Qualicare
3910 Bathurst Street, Suite 404, Toronto, ON M3H 5Z3
Telephone: 416-630-0202 , info@qualicare.ca
Map

Wayne Nathanson
QualicareTM
Managed HomeCare
Phone: (416) 630-0202
mailto:wayne@qualicare.ca
http://www.qualicare.ca/

Keeping a journal can also be useful to an elderly or ill person dealing with incapacity or a new living situation with a live-in-care worker. People living alone can also use a journal to remember things, pass requests on to their family and live-in-care workers.

You can use paper, a notebook, a sketchbook, or word processor or anything else that suits you. Don’t think of yourself as a writer. Don’t try to be profound or get caught up in spelling, grammar, or censorship. Write what you want, when you want. Create a safe place for yourself in your Journal.

To get started:
• Tell the story of your day or the day of your parent or loved one.
• Make lists. What happened? What has to happen? What steps need to be taken? What needs to get purchased? What paper work has to get done?
• Be philosophical and/or spiritual. What’s on your mind? What do you think about life, illness and even death?
• Plot out Conversations. Write outlines of conversations, things that you should say with your loved one, your family, or anyone else? Plot the purpose of each conversation? State any questions or concerns that you may have? Mention any specific issues that need to be addressed.

With a bit of effort the journal will help you get focused and create a treasure to remember a challenging but important time in your family’s history. Journaling is just one tool to help family members, the older or ill person and home-care-worker communicate better.

Live-in-care can be scary for a loved-one as having a stranger in one’s home can be overwhelming. It may help to interview several caregivers and have a trial period before hiring. To ensure the comfort of a loved one during this process, a family member should stay with him or her during a trail. Many elderly patients may not want to have a caregiver because it is too expensive. It is extremely important that family members are educated about the resources that are available to ensure that what is available from the government is being utilized. If a loved one suffers from a certain disease, family members should be aware of the stages of this disease in order to be proactive in providing the correct care. They should remain in touch with the family doctor and attend appointments if possible.

The CCAC are a great resource for elderly patients and can assess further deterioration and deal with it. They can be contacted through many of the senior centers have social workers and intake. Seniors centers, family Docs, and social workers can assist in who to call and can assist with determining core needs.

There are many challenges when faced with illness. Daily activities or complex care issues can be frustrating. Unless family members have medical and social care experience, there is no one to turn to on a consistent basis. Qualicare fills that void. Qualicare will assign a Personal Care Manager, (PCM) who is committed to ensuring that you receive the highest level of care. Your PCM is an experienced, compassionate professional who is always there for you.

Doorways to Care is another helpful resource that connects seniors to community care. By calling the toll free number (1-866-626-0222) a patient or family member can get assistance by talking to a real person as apposed to a machine in a variety of languages. The service is manned twelve hours a day, seven days a week, from 8:30-8:30 and if you leave a message they will call you back. This hotline can at least point you to the service you might need if you have a problem.

These issues may not be readily obvious so here is a list of clues that families should look out for:
- Your elderly loved one who is still driving gets lost on the road, fumbles with car keys, or if his or her friends will no longer drive with him or her.
- His or her home begins to look dilapidated and food in the fridge is left unopened and/or appears rotten and expired
- The friend of a loved one or another family member may notice changes so talking to him or her may be helpful in confirming your suspicions
- A loved one may become more paranoid than usual and may barricade him or herself inside his or her room or house.
- If a loved one forgets to turn off the stove, oven etc.

However, it is important to realize that these clues may not be caused by a loved one’s deterioration but may have other reasons. For example:
- A loved one may not take care of his or her home because he or she does not want to spend money
- A simple condition like a urinary tract infection may have a huge effect on a patient’s cognition
- Uneaten food in the fridge may simply be forgotten. It does not necessarily mean that a loved one is deteriorating.

Families should to be wary of any changes in the behavior of a loved one and should be aware that these instances need further investigation as they may not mean that a loved one has deteriorated.

Family members have to be very careful when confronting a loved one as he or she may become very defensive. It is suggested that the family members discuss what is going on and make sure that everyone is in the same boat and that the person(s) who notices the changes is not just being paranoid. After this discussion has taken place it you can sit down with your parents and express your concerns.

Memory clinics are extremely helpful in these cases as they take the heat off the family. These clinics evaluate a patient and determine whether he or she has declined or if the changes in behavior stem from other issues that can be solved such as a urinary tract infection. It is a lot easier to convince a loved one that changes need to be made when a professional opinion is provided and legal action is taken based on the findings. This may be very effective for those that are just beginning or are midway through such cognitive problems.

However, some patients may be in denial or they may not be cognitively able to understand that that there is a problem. He or she may become upset and refuse the help or restrictions that are suggested by professionals. In this case the professionals need to be the bad guys and the family needs to step back and agree with the professionals recommendations. Counseling may be very helpful for families who may be in denial about a loved one’s decline.

Medical science has learned recently about the physical and mental connection in the human body. For example, if the hobby you are interested in requires a minimal of physical activity, you will still benefit physically from the mental activity. How? The mental stimulation of engaging in a senior hobby you enjoy, translates into a form of physical activity. Researchers tell us that it creates virtual, physical effort at the cellular level. The physical responses may be subtle, but the benefits of it are nevertheless felt by the body.
Start a senior hobby today! Go for it! This site has a great list of hobbies for seniors: http://www.seniorark.com/senior_tips_hobbies.htm.

Gardening is an enjoyable pastime and an excellent form of exercise for seniors to build mobility, flexibility, the use of motor skills, strength and endurance.
Puttering around in the garden on a warm Spring wad can also help prevent osteoporosis, reduces stress levels and help you rest better at night.

Here are some suggestions for safe and healthy gardening:
* Drink plenty of liquids (avoiding alcohol), to keep your body well hydrated.
* Take care of cuts, bruises scrapes and insect bites right away to help avoid infection.
* Work in the garden early in the morning or late in the day to avoid the hot midday sun.
* Wear comfortable clothes and shoes. Wear a hat and gloves to cover your skin. Remember to use sunscreen.

Don’t overexert yourself. Take breaks when you feel you need them.

Rotate your gardening tasks every half hour. This will help you to use your larger muscles and be less taxing on those smaller muscles that can cause soreness. Avoid using tools that will put you in awkward body positions. Use a new breed of ergonomic garden tools which are designed to work in conjunction with your body movements. These tools are also light and sturdy to give you better control.

Here are a few more safety tips and easy steps that seniors should take into consideration when gardening. They will help prevent injury and minor aches and pains:
* Be careful with power tools.
* Plant vertical or raised garden beds to avoid bending or stooping
* Bend at the knees and hips,
* Avoid twisting the forearm back and forth. Instead, work with your hands in a neutral position.
* Wear gardening gloves
* Work below shoulder level and keep tour elbows partially bent.
* Provide yourself with shaded areas for working whenever possible

The presence of stairs can challenging if a patient needs to be able to climb them to get to his/her bedroom etc. If this is an issue for a patient, a variety of options will be explored. For example, if a patient can be moved to a bedroom downstairs or not. The social worker may recommend having the CCAC install home safety devices that may include a bath bar, a bath seat etc. The CCAC may provide advice on what to do to prevent accidents such as picking up loose rugs.
The discharge plan will also include rehabilitation. To get a patient home, social workers must examine the need for rehabilitation. A patient’s compatibility for rehab is determined by whether or not he/she is going to get any better and if the patient will be able to grasp the information without confusion.

Another issue with the transition home is dealing with the level of supervision that a patient requires. A social worker will ask; Does the patient live alone? Is it appropriate for him/her to still be living alone? If there isn’t another option, what supports can be put in place to assist the patient? Obviously, CCAC can’t be employed and their services are limited, especially with recent government cut backs.

There is also the option to hire live-in care as a more cost-effective alternative. The problem is affording it and agreeing to it. Some may not have room to have a live-in caregiver. Some may not want somebody living in their home.

Home-care can be very limited. A trained homecare giver will come to change diapers, but certainly not four times a day. They will teach family members to use a feeding tube, but will not always be there to use administer it.

The physical transition from the hospital to home is usually the easiest part of the whole process. A thoughtful transition plan can make it work.

During the process, social workers use their expertise to look at important questions in terms of a patient’s well being and the complexity of his or her situation. For example, a social worker may ask; Is live-in care required? How safe is the person to be home alone? Does he/she know how to call for help? Does he/she need help with medications? If home alone is the absolute plan, what are some services that can be put into place to ensure the safety of a patient? What if a patient falls? What if he/she can’t reach the phone? What if he/she can’t get help? What if he/she is not awake after a fall? Some people live with their family members and they’re home alone during the day. How many hours is that? If for example a relative leaves for work at 7:30 and he/she gets back at 4:30. Can home-care be arranged to come during those hours? Can the patient let home-care in? What equipment is needed to be put into place?

Specific components of a Discharge Plan can include:
- Spaces available at nearby facilities
- Appropriate tasks for family care givers
- An assessment of the need for a fulltime, live-in care giver
- Management of that full-time, live-in caregiver
- Appropriate tasks for family members
- Budgets
- Emergency alert technologies
- Government resources
- Equipment to make the home accessible for a patient

Discharge Planning involves the exploration of sensitive issues that are centered around a patient’s mental and physical capacity. The purpose of this process is to establish realistic expectations in terms of a patient’s full or partial recovery, financial resources, the availability of family caregivers, live-in-care options, and legal issues like powers of attorney. This assessment will include an analysis of the physical barriers a patient may face at home and resources that are available to a patient in terms of community and commercial support.

It can be hard for family members to accept change in a loved one. Even if the best results are obtained, an older patient can still decline after a hospital stay. It may be hard for family members to agree on the level of care needed and for the patient to go along with the decision. Patients may refuse much needed live-in care help. Occasional assistance provided by family members may not be a sufficient solution for long term care. A thoughtful and realistic “Discharge Plan” can ensure a well-organized and secure transition for a patient who requires a change in lifestyle.