Customized Topical CBD Remedies – Plus Your Chance to Win a Prize!

 

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Image courtesy of Zuzuan at FreeDigitalPhotos.net

Guest Post: Pharmacist Judy Lee-Wing, Consultant on Cannabis

(See updated post)

Are you not sure if cannabis (marijuana) is safe to use, but you want to try it for your chronic back, wrist, shoulder, or knee pain? You are not alone. Many people are considering cannabis to relieve chronic pain, inflammation, and stiffness. (Note: Cannabis is legal for medical and recreational use in Canada.)

Be careful. Natural doesn’t mean safe.

For example, it has been reported that a marijuana lollipop having 90 mg of THC caused a 70-year-old man to have a heart attack. He tried it on his own without consulting anyone.

Many pharmaceutical medications are found naturally in plants such as digoxin in the Foxglove plant, quinine in the Chinchona tree, and aspirin in the White Willow bark. Pharmacist Judy advises to “know before you go.”

About Judy

Judy Lee-Wing is a licensed Pharmacist Consultant in Winnipeg, Manitoba, with over 25 years of diverse pharmacy experience including management, caring for people in the community, long-term care, and in the hospital.

Judy is:

  • committed to promoting the safe and appropriate use of medications
  • dedicated to serving others by providing excellent pharmaceutical care
  • interested in collaborating with healthcare providers and others to promote health and wellness

Judy’s story

“I was very skeptical at first, but after having made a topical cannabinoid remedy for my chronic pain, I became convinced of the usefulness and effectiveness of cannabis. I was looking for cannabidiol (CBD) to relieve pain and swelling but was looking for something other than ingesting oils or inhaling or vaping cannabis. I did not want anything affecting my cognitive function, and I wanted something of high quality that worked faster than in two hours. Hence, I made my own topical botanical CBD tincture as I wanted a pharmaceutically elegant, good quality product to use as a rub on the skin or to incorporate into a cream. I chose a tincture as it is alcohol-based rather than oil-based and by nature less greasy, which is my preference.”

– Judy Lee-Wing

What Judy Offers

For a consultation fee, Judy makes topical botanical tinctures, creams, and oils customized for you. Her service includes assessment, medication review, product sampling, and follow up. For a nominal fee, Judy can also safely and professionally incorporate your own CBD oil into an OTC base that is appropriate for you. This would also include follow-up. She will donate a portion of the proceeds to Riverview Health Centre to go towards buying items for the older adults who live there.

As a pharmacist, Judy plays a much-needed role in working to ensure the safe and appropriate use of cannabis. Pharmacists work collaboratively with other healthcare providers to optimize health outcomes. By performing medication reviews and consults, pharmacists can help to identify possible drug-related problems, interactions, side effects, and adverse drug reactions which might occur in combination with existing medications.

NAME THAT MEDICATION CONTEST! We need your help with finding a name for Judy’s products! (see information below for more details on how you could win a $25 Gift Certificate to Tim Horton’s — Canadian residents only). For now, she will use Judy’s Botanical PharmaTincture and Judy’s Botanical PharmaCream.

Judy’s Botanical PharmaTincture is highly effective in relieving pain, inflammation and muscle stiffness. She does not know all of the uses yet, and she is still discovering and eagerly listening to everyone’s amazing stories! The tincture has an alcohol smell which dissipates in less than one minute, leaving a mild, fresh scent. Customized for you, essential oils like lavender can be added as a fragrance and for a combined therapeutic effect. Judy recommends using a moisturizer as needed.

Judy’s Botanical PharmaCream is the botanical tincture (mentioned above) combined with a pharmaceutical over-the-counter (OTC) cream, customized for you. There is no need to reinvent the wheel as these products are highly regulated and have proven therapy. Customization promotes the safe and appropriate use of medications and enhances the optimal relief of pain, swelling, and stiffness. The medicinal ingredients work synergistically to enhance the effectiveness to relieve pain and inflammation.

Testimonial

“This product has helped my son’s back so much. He has two herniated disks. He puts it on before bed & when he wakes he can actually get out of bed without using any assistance (a broom). He saw great relief after three days. Over the years, my husband’s shoulder had a lot of hockey injury issues. He started using it at night & the pain is gone by morning! Amazing product. Thank You, Judy” – K. & G.

Judy’s products have a natural sanitizer

Organic oils and creams, by nature, may contain ingredients which can degrade or go rancid. Additionally, organic oils and creams may be prone to bacterial and mould growth. In Judy’s Botanical PharmaTincture and Botanical PharmaCream, the alcohol in the tincture is a natural sanitizer.

Judy’s specialties

Judy sees cannabinoids as she sees other medications. She has a particular interest in helping those who are curious about using cannabinoids topically for pain, inflammation, and muscle stiffness, particularly:

  • Middle-aged and older adults

Many older adults are sensitive to medications, including cannabis and are already on a complex medication regime. Topical rather than oral medications may help to reduce pill burden.

  • Athletes or former athletes

Athletes are at risk for overuse of pain-relieving medications and opioids. Applying topicals may help to decrease risk.

  • Young adults

Research has shown that the brain is not fully developed until age 25 so youth are especially vulnerable to the effects of cannabis on brain development and function. Topical is preferred over vaping, smoking or ingesting to help to relieve minor pain.

  • Pets

Improved options for pain-relieving topicals for pets.

***Please discuss with your physician, veterinarian, or health care provider prior to use.***

Testimonial

“Judy is awesome! She is very caring, friendly and knowledgeable. Her consult is worth every penny. The tincture works great for the pain in my wrist that has been bothering me for years. Thanks.” – Mike

Some additional points

  • Please consult with a physician prior to using topicals. If medical attention is required, please seek medical attention.
  • Ingesting, smoking, or vaping cannabis is not appropriate in people at risk of psychosis or schizophrenia, cannabis use disorder, or heart conditions.
  • Customized topical CBD remedies including Botanical PharmaTincture and PharmaCream works almost instantly in a lot of cases.
  • Ingesting oil or capsules may take up to 1.5 hours for effect. Your customized remedy works to relieve pain and inflammation before oral kicks in.

 

Name that remedy contest! We are brainstorming for ideas for a name and need your help!

For now, we are using Judy’s Botanical PharmaTincture and Judy’s Botanical PharmaCream but we are looking for a new name! Submit your wonderful ideas to our “Name that Medication” contest by emailing Judy at judyleewing@gmail.com. The chosen winner will receive a $25 Gift Certificate to Tim Horton’s. Contest open to Canadian residents only and closes March 31, 2019.

 

Resource information

1. Health Canada – Cannabis Education Resources.
2. Judy Lee-Wing attends cannabis workshops, conferences, webinars, continually researches the topic on the internet and very importantly, talks to people.

Questions? Please email Judy at judyleewing@gmail.com, phone or text (204) 488-0812 (Winnipeg, Manitoba, Canada).

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Caring for Parents with Memory Issues (Video; 28 minutes)

 

 

Where does one begin when memory problems become an issue with an aging parent?

Issues such as getting a diagnosis, terminology (What is the difference between Alzheimer’s and dementia?), resources (Book: Caring for a Husband with Dementia; App: Dementia Caregiver Solutions for iOS; Alzheimer Society), sundowning, and managing difficult behaviours are all discussed in this half-hour video.

Check out my video interview with Nancy Baker from Healing Healthy with Nancy called “Caring for Parents with Memory Issues.”

 

Angela G. Gentile, MSW, RSW

 

Keywords: Dementia, Alzheimer’s, Book, App, Essential Oils

The Mighty Ant: An Anthology of Short Stories for Seniors

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I am a contributor to a collection of short stories, called The Mighty Ant, edited by Jessica Bryan. This collection will delight anyone who enjoys reading or being read to.

My two stories include “You are Never Too Old” and “For the Love of Flowers.” These are my first attempts at short-story writing.

Here’s me reading my short story called “For the Love of Flowers.”

The book is in large print and is a fundraiser for the North Carolina Chatham County Council on Aging.

Get your own copy and enjoy reading and sharing with others! The stories are also great conversation starters!

Happy reading!

Angela G. Gentile

 

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Angela G. Gentile, B.S.W., M.S.W., is a registered social worker and is employed as a Geriatric Mental Health Clinician in Winnipeg, Manitoba. She is married to Agapito and has two adult children, Lorenzo and Simone. Angela enjoys writing, reading, and travelling and considers herself a realistic optimist. For more info: www.AngelaGGentile.com

“The Memory Keeper” Will Touch Your Heart and Tickle Your Funny Bone – Book Review

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Five Stars *****

JESSICA BRYAN’S SWEET AND HUMOROUS ACCOUNTS of life with her 99-year-old mother who has Alzheimer’s disease will touch your heart and tickle your funny bone. Jessica states there is never a dull moment in the Bryan household, and you will be entertained as she writes about her experiences in an easy-to-read, conversational tone. Jessica believes “When things get too heavy, you just have to lighten the mood.”

Although it is heart-wrenching when she writes about her mother “disappearing moment by moment, memory by memory,” her stories will encourage you—knowing that caring for a loved one who has Alzheimer’s has its rewards and there is humour to be found in any situation. The photos sprinkled throughout add a beautiful, personal touch. Anyone who values the importance of love and caring for one another in difficult times (especially caregivers and family members) will enjoy reading “The Memory Keeper” (2018).

Available in Kindle and paperback on Amazon.

Angela G. Gentile

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Angela G. Gentile  MSW, RSW is a clinical social worker and author of the book, “Caring for a Husband with Dementia: The Ultimate Survival Guide,” “A Book About Burnout: One Social Worker’s Tale of Survival,” “How to Edit an Anthology: Write or Compile a Collection that Sells,” and the “Dementia Caregiver Solutions” app for iPhone and iPad. She lives in Winnipeg, Manitoba with her husband and has two adult children. For more information, visit: www.AngelaGGentile.com

This Self-Help Book for Caregivers Educates, Supports and Comforts

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When I titled my book “Caring for a Husband with Dementia: The Ultimate Survival Guide” (2015) I did not expect to have people mistakenly assume that I am a wife caring for a husband with dementia. The warmth and sympathy I receive from people who don’t know me personally has been incredible. I gently explain that I am not a wife caregiver and that the book is inspired by the experience I had in counseling eight amazing caregiving women.

When I was deciding on a topic for my master’s degree final project, I decided to focus on older women. I explored what issues are affecting them, and the subject of caregiving came up quite often. I did some research on the subject and discovered that there was very little written about women who care for husbands with Alzheimer’s or a related dementia. My career as a geriatric clinician and social worker exposes me to many different mental health issues, and dementia is unfortunately a common one. I quickly became an expert in assessing and screening for dementia, and recognizing the symptoms of caregiver stress and burnout.

The short-term, individual counseling program I designed, implemented and evaluated with eight caregiving wives was very rewarding and successful. It inspired me to want to help others like the women I had learned so much from. What started out as a small booklet turned into a 16-chapter book. “Caring for a Husband with Dementia” was written specifically to help women who care for husbands who have been diagnosed with a dementing illness such as vascular dementia or Alzheimer’s disease. I dedicated this book to caregiving wives, everywhere.

Writing this book came surprisingly easy to me. I called it a “Divine Intervention.” I received help from colleagues and other experts in the field who generously donated their time reviewing, editing and offering feedback. It is a unique, informative and therapeutic self-help type of book. The book offers opportunity to make it personal for the reader. There is space for self-reflection on important questions. Don’t know what to “Google” to find your local resources? I’ll help with that, too. There is a listing of helpful and important resources, plus more.

All of the reviews and feedback I have received thus far has been very positive. Some of the more helpful feedback has been that this book is written not only for wives, but for all caregivers. I have been told this book is like a bible and it is kept at the bedside and is read every night. It’s a reference guide, a companion, and a source of education and support. It’s like a year’s worth of therapy all in one book.

I know this book has helped spouses and other caregivers. They have told me, “Everything I was thinking, feeling and wondering about was written in this book.” I am honoured to be able to help those who are struggling with the issues of diagnosis, getting help, difficult behaviours, grief and loss, legal issues and more. I have been at book signing events where even men say they want their wives to buy this book as they want them to be prepared – “…just in case.”

My hope is that this book reaches those who are in need of education, support and tips on how to survive the difficult task of caring for a loved one with dementia. It is also a great gift for someone in need.

Angela G. Gentile, MSW, RSW

Link to original article on #AlzAuthors, published 23 Nov 2016.

 

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Angela G. Gentile  MSW, RSW. is a clinical social worker and author of the book, “Caring for a Husband with Dementia: The Ultimate Survival Guide”, “A Book About Burnout: One Social Worker’s Tale of Survival” and the “Dementia Caregiver Solutions” app for iPhone and iPad. She lives in Winnipeg, Manitoba with her husband and two adult children. She is passionate about all things related to Aging Well. For more information, visit: www.AngelaGGentile.com

Myths or Truths? A Guide to Achieving Retirement Community Gold Standard

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Image courtesy of pixatawan at FreeDigitalPhotos.net

(This article was written in collaboration with guest Alan S. Wolkenstein, MSW, ACSW)

As an administrator or manager of a retirement community, you likely hold specific beliefs and understandings of the residents (or tenants) and the workings of the facility. These understandings may be ones that you have learned from others, or perhaps you have come to believe based on your own experiences. Sometimes beliefs about your retirement community can hinder growth and success due to the fact that they are myths (widely held false beliefs).

Myths can hold us back from achieving our full potential for success. While myths exist to help us explain and make sense of our experiences, they can be, and often are not helpful in that they simply are not true. Sometimes these traditional stories are widely held but are not based on facts. Taking our head out of the sand and taking a close look at reality can help us move forward.

Do You Hold Any Myths About Your Retirement Community?

It is important to identify if there are any myths you hold about your retirement community and those you serve. By asking yourself if there is truth or if it is simply myth to each of the following thirteen statements will place you in a more favorable position to exert constructive political, cultural or systems energy. By answering these statements honestly, you will be able to identify them as either truths or myths.

If you happen to recognize some of these statements as myths, you may come to realize that these untruths can inhibit the functioning of your retirement community in meeting the best needs of the residents (and families), staff and institution (bottom-line). The acknowledgement and examination of these falsely held beliefs can challenge you to take on the potentially arduous task of transforming them into truths.

There is a potential for great change in the overall success of your retirement community by focusing on challenging or debunking any myths and doing something about it. Myths are generally difficult to disbelieve due to your strong emotional attachments to them. For example, you may find it a bit troubling to realize your residents may or may not be provided all the services that are essential, available or needed.

Myths or Truths?                                            

While we have developed thirteen statements, we believe there will not be less. There may be some that have not been included that can be exchanged or added for conversation and potential action. They are not mutually exclusive, but designed in a way to encourage thoughtful reflection by individuals and for discussion within the staff or team at your retirement community.

Consider these thirteen statements and decide if these statements are myths or truths when it comes to your retirement community:

  1. Our residents are a priority, and our retirement community has all the amenities, staff and services the residents need for enhancing their quality of life.
  1. We understand that older adults who have chosen to come to our retirement community may or may not have completed and successfully coped with their Family Life Cycle¹ tasks (such as launching adult children, retirement, widowhood, accepting bodily changes and dealing with the realities of their living arrangements), eliminated their intra-familial conflicts and made all important amends. They may or may not be emotionally and psychologically prepared to handle potential losses, grief experiences and transformation.
  1. Our retirement community adopts a holistic approach to care and has fully trained and specialized staff to identify, assess, treat and monitor the physical, emotional, psychological, cultural and spiritual needs of our residents. Administrative personnel and managers are up-to-date on the resources available and continuously strive for improvements in this area.
  1. Residents are properly screened and/or assessed by qualified personnel for anxiety, depression, mood and thought disorders and mental status (including Alzheimer’s disease and related dementias). If these services are not available in-house, staff are trained to identify issues. Residents and/or family advocates are encouraged to seek out advice from an appropriate health care or mental health professional.
  1. There is an active involvement with families and social/cultural communities of residents for continuity of attitudes, values and belief systems. In addition, all elders need connections with their significant others and our retirement community fosters and encourages these relationships.
  1. Administrators, managers and select staff are encouraged and trained to provide continuing adult education programming and support within our community to individuals and families in troubled elder-parent and adult-children relationships.
  1. Our retirement community welcomes and embraces the roles of residents’ advocates and an ombudsman in the holistic and total care concept of our residents.
  1. Our retirement community has sufficient and ongoing staff training opportunities, supervision and evaluation of all appropriate staff.
  1. If present, frequent staff turnover is vigorously addressed. We believe a disjointed or fragmented system can lead to a less than viable milieu for residents and staff morale. We strive for continuity and consistency. Satisfied staff leads to satisfied residents.
  1. Administrative personnel have a clear understanding of and methodology to deal effectively with staff burnout or impairments (permanent or temporary).
  1. Our retirement community has a Human Resource Department that is staffed with (or has access to) professional mental health personnel: those who can identify, assess, and refer for proper treatment (or other actions) staff who are troubled, deficient, show signs of burnout and impairment, and those in violation of local, state, federal and institutional laws and guidelines.
  1. Our retirement community understands and encourages interagency cooperation within our communities.
  1. Our retirement community interacts with educational and academic resources to foster community public awareness and psychosocial services for older adults within our community. This includes placement, internships and fieldwork for learners in the field of geriatrics and mental health services. All such learners are supervised and guided by specialists in eldercare from appropriate professions within the institution.

While self-imposed institutional denial that services are not lacking and provided, or rationalizing that if they were needed, they would be adequately provided, ultimately such institutional defenses are insufficient and hinder best care and utilization of accumulated knowledge and skills in residential care for older adults.

No retirement community consciously chooses to deny services to their residents and staff, but may be acting only from a strong and important fiscal basis. However, this is insufficient. Boards and administrators may be very good at their roles, but not sufficiently trained to assess the holistic need of their residents and staff. They may ultimately fear resources are not sufficient to turn any of the myths into real-time community truths.

If we believe we are functioning from a more enlightened perspective than the one that a retirement community is meeting all these beliefs as truths when they are not, then conceptual shifts are in order.

Your Score and What To Do About It

If you answered “Myth” to any of the above statements, then an action plan for remediation and change may be essential.

This action plan may include:

  • an examination of policy and procedures
  • reassessment of priorities
  • modification of scarce resources
  • finding and securing new funding to change some specific myths to truths
  • a review of long-range goals and objectives

Achieving Gold Standard

We have painfully learned that if a system remains profit and profit margin motivated and not sufficiently focused on customer/family/consumer needs and satisfaction, it will not survive in these difficult and challenging times. There will be intra-system anxiety when confronted with the two, apparently opposite, goals. Anxiety can be a powerful force in creating a milieu that fosters change, enlightenment and growth. If guided and properly mentored, anxiety can help individuals achieve their full potential. We believe this is also true for retirement communities.

It is a truth that a society is best measured by how it cares for its very young and very old. Let your retirement community be the gold standard of care for its residents and their families. Maybe now is the time to secure and support consultation to reach new visions for your retirement community.

Alan S. Wolkenstein, MSW, ACSW
Clinical Professor of Family Medicine (Ret.)
University of Wisconsin School of Medicine and Public Health
Wolkenstein and Associates, LLC
Mequon, Wisconsin, 53092
Alan.Wolkenstein@gmail.com

Angela G. Gentile, MSW, RSW
Specialist in Aging

¹ Wolkenstein, A. S., Lawrence, S. L., & Butler, D. J. (1985). Teaching “family”: The Family Medicine Chart Review. Family Systems Medicine, 3(2), 171-178.

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Angela G. Gentile  MSW, RSW. is a clinical social worker and author of the book, “Caring for a Husband with Dementia: The Ultimate Survival Guide”, “A Book About Burnout: One Social Worker’s Tale of Survival” and the “Dementia Caregiver Solutions” app for iPhone and iPad. She lives in Winnipeg, Manitoba with her husband and two adult children. She is passionate about all things related to Aging Well. For more information, visit: www.AngelaGGentile.com

 

Twelve Areas to Consider When Thinking About a Retirement Community with Lifelong Services

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Image courtesy of powerbee-photo at FreeDigitalPhotos.net

(This article has been written with guest blogger, Alan Wolkenstein MSW, ACSW)

As family members age, there may come a time when an older person’s needs can no longer be met in his/her current home. It may be unsafe, there may be too many worries, or it may be stressful for all involved. For example, if Mom and Dad lived in their moderate-sized bungalow for the past 40 years, things may change dramatically when one of them passes away. Maybe Mom is now left in this house on her own, and she is overwhelmed with all there is to do. Even with family support, and the supports from other agencies and programs, Mom is still not being cared for the same way she was when dad lived with her. Although Mom does not want to move from the home she has known for so many years, sometimes a move to a more supportive environment is needed. Having this discussion can be difficult.

There are many issues that can arise with respect to an aging family member and housing needs. Illness, finances, mobility, socialization, recreation and access to services are some of the issues that may have to be considered. How does one make the right choice? Should the older family member stay in the house longer, or move to an appropriate “elderly persons housing”? Maybe he/she should move to a retirement community, or a place that also has lifelong service options. Should the person move to a 24-hour care facility like a nursing home? A good quality of life is usually the overall goal.

Conversations About Moving Can Be Difficult

Conversations about relocation may become uncomfortable and anxiety-provoking because they usually consist of making major changes in where one lives, relationships and even in family dynamics. The older person him/herself or other family members may be thinking about these issues, but the conversations may be avoided in order to prevent upset or problems in the relationship. We already know that everyone seems to have a slightly different opinion on the subject.

For those directly involved, the stakes are very high, and previous attempts to have such conversations may have not turned out very well. People can feel unsure of themselves and the older adult may experience that their own wishes may be disregarded by their children who push for changes to ensure a more safe and healthy environment. Relocation usually involves downsizing, a major disruption, adjustment issues, loss, and a change in daily routines. Ultimately, it should also come with benefits that outweigh the negatives.

This may be the first time adult children have seen their parent(s) unsure of themselves, possibly afraid of the future, and even angry or refusing to participate in these talks. It seems that no matter what is decided, many feelings may be hurt and someone will feel disregarded and not appreciated for their wishes.

Conversations About Moving Can Be Welcomed

However, in many situations, the family discussions around this topic go well. For example, an older adult may want to move on. In this case, the family can come together with a unified plan that seems positive and helpful to the whole family. Then the issues become where to look, how to assess, and when to choose a place.

Making Decisions Regarding Housing Needs Can Be Confusing and Complex

For others navigating the housing dilemma, the situation is confusing and complex, and there seems to be no way to satisfy all. In the end, no one feels or experiences satisfaction. If an older person moves into a retirement community following this scenario, the likelihood of a successful adjustment is deeply compromised.

Many situations regarding decision-making related to relocating an older family member require and benefit from professional intervention. Professional assistance could come in the form of:

  • helping the older person and his/her family members choose a suitable place
  • mentor and support the family so they can choose for themselves
  • help them sort through the levels of conflict

12 Areas to Consider When Choosing Seniors’ Housing

The following are a number of questions to be used as a working outline in maneuvering through these scenarios. Each requires input and shared conversation with a guide or mentor to monitor and direct the conversations and the powerful emotions they generate. In order to get answers to these question, you (the person seeking housing and/or the person’s advocate) will have to make arrangements for tours and meetings with key people. A trusted professional or seniors’ organization can help you get a list of possible options to choose from. Keep a log of the answers so when decision time comes, you will have some notes to look back on. The questions are not listed in any rank order of importance, but as they come to our mind as we have worked with older adults and families during these potentially troubling and stressful times. As always, take with you what seems most helpful to your unique situation. Note: These questions are written for the person who will be moving. Sometimes a trusted family member or advocate (someone who knows the older person very well) can assist through this process.

1. Costs and how they will be paid for. Remember that the highest cost establishments may not be the most rewarding one. Many have entrance fees that may or may not be refundable in some degree if you leave or pass on. All require fees for their services. Ask if there are any move-in incentives. What is included in the costs (i.e., meals, housekeeping, recreation, etc.). Do they have a free or low-cost “trial stay” option? In the United States, some may take Medicare. In Canada, some of the facilities may be government subsidized. Get the facts down right. Higher cost is not always an indicator of better service and dedication to you. You may also want facts about the establishment’s financial health to guarantee their viability.

2. Location, location, location. How far is it from your family and friends? How close or far are familiar places such as services, restaurants, theatre, clubs, church or synagogue? Are there plans to establish all these in the retirement community once there, or will your time be split? Remember that connection with important people in your life is a definite component of good quality of life.

3. Values and commitment. Ask the management or representative at the establishment about values and commitment to each person. Get this from the people you talk with, not the brochures they send out. While it is good to talk to folks who are available to talk and share their experiences there, they will probably have you speak with the most satisfied members.. Ask for a list of complaints they have received and dealt with. Seek a place that shares your values about what is important in your life and maintaining a high quality of life: continuity here is also important to your quality of life. Ask what procedures are in place to ensure they uphold their commitment to these core values. Ask how these core values are implemented and evaluated. Are they open to improvements? Is there a “Comment Card” system where the residents/tenants can forward their comments and concerns anonymously? Alternatively, what avenues are in place to motivate, celebrate and encourage outstanding service and achievements by staff?

4. Religious affiliation is only part of the equation. Try not to select by religion alone. You may find the system falls far short of meeting your overall needs. While many families share they receive much comfort if the community is of their religion, this does not guarantee a successful placement.

5. Processes in place to ensure a warm welcome and adjustment. What processes are in place to help you or your loved one transition into their system and become part of their “community”? Who is the “go-to” person if there are questions?

6. Supports to help with the adjustment. How will they assist you or your loved one in coping and adapting to their environment? You or your loved one may find it more complicated and anxiety-provoking to move through the process of adjusting there. Who are the staff and what are their qualifications to do this with you or your loved one?

7. Availability of care and counseling after a major life stressor. Many people and families seek out a place following a serious loss to them, such as death of a loved one; illness; financial problems; or diminished ability to provide activities of daily living (ADLs). Attempting to adjust now can strain an individual’s ability to cope and adapt. How will the community provide care and counseling? Does administration view the need for counseling as necessary for enhanced quality of life for some tenants/residents? Is this included in the overall fee? Is it an add-on expense? If counseling is an additional expense (versus an available built-in service), administration does not view this need as a normative cost to them.

8. Counseling and advocacy for relocation concerns. Most people have some degree of ambivalence and uncertainty about such an important move. Who is there to smooth the way and champion their concerns?

9. Counseling for family members. What family counseling services are available to your family? Not all of us have made our amends with our family, dealt with the issues that cause us strife and worry, and resolved any family guilt or anger between members.

10. Regular assessments to assist with adjustment. Are there regularly scheduled assessments of how you or your loved one is coping and adapting? Who are the people and what are their qualifications?

11. Health services. Your health is crucial. How do they incorporate physicians, nursing, and allied health services into their system?

12. Future care needs. What does the facility offer in terms of long-term care needs? Do they adhere to an “aging in place” concept? Meaning, if your health or condition declines, do they continue to support you in their facility, or do you have to move again? Ask them how long you could stay, and what are the reasons you may be asked to leave (“Exit-criteria” or reasons for “eviction”).

We have listed for you 12 areas of concern we feel are important. There are certainly more and some may be equally as important or more important that any on this list. Think for a moment what they might be for you or your loved one. You may be surprised how these questions and concerns bring other ones to the surface. For example, is there a pet involved? Is the pet welcomed?

Reconsidering a Move

What if you began to rethink about your loved one remaining in their home? What services would they need? What services would they accept? Where would the funds come from? Is this just a temporary measure, and if so, would it give everyone time to breathe easier and simply let the person remain in his/her home for a little while longer? Would this be reasonable for a family with many different opinions? Would it be reasonable for an older person who may perceive these service providers as strangers intruding their home further solidifying their sense and awareness of growing frailty and needs?

Seek Professional Consultation

Consider a consultation by a specialist during this challenging time. Seek out someone who has the experience and expertise to guide you and your family with and through this process. Meeting with this person can illuminate a path that you may not have thought of, and provide guidance to see you through.

Many older adults and their families find selecting appropriate seniors’ housing and the accompanying transition somewhat stress-free. Many do not. If your loved one or family is finding this transition difficult, there is help available. There are many fine people in the community to serve you. Start by discussing with your loved one’s mental health professional or doctor. Start by making an appointment.

We wish you and your family well.

Alan S. Wolkenstein, MSW, ACSW
Clinical Professor of Family Medicine (Ret.)
University of Wisconsin School of Medicine and Public Health
Wolkenstein and Associates, LLC
Mequon, Wisconsin, 53092
Alan.Wolkenstein@gmail.com

Angela G. Gentile MSW, RSW
Specialist in Aging

 

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Angela G. Gentile  MSW, RSW. is a clinical social worker and author of the book, “Caring for a Husband with Dementia: The Ultimate Survival Guide”, “A Book About Burnout: One Social Worker’s Tale of Survival” and the “Dementia Caregiver Solutions” app for iPhone and iPad. She lives in Winnipeg, Manitoba with her husband and two adult children. She is passionate about all things related to Aging Well. For more information, visit: www.AngelaGGentile.com

When Confusion is Confusing: Older Adults and Delirium

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Delirium – Photo Credit: Angela G. Gentile

I have been a geriatric mental health clinician since 2010. One of the most complex and perplexing conditions that I have seen in those 65 and older is delirium. Of the troubling “3Ds” (Delirium, Depression and Dementia) often found in the geriatric population, it is easier for me to identify depression and dementia because of the psychological and behavioural features. To complicate matters, these 3Ds can also overlap.

Delirium (or “sudden-onset confusion”) has it’s own unique features, and it affects people in different ways. It is one of those conditions that doesn’t have a specific laboratory test, and takes at least 24-hours of observation to detect.

Watching a loved one in a delirious state can be very distressing. I have interviewed three women (Mary, Donna and Emma) and I will share their stories of delirium and their older family members. I hope it will help you if you or a loved one happens to be in a similar situation (I have changed all the names to protect privacy).

Delirium is often unrecognized and often misdiagnosed as depression or dementia.

Delirium is a common, serious and frightening brain disorder. It is also reversible in most situations. It can also be life threatening. I have seen how delirium affects people. I remember assessing a woman in a nursing home who was about 80 years old, “picking” at the air. It struck me how inattentive she was. Another man, about 90, was walking around in his apartment complex, oblivious to me as I was trying to get his attention.

Delirium is a medical emergency and requires immediate medical attention.

Delirium is a confused mental state that causes problems with thinking and speaking. A hallmark of the condition is “inattentiveness” with a fluctuating course. The cause of delirium can usually be determined (not always), and it is often medication side effects, infection or some other medical illness that causes a disruption in normal thinking patterns. It usually comes on quite suddenly. It often leaves suddenly as well. In some older people it is harder to detect, especially if the person already has an underlying cognitive impairment such as Alzheimer’s or another related dementia.

Delirium often comes on suddenly. Sudden changes in behaviour or mental functioning requires medical attention.

Some health care professionals also find it difficult to determine if the person is having a sudden-onset of mental problems because of dementia or a medical problem such as a stroke (like in Emma’s story, below). Sometimes it takes a bit of guesswork because there isn’t a “delirium blood test” that can be taken to determine if the person is experiencing delirium.

Health care professionals can be helpful, as in Mary’s story, or unhelpful as in Emma’s story. Delirium can come at the end of life, as you will learn in Donna’s story.

There are three subtypes of delirium: Hyperactive (restlessness, agitation, hallucinations), Hypoactive (drowsy, quiet, confused), and Mixed (both hyperactive and hypoactive).

“The Confusion Assessment Method (CAM) is a quick way to determine if the person in question may or may not be experiencing delirium:

Ask these questions, and answer to the best of your ability (scoring information below):

1. Acute (comes on quickly) change in mental status and fluctuating (tends to come and go) course:

a) Has there been a sudden change in the person’s thinking and usual behaviour?

b) Does the unusual behaviour fluctuate or change during the day? (i.e. tends to come and go, or increase and decrease in severity, periods of clarity mixed with confused episodes)

2. Inattention: Does the person have difficulty focusing attention or become easily distracted? (i.e. has difficulty keeping track of what is being said, can’t concentrate)

3. Disorganized thinking: Is the person’s thinking disorganized or incoherent (doesn’t make sense)? (i.e. rambling speech or irrelevant/unrelated conversation, unclear or illogical (nonsensical) flow of ideas, or unpredictable switching of subjects)

4. Altered level of consciousness: Is the person appearing as anything besides normal alertness? (i.e. vigilant/careful/watchful or hyper alert; lethargic/lazy/sluggish or drowsy but easily aroused, stuporous/lazy or difficult to arouse/awaken/excite, comatose/unconscious or unable to arouse).

Scoring: The diagnosis of delirium requires the presence of features 1 and 2 and either 3 or 4.

Mary’s Story – When Delirium is Diagnosed in Hospital

Mary’s mom and dad are up in years. Her mom is 87 and her dad is 97. Dad is a very healthy and active senior who still participates in many social activities, including driving. Mom has mild-to-moderate dementia. Dad is her primary support, while Mary and her sisters help with caregiving tasks.

One night, Mary stayed with her mom because her mom was experiencing pain due to compression fractures in her back (she also has osteoporosis). Her mom, who is a petite lady (112 lbs.), was taking one Tylenol #3 every four hours. In the night, her mom was unable to follow commands to walk with Mary’s assistance to the commode. She noticed her mom had a “blank look” on her face. Her mom was scared. Things didn’t seem right to Mary. She decided to call 911. The paramedics assessed her and Mom was transferred to the hospital via ambulance.

Delirium often occurs in people with other conditions such as dementia or depression. It is often difficult for health care providers to determine the reason for the changes in behaviour or mental functioning.

While in hospital, pain control was a main issue, so they gave her Percocet and Hydromorphone. These are strong painkillers, both in the opioid class of medications, also referred to as narcotics. Mary explained her mom’s behaviour:

  • Soon after, her mom was shrieking, her eyes looked “wild”, she was paranoid – but couldn’t really say what she was afraid of.
  • Her hearing was super-sensitive (hyper alert), although she had a hearing impairment.
  • She was hallucinating and saw a waterfall coming from the ceiling.
  • Her paranoia escalated and she asked her family members if they were afraid too.
  • Her hallucinations continued and she started picking at imaginary things in the air.
  • She took off her gown and her adult brief.
  • She had periods of lucidity (thinking clearly).

This went on for three weeks.

Mary says it is very hard, emotionally, for her and her sisters to see her mother, who is such a modest person, act in a way that is so out of character. She said she sees occasional glimpses of her mother, then she “disappears.” Her mom knows there is something wrong, but she can’t figure out what it is.

I asked Mary what the medical professionals told her about what was going on with her mom. Mary said it took a couple of days before she could convince them that this was not her mom’s typical behaviour. This was not how her mom usually acts, and it was different from her mom’s dementia-related behaviour. She says the hospital staff were very good, and explained that her mom was experiencing a delirium. They were also suspecting she may have had a small stroke.

Delirium can last days, weeks or months.

I asked Mary what advice she has to give others who are going through a similar experience. She told me she wishes she had advice. She is still trying to figure it out. She goes to see her mom, and they try to be there with her. Sometimes she’s mad at them. Sometimes she cries. Sometimes she fixates on things. She can be good in the morning, then confused in the afternoon. The hospital floor she is on has people that are calling out, screaming, walking the hallways and are agitated. This is not helping matters.

Mary says she advises family members to ask the health care team questions. How long will she be like this? What happens if mom doesn’t improve, then what? Unfortunately, they may not have all the answers either.

Sometimes the cause of delirium is never determined.

Mary said her dad has been very quiet throughout all of this. He visits as often as he can, and talks to her on the phone. He worries about her, but doesn’t talk about it to Mary and her sister.

Mary’s advice is, if your loved one has delirium, educate yourself on the subject. Read books, do some research and talk to the professionals. She says we “figure it out day-by-day, hour-by-hour.”

Both Mary and her sister Wendy say it’s so important to be an advocate for your loved one. She says it’s okay to ask the doctors and nurses what is being planned, or what medications will be given to your loved one. She says numerous people have told her such as her doctor, nurses and friends that she needs to look after herself, too. She says it’s hard. “It’s hard to find time for myself. Sometimes I wake up in the morning and I ‘hit the wall.’ There are some days where I just cry and sleep because I feel so overwhelmed.”

Both Mary and Wendy wonder why the emergency doctors don’t have more insight in terms of the best practices when working with the elderly, especially in terms of medications. They feel geriatric specialists should be consulted more and the emergency doctors may require more training in this area.

A few weeks later Mary is relieved as her mom’s condition is improving. She was transferred to a geriatric rehabilitation ward where she is receiving excellent care. She states her mom’s memory is perhaps a little worse than it was before her hospitalization. She is still a little delirious, and they think she may have had another stroke. But overall, “She is much more like our mom, and that is great.”

Emma’s Story – When Delirium is Not Diagnosed

Oftentimes even health care professionals don’t recognize delirium. Sometimes they don’t listen to family members as well as they should, either. In Emma’s case, her mother Nellie went to a long-term care facility due to complications from a stroke she experienced when she was 78. Her condition resulted in frequent trips to the hospital. Emma looked after her mom for over a year before she went into a long-term care facility.

Emma had negative experiences with both the long-term care facility and the hospital regarding how they handled her mom’s sudden-onset confusion while ignoring the concerns from family. Emma suspects many of the difficulties her mom was experiencing were related to delirium, although a doctor never diagnosed it.

“Hospital visits were painful, difficult, frustrating and sometimes harrowing experiences.”  – Emma

Emma accompanied her mom to the hospital on all occasions. Emma states her mom was “handled poorly once delirium began.” She explained the doctor or nurse would often assume her mom had “full-blown dementia” and they would “no longer consult” with either Emma or her mom regarding reasons for the visit. Doctors seemed to be indifferent for the cause of her mom’s sudden confusion and determined it was dementia-related behaviour. There was never a diagnosis of delirium given to Emma, her mom or other family members.

The delirium-related symptoms that Emma’s mom had while in hospital were:

  • Struggling to get out of the stretcher repeatedly/constantly
  • Seeming to have no idea where she was or why she was there
  • Attempting to get people to help her “escape”; i.e. she would say, “Let’s say we’re going to the washroom and we can leave.”
  • Crying and sobbing; high emotional distress
  • Indications of increased pain

Emma also mentioned what she believes to be misdiagnoses her mother was given. Her mom never had a psychiatric diagnosis in her 80 years. She was surprised to find out that her mother, now in her 80’s, had been diagnosed with schizophrenia and another time she was diagnosed with bipolar disorder by the doctor at the long-term care home.

“Be alert to sudden changes in behaviour triggered by new medication or change in environment or emotional distress and keep a diary to track patterns and common themes related to the changes.” – Emma

A social worker by training, Emma did her research and read up on drug interactions and the impact they could have on her mom’s mental health. She began looking at the causes of sudden-onset behaviour changes and discovered delirium as a possible explanation.

Emma suspects it was some of the psychotropic or mind-altering drugs that were the cause of her mother’s delirious episodes. Medications that were in the antidepressant, benzodiazepine/anxiolytic, antipsychotic and hypnotic categories were all used both effectively and ineffectively in her mom’s case. Her mom found one of the anxiolytic and hypnotics helpful, but not harmful, in the end. It’s also important to note that some pain medications such as morphine and oxycodone (also called narcotics) can also cause delirium (as in Mary’s story, above).

Emma states throughout these experiences it’s difficult for her to put her feelings into words, but the experiences stay with her. “I felt helpless, useless, ineffective, frustrated, maybe even a bit hopeless about our system of care.” The other family members felt overwhelmed and torn in terms of what the doctors were saying and how they directed care. The family members found it difficult to vocalize their legitimate concerns. Ultimately, the family did not want to “make a fuss” and felt confused, distressed and frustrated.

“If you ever find yourself in a similar situation, to seek out a professional who specializes in studying, treating and diagnosing delirium.” – Emma

Emma advises if you have a loved one in a facility, or are considering a move to one, it is “critically important to know the possible side effects and adverse events related to psychiatric drugs; and to know the rate and use of psychiatric medications” in long-term care centres or residential care facilities.

Professionals such as geriatricians (doctors who work with adults aged 65 and older) and geriatric psychiatrists are two types of specialists who can be consulted to help sort out behavioural and mental health problems in older adults. Geriatric Mental Health Clinicians, or those who specialize in psychogeriatrics are also helpful in these situations.

Donna’s Story – Delirium at the End of Life

Delirium is common at the end of life. Donna had experience with knowing three people who became delirious. She said the behaviours were consistent in all three of them: “Extreme agitation, taking sheets and clothes off, in and out of bed and expressing the need to go home.”

Donna lost her dad a few years ago. Near the end of his life, he experienced delirium. The symptoms he experienced were heightened restlessness and agitation, pulling at his sheets and clothing, and constantly trying to get out of bed to “go home.” Sometimes he spoke incoherently and often he believed he was in a different time in his life. He was a firefighter and also used to sell cars.

Donna explains, “One morning he asked me if that guy had come to pick up his keys for his new car. When I told him he had, he settled down. Another day he was fighting fires and that is how it went. Sometimes we could not understand what he wanted if his speech was not clear and had to do our best to figure it out.”

The following is Donna’s advice to others going through this experience:

“I would say to just go with what is happening depending on the circumstances and do not make the person feel bad for whatever they say. If they are in the past, you need to be in the past, this is not a time to create more anxiety for the person. Also, recognize that even though they are delirious, they are still often aware of what is happening around them.

One time we thought my dad was not really with it and an old song came on the radio. We were all trying to figure out who sang it and he suddenly blurted out ‘Patsy Cline.’ This type of thing happened often and showed me how aware a person experiencing this still is.

Even when he seemed to be in a deep sleep or delirious, if my mom would take her hand away, his hand would begin to move around looking for her. We saw many signs that dad was still there even when in and out of delirium or coma. It is so important to be there for them and continue to do the things that make them comfortable.

This is not a journey we wanted or that anyone wants, but none of us would have missed taking it with dad for anything. We experienced great sadness, moments of joy, tears and laughter. I would tell anyone to allow themselves to fully engage in the process and do not be afraid to laugh – it is not inappropriate and not an insult to your loved one.”

What I Have Learned About Delirium

Delirium can last for days, weeks or months. It can recur in people who have had delirium in the past. Medications, illnesses (such as a urinary tract infection), dehydration, or sleep deprivation are some of the risk factors. When delirium is superimposed onto a dementia, it can also be difficult to sort out what is causing the confusion.

Evenings can be more difficult for a person with delirium. They may be more afraid or agitated for example (also called Sundowning or late-day confusion). Being with familiar people and objects can help, but it won’t make the symptoms go away. This can be very hard on family members.

When a person has delirium, it is very important to try and determine and remove what caused the delirium in the first place. This is not always possible. The delirium can clear just as quickly as it came, without any notice. It is not contagious, but I see it like a “little intruder” that invades the brain for a bit, causing all kinds of problems. Once the intruder is eliminated, or “burns out,” then things get back to normal. Sometimes there is a bit of a step-wise decline and there is a bit of a change in the person’s new normal, or baseline functioning. The person plateaus in terms of his or her thinking and functioning, but at a slightly lower level. Sometimes s/he gets right back to where s/he was to begin with.

Recovering from Delirium

People who are delirious need to be taken off medications that could be causing the problem. They need to be kept comfortable, safe, hydrated with proper fluids and fed with proper nutrients. If they are dehydrated, intravenous fluid administration (and electrolytes) may be required until they can tolerate oral rehydration (drinking by mouth). Make sure they have their eyeglasses, hearing aids and someone to interpret if required. They need to get up and walk around and socialize. They need frequent reminders of their location, and orientation to the time. Involvement of friends and family is important. They need to sleep. Their sleep patterns may be disrupted, so they will need daylight and activity during the day to help keep them stimulated (as tolerated). They may benefit from relaxation techniques such as music, massage or breathing exercises. They will need lots of tender loving care and close supervision. Encourage them to safely walk and do self-care with assistance if required. Aim for a normal sleep-wake cycle, having them sleep in a quiet room with low-level lighting. Discourage daytime napping. Offer a non-caffeinated warm drink at bedtime. Treat pain. It can last days, weeks or months.

According to the 2012 Beers Criteria, the following list of medications should be avoided, especially for those older adults who are already delirious or at risk for delirium:

  • All Tricyclic Antidepressants
  • All Anticholinergic drugs
  • Benzodiazepines
  • Chlorpromazine
  • Corticosteroids
  • H2-receptor antagonist
  • Meperidine
  • Sedative Hypnotics
  • Thioridazine

A low-dose of an antipsychotic medication may be prescribed temporarily to decrease severity and duration of delirium. Antipsychotics should be reduced after the severe symptoms of delirium have resolved with discontinuation as the ultimate goal (Forsberg, 2017).  However, a study on antipsychotics and those who are palliative (dying) revealed they can increase the symptoms of delirium (Agar, Lawlor & Quinn, 2017).

Unfortunately, delirium can increase the risk for developing dementia. Therefore, it is important to diagnose and treat as soon as possible. Delirium can also increase the risk for death.

Delirium prevention in older adults includes keeping on top of risk factors that may trigger an episode. Medication side effects, withdrawal, surgery and illness are all factors that can lead to delirium. The symptoms of delirium can be lessened by removing the cause, supporting good sleep and nutrition habits, helping the person remain calm and orientated, and helping prevent medical problems or complications. For older people who need to go to the hospital, this brochure on Delirium that may help.

A special thank you to the three women who shared their stories here in hopes of helping others.

Angela G. Gentile

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Angela G. Gentile, M.S.W., R.S.W. is a clinical social worker and author of the books, “Caring for a Husband with Dementia: The Ultimate Survival Guide”, “A Book About Burnout: One Social Worker’s Tale of Survival,” “How to Edit an Anthology: Write or Compile a Collectino that Sells,” and the “Dementia Caregiver Solutions” app for iPhone and iPad. She lives in Winnipeg, Manitoba with her husband, daughter and two lovable dogs. She is passionate about all things related to Aging Well. For more information, visit: www.AngelaGGentile.com

For further information:

Delirium – Mayo Clinic

For more information on delirium at the end-of-life, check out this article on Mental Confusion or Delirium from cancer.net.

For Health Care Professionals:

Canadian Coalition for Seniors’ Mental Health – Tools for Health Care Providers: The Assessment & Treatment of Delirium in Older Adults and the Delirium Tool Layout.

Clarifying the Confusion About Confusion: Current Practices in Managing Geriatric Delirium

Delirium Treatment and Management

Delirium Update for Post Acute Care and Long-Term Care Settings – A Narrative Review by Martin Forsberg (2017)

Delirium in Elderly Adults: Diagnosis, Prevention and Treatment

The “Confusion Assessment Method” is a fairly easy and commonly used tool that has been written in 14 different languages. It is often used by healthcare professionals.

Efficacy of Oral Risperidone, Haloperidol, or Placebo for Symptoms of Delirium Among Patients in Palliative Care: A Randomized Clinical Trial by Agar, Lawlor and Quinn (2017).

Supports and Services for Older Adults in Gravenhurst, Ontario

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Image source: Muskoka Pest Control

 

I have aging relatives in Gravenhurst, Ontario. I went there for a visit in August 2016. While there, I was looking into the services and resources available to older adults. What I found, or should I say didn’t find, was quite alarming.

The Aging in Place Strategy for Canada is great in theory, but providing resources and services to meet the needs of the aging population is proving to be quite the challenge.

Gravenhurst is a small, pretty lake town located just 90 minutes north of Toronto. It has a population of 12,179 according to the Gravenhurst Community Profile 2013. A whopping 23% of the residents are 65 and older (compared to 14.6% in all of Ontario). This community is growing older, and the needs of this aging population are also growing.

In the summer the population swells due to the number of cottagers who escape the summer heat to their cool lakeside getaways. Some of the cottages on Lake Muskoka are huge! I took a tour with William of Big 3 Tours and he showed us some cottages that are 1-5 million dollar price range. Celebrities such as Martin Short own cottages in the area.

In terms of at risk seniors and meeting their needs, it seems like Gravenhurst is lacking in the basics. I was told to call “211” to speak to a nurse about health care resources. The lady on the line was very helpful. I ended up talking to a few very nice and well-meaning individuals and sometimes my conversations went full-circle without any definite answers. It seems like there is no one place for all the information I was looking for which proved to be very frustrating. I spent a few hours on the phone but came up with some answers and resources which I’ll share here.

 

Meal Delivery

There are no hot Meals on Wheels available in Gravenhurst due to the lack of available volunteers. There are services available in Bracebridge, a neighbouring community which is a 15-minute drive north. In Gravenhurst, the only option recommended to me is a company called Apetito.ca. They will deliver frozen meals once monthly. All of the information is online, so it can be difficult for those who do not have access to a computer, or do not know how to use a computer. It appears to me that the only meals on wheels available to older adults are the fast food restaurants such as McDonald’s and Tim Hortons which also conveniently have a drive-thru. I am also assuming that the local grocery stores have ready prepared meals, which may be a better option. For those with special diets (cardiac, diabetic, gluten free), this can pose a challenge.

 

Housekeeping and Yard Work (Home Support)

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Image source: Closing the Gap Healthcare

In terms of housekeeping, the Ontario government does not offer any services. In Winnipeg, to those who cannot afford to hire privately. In Gravenhurst, I was given a few different private companies to follow up with:

Seniors for Seniors – 1-705-645-0199 (Tom)

Closing the Gap Healthcare – 1-877-560-0202

Happy at Home Support Services – 1-705-703-9980 (light housekeeping and yard work)

Bayshore Healthcare – 1-705-722-8993 (Barrie office)

Red Cross Community Support Services – 1-705-721-3313

Busy Lizzie Cleaning Services – 1-877-207-8718 or 1-705-687-6183

 

Transportation

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Image source: Muskoka Seniors

There are two taxi companies in Gravenhurst – OK Taxi (705-684-8294) and Gravenhurst Taxi (705-687-2246). I’ve been told that Red Cross will provide transportation to the nearest hospital  if needed (South Muskoka Memorial Hospital), which is in Bracebridge, at 75 Ann Street. There are two bus companies that serve Gravenhurst – Ontario Northland for service north or south, and the Corridor 11 bus which can take you directly to the front door of the hospital in Bracebridge for $7.00. OK Taxi will pick you up from the hospital and bring you back to your home in Gravenhurst for $25.00. (Prices from 2017 and subject to change without notice.)

Aging at Home Vans or Registered Volunteers are offered through Muskoka Seniors.

 

Housing for Seniors

In terms of seniors’ housing, there are a few options. There are “retirement residences” and a “long term care” facility.

The Manor at Gravenhurst (operated by Lifetimes Living Inc.) is a quaint little 40-bed retirement residence I toured in August 2016. It was originally a hotel, and there are studio apartments with attached washrooms, studio apartments with shared washrooms, and double rooms (two studios with an attached washroom). All meals, medications, housekeeping, laundry, recreation and parking are included in the rent which ranges from $1,900/month to $4,000/month. Residents are free to come and go as they please and the ages range from 60 to 100. 1-705-687-3356.

Granite Ridge Retirement Residence Assisted Care – 1-705-687-0007

Muskoka Shores Care Community – Transitions operated by Sienna Senior Living (formerly Leisure World) – 1-705-687-3444

The Pines Long-Term Care Home – 160 beds, located in Bracebridge.

Affordable Housing Programs

Social Housing (Low Income Housing) 

 

Other Important Resources

Your doctor. Physicians have access to and knowledge of resources that I may have missed here.

North Simcoe Muskoka Community Care Access Centre  (CCAC)- Accessing Home Care services. Office located in Huntsville, Ontario. 1-888-721-2222 or 1-705-721-8010

Seniors Assessment and Support Outreach Team (SASOT) – Operated out of the hospital in Bracebridge. I spoke to a very nice person there, and she says they “dig deeper” and all you need to do is get the doctor to make a referral to their team. 1-705-645-4400. ext. 3505.

Muskoka Seniors – Helping Seniors Live at Home. 1-705-789-6676.

Assisted Living Services for High Risk Seniors – Currently a six-month wait list. Services provided by The Friends (1-705-697-5100, ext. 22). It is a not-for-profit organization. There is also an Adult Day Program available for socialization and a meal. It costs $15 a day and $2 for transportation one way. There is a wait list of about six months. The wait list for homemaking is five years. They do not do yard work. For information on Assisted Living Services for High Risk Seniors, go through the CCAC case manager or call 1-888-721-2222 or 1-705-721-8010.

Long-Term Care Homes in North Simcoe Muskoka – 9-page document with information on long-term care homes.

North Simcoe Muskoka Healthline – Online listing of health services in the area.

The District of MuskokaSeniors Wellness Outreach Coordinator, 1-705-645-2412, ext. 444.

 

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Image source: Seniors Centre – Town of Gravenhurst

 

Seniors Centre – The Town of Gravenhurst has an active seniors’ centre and there is plenty of socialization and things to do for those wanting to remain active and involved.

 

Working Towards Age-Friendly Solutions

As I was doing my research, I was happy to find out that the District of Muskoka is working on a Master Aging Plan with assistance from an Age-Friendly Community grant received from the Ontario government. Here is a link for more information on how you can get involved: www.muskoka.on.ca//AgeFriendlyCommunities. I hope that they will be able to fill in the gaps soon to enable the residents of Gravenhurst remain in their homes as long as possible.

Overall, I would say that it is a very complex and frustrating experience to get information on services for older adults in need in Gravenhurst. The Seniors Wellness Outreach Coordinator at The District of Muskoka was most helpful. Those who have limitations or who have limited family support will especially find it difficult to get the services they require. If you have any further information to add to this list, please let me know in the comments below.

If you are planning a trip to Gravenhurst, check out the travel guide on wikivoyage for more information. For current events, check out the Muskoka Region News.

 

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Angela G. Gentile, M.S.W., R.S.W. is a clinical social worker and author of the book, “Caring for a Husband with Dementia: The Ultimate Survival Guide” and the “Dementia Caregiver Solutions” app for iPhone and iPad. She lives in Winnipeg, Manitoba with her husband and two adult children. For more information, visit: www.AngelaGGentile.com

Malnutrition: A Hidden Epidemic in Older Adults

Over the years, many older adults have let me into their homes because they have been referred to one of the health programs I work for. Part of my job as a geriatric clinician requires me to assess the person and to ask them information about their private lives, including their appetite. I then ask for their height and weight and if they have gained or lost any weight over the last few months. I am even required to ask if it is okay to open their fridges to see what kind of food they consume (I also check expiry dates to be sure no one is neglecting to dispose of rotten food).

Sometimes I come across older adults who have lost a lot of weight. Most of them live on their own. Many of these people have other conditions such as memory loss, decreased mobility, and serious medical problems such as diabetes or heart disease.

Some of the most remarkable weight loss situations in my experience has been found in people with Alzheimer’s or a related dementia. Someone with dementia may forget to eat, forget how to prepare a meal, or have a decreased appetite. They may simply forget how to get food (arrange transportation, grocery shop, order groceries) or have an inability to problem solve their situation.

Proper nutrition and hydration are very important to help keep a person’s body (and mind) strong and running optimally. Here’s a great video from Alliance for Aging Research that explains the hidden epidemic of malnutrition in older people.

If the video doesn’t work for you, try this YouTube link: https://youtu.be/iPNZKyXqN1U

Check out the YouTube channel for Alliance for Aging Research for more great videos like this.

 

Angela G. Gentile, MSW, RSW

www.AngelaGGentile.com