Allaboutestates.ca Written on May 14, 2012 – 7:37 am | by Audrey Miller:

In preparing my blog for today, I wanted to celebrate mothers and especially the important role that they play in all of our lives. I have reposted Carol Bradley Bursack’s blog originally posted on www.Aging.com on May 01, 2012 who eloquently sums it up.

Nearly any of us who are mothers have wanted to be a perfect example of motherhood. Yet, the reality is, since we are human, most of us perceive some failures in our own mothering. We do the best that we can and often overcome tough issues of our own. Yet we are rarely the saints who are often portrayed in literature and advertisements, especially during this special time when we celebrate mothers.

We need to understand, love and forgive ourselves for our perceived imperfections as mothers. And yes, we need to try to understand, love and forgive our mothers for what may have been less than perfect mothering practices. Perfection is hard to define and resides in the eye of the beholder, so it’s a subjective idea, anyway.

Most readers will feel that their mothers have or had some flaws, but did a pretty good job. Some readers, unfortunately, were raised by abusive mothers – often women who were themselves abused and were too emotionally damaged to break the cycle.

Most of our mothers did their best.

I’d like to pay tribute to my own mother. She was a wonderful, loving person. Was she perfect? No. She was human, so she had her faults. But I look back on our relationship with love, appreciation and compassion. I do know that I was fortunate to have her as my mother.

How about your mother? Can you look back on your childhood and say “she did her best?” For readers who suffered emotional and/or physical abuse from mothers with compromised minds, hearts and spirits, that takes a lot of understanding, forgiveness, and perhaps professional help. However, reaching the point of forgiveness is important. For only by understanding and forgiving our mothers can we understand and forgive ourselves.

In order to view our parent with compassion we need to:

Remember that we carry our early learning throughout life even when we “think” we’ve gotten past events and teachings from our childhood. We are the sum total of our life experience, so nothing is completely forgotten.
Most of our mothers were a mixture of nearly all human emotions. They were human beings who were raised by human beings, meaning that they had some flaws.
Look at your grandparents or whoever raised your mother. Think of them as your mother’s parents. That should give you one clue to why your mother is how she is.
Ask your mother to tell you stories of her childhood. If she paints a rosy picture but her actions raising you tell a different story, try to understand that she may still, perhaps subconsciously, be running from her past.
If her stories tell of emotional, verbal and/or physical abuse, ask how she learned to cope with the after effects of this abuse.
Does your mother have mental issues? Many people in the AgingCare.com community write about mothers with very difficult personalities having nothing to do with age or dementia. Many of these issues are caused by mental disorders. I’m not suggesting that anyone take abuse from a person who has personality issues caused by a mental disorder, but understanding your mother’s illness may help your relationship survive.
Most readers are caregivers of their aging parents, at least to some extent. Understanding your mother’s past will help you better understand the role you are able to play in caring for your aging mother.
Forgiveness doesn’t necessarily mean forgetting. We learn from mistakes – ours and those of other people.
Realize that your mother’s issues were not caused by you – even if she says they were. You were a child. Perhaps an “easy” child. Perhaps a “difficult” child. But you were a child. You could not cause your parent to be a bad parent.

Celebrate the spirit of Mother’s Day by realizing that the sainted ideal of motherhood is a myth. The reality is that your own mother may have been a wounded soul who overcame her difficulties the best she could. If she was a good mother – or good enough – that’s wonderful. Celebrate her for all she did for you.

If she wasn’t a wonderful mother – or even a good mother – try to remember that she didn’t set out to harm her child or children. Gaining insight into your mother’s childhood may inspire you to move on with your own life. Understanding often makes forgiveness possible. We don’t forgive people just for their sakes – we forgive them for ourselves, as well. Otherwise, anger and resentment just make us bitter and disagreeable. Many people need professional help in making peace with their childhoods. However, once they do, they are then free to improve their own lives.

Even those of us who can look back on our mothers as examples of the idealized mother role will likely see, through the historical view, some flaws. Or maybe we won’t. Maybe we’ll still view our mothers as saints. That’s okay – even commendable – as long as we don’t harbor guilt about our own failings and compare our flawed, human selves to our sainted mothers. Celebrate Mother’s Day remembering the women who’ve helped us throughout our lives all the while coping with their own issues. Celebrate the human mother who gave you life and most likely did the best she could for you.

Thank you Mom

Written on May 4, 2012 – 7:08 am | allaboutestates.ca by Audrey Miller

I had the pleasure of attending a conference on “Conquering Pain” presented by Dr. Mary O’Brien and I thought I would share a few things. However, I would like to preface my comments with the following: I am a patient -not a doctor; I work with seniors everyday and while some are over medicated, most are dealing with pain symptomatology on a daily basis. Speak with your own doctor and help them to obtain a good history. Keep a record of your symptoms as you know your own body best of all. Speak up- if new symptoms or different symptoms/side effects begin, get medical attention.

We have all experienced pain in some degree yet we all have difficulty imagining or feeling someone else’s pain. It remains a subjective experience and one that is difficult to share. There are many different types of pain including nociceptive (somatic and visceral) and neuropathic pain and many different causes. Regardless, it seems to me that the experience of having pain is universal yet being properly treated for pain so that symptoms can be controlled- continues to be an elusive hunt.

The Canadian Pain Coalition reported that at least 1 in 5 adults lives with chronic pain. (Canadian Pain Coalition, Report on pain. Oshawa, ON: Canadian Pain Coalition; 2011). In their January 10, 2011 Report on Pain it was documented that “Twenty-one per cent of Canadians who experience chronic pain stated they had to wait more than two years for a diagnosis for their condition, while only 54 per cent of those who have a diagnosis have a treatment plan. Not surprisingly therefore almost half (45 per cent) believe there are no treatment options that can help them with their condition.”
I was reminded that medically, we are a society that tends to under treat pain. I know that even in the last days of life, we were unable to get a palliative care consult and access to morphine without the pre-requisite diagnosis. See Old Age is Not a Diagnosis blog. It truly cannot be that the physicians were worried about addiction issues in my 96 year old mother in law- or could it be?

I was reminded that we should not chase pain but that we should anticipate it such as taking the acetaminophen before gardening, or the activity that you want to do but you know will hurt afterwards (such as helping your children move back home or leave home for that matter). Understanding the difference between hurt and harm is part of it. Have your physician address and treat the other factors that can aggravate or increase the perception of pain, such as insomnia, anxiety, depression or a co-morbid illnesses. This can be a challenge when doctors don’t have enough time with each patient (reported at 7 minutes per patient- although I cannot confirm this data). I was reminded that pain can be in your head and a positive attitude can lead to a faster recovery and that negative expectations can even limit the effectiveness of pain medications. Reminder of the day: ‘the less you do, the less you will be able to do’

Written on April 26, 2012 – 7:15 am | Allaboutestates by Audrey Miller

Further to last week’s blog: Who Needs Home Care and What Is It? Written on April 18, 2012 , a few key points made by The Health Council of Canada (2012) article: Seniors in need, caregivers in distress: What are the home care priorities for seniors in Canada? is as follows.

One third of the group sampled across five regions (Nova Scotia, Ontario, Manitoba, BC and Yukon) have complex health needs (both a physical and cognitive impairment) and are not receiving adequate assistance from the Home Care program. The majority of care is left to family members and they are reporting being distressed with feelings of stress, anger, and depression.
Burned out caregivers is not a new theme; the majority of carers wait 5 years before they seek assistance. Caring for the carer continues to be an important issue.
The report “calls for a system that regularly assesses the situations of seniors and their family caregivers and provides support, whether it is additional hours of home care or faster placement {of} a loved one into a long-term facility.” What this means and how this will be addressed is still to be determined.

In addition to more funding, better communication and integration with community partners is needed. The report advocates for the family physician to be included as part of the home care team. While a great concept in theory, we do have a shortage of family docs and the challenge to find a physician continues- especially one with an interest in working with seniors. The various Home Care programs are continuing to try new approaches in supporting individuals in their own homes. In addition to most seniors wanted to remain in their own homes for as long as possible, the cost savings to the Province to keeping seniors out of the hospital is huge.
Perhaps with this additional research and information, we will be able to proactively plan and prepare for tomorrow. After all, while we may feel healthy and well today, we may be the folks needing care tomorrow.
-Audrey Miller

April 18, 2012: Allaboutestates blog:
We may all need it, at some time or another. The Health Council of Canada (2012) has recently published: Seniors in need, caregivers in distress: What are the home care priorities for seniors in Canada?
It is an excellent paper that explores the growing issue of home care in Canada. The report takes a deeper look at the seniors who are receiving home care, the family caregivers that are lending support, as well as the challenges of home care in Canada. The government has heard this before so let’s hope that these findings do not fall on deaf ears.

The Health Council of Canada reports the following:
“Home care has many faces. It is used to provide care after hospitalization or when someone is dying, to help vulnerable seniors stay in their homes independently, and to manage chronic conditions, disabilities, and mental illness. Home care programs are also linked with community support services such as food delivery, house cleaning, and transportation, which are often provided to the client at additional cost.
The Canadian Home Care Association defines home care as “an array of services for people of all ages, provided in the home and community setting, that encompasses health promotion and teaching, curative intervention, end-of-life care, rehabilitation, support and maintenance, social adaptation and integration, and support for the informal (family) caregiver.” Home care, defined as an “extended health service,” is not an insured health service under the Canada Health Act. Each province and territory administers its own publicly funded home care programs and services, but these vary in terms of levels of coverage, eligibility criteria, and funding schemes.”
The report kindly includes a list of terms and definitions; given the importance of understanding the subject matter, it is reprinted below. My next blog will review some of the report’s key findings. Terms used in the report and generally agreed upon, include:
Home care – publicly funded and administered services received in the home.
Senior – a person age 65 and older.
Client or care recipient – the person who is receiving home care services.
Caregiver – family members, friends, or others who are providing unpaid care.
Provider – any paid professional or worker who provides home care services.
Personal support worker (PSW) – an unregulated worker who provides support for personal care, such as bathing, toileting, and homemaking functions. Personal support workers are employed in home care, long-term care, and hospital settings. This role is known by different names, such as home support worker or health care aide.
Long-term care – care received in an institution such as a nursing home.
Continuing care – a general term used to encompass home care, assisted living, and long-term care facilities where the sectors are not clearly separated, but seen as part of a continuum.
Assisted living – a type of residential living that provides supportive services, such as housekeeping, communal dining, and in some cases personal care assistance to seniors who require some help with daily living.
Community supports (or community support services) – services provided in or through the community, such as transportation, shopping, house cleaning, and yard maintenance.
Vulnerable senior – someone who has some challenges with independent living due to health limitations and who may be at risk for further disability or complications. The word “frail” senior is often used to describe this population, but frailty is considered a pre-disability state. As many seniors receiving home care services already have disabilities, in our report we will refer to this group as “vulnerable.”
Alternate Level of Care (ALC) patients – people who no longer need acute care, but who still require a lower level of care as they cannot manage independently. These patients must remain in hospital while waiting for space to become available in another facility (such as a rehabilitation hospital or long-term care facility), or for home care supports to be put in place.
IADL – instrumental activities of daily living, such as cleaning, cooking, grocery shopping, and home maintenance.
ADL – activities of daily living, such as bathing, eating, and toileting.
Note: Abellan Van Kan, G., Rolland, Y., Bergman, H., Morley, J.E., Kritchevsky, S.B. & Vellas, B. (2008). The I.A.N.A. task force on frailty assessment of older people in clinical practice. The Journal of Nutrition, Health and Aging, 12(1), 29-37.
Until next time.- Audrey Miller

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Spring 2012

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Word from the Managing Director

Spring is here and the Easter/Passover holidays are now concluding. I had the pleasure of having my mother join us for our celebration. We cooked together, laughed together, sang together and even cried together. However, there was still an empty place at our table. Was there someone missing around your table this year? Not only does death take people away, but sometimes family conflicts can result in a loss as well. As we reflect on previous times, perhaps through rose coloured glasses, I think that we should also look ahead to see if there is some way to extend forgiveness or acceptance to those who chose to be missing from the family table this year.

Physiotherapy Awareness Month

Falls are the number one reason for senior’s admissions into the hospital. The majority of falls occur within the home and more specifically, within the bathroom. However, like my mother, who was walking down the street, caught her shoe on uneven pavement and down she went, falls can happen anywhere. Fortunately it was her nose that she broke and not her hip…..

Remaining mobile is paramount. In acknowledgment of Physiotherapy Awareness Month I have attached an article by Gwen Rose, Physiotherapist, in which she outlines her top 5 picks to help maintain functional independence.
“A Physiotherapist’s Top Five Product Picks”

April 16th 2012 is Advance Care Planning Day

Do you know what Advance Care Planning means? How about end of life decisions? Do you know about the importance of communicating to loved ones, friends and physicians about ones’ own future health care wishes and end of life care? We all have choices and it is imperative that we vocalize them before we are no longer able. April 16, 2012 is the Annual National Advance Care Planning Day. READ MORE.

For more information on this topic join the “Speak up Campaign” and support the Annual National Advance Care Planning Day.

MoneySense Magazine, April/May 2012
The toughest choice: Dealing with an aging parent isn’t just emotionally difficult: it also involves a confusing array of services,from in-home care to nursing homes.
By David Aston | From MoneySense Magazine, April/May 2012

Back in 2008, Lise Hafner and her two brothers sensed something was not quite right with their mom. Then the doctor made the dreaded diagnosis: Priscilla Hafner, their energetic and independent 78-year-old mother who lived alone in Toronto, was in the early stages of Alzheimer’s disease. Lise and her brothers realized their mother was facing a hard road. How could they ensure their mother was safe? How could they honour their other’s wish to remain in her home “until she was carried out feet first?” And how much would it all cost? Chances are you or a loved one will one day be in a situation much like the Hafners, where you’re making arrangements for an aging parent who needs help with daily activities. And like Priscilla, most people probably prefer to get that care in their own home, at least while it remains a viable choice. Unfortunately, just understanding the patchwork system of private and public senior care is no small feat. To help, we’ll describe what you can expect from in-home care. Then we’ll advise what help governments typically provide, and what you’ll need to pay for yourself. We’ll help you understand when in-home care makes the most sense, and describe when a retirement residence or a nursing home are better alternatives. You may be surprised to learn these options are more attractive than you think. Get by with a little help. When a parent or other relative starts to get frail, daily tasks often start to slip. Perhaps housework and yard work start to build up, and it is hard to keep fresh food in the fridge. The parent may no longer drive, and may have trouble managing basic activities like bathing, changing, preparing meals, or keeping track of their medications. The children often get more involved at this stage, but they are probably busy with their own families and jobs, and may not even live close by. It’s easy to feel overwhelmed.

“Get help before you’re totally exhausted,” suggests Peter Silin, a care manager and principal with Diamond Geriatrics, Inc. of Vancouver. (Care managers are typically hired by families to oversee care for a loved one.) There’s a whole industry of in-home caregivers devoted to helping frail seniors with daily activities. While you may feel guilty about off-loading these tasks, you’ll find that it frees you up to spend more meaningful time with your parent. When you think of in-home care, you might picture it being done by a nurse. But most paid care in the home is provided by legions of hardworking paraprofessionals with job titles like “personal support worker” or “personal care worker.” They don’t have medical training, but they know all about helping with mundane activities like bathing, changing clothes, toileting, grooming, getting groceries, preparing meals, helping frail seniors eat, doing housework, driving to appointments, and helping your loved one get around the house. You can hire these personal care workers yourself, go through an agency, or sometimes get these services assigned and supported by governments. Providers range from non-profits like the Victorian Order of Nurses, to small local businesses, to large national companies. If your loved one is mobile and needs just a bit of help, a personal care worker might come twice a week for two hours each to help with bathing and grooming. If your parent needs more help, the worker might come once a day to help with changing, toileting and preparing a hot meal as well. Other home care needs may arise on a shorter-term basis, such as after an operation. (And here nurses are more likely to directly provide care.) Or if an elderly person is near the end of life, the hospital may send him or her home to be with family but have a nurse stop by periodically to provide pain medication. That’s what’s known as “palliative” care.

When Diane Speirs’s aunt came home from the hospital in Vancouver after falling and breaking her arm, a personal care worker visited for up to 1½ hours every day to help her change clothes and sanitary garments, clean the bathroom and kitchen, help her bathe and do laundry. But Diane and her husband Brian also visited four or five times a week to bring groceries, help with housework and yard work, pay bills and take her to doctor’s appointments. “We did whatever else needed to be done,” says Diane. Who picks up the bill? At this point you’re probably wondering who pays for all this care. The good news is provincial governments will help out—but only so much. Short-term post-operative or palliative care are frequently covered, but beyond that, governments keep a tight hand on their wallets. Typically provincial governments provide in-home care through a regional health agency. (They’re called local “health authorities” in B.C. and “community care access centres” in Ontario.) If you’re looking for government help, you can get a referral from the family doctor or contact your local health agency directly. On request, they’ll generally send a case manager to assess your loved one’s needs. They allocate their support based on need, and in some provinces, also on your ability to afford care
yourself. The maximum you can generally expect government to pay for is two hours a day, says John Schram, president of the Canadian Home Care Association. Unfortunately, “that quite often isn’t enough. There’s a huge gap between what people need and what they typically get,” says Schram, who is also CEO of We Care Home Health Services LP. Nothing is automatic, even for basic forms of government-paid help: you need to make your case persuasively. For example, in Ontario, “the government realizes that if the risk of falls can be minimized, there’s a better chance of keeping that senior safe and in the home,” says Audrey Miller, care manager and managing director of Elder Caring Inc. in Toronto. “What I’ve learned in my time is the way to get some help with bathing is to say something like ‘My mother had a fall. I’m concerned she’s at risk while bathing because she lives alone.’” For what government or family members aren’t able to provide, you’ll need to pay for yourself—and the costs quickly escalate. Personal care workers hired through an agency typically cost $20 to $28 per hour, often with a minimum of two hours or more per visit. A full-time, live-in personal care worker can cost $1,800 to $3,000 a month, plus room and board. (Add another $1,500 to $2,000 a month if room and board is not provided.) If you need round-the-clock care, that may require two or three full-time caregivers. (Even live-in caregivers can only be asked to work one shift a day, and they require time off.) While most middle-class seniors can afford to pay for a little bit of help, you can quickly get to the point where only the very rich can afford it. “If money is not an issue, you can always make in-home care work, but it might mean making your home into a hospital,” says Miller. Better than you think. Eventually you’re likely to go beyond the point when in-home care makes sense. Just where that point lies is different for everyone. It depends on your loved ones specific needs, personal preferences, finances, and the practical difficulties of providing extensive care in a family home. Fortunately, the other options are probably better than you think—and
they are often within financial reach for middle-class Canadians. A retirement home may be a good choice for seniors who want their own apartments but also want common meals, housekeeping and social activities in a home-like setting. They often have “independent living” sections for mobile residents who require little or
no personal care, as well as “assisted living” for those who need moderate help with bathing, changing, or taking medicine. While retirement homes are not cheap, middle-class Canadians can usually afford them with the proceeds from selling their home. If your loved one needs a lot of care—say he or she has advanced dementia or requires help with the most basic activities like transferring from a bed to a chair or toilet—it may be time for a publicly supported and regulated nursing home. We know what you’re thinking. The idea evokes images of dreary Victorian-era wards, but nursing homes these days are much homier and less institutional than you may think. (Confusingly, nursing homes go by many other names these days, such as “long-term care” in Ontario and “residential care” in B.C. ) Even if you can afford the most elaborate and expensive in-home care possible, your parent may prefer the social interaction of a retirement residence or nursing home to isolation. “You can buy all the services you need at home, but you can’t buy a community, a peer group, which you can get in assisted living, independent living or a nursing home,” says care manager Silin, who is also author of Nursing Homes and Assisted Living. The Hafners’ journey. The right care option for your parent or loved one is ultimately a personal decision. Consider the journey the Hafners went through after Priscilla was diagnosed with Alzheimer’s. Lise and her brothers, Eric and Gordon, realized they needed help to keep her as safe and happy as possible. The three siblings lived many miles away with families of their own in separate U.S. cities. As a result, they were limited in how much time they could spend directly caring for their mom in Toronto. Priscilla was an energetic, no-nonsense woman who had lived on her own since her husband died in 1994. But the combination of an independent spirit and the symptoms of the disease made their mother difficult to help. She turned down pleas from her children to move closer to one of them. That’s not surprising: seniors with Alzheimer’s tend to cherish familiar surroundings and get along best with people they know. Lise and her brothers started off hiring a driver to take their mother to her daily appointments and other outings. That was
enough for a while, but as the disease progressed they found Priscilla needed more. The next step was finding a live-in caregiver and making a few changes to the townhouse, like removing the knobs from the gas stove. Eventually they needed three live-in caregivers providing round-the-clock support. The siblings realized they were unable to coordinate all of this from afar. “Don’t underestimate the logistics,” Lise advises. “It’s expensive. It’s exhausting. It’s emotionally draining.” The Hafners hired Audrey Miller of Elder Caring Inc. as care manager to handle the staff, monitor their mom’s condition, and take her to doctor’s appointments.
Gradually the elaborate system of in-home care became unworkable. As Priscilla’s Alzheimer’s got worse and other medical issues developed, they realized her home was no longer safe. And although they felt conflicted, they realized the need for safety trumped their desire to fulfill their mother’s wishes to stay in her home. “The time came when we just could not keep her in her home any longer,” Lise says. So recently the three kids moved Priscilla to a facility that provides long-term specialized care for seniors with dementia. Now they’re working to make life as rich as possible in this new setting. “Is it ideal?” Lise asks. “No. But I think we all have a sense of relief, because we know we’re over the first major hurdle, because she is safe.”

MoneySense Magazine, April/May 2012
Caring for aging parents | MoneySense http://www.moneysense.ca/2012/04/09/the-toughest-choice-2/
3 of 3 4/10/2012 12:43 PM

By: Audrey R. Miller MSW, RSW,CCRC, CCLCP
Printed online @ CARP, April 10, 2012

I know about the importance of communicating to loved ones, friends and physicians about ones’ own future health care wishes and end of life care. The question is, what do you know about it? We all have choices and it is imperative that we vocalize them before we are no longer able to. April 16, 2012 is the Annual National Advance Care Planning Day
This is a day to begin a conversation with a loved one about their wishes for end of life care – or it might remind you to review your own plan. For those of you who have heard any of my presentations, a key message is about having the family meeting- having the talk. As difficult as it may be, it is critical that your own wishes are known- so they can be followed.

What is Advance Care Planning?

Advance care planning is a process of reflection and communication, a time for you to reflect on your values and wishes, and to let others know your future health and personal care preferences in the event that you become incapable of consenting to or
refusing treatment or other care. Advance care planning means having discussions with family and friends, especially your Substitute Decision Maker – the person who will speak for you when you cannot. It could also include writing down your wishes, and may even involve talking with healthcare providers and financial and legal professional.

The Speak Up campaign was developed to raise awareness of the importance of advance care planning, as well as the issues related to an aging population, a strained health care system and end of life care. The Speak Up campaign reminds Canadians to think about and talk about their end of life wishes. It can also: Help improve the quality of end of life care – Research indicates that Canadians with advance care plans require fewer interventions at the end of life, place less of a strain on caregivers and are more likely to take advantage of hospice resources or die at home. They and their caregivers report greater satisfaction with end of life care.

Improve communication and access to information about end of life care across the country – The Speak Up campaign begins a national conversation about planning for end of life care by providing access to shared tools and terminology for Canadians, making it easier for them to share their preferences with family, financial and legal professionals, friends and health professionals, no matter where they live.
Why plan for end-of-life care?
While most of us hope that we will die peacefully and able to communicate with loved ones until the very end, the simple fact is that most deaths do not occur this way. According to a 2004 poll conducted by Ipso-Reid on behalf of the Canadian Hospice Palliative Care Association and GlaxoSmithKline, eight in ten of Canadians agreed that people should start planning for end of life when they are healthy. But:
• 70% of Canadians had not prepared a living will or advance care plan
• 47% of Canadians had not designated a Substitute Decision Maker to make healthcare decisions for them if they are unable
• Fewer than 44% Canadians had discussed end-of-life care with a family member.
(Advance Care Planning Worksheet)

I enjoyed Mark Handelman’s blog “What Wishes Should a Power of Attorney for Personal Care Express posted on April 5, 2012 on the Whaley Estate website and have linked it here for your reading pleasure. It provides some very beneficial information. April 16th- count yourself in.
-Audrey Miller

March 30, 2012, Allaboutestates.ca
Sometimes it is hard to leave work behind. While on vacation recently, my sister had purchased tickets to see a new play, In Basildon by David Eldridge. Not knowing what it was about, except that it had been well received by theatre goers, I soon realized that the issues faced by families (as portrayed by the characters in the play) and clearly by the discussion during intermission of those watching) are the same regardless of geographic location and social economic status.
The play opens with Len on his deathbed and the family has gathered to say their final farewells. Len’s sisters still aren’t speaking after nearly twenty years, and his nephew, who is living in Len’s house with his mother and new wife, believes that the house was left to him. As the funeral spread is laid out and the ham sandwiches sit next to the wreaths, the family drama unfolds. The play addresses issues regarding family conflict, changing of the will, executor decisions, end of life choice and inheritance disappointment. Most poignant was the reflection (which can be done on stage) of how things came to be. Understanding Len’s decision of why he changed his will – and the hurt that never gets discussed.
The theme for the evening portrayed in this excellent family drama was that many times families don’t remember why they are in conflict. Years have gone by and the initial cause of the discontent gets forgotten. This play reminded me of the importance of talking together and how wonderfully complicated families can be.
-Audrey Miller

March 14, 2012, Allaboutestates.ca

I am frequently asked about payment of family members who have assumed a primary caregiving role. While there is no one answer, there are a few key considerations

1) What does the parent need?
2) What are the tasks that the family member would be doing? Note that what is needed when they start might change drastically in six months or a year. Have some built in re-evaluations written in.
3) What is the time needed to accomplish these tasks?
4) Does the family member have the skills to be doing the tasks required?
5) Once the tasks are listed (be specific) and time needed (be somewhat flexible) – this would need to be written out and agreed upon by all the siblings.
6) Be sure to write in respite or time off for the family caregiver and include an “escape” clause. The escape clause allows the family caregiver to gracefully bow out of the tasks as they become more challenging or beyond their skills.
7) What do you do when the family caregiver gets sick – what is Plan B?
Do you have a Geriatric Care Manager to check on the plan of care to ensure quality of life for the elder and reduce stress for the caregiver?
9) Set a salary (based on the local hourly rate paid to the caregiver rather than the market rate charged by the agency).
10) Consult with a lawyer
11) Family caregivers need to be aware of tax implications. They will need to pay taxes. The best way would be to consult a bookkeeper to calculate the taxes, assist with the withholding and quarterly tax reporting. This also should be spelled out in the agreement. They might also agree to pay or not pay for vacation time, and health insurance, Be clear, especially if someone is giving up a job to care for the parent.
12) In the best-case scenario, another sibling or professional fiduciary would generate the checks. If the family member doing the care writes the checks they should be accountable to another – this could be a trustee, book keeper, accountant or financial institution.
13) Be sure to have homeowners insurance to cover the family caregiver’s time in employment – in case there is a work related injury.
(source: NAPGCM President, Linda Fodrini-Johnson).

Something to think about. -Audrey Miller

March 22, 2011, Allaboutestates:
When touring retirement residences with my client who was in her late 90’s at the time, she turned and looked at me and said- boy, there are lots of old people here. I don’t think this is for me.
I can tell you that it is a typical response; and quite a good one I would say. You may be familiar with the maxim “you are as old as you feel”- well this sure holds true for those who do not see themselves as ‘old’. Perhaps they seem themselves as ‘older’ but clearly age is only a birthdate.
Many retirement residences cater to well seniors and are targeted to the young senior. A perfect alternative for those who wish to downsize, remain their independence and give up the chores of home ownership- such as snow shoveling, maintenance and repairs. As well, the option to give up other household responsibilities such as cleaning, laundry and cooking are also positive incentives.
Most retirement residences include rent, meals (one, two or three a day), laundry and housekeeping, 24 hour on call supervision, supervised activities as well as access to all on site amenities. These amenities may include an exercise room, billiard room, large screen television/media room, chapel, library and some may have a private dining area where family functions can be held). Some may have beauty salons on site. Most also have a visiting physician on a weekly basis.
Health related services such as medication monitoring and any additional care assistance provided by the facilities staff (personal support workers, registered nurse) are add on services available at a monthly fee. Some residents are able to still access publicly funded services from their local Community Care Access Centre (CCAC) and other choose to bring in their own private companions in addition to the care component available at the residence.
Some retirement settings are designed for residents to ‘age in place’ which provides for an increased availability of care including palliative services. Others are unable to meet the medical needs of a new or changed condition and decline in functional status. Unfortunately, this then results in clients have to make yet another move. When reviewing our retirement choice questionnaire and providing counsel to my clients regarding choice of retirement settings, I review the 3 C’s: Care, Cost, Choice.
Care: understand the current and anticipated course of the person’s disease/health status. What health services and medical care is available or is able to be easily accessed at the various retirement settings.
Cost: how much will it cost? What do I need to live out my days with the level of support that I need or desire and in the lifestyle I have chosen?
Choice: What geographic area is preferred? Identify some boundaries. Would you like to live close to your community- whether this is church, family, friends or shopping?
I also recommend that trial stays, short term, respite or convalescent stays are an excellent way to try out the new considered setting. Enjoy a tour and lunch or participate in one of their community welcome events. Retirement settings are an excellent alternative for many.
-Audrey Miller