In this issue we’ve discussed home care, preventable injuries/accidents and the toll they can take on older Canadians as well explored some of ways in which ageing at home can be facilitated.
The Globe and Mail recently published a very fine piece of investigative journalism on the state of Ontario’s home care system. Over the past decade healthcare reforms across the country have sought to enhance their ability to deliver targeted and tailored healthcare to various communities by creating regional administrative bodies tasked with budgeting and with the integration of certain care services.
In Ontario these regional health bodies are the Local Health Integration Units (LHINs). They have authority over Community Care Access Centres (CCACs), hospitals, long-term care, community services, mental health agencies and some parts of primary care. On paper, hospitals are under the purview of the LHINs, but in reality hospitals often wield more influence than one might think. The province’s 14 CCACs are tasked with coordinating home and community care and authorizing admission to long-term-care homes.
Unlike physician services and hospital care, home care is not included in the Canada Health Act. In reality some provinces have a long history of paying for some forms of home care with public dollars. The popular healthcare policy wisdom of the past decade has suggested that we need to provide more patient-centric care to individuals in their communities and that a continuum of care needs to be on offer so as to avoid providing only acute, episodic primary care which is worse for our health and much more expensive, all things considered. While policy persons and politicians realized that people did not want to age and die in nursing homes or in hospitals, if it was possible for them to stay in their homes, they also realized that this was a much, much cheaper option. The best of both worlds right?
Unfortunately the problem is that in order to age at home people need certain things to be in place – an age-friendly, safe and accessible home and a variety of home care services. In Canada there is no standard to guarantee what a Canadian will get and there is very little agreement on what government funded home care is, how it should work, what it should entail and who should pay for it.
As the Globe report indicates: “Pharmacare is often cited as the most egregious exclusion from Canada’s universal health-care system. But when it comes to prescription drugs, Canadians can at least discover with relative ease what their provincial governments will pay for, and seek private insurance to cover what they won’t. Home care, on the other hand, is often a black hole of information, one many Canadians do not stumble into until they are old or ill or both.”
This is a top priority problem and it grows more pressing by the day. In 2011, 1.5 million Canadians received publicly funded care in their homes and communities; up from 55% three years earlier and the trend will only continue to grow exponentially. According to StatsCan there were 2.2 million people receiving publicly and privately funded care in 2012. Here is what we know: we need a lot of home care, we cannot provide enough and the regional healthcare administrative units make it difficult to have an honest conversation about costs, eligibility, resources and budgets.
They operate with various levels of transparency ranging from the completely opaque to the reasonably gossamer and have been known to execute drastic eligibility requirement changes in complete secrecy – even when it means that many people in need will lose their services. One can partly sympathize with their plight – they have finite resources and cannot possibly meet the demand they encounter – but not their methods.
Last year the Ottawa Champlain CCAC had been receiving an influx of new clients with extremely high care needs and they just did not have enough resources to go round. One of the Globe and Mail’s most astounding and appalling investigative findings was a six-page memo that landed in staff inboxes at the Ottawa area’s Champlain CCAC last year, the memo advised workers on how to quietly – very quietly – cut off the services of their lower-needs clients: “Do not direct clients to contact their MPP, LHIN [Local Health Integration Network] or media,” reads the memo, obtained by The Globe. It provided a three-step response to the question: “What do I do if a client threatens to go to the media?”
It seems rather terrible that people should not be able to know and plan for the service levels they can expect, that they be unable to discover how these decision are made and why they were cut off or ceased to qualify. Most importantly it seems a rather terrible idea that these dealings should be conducted in secrecy instead of announced in an open forum where tax-payers can form on opinion on the matter and hold those ultimately responsible to account. Critics have argued that regional bodies like LHINs allow politicians to distance themselves from controversial decisions and it seems like sounds logic.
And yet there are no simple solutions on the table in the immediate future – consolidation has been suggested but critics of consolidation would argue that with fewer boards, the communities will lose previous avenues for input. There is speculation that this amalgamation could lead to mergers in the healthcare system and that we would subsequently be left with fewer hospitals – “mega hospitals”- leading to a much bigger role for private specialty clinics. Perhaps it would be easier to find the solutions if we had a clear view of the problems. As it stands neither the public nor the media have a good grasp on the issues since they are handled by a complex system that would have made it difficult enough to get a clear picture even if they were not trying to hamper fact-finding missions.
All we know is that it is rare that secrecy and regionalism lead to the solving of complex problems and that in the meantime, nobody is struggling more than Ontario’s – and Canada’s – unpaid caregivers. Those who discover they cannot get the government-funded care they need when it is too late are especially suffering.
What CAN we do to prepare – Home Safety and Technologies to help you Age at Home
These are all factors that should go into shaping the decisions we make about how and where we grow older. It is an unfortunate reality that we may not be eligible for the amount of publicly funded home care we may have anticipated or may need. This could mean having to pay for care out of pocket and that is also an important consideration. It is better to have a plan and to consider these eventualities before they occur than to be taken by surprise and forced to make rash decisions that may have been avoided with with advanced planning. Even for those of us fortunate enough to be mobile, life-changes can often be a fall, an accident or a diagnosis away, be it our own, our spouse’s or our parents’.
When older people ask themselves whether they should stay put or seek out a retirement community/condo/rental apartment that is universally accessible, most settle on staying put. Surveys show across the board consistency; people really do want to stay in their homes.
But while home might be cosier and cheaper than a residential center, it’s not always safer. According to StatsCan 1.6 million seniors fell at least once in 2010 with 85% of them being hospitalized as a result. 1 out of 3 of seniors that are hospitalized because of a fall will end up in long-term care. For more information on injuries, accidents, costs and prevention measures please read our recently published article on this topic.
Taking Stock of Risks, Weaknesses and Assets
The first step of developing a plan involves taking stock of risks, weaknesses and assets. Learn where the potential hazards lie and how you can reduce them. There are many things you can do to make your home safer; below we will provide you with a helpful and fairly detailed checklist. You can also look to the expanding field of technological assistive devices and life solutions – another area we will explore in this column (stay tuned and keep reading)!
An entire service industry is slowly taking shape around the goal of letting people age in place. Like everything else in life this can be both good and bad – it can mean more providers and better services but unfortunately, it can also mean that everyone and their sister is now claiming to be an ageing in place/home expert. If anyone claims to have expertise don’t be shy to ask questions about their formation and qualifications. Many people do not want to be rude but consider that if someone is passing themselves off as a specialist and charging you for the privilege of being mislead, you could wind up with more than a wasted consultation fee.
In this area bad advice can have very serious consequences and could derail your plan. You are entitled to ask questions and if you are not satisfied or if you are left with doubt, do some research or consult your physician to ascertain whether the so-called “expert’s” formation is legitimate and thorough. If you want to make your own home, an older relative or friend’s home a safer and more supportive place to live, here are basic guidelines and approaches you might consider.
- A Professional Assessment: If you have multiple medical issues, say arthritis and poor vision, ask your doctor for a referral to an occupational therapist — an O.T.— who specializes in home modifications. The O.T. can analyze your potential challenges and your home’s shortcomings to come up with a plan that a contractor or handyman can easily follow. An O.T. can also supply you with an invoice that lists the medical necessity of each improvement — a document that you might need to get reimbursed, say, from a long-term care insurer or benefits provider.
- Renovations: When considering renovations it is important to have clear goals in mind and to realize that renovations are a commitment in more ways than one. If the renovation is brought on by a physical need it might be a good idea to find out how this will impact the market value of your house if that is a consideration for you. If you renovate to stay in your home and move a few years later after having depressed the value of your house through the renovations – this may not have been a good strategy. Both Ontario and BC offer tax credits for seniors doing renovations; $1500 in Ontario and $1000 in B.C. and you have to spend the money to get the credit so it is important to realize that these breaks won’t get you very far in terms of financing. We referenced the possibility of depressing a property’s value through renovations, though the effect of mobility enhancing renovations can sometimes be unpredictable because this is a market that is changing and evolving as we speak. People are increasingly recognizing the value of these features and whereas a 40-year old couple is still unlikely to want a walk-in bathtub, accessibility is becoming more and more important. With the advent of attempts at universal design that are both functional and esthetically pleasing – some real estate agents say their clients are stating to see a better return on these renovations and that there is starting to be more demand for homes that can be entirely accessible (like bungalows with wide enough doorways for a wheelchair).
- Technology: Although there are a few technological items on the checklist below they provide the barest simplicities. Beyond these there is an entire world of technological options and possibilities designed or suited to helping people age at home. Not only are some of these tech options fascinating and innovative, some of them could actually be fun and help prevent or overcome loneliness and social isolation. Self-driving cars and robotic butlers made to look like your long-distance relatives: the space age has arrived! But you will have to read on to hear about it… Technological solutions will be discussed after the checklist.
- Checklist: Although it would be virtually impossible to create a checklist that in entirely exhaustive when it comes to every single safety and accessibility modification that can be made in a home we have put together a basic home safety checklist that would be of use to seniors.
The following can obviously be adapted, adding and adopting the items as they fit and suit projected needs. It should be noted that these are general suggestions that would enhance safety in any home – they are all good ideas. Acting on these recommendations even if they are not yet needed can help ensure your home is safe for everyone. You can print out the following checklist and write “Yes” or “No” next to each point.
Home Safety Checklist for Older Canadians
|1. Are they in good shape?|
|2. Do they have a smooth, safe surface?|
|3. Are there handrails on both sides of the stairway?|
|4. How about light switches at the top and bottom of the stairs?|
|5. Is there grasping space for both knuckles and fingers on railings?|
|6. Are the stair treads deep enough for your whole foot?|
|7. Would a ramp be feasible in any of these areas if it became necessary?|
|1. Is the surface safe?|
|3. Any throw rugs or doormats that might slip underfoot?|
|4. Is carpeting loose or torn?|
|5. Are there changes in floor levels?|
|6. If so, are they obvious or well marked?|
|7. Do you have to step over any electric, telephone, or extension cords?|
Driveway and Garage
|1. Is there always space to park?|
|2. Is it convenient to the entrance?|
|3. Does the garage door open automatically?|
Windows & Doors
|1. Are windows and doors easy to open and close?|
|2. Are locks sturdy and easy to operate?|
|3. Do doorways accommodate a walker or wheelchair?|
|4. Can you walk through the doorways easily?|
|5. Is there space to maneuver while opening and closing doors?|
|6. Does the front door have a view panel or peephole at the right height?|
|1. Is the room arranged safely and conveniently?|
|2. Do the oven and fridge open easily?|
|3. Are stove controls clearly marked and easy to use?|
|4. Is the counter the right height and depth?|
|5. Can you work sitting down?|
|6. Are cabinet doorknobs easy to use?|
|7. Are faucets easy to use?|
|8. Do you have a hand-held shower head?9. Bath mat inside tub and shower to prevent slipping?|
|10. Are the items you use often on high shelves?|
|11. Do you have a step stool with handles?12. Toilet frame and seat riser for easier accessibility?|
|13. Can you easily get in and out of the tub or shower?|
|14. Do you have a bath or shower seat?|
|15. Are there grab bars where needed? Suggestions include near the commode and sink to provide support and prevent falls.|
|16. Is the hot water heater regulated to prevent scalding or burning?17. First Aid Kit!|
|1. Are there enough lights, and are they bright enough?|
|2. Do you have night lights where needed?|
|3. Is area well ventilated?|
|1. Can you turn switches easily on and off?|
|2. Are outlets properly grounded to prevent a shock?|
|3. Are extension cords in good shape?|
|4. Do you have smoke detectors in all key areas?|
|5. Do you have an alarm system?|
|6. Is the telephone readily available for emergencies?|
|7. Does the telephone have volume control?|
|8. Can you hear the doorbell ring all throughout the house?|
|1. Padding for sharp edges and corners to avoid head injuries?2. Pill and Medicine Aids to organize medications and help with dispensing?3. Height adjustable Beds with safety guardrails to prevent falling or wandering at night?4. Alarms and motion-sensors to warn of danger?5. Blood Pressure Monitor?
6. Reachers to avoid over-reaching, which can cause falling?
7. Powered Lift Assist Chairs and Seats for help getting and down (in and out of bed and other usages)
Helpful and Innovative Ageing at Home Technology
Before we cover the robot and the self-driving car we will cover the more traditional varieties of assistive technologies. There are a plethora of them but a hefty portion fall into one of the following categories:
- Mobile Apps
- Big Data
- Social Network Based Technologies
- The Very Cutting Edge of Innovation (including robotic household staff and self-driving cares a technology that was not developed for seniors but one can surely envision possibilities).
Sensors: Advanced remote patient monitoring sales accounted for $29.7 billion worldwide in 2014, according to Kalorama Information, and a good deal of that demand came from home treatment and health facilities. “We have received significant interest from elder care providers who are seeking to keep the elderly in their homes rather than moving them to assisted-living centers,” Jason Johnson, chair of the Internet of Things Consortium, told Scientific American.
Sensors can be placed around the home as well as in appliances and on the patient. They alert caregivers if the senior misses a meal, doesn’t get out of bed, or falls. Some Alzheimer’s patients, for example, remain at home under a program that monitors their movements via sensors and smartphone apps, and alerts their nearby caretakers to risky behavior — such as leaving the house, forgetting to eat, or leaving water running too long.
One example of a worn sensor is the Lively safety watch, which looks like a smartwatch. “A lot of people don’t want to wear the garage door opener,” CEO Iggy Fanlo told InformationWeek. “We had to make a beautiful product people aren’t ashamed of wearing.”
The device, which detects falls as well as inactivity and other situations, connects to sensors and an around-the-clock call center. The waterproof device also has a one-push help button, switchable colored bands, medication reminders, daily activity sharing, step counting, and family alerts.
GPS: When seniors are away from home, GPS-tracking technologies allow families, health workers, or law enforcement professionals to locate them in case of emergency. In November, Royal Philips began offering Philips Lifeline GoSafe, a mobile medical alert service. GoSafe covers users via its around-the-clock US-based emergency call response center and a “hybrid” locating approach, which allows response center workers to find seniors in need of assistance even in areas where GPS might not be available, such as indoors or in a parking garage. The technology also senses if users fall, and automatically calls for assistance even if the wearer is incapacitated, Philips said.
Mobile apps: From monitoring to communication, simple mobile applications give caregivers peace of mind while allowing seniors to get in touch with a few taps on their phones. Reminder apps, which can notify seniors about medications or appointments, are a great tool for busy or absent-minded people of any age. Other apps, such as Red Panic Button, Philips Lifeline, 5Star Service, and TrackerAssist for iOS and Android can be set to alert any number of people if a senior hits a panic button on the smartphone.
Big data: Collecting information from multiple sources and analyzing it for insights has become a vital part of healthcare, including care provided to seniors. The Evangelical Lutheran Good Samaritan Society, for instance, uses big data and analytics to provide home-health services for seniors. Participants in Good Samaritan’s LivingWell@Home program use sensors to help identify developing medical conditions before they become problems. The sensors detect seniors’ activity levels, sleep patterns, or if they’ve fallen, enabling Good Samaritan to respond and provide better care around the clock. The program uses IBM analytics software to consolidate the sensor information with clinical and operational data on patients. The data appears in an online dashboard, which a licensed nurse reviews daily for any changes in clients’ routines that might suggest a medical concern.
“Partnering with IBM, we’re working to enable our clients to take control of their health and make the choice to safely stay in their homes, preventing or delaying the need for a higher level of care,” said Rustan Williams, vice president and CIO at The Good Samaritan Society, in a statement. “For many, this is a more affordable option and provides a much better quality of life.”