caring for their parents. Of course children want to be there for mom and dad, but it’s important to know your own financial capacity to help. If you have your own plan in place  — one that takes into account the likelihood that you’ll live longer than your parents — you’ll better know those boundaries.

Unfortunately, most seniors today haven’t purchased long-term care insurance, and by the time they know they’ll need it, such policies are prohibitively expensive. But if you have aging parents, buying long-term care insurance for yourself may provide you with the certainty needed to be able to spend income and assets on your parents’ care.

Open up the conversation… gently

Getting your parents to be forthright with you about their financial situation can be very difficult. For decades, they have been the ones caring for you, and the ones dispensing advice. Reversing those roles can be trying for both you and your parents. That’s why framing the conversation effectively is important, broaching the subject in such a way that comes across as asking for help rather than offering it. Like, ‘Hey, Dad/Mom, I’ve been thinking about my long-term financial stability and it looks like you’re doing well. How did you plan for this?’” This way you can gauge if you’re parents are struggling, and if they’re not. It can also be great way to learn some planning strategies for yourself as well.

Get help

Dealing with ageing parents can be a source of acrimony between siblings. If you’re the adult child taking the lead, it’s important to involve your siblings early in the process – both to avoid resentment, and to avoid having the burden placed entirely on your shoulders. It is also a good idea to bring professionals into the conversation – a doctor, lawyer and financial adviser that your parents already trust. This will add outside authority to your discussions and help mitigate any qualms your parents have with being told what to do by their children.

Make it legal

In case your parent’s health deteriorates quickly, you or a trusted ally will need to be given the legal authority to make financial and health decisions for them. Documents like a durable power of attorney will allow a proxy to make financial decisions for your parents in case they become incapacitated. A living trust will allow a proxy to manage your parent’s estate under similar circumstances, and a will is necessary to dictate how your parents’ estate will be disposed of after they pass.

Simplify their financial life

Many seniors are resistant to online banking, but showing your folks the ropes will allow them to set up automatic bill pay, which will help them stay up on their financial responsibilities. It will also allow you to monitor their finances and make sure everything’s okay. Many individuals have their financial assets spread among a range of financial institutions; you’ll want to consolidate those assets to some extent.

Take over gradually

As you begin to take a larger role in your parents’ medical care and finances, it’s important to make the transition slowly if possible. Give them autonomy where they can handle it, as this will reduce tension between you and your parents. For health reasons, it’s also important for your parents to maintain a sense of autonomy and self-reliance.

As you move forward in the process of taking responsibility from your parents, the most important thing you can do for yourself is learn from your pa
rents’ experiences. Today, people are living a third longer than they thought they would, and that trend is likely to continue. Doing things like buying long-term care insurance and setting up your own legal directives while you’re still young will make the process that much smoother when you and your children face it.

Planning for the discussion:

If you are working with your elderly parents, choose a quiet moment to introduce a conversation about the five wishes concept. It is a good idea to document the answers. These points can formalize the five wishes as part of their legal documents, including their Power of Attorney and will documents. Five Wishes allows a person to spell out exactly how he or she wants to be treated should he or she become seriously ill. Note that specific funeral instructions, memorial services, and burial requests may be included in this document. Give your parent time to think about the following questions.

Wish 1: Whom do you wish to make health-care decisions for you, when you can’t make them for yourself?

Choose someone who knows you very well, cares about you, and who is able to make difficult decisions. Family members or your spouse may not be the best choice as they are too emotionally involved. Choose someone who is able to stand up for your wishes and lives close enough to help whenever needed. Be sure to discuss your wishes with this person; first ask if he or she is willing and able to take on this responsibility. You will need to fully discuss your wishes with this person. Ask if he or she is prepared to act on your wishes.

Wish 2: What is your wish for the type of medical treatment you want?

Traditionally this wish begins with the following statement: I believe that my life is precious and I deserve to be treated with dignity. When the time comes that I am very sick and I am not able to speak for myself, I want the following wishes and any other directions I have given to my health-care agent, to be respected and followed.

Describe your wishes for pain management, comfort issues, life support or extraordinary measures and what to do in specific situations (e.g., close to death, in a coma, or having permanent and severe brain injury with no expectation of recovery).

Wish 3: How comfortable do you wish to be?

This wish may contain specific requests; for example, music to be played, poems or favourite passages read out loud, or photos to be kept nearby. This may also include information about your grooming needs and cleanliness of bed and towel linens.

Wish 4: How do you wish people to treat you?

This wish may include requests for who you will want to be by your side in your dying days such as whom you would like to see (e.g., family, friends, clergy) and whether or not you want someone by your side to comfort you. You can also specify that you want to die in your own home (if possible) or to be in a facility with professional caregivers while family and friends visit as guests (as opposed to being caregivers).

Wish 5: What do you wish your loved ones to know?

This wish may contain statements that you want the family to know; for example, that you love them, or you may ask for forgiveness for times you have hurt family, friends, or others. It may also show forgiveness for hurts you have experienced from others. It is a wish that can evoke a need to make peace with yourself, your family, and your community; or to remind loved ones to celebrate your life with memories of joy, not sorrow. When you die, your debts must be paid first – before any money or property you leave behind is passed on to your loved ones. There may also be funeral costs, legal fees and other administrative expenses in settling your estate. There may be other estate costs, such as probate fees and taxes on investments that you may not have considered.

Common Estate Costs

Probate fees
When you die, your executor often needs proof (requested by financial institutions, government agencies and others) that they are the person authorized to represent your estate. Probate is the process that provides court certification of this fact. There can be a cost to this – and probate fees to settle your estate can be high depending on the province you live in. In Ontario, the fees (officially called an estate administration tax) equal almost 1.5% of your estate’s value.

Tax on capital gains
You’re deemed to dispose of all capital property at death.  Your estate must cover the tax on any capital gains.

Tax on tax-sheltered savings plans
Registered plans such as RRSPs and RRIFs can be transferred tax-free to your spouse’s plan. If you don’t have a spouse, these savings are fully taxable at your death.

Ways to manage estate costs

Personal Finances2Leave a valid will
If you die without a valid will, your estate gets settled according to the laws of your province, rather than according to your personal wishes. This can be a more complic
ated process, with higher legal fees and the potential for costly disputes. 

Name beneficiaries for insurance and registered plans
When you buy life insurance or open an RRSP or other registered plan account, you can name a beneficiary to receive the money when you die. This means the money bypasses the estate process and is paid directly to that person. Because it does not form part of your estate, the money is not subject to probate fees and there is no delay in your beneficiaries receiving the money.

Jointly own property
Holding assets – such as a home or cottage – with another person is another strategy for reducing probate fees. Joint assets pass automatically to the surviving joint owner – and are generally not considered part of your estate and subject to probate fees. However, there can be complications to joint ownership, especially if you co-own an asset with someone other than your spouse.

For example:

  • If you transfer half-ownership of an asset to an adult child – and they have a spouse who they later separate from – the spouse could have a claim on your child’s half of the asset.
  • If your child has financial problems or declares bankruptcy, their ownership in the asset could be subject to claims by creditors.
  • If the asset has increased in value, you may have to pay tax on any capital gains when you transfer your half ownership. This is because a transfer is considered a sale for tax purposes.
  • You can no longer deal freely with the asset and must make joint decisions in managing or selling it.

Professional advice is essential: Joint ownership arrangements can be complicated. Get expert legal and tax advice before entering into one of these arrangements.

Preplan and prepay your funeral
Preplanning and prepaying your funeral doesn’t necessarily save you money, but it does remove a key expense that your family or estate must cover upon your death. When you prepay, the money goes into a trust account or insurance fund until your funeral. You gain certainty over costs because you choose the type of funeral you want in advance. And your family is saved the difficult job of making decisions during a time of grief.

Buy permanent life insurance
Life insurance proceeds can be paid to your estate to cover estate costs or left directly to a beneficiary to provide additional amounts to a particular person. The proceeds are always paid tax-free. Consider a permanent insurance policy for estate planning purposes. Permanent insurance covers you for life, no matter how long you might live. Term insurance does not.

Probate fees and life insurance
When you name a beneficiary for your insurance proceeds, the money is paid directly to your beneficiary. It does not form part of your estate and is not subject to probate fees.

You can also use insurance to cover estate costs. To do this, name your estate as the beneficiary. Your estate will pay probate fees on the insurance proceeds, but it gives your estate the cash to pay debts, taxes or other obligations. This can avoid the sale of estate assets – such as a home or cottage – that beneficiaries may want to keep in the family.

Life insurance can help cover estate costs: Taking out a life insurance policy can help cover the cost of capital gains taxes.

I know this a lot to cover in one sitting, but should really be broken down and discussed over a course of time… that allows for both parties to really have time to form questions and seek answers.

So what’s next?

Your mom and dad paid taxes all their life. Let the government take care of him/her? He/she should get rid of their assets so they’ll qualify. While some financial planners considered this to be good advice others consider it to be terrible advice.

What the financial advisor is tellingyou or your aging parent with this suggestion is that it is a good idea for your aging parent to give away his assets or otherwise impoverish himself so he can qualify for Medical Aide. Medical Aide is a state, county and federally funded health insurance program for the indigent. The benefits are quite limited

An impoverished elder may have only one option for care when care is needed for the basics, such as bathing, dressing, and walking. That option is a nursing home.

Some counties have programs, such as In Home Supportive Services, which will provide limited home care services through paid caregivers or sometimes through a relative. The care provided can enable a low income elder to remain at home rather than go into a nursing home.  However, with the severe budget cuts going on in most states and provinces, these kinds of programs are either being cut back severely, or eliminated entirely.

If mom/dad needs help only with bathing, dressing, eating or meal preparation, walking, getting out of the chair or bed, or using the bathroom, Medical Aide will not cover care in a nursing home.  Help with this so called “custodial care” is not a covered service under Medical Aide, or other health insurance. (Long term care insurance is the only exception).

Ask your parent what he or she wants for the long run.

“I want to stay at home as long as possible” may be in direct conflict with “I want to leave my assets to you kids and grandkids”.  Some people simply do not have sufficient assets to do both, should they live long enough to need care.

Figure out the cost of caregiving at home.

There are many services that enable an older person to remain at home with additional care and services such as meals-on-wheels, adult day services, and home modifications. You will want to understand all the options in your community and calculate the costs.

Compare the cost of home care services with your parent’s income and assets.  If there is no way their assets can match what they will need at home, and no other resources are available from you, or anyone else, by all means get legal advice about qualification for Medical aide.  However, if they can take care of themselves with what they own, put their needs first and “your inheritance” second.  Sorry, it’s their money.  They deserve to stay at home with services if they want to.

Be realistic about expectations concerning inheritance.

Any competent estate attorney will advise adult children that no one is “entitled” to an inheritance.  An aging parent can do whatever he or she wishes with assets.  When parents lose competence and need daily supervision or have physical decline and need paid caregiving, they can burn through their assets rapidly.  If your parents don’t have long term care insurance, they are likely to be paying out of pocket for the care they may need with advanced age. If that care lasts long enough, there may be nothing left when they pass.

As a person who makes a living giving advice and caring for seniors, I learn a lot from my clients.  One thing I have learned based on not only my own experience but also on research is that our parents are likely to want to stay in their own homes.  Most are happier if care can be brought to them, rather than expecting them to go to where the care is delivered in a facility. With that in mind, I hope you’ll carefully rethink any advice about relying on government benefits for your aging parent.  Considering how to provide the best quality of life for them as they age needs to be the priority.  Caring can take many forms.  Helping parents plan ahead is one way to show you care.

Look down the road. Learn from what your parents did or didn’t do to plan for this phase of life.  One day, it will be you and I.

Please contact us today, to discuss any challenges you may be facing and how our services can help you remain independent, protected, safe, and in you home / community.

You got questions, we have answers: (905) 785-2341 or email us at