On May 12, 2010 we participated in a celebration of Nurses Week with the Gerontological Nursing Association.
We had a diverse audience made up of Nursing Students, Nurses in active practice as well as several honoured guests, now living at the Belmont Nursing Home, who were retired Nurses. Talk about perspective!
The most experienced of the group reminisced about the days when flight attendants had to be Registered Nurses and the newest of the group, were a group of Nursing students in their consolidation period but visiting Toronto from Finland.
We met for dinner and a presentation by Nurse and social justice advocate Cathy Crowe.
You may remember Cathy as a candidate in the recent Ontario by-election. She ran in the riding where George Smitherman gave up his seat in order to toss his hat into the mayoral ring. (Unfortunately her bid for a seat was not successful).
Cathy has an impressive resume. She has become known as the "street nurse" and in addition to providing frontline nursing care, works with her peers, meeting with various Ministers in efforts to promote social justice - particularly around the issues of housing, medical care and nutrition for the poor. Also to her credit, she is an author and a documentary film maker.
Cathy spends her working days facing difficult situations but remains a positive, enthusiastic, practical and energetic professional.
What a perfect choice for a Nurse colleague to honor during Nurses Week.
Lisa
Friday, May 14, 2010
Wednesday, May 12, 2010
Ask Lisa - recent inquiry
I receive inquiries every day from near and far, from people trying to organize care for an elderly person in their lives. From time to time, I'll publish some of those inquiries here, (names withheld of course)along with the advice I've given. Hopefully you will find these scenarios instructive and you will come to see that there are many people who are struggling with the very same issues as you. Perhaps you'll even learn about some new resources or approaches that would work in your own situation.
Best Wishes,
Lisa
Sent: May 4, 2010 9:27 PM
To: Lisa Wiseman
Subject: Loss of appetite
I am desperate for some guidance.
My 88 year old mother has lost her desire to eat. She just recently came down with pneumonia in mid April and was treated with a 7 day prescription of Avelox. After her first pill there was a marked improvement in her pneumonia symptoms and she seemed to be bouncing back. ½ way through her prescription she was still eating.
We were so anxious to cure the pneumonia that we continued the remainder of the prescription, not noticing that she had developed some redness and soreness in her mouth which looked quite painful. Her mouth appears healed now however she does not seem to want to eat. It is a battle just to get some liquids into her.
I am still hoping that the loss of appetite is due to the pneumonia and that she has not made a 100% recovery yet, even though she finished her medication two weeks ago. I have also read some pretty scary things about Avelox.
I know every situation is different and there is always a chance of some underlying condition causing the lack of desire to eat, but to you have any advice or treatment that you can recommend?
I am in the process of trying to assess her care needs, I know we need help with her. I hesitate to take her back to the hospital because she gets so confused when she is out of familiar surroundings. Since her illness I have been working from home half days trying to encourage her to eat and not winning the battle.
Thank you for listening.
Hi Anne,
There seem to be a number of health concerns for your mother at this time. The most pressing, from what you have described in your e-mail, is fluid intake. If your mother has not been drinking well for the past number of days, she is likely dehydrated and should be taken to an emergency department so that she can be assessed and if needed, receive fluids by IV.
With respect to her pneumonia, often times it is not resolved quickly and it often takes more than the first course of antibiotics. She should be followed by either her doctor or a visiting nurse.
There are various reasons why your mother may be reluctant to eat. I would need to know a little bit more about your mother and her health before offering an opinion.
If you have further questions, would like to provide us with more information or would like to arrange an assessment by a Registered Nurse, please contact us at any time.
Best Wishes,
Lisa Wiseman BScN RN
President
Eldercare Home Health Inc.
234 Eglinton Ave. East, Suite 207
T: 416 482-8292
F: 416 482-8278
www.EldercareHomeHealth.com
Best Wishes,
Lisa
Sent: May 4, 2010 9:27 PM
To: Lisa Wiseman
Subject: Loss of appetite
I am desperate for some guidance.
My 88 year old mother has lost her desire to eat. She just recently came down with pneumonia in mid April and was treated with a 7 day prescription of Avelox. After her first pill there was a marked improvement in her pneumonia symptoms and she seemed to be bouncing back. ½ way through her prescription she was still eating.
We were so anxious to cure the pneumonia that we continued the remainder of the prescription, not noticing that she had developed some redness and soreness in her mouth which looked quite painful. Her mouth appears healed now however she does not seem to want to eat. It is a battle just to get some liquids into her.
I am still hoping that the loss of appetite is due to the pneumonia and that she has not made a 100% recovery yet, even though she finished her medication two weeks ago. I have also read some pretty scary things about Avelox.
I know every situation is different and there is always a chance of some underlying condition causing the lack of desire to eat, but to you have any advice or treatment that you can recommend?
I am in the process of trying to assess her care needs, I know we need help with her. I hesitate to take her back to the hospital because she gets so confused when she is out of familiar surroundings. Since her illness I have been working from home half days trying to encourage her to eat and not winning the battle.
Thank you for listening.
Hi Anne,
There seem to be a number of health concerns for your mother at this time. The most pressing, from what you have described in your e-mail, is fluid intake. If your mother has not been drinking well for the past number of days, she is likely dehydrated and should be taken to an emergency department so that she can be assessed and if needed, receive fluids by IV.
With respect to her pneumonia, often times it is not resolved quickly and it often takes more than the first course of antibiotics. She should be followed by either her doctor or a visiting nurse.
There are various reasons why your mother may be reluctant to eat. I would need to know a little bit more about your mother and her health before offering an opinion.
If you have further questions, would like to provide us with more information or would like to arrange an assessment by a Registered Nurse, please contact us at any time.
Best Wishes,
Lisa Wiseman BScN RN
President
Eldercare Home Health Inc.
234 Eglinton Ave. East, Suite 207
T: 416 482-8292
F: 416 482-8278
www.EldercareHomeHealth.com
Tuesday, May 11, 2010
Dementia Risk higher for spouse
This week an article appeared in the Globe and Mail citing research that indicated that people who care for spouses with dementia are, on average, six times more likely to develop the condition than those who don't have an affected partner.
This study is no surprise to those of us involved in the care of people with dementia. It is stressful and difficult work, made even more so when the emotional context of a life partner being affected is added.
Dementia caregiving is associated with depression, physical health problems and mortality.
One way of decreasing stress for spousal caregivers is to provide caregiver relief in the form of a professional caregiver. The caregiver, can assist with physical care activities such as bathing, dressing,transferring, toileting and exercises.
The supportive spouse can take the time to socialize with friends, attend a class, exercise or even catch up on some much needed sleep. The supportive spouse will return to their caregiving role refreshed, de-stressed and hopefully less at risk to develop dementia themselves.
At Eldercare Home Health, many of our caregivers have taken the certification program from the Alzheimer Society. It prepares caregivers to work successfully with dementia Clients. Having a professional, reliable caregiver available to offset some of the stress of spousal caregiving, keeps both partners in the marriage as happy, healthy and independent as possible.
This study is no surprise to those of us involved in the care of people with dementia. It is stressful and difficult work, made even more so when the emotional context of a life partner being affected is added.
Dementia caregiving is associated with depression, physical health problems and mortality.
One way of decreasing stress for spousal caregivers is to provide caregiver relief in the form of a professional caregiver. The caregiver, can assist with physical care activities such as bathing, dressing,transferring, toileting and exercises.
The supportive spouse can take the time to socialize with friends, attend a class, exercise or even catch up on some much needed sleep. The supportive spouse will return to their caregiving role refreshed, de-stressed and hopefully less at risk to develop dementia themselves.
At Eldercare Home Health, many of our caregivers have taken the certification program from the Alzheimer Society. It prepares caregivers to work successfully with dementia Clients. Having a professional, reliable caregiver available to offset some of the stress of spousal caregiving, keeps both partners in the marriage as happy, healthy and independent as possible.
Thursday, May 6, 2010
Registered Nurse Supervision - Medications
For those of you who are not familiar with Eldercare Home Health, we always follow up a request for care with a face to face Registered Nurse assessment. It's not that we don't believe the person on the phone who is giving us details about a Client's need for care, it's just that our perspective as the Visiting Nurse, may reveal some additional important safety issues.
We will always want to see a current list of medications. These include prescriptions as well as over the counter medications that a Client may be taking. A Client's doctor or pharmacist may not have been aware of some of these nonprescription medications when they either prescribed or delivered medications.
It always amazes me how many prescriptions some of our Client's do have. Ten medications with three or four differing administration times is not unusual. I don't know about you, but I find it difficult just to remember to take one multi-vitamin each day. These older adults, some of whom have memory deficits, are being asked to organize a personal pharmacy!!
We always recommend either a medication dossette - a "pill box" with multiple compartments that clearly show when medications are due, or asking the pharmacy to provide blister packs - a pill "card" where the times and dates are clearly labelled for each day and the Client can punch out the medications when they are due.
There are so many variables to be aware of when taking medications. Some medications must be taken with food. Some must be taken on an empty stomach. Some medications interact with one another. Others must be taken at specific intervals to be effective. Some medications are best taken in the evening and some in the morning. Lifestyle factors must be taken into consideration for some medications, like a diuretic or "water pill" where a Client will need to be close to the bathroom for a period of time when the medication will cause a strong urge to void.
There are some medications which are not well tolerated by seniors. Codeine is an example of a medication where the side effects make it a less than perfect choice for many seniors. Codeine can be found in Tylenol 1,2 and 3. The numbers represent how much codeine is in each tablet. One of the unfortunate side effects of codeine is constipation. Another is to make the Client seem "loopy" (not a medical term) or confused.
Despite these well documented side effects, many seniors still receive prescriptions for codeine when they present to hospital with complaints of pain, for example, after a fall.
In addition to these known side effects, interactions and timing issues, there are also issues relating to absorption, allergies and individuals differing responses to medications.
Taking the right medications, in the right dosages, by the right route, at the right time is a complicated matter. Sorting it all out will mean that the Client is receiving the optimal effect from the medication.
Clients must be sure that all prescribing physicians and the pharmacist filling the prescriptions are aware of all of their medications, even the over the counter ones or "natural remedies". And of course, having the expertise of a Registered Nurse,specialized in the care needs of the elderly, to assist with monitoring medication efficacy will go a long way to minimizing potential side effects and negative outcomes of medication administration.
When it comes to starting with new medications or determining the right medications for Clients there's the old adage that I always practice by: Start Low....Go Slow.
We will always want to see a current list of medications. These include prescriptions as well as over the counter medications that a Client may be taking. A Client's doctor or pharmacist may not have been aware of some of these nonprescription medications when they either prescribed or delivered medications.
It always amazes me how many prescriptions some of our Client's do have. Ten medications with three or four differing administration times is not unusual. I don't know about you, but I find it difficult just to remember to take one multi-vitamin each day. These older adults, some of whom have memory deficits, are being asked to organize a personal pharmacy!!
We always recommend either a medication dossette - a "pill box" with multiple compartments that clearly show when medications are due, or asking the pharmacy to provide blister packs - a pill "card" where the times and dates are clearly labelled for each day and the Client can punch out the medications when they are due.
There are so many variables to be aware of when taking medications. Some medications must be taken with food. Some must be taken on an empty stomach. Some medications interact with one another. Others must be taken at specific intervals to be effective. Some medications are best taken in the evening and some in the morning. Lifestyle factors must be taken into consideration for some medications, like a diuretic or "water pill" where a Client will need to be close to the bathroom for a period of time when the medication will cause a strong urge to void.
There are some medications which are not well tolerated by seniors. Codeine is an example of a medication where the side effects make it a less than perfect choice for many seniors. Codeine can be found in Tylenol 1,2 and 3. The numbers represent how much codeine is in each tablet. One of the unfortunate side effects of codeine is constipation. Another is to make the Client seem "loopy" (not a medical term) or confused.
Despite these well documented side effects, many seniors still receive prescriptions for codeine when they present to hospital with complaints of pain, for example, after a fall.
In addition to these known side effects, interactions and timing issues, there are also issues relating to absorption, allergies and individuals differing responses to medications.
Taking the right medications, in the right dosages, by the right route, at the right time is a complicated matter. Sorting it all out will mean that the Client is receiving the optimal effect from the medication.
Clients must be sure that all prescribing physicians and the pharmacist filling the prescriptions are aware of all of their medications, even the over the counter ones or "natural remedies". And of course, having the expertise of a Registered Nurse,specialized in the care needs of the elderly, to assist with monitoring medication efficacy will go a long way to minimizing potential side effects and negative outcomes of medication administration.
When it comes to starting with new medications or determining the right medications for Clients there's the old adage that I always practice by: Start Low....Go Slow.
Wednesday, May 5, 2010
HST Impact on Frail Seniors and their Families
HST poses a threat to seniors living at home.
The proposed tax represents a significant financial barrier to seniors who require personal care in order to remain safely in their homes.
The application of the proposed HST on home health care services for seniors will also have a negative impact on seniors and their families.
The financial resources of the healthcare system are stretched. For many seniors, hiring supplementary care is not a luxury, it’s a necessity. Having help at home can mean the difference between staying at home safely and maintaining their health and independence, or having to make multiple trips to the Emergency Department, and possible admission to a Long Term Care Facility.
Seniors who receive home health care services save Ontario tax payers money by reducing the demand for urgent medical interventions. They also reduce the burden on Emergency Rooms. Treatment costs for acute care are astronomical. Home health care, by comparison, is not (not to mention that it is the individual and his/her family that is bearing the lion’s share of the cost for home health care while it is the taxpayer bearing the cost for institutional and acute care stays.)
People willing to take on the responsibility and the cost for their home health care reduce the financial impact on the healthcare system as a whole, yet the HST is coming along to penalize them.
The additional cost for a senior, as a result of the proposed HST can range from $713per year for someone receiving 4 hours of care 3 times a week to $7981 per year for someone receiving 12 hours of care 7 days a week.
It is not only wealthy seniors that hire supplementary care. Many seniors, who would be considered to be middle income earners, have made the decision to commit their financial resources to prioritize their own independence and safety.
Application of the HST to home health care services will have a negative impact on the ability of some seniors to make the best health care decisions.
Another possibly overlooked and undesirable effect of the HST will be to encourage more illegal, “under the table” financial arrangements between seniors and caregivers. These “work for cash” arrangements have both parties avoiding paying remittances to Revenue Canada, (CPP, EI, EHT..) and often times the work arrangements are in contravention of Canadian Labour Laws. In most of these cases, these illegal arrangements mean that there is no workplace insurance.
Vulnerable seniors are already at greater risk for such things as unreported accidents, physical, mental or financial abuse, theft, neglect etc. Forcing individuals and their families to consider illegal care workers and illegal financial payments puts these already vulnerable seniors at even greater risk.
The HST will affect seniors who need care – people who have paid taxes all their lives – at a t time when they need help the most. To be respectful, fair and fiscally responsible, the cost of seniors’ home health care needs to be exempt from the HST.
The proposed tax represents a significant financial barrier to seniors who require personal care in order to remain safely in their homes.
The application of the proposed HST on home health care services for seniors will also have a negative impact on seniors and their families.
The financial resources of the healthcare system are stretched. For many seniors, hiring supplementary care is not a luxury, it’s a necessity. Having help at home can mean the difference between staying at home safely and maintaining their health and independence, or having to make multiple trips to the Emergency Department, and possible admission to a Long Term Care Facility.
Seniors who receive home health care services save Ontario tax payers money by reducing the demand for urgent medical interventions. They also reduce the burden on Emergency Rooms. Treatment costs for acute care are astronomical. Home health care, by comparison, is not (not to mention that it is the individual and his/her family that is bearing the lion’s share of the cost for home health care while it is the taxpayer bearing the cost for institutional and acute care stays.)
People willing to take on the responsibility and the cost for their home health care reduce the financial impact on the healthcare system as a whole, yet the HST is coming along to penalize them.
The additional cost for a senior, as a result of the proposed HST can range from $713per year for someone receiving 4 hours of care 3 times a week to $7981 per year for someone receiving 12 hours of care 7 days a week.
It is not only wealthy seniors that hire supplementary care. Many seniors, who would be considered to be middle income earners, have made the decision to commit their financial resources to prioritize their own independence and safety.
Application of the HST to home health care services will have a negative impact on the ability of some seniors to make the best health care decisions.
Another possibly overlooked and undesirable effect of the HST will be to encourage more illegal, “under the table” financial arrangements between seniors and caregivers. These “work for cash” arrangements have both parties avoiding paying remittances to Revenue Canada, (CPP, EI, EHT..) and often times the work arrangements are in contravention of Canadian Labour Laws. In most of these cases, these illegal arrangements mean that there is no workplace insurance.
Vulnerable seniors are already at greater risk for such things as unreported accidents, physical, mental or financial abuse, theft, neglect etc. Forcing individuals and their families to consider illegal care workers and illegal financial payments puts these already vulnerable seniors at even greater risk.
The HST will affect seniors who need care – people who have paid taxes all their lives – at a t time when they need help the most. To be respectful, fair and fiscally responsible, the cost of seniors’ home health care needs to be exempt from the HST.
Tuesday, May 4, 2010
Interview by CBC
Last week I had the opportunity to be interviewed by Karen Horsman of CBC radio on the topic of the government's decision not to regulate Personal Support Workers. Here's an overview of our discussion;
Karen asked me to speculate on the reasons that the decision was made not to regulate and why I thought it had turned out that way.
We know that regulation is seen as a positive measure to assure public safety and a high standard of practice from our health professionals. Nurses, dentists, doctors, physiotherapists are all regulated health care professionals. Personal Support Workers interact with a vulnerable sector of the public and it would stand to reason that their practice be regulated.
There are a couple of reasons that come to mind as possibly contributing to the decision not to regulate Personal Support Workers.
1. The sheer number. There are apparently 100,000 PSWs who have now graduated from either a College or vocational school program. To wrangle that many individuals and attempt to regulate their practice could prove to be a logistical nightmare.
2. There would be a large price tag attached to the creation of a new regulatory body, the development of a set of standards of practice and education, an enrollment procedure for the current practitioners and the development of leadership and committees to oversee the practice of current and future Personal Support Workers.
3. A lack of recognition for the value of the role. It may be that the decision makers undervalue the work of the Personal Support Worker. Certainly any one of us who has needed the care of a PSW for ourselves or for a loved one, can attest to the value of their work.
One comment made was that the Personal Support Worker does not have a distinct body of knowledge to call their own and therefore should not be recognized and regulated as a profession. However, Personal Support Workers have a valuable role in our health care system. They do graduate from a course of study set out by the Ministry of Education and they write a standardized exam in order to become "certified".
So, what to do?
We need to recognize the skills and contributions of the Personal Support Workers as a necessary part in the care of seniors. We already see the value of regulation for health care professionals and the PSW must be recognized as a valued newcomer to this group. All 100,000 existing title holders do not have to be regulated tomorrow. A 5 or 7 year plan to reach all existing practitioners is a realistic one. But for the very same reasons that we see value in the regulation of other health care practitioners; to set standards of practice; to protect the public; to standardize education; and to provide leadership and discipline even, we must begin the process of recognizing and regulating this group.
Karen asked me to speculate on the reasons that the decision was made not to regulate and why I thought it had turned out that way.
We know that regulation is seen as a positive measure to assure public safety and a high standard of practice from our health professionals. Nurses, dentists, doctors, physiotherapists are all regulated health care professionals. Personal Support Workers interact with a vulnerable sector of the public and it would stand to reason that their practice be regulated.
There are a couple of reasons that come to mind as possibly contributing to the decision not to regulate Personal Support Workers.
1. The sheer number. There are apparently 100,000 PSWs who have now graduated from either a College or vocational school program. To wrangle that many individuals and attempt to regulate their practice could prove to be a logistical nightmare.
2. There would be a large price tag attached to the creation of a new regulatory body, the development of a set of standards of practice and education, an enrollment procedure for the current practitioners and the development of leadership and committees to oversee the practice of current and future Personal Support Workers.
3. A lack of recognition for the value of the role. It may be that the decision makers undervalue the work of the Personal Support Worker. Certainly any one of us who has needed the care of a PSW for ourselves or for a loved one, can attest to the value of their work.
One comment made was that the Personal Support Worker does not have a distinct body of knowledge to call their own and therefore should not be recognized and regulated as a profession. However, Personal Support Workers have a valuable role in our health care system. They do graduate from a course of study set out by the Ministry of Education and they write a standardized exam in order to become "certified".
So, what to do?
We need to recognize the skills and contributions of the Personal Support Workers as a necessary part in the care of seniors. We already see the value of regulation for health care professionals and the PSW must be recognized as a valued newcomer to this group. All 100,000 existing title holders do not have to be regulated tomorrow. A 5 or 7 year plan to reach all existing practitioners is a realistic one. But for the very same reasons that we see value in the regulation of other health care practitioners; to set standards of practice; to protect the public; to standardize education; and to provide leadership and discipline even, we must begin the process of recognizing and regulating this group.
Wednesday, March 31, 2010
We're sponsors of the North York Senior Games
We are happy to be supportive of events, like this one, that offer opportunities to seniors to keep mentally and physically active in the community.To find out more;
http://www.ontarioseniorgames.ca/complete-list-of-40-districts/-15-north-york-6.html
http://www.ontarioseniorgames.ca/complete-list-of-40-districts/-15-north-york-6.html
Wednesday, March 24, 2010
Alzheimer Certification and Training for our Caregivers
Once again we are delighted to be partnering with the Alzheimer Society to offer caregivers of Eldercare Home Health Enhanced Training for Formal Caregivers of Persons with Dementia.
This 9 hour course uses a person centred approach to care, the goal of this comprehensive program is to enhance the knowledge and understanding of dementia of front line workers, enabling them to provide quality care for persons with dementia.
Many of our caregivers have successfully completed this certificate course. They have provided positive feedback about their ability to apply new learning to their everyday practice. Our next classroom is scheduled to begin in April.
This 9 hour course uses a person centred approach to care, the goal of this comprehensive program is to enhance the knowledge and understanding of dementia of front line workers, enabling them to provide quality care for persons with dementia.
Many of our caregivers have successfully completed this certificate course. They have provided positive feedback about their ability to apply new learning to their everyday practice. Our next classroom is scheduled to begin in April.
Friday, March 19, 2010
Social Work Clinic Day at North York General Hospital
We were pleased to be part of the March 3rd special learning opportunity offered by Social Workers at North York General Hospital. Their speaker, Brigette Kitchen, was very well received. The event attracted about 75 participants and included those practicing at the Branson site - the lecture was shared by webcam broadcast.
Attendees at both sites enjoyed a buffet lunch, received lootbag gifts and entered to win the latest book by Jack Lalanne - Live Young Forever.
We lunched, we learned, and caught up with colleagues. What a productive lunch hour!
Attendees at both sites enjoyed a buffet lunch, received lootbag gifts and entered to win the latest book by Jack Lalanne - Live Young Forever.
We lunched, we learned, and caught up with colleagues. What a productive lunch hour!
Thursday, February 25, 2010
Social Work Clinic Day
The first week of March is Social Work Week in Ontario. We are happy to have the opportunity to support several educational events for our Social Worker colleagues. Next week, March 3, 2010 we are sponsoring the luncheon and speaker at North York General Hospital.The event is entitled "The Long Shadow of Poverty for Social Work Practice” and is being presented by Brigitte Kitchen, M.S.W., Ph.D.
Dr. Brigitte Kitchen is a senior scholar and well respected in the field of social work/social policy and poverty. She is the co-editor and founder of the Canadian Review of Social Policy/Revue Canadienne de Politique Sociale and Professor Emeritus at York University School of Social Work.
We are looking forward to attending this important event and we wish all of our Social Work colleagues an inspiring Social Work Week!
Dr. Brigitte Kitchen is a senior scholar and well respected in the field of social work/social policy and poverty. She is the co-editor and founder of the Canadian Review of Social Policy/Revue Canadienne de Politique Sociale and Professor Emeritus at York University School of Social Work.
We are looking forward to attending this important event and we wish all of our Social Work colleagues an inspiring Social Work Week!
Thursday, February 18, 2010
Photos from the Alzheimer Fund Raising Event
The Alzheimers Walk for Memories was a great success. This is the third year we participated. We sent a team of 34 strong - our largest team size yet! We marched around Brookfield Place, along the underground PATH. There was food, friends and fundraising - a great combination. Check out the photos listed under EVENTS on our website; www.eldercarehomehealth.com
Wednesday, February 17, 2010
What we're all about
We're a home health care service, dedicated to providing for the care needs of people over 80 years old. Our Clients live in Nursing Homes, Retirement Homes or their own "Home Sweet Home". We see people over 80, on average 90 and many people over 100 years old. Our Clients are diverse - some incredibly vital and well at 101years of age, some not as well at 80. We provide care, delivered by Personal Support Workers and supervised by Registered Nurses, to seniors in the GTA. We've been doing this since 1995. You're welcome to find out more by visiting our website - www.eldercarehomehealth.com
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