By Muniyra Douglas
Transcribed By Shira Ragosin
While entering the later stage of life, Canada’s elderly population is subjected to numerous systematic problems and issues. This doubles the challenge as most elderly have to single-handedly battle physical and mental health problems, almost at the same time.
In attempt to further understand why these systematic problems exist for the elderly in the country, we look deeper into issues such as care facilities, residential care, and monetary assistance available for those who qualify.
In this VIBE Talks interview, Correspondent Muniyra Douglas speaks with Isobel Mackenzie – Canada’s first Seniors Advocate for the Senior Advocates of British Columbia. We discuss topics such as government funding, and financial assistance for home modification. Additionally, Isobel sheds insight on why financial abuse is so high among the elderly.
Muniyra: What services do you provide at Seniors Advocate of British Columbia?
Isobel: I am the Seniors Advocate for the province of B.C. which [means that I’m] a statutory officer responsible for monitoring senior services, reporting out to the minister responsible, and to the province on the state of senior services, and making recommendations for improvement. The senior services that we look at cover transportation, housing, health care, income support and personal support.
Muniyra: You were appointed in 2014, what progressions have been made since your induction?
Isobel: When you’re looking at progress I think it’s difficult to measure on a tree or scale, you sort of have to look at a longer-range scale. I think I would reflect back on my 20 plus years in senior’s care, and what I’ve seen as progression during that time. Sometimes you don’t realize how much progress you’ve made because it is so incremental, until you reflect back on what things were like 10 or 20 years ago. What I have seen is a tremendous shift over the last 20 years, to supporting people to live independently in their own homes for as long as possible. Twenty years ago we saw people moving into facilities that today are living [on their own], with a little bit of support, in their own homes.
Muniyra: What types of options are available for residential homecare?
Isobel: It’s interesting, because as we’ve shifted to allowing more people to stay at home, what has happened is that the people who are in residential care facilities, tend to have higher levels of care needs, either physically or [mentally, meaning] they have greater cognitive impairments then you would have seen 20 years ago. And so it becomes really important that you get the correct mix of people in a care home. One of the things, the unintended consequences if you will, of our move toward higher level of care in facilities and allowing people with lower care needs to live at home, is that we’ve created, certainly in British Columbia, one level of care called ‘complex care’. We say anybody who needs to be in a care facility goes into the same care facility. And you can see quite a range, although the majority of people have fairly high level care needs, not all of them do. What we’ve done is, we haven’t really done a very good job of creating a meaningful environment for those who still have significant cognitive awareness, for example.
Muniyra: How is eligibility determined, whether a client can get home care or not?
Isobel: Most provinces go through an assessment process, through their provincial home and community care program. Every province will be a little bit different, but most use what’s called the Home Care Resident Assessment Instrument (RAI-HC). It’s a standardized assessment form, and it will look at your cognitive function and how you are able to think. It will [also] look at your physical function, what we call your activities of daily living; if you can get up, if you can get yourself dressed. And it will look at your mood [to see if you are] expressing signs of depressive symptoms or behavioural challenges, and it will look at your medication regime, and if you have support in your own home and in your community. So it’s sort of a total basket assessment. Then from that assessment will emerge a picture or a profile of what your care needs are. You might need somebody to come in the morning and help you get up, maybe get you dressed, and that’s all you need until the next morning. You might need somebody to come in the morning, but come back again at night, make sure you’re in bed, part of that will depend on whether you live alone or not. Most provinces will decide the point at which the care needs in the home are so excessive that you actually will be better off in a care facility, and so you would be assessed to qualify for a care facility. Generally speaking, somebody who’s going into a care facility requires what we call ‘unscheduled nursing care 24 hours a day’. So they will typically be somebody who can’t be left alone. They may not have significant physical impairment, but they have significant cognitive impairment, they’re moderately demented, and so they can’t reasonably be left alone. That person is probably going to be referred to a care facility if there is nobody who can live at home with them.
Muniyra: For home modification - is this government funded?
Isobel: Every province is a little bit different and I think you’re beginning to see part of the challenge, of seeing that it’s a little bit different in every province. Some provinces will have programs that will give grants to people to make adaptations to their home, and the amount of that grant and how you qualify for that grant, will be different in every province. But there’s usually some way to help you put a ramp in, if you need a ramp to get up to the front door, or if you need some money to take out the bathtub and put in a shower, or put a listening device in the home. So depending on which province you live in, there will be some degree of help (with that).
Muniyra: Can you explain financial abuse and its relation to the elderly?
Isobel: So the types of abuses that you can see, are family members who will convince their mom or dad to sign the house over to the kids, or the mom and dad will go and live with the kids, and the kids will say: “Send your pension cheques to me and I’ll take care of everything and give you an allowance. Let me take over your investments, I will invest your money.” One of the things we’re trying, and I think the system is trying to do, is encourage more reporting of elder abuse. When we look at the category of elder abuse, we know that the most prolific type of abuse is financial abuse. Physical abuse does happen, but it’s more rare then financial abuse. Physical abuse happens both in the home, and in care facility settings, and it can happen at the hands of a family member, and it can also happen at the hands of a staff person who’s been hired to care for that person, either in the home or in the care facility. So we need to be diligent about making people aware of what is abuse and reporting it, and as we increase our rigour around that, we will be able to better identify what is likely to predict that kind of abuse and if we can determine how to predict it, we can to some extent try to prevent it.
Muniyra: How does their mental health affect their living options?
Isobel: Mental health issues in the geriatric population is complicated, and it’s complicated because what are sometimes very easily identified as mental health issues when you’re 45, when you’re 85 and 90, they start to co-mix with “Is it a mental health problem?” or “Is it dementia?” And sorting out, because one has a certain treatment option, or treatment course, and the other one doesn’t. So it becomes a bit difficult number one. Number two, it’s tricky with the geriatric population because you’ll often have mental health issues coexisting with physical frailty, and that’s what leads to challenges around where and how you are going to live. So managing someone’s mental health when they’re physically robust is one thing. But managing mental health issues when they’re frail, when they might have neuropathy and they’re unsteady when they walk, or they might have maculate degeneration, and they can’t see that well, or they can’t hear that well, it exacerbates the situation. And it makes living independently more challenging.
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