A last wish: to die at home

Have you heard this from an aging parent? "It's a last wish: to die at home".

I've heard that from hundreds of families.

And it's not an unrealistic wish.

There is a certain comfort and dignity to being able to die in one's own bed, in one's own home. Clearly this is not an option for a parent whose been institutionalized in a hospital or nursing home. Howevever, it seems that dying at home with the appropriate care for someone who is sliding toward the end can be accommodated. 

Hospic-like arrangements can be provided in the home, and ideally as much of the broader family would be engaged in the process.

This also can allow time to share memories, and if possible photos.

It's worth exporing if the circumstances are right.

Our annual eldercare advice for the holidays

This seems to be a big favourite year over year:

Suggestions of how to bet support aging parents and loved ones through family events.

Please take a look, and share with your friends, too.

Here it is:  http://www.parentingyourparents.ca/plan-good-holida…derly-loved-ones/ ‎

Aging and engaging: what can that mean for the elderly?

Aging and engaging: what can the mean for the elderly?

This interesting article can offer good insight.

Take a read. You'll find in helpful!


Plan now to plan ahead for the right substitute decision maker

Choose the right substitute decision makers (SDM) now.

With all the recent focus on what is now called advance care planning (ACP) in the medical and social work literature, it is important for people especially middle-aged and older people to understand what is at stake.

Using the old terminology of a "living well" there has been a transformation from what used to be a few words in a document somewhere or as a conversation with the family member likely to be the SDM that for example the parent "would not want any heroics" if they develop a terminal illness. The reality is that is no longer enough to help those empowered to make such decisions on your behalf. The new world of medicine has many things that can be done that are no longer considered "heroics" but just part of contemporary every day medicine.

Continue reading “Plan now to plan ahead for the right substitute decision maker”

A parent facing the loss of the driver’s license

One of the biggest challenges your parent may face is the impending or actual loss of the ability to drive, or the loss of the driver's license.

Some elders have enough insight to realize that driving is becoming too stressful or perhaps dangerous and gradually decrease the nature of their driving.

I have seen many who on their own cease to drive on major highways or do not drive after dark or when the weather is inclement. Some decide on their own to give up their car because owning it has become a hassle, what with the costs, the repairs, the parking issues depending on where they live.

I recall the challenge to my late father and the early indication of his cognitive decline when he began getting parking tickets for failing to move the car to the correct side the street when the city introduced alternate side of street parking for street cleaning. As often happened, he correctly moved the car, but failed to recall he did so and then moved it back to the "wrong" side of the street with the subsequent hefty parking fine.

The most challenging scenario that you may be called up to assist your parent is after a visit to a physician, such as a geriatrician for an assessment of cognitive decline where the issue of driving comes up, which is not expected by the patient and by the end of the visit, your parent discovers that his or her driver's license is either in jeopardy pending a more in-depth driving assessment. Or, of a report that is going to be sent to the licensing authority reporting significant cognitive impairment or dementia which in most jurisdictions results in the cancellation of the driving license. This often leads to outrage, fury or disbelief on your parent's part as they try to dissuade the doctor, or put the blame on you for taking them to the appointment.

It is not easy to deal with this, but with time and repeated explanations by the doctor as to the necessity of following the law the anger may wear off. Moreover, if you do a good accounting of the cost of keeping the car, the cost of insurance, repairs and parking, it often turns out that the money saved will more than pay for any taxi trips required by the person to do what they were doing with their car. Many local taxi companies happily create accounts with elders that avoids having to pay for each ride and many provide assistance with walking devices for example. It is a challenge, one that occurs often, but will usually wane in time–it cannot be avoided but can also be dealt with in a supportive and compassionate manner.

All our best wishes…

At this holiday period, we extend all our best wishes to you and your family.

Thank you for engaging with us.

Most importantly, thank you for caring about your elderly parents and other aging loved ones.

It is a journey that is not easy. We always say it's a journey of discovery. We all can and will learn so much. We will grow. We will eventually hurt and grieve. And we will recover and move on with loving memories.

Caring for aging parents is not something most of us plan for.

But it comes, happens, consumes us.

So again, all our best wishes as we all move forward with our lives and worlds.

          Bart & Michael


How to communicate with someone who has dementia

How to com­mu­ni­cate with some­one who has de­men­tia is a terrific recent Globe & Mail article by Renée Henriques.

Her recommendations are very sound and mirror the ones in our Parenting Your Parents books. Please read, absorb, and apply.

I own a senior home-care company in Toronto, and most of our clients have some form of dementia. Last week, one of our clients, who I will call Mrs. Smith, called to cancel her caregiver for the following day:

“I feel like I am doing better, Renée, and I just want to see if I can get through the afternoon without a caregiver.”

“Sure, Mrs. Smith,” I said, and cancelled her caregiver.

The next day Mrs. Smith called and angrily demanded why her caregiver had not shown up. I apologized for my oversight. I told her that we would ensure that her caregiver was there within half an hour. Trying to explain what really happened would have been like trying to convince her that her name was not Mrs. Smith. Rule No. 1 of dealing with people with dementia: Never argue.

According to the most recent count from the Alzheimer Society of Canada, 747,000 Canadians suffer from Alzheimer’s disease and other dementias. That’s 14.9 per cent of Canadians 65 and older. For those living with dementia, life can be very frightening. Every interaction feels like a big question mark. For those of us who work with people with dementia, and those people who have loved ones or friends suffering from dementia, a few changes in the way we communicate can bring great comfort, and diffuse potentially anxious situations. Here are some key tips that have helped me over the years:

1) Never argue. Ever. Drop your need to be right. If Dad says he wants to call Aunt Eileen, who died 50 years ago, just pick up the phone and dial. Be creative; leave a message somewhere. Trying to convince Dad that his aunt passed away a long time ago will be confusing and distressing. In our industry, we call these little white lies “therapeutic fiblets.” They preserve our clients’ dignity and peace of mind, two things more important than having a firm grasp on reality for many dementia sufferers.

2) Redirect. After your therapeutic fiblet, try to get Dad thinking about something else. Get Dad to tell some stories about Aunt Eileen, and then use something in that conversation to direct the conversation elsewhere: “Aunt Eileen used to walk every day? Did you want to take your walk now?” Talking about anything not having to do with Aunt Eileen may take Dad’s mind into a different place and he may lose the need to call his longdead relative. And if he does not forget, then just check messages to see if Aunt Eileen has called back and repeat.

3) Be aware of your mood and your body language. People with dementia read your body language to pick up cues. If you are distressed or frustrated about anything, your mom will read that discomfort and surmise that something is wrong. She won’t know what it is and may assume that she has done something wrong. When you are calm, she will be calm. When you are anxious, she will take that on, too. Check yourself at the door as much as possible.

4) Strike the phrase “remember when” from your vocabulary. “Remember when we talked about this yesterday Mom, and you said you wanted to go to dinner?” Mom does not remember, and this question could make her confused and embarrassed.

5) Offer options and ask yes or no questions. Phrase questions simply, and ask questions that require a yes or no answer, not a narrative response. Always offer choices when possible, and present no more than two options. People with dementia are likely to pick the last choice, so craft your questions accordingly. The need to choose and feel autonomous and in control stays with us, even if our memory is fading. Offering Dad choices will give him a sense of control, a hot commodity in a dementia sufferer’s life.

To paraphrase Bob DeMarco of the Alzheimer’s Reading Room (a respected website about dementia-care issues): “If someone with dementia thinks something is true, it’s true.” Mrs. Smith was right to think I had forgotten to send her caregiver, because she did not remember that she had cancelled. It was my job to accommodate her reality, admit my “mistake,” and fix it. Honouring the reality of the dementia sufferer in your life will create empathy, smooth difficult interactions and create opportunities for moments of surprise and joy. Who knows? One of these days, Aunt Eileen might pick up the phone when you call.

Renée Henriques is a registered nurse and the owner and managing director of ComForcare Home Care Toronto, providing personal support services to seniors. Her passion for seniors and their families stems from her past work as a neurosurgical nurse, and her experience going through a lengthy caregiving journey with her own family members.

© Copyright The Globe and Mail Inc. All Rights Reserved

Mediation can help resolve sibling issues in eldercare.

Mediation can help resolve sibling issues in eldercare.

Sibling misunderstndings, competing agenda, conflicts, mistrust: all can too easly lead to troubles when trying to care for an aging parent. Here is a very good piece from the New York Times worth reading to know more about this issue and how mediation can help.


Canada slips in global ranking of best places to grow old

[The following was sent to us and we believe is from CTV online website]

Canada slips in global ranking of best places to grow old

Canada has dropped to fifth in an annual ranking of the best places in the world to grow old.

Though we slipped behind Germany in this year’s Global AgeWatch Index, Canada still fared better than the U.S and the United Kingdom, which were ranked ninth and tenth respectively. Canada finished ahead of these two countries thanks in part to our generous health care system, and income programs that result in lower poverty rates among seniors.

Yet Switzerland continues to be the very best place to grow old, followed by Norway and Sweden, which do the best job at ensuring the financial security of seniors. All three countries started social pensions over a century ago, allowing these countries to build up their welfare economies.

Toby Porter, the chief executive of HelpAge International, the charity that compiles the AgeWatch index, says the ranking is based on the four aspects of life that seniors say matter to them most.

“If you ask (seniors) what their concerns are, they’ll often talk about four broad areas: How’s my health?; How’s my income and my financial security?; How am I feeling about my local environment — am I near my family and friends and do I feel safe?; and also, am I valued and allowed to keep contributing — am I able to work or volunteer or assist my community?” he told CTV’s Canada AM from New York on Wednesday.

When governments invest in those four areas, Porter says seniors can grow old “in decent and dignified environments.”

It’s critical that countries look at how they treat their oldest citizens because the globe is aging as a whole.

Twelve per cent of the world’s population is now over 60 and that is projected to rise to 16.5 per cent by 2030, and 21.5 per cent by 2050. That will mean 2.1 billion people will be seniors – more than double the current count of 901 million.

Because seniors are the world’s fastest growing population group, they are profoundly affecting our economies, our living arrangements and our cities and towns.

On the one hand, it’s heartening to know that people are living longer as a whole thanks for improved health and lower birth rates, Porter says. But he says countries need to think about how they are going to keep these seniors active and making the best of their golden years, as well as staying safe and well-cared for.

“We now have to come together and think about intelligent, long-term responses to aging population,” he said.

Those responses need to go beyond just determining how to pay for aging seniors, the report authors said. They also need to address how to encourage more older people in volunteering, working and engaged.

“Every person should be able to live the best life that they can at every stage, with dignity and freedom of choice,” the authors write.

The report points to Japan as a country that is doing things right when it comes to seniors.

A third of the population there is already over 60 and many are living full lives. In the 1960s, Japan adopted a comprehensive welfare policy, introduced universal health care, a universal social pension, and a plan for income redistribution.

“This investment has paid off with a healthier labour force and increased longevity. As a result, Japan is not just the oldest, but also one of the healthiest and wealthiest countries in the world,” the authors write.

But the authors note that around the world, women are at greater risk of poverty than men in old age. Less than half of women aged 55 to 64 around the world work, compared with nearly three-quarters of men, according to the report. In addition, women typically earn less than men, increasing their risk for poverty in old age.

Afghanistan is ranked last on the list, while countries in Africa occupy seven of the remaining nine lowest places on the bottom 10.

The rankings include about 91 per cent of the world’s population aged 60 and over — and yet 98 countries could not be included in the rankings, due to a lack of data.

That means that millions of seniors are essentially “invisible” to the rest of the world, living their lives in countries where information on their aging experience is missing, Chris Roles, the director of Age International said in a statement.

“We need better national, regional and global data, broken down by age and gender, if we are to fully understand what is happening to people in later life in all parts of the world,” he said.

“Without this, older people, and especially older women, will continue to be marginalized in many parts of the world.”

Global Age Watch Index ranking Top 10:

United States
United Kingdom