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Email this5:53 pm
October 21, 2013
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Good link, Norman.
It leaves open the question of why this system is not well known and why a hospital would be reluctant to let a family know about it. I had endless calls from hospital staff including "patient flow navigators" (whose sole job is apparently to get patients moved out of the hospital, regardless of verifiable suitability of the destination), but none ever told me even though I obviously wanted to know. I still think this was because it was not in the best interests of the hospital and its "patient flow navigators".
I am dealing with a new set of "patient flow navigators" right now, as it happens. They are chirpy but went ahead and set up admission and transportation to move my mum somewhere that she is obviously not ready for. They have no clue about the actual patient, and work like robots. Fortunately, at the last moment, a doctor refused to release the patient. This may be a bit of a rant, but there is much much more that I'm holding back!
8:56 pm
April 6, 2013
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Loonie said
Good link, Norman.
It leaves open the question of why this system is not well known and why a hospital would be reluctant to let a family know about it. …
Hospital staff may not be aware of venues to assess capacity for financial or testamentary decisions because that is not their focus. Their focus is on capacity to consent to medical treatments. The two capacities are different.
That CMPA article about capacity assessments highlights the subtle difference:
Assessments may be used as evidence in legal proceedings
Physicians assessing a patient’s capacity to consent to treatment should be aware that such an assessment may later be used as evidence by third parties seeking to demonstrate that the patient did (or did not) have capacity for non-treatment purposes. A physician may be subpoenaed to provide evidence in court to this effect.
…
Physician asked to comment on past capacity for non-treatment purpose1
A family physician is contacted by an estates lawyer representing a patient’s son. The son is trying to challenge a change to his father’s will, which was made a year earlier. The lawyer asks the physician whether she saw the patient at that time. The physician says she did, but only assessed whether the patient was capable of consenting to medical treatment. Her notes clearly reflect the purpose and nature of the assessment she conducted.
Since the physician did not assess the patient for capacity unrelated to treatment in the previous year, she can tell the lawyer she does not feel sufficiently informed or comfortable commenting on the patient’s capacity to make financial or testamentary decisions at the relevant time. The physician can say with confidence only that she thought the patient had the capacity to make decisions about the medical care required.
11:20 pm
October 21, 2013
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I may not have explained myself properly.
The issue was not capacity for finances in the case to which I most recently referred. It was capacity to decide where one would live, and hospital staff definitely knew who to ask to assess this. They just didn't want to because they knew the likelihood was that the patient would remain in their care much longer - something they were ferociously determined to avoid. I have evidence for this allegation, but it's a really long and ghastly story. Suffice it to say that I ultimately outwitted them but it took everything I have. Otherwise the wife would have died.
5:31 am
September 29, 2017
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I would be very interested in how you outwitted them because I keep facing a similar situation. You can PM me if you would like.
10:51 pm
October 21, 2013
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Things are much more difficult now than they were ten yrs ago due to Ontario govt decisions, but I sent you a PM
9:16 am
April 6, 2013
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Loonie said
… It was capacity to decide where one would live, and hospital staff definitely knew who to ask to assess this. They just didn't want to because they knew the likelihood was that the patient would remain in their care much longer - something they were ferociously determined to avoid. …
I believe that. The hospitals are under pressure to discharge or transfer patients as soon as possible to free up beds. Staff will even give out a shaky option of home care.
Relatives who actually took the home care option found out that the option is not as good as being in a hospital. The patient and family find out that some support workers don't show up for work last minute and the agency doesn't have a backup.
Good luck if one needs help in the morning to get out of bed and the worker is a no-show. The worker who brings lunch later will just drop off lunch and leave. The lunchtime worker won't help because the worker doesn't have the time in his/her schedule to get someone out of bed! Same with the dinner time worker. The patient will end up suffering until the next morning when hopefully a morning worker will show up.
2:15 pm
September 11, 2013
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Like every workplace, dedication of workers varies greatly. Some are great, some plunk themselves on the couch and play with their phones for as much of the allotted time as they can, and then everything in between, in my experience.
Hospitals are designed as medical care facilities, they are not residences, whether patient has other residential options or not, that's up to old folks and whoever's helping them to sort out (although there's great inconsistency often depending on how full a particular hospital is at any given time). I was told more than once that some families just drop off the old folks and then leave, I can understand medical staff being vigilant re people who can't be helped any further at the hospital at a point in time and have to go either to rehab facility or elsewhere to live. And at a certain point there's just a lot of in and out of the hospital for many oldsters getting near the end, just the way it is.
And I'm sure errors are made along the way, it's essential to have someone advocate on old person's behalf at this time of life.
2:28 pm
October 27, 2013
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Norman1 said
I believe that. The hospitals are under pressure to discharge or transfer patients as soon as possible to free up beds. Staff will even give out a shaky option of home care.Relatives who actually took the home care option found out that the option is not as good as being in a hospital. The patient and family find out that some support workers don't show up for work last minute and the agency doesn't have a backup.
Good luck if one needs help in the morning to get out of bed and the worker is a no-show. The worker who brings lunch later will just drop off lunch and leave. The lunchtime worker won't help because the worker doesn't have the time in his/her schedule to get someone out of bed! Same with the dinner time worker. The patient will end up suffering until the next morning when hopefully a morning worker will show up.
Anecdotally, I have heard the same stuff about Home Care in AB and BC as well. Quality and consistency is a roll of the roulette wheel with most of it less than adequate. Even privately paid (and controlled) home care is somewhat hit and miss with diligence required (cameras anyone?) required to mitigate elder neglect/abuse by the individual paid to be on duty.
There are no good answers.
7:56 pm
October 21, 2013
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I don't want to get into a long saga, but in my experience, which covers both ten years ago and this very month, with several points in between with various hospitals, long term care homes and a retirement home. I've seen much worse even than Norman has said
As for cameras, it's common now for long term care home contracts with patients/POAs to specify that you agree not to install a camera without permission of the facility - which, of course, you would never get.
Good answers are indeed next to impossible to find, given the mess that our health care system has become. Ontario is the worst in the country by some measures. Some other countries are better. But it's just too complicated, with too many moving parts, for this forum.
It's not usually the fault of individual workers at any level. Most are doing the best they can with what they've got, but a great many are leaving the sector.
Hiring home care workers or depending on those supplied by the provincial authority has been dicey for a long time. Many of the patients living at home who can't get themselves out of bed really should be in a nursing home but there is this idea, often false, that they could manage with Home Care. Someone who can't safely get out of bed really should not be living alone in my view but they either don't want to go to long term care (especially given the horrid conditions often found there) or can't get in because even they are not the highest priority - that's reserved for even more dire situations.
Anyone who is not getting sufficient help at home because there aren't enough PSWs would, in my opinion, be much better off in a retirement home if finances allow. In a home like that which has numerous residents needing help getting up, there will typically be a PSW working regularly in the building who is funded by provincial health care and you are much more likely to get PSW to come. This is a strategic suggestion for some individuals, not a solution. We all have to think creatively on behalf of our loved ones. As a bonus, the meals will be supplied regularly and may be better than whatever else you're getting.
There are many reasons why PSWs going to individual residences don't show up. These include, but are not limited to: illness, transportation problems (they are not paid enough to own a car), being phoned at 6 a.m or earlier to make the visit on their day off, staff shortages, and running out of time because the previous patients were too complex and may not have been looked after the previous day or you may have had to call an ambulance for them. Generally, people want to work at the job they trained for and were hired to do and they want to get paid, but they also need decent working conditions and pay.
8:45 pm
April 27, 2017
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Parent in law experience in the UK was mostly similar. The hospital gave a 2 week deadline. She didn’t want to go to a nursing home, so went back to assisted living but we hired a company which was supposed to turn up 3 times a day. They were mostly Ok but not 100% reliable. Every now and then we would get an “emergency” panic call because nobody turned up. Looked like the nursing home option was unavoidable.
Thankfully UK has private healthcare. A consultant was well worth the money. Turned out that a fairly simple operation on spine restored her mobility. Something to do with a pinched nerve, which was impacting both legs and arms. After the operation functions were restored, which I thought was magic, given the age. Someone is still coming in once a day but she doesn’t really need it as she is completely mobile.
9:22 pm
October 21, 2013
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If the NHS (government-funded health care) doctors weren't able to provide a "simple" solution, then the NHS needs a lot of fixing, which could include anything from more doctors with more time to updated diagnostic tools. Privatization means that the society thinks it's fine for some people to suffer, sometimes indefinitely, as long as some others can pay their way out of their misery.
9:25 am
November 3, 2022
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This thread offers much to think about.
During the pandemic, when care homes became killing fields, I thought I would aim for home care and never set foot in a congregate living facility.
Now, given the stories posted here, I am less sure.
One possibility that I wonder about is relocating to a home with a basement suite, where full time caregivers could live (perhaps rent free to incentivize them to keep the job?). There are many such dwellings in Vancouver, and that would eliminate the transportation challenges of getting caregivers to show up each day.
I have a friend who has such an arrangement. He used to rent out his basement suite to help with the mortgage. But now that he's retired and the mortgage is paid off, he's found a tenant who lives downstairsand does maintenance, gardening cooking and cleaning in lieu of rent. It's a do-it-yourself independent living community of one. It will be interesting to see if that evolves into a DIY assisted living arrangement.
Fortunately (for me), my friend is older than me, so I get to see how this works out before making such a big move. A lot depends on the people one finds for such live-in caregiving, but given the housing crisis in Vancouver, there are many people who might jump at such a chance.
10:19 am
October 27, 2013
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Arrangements like that could work until a senior becomes compromised mentally and/or physically to the point that said senior can become a victim of elder abuse. A live-in caregiver can ultimately have unimaginable control and it is not all that rare* for such a caregiver to manipulate the senior for changes in Will, access to bank card, etc, etc. Without some kind of advocacy/oversight, any arrangement is subject to abuse.
I see in multiple discussion/financial forums where aging boomers talk about staying in their homes as long as possible, to the point of going out 'boots first'. I don't think they have thought through the risks, nor the isolation from the community, etc, etc. I am not going to be one of those persons. I will go to independent living staying as long as I can with a social environment around me and reluctantly go to assisted living thereafter as/when necessary. I would rather the abuse be in a congregate facility than alone within the confines of the walls of my home that have become a prison.
* How many estates have been disputed by family because the caregiver has ingratiated himself/herself into that senior's affairs? How many movie scripts have been written on this subject?
5:17 pm
December 12, 2009
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Loonie said
I have recently learned that a friend is managing his mother's money, but not necessarily to best effect.He has POA, and his mother signed all the necessary papers to put this into effect at Meridian CU some years ago. For some complicated legal reasons, it is now very difficult for him to consider moving any of her money elsewhere.
The problem is that the money is in the high six figures and thus not fully insured. Also, it's all in a savings account. I think the insurance is the bigger issue as he doesn't seem concerned about return so much.
Does anyone know any way of making this work within Meridian? The only thing I could think of was perhaps their affiliated discount brokerage, whatever it is, where he could probably buy assortment of insured GICs and/or ISAs,but I don't know if the POA would be accepted at the brokerage without the mother's active consent - and she is unable to do this due to health. He has the ability to move her money aroun in Meridian as he sees fit.
No RIF. Too old for RSP. TFSA is full. No existing brokerage accounts. My friend will be the sole heir.What do you think his options are at Meridian?
Good thought, Loonie, on consolidating assets with Meridian Credit Union's discount brokerage account. I like the idea of consolidating deposits; however, looking at the FundSERV website for "Meridian" in the fund name field, it looks like Meridian doesn't source deposits in the discount brokerage / mutual fund dealer channel, unfortunately.
Also, keep in mind that Meridian, like most credit unions in Canada, don't actually have their own discount brokerages; they partner with Qtrade, which is owned by Aviso Wealth, which is, in turn, majority owned by Desjardins and minority owned by provincial credit union centrals, so Meridian's interest would be both very small and very indirect.
Meridian is pretty safe, so your friend will probably be fine in consolidating, but if they want an iron clad guarantee, they'll likely have to diversify, or perhaps use a Big 5 bank and a Big 5 bank discount brokerage instead?
Cheers,
Doug
5:22 pm
December 12, 2009
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Loonie, could your friend apply to the Ontario court for a committeeship? It's more expensive than an POA, but once approve, becomes an order of the court that any financial institution is compelled to accept.
This may be the relevant webpage: https://www.ontario.ca/page/guardianship
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