Health Care Team and System

Articles about who’s who on the health care team, what you can expect or encounter when using Canada’s health care system.

Talking to Your Parents’ Doctor

Posted by on Apr 24, 2011 in Family Relationships, Health Care Team and System | 0 comments

  “Mom has been having dizzy spells and seems to be losing interest in her normal activities. She tells us “everything is fine”, but we’re worried would like to talk to her doctor about our concern. How should we do this?” This is a common dilemma for adult children who are worried about aging parents.  When you see signs that cause concern, it is natural to wonder what is wrong. Often, the elderly parent will be “reassuring” or might try to dismiss your concerns.  But your worries don’t go away easily. You would prefer to be reassured from the doctor. Have you tried calling the doctor, and been told that he/she won’t see you without your parent present?  Maybe the doctor doesn’t return your call?  Here are three things to consider if you want to talk to your parents’ doctor: Doctor-Patient Confidentiality This is the obligation of one person to preserve the secrecy of another’s personal information.  A doctor’s guiding code of ethics requires them to maintain confidentiality.  When physicians are licensed to practice, they take the Oath of Hippocrates and promise: “Whatever, in connection with my professional service, I see or hear, which ought not to be spoken of abroad, I will not divulge” (abridged). Confidentiality stems from the therapeutic relationship between patient and doctor.  Patients want to trust that their personal information will be kept private. They want to be able to speak honestly, without worry that their condition or treatment could be revealed to others without their consent. Right To Privacy Privacy is the right of individuals to be left alone, and to determine when, how, and to what extent they share information about themselves with others.  But you have the right to share your worry and concern with your parent, and ask if you can come to the next doctor’s visit. Explain what you want to do: for example “I want to help you remember the things you wanted to talk about.” Or “I want to ask the doctor about your dizziness.” Suggest that having a family member or friend with them can help your parent get the most out of a visit. Being Your Parent’s Advocate The doctor may appreciate learning more about your parent’s problem from your point of view. If you want to advocate for your parent, consider writing the doctor to express your concerns.  But keep in mind that the doctor may still not be willing to share private information with you.  A word of warning: tell your parent you are writing the letter.  Don’t expect the doctor to keep it a secret! The first steps to opening the lines of communication are to help your parent(s) understand the benefits of this information exchange, and to get their consent. If you do meet with the doctor, or have a telephone conversation, be prepared.  Be specific about your concerns and ask: What is wrong? What do I need to know? What can I do to help my parent? Whether your parent is at home or in hospital, and whether you live in the same city or across the country, establishing a relationship with your parent’s doctor can benefit all parties.  Vol.3, No. 17 © ElderWise Inc. 2007. You have permission to reprint this or any other ElderWise INFO article, provided you reproduce it in its entirety, acknowledge our copyright, and include the following statement: Originally published by ElderWise Publishing, a division of ElderWise Inc. We provide clear, concise and practical direction to Canadians with aging parents. Visit us at http://elderwise.memwebs.com/ and subscribe to our FREE e-newsletter      ...

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Long Term Care Terminology

Posted by on Mar 1, 2011 in Health Care Team and System, Living Arrangements | 0 comments

Long-term care refers to care homes, as well as to a variety of services for people who experience prolonged physical illness, disability or severe cognitive problems. These care homes and services help people maintain a level of functioning rather than correct or cure medical problems. Most commonly, they include help with Activities of Daily Living (ADL) and professional care. They may be delivered as in-home services; or the person needing care may travel to a community services such as adult day programs and respite.  Or this person may need to live full-time in a care home in order to receive the services.  Care homes may provide supportive housing and personal care, such as Assisted Living and Designated Assisted Living. Care homes provide 24-hour nursing and professional care. Depending on your province, they may be called Nursing Homes, Residential Care Facilities (RCF), Homes for the Aged, Extended Care, or Long Term Care Centres (LTCC).  To receive any services provided by government-funded programs, you must undergo assessment and meet eligibility criteria. Here are more detailed explanations for the highlighted terms: Activities of Daily Living (ADL) are everyday activities that most adults do independently including bathing, continence, dressing, eating, toileting, and transferring or mobility (arising from bed and moving around the home environment). Services that support ADLs are called “personal care services” and provided by workers such as Home Health Aides, Nursing Assistants and Personal Care Aides. Adult Day Programs help adults with physical and mental disabilities through group programs that may include personal care services, therapeutic recreation, social activities and meals. Assessment usually precedes government-funded programs, and is completed by a professional (e.g., nurse or social worker) to determine eligibility for the variety of home, community and care home services. Cognitive problems arise from the inability to think, reason, remember or perceive. Alzheimer Disease, for example, is a major cause of cognitive impairment. Eligibility for government-funded programs is determined through a professional assessment and may include criteria such as age, medical status, residence requirements (e.g. living in the province for 1 year) and other criteria unique to each program. In privately funded programs, the client and/or the provider determine eligibility. Care Homes provide nursing and professional care, 24 hours/day, to support individuals with physical and cognitive problems. Each province determines the name commonly used for facilitis offering long-term care. In-Home Services are professional and personal care services are provided to individuals living in private homes, apartments, seniors’ lodges and other congregate dwellings. Professional Care refers to assessment and therapeutic interventions delivered by professionals, such as registered nurses, social workers, and therapists. Professional care may be delivered in-home or in community settings, and is always available in care homes. Respite is designed for family and friends who require rest from the physical and emotional demands of caregiving. Respite services might be brought to the home, or the individual may attend a community program or be admitted temporarily to a care home. Some of these services are provided without charge through government-funded programs, others require a fee. The amount charged varies between programs and between provinces.   Vol.2, No.21; © ElderWise Inc. 2006-2011. You have permission to reprint this or any other ElderWise INFO article, provided you reproduce it in its entirety, acknowledge our copyright, and include the following statement: Originally published by ElderWise Inc., Canada’s go-to place for “age-smart” planning.  Visit us at http://elderwise.memwebs.com and subscribe to our FREE e-newsletter.                     ...

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Why Geriatrics and Gerontology Matter

Posted by on Feb 24, 2011 in Caregiving, Health Care Team and System | 0 comments

Aging is complex – and unique to each individual. When older adults experience acute illness, they need – and deserve – specialized care. Health professionals specialized in Geriatrics or Gerontology have the expertise to recognize normal aging, identify common diseases of old age and provide holistic care. The term “Geriatric” refers to the study, diagnosis and treatment of common diseases associated with aging. The term “Gerontology” is derived from Greek, and means “the study of elders”. Gerontology is multidisciplinary and therefore looks at physical, mental and social aspects of a senior’s life.  Why know these terms? There are a variety of practitioners in your community. Knowing how to find those with specialized knowledge and expertise will help you or a senior family member get the best possible care. In hospital: A geriatrician is as important to an older adult as a pediatrician is to a child! So ask for a geriatrician – a physician who can work with the health care team to determine an appropriate plan of care. Geriatricians have been certified in Canada since 1981. For more information, visit their website: http://canadiangeriatrics.com/ In a long-term care facility: Ask for a Certified Gerontological Nurse. These nurses have written national certification exams to demonstrate their knowledge and skills. Their education makes them exemplary problem-solvers. As part of the health care team, their focus includes avoiding the dangers of over-treating as well as under- treating chronic and acute health problems in older adults. In the community: If a senior is still healthy and wants to stay that way as long as possible, look for a Geriatric or Gerontological Nurse Practitioner. Contact your local health authority or the provincial nursing association to locate resources near you. For more information, visit the Canadian Gerontological Nurses Association website: http://cgna.net/ Vol.2, No.9; © ElderWise Inc. 2005 You have permission to reprint this or any other ElderWise INFO articles, provided you reproduce it in its entirety, acknowledge our copyright, and include the following statement: Originally published by ElderWise Inc., Canada’s go-to place for “age-smart” planning. Visit us at www.elderwise.ca and subscribe to our...

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A Surprise Call From The Hospital

Posted by on Feb 23, 2011 in Health Care Team and System, Health Emergencies, Powers of Attorney | 0 comments

John’s aging parent,  Mary, 90, lives in another province. One day, he gets the call he has long dreaded: his mother has fallen, broken her wrist, and has been taken by ambulance to the hospital.  She has had surgery and her arm is in a cast. Is she ready to go home? Not so fast.  John is told that his mother is showing signs of mild cognitive impairment and that the discharge planner wants an assessment. John must call the doctor for more information. John manages to talk to the doctor later that day. He learns that Mary is doing very well physically, but the doctor is concerned about the possibility of dementia and has referred her to the Geriatric Team.  John asks if he should take time off work and come. The doctor advises him to wait a few days until the outcome of the assessment. During the next few days, John calls the hospital for updates. He talks to: the Registered Nurse on the unit; the Head Nurse on the unit; the Relief Nurse on shift; and the Discharge Planner. John is confused. Some of these professionals believe that Mary has signs of dementia while others are not sure. The discharge planner is concerned that Mary may not be safe to return home; John worries, because Mom has refused previous attempts to talk about moving to assisted living. Later, John hears from the Geriatric Case Manager that, for now, they have not confirmed dementia. His mother had delirium because of the injury, pain, unfamiliar environment and anxiety. Mary is moved to a transition unit.  Soon after, Mary calls John to tell him that she is discharged and will get home care. John wonders if she will accept strangers coming into her house because she has refused previous offers of household help. John takes a week’s vacation time and goes to help his mother. During his time there, he meets: the community care (home care) coordinator; the home care nurse; a home health aide; the transition coordinator; the geriatric case manager; and an occupational therapist. Collectively, they offer the following advice: Arrange for Meals on Wheels Make changes for safety at home: get a bathroom grab bar; remove scatter rugs; add a night light; get Mary an emergency response system Mary should accept home care services for help with bathing John should get Power of Attorney to look after Mary’s finances Mary should write a Personal Health Care Directive John is told that they will follow-up to monitor his mother’s safety at home. If she is not safe, the team will encourage her to move into assisted living.  John returns home and stays in daily phone contact with his mother. Contacting the health care professionals is difficult, given time zone differences and work schedules. They encourage him to talk to his mother so she can keep him up to date. But John senses that Mary is avoiding detailed questions. He assumes that she wants to appear to be doing well so that she can stay at home instead of living in a care home. Who am I supposed to talk to? How do I reconcile different opinions from the various professionals? Why is the medical team so guarded about what to tell me? When should I go help my mother – right away or when she is discharged? Will I have enough warning to arrange vacation time and travel? Why is Mom moving to another unit in the hospital? What is her diagnosis? What will she need from now on? On the medical team, who is responsible for what? Why are so many people involved? John finds out...

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Family Helps Rehab after Stroke

Posted by on Sep 8, 2010 in Health Care Team and System, Health Emergencies | 0 comments

  After injury or disease strikes, a structured program of rehabilitation therapy can restore a part of the body or a person to normal or near-normal function. The goal of a rehabilitation program is to help someone become as independent as possible and to function despite a disability.  Rehabilitation may focus either on multiple areas or be very specific. Physical rehabilitation activities and treatments may include: Exercise Electrical stimulation Massage Repetition and practice of daily activities; e.g., walking, climbing stairs These rehab activities can help the individual regain co-ordination, endurance, flexibility, mobility, and strength. Who needs it? In addition to stroke, some of the circumstances that call for rehabilitation therapy are: Acquired brain injury, including stroke and head injury Amputation Bone fracture Heart conditions Joint replacement Often, more than one type of rehabilitation therapy may be needed, meaning a team effort is called for. Who delivers it? Several professionals, trained in specific areas, may work together in the rehabilitation process. Their common goal is to help individuals to regain skills, learn new ones, and make the best use of remaining abilities. Occupational Therapist (OT): The OT will focus on everyday tasks, such as dressing and preparing meals. An OT sometimes recommends changes to the environment (e.g., bathroom grab bars) that encourage safety and independence.  Physiotherapist:  The “physio” teaches special exercises to help the individual improve balance, muscle control and strength, and to practice tasks such as walking and managing stairs. Recreational Therapist:  This professional can help an individual to plan new hobbies and interests, or to learn new or different ways to resume old ones. Speech-Language Therapist: This professional is trained in assessment of swallowing, and in assessing and treating speech and language problems. Some people regain the ability to speak within a few months. Early speech therapy can help the person make the most of the remaining language skills. Psychologist, social worker, or family therapist: These professionals specialize in assessing and treating emotional health issues. Counseling may assist the individual and the family to adapt to the changes that occur following the stroke. Families play an important role in enhancing the work of professional teams. Particularly in the case of stroke, early rehabilitation can dramatically improve recovery. Understanding the recovery process and knowing how to support a stroke patient while in hospital, and after discharge, can make a huge difference. For more insight on this topic, check out the ElderWise e-guide, “Enhancing Rehab After A Stroke”, available in our on-line store. Vol. 5, No. 10, © ElderWise Publishing 2009. You have permission to reprint this or any other ElderWise INFO article, provided you reproduce it in its entirety, acknowledge our copyright, and include the following statement: Originally published by ElderWise, Canada’s go-to place for “age-smart” planning. Visit us at http://elderwise.memwebs.com/ and subscribe to our FREE...

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Drawbacks of Bed Rest

Posted by on Sep 8, 2010 in Caregiving, Health Care Team and System | 0 comments

Sometimes acute injury or illness leaves a senior bedridden but too much bed rest can have negative health effects. For the older adult, bed rest or chair rest, even for a few days, can cause deconditioning; that is changes in muscle strength and muscle bulk that can result in dependence and  impairment in balance.  Muscle strength is important to perform daily activities.  For example, strength in the quadriceps (thigh muscle) is necessary to rise from a chair, independently. Loss of strength in the muscles of the ankle joint may result in falls. Deconditioning can result in a loss of independence that lasts long after the acute problem has been treated. How does deconditioning begin? The human body is designed for movement. It is also subject to the forces of gravity, so  that each move we make to stand and walk is a move against gravity.  When we are at rest, gravity doesn’t have its usual effect. Without this force to pull against, muscles and  bones get weaker. This weakness can lead to loss of muscle mass, muscle shortening, changes in the joints, changes in cognitive abilities, and reduced circulation. Keeping moving, even small steps or little stretches can make a big difference to recovery. How can you help? If you have a senior who is in hospital or a long-term care home, ask for a physiotherapist who can work with them to prevent deconditioning.  Many hospitals have programs designed to help.  Some even bring specialized equipment like a half-barrel or sling to help a senior in bed gently work their muscles. You can also ask the nursing staff to show you how to help the older adult do the exercises safely. As a family member, you can provide essential support and encouragement. If an exercise program is not offered or you have a senior who is at home and on bed rest, simple range of motion exercises can be done while lying in bed.  Start at the shoulders and work through all the joints of the body gently moving the limb through its normal range of movement.  These movements should be gentle and not cause strain or pain.   1. Make circles with the arms and straighten and bend the elbow.  Rotate the wrists. Open the hand and then make a fist. 2. To help hips remain loose, lift the leg and move it away from the body, then return it to rest. 3. Bend and straighten the knee. If the person is able, bring the knee toward the chest and then return the leg to rest on the bed. 4. Rotate the foot in a full circle. Reverse the direction. 5. Even sitting up in bed a few times can help the muscles, since multiple muscle groups are required to move from a lying to a seated position.  Sometimes we feel a person is safer lying quietly in a bed, and when bed rest is required it can be just what the doctor ordered.  However, we should change our view that bed rest means complete rest.  It should include working the muscles and bones that were designed to be in motion. Vol. 3, No. 23 © ElderWise Inc. 2007. You have permission to reprint this or any other ElderWise INFO article, provided you reproduce it in its entirety, acknowledge our copyright, and include the following statement: Originally published by ElderWise Inc., Canada’s go-to place for “age-smart” planning. Visit us at www.elderwise.ca and subscribe to our FREE bi-weekly...

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