By now your body has started to tell you that it too is 70+ years old – if it hasn’t already begun to cave. And like it or not, older folks need help and yes, they need to request assistance because their parts just don’t work as well as they did. Maybe not all of your faculties are beginning to diminish, but some of them ARE. Best to admit that cleaning out eavestroughs, installing storm windows, turning mattresses, cleaning behind the refregierator and the stove are best left to more agile and stronger bodies.

Face it. It just isn’t worth the pain (in your hands, your back, knees – or head post fall)  to be in denial. Most of all denial could be the cause of loss of independence – that very aspect you are gripping onto.
The easiest people to ask for help are your family members - if you are fortunate to have kids. And if you are really fortunate, your children (and their kids) live around where you are or not far. And they like you and you like them.
If children aren’t close, then start to build your support “family” so that you have help when you need it. Don’t be in denial. The very last event you want to have happen is to land in a hospital emergency with no one to advocate for you; the second last thing you want to happen is to have made no plans about what to do if you land in “emerge”.

One day this will happen – not might; WILL!

I recommend that you don’t be mean to your kids so that they will want to help you when you want help. Yes, read the sentence again.

You are not in denial but you also don’t want interference – at least not yet. You are in control i.e. on top of your affairs because you are not in denial. You cannot shovel the snow so a neighbour’s child is helping you out. You don’t need to show off your muscles any more: you need to show off your common sense. When the weather is really inclement you are willing to hand over your grocery list to the neighbour if you are at risk for a fall. You have installed a Lifeline in your home if you live alone and you keep it handy: it’s not left on the bed post. You have connected to at least 3 neighbours or family members who could be at your side in a heartbeat if you need help. They don’t need to be medical folks – just trusty neighbours with common sense if you need a hand up – literally.

Not one of these actions diminishes your independence or speaks to anyone about being old. All demonstrate common sense, love of life and reassuring your support team that you are wise because you have mitigated potentially hazardous situations.

If any reader is concerned about their faculties or a family member has a gut instinct that all’s not well in their parent’s home, the holidays are a good time to spend a little more time initiating an amiable discussion about the future. Our parents are really good at pulling the wool over our eyes for a few hours; it’s much more difficult to cover up for a day or two during a holiday visit.

Recall: no plan = a crisis = no control = loss of independence = diminished quality of life.

I wouldn’t wish this on anyone.

Please read the Financial Post, Thursday November 29, 2013 for another angle to this theme. It’s on the back page.

Readers who are not aware of the benefits of these programs in facilites – both Long Term Care and retirement residences let me enlighten you:

1. Improve and maintain strength and flexibility and subsequently maintain optimum quality of life
2. Post injury rehabilitation which will optimally keep the person on their feet
3. Improve mood and even overcome depression
4. Source of camaraderie, scheduling, normalcy – also something meaningful to do
5. Improved appetite, regularity, homeostasis
6. A place to go to in LTC where someone has time to talk who knows you (it isn’t often that the environment changes within a long tern care facility for some residents)
7. Opportunities to retain a sense of empowerment
8. An opportunity to regain lost abilities
9. and more

Some lucky residents won’t be as affected by these changes because they own health benefits that will mitigate the loss of the programs. In the community they will have to find the physio centers and the transportation.

I am counting on an intrepid graduate student who will track the results (catastrophic?)from this loss of daily physio in Ontario’s eldercare facilities. If you have been in the senior care field for more than a decade you will recall Dr. Marcus Hollander’s study in B.C where elders were lined up to get into facilities after that Ministry withdrew their home help. If I recall correctly the line-ups began only 6 months after cancelling the non-profit service. I will predict that elders will be lining up at emergency doors in Ontario hospitals due to this poorly thought out policy change.

How long? Well, it takes only a week of lying in bed  to change an elder’s muscles to mush. (They can lose up to 5% per day when the muscle is not used!!) so I predict that by February, 2014 we will see the negative affects of this policy change.

Not a day goes by that we aren’t reading, hearing and seeing the benefits of exercise for everyone. Why shouldn’t our elderly Ontario folks be treated the same? They don’t want to be in these facilities but due to their disabilties that cannot cope in the community and there are few options. I believe that it is our civil duty to provide them with humane and responsible care. This is includes a supervised daily walking program, minimally.

To lose your exercise opportunities? In a word: irresponsible.

Will we ever learn?

Sadly but not surprisingly, the report said that our health system is fundamentally fractured and failing — especially for vulnerable groups such as children, the elderly, aboriginal peoples and those with mental illness.

For elderly patients, one of the reason the system fails them is because it was not designed for long term care or care provided in the home. It is designed for short term hospital stays, which is reinforced by funding models. The result is that when an elderly patient falls ill, the focus is on getting them back to the point where they can free up a hospital bed rather than restoring their health and helping them get ‘on their feet’.

Today, there is no other place to get care for a medical “emergency” for the elderly and this is a shame. It is costly, inconvenient and the elderly are given a bad rap as bed blockers. My recommendation: get ‘em up and outa there to their own facility which will support them. And then send them home with community supports to enable ongoing rehabilitation.

In an ideal world, we would have more health care professionals such as physiotherapists and nurse practitioners (who follow-up the doctor’s orders), occupational therapists, visiting pharmacists, geriatric care managers to provide care once an elderly patient is discharged from the hospital. Currently discharge planners are obligated to get patients on the road as quickly as possible – at the very least out of hospital beds. (Yes, old folks can land in ALC beds but this is completely unnecessary if post-care in the community was better and available). And let me be clear: this is not patient care orchestrated and delivered by families.

A convalescent care facility would have a slower pace and caregivers would have a better understanding of the elderly and their shortfalls (poor hearing and eyesight, poor balance, perhaps some denial of their predicament). Any of you caring for an elderly person can add to the list.

Another advantage of this approach is that there is less cost because all the care is in one place, reducing the need to move patients from one facility to another. It is also easier on the patient and ensures that all of the recommended treatment is followed.

Until there is a caring facility in place the elderly will be forced back to the hospital doors, needing more medical care “plugging up” the emergency system again. The hospital system of care as designed to-day is not for the chronically ill. Inroads have been made (GEM) but essentially the elderly should not be in a hospital at all. And we know this.

Denial starts when clear information isn’t provided in the hospital by a doctor. Too often the elderly patient doesn’t have a clue who the doctor is and consequently family is left explaining the situation, and the elderly person is in denial. This is not a family responsibility. The elderly patient should not have to schedule yet another appointment with their primary care physician to receive this information. A bedside visit prior to discharge would be so helpful to their recovery and future planning.

If your family member is in the hospital, try and arrange for a bedside visit where the doctor makes it clear what future treatment will be and what the patient should expect in terms of recovery. If at all possible, it is important that another family member be present during the meeting and that way they can help to make sure that your elder understands what the doctor is saying.