Using Technology to Age In Place

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According to a September 2021 poll by Campaign Research, 96 percent of Ontario seniors over age 55 currently plan to remain in their own homes for as long as possible. The Globe and Mail reported that many Canadians watched with panic as long-term care residents bore the brunt of the pandemic, with thousands dying and many forced to isolate for months.

“The pandemic has created an opportunity to rethink a number of different approaches to ageing,” says Dr. Samir Sinha, director of Health Policy Research and co-chair of Ryerson University’s National Institute on Ageing (NIA). “They’re thinking: I don’t want to be one of those statistics on the news,” he said.

Nearly 100 percent of older Canadians recently surveyed plan to live independently in their own homes. Thirty percent don’t feel prepared should they be alone when a medical emergency occurs in their own homes. Close to 80 percent say they have not spoken to their healthcare professionals about what to do if a fall occurs to themselves or a loved one, but 83 percent of Canadians aged 55+ said they are open to receiving advice on how to live safely on their own.

Dr. Sinha is one of the nation’s most renowned gerontologists who is also the director of geriatrics at Sinai Health and University Health Network (UHN). He recently conducted a webinar for close to 800 people on “Practical Technologies that can Enable Ageing in Place” as part of NIA’s Healthy Ageing 101 webinar series.

As older Canadians, more so than ever before, want to maintain their independence as they age and live at home for as long as possible, they will face a growing risk for falls, and other medical or health emergencies that can occur at home, threatening their long-term health and independence. Dr. Sinha said older adults and their families are, in general, open to receiving advice on how to age well in their own homes, but are not asking for advice from their primary or other regular care providers. According to him, most healthcare providers are not aware of the rapidly evolving technology solutions, and what to consider recommending, that can better enable their patients and their families to age in place. This last point he made, in particular, was surprising and worrisome.

Dr. Sinha pointed out that falls are the leading cause of injury-related hospitalizations among Canadians 65 years and above. He said 25 percent of older Canadians have vision problems, including cataracts and glaucoma, and hearing problems that can impact day-to-day tasks that require focus and balance.

Other health conditions such as diabetes, obesity, cardiovascular and respiratory diseases, as well as dementia, acute illnesses and a lack of exercise can make maintaining one’s balance and mobility more difficult. Clutter and other tripping hazards, poor lighting, not using gait aids, and using several medications can all increase one’s risk of falling.

Dr. Sinha then provided some chilling statistics relating to falls. One in three older Canadians fall each year; and one in three falls result in serious injuries. Four in five hospitalizations due to injuries amongst older persons are because of a fall. Forty percent of falls treated in hospitals involved fractured hips. Most importantly, half of all falls occur at home. If a person has fallen in the past six months, the likelihood of them falling again is high in the near future. The annual cost of falls alone to Public Health is a warping $2.3 billion.

A 2008 BMJ study published by the British Medical Association found that 82 percent of falls occurred when the person was alone. Eighty percent of those who fell were unable to get up after at least one fall. And a disturbing 30 percent had lain on the floor for an hour or more after they fell.

The last part of Dr. Sinha’s presentation focused on understanding the practical technologies that can enable ageing in place. A lot of them are already common knowledge if one is well informed, but they are still good reminders. Smart phones, virtual healthcare, remote health monitoring, fitness trackers or smart watches, smart home devices, and personal emergency response services (PERS) are all useful supportive technologies for older people who want to stay at home instead of going to a long-term care facility or a retirement home.

Most people are probably already familiar with the first five technologies, so I will elaborate more on PERS. These kind of services usually involve an electronic hardware, for example, a pendant, a bracelet, or a smart watch worn on a person with a help button to initiate an alert. The hardware is connected to an emergency response centre and dispatch of help. Advanced features include a fall detection and GPS tracking, and some allow two-way voice interaction if a user can’t reach a phone.

Dr. Sinha said that studies have reported positive health impacts of PERS in terms of gaining faster assistance in an emergency situation and preventing additional complications; extending the time users are able to remain living at home; increasing users’ sense of security; and reducing anxiety about falling, and increasing confidence in performing everyday activities and managing unpredictability.

Four PERS options were suggested in the webinar. They include LivingWell Companion by TELUS Health (starting at $15 per month); PHILIPS Lifeline (starting at $36 per month); LifeAssure (starting at $29.99 per month); and Galaxy MedicalAlert (starting at $29.95 per month).

Of course, as always, prevention is better than cure. Apart from having the right supportive technologies, Dr. Sinha suggested that older people should ask their primary healthcare providers or close family members to assess their risks for falls and other hazards around the home. They need to stay active with at least 150 minutes of exercise per week to strengthen muscles, increase stability, improve one’s mood, prevent dementia, and maintain one’s overall health. They should also use digital supports and services that keep them connected to loved ones, the community and care services.

Dr. Sinha and other gerontologists in Ontario can conduct house calls to patients via a program called OT Home Safety Assessment to assess the risks of falls for older people at home. But patients will first need to ask their family doctors to write a referral before such house visits can take place. For more information on preventing falls or to view the webinar, please contact the NIA at [email protected]. The entire presentation by Dr. Sinha is also available for viewing on YouTube.

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Saluting Two Musical Legends

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Music has helped me and many others a lot during the pandemic lockdowns. In fact, the influence of music on the brain and body has been a steadily growing field of research for decades. It has long been proven that music can trigger feelings of happiness; it is used in various forms of therapy; and it can slow down the heart rate.

While we were seeking solace in music throughout the past 18 months of the pandemic, two iconic musicians were either making or putting the final touches to their new music during the COVID-19 lockdowns to nurture our souls.

I was first drawn to Northern Irish singer-songwriter Van Morrison long after his song “Brown Eyed Girl” hit the Billboard charts in 1967. Since then, I’ve been following his works throughout the years and even attended one of his concerts in Toronto back in 2004. While I wasn’t blown away by his live performance, his voice and soulful and bluesy music are still stellar at age 76.

“Van the Man,” as his fans like to call him, is a prolific artist whose recording career spans seven decades. He has produced 42 studio albums so far and won two Grammy Awards. My favourite album among his more recent works are “Born to Sing: No Plan B” in 2012 and “Latest Record Project, Volume 1” which dropped in May 2021. Many see his genre as rock and country music, but I appreciate him as an Irish white man singing the blues, jazz and r&b. Not only is he very successful back home, scoring top 10 albums in the UK in four consecutive decades, but 18 of his albums have reached the top 40 in the US, 12 of them between 1997 and 2017. So this ageing Belfast lion is definitely still roaring.

Morrison’s music has always been the most self-expressive, so it’s not surprising that he has evolved from the jolly, happy musician in the 70s to the grumpy old blues singer in current times. In spite of the bad reviews of his “Latest Record Project” from quite a few renowned music critics, I beg to differ as a long-time fan. The record was born of Morrison’s frustration and isolation due to the COVID pandemic, but he ended up using this time to produce new material of classic R&B and country and blues. My personal favourites are “Thank God For The Blues” and “Big Lie” which remind me of another blues giant Buddy Guy. Morrison grew up listening to his father’s blues and jazz records, and the two songs totally embody these styles. Both “Love Should Come With A Warning” and “Jealousy” come with a 60s soul vibe and the lyrics are not necessarily autobiographical.

What I love about Van Morrison’s songs is that a musical instrument is always given a solo feature in most of his music. The singer himself plays the guitar, the harmonica, the saxophone, keyboards, drums, tambourine, and ukulele. With this latest album, the harmonica and the saxophone are prominently featured in a few of his songs.

One may not approve of Morrison’s anti-vaccination and anti-lockdown protests, but one should be pleasantly surprised and grateful that Van the Man is nowhere near being done with songwriting – the lyrics are a bit negative but his music and voice are still impeccable.

Tony Bennett and Lady Gaga’s latest album “Love For Sale” was their second, and probably their last, collaboration following their “Cheek to Cheek” in 2014. At 95 and living with Alzheimer’s for a few years now, Bennett has probably recorded his last masterpiece.

The pairing up of a jazz icon and a pop music queen was not only a musical accomplishment, but a huge marketing success. With a 60-year age difference between Bennett and Gaga, they successfully “cross-fertilized” respectively into each other’s fan base demographic to expand their target audiences. As a boomer, I’ve never liked any of Gaga’s pop music and never owned any of her music until she collaborated with Bennett in the jazz genre. For Lady Gaga, it’s a perfect salute to her humble origins when she was a struggling musician in some of New York’s jazz bars during the earliest days of her career.

Kudos went to Bennett who recognized a talent when he heard one. After collaborating with Amy Winehouse, he spotted Gaga’s vocal talent right away when they recorded the duet “The Lady Is A Tramp” in 2011. He could have selected any songstress to record a duet album with him, but he chose Lady Gaga for “Cheek to Cheek” which won him a 2015 Grammy Award for Best Traditional Pop Vocal Album, and made him the oldest artist ever to score a No. 1 album. With the new album “Love For Sale,” the Grammy-Award-winning singer just set another Guinness World Record for being the oldest person to release the album of new material.

The new album, which celebrates the music of Cole Porter, is, in my opinion, an even better album than “Cheek to Cheek” and I would not be surprised if this wins them another Grammy Award next year. According to NPR, they each gained something from their pairing. Lady Gaga was seeking a certain validation as a singer – and having the Bennett benediction, so to speak, really put her in a different light. There’s nowhere to hide, musically, when you’re singing in this style. Bennett, on the other hand, has devoted his entire life to a celebration of the Great American Songbook, and the art of jazz singing. Gaga’s sincere attraction to that tradition was something they hoped would resonate with her fan base. And as Lady Gaga recently told NPR, it has.

In spite of his Alzheimer’s, Bennett is still singing at home with a pianist a couple of times a week. And whatever fog exists around his everyday life, it seems to dispel when the music starts. According to his wife Susan Benedetto, this was even true at his farewell concert with Gaga at Radio City Music Hall a couple of months ago. “Prior to singing, and when he gets offstage, he would not necessarily know where he was or why he was there. And he couldn’t even tell you if he sang or not. But in that moment, you can just tell: all the mannerisms and the music, everything just comes right back,” she said.

This musical legend has given so much of himself to jazz music over the course of his 70-year recording career. Now it’s fair to say that the music is giving back – a miracle in the music!

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Ending The Pandemic Is The Only Priority For This Election

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It’s now less than one week prior to Elections Day in Canada, and if you’re still struggling to decide which party to vote for, I would suggest that you stop going through all your usual top issues such as the economy, healthcare and climate change and comparing the parties’ platforms on various policies that might matter to you. Clear the clutter both on your desk and in your head and ask yourself this question: Do you want the pandemic to drag on indefinitely so that unvaccinated individuals would continue to generate new variants that would lead to more lockdowns and overwhelmed hospitals? Do you want to prolong the pandemic to two, three or four more years after 18 months of hunkering down at home, not seeing and hugging your friends and colleagues, and not having as much fun?

If your answer is No, then there is only one party to vote for. The Liberals announced before the election call that the government would make COVID vaccines mandatory for federal public service employees this fall, as well as some workers in federally-regulated industries, including airlines and railways. Commercial air travellers and passengers on interprovincial trains and large marine vessels with overnight accommodations will also have to be vaccinated.

This announcement immediately prompted many financial institutions, municipalities, airlines, train and transit operators, sports event companies, and large corporations in the private sector to immediately put mandatory vaccination in place for its employees and customers.

The Liberals further promise on their platform to spend $1 billion to help provinces and territories bring in proof-of-vaccination credentials in their jurisdictions for nonessential businesses and public spaces. This announcement might not directly lead to Doug Ford’s about-face launch of a vaccine passport system for the most populous province in Canada, but it certainly helps making it a long overdue reality.

The Conservatives, on the other hand, would not demand that federal civil servants and travellers are vaccinated against COVID. Instead, unvaccinated public servants would need to pass a daily rapid test. Canadian travellers would also need to pass a rapid test or present a recent negative test result before boarding a plane, train, bus or ship.

Unfortunately, the only formidable enemy of the virus is a double-dose vaccination, not constant tests. Rapid tests are useful if vaccines are not readily available, but with the current ample supply and accessibility of effective COVID vaccines throughout the entire country, there’s really no excuse just to do the minimal preventive task of testing. The only offence strategy to permanently eradicate the COVID-19 virus is to have everybody vaccinated – 90 percent of the eligible population if not 100 percent.

The NDP also supports mandatory vaccinations for federal public civil servants and workers in federally-regulated industries. However, during the campaign, they naively set a deadline for a mandatory vaccine policy and domestic vaccine passports to be in place by Labour Day. Labour Day has now come and gone, and very little has changed. Did Jagmeet Singh and his team not realize that for somebody to be fully vaccinated, it will take at least two to three months given the required interval of at least 21 – 28 days between the first and second jabs and the minimum duration of two weeks after each shot for the vaccines to effectively trigger the immune system? So setting a deadline of September 6 when campaigning on August 16 was just not achievable. Promising a federal vaccine passport to be used domestically and internationally if elected is also unrealistic. Healthcare policies fall under provincial jurisdictions and even if the provinces allow the Federal Government to issue a domestic vaccine passport, transferring the provinces’ vaccination data to the Federal Government and combining the domestic vaccine passport with an international one good for out-of-Canada travel will just take far too long a time.

As The Toronto Star pointed out, getting vaccinated was never just about protecting one’s individual health, but protecting everyone else, as well. When it turned out that asking politely wasn’t enough to get the vaccination numbers to that critical level of community immunity, making it harder for people to remain unvaxxed logically follows. This is why The Liberals have doubled down on that position during the campaign. They’ve also said they’ll try to shield businesses that impose vaccine mandates on staff or customers from lawsuits.

Contrast that with the Conservatives, who insist mandatory vaccine requirements are a step too far, and Erin O’Toole says he will “respect personal health decisions.” He won’t even require all his own party’s candidates to follow him and get their shots. And his argument that requiring regular testing is an acceptable substitute for mandating vaccines fails the logic test. All testing does is to confirm whether someone has the disease; only vaccines offer any real protection.

Without mandatory vaccinations, the pandemic will never end – which means the economy will not recover because restaurants and non-essential services cannot fully reopen; schools will be shut down again; the fourth wave will be followed by innumerable waves; hospitals will continue to be overwhelmed and life-saving surgeries postponed as happening currently in Alberta and Saskatchewan; people will continue to drive their cars instead of using public transit, thereby hurting the climate even more; workers cannot return to the offices; arts and cultural activities will not be able to resume on a large scale; and nobody could safely travel very far. Under such circumstances, does it really matter what the various party platforms are proposing to improve the economy, child care, climate change, foreign policy, gun control, healthcare, housing, indigenous services, seniors policy, and job creation? None of these good ideas could ever be implemented so long as the pandemic lingers. We will constantly be in a crisis-management mode. So is it not crystal clear what’s the number-one election issue we should be focusing on now and, therefore, which choice to make on September 20?

For further information on the federal parties’ respective platforms, below is a good summary from the CBC:

https://newsinteractives.cbc.ca/elections/federal/2021/party-platforms/

Happy voting!



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Federal Leaders Courting Seniors’ Votes

Almost all Canadian boomers – five million in total – will turn 65 or older and become senior citizens in this decade, except for those born in 1965. Historically, older Canadians find a way to vote. In 2019, voters aged 65 to 74 had the highest participation rate, with 79.1 per cent casting a ballot, making seniors an attractive voting cohort for campaigning parties. The federal party leaders vying for votes on September 20 have all included policies designed to court seniors in their respective platforms. Let’s take a look at those from the top three major parties.

Liberals

The Liberals promise to introduce legislation, the Safe Long-Term Care Act, that would set national standards for Canada’s long-term care (LTC) sector and pledge to spend $9 billion to address LTC care. That includes a commitment to work with provinces and territories to hire an additional 50,000 Personal Support Workers (PSW) and to raise their wages, including a guaranteed minimum wage of at least $25 an hour.

The party also plans to double the Home Accessibility Tax Credit – meant to help make homes more accessible for seniors and people with disabilities – to provide up to an additional $1,500, making it a total credit of up to $20,000.

Budget 2021 already included a one-time $500 Old Age Security (OAS) payment that landed in the bank accounts of pensioners 75 and over this year. The Liberals also pledge to move forward with their plan to boost the OAS benefit by 10 percent next year for those aged 75 and over starting in July 2022. The party also promises to increase the Guaranteed Income Supplement (GIS) by $500 a year for single seniors and $750 for couples, starting at age 65.

As well, the party said they would work with provinces and territories to raise the Canada Pension Plan (CPP) and Quebec Pension Plan survivor’s benefit by 25 percent. Other pledges include creating a new 1-800 number that connects seniors with government services.

Conservatives

The party is promising to double the Canada Workers Benefit up to a maximum of $2,800 for individuals or $5,000 for families and to pay it as a quarterly direct deposit rather than a year-end tax refund. The party said this will give seniors who choose to continue working past retirement more income.

A Conservative government said it would change legislation to ensure that pensioners would have priority over executives if a company enters bankruptcy or restructuring.

To keep seniors in their homes, the party said it would increase the Home Accessibility Tax Credit limit from $10,000 per dwelling to $10,000 per person. It would allow seniors or their caregivers, including their children, to claim the Medical Expense Tax Credit for home care instead of allowing them to claim attendant care only if they live in a group home.

To avoid long-term care homes, the Conservatives are also promising to help those who take care of their parents by introducing the Canada Seniors Care benefit – $200 a month per household to any Canadian who is living with and taking care of a parent over the age of 70.

NDP

The NDP’s commitments, released before the campaign officially launched, includes a National Seniors Strategy to work with the provinces, territories and Indigenous communities on isolation and seniors poverty.

It also promises to create a pension advisory commission to develop a long-term plan to enhance OAS. An NDP government would also boost the GIS and strengthen the Canada Pension Plan (CPP). The GIS is a monthly payment for seniors with an income below $18,984. They’ve vowed to make automatic enrolment in the OAS and GIS programs retroactive.

The party also vows to end all private and for-profit LTC homes. It said its universal pharmacare and dental care promise would also improve the lives of seniors.

According to Bill VanGorder, chief operating officer of the seniors advocacy group CARP, the top concern he hears from members is financial security. “This is the first election where I’ve seen that all of the major parties seem to be saying that issues that are of concern to older Canadians are very high on their list,” he said.

The CBC reported that the think tank CD Howe Institute questioned the benefit of expanding a universal program like OAS rather than creating targeted programs for seniors living on the poverty line. “There’s a windfall for people getting extra OAS who don’t really need it, and it adds to the cost,” said Alex Lauren, director of research at the Institute. “Those who are paying for this will be future taxpayers, because no political party has promised to balance the budget for a very long time. So all of these increases would be paid by debt,” he said.

It’s also important to point out that apart from the Liberal Party’s platform which has been costed out by the non-partisan Parliamentary Budget Office (PBO) and posted on the PBO website, neither the Conservatives nor the NDPs have costed out their respective platforms yet even though we’re already half way through the elections campaign.

If you have questions after reviewing these election promises, there is still time for you to ask for clarification or share your concerns with the respective parties to help you make your decision before Elections Day.


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Pandemic Changes Our Views On Long-Term Care


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New data from the non-profit Angus Reid Institute finds four in five Canadians saying the pandemic fundamentally altered the way they view the long-term-care (LTC) industry.

Almost half of Canadians (47 percent) now say they will do everything in their power to avoid entering LTC themselves, and to keep close family members out. One in five (22 percent) said they’ll start saving for such a plan, while more than twice that number say they “dread” the thought of living in LTC (44 percent).

If the industry is to be improved, three-quarters of Canadians say either significant changes (45 percent) or a total overhaul (31 percent) is necessary. For some, this means more federal government involvement. At least three in five residents in British Columbia, Manitoba, Ontario, and Atlantic Canada say that the federal government should be directly involved in creating standards for the industry. However, in Alberta, Saskatchewan and Quebec, the same number disagree, and say it should be solely up to the provinces.

In the U.S., where the official COVID-19 death toll in nursing homes stands at more than 133,000, accounting for more than one in five of the nation’s pandemic fatalities, the same perspective prevails. Nobody wants to live in a nursing home. Even pre-pandemic, most Americans said they wanted to age at home – 76 percent of those 50 and older, according to a 2018 survey by the AARP. The vast majority – over 90 percent of those 65 and older – are already doing just that.

According to The New York Times, in spite of President Biden’s call for a US$400 billion investment in home- and community-based care, the need for institutional care in the U.S. will not vanish. Many seniors still require more support than can be provided at home. And the demographics are daunting: The number of Americans aged 85 and older is expected to top 19 million by 2050.

In Canada, although 55 percent of Canadians say they would accept a tax increase to fund improvements in LTC, fixing long-term care in the nation could cost CDN$13.7 billion, the government budget watchdog estimates. A report published last week by parliamentary budget officer Yves Giroux estimates ending wait lists, increasing staff pay and benefits, providing more hours of care each day and expanding home care make up that cost estimate.

That includes more than $8 billion to add 52,000 new LTC facility beds, increase private-sector wages by 15 percent, and ensure every resident gets about four hours of direct care per day – an increase of almost one hour compared to current averages. It would take another $5.2 billion to ensure spending on home care amounts to no less than 35 percent of total spending on long-term care.

The Toronto Star reported that all these estimates are over and above the $23.7 billion provincial and territorial governments spent on LTC and home care in 2019-20. Giroux’s report also estimates the funding would have to increase by more than four percent a year to keep pace with Canada’s ageing population and inflationary pressure on wages.

According to the National Institute on Ageing (NIA) at Ryerson University, nobody should be surprised by the size of the figure. It’s time for Canadians to have a conversation about what kind of Canada do we want people to age in.

The pandemic raced through hundreds of Canada’s LTC facilities, infecting more than a quarter of the 205,000 residents and killing more than 15,000 of them. That is more than half of the country’s total COVID-19 death toll.

All of us should remember a report from members of the Canadian Armed Forces deployed to help staff care homes in Ontario and Quebec last year that listed shocking conditions in some of the hardest-hit facilities. They include cockroach infestations, poorly paid and trained staff, residents left to sit in soiled clothing for hours, and others sleeping in crowded rooms, with little effort at all in infection control.

In addition to the Angus Reid Institute data, a survey taken by the NIA in July 2020 found almost 100 percent of those asked said they had no interest in going to a LTC facility, and as many as 70 percent said that decision was influenced by the pandemic.

The Toronto Star reported that the conversation may need to be more specific about whether adding beds and building more homes is the answer, or if we should be doing more to help Canadians age at home. Perhaps the federal government should be considering Biden’s call for investment in home- and community- based care for Canada as well.

In the imminent federal election, it’s almost certain that Canadians will be watching closely to see what parties offer to do for long-term care. It’s an issue not just for seniors living in care homes, but also for their families, and for those seniors and older boomers looking at their own options for the not-too-distant future.

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