Bill was a dairy farmer and spent his entire life outside. He was up before sunrise milking cows before the birds had even started chirping. Every evening, he was out milking again. His entire life was set by the rhythm of farm life.
Bill now resides in your long term care home in your secure unit since he is adamant he needs to get outside and milk the cows. With his advanced dementia, he does not realize that he hasn’t milked the cows in nearly 25 years, but his circadian rhythm is indelibly marked by the farm rhythm and he’s bound and determined to get outside.
Of course, Bill is safe on your secure floor and he cannot leave. But as dusk arrives, Bill becomes increasingly agitated as he feels the need to be out on the farm, and his agitation is contagious. He paces the floor back and forth, he looks out each window longingly and he searches for the exit. Other residents can sense his unease and though they don’t know what he’s anxious about, they share the sentiment.
The approaching evening as the sun is setting can be a challenging enough time within long term care as many residents have competing needs at that time of day. Bill’s increasing agitation only compounds those needs.
What Bill really needs is a dedicated caregiver companion who can address his personal needs. A caregiver can take Bill on safe outings, fulfilling his desire to be outside. When evening approaches Bill’s caregiver can reassure him “not to worry, you milked the cows a little early today; everything is fine on the farm.”
His caregiver can keep Bill occupied so that he doesn’t start looking for something to do—his history dictates that if he had a moment of boredom, he cured it by heading out to the barn. Instead of letting Bill feel bored—and likely to want to exit seek—his dedicated caregiver can keep Bill engaged in conversation and activities until dinner time when he typically settles into a routine.
Of course, Bill receives the most direct positive impact from his caregiver, but the incredible part is that he is not the only recipient! Other residents also benefit when Bill is calm and redirected. The source of the anxiousness and agitation that spread contagiously is solved. By extension, staff benefit when residents are content and happy. Bill’s caregiver addresses his emotional need, which frees staff to care for other residents who may be in need.
When you have a resident who is intent on leaving the secure floor, remember that one of the most effective strategies may be a dedicated caregiver who can address emotional needs and redirect attention. The positive impact will have a ripple effect across the entire floor!
September is synonymous with back-to-school time. Long after you’ve graduated, it’s hard not to feel the appeal of the fresh new school year that starts each September. The back-to-school advertisements start (far too early!) in the summer and remind everyone—even those who are not students—that the new school year is fast approaching.
With all the anticipation over new school supplies, different classes, reconnecting with old friends and meeting new teachers, September is tinged with excitement.
For some people though, September comes with a whole new set of challenges. Those who are squeezed into the sandwich generation can feel the extra pressure that the school year brings.
The sandwich generation includes those who are caught between caring for their children, while simultaneously providing care to their ageing parents. Those feeling the crunch in September are likely even members of the club-sandwich generation: mothers who have young children at home who are providing help to their parents and their grandparents at the same time.
Club sandwich members are lucky enough to be in families who have four living generations at the same time. Their young children are the youngest generation, the hectic mother is the second youngest. The grandmother may be in her 60’s or 70’s and the great-grandmother in her 80’s or 90’s.
The young mother is caught between raising her young children, getting them out the door on the first day of school and being there for them when they step off the bus at the end of the day and also helping her mother to care for the elderly great-grandmother whose needs have suddenly increased.
September may represent a time of excitement and fresh beginnings for many people, but for this sandwich generation young mother, it may mean increased stress and an even more hectic schedule as she’s attempting to ferry children to after school activities, help with homework, and also deliver meals to her nanna across town.
Those in the throes of the club sandwich generation need support to manage the needs of so many generations at once. The help can take many different forms—extended family and friends, a nanny for childcare, a driver to chauffer children to all their activities, or a caregiver to support great-grandmother Nanna.
A professional caregiver can provide the support that Nanna needs, while also alleviating pressure off the young mother who is hoping to get her children’s school year off to a good start. September can be a time of exciting new beginnings for Nanna too! She can look forward to meeting friendly caregivers who will become new friends.
Who in your family or circle of friends might benefit from the back-to-school excitement of September by engaging the support of a professional caregiver?
You grow attached to your residents and you hate to see them move on from your residence into Long Term Care. You wish you could keep them with you even longer! You may even feel a little torn because on one hand, you have grown fond of each resident and you want them to remain in your home, but you also see the toll it takes on your staff when care needs suddenly increase.
Warm Embrace can help you to have the best of both worlds! Your residents can remain living with you much longer, without placing an increased burden on your staff.
One of our greatest success stories was with a gentleman at a retirement home in Kitchener. When he moved into the retirement home, he had occasional nighttime urinary incontinence due to prostate issues. After prostate surgery, he became entirely incontinent and he wasn’t able to self-manage. Because of this, he was self-isolating, remaining in his room and not attending any activities or events.
He had AM/PM care from the LHIN, but many days he wasn’t ready to get out of bed when the PSW from the LHIN arrived. That left the retirement home staff to attend to his needs at the busiest time of day—the morning rush. He needed assistance numerous times throughout the day as well and it was taking quite a toll on the staff.
Warm Embrace was brought in to help support this gentleman so he could remain living in retirement and not move into long term care. We intentionally scheduled our service at the time of day that was heaviest for the retirement home team. That way, their efforts could be focused on other residents, knowing this gentleman was well-cared for.
Our caregivers attended to his personal care needs in the morning—on his schedule when he was ready to get up. Our caregivers ensured that he was bathed and dressed in fresh clothes. Each day, they changed the bedsheets and laundered them, along with any other soiled laundry. While this gentleman had weekly laundry included in his package, our team was responsible to immediately launder soiled items so they didn’t remain in his suite until laundry day.
Once he was dressed and ready for the day, we’d get him to breakfast and then take him on an outing. With a caregiver’s reassurance, he began leaving his room to attend events and activities. When he required assistance, we’d be right there to provide it. His confidence began to return!
Our morning visits thoroughly covered the busiest time of day, and the retirement home staff was able to provide the coverage for this gentleman required in the afternoon. Working together as a team, we supported this gentleman in remaining in his retirement home of choice for an additional three and a half years.
We are pleased to partner with you and your team to provide the same support to any of your residents who require it. We intentionally schedule our services at your highest need times of day to reduce the strain on your staff.
Our Warm Embrace caregivers can support your highest-needs residents on a one-to-one basis, freeing your staff to attend to all the other residents in their care. Together, we can help your residents to remain with you for many more years to come!
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.
Privatehomecare 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:
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.
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.
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.
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.
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-relatedhospitalizations 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:
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
Neuropathy (abnormal sensory feedback)
Low blood pressure
Pain and foot drop
Weakness and tightness
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?
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.
Homecare can be defined pretty broadly and mean different things to different people. To some, it might mean dropping in to check on someone for 5 or 10 mins, for someone else it could be 24/7 care in someone’s home. It could be just about anything in between!
To ensure that our clients receive the best possible service, we have placed parameters around the type of service we can offer to ensure top quality. Here at Warm Embrace, the minimum visit length we offer is three hours. We have set this minimum to ensure that we are fulfilling our mission and our philosophy of care.
Within the context of homecare, where an elderly client is living in their own home, apartment or condo, there are some additional reasons why the three-hour minimum is necessary.
Have you ever dropped by your elderly parents’ home with the intent of staying for a half hour visit? How did that turn out? I’m willing to bet that you stayed much longer than just 30 minutes! Why is that?
I’m guessing that by the time you got in the door and settled, got caught up with some friendly chit-chat and had a coffee, you were already at the 30-minute mark. Just as you were thinking you would head out the door, your mother mentioned a new symptom that’s bothering her. You discussed that and tried to track down whether a doctor’s appointment had been made since your mother couldn’t remember. Then your father mentioned that the microwave wasn’t working properly so they weren’t sure what they were going to have for dinner. The next thing you know, you’re busy making dinner for them and your quick 30-minute drop-in lasted a few hours.
Of course, your parents tend to stock-pile all the issues until you arrive. Then it takes longer to address everything. The same is true for our visits. Clients may save up the dishes and the housekeeping and laundry pile up. The items you plan in advance that you figure might take an hour or so end up taking much longer when the list keeps growing!
It’s not just about tasks; it’s also about pacing.
If you personally have a doctor’s appointment at 11 am, how much time do you allow yourself to get showered, dressed, ready and out the door? Now, what if your parents have a doctor’s appointment at 11 am? It takes a lot more time since every step in the process needs to be adjusted to allow the extra time they may require or prefer.
It likely takes much longer for them to manage to get in and out of the shower. Selecting an outfit and dressing likely takes longer, as does personal grooming and other morning routines. Physically getting into and out of the car may take longer, and your parents may prefer to be at the appointment 20 minutes early instead of arriving just on time. . .despite the fact that the doctor is always behind schedule and you know you’ll end up waiting anyway!
Out of respect for your parents, we allow significant time for outings to ensure that we can match their preferred pace, not our preferred pace. We know that each stage will take much longer and that we need to allow lots of extra time should something unexpected arise. If we’re just getting your parents settled in the car and your mother suddenly needs the washroom once more before leaving, we need to have allowed lots of extra time to deal with the (somewhat) unexpected. For your parents’ sake, we would never attempt to accomplish an outing in only an hour long shift. Part of providing dignified care is allowing sufficient time for outings and errands and matching your parents’ pace, not necessarily just focusing on fastest efficiency. It takes time to do things well and the minimum time we need to ensure top quality is three hours.
Granting your parents the dignity of matching their preferred pace, ensuring that we have extra time built in for the unexpected, and knowing that they may have a stockpiled list ready for our arrival are all part of how we plan in advance to meet your parents’ needs.
Relationships are about so much more than speed and efficiency; your parents will thrive from the attention they receive from a wonderful caregiver who takes the time to appreciate them for who they are and who gets to know them on a personal level without rushing.