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.
Are you doing everything for your elderly parents?
Thursday, January 24, 2019
You’ve been managing your own household, your parents’ household and now your in-laws need some help too. You already feel stretched too thin, and your parents’ needs keep increasing. You need homecare support for your parents, but they refuse to even consider it.
Your father says he “doesn’t need a babysitter” and your mother declares that she can “do everything just fine myself”. And by that, what she really means is that you are doing everything just fine for them!
Your parents think they’re managing just fine because you’re filling in all the gaps. They don’t realize just how much you’re doing. They just benefit from the fact that everything gets done.
For years, you’ve been trying to follow your parent’s wishes. You respect their decisions and do your best to help support them in those decisions. They keep saying they don’t want or need any help and you’ve been trying to respect it.
The problem is, they not only need the help, but they are also already receiving help. The help is coming from you, and it’s now more than you can manage on your own. It is okay to acknowledge that you can no longer provide all the assistance that they need. You aren’t failing to respect their decision, you are making a decision that is necessary for your own health and wellness.
You can explain to your parents what you are able to do, and outline the tasks that are now becoming too much. You can outline options for how your parents can fill the remaining gaps and empower them to make a decision that best suits their needs.
For example, you are willing to do the weekly grocery shopping and visit with your parents after putting all the groceries away, but it is no longer feasible for you to be cooking dinner for them every day.
You can then outline meal options for them. They could order Meals on Wheels or another meal delivery service. They could move into a retirement home where meals are provided. They can have a caregiver cook meals together with them in their own kitchen, using their own preferred recipes.
You can help outline the pros and cons of each option, and how each option would fit into their lifestyle.
Stepping back and acknowledging what you need for yourself does not take away your parents’ ability to make their own decision. It just eliminates one of the options from the list—the option of you cooking the meals daily.
As long as you continue to be the primary option, as long as you continue to cook dinner daily, your parents will not seriously consider any other option on the list. You need to clearly articulate what you can and cannot do, and then guide your parents through the decision making process about how to solve the remaining gaps.
Homecare can address many of those gaps and provide the individualized attention and assistance they are accustomed to receiving. Homecare is not always just about the senior client; it is often about alleviating family members who have been doing far more than is sustainable.
A wonderful caregiver—or team of caregivers—can take care of your parents’ to-do list so that it doesn’t all fall on your shoulders.
You’re worried about your parents and you think they could use more help. You suggested homecare, but they wouldn’t hear of it. They told you: “we’ve managed just fine on our own this long, we don’t need any help.”
What they’re really saying is that they don’t want to face change.
That’s because change is scary.
Change is scary for all of us, at some level. Each person has a different tolerance for change, and it might take a lot more change to scare some people than others. But if you introduce a drastic enough change, eventually, any of us would feel trepidation about that change.
It’s little wonder then, that for seniors in their 80’s or 90’s, the thought of even a small change can be quite scary. After eight or nine decades, they are likely pretty set in their ways. They want things done a certain way; they want to keep their environment the same. As long as everything remains the same, it feels more manageable. It might help your parents to understand that homecare is all about reducing the amount of change that your parents will experience.
Warm Embrace Caregivers are trained to match each client’s specific preferences.
Caregivers DO NOT barge into a client’s home and just take over. Caregivers DO wait to be invited in, and they ASK permission to proceed. They ask how that particular client prefers the laundry or housekeeping to be done. They cook from the client’s recipes or directions to match their particular tastes. They help to keep clients’ lives consistent.
Homecare is one of the best prevention strategies to one of the biggest possible life changes: admission to a long term care home. Moving to long term care is a HUGE change—absolutely every single element of someone’s routine is changed. From the time they get out of bed, to when they eat, and whether they wear pyjamas to breakfast—everything is adjusted to match the schedule of the long term care home.
Homecare ensures that individual clients maintain their own personal routine, they maintain their home, they maintain familiar comforts. Caregivers match clients, rather than clients matching caregivers. It reduces the amount of change they must experience.
Since homecare is completely client-focused, each client calls the shots. The client decides what they’re doing each day and how they want things done and in which order. It is very empowering for seniors to get to make all the decisions that impact their own day-to-day living. Homecare grants this level of autonomy and independence.
Help your parents to see that homecare will ensure the least amount of change and help them to maintain the lifestyle that they know and love.
What do you get for the grandparent or senior who already has everything? The great-grandparents are even harder to shop for! What is the perfect gift for someone who is 80+? Different gifts are ideal depending upon where someone lives. Here are two gift list ideas to suit different living situations.
4 IDEAS FOR SENIORS LIVING AT HOME
If your 80+ relative is living independently at home (either a house, condo, or apartment), then the best gifts you can give them are practical items that will prolong their independence. Your loved one is likely very focused upon remaining at home for as long as possible; any gift you give that helps in achieving that goal is a good idea.
Here are some suggestions
1. Gift Certificates for property maintenance. The physically demanding activities of home maintenance are likely difficult, so provide your loved one with a gift certificate for regular home maintenance chores such as snow shovelling, grass cutting, garden upkeep, window washing, etc.
2. Homemaking and Household Assistance. Out-door house maintenance is not the only area of challenge for the elderly. Household chores can also become quite onerous. Your loved one will greatly appreciate a gift certificate for housekeeping.
3. Assistive Devices. Assistive devices can include a whole range of products to help with any variety of needs. There are specially designed items for challenges such as hearing impairment, sight impairment, weakness following a stroke, dexterity, memory loss, etc. You might be surprised at some of the items available for purchase at your local assistive devices store. Your loved one will truly appreciate this gift if they have already acknowledged challenge in a particular area.
4. Transportation. Many elderly seniors no longer have a licence and no longer drive. No access to transportation can be isolating, especially in the winter months. Providing your loved one with pre-paid driving options ensures that they will not be home-bound when the winter weather hits. Warm Embrace caregivers are pleased to drive your loved ones wherever they need to go.
4 IDEAS FOR THOSE LIVING IN NURSING HOMES
If your loved one lives in a retirement home or long-term care centre, then different gifts might be more appropriate. Their personal quarters are much smaller, so they do not have space to keep many belongings. Here are some ideas that won’t take up too much space but will still bring a smile on Christmas day.
1. Window Ornaments. Glass window ornaments are pretty to look at, and cast a cheerful glow when the sun is shining. There may not be much shelf space available for knick-knacks, but adding a personal touch to the window doesn't take up any additional space.
2.Personal Items. Residents in long-term care use their own preferred personal care items such as hand soap, lotion, toothpaste, etc. A care package of your loved one’s favourite items is always appreciated! The scent is strongly linked with memory and emotion; selecting a favourite scent can induce positive memories.
3. Blanket or Lap Quilt. Having a cozy item such as a small blanket or lap quilt is always comforting. It can be left on the bed or on a chair in your loved one’s room. If recognition of new items is difficult for your loved one, a blanket on the bed implies its purpose in a way that new clothing items do not.
4. Companionship. Providing your loved one with on-going visits is probably the best gift you could offer. Warm Embrace provides Companion Aides to long-term care centers across the region. Companion Aides visit one-on-one with residents and can take them on personal outings into the community. They provide mental and social stimulation, as well as an opportunity for physical activity. This is a gift that keeps on giving long after the holiday season!
FOR SENIORS LIVING ANYWHERE:
Triple Vitality. This gift is suitable for someone living in retirement or long-term care, as well as those still living in the community. Triple Vitality is a proactive approach that focuses on three areas of health—physical fitness, mental stimulation, and social interaction. By maintaining strength and functioning in each of these areas, people maintain independence and enjoy an increased quality of life.
If you just have questions about the above list of gift ideas, please don’t hesitate to call. We love to know that the seniors in this area will have a meaningful holiday season!
These are great ideas. Thank you so much! I also wanted to say if you have clients in need of Foot Care, Basic or Advanced (diabetics etc.) I offer this service in Listowel, Milverton, Rostock, Stratford and some in Cambridge areas. Foot Care is a great gift for the elderly as well. :)