When people hear the term “advanced care planning” they often think it’s about having a will or planning a funeral.  While those topics are important, they are not part of Advanced Care Planning.  Advanced Care Planning is all about while you’re still alive—what happens if you are unable to make a decision for yourself?  Who will make a decision on your behalf?

The person to make a decision on your behalf is called a Substitute Decision Maker (SDM).  The SDM should be someone you trust, and someone who knows you very well so that they can make the types of decisions that you would make yourself.  It is the responsibility of the SDM to act in your best interests and to make decisions that you would make, even if they would personally choose something different.

Did you know that you already have an SDM? Even if you haven’t selected someone, there is a hierarchy that is set out and followed, in lieu of having selected your SDM.  Here is the hierarchy:

1. Guardian

2. Power of Attorney (POA) for Personal Care

3. A representative appointed by the Consent and Capacity Board

4. Spouse or partner

5. Children or parents

6. Parent with the right of access (i.e. custody)

7. Brother or sister

8. Any other relative by blood, marriage, or adoption

9. Office of the Public Guardian and Trustee

If a substitute decision-maker is required, this list is consulted—starting at the top, if someone doesn’t have number one, they move onto number two and likewise until they find someone who can act as your substitute. The catch is that you might select someone who isn’t reflected on this list. For example, you might have a really close friend who has known you for 40 years but friends don’t make the list.  Instead, a long-lost cousin would qualify as “any other relative by blood, marriage or adoption.” If you would like the friend to make your decisions for you, then you need to appoint that friend as your Power of Attorney for Personal Care — then they are at the top of the hierarchy should the need ever arise.

Sometimes people figure that they have lots of relatives and people who care about them, so they don’t appoint a POA.  Such situations can be tricky though. For example, if someone is in their 60’s and no longer married, but they have three adult children in their 30’s as well as parents who are aged 85 and 92 — all five of these people would need to agree on every single decision.  Based on the hierarchy chart, parents and children have equal ranking; one does not trump the other.  As long as the children are over age 16, they can be an SDM. In this example, there are three children over age 16 and two parents who are presumed capable and a unanimous decision would be required for any medical decisions.  You can imagine how complicated this situation would become!

Looking at the hierarchy, you may be content with the automatic SDM.  For many people, the automatic option is number four — spouse or partner.  To be considered common-law for the purpose of assigning the SDM, the couple must have been living together for at least one year prior to the SDM being appointed. 

If a couple separates or divorces, they are no longer considered under option number four.  An ex-spouse of decades would be overlooked as the SDM and a distant relative could be assigned instead.  If a divorcing couple were amicable and still wanted to be SDM for each other, they would need to assign each other as their POA for personal care.

The safest way to ensure that your medical decisions are made as YOU would wish is to confirm your selection for SDM or appoint a Power of Attorney for Personal Care.  This eliminates possible confusion or delay as people sort through the hierarchy.  Appointing an SDM or POA gives you the opportunity to discuss in advance what your wishes would be.  Don’t assume that someone else would know your preferences — tell them what you would like for your own personal care.

While it is always preferable to discuss your wishes with your POA, you might be surprised to know that it is possible to appoint someone as POA without their knowledge!  There is no paperwork requiring a POA to accept the position.  Theoretically, someone can be appointed as a POA and never be informed. They are just called upon to act as SDM when the need arises.

However, there is no requirement that someone accepts the role of Substitute Decision Maker (SDM) at any time.  A spouse who is highest on the hierarchy can refuse to act as the SDM and have the responsibility roll over to the next level.  Even a POA can refuse the responsibility of the SDM and decline being involved.  For this reason, it is often advised that you select an SDM or POA as well as a backup — in case your first SDM is unavailable or unwilling to act as SDM.

There are a few requirements for who is eligible to be an SDM:

1. They must be capable

2. 16 years of age or older

3. Have no court orders or separation agreements in place

4. Be available

5. Be willing to act as SDM

Beyond these basic criteria, you want to select someone who will act in your best interests, so what other criteria can you use? 

Here are a few important elements to consider:

• Do you trust this person to make all your decisions for you?
• How well does this person react in stressful times? 
• How well do they handle emergencies?
• Is this person willing to be your SDM? (remember—just because you appoint them, doesn't make them willing to act as SDM!)
• Express your wishes to them; communicate your health care goals and preferences so they can be confident in making decisions on your behalf.

If there is ever a situation when you are unable to make your own health care decisions, you want to be certain that you have the right person in place who will make decisions that you would make for yourself — this is what Advance Care Planning is all about.

The quick synopsis of what to do for Advanced Care Planning:

• Select and confirm in writing your selection of SDM or legally appoint a POA;
• Ensure that person/those people are informed that they have been listed;
• Provide them with information about your wishes so they can confidently decide on your behalf.

When families are seeking companionship for their loved ones—especially within retirement homes or long term care centres—some families are surprised that the minimum companionship visit is three hours.  The reason we have minimums is to fulfill our mission and philosophy of care. Within the context of long term care, there is another element that is also crucial and that is providing your loved one with one-on-one undivided attention.

One-on-One Undivided Attention

One of the reasons that companionship services are so beneficial within long term care homes is your loved one receives one-on-one undivided attention.  Of course, there are wonderful staff members in the long term care home who are providing various types of care and assistance, but their attention is not undivided.  They are typically rushing off to attend to the next resident because there are so many people who are in need, all at the same time.  Your loved one can feel this. They can feel the sense that someone is hurrying along, or watching the clock, or checking a pager or other device. While completely unintended, your loved one might not feel important at that moment.

Our companionship services are an antidote to the rushing around and unfocused attention they’re receiving.  Our caregivers slow right down and sit with your loved one.  They’ll exude a sense of peace and calm that says “I’m here for you, and I’m not rushing anywhere else.”  Because they have the luxury of time (at least three hours), they are not watching the clock, they are not rushing off to attend to other residents. They are focused entirely on your loved one giving much-needed undivided attention for hours on end. 

We have served many clients in long term care who are in the very late stages of dementia.  In many cases, these clients have very little verbal communication left.  Many would say that they are past being able to recognize faces, and certainly beyond knowing names. 

We served one such lady at a long term care home in Kitchener.  She was non-verbal and most of the time her head hung low. She rarely made eye contact and only groaned occasionally.  When family enlisted our help, many others wondered why they even bothered having a caregiver visit. Others assumed this woman could not benefit from a companionship visit since she couldn’t converse.

We paired this woman with a caregiver who had a particular knack for connecting with people who are non-verbal.  The caregiver spent hours with this woman, slowly getting to know her and understand her body language. She developed trust and rapport with this woman. Before long, the elderly woman was responding to the caregiver’s voice. 

The woman could be sitting in her wheelchair, slumped over with her head drooping, but at the sound of the caregiver’s voice, she would suddenly open her eyes and lift her head.  When the caregiver was within sight her eyes would sparkle.  She knew that the caregiver was there to see her personally.  That caregiver wasn’t there to help everyone; she wasn’t there to do activities with or entertain the whole crowd. She was there for the sole purpose of being with this particular woman, and the woman knew that and responded to that individual attention.

This woman—who many might have disregarded as being unresponsive or too progressed with dementia to bother providing companionship—clearly benefitted hugely.  We’ll never know how much she comprehended the caregiver’s one-sided conversation, but we know that she comprehended the feelings elicited by the caregiver. The woman felt noticed and appreciated, she felt valued and she recognized that the caregiver was there for her alone.

That is why we provide companionship to clients regardless of their physical or mental diagnoses or conditions.  Making that woman’s day, providing her with a sense of joy and moments of contentment and fulfilment are what it’s all about.  Would you like to have the same for your loved one?

In the world of homecare, terms like ‘minimum’, ‘maximum’, and ‘eligibility’ frequently arise.

When arranging publicly-funded homecare through the LHIN, the first concern will be eligibility—is your loved one eligible for LHIN homecare?  If they are, the next question will be “for how much homecare?” Publicly-funded homecare is all about eligibility and maximums—the maximum amount of service that can be provided based on eligibility.

Private homecare is exactly the opposite.  There are no eligibility criteria, and there is no maximum amount of service.  We gladly provide as much service as a client needs or wants.  In fact, to ensure that clients truly are well-served, we have minimum service provisions rather than maximums.

Why do we have minimum service provisions?

Here at Warm Embrace Elder Care, we have service minimums as a way of ensuring that we always provide service in line with our philosophy of care. Here are a few important ways that minimum service provisions contribute to the fulfillment of our mission and our philosophy of care:

Promoting Abilities

Our philosophy of care is about promoting abilities and never doing for a client what he or she can manage independently.  It takes significantly longer to support someone in doing a task slowly, at their ability level, than having caregivers just rush through a task on a client’s behalf.  What is best for the client though?  If caregivers always just do the task because it’s faster, eventually, the client will lose the ability to manage that task independently. Promoting abilities—even though it may take much longer and requires more support—is better for clients, so we allow enough time to support independence and not just do tasks ourselves.

Dignified Care

Part of dignified care is ensuring that we match each client’s individual pace.  Being rushed through your daily routine, especially with something as intimate as personal care, can feel very dehumanizing. Our clients deserve the dignity of taking time and lingering over their personal routines and not being rushed by an artificial deadline imposed by a one-hour visit.

Building Rapport

Companionship is an essential element of our service. Our clients and caregivers establish a special bond, and this bond is developed by sharing quality time together. If caregivers simply rush in the door hurrying to complete a specified task in less than an hour and rush back out the door, it is difficult for rapport to develop.  Slowing down and getting to know each other as human beings first, before jumping into tasks or personal care, puts the focus where it should be—on the people first and not on the tasks alone.

Comprehensive Services

When a caregiver is paired with your loved one, that caregiver is prepared to assist in numerous ways.  Caregivers are able to help with numerous tasks in the time they are present—they might do some laundry, wash dishes, make dinner, help your loved one to shower and get dressed, and then run errands. The benefit of this model is that you don’t need a separate person for each task—you don’t need a driver who only does errands, and someone else who only assists with personal care, and someone else who only does laundry, etc. It’s a more comprehensive approach where all the different elements of daily life can be seamlessly woven together—the same as you weave numerous elements throughout your day.  Because we’re aiming to assist with so many different elements of daily living it takes more than an hour or two to effectively assist with each.

Living and serving by our mission and our philosophy of care is what makes our service exceptional.  Minimum service is the first step to abiding by our mission.  Beyond the minimum, the sky is the limit! Clients don’t need to worry about exceeding the maximum or being capped at a certain level. Instead of feeling limited by caps, maximums or restraints, clients can know that we’ll be there to assist as needed.

You have a resident, Henry, who insists on “going home”.  Henry is adamant that he is “getting out of here” and that you can’t stop him.  As the afternoon progresses, he becomes increasingly agitated and more insistent. Henry’s agitation is contagious; other residents are upset that he is upset.

Of course, logic won’t be helpful at this point. Reminding Henry that this is his home and he has lived here for months now is not effective. In fact, the more you try to reason with him and explain that this is his home, the more upset he becomes and the more he wants to leave.

“Going home” is not about the location. It’s more about the feeling Henry is experiencing. Henry is trying to communicate how he feels. He wants to go home because home is a place that represents feeling safe and secure, feeling in charge, feeling productive and knowing what to do. He wants to “get out of here” because he isn’t feeling safe, in charge or productive. He’s not sure what to do, so he figures he should go home where everything will make more sense.

Answering Henry’s emotional plea with logical answers won’t work. Explaining how long he’s lived there or which city he’s in, or the fact that he chose this home when he toured with his son—none of these explanations will be helpful. Instead, he needs someone to address his emotional needs.

The challenging part is that it takes a lot of time, a lot of patience, and a lot of one-on-one focused attention to effectively help Henry. It may take more individual time than your staffing allows, and other residents may have more pressing needs. This is where Warm Embrace comes in.  Our caregivers provide one-on-one support to help redirect Henry when he wants to go home.

Better yet, our caregivers proactively address Henry’s needs.  Since we know that Henry is more likely to want to go home as the afternoon progresses, we schedule an afternoon visit that starts before he typically becomes agitated.  We keep Henry engaged in activities and provide positive reinforcement that confirms for Henry that he’s in the right place and he belongs. When Henry is busy working on a puzzle with his caregiver, or he’s in the courtyard enjoying the sunshine, or he’s joining in the sing-a-long in a chapel, he is less likely to focus on going home.

One-on-one companionship meets Henry’s needs in a non-pharmacological way.  We can help to reduce his agitation and no medication is required.  Other residents are also relieved when Henry is content and not agitated.  Your staff is then free to attend to the needs of all the other residents in their care, knowing that Henry is in good hands.  

Which of your residents would benefit from the same support as Henry?

Do you know a senior who has suffered a serious fall? Likely you do, since approximately 30% of seniors who live in the community suffer a fall each year. The consequences of a fall can be quite serious—injury, hospitalization, even death from complications.

Did you know that falls are the cause of 90% of all hip fractures, 50% of all injury-related hospitalizations in seniors, and the 5th leading cause of death in the elderly?! These numbers also double when a senior has dementia. So, it is extremely vital in keeping seniors strong and steady on their feet.

Why do seniors fall in the first place?

“Falling isn’t as much about slips and trips. It’s about the failure to recover. Slips and trips happen at all ages” (Dr. George Fernie). There are various external factors at play that contribute to slips and trips; such as:

• Loose carpets/rugs
• Poor lighting
• Unstable chairs
• Steep stairs
• Poor footwear (e.g. slippers)

While some falls can be attributed to tripping—such as tripping over floor mats, pets or curbs—other falls seem mysterious. The person will report that they just went down and we're not sure why. In many of those mysterious cases, the fall is due to internal factors such as:

• Visual and hearing deficits
• Vestibular dysfunction
• Cognitive impairment
• Neuropathy (abnormal sensory feedback)
• Low blood pressure
• Edema/swelling
• Pain and foot drop
• Weakness and tightness
• Decreased flexibility
• Slowed reflexes and balance disorders
• What can we do to prevent falls?

1.  Get rid of all the external factors that cause slips and trips!

Ensure that your living space has no loose carpets or rugs, the lighting is bright for increased visibility, all chairs are sturdy with armrests, everything needed is on the main floor (no stairs), and that proper footwear is worn in the house.

2. Improve balance and stability!

“She says she wants to keep living in her home. We say it starts by keeping her on her feet” (American Academy of Orthopedic Surgeons). The number one key to fall prevention is staying active! Physical activity has shown to mitigate the deathly consequences of falls – just walking, gardening or housework is enough for an elderly loved one.

However, when your elderly loved one refuses to do regular exercise the best option is to increase their base of support.

To remain balanced, there must be a stable base of support—the wider the base of support the more stable it becomes. The base of support is the invisible box that can be drawn around your feet when you are standing. Added to this is our centre of mass—which is approximately where our belly button is located.

When someone’s centre of mass is in the middle of their base of support, they are perfectly balanced. When their centre of mass begins to reach the outer edge of their base of support, they are more prone to falling.

For example, a ballerina narrows her base of support to be only one square inch when she is en pointe. Her balance is quite precarious because her base of support has been reduced. The only way that she remains upright is by perfectly hovering her centre of mass over her base of support.  She is constantly adjusting to ensure that her centre of mass doesn't sway too far aware from her base of support.

In contrast, a football player crouches low and spreads his feet wide so that he has a wider base of support than he normally would. He may even put one hand to the ground adding a third point of contact and expanding his base of support further. He has a stable base of support, and his centre of mass is positioned in the middle of his base.

In the case of a frail senior, their feet may ache or have bunions, causing that person to only walk on the edges of their feet, which reduces their base of support and their balance. Instead of using the full surface of their foot, they have reduced their base of support more like a ballerina.  As well, the senior’s posture may be more forward-leaning, pushing the centre of mass to the outer edge of the base of support, causing instability. A senior will not likely be crouching down to touch the ground for support, the way a football player does.

The best way to create a strong base of support is to use a walker. The four wheels of the walker expand someone’s base and provide the necessary support. Much like a football player, a well-balanced senior using a walker is less likely to fall than a senior who is precariously balancing on sore feet. If their posture is forward leaning then the walker extends the base of support ensuring that the centre of mass remains in the middle of the base of support.

Encourage the seniors in your life to carefully assess their centre of mass and base of support to ensure that they are as safely balanced as possible. Every fall that is prevented is a great success and ensures a longer and healthier life for that senior!

You’re always encouraged when your residents have visitors. It brightens their spirits and gives them something to look forward to.

You have a fairly new resident who moved in last month and her daughter has been visiting daily.  Initially, you thought it was to help ease the transition, but after a month, the daily routine is still in place.  You’ve noticed that the daughter is looking increasingly strained herself.  While the mother certainly seems to appreciate the daily visits, it seems to be taking a toll on the daughter.

This daughter needs a Warm Embrace caregiver!  She needs a reliable visitor who will befriend her mother and visit consistently on set days of the week. We certainly can’t replace family, but we can supplement family visits. Maintaining a daily visiting routine is not sustainable for most families, and this daughter could be relieved to know that a reliable caregiver will cover set days of the week.

We can protect the daughter from burnout by alleviating her before she hits a breaking point with an unsustainable routine.  If she reaches the point of burnout, there’s a risk she will no longer be able to visit at all.  If she stretches herself too thin, she may become susceptible to illness herself, catching every cold or flu that circulates.  If she becomes contagiously ill, she won’t be able to visit and then her mother will be left with no visitor at all.

Our wonderful caregivers create balance. We can supplement family visits by coordinating to match each family’s routine and schedule.  Perhaps the daughter would like to maintain visits three days a week; we can provide a caregiver to visit on the other four days of the week. When the daughter would like to go on holidays, we can provide additional visits to cover the days when she would usually have visited.

By recommending a Warm Embrace caregiver for this new resident, you are supporting this family when they need it most.  Which residents—or family members—do you see who are most in need right now? 

You want what is best for your parents, and you worry that they need additional help.  Your parents believe that they’re managing just fine on their own.

So, Who decides?

First of all, you need to consider whether your parents are cognitively well and capable of making sound decisions.  A “sound decision” is not necessarily a decision you agree with—two people of sound mind can arrive at different decisions!

Capacity to make decisions is based upon someone’s ability to understand the choices with which they are faced, and the consequences of their decisions.  For example, as an adult with capacity, you are aware that your chance of winning the lottery is very limited, and yet you choose to spend your hard earned money on a lottery ticket.  Someone could say that is an unwise decision because the consequences are not in your favour; however, you understand the risk involved and the likelihood that you will not win.  The reason that minors are not permitted to gamble is that they do not fully understand the consequences of their decisions.  As a capable adult, you are permitted to make decisions that others might judge to be unwise, but it is your prerogative to do so.

Your parents have the same right.  If they have the capacity—meaning they understand their options, and they understand the risk associated with those options—they are entitled to make decisions. 

My parents won’t face reality — they won’t decide anything!

While it might appear that your parents aren’t planning because they aren’t changing anything, they might just be sticking with the status quo because they aren’t aware of all possible options.  You feel that your parents require more help—have you suggested various sources or types of assistance?

It is possible that your parents view the decision as a dichotomy—living at home and “getting by” as they always have, versus complete institutionalization in a nursing home.  While these may be two possible options, there is a myriad of other options that fall somewhere in between!

Help educate your parents on some of the options for assistance that won’t feel like such extremes.  If your parents are cognitively well, it is their right to choose the type of care that they feel will best meet their current needs.  Engaging your parents in the research and ensuring that they feel in charge of their own decisions will ease the process.  When your parents realize that you’re not just trying to force them out of their beloved home (as so many seniors fear!), they might be more open to alternate care options.

To start your research journey, you can learn about some homecare options that emphasize health and wellness.

You care deeply about each of your residents but sometimes it can be difficult to meet their varying needs simultaneously.  It can be especially tough when a resident with dementia progresses, and other residents are perturbed by the new symptoms.  Sometimes other residents inadvertently exclude or even ostracize residents with dementia, which only increase agitation and confusion.

Our caregivers can help remedy this situation!

One of our favourite client success stories was with Lydia, who lived in a Waterloo retirement home. Lydia was quite spry physically and she was keen to “assist” other residents. However, her advancing dementia impaired her judgement and her ability to assess the situation. In some cases, Lydia was moving walkers out of reach or rearranging chairs as others were about to sit down, placing others at serious risk of falling. 

This presented a challenge for retirement home staff. Of course, the safety of all residents needs to be a top priority, and managing Lydia’s need to be active and assist is also important.  The BSO team was brought in to help problem-solve the situation and they determined that the best non-pharmacological option would be attendant care.  Since Warm Embrace offers extensive dementia training to our caregivers, our team is particularly well-suited to support residents whose dementia is advancing. 

Warm Embrace caregivers were paired with Lydia and found her to be delightful! When redirected to positive and constructive activities, Lydia stopped interfering with other residents. Her need to feel helpful, involved and productive could be met in ways that protected the safety of other residents.

Within a week, the other upset residents had stopped complaining about interferences and they became contented residents again. The staff could return to their regular responsibilities since they no longer had to be completely preoccupied with just one resident. Lydia herself was so much more content and happy; all traces of agitation evaporated.

Attendant care made all the difference in this situation.  Retirement home staff were pulled in many directions attempting to meet everyone’s needs at once. By providing one-on-one support to Lydia, everyone’s needs could be met simultaneously, which also relieved the strain and stress on staff.

Which resident in your home could use the same support?

February is all about hearts. . . but not just the cupid and chocolate kind of hearts. It’s also heart awareness month as the Heart and Stroke Foundation promote heart health and disease prevention.

Did you know that every seven minutes someone in Canada dies from heart disease or stroke? And 32% of all deaths are attributed to heart disease or stroke? With heart disease this rampant, it is bound to affect you personally through someone that you know.

Here are the Top 10 healthy living choices you can make to help prevent heart disease:

1. If you smoke, become smoke-free.

2. Be aware of your cholesterol, blood pressure and blood sugar levels and keep them in the healthy range.

3. Engage in regular physical activity for a minimum of 150 minutes weekly– choose activities you find fun so you’ll stick with them. Bouts of 10 minutes of exercise at a time count toward your 150 weekly minutes.

4. Achieve and maintain a healthy weight. Weight loss of 5-10% of your current weight can have significant health benefits.

5. Consume at least five servings of vegetables and fruits per day by including vegetables with every meal and fruit for dessert. Boomers are notorious for failing to eat enough fruit and veggies; 80% of all boomers do not eat the recommended five veggies daily.

6. Develop and maintain personal relationships to help reduce any stress that can lead to unhealthy habits such as overeating and lack of physical activity.

7. Choose lean meat, fish, poultry and meat alternatives such as beans along with low-fat milk.

8. Include a small amount of soft non-hydrogenated margarine, vegetable oils and nuts each day.

9. Make at least half of your grain products whole grain each day.

10. Choose foods that are lower in sodium and limit the amount of salt you add in cooking or at the table. Begin using fresh herbs or spices to flavour your food, rather than depending on salt.

Starting and sticking to new habits can be difficult - especially when done alone. However, you don't have to do it alone! We are fabulous caregivers who will encourage and guide you - or your elderly loved one – in staying on track. Your heart health is important, it’s never too late to introduce new living choices, start today!

Many of the couples who reside in your home have been with you for years. They downsized out of the large family home when the house maintenance became too much and they relished meals being prepared for them, but they were still healthy and active and ready to enjoy all your residence has to offer.

Over the years though, their health has declined. The hard part is when one person declines more rapidly and begins to need more care, but the couple desperately does not want to be separated.  That’s exactly the case with Walter and Margaret.

Walter and Margaret have been married for 64 years, and in all those years, they’ve never spent a night apart. When they first moved into your residence six years ago, they joined every activity and club — they played bridge twice a week, Margaret sang in the choir and Walter joined the woodworking club.

Over the past year, they’ve pulled out of all their activities because Walter is struggling to participate.  Now playing Bridge is too complicated to follow and he finds crowds overwhelming. 

Margaret is a social butterfly who is missing her friends and her activities, but she doesn’t want to leave Walter alone in their room all day. If she leaves him for more than 10 minutes, he starts worrying and is terribly upset when she returns. You fear the day when Walter’s cognition might require a move to long term care and they could be separated.

Warm Embrace will support Walter and Margaret within your residence, allowing them to remain together in their preferred residence.  A Warm Embrace caregiver will spend one-on-one time with Walter, engaging him in activities that he can manage by modifying everything to match his current ability level.  Margaret will receive some much-needed respite and an opportunity to see her friends and rejoin her social groups.

Most importantly, Walter and Margaret will still be living together in your residence for their 65th wedding anniversary, maintaining their perfect track record of never spending a single night apart.