Group items tagged

Our report shows that while demand for seniors' housing in B.C. is outpacing supply as more seniors opt for homes in independent living communities , not enough is being done to understand their longer-term health and housing needs. In the next 25 years, seniors will make up 25 per cent of B.C.'s population. We think it's time for the provincial and municipal governments to sit down with us and come up with a new plan to support the development of more independent housing and assisted living as a cost-effective alternative to residential care.

We also need improved planning and implementation of home health services provided by the Ministry of Health and the health authorities to residents of independent living communities to allow them to remain in the communities for as long as possible. There are approximately 355,700 people in B.C. over the age of 75, of which 8.2 per cent live in seniors' residences. Improved utilization and expansion of B.C.'s independent living and assisted living sectors to accommodate residents with a broader range of health and social needs could reduce reliance on residential care.

In the past, residential care was the primary option for people who needed additional care and support, but increasing costs and a shortage of publicly subsidized residential care facilities led to the development of publicly subsidized assisted living facilities. Since 2004, there has been a dramatic increase in the number of both independent living and assisted living units, which are often located in the same development and provide many benefits for their residents. But the time has come to take a fresh look at the services available to seniors and how we provide them. For example, the Ministry of Health could explore options to allow registered assisted living facilities to offer a more flexible approach to what and how services are provided to residents. Expanding the range of services could allow residents to return from hospital sooner and free up beds for other patients, or delay their admission to residential care facilities .

Not everyone has the resources to look after their own care and housing needs in their senior years, but the public resources to help are not unlimited. That means we have to be smart how we develop and implement policies for our seniors. Carole Holmes is president of the B.C. Seniors Living Association. Elder care in B.C.

Private-pay and publicly subsidized housing and care options for seniors in B.C. include: Independent living: A combination of housing and hospitality services for functionally independent seniors. Assisted living: A semiindependent type of housing regulated under the Community Care and Assisted Living Act and includes housing, hospitality services and at least one, but not more than two prescribed services for people who require regular help with daily activities. Residential care: 24-hour professional supervision and care in a protective, supportive environment for people who have complex care needs and can no longer be cared for in their own homes or in an assisted living residence.

In 2012, age-related needs were identified as the single most common problem requiring help from caregivers (28%) (Chart 1). This was followed by cancer (11%), cardio-vascular disease (9%), mental illness (7%), and Alzheimer’s disease and dementia (6%).

The majority of caregivers reported providing transportation to their primary care receiver, making it the most frequent type of care provided in the last 12 months (73%)

In addition, about half of caregivers (51%) reported that they performed tasks inside the care recipients’ home in the last 12 months, such as preparing meals, cleaning, and laundry. Another 45% reported providing assistance with house maintenance or outdoor work.

The most common types of care were not always the ones most likely to be performed on a regular basis (i.e., at least once a week). For instance, despite the fact that personal care and providing medical assistance were the least common forms of care, when they were performed, these tasks were most likely to be done more regularly.

Emotional support often accompanied other help to the care receiver. Nearly nine in ten caregivers (88%) reported spending time with the person, talking with and listening to them, cheering them up or providing some other form of emotional support. Virtually all caregivers (96%) ensured that the ill or disabled family member or friend was okay, either by visiting or calling.

Overall, caregivers spent a median of 3 hours a week caring for an ill or disabled family member or friend. This climbed to a median of 10 hours per week for caregivers assisting a child and 14 hours for those providing care to an ill spouse (Chart 3).

Most often, caregivers spent under 10 hours a week on caregiving duties. In particular, one-quarter of caregivers (26%) reported spending one hour or less per week caring for a family member or friend. Another 32% reported spending an average of 2 to 4 hours per week and 16% spent 5 to 9 hours per week on caregiving activities.  

For some, caregiving was a large part of their life - equivalent to a full time job. Approximately one in ten caregivers were spending 30 or more hours a week providing some form of assistance to their ill family member or friend.  These caregivers were most likely caring for an ill spouse (31%) or child (29%).5

The actual time spent performing tasks is often combined with time needed to travel to provide care. Approximately three-quarters (73%) of caregivers indicated that they did not live in the same household or building as their care receiver, meaning they often had to travel to reach the care recipients’ home. Just over half (52%), however, reported having to travel less than 30 minutes by car.  Roughly 12% of caregivers provided help to a family member who lived at least one hour away by car.

Certain health conditions required more hours of care. This was the case for developmental disabilities or disorders, where 51% of these caregivers were spending at least 10 hours a week providing help

Caring for an ill or disabled family member or friend can span months or years. For the vast majority of caregivers (89%), their caregiving activities had been going on at least one year or longer, with half reporting they had been caring for a loved one for four years or more.

Four provinces had rates above the national average of 28%, including Ontario (29%), Nova Scotia (31%), Manitoba (33%) and Saskatchewan (34%) (Textbox Chart 1). The higher levels of caregiving in Ontario, Nova Scotia and Manitoba were largely related to caring for a loved one suffering from a chronic health condition or disability, whereas in Saskatchewan, the higher level of caregiving was attributed to aging needs. 

Historically, caregivers have been disproportionally women (Cranswick and Dosman 2008). This was also true in 2012, when an estimated 54% of caregivers were women.

Although the median number of caregiving hours was similar between men and women (3 and 4 hours per week, respectively), women were more likely than their male counterparts to spend 20 or more hours per week on caregiving tasks (17% versus 11%). Meanwhile, men were more likely than women to spend less than one hour per week providing care (29% versus 23%) (Chart 5).

For instance, they were twice as likely as their male counterparts to provide personal care to the primary care receiver, including bathing and dressing (29% versus 13%).

Caregivers have multiple responsibilities beyond caring for their chronically ill, disabled or aging family member or friend. In 2012, 28% of caregivers could be considered “sandwiched” between caregiving and childrearing, having at least one child under 18 years living at home

The aging of the population, higher life expectancies and the shift in emphasis from institutionalized care to home care may suggest that more chronically ill, disabled and frail people are relying on help from family and friends than in the past. Using the GSS, it is possible to examine the changes in the number of caregivers aged 45 years and older, recognizing that methodological differences between survey cycles warrant caution when interpreting any results.

Bearing in mind these caveats, results from the GSS show that between 2007 and 2012, the number of caregivers aged 45 and over increased by 760,000 to 4.5 million caregivers, representing a 20% increase in the number of caregivers over the five years.

Having less time with children was an often cited outcome of providing care to a chronically ill, disabled, or aging family member or friend. About half (49%) of caregivers with children under 18 indicated that their caregiving responsibilities caused them to reduce the amount of time spent with their children.6

Overall, the vast majority of caregivers (95%) indicated that they were effectively coping with their caregiving responsibilities, with only 5% reporting that they were not coping well.7 However, the feeling of being unable to cope grew with a greater number of hours of care. By the time caregivers were spending 20 or more hours per week on caregiving tasks, one in ten (10%) were not coping well.  

In addition, while most were able to effectively manage their caregiving responsibilities, 28% found providing care somewhat or very stressful and 19% of caregivers indicated that their physical and emotional health suffered in the last 12 months as a result of their caregiving responsibilities.

The health consequences of caregiving were even more pronounced when caregivers were asked specific questions on their health symptoms. Over half (55%) of caregivers felt worried or anxious as a result of their caregiving responsibilities, while about half (51%) felt tired during the past 12 months (Chart 8). Other common symptoms associated with providing care included feeling short-tempered or irritable (36%), feeling overwhelmed (35%) and having a disturbed sleep (34%).8

The financial impacts related to caring for a loved one can be significant. Lost days at work may reduce household income, while out-of-pocket expenses, such as purchasing specialized aids or devices, transportation costs, and hiring professional help to assist with care, can be borne from caring for a loved one. In many cases, financial support, from either informal or formal sources, can ease the financial burden associated with caregiving responsibilities. Overall, about one in five caregivers (19%) were receiving some form of financial support. 

After decorating Halloween cookies together, Han brings his own masterpiece, smothered in smarties and sprinkles, to Clark and encourages her to try it. Few words are exchanged, but smiles and giggles are constant at the intergenerational program at Youville Residence, a long-term care facility for seniors in Vancouver. Han Jr. is among a half dozen children visiting this day from the Montessori Children's Community - a daycare located on the same site as Youville, at 33rd and Heather.

Montessori Children's Community administrator Kristina Yang said it's a win-win situation. "Even if there is not a lot of communication with words you can see the beautiful smiles on everyone's face. Many of the children come to know a lot of the seniors and when they pass by our window they'll be excited waving and saying 'Hi ,'" Yang said.

Youville occupational therapist Sheralyn Manning said the children's visits are a big part of the seniors'day. Besides planned events, such as doing crafts together, every so often the children will visit when the weather is bad and they are not able to play outdoors. Manning pointed out the friendship between Clark and Han has been particularly touching to watch and Clark has a recent craft project Han gave her prominently displayed in her room. When most people think of nursing homes the image that comes to mind is a stand-alone building offering residential care only for the aged.

It's a place seldom visited unless you are a family member, friend or volunteer. But these days more homes are trying to build bridges to the wider community. Of B. C.'s 460 government and private nursing homes, only a handful have daycares or doctor's offices on site, said Daniel Fontaine, CEO of the B. C. Care Providers Association, which represents 60 per cent of the privately-operated homes. But none are attached to a facility that offers a large variety of community services. One of the best Canadian examples of a nursing home that achieves just that, said Fontaine, is Niverville Heritage Centre, near Winnipeg. It is home to 116 seniors but is also a gathering place for major community events.

The centre hosts 100 weddings each year. As well, about 50,000 visitors drop in at the centre annually to access their doctor's office, dentist and pharmacist or visit the full-service restaurant and pub. "We found seniors don't want to be retired to a quiet part of the community and left to live out their lives. They want to live in an active community and retreat back to their suite when they want that peace and quiet ," said Niverville Heritage Centre's CEO Steven Neufeld.

Before the centre opened in 2007, he said, members from the non-profit board that operates the centre visited traditional nursing homes and discovered that the lounges that were built for seniors were seldom used. "I remember going to one place where there was a screened-in porch that was packed. The seniors were all there wanting to watch the soccer game of the school next door ," he said. Having services like doctors'offices, dentists, a daycare, a full-service restaurant, and hair styling shop on site fulfil the centre's mission of being an "inter-generational meeting place which fosters personal and community well-being." Fontaine said it's worth noting that Niverville was able to "pull all of this together in a community with a population of less than 5,000 people." He hopes more B. C. nursing homes follow Niverville's lead.

Elim Village in Surrey, which offers all levels of residential senior care on its 25-acre site, is on that track. There are 250 independent living units, 109 assisted living units and 193 traditional nursing home beds. The village also has a 500-seat auditorium, located in the centre of the village, that hosts weddings and is available for rent for other public events. Elim Village also rents out space in one of its 10 buildings to a school, which allows inter-generational programs to take place easily between students and seniors. Another "continuing care hub " at Menno Place, in Abbotsford, has a public restaurant called Fireside Cafe, popular with staff from nearby Abbotsford Regional Hospital and Cancer Centre. There's also a pharmacy and hairdresser on its 11-acre "campus " site but these services are available only to the 700 residents and staff. "We purposely try to involve the community as much as possible ," said Menno Place CEO Karen Baillie. "It's Niverville on a smaller scale." She said Menno Place partners with high schools and church groups and hundreds of volunteers visit regularly. "Seniors are often challenged with isolation and fight depression. That's why we have different programs to encourage them to socialize ," she said.

Research shows 44 per cent of seniors in residential care in Canada have been diagnosed with depression, and one in four seniors live with a mental health problem, such as depression or anxiety, whether they live in their own home or are in residential care. A 2014 report by the National Seniors Council found socially isolated seniors are at a higher risk for negative health behaviours including drinking, smoking, not eating well and being sedentary. The report also found social isolation is a predictor of mortality from coronary disease and stroke, and socially isolated seniors are four to five times more likely to be hospitalized.

Since more seniors now remain in their own homes longer those who move into care homes are often more frail and need a higher level of assistance, said Menno Place director of communications and marketing Sharon Simpson. Seniors with dementia, in particular, can be socially isolated as friends and family often find it more difficult to visit them as they decline, she said. But Simpson said an intergenerational dance program, run by ballet teacher Lee Kwidzinski, has been a wonderful opportunity for seniors with dementia to be connected to the community. The program is also offered in four other nursing homes in the Fraser Valley. "For them it's an opportunity to see children. You can see the seniors come to life, smiling and giggling at the girls'antics. It's very engaging ," she said. "Some may not be verbal but they are still able to connect. They feel their emotions and they know whether someone is good to them. They feel these girls and become vibrantly alive. It's one of the most powerful things I've ever seen."

Creating community connections is key as Providence Health begins its planning stage to replace some of its older nursing homes in Vancouver, said David Thompson, who is responsible for the Elder Care Program and Palliative Services. Providence Health operates five long-term-care homes for approximately 700 residents at four different sites in the city. "It's always been our vision to create a campus of care on the land ," said Thompson, of the six acres owned by Providence Health where Youville is located.

He said the plan is to build another facility nearby, with 320 traditional nursing home beds. One of the ways to partly fund the cost is to include facilities that could be rented out by the larger community, which would be a benefit to the seniors as well, he said. There is already child care on site, and future plans to help draw in the community include a restaurant, retail space and an art gallery. He said another idea is to partner with nearby Eric Hamber Secondary School by providing a music room for students to practise.

"Cambie is at our doorsteps. If you have people coming in (to a residential care facility) it brings vibrancy and liveliness ," Thompson said

It has been asked to recommend options for how the government should respond to the Supreme Court's ruling last February, which struck down the prohibition on physician-assisted suicide. "But let's not forget: at the end of that process, whoever that justice minister and health minister may be, whatever government may be, those are just recommendations," MacKay said. The British Columbia Civil Liberties Association has expressed concern that two of the three panellists were federal witnesses opposed to medical aid in dying when the case was before the top court.

The panel's chairman is Harvey Max Chochinov, the Canada research chair in palliative care at the University of Manitoba. His co-panellists are University of Ottawa law professor Benoit Pelletier, a former Quebec cabinet minister who is a constitutional expert; and Catherine Frazee, former co-director of Ryerson University's institute for disability research and education. Chochinov and Frazee both argued against doctor-assisted dying before the Supreme Court. MacKay denied the panel composition was designed to predetermine an outcome, although he acknowledged that the decision left him personally troubled.

"When the Supreme Court stripped out those two sections of the (criminal) code, it does leave room for quite broad interpretation of an area that I find quite troubling, and that is assisted-dying," MacKay said. "When I say troubling, I say it is something that touches on deeply held beliefs, it touches on an array of issues whether they be faith, whether they be legal, medical, whether they be concerns around persons for disabilities, so it touches on really important issues for Canadians." The court gave the government one year in which to craft new legislation that would recognize the right of clearly consenting adults who are enduring intolerable physical or mental suffering to seek medical help to end their lives.

MacKay said he personally doesn't think the deadline is "realistic," especially given that a federal election this fall will disrupt the legislative process. "I think on a subject as far-reaching and as serious as this, a government, a future government, a future minister, should take the time to get it right," he said. "That would be my personal view."

The New Brunswick branch of the Canadian Union of Public Employees accused the government of fear-mongering by releasing the wish list, while the president of the New Brunswick Union said generating revenue should be at the top of the list for the provincial government. "We are always open to looking at ways to improve the quality of public services, so long as there are no job losses among public sector workers who are already stretched to the max," Susie Proulx-Daigle said in a statement. "We also believe public services need to stay public." Education

In schools, the government may cut additional teachers on top of the 249 teaching positions slashed in the 2015-16 budget. Enrolment has declined by 30 per cent over the past 23 years, but the number of teachers hasn't seen a significant decline. Cutting one teacher for every 20 students who leave New Brunswick's school system could save $10 million to $12 million, the government estimated. "What was done in the first budget was done," said Health Minister Victor Boudreau, who is responsible for overseeing the program review. "What we're saying is we could continue doing the same on an annual basis." Other options include increasing the maximum class size by four students per class, which could save $50 million to $70 million, and reducing the number of educational assistants to meet enrolment, a move that could save $3 million to $6 million. They may also privatize all custodial services within the education system, estimating savings of $5 million to $7 million, and convert pensions for school bus drivers, nursing home workers and custodians to the shared risk model ($7.5 million to $9 million in estimated savings).

The New Brunswick Teachers' Association was not available to comment on the possible cuts on Friday afternoon. Bennett believes the government could find savings and have little impact on classrooms by cutting the number of teachers and increasing class sizes.

He said research shows that class size reductions only have an impact on student performance up to Grade 3. After that, he said they don't have much impact and can be expensive. The New Brunswick government decreased class sizes about a decade ago and officials say that has cost taxpayers $50 million per year. But he is "extremely nervous" about basing cuts of educational assistants on financial considerations alone, arguing it could add tremendous pressure to teachers.

I think they need to re-think that." He's also disappointed the government isn't considering suggestions from a paper he co-wrote in January, which suggests the New Brunswick government could find savings by contracting out bus services in some of its school districts, which would produce competition. Health care

The provincial government is considering closing rural hospitals, trimming the number of full-service emergency rooms or centralizing specialized services in one location, like the New Brunswick heart centre in Saint John. The government estimates that could save between $50 million to $80 million. Gilles Lanteigne, president and CEO of Vitalité Health Network, said there isn't enough detail in the report to give him a sense yet of how it might affect service delivery in the francophone health authority. The health network is rolling out a plan to reduce 99 acute care beds in order to save $10 million.

The president of CUPE Local 1252, the union representing hospital workers, is concerned about "significant job losses" that could come from closing rural hospitals. But Norma Robinson is also concerned about the impact on people who live in rural New Brunswick and will have to drive up to an hour to get to an emergency room or to a major urban centre for specialized services. The government estimates 90 per cent of New Brunswickers live within an hour's drive of an emergency room. Universities

The province is also considering changing the funding model for universities, moving toward a performance-based formula that focuses on criteria like graduation rates and limiting duplication. The possible changes could save between $15 million and $45 million, the government says.

When we established our universal health care system more than 50 years ago, the average Ontarian was 27 years of age and less likely to be living with chronic and complex health issues. In contrast, 60 per cent of our total hospital days last year were amongst older Ontarians, particularly those living with multiple health issues, and with minimal social supports.

When these patients end up in hospitals, it becomes a particular challenge to get them back in their own homes. In fact, more than 14 per cent of Ontario's hospital beds are currently occupied by patients like these who cannot be discharged because we don't have the right types of services available in the community. By having to stay in hospital, these patients aren't getting the kind of care that they should. And by remaining in hospital, the cost of their care and cost to their overall health is much higher than it actually needs to be. The majority of these patients are waiting for less costly at-home care services through home and community care agencies, or care in more supervised or assisted living environments, such as nursing homes. We also know that too many older Ontarians are still sent to nursing homes when there isn't enough home care, which is less expensive, available. With these growing pressures coming to a head, now is the time to act and make sure that our province can continue to provide the high-quality care that Ontarians want, need and deserve.

It is time to invest aggressively in home and community care, nursing home and assisted living services, and other vital areas so that patients can stay healthy and independent in their communities for as long as possible and when hospitalized, be discharged quickly and safely to get quality care in their community.

We need to identify the right mix of services to ensure all Ontarians can get the right kinds of care where and when they need it. That means knowing the right number of beds needed in hospitals or long-term care homes, as well as the number of assisted living spaces, home care hours, and primary care and mental health services required to meet the needs of our aging population. Given the exploding need for different kinds of services, it also means we need to be innovative by creating new models of care.

While the government has recently acknowledged the importance of robust health-service capacity planning, neither we nor any other Canadian jurisdiction currently has such a plan. This is worrisome because what we do know with absolute certainty is that the number of older Ontarians will double over the next two decades. With service demands growing rapidly at the same time that the system moves to further contain cost growth, we owe it to patients and clients to meet their changing health care needs not only for today but for the decades still to come.

Ontario needs clear-eyed and effective long-term planning to ensure its health care system has the ability meet the evolving health care needs of Ontarians. Until we know exactly what services the people of Ontario need, our system won't have the long-term plan required to meet them. Dr. Samir Sinha is director of geriatrics at Mount Sinai and the University Health Network Hospitals and provincial lead of Ontario's Seniors Strategy. Anthony Dale is president and CEO of the Ontario Hospital Association.

The two towers of the development look very much like an upscale residential development. They are connected with a gracious lobby manned around the clock by attentive concierges. There's a gym - complete with personal trainers - on an upper floor, as well as a communal kitchen that can be used for cooking demonstrations. There is enough polished stone and fancy millwork in the suites to satisfy even the most sophisticated of tastes. Outside, residents can putter in the gardens or host a barbecue on the terrace.

The executive chef - who previously worked at high-end Vancouver restaurant Italian Kitchen - sources produce directly from the nearby UBC Farm and refreshes the menu quarterly, with input from the residents.

A community shuttle can take people around to various neighbourhood destinations, although grocery shopping, banking, and medical appointments are all within very easy walking distance. A private car with driver can also be booked for an additional cost.

The meal options at Tapestry may be where it differs the most significantly from other seniors' facilities. Residents can cook for themselves in the fully-equipped kitchens in their individual suites, have meals brought to their suites, meet up with friends at the on-site pub, or entertain friends and family at the restaurant-style dining room. There are no set meal times and there is no assigned seating. The cost of the restaurant meals are debited individually from a monthly credit, much like the dining plan used by students living in dorms.

However, the services available go far beyond what you might find in most condo buildings. People can also take advantage of a beauty salon and spa, play a couple of rounds in a golf simulator, or engage in some mental stimulation in the brain fitness centre. Housekeeping is provided weekly, with medical staff on call around the clock. Medical treatments are delivered privately in the homes of residents, rather than requiring people to move to a hospital wing if they are ill.

"A lot of facilities come from a nursing or hospital style approach," explains Catherine Wallbank, vice-president of operations for Leisure Care. That firm manages Tapestry for developer Concert Properties. "We think about it from the hospitality perspective, and offering opportunities to enjoy life to the fullest."

It's an approach that suits 73-year-old Carol Byram and her 68-year-old husband Adrian. They purchased a home at Tapestry at Wesbrook after Adrian decided to return to school, and after Carol read a September 2010 Vancouver Sun profile of the project. After a long tech and entrepreneurial career in the U.S., Adrian is now working

toward a PhD in neuroethics at UBC. Carol is busy on the strata council and various committees for the building, as well as her work with Ballet BC "I tell people that living here is like being on a cruise ship or at the Four Seasons with all your friends," the former communications director for Sony Electronics says. "There is something to do all the time if you want to."

With isolation being a known hazard for seniors, Byram says she doesn't understand people who hang on to living in single-family homes until the bitter end. Activities at Tapestry include movie nights, day trips, fitness classes, and musical performances. She also says there is no shortage of people to go for a walk or meal with.

Byram enjoys being part of the larger community at UBC, saying there is a noticeable energy on campus as students stream in and out of classes. She volunteered to be a subject for a study examining the effects of companionship and exercise on aging. She is also involved in Project Chef, where students from a nearby elementary school come and cook with residents.

She often runs into her neighbours Yul and Joanne Kwon in the gym. Yul is 79, and Joanne is 77.

Yul has qualified to run the Boston Marathon next year, and is an adjunct professor of economics at SFU, after decades teaching at the University of Regina and a university in Australia. He tends to have his daughter accompany him on his longer runs through Pacific Spirit Park. "I am writing a book, so I am too busy to take advantage of all of these programs right now," he laughs. "But Joanne participates, and as time goes on, we appreciate that the events are available to us." They purchased their home three years ago at the urging of their son, and at the time, had no idea it was even a seniors residence. He and Carol agree that downsizing directly to Tapestry was the right choice to make, because of all of the amenities and the peace of mind offered by the staff.

Ambulance NB has a number of resources already in place to support its paramedics, flight nurses and medical dispatchers. There's a critical incident stress-management program, which is supported by the Department of Health and the College of Psychologists of New Brunswick. It offers peer-to-peer support for paramedics who've responded to difficult calls. The provincial ambulance service also has a free, confidential employee and family assistance program. It's available around the clock and offers employees one-on-one counselling to help them cope with stresses from work or home. Tracy Bell, a spokeswoman for Ambulance NB, told The Daily Gleaner in February that the organization was taking steps to expand its offerings to paramedics.

"We recognize that we need to do more to support our front-line employees and are taking the necessary steps to get there," she said. "In addition to existing resources, Ambulance NB will be introducing an expanded employee support program in the coming weeks. We are also looking seriously at what options are available in terms of facilitating direct access to a mental health professional or network of professionals for our employees. We hope to be able to be able to share news of these new initiatives with staff very soon." When the newspaper asked for an update this week, Bell said Ambulance NB is still working on this project. "Ambulance NB looks forward to being able to share news of new mental health supports with our employees soon," she said. "Our priority is to share information first with our paramedics, dispatchers and flight nurses." Judy Astle, president of paramedics union CUPE Local 4848, said she's still waiting for some more information. "They supposedly have what they're calling an enhanced employee assistance program. But we have not seen the details as a union yet," she said.

"We have a labour management meeting coming up next week. They may present it there. That's what we're hoping." Astle said enhancing the mental health resources for paramedics should help many professionals deal with the difficulties they experience in the line of duty. "Anything that's going to try to prevent high levels of stress in our job is valuable. It's hard to do. But the support is needed out there," she said. "It's a very trying job, to say the least. What affects me may not affect someone else. But what could affect them may not affect someone else. It's often a build up of things." MLA Ross Wetmore, the Progressive Conservative member who represents the Gagetown-Petitcodiac region, recently introduced a private member's bill in the New Brunswick legislature designed to eliminate the need for first responders to prove their post-traumatic stress disorder was caused while on the job. If it passes, that could eliminate the mountains of red tape that many first responders now face as they seek benefits while on leave for treatment.

Specifically, Bill 15 would amend the Workers' Compensation Act to presume post-traumatic stress disorder in first responders has been caused by "a traumatic event or a series of traumatic events to which the worker was exposed" while at work. That would apply to both current and former firefighters, paramedics, police officers and sheriffs who have been diagnosed as having PTSD by a physician or psychologist. A second part of the bill would require workers' compensation to offer, "treatment by culturally competent clinicians who are familiar with the research concerning treatment of first responders for post-traumatic stress disorder." Astle said she supports the bill, and says it could really help first responders as they struggle to get the help they need. "That was fantastic. That's a step in the right direction," she said. "People are talking about it more, are relating to it more. In our job, we're supposed to be the 'tough guy.' We have to share with our co-workers some of the things that are bothering us. Most of us do that. We talk it out." Chris Hood, executive director of the Paramedics Association of New Brunswick, said he's going to be meeting with government soon to ask for their support of this legislation, though he currently doesn't know how they feel about such a program. "We don't know whether or not government is going to support it," he said.

Hood said his organization wants to join the effort to make life easier for paramedics. So it's announced a few goals for the future. "We're working towards increased screening and education prior to entering the profession, improved training during the (early stages of your career), high-quality mental health support through a team of dedicated practitioners during your employment, and then the presumptive diagnosis legislation (introduced by Wetmore)," he said.

Also a nursing teacher, Cleveland has brought her compassion and care to clients in hospitals, hospices and private homes. "Home is always best for palliative care, but these days, that's not always possible," said Cleveland. "The two vital pieces of this picture are accessibility and how well the care is being provided. Ontario has large areas where palliative care is not accessible." Statistics from the Canadian Hospice Palliative Care Association (CHPCA) estimate less than 30 per cent of Canadians receive any palliative or end-of-life care - and even that depends on where you live.

"There's definitely not enough money, not enough staff and there's not enough time," said Cleveland. "The staff has to fly in and fly out of homes, instead of having the time to sit and talk. "Often, the care that a person needs is just somebody listening to them." Ontario's nursing leaders know accessibility is the big tipping point for palliative care. But they also believe the Supreme Court of Canada's decision to lift the ban on physician-assisted suicide will focus more attention on all end-of-life services.

We hope the public dialogue over the Supreme Court decision will push up funding for palliative care, if we want top notch, universally accessible palliative care in every corner of this province and country. And that's not the case at present," said Dr. Doris Grinspun, executive director of the Registered Nurses' Association of Ontario. Certainly, the demand for end-of-life care in Ontario is growing fast. Within 20 years, people over 65 will double to four million, making up almost a quarter of this province's population. Many can expect to live longer, even with advanced illnesses. "There is a risk in the focus of palliative care that we will forget that the elderly, dying of natural causes, still need all of the comfort and attention of palliative care as anyone dying of life-altering illness such as cancer," cautions Dianne Martin, executive director of the Registered Practical Nurses' Association of Ontario (RPNAO).

Today, Ontario provides palliative care through a maze of sources: hospitals; 14 Local Health Integration Networks (LHINs); community care access centres; 32 hospices; and 60 other agencies providing companionship visits. Among the fortunate ones served by palliative care is 74-year-old retired firefighter Stuart Ross, who is trying to cope with the death of his wife of 46 years. Ross is a patient of the Trent Hills Family Health Team in Campbellford, southeast of Peterborough, Ont., and is able to draw on the services of Cleveland.

Cleveland provided palliative care to his wife, Barbara Ross, in the final weeks of her life at home. Now she gives followup care and support to the widower over a cup of tea at the kitchen table. "I talk to Gwen about the loneliness," says Ross. "She explains to me it can be a normal part of the recovery period. "Sometimes I just need her words of encouragement over something I'm having difficult in handling."

Seniors must find help for house cleaning, shopping or errands elsewhere, either by paying privately, relying on family and friends or turning to a replacement program funded by the United Way called Better at Home, which has received $22 million from the province. Vancouver-Mt. Pleasant NDP MLA Jenny Kwan says Mayer's story is similar to those she's heard from other seniors in her riding during the last month. At least five couples and individuals - most of them Chinese-speaking - contacted her about having their weekly home care hours cut in half. Most have gone from two hours to one, just enough time for a bath. "The government wants seniors to live longer at home, but if you don't provide the supports for them to live successfully and safely, how are they going to manage? That will only mean they are going to need hospitalization, residential care or assisted living," Kwan said. "It's pay now or pay later and pay more," she added, noting that a day in an acute care hospital bed costs taxpayers about $1,500, enough to pay for plenty of routine in-home care. The change in home support hours from Vancouver Coastal Health is part of a move to follow provincial rules more closely, said Bonnie Wilson, director of home and community care for the health authority.

Home support is supposed to help clients with daily needs including bathing, dressing, using the toilet, taking medication or setting up a meal. These are considered medical services. Home support workers are paid only to do those tasks and not a wider range of duties that were covered before policy changes about 10 years ago: visiting, transportation, light yard work, minor home repairs, light housekeeping and grocery shopping. "VCH's home support guidelines are consistent with the Ministry of Health and other health authorities. Historically the mandate for home support services used to be broader, but this was sometime before 2004 (the guidelines that preceded our current ones)," Wilson explained in an email. "This was at a time when there was no distinction between medical and non-medical support services, and when clients went to residential care much sooner than they are now."

The complex medical problems experienced by some of Canada's oldest residents reflect a growing trend: people are living much longer, but not necessarily in good health. They can often stay at home - and avoid the high cost of either private or publicly funded nursing in residential care - but home support workers are being called upon to deliver some services that formerly fell to nurses. Doing laundry or picking up groceries are long gone from their to-do list. Exceptions to that, says Wilson, are allowed if it's unsafe for workers or the client to be in the home because of the mess, or if a client risks eviction or has been refused other government-subsidized services such as HandyDart because of a lack of cleanliness.

In British Columbia, home care is typically provided and subsidized - depending on income - by a local health authority that contracts the duty to a handful of accredited private companies. Clients with higher incomes often hire their own help. In 2013-14, B.C's health authorities spent $1.1 billion on home support for about 39,000 clients. That compares to $1.8 billion spent on residential care for 27,308 seniors. In 2012-13, the province funded 7.37 million hours of home support, according to the Ministry of Health, 23 per cent more than three years earlier. B.C.'s Office of the Seniors Advocate is planning to survey all recipients of publicly funded home support in the province about their experiences for an upcoming report. The Minister of Health was unavailable for comment by press time.

The decision to strike down the ban on doctor-assisted dying was set to take effect on Feb. 6 but the federal government obtained a four-month extension, during which those seeking the service must get approval from court. "We believe this guidance needs to be in place as patients will have the option over this period to apply to a judge for an exception to the current law," CPSO president Dr. Joel Kirsh said in a statement.

Quebec is the first province to pass such legislation, arguing it is an extension of end-of-life care and thus a health issue, which falls under provincial jurisdiction. The injunction sought by the Quebec-based Coalition of Physicians for Social Justice and Lisa D'Amico, a handicapped woman, was related to a Supreme Court ruling last February that struck down the prohibition on physician-assisted dying.

Nearly 2 million women, half of whom are women of color, provide support and assistance

The idea that domestic work is not “real work” has kept wages low for all types of “women’s work.” For home-care workers, the average wage is $9.40 an hour. Annual incomes average $16,600

Many workers are unable to find full-time employment. About 50 percent of home-care workers live in households that rely on public benefits such as food stamps and Medicaid to make ends meet. A third of these workers lack health insurance coverage.

excessively high turnover rates plague the industry. Annual turnover of 50 to 60 percent costs the industry about $2 billion, money that could otherwise go to improving wages, training and workplace supports. Moreover, high turnover undermines quality of care, as clients try to cope with a revolving door of caregivers.

Lack of access to quality care imposes real costs on society. Research published last year by AARP shows that family caregivers suffer high levels of stress and ill health. They often lose significant income during the years they are helping elderly parents, and they use up their savings, making their own retirements uncertain. Workers with substantial caregiving responsibilities are also less productive on the job.

The country needs a national solution that helps us all meet our family responsibilities. That includes building a skilled, stable workforce by treating caregiving as real work and paying those who provide these services a living wage.

Mayor Michael Bloomberg is fighting this change

A similar law enacted in 2003 in Los Angeles requires companies receiving city subsidies to pay workers $10.42 an hour or $11.67 without benefits. Despite warnings that the city would lose projects, Donald Spivack, a development official in Los Angeles, said at a Council hearing last month that those predictions were wrong and that he was unaware of any project that was canceled because of the wage requirement. The Center for American Progress found that 15 cities with living wage laws, including Los Angeles, Philadelphia, Cleveland and San Francisco, “had the same levels of employment growth” as other similar cities without the requirements.

Mayor Bloomberg’s arguments against this modest wage increase contrast with his endorsement of a 2002 city law that now sets a minimum of $10 an hour for about 60,000 workers employed by service contractors hired by the city, many of them home health care workers. Home care workers got a similar increase as part of Gov. Andrew Cuomo’s Medicaid redesign this year.

Now the four-storey retirement home is under insolvency protection and up for sale. Court documents prepared by the home's owner warn that if a solution is not found it would "jeopardize" the care of the handful of residents now living in the Alzheimer Centre of Excellence near Bathurst St. and Finch Ave. Meanwhile, bills are piling up.

Mostyn and others involved in the process stressed that the residents of the home are the priority in this process. Last fall, Mostyn replaced Frank Dimant, who ran B'nai Brith for 36 years and came up with the plan for the home. Dimant said it took too long to build and he mistakenly kept a sign up saying "opening soon," which led to a loss of confidence in the community as construction dragged on. Those funding the project became concerned. "My policy was always to beg and plead (with the bank) and try for another day," former CEO Dimant said in an interview. "Things caught up, I guess." The Alzheimer Society of Canada states that in 2011, the most recent figures on its website, 747,000 Canadians were living with Alzheimer's disease and other dementias.

Researchers predict that will rise to 1.4 million by 2031. Dimant said he spotted this trend years ago and he envisioned a "beautiful modern facility." B'nai Brith, known for community lodges, social housing, sports programs and its work combating anti-semitism, began designing the project in 2002. Some of the land was donated, some purchased. Donations were sought, and the federal government kicked in money, some of it earmarked for work done for the home by specialists in innovative health care at Western University. Western professor Anne Snowdon would not answer questions about the home, saying "we no longer have any affiliation with this organization."

Just before it opened in 2013, B'nai Brith issued a release promising to "offer new hope to families afflicted by the cruelty of Alzheimer's disease." "We understand you only want what's best for your loved one. And we truly offer the most caring approach to living with Alzheimer's. By offering cutting-edge programs. By collaborating on therapies at the forefront of Alzheimer's research. And by providing the highest quality of personal, loving care that makes the difference between living with the disease, and living."

The home boasts beautiful gardens, well-appointed private rooms, and round- the-clock care. "If you build it, they will come," said Dimant, acknowledging more should have been done to market the home before it opened. The other problems? Officials at B'nai Brith say the monthly charge - $7,500 - was too high. Then there were issues with the home. For example, none of the washrooms are wheelchair accessible. All residents must be able bodied, something that in hindsight was a mistake, officials say. The home opened in December 2013 with four residents. During Dimant's time it rose to 17. Recently, it has reached 20 residents. There are more staff than residents at the home, with 12 full-time staff and 20 part-timers.

nsolvency documents prepared by the home show that in February, the home wrote to the Bank of Nova Scotia to say it would be out of cash within two months and could not continue loan payments. Between then and now, the bank worked with the home (and then the insolvency trustee) to come up with a plan to sell the home. The home cost about $16 million to build and outfit. There were numerous work stoppages, cost overruns, and some legal action regarding unpaid contractors bills over the lengthy construction process. A selling price has not been set for the home. B'nai Brith's Mostyn said he is committed to returning his organization to the community work it has done so well over the years. "My goal has been to modernize the way the charity conducts its business. That means taking advantage of new technologies and improving on the many grassroots initiatives and community services that B'nai Brith provides, like our principled advocacy initiatives, sports leagues, food basket programs and affordable housing," he said.

Japan is far from alone. Dementia is increasing across the globe - 47 million people already live with the disease, with more than 130 million projected by 2050. But the first waves have crashed over Japan. When it comes to dementia - a group of disorders affecting memory and cognition, for which there is no known cure - age is the greatest risk factor. No country has gotten older faster than Japan, the world's first "super-aged" nation. In the early '60s, Japan was the youngest of today's G7 countries. Now, it is the oldest - a dramatic shift fuelled by plummeting birth rates and the world's highest life expectancy, according to the World Health Organization, with an average of 84 years (in Canada, it's 82).

A quarter of Japan's 128 million people are already elderly, meaning over 65. By 2060, the elderly will make up 40 per cent of the population. Many will spend their dying days addled by dementia, which already affects 4.62 million Japanese. Ten years from now, an estimated 7.3 million people in Japan will have dementia - more people than live in Hong Kong, Rio de Janeiro or the entire GTA. "The impact will be so huge," said Dr. Koji Miura, director general of the Ministry of Health, Labour and Welfare's bureau for the elderly. "The burden on younger people is very rapidly increasing. If we don't do anything, society will be in trouble." Last year, more than 10,700 people with dementia went missing in Japan. The vast majority were found - some dead - but 168 were not. Violent crimes fuelled by kaigo jigoku, the Japanese term meaning "caregiver hell," are increasingly making headlines.

In July, 83-year-old Kyuji Takahashi was accused of stabbing his wife. He allegedly told police: "My wife has dementia and I am worn out from looking after her." Right now, these stories are still the exception, but Japan's challenge is to stop a public health crisis from unspooling - while battling the world's highest debt.

There is little any government can do about changing the course of dementia. The only thing Japan can change is Japan. "We see the crisis point as 2025," said Mayumi Hayashi, a research fellow with the Institute of Gerontology at King's College London. "And to cope with that crisis point, Japan is trying to create a society where everybody contributes and people with dementia have a better experience and quality of life." Grassroots efforts play a leading role in building this new society, with volunteers spearheading efforts to increase awareness and to form networks to find wanderers - those who go missing after becoming disoriented or confused.

Over the past 15 years, Japanese policy-makers have also changed everything from the social welfare system to the very word for "dementia." Before, the commonly used term was chiho, meaning "idiocy" or "stupidity," even in medical literature. In 2004, the government made an unusual announcement: chiho would know be known as ninchisho, meaning "cognitive disorder." "After the change of the name, the knowledge and acceptance of dementia has spread widely all over this country," said Dr. Takashi Asada, a psychogeriatrician who was a member of the renaming committee.

Japan's all-hands-on-deck dementia strategy - introduced in 2012 and revised last year - involves not just the health ministry but 11 other ministries and agencies. The strategy funds research but also prioritizes early detection, training front line health workers, support for caregivers and creating "dementia-friendly" communities. But the single most important - and radical - change Japan has made to improve dementia care came in 2000, when the government introduced mandatory long-term care insurance.

A primary goal was to help seniors live more independently and reduce the burden on relatives - particularly women, who are often the caregivers. So unlike long-term care insurance in countries like Germany, which offer cash, Japan's system offers services - and consumer choice. The scheme works like this: at age 40, every Japanese resident pays a monthly insurance premium. When they turn 65 - or get sick with an aging-related disease - they become eligible for a range of services: everything from dementia daycare to lunch delivery and bathing assistance. Depending on income, users also pay a 10- or 20-per-cent service fee - a measure that discourages overuse. This system also created something crucial in the field of long-term care: a market.

"Lots and lots of services developed very rapidly," said John Creighton Campbell, a University of Michigan professor emeritus and expert on Japan's long-term care system. "Without the long-term care insurance system, they wouldn't be conceivable." Campbell believes Japan is "better than any other place in the world for dementia care." Of course, Japan's unique and complicated system won't necessarily translate in other countries and significant issues remain, particularly when it comes to financial sustainability; the number of Japanese using long-term care has more than doubled since the program began, with 5.6 million people accessing it in 2013. Japanese families also continue to demand institutionalized care for their relatives and caregiver burnout is still a growing problem. But Japan's trials and errors are instructive for other nations, marching their own paths toward the destination of super-aged. The country is already living the future that countries like Canada are bracing for.

In September, national anxiety followed Statistics Canada's announcement that, for the first time ever, Canada's elderly population had surpassed its population of children. Japan hit this same milestone - in 1997. Clearly, there is good reason to keep an eye toward the Land of the Rising Sun, the Lancet medical journal recently suggested. "How Japan addresses the challenges - and opportunities - posed by a rapidly aging society will become a model for other countries facing their own demographic time bombs."

Dementia by the numbers 61,568 Japanese centenarians today 153 Japanese centenarians in 1963 1 in 5 Elderly Japanese who will have dementia in 2025 1 million

Nurses and care workers needed by 2025 to deal with dementia 40% Percentage of Japan's population that will be over 65 in 2060 15,731 Number of over-65 Japanese abused by families or relatives, according to a 2013 survey 14.5 trillion yen

Cost of dementia on the Japanese economy in 2013 6.2 trillion yen Estimated cost of informal care for de

24.3 trillion yen Estimated cost of dementia in 2060

Elderly people work out with wooden dumbbells in Tokyo to celebrate Japan's Respect for the Aged Day in September. A quarter of Japan's 128 million people are over 65. By 2060, that figure will be 40 per cent. • Nobuko Tsuboi runs a seniors daycare, covered by Japan's long-term care insurance. • Tomofumi Yamamoto is staying fit in hopes of warding off dementia.

Staffing levels were what influenced the ratings most, with a significant minority of families complaining there was no one available to help the resident eat or go to the toilet.

38 per cent gave the meals a failing grade of six or less.

Ruth Adria, executive director of the Elder Advocates Society of Alberta, said the survey's most significant finding was that one-third of those who were unhappy with the care didn't complain to the facility because they were afraid the resident would face retribution from staff.

“This is my passion,” said Cleveland, 38 years in nursing, 25 of them in palliative care. “I ask the client, ‘What is it you want? How can I help you?’ And I add, ‘As long as it’s legal and ethical, I will support you.’ ” But Cleveland and other nurses know palliative care in Ontario is about to experience a shift of seismic proportions; the recent historic ruling by the Supreme Court of Canada legalizing physician-assisted suicides for the terminally ill has redefined what’s legal and ethical in palliative care.