Seniors' Caregiver Handbook

People and Organizations in North Toronto

SENIORS’ CAREGIVER HANDBOOK

ADVOCACY INFORMATION

COMMUNITY CARE RESOURCES

GUIDANCE SUPPORT

A STEP BY STEP GUIDE

pointinc.org

Acknowledgements

I have greatly enjoyed the experience of creating the second edition of the Seniors’ Caregiver Handbook , and working in partnership with a supportive team of individuals, in an effort to offer a practical and user-friendly guide to assist Caregivers in providing the best quality of life possible for the senior family member, friend, or neighbour.

Thank you to all the members of the PLANTSS Committee, especially Care Watch Toronto, SAINTS, SPRINT, and Toronto Community Care Access Centre, who contributed ideas, advice, and professional expertise to the Handbook.

Many thanks to the individual Caregivers, North Toronto and Toronto-wide agencies, and volunteers who provided input, shared personal experiences, assisted with data collection, organizing information, and proof reading the materials for the Handbook. A special word of appreciation to Judith Wahl, Advocacy Centre for the Elderly, for her guidance and allowing the use of materials especially pertaining to legal issues and accommodation facilities for seniors.

Thank you to the Ontario Seniors Secretariat for the funding to produce the original Caregiver Handbook, and International Year of Older Persons Committee for supporting the original proposal to create the Handbook.

Special thanks to the following organizations, groups and government departments for sharing their printed materials and resources with us: Advocacy Centre for the Elderly, Canadian Medical Association, Caregiver Alliance of North York, Family Caregivers’ Support Network, Health Canada, Ministry of Citizenship, Culture and Recreation, Saint Elizabeth Health Care Foundation, The Caregiver Network Inc., and Woodgreen Community Centre.

Finally, many thanks to POINT, the sponsoring agency, and Diane Werner, Executive Director, and the POINT staff; John Patton, Blythe Runnett, and Janice Webster for the coordination, support and technical aspects of producing this handbook .

Sincerely,

Joan Berndt Volunteer, POINT April 2011

SENIORS’ CAREGIVER HANDBOOK

Table of Contents

 What is a Caregiver………………………………………………… Section 1

 When Does a Person Become a Care-Receiver…………………. Section 2

 Caring for the Caregiver……………………………………………… Section 3

 Where to Start: Helpful Information You Should Gather………… Section 4

 Power of Attorney…………………………………………………… Section 5

 Community Care Access Centres and LHINs……………………... Section 6

 Support Services for the Caregiver & the Care Receiver ………… Section 7

 Services that can be Available in the Home……………………… Section 8

 Health Care Resources……………………………………………… Section 9

 Nutrition……………………………………………………………… Section 10

 Transportation……………………………………………………… Section 11

 Accommodation………………………………………………………Section 12

 Elder Abuse………………………………………………………… Section 13

 Advocacy……………………………………………………………... Section 14

 Hospice/Palliative Care…………………………………………….. Section 15

 Concluding Comments and Feedback Form

MISSION STATEMENT

This Handbook is a step by step guide to provide information, guidance and support for you as a Caregiver.

The Handbook offers information about a variety of resources that are available to help you with caregiving.

It also provides suggestions to assist you in accessing and effectively interacting with Community Support agencies, health care service providers, support groups and various organizations.

Our goal is to help you as a Caregiver to provide the best quality of care for the Care-Receiver and equally important to maintain well-being and a positive outlook for yourself.

Seniors’ Caregiver Handbook

Section 1

What is a Caregiver?

Definition of a Caregiver - A person, male or female, who provides care in the name of protection, supervision and conscientiousness.

A Caregiver is: - a spouse - a relative - a friend/neighbour - a professional

You become a Caregiver when you assume the responsibility to provide help or a service that the Care-Receiver normally or regularly performed.

The Caregivers’ Bill of Rights

1. I have the right to take care of my own needs.

2. I have the right to feel and appropriately express all of my feelings, positive and negative.

3. I have the right to set limits about how much I am willing to do.

4. I have the right to ask other family members and friends for help.

5. I have the right to seek professional help and information that will make my job as Caregiver easier.

6. I have the right to develop areas of my life that have nothing to do with the care of the receiver.

7. I have the right to free time.

8. I have the right to feel good about the difficult job I am doing.

9. I have a responsibility to be honest and truthful.

10. I have a responsibility to respect the Care-Receiver.

11. I have a responsibility to encourage good relations with other care providers and family members. (Source: Caregiver Alliance of North York) 1

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Section 2

When does a person become a Care-Receiver

Aging in Place:

Indicators of health problems needing assistance:

 repeated memory loss  failure to cook meals, not getting proper nutrition  forgetting to turn stove off, burned pots  unable to organize shopping  forgetting to do banking or pay bills  unable to bath, incontinence  personal appearance begins to look messy  unable to do laundry or do housekeeping  becomes isolated in home  misuse or under use of medications  continued worrying about not having enough money  obsession with theft of money or possessions  weight loss

Cognitive Impairment Symptoms:

 loss of short-term memory, repetition of thoughts  impaired visual-spatial ability  disorientation  difficulty choosing and using words  loss of ability to perform daily functions  hallucinating

Signs of Dementia:

 loss of short-term memory and long-term memory  impaired visual-spatial ability  problems with abstract thinking  impaired judgement  difficulties with language  personality changes

Seniors’ Caregiver Handbook

Signs of Depression:

 inability to concentrate or make decisions  lack of enjoyment or enthusiasm for anything  changes in eating habits - weight loss or gain  lack of interest in being with other people  feeling unwanted or worthless  sadness or crying for no apparent reason  problems with sleeping  feeling tired most of the time

What Leads to Depression:

 recent physical or medical problems  reaction to medication  changes in hearing, seeing, moving or other functions  recent personal losses, (family, friend or pet)  isolation  not feeling useful  not being mentally stimulated  focusing on the past and not feeling enthusiastic about the future  not getting the proper nutrition

Mental Health

You can encourage positive mental health by:

 involving your Care-Receiver in decision-making as long as possible  accepting the personality and emotional changes after an illness  recognizing the strengths and abilities of the Care-Receiver  encouraging the Care-Receiver to socialize with friends and relatives  arranging fun times  helping Care-Receiver to start hobbies or revive old ones  encouraging activities outside, if possible  listening, talking and sharing feelings  assuring privacy and dignity  encouraging exercise  communicating with the Care-Receiver

Seniors’ Caregiver Handbook

If you are concerned about the mental health of the Care-Receiver and/or you notice these symptoms as previously described then:

 have a family conference  discuss with Care-Receiver/spouse and develop a plan  discuss with family doctor, nurse, or social worker  call Community Care Access Centre (CCAC) or POINT Community Information Service (CIS) for in-home resources

Paranoia

Many Care-Receivers experience paranoia or anxiety and deal every day with fear, panic attacks, obsessions, confusion, irritability, restlessness, and anger.

Causes:  Worrying  Poor nutrition  Depression – psychiatric disorders  Brain damage or memory loss  Reactions to medications  Alcoholism  Medical problems (pain infections, heart disease, blood sugar disorders)  Reduced hearing or sight  A blow to the head  Environmental changes – change and disruption

The Caregiver can help by:  Don’t take accusations personally  Maintain a calm, caring manner  Reassure  Don’t argue or contradict – redirect the conversation  Remind where valuables are kept and help to look for them – never scold for losing or hiding items  Remind and repeat information about visits and care plans  Take the person’s hand in yours to sooth  Engage the person in a familiar activity  Following routine builds a sense of security

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Section 3

Caring for the Caregiver

There are positive aspects of providing care in the home to a family member who needs it but when the care giving goes on for years, it takes a toll. In the process of providing care, the caregiver may become fatigued to the point of complete exhaustion, suffering from depression, anxiety and poor health and a feeling of hopelessness. Friends and family members of caregivers can also be on guard for signs of caregiver’s burnout by asking about feelings of sadness or of being overwhelmed. If a person seems particularly low, don’t be afraid to ask about thoughts of suicide. Talking to someone about such difficult feelings can help to relieve their distress. Care giving at home is a very isolating activity. It is more difficult for older men who don’t have the friendships older women have. Tell the caregiver you care about them and are available to help. Caregivers need to know this.

Tips for Caregivers

1. Have a sense of humour and a good laugh.

2. Tell family and friends how they can share care-giving duties. Be honest, appreciative and clear in what you require and divide the responsibilities.

3. Take one step at a time and solve one problem at a time.

4. Be tactful, diplomatic and very patient.

5. Take care of your health - you need rest, exercise and a nutritious diet

6. Accept the impaired person as is, today.

7. Connect with other Caregivers to share experiences, but seek/obtain specific information with knowledgeable and trained professionals.

8. Accept your feelings and decisions without guilt.

Seniors’ Caregiver Handbook

9. Take a break - use respite care when you begin to notice signs of stress - tiredness, irritability, lack of sleep, loss of appetite, depression.

10. When you take a break from care-giving, do something for yourself.

11. Make sure your family is not ignored when you are care-giving.

12. Keep a list of important phone numbers by the telephone.

Tasks of the Caregiver

1. Learn to advocate for the Care-Receiver and ask questions.

2. Accompany the Care-Receiver on appointments and assist with

errands.

3. Work as a team player with the professionals.

4. Ensure respect dignity, privacy and confidentiality of the Care-

Receiver.

5. Communicate with the personal care workers.

6. Make decisions that are the most suitable for the Care-Receiver and explain your reasons.

7. When a move is necessary, help the Care-Receiver deal with the emotional stress.

8. Discuss early signs of Alzheimer’s disease and dementia openly - do not try to hide symptoms because of embarrassment.

9. Have a contingency plan for care if you become ill - have a list of your doctors and medical needs.

Seniors’ Caregiver Handbook 10. Can provide assistance with regular household tasks, transportation, personal care.

11. Provide companionship.

12. Monitors challenging behaviours (wandering, aggression)

Communicating with Agencies, Organizations and Groups

1. Have your diary/notebook handy

2. Respect confidentiality of the Care-Receiver

3. Phone early in the morning, or immediately after lunch

4. Record the name, the telephone number and extension of the agency person and write down your comments/impression of the conversation

5. Have many copies of important documents

6. Be specific, polite but firm

7. Be patient; you may have to repeat your story, or be put on hold or your call may be transferred

8. Prepare to invest time in getting your questions answered

9. Read carefully any contracts and review regularly

10. Be assertive; do not apologize for asking for help

If you are going for an interview or meeting, ask what information you need to bring with you.

 Don’t be afraid to ask questions

 Don’t be pressured into making quick decisions because you have been told you have to decide immediately.

Seniors’ Caregiver Handbook

Caregivers can become so frustrated that they become angry. There are some ways to control the anger.

 Take a time out  Talk with a friend, relative or counselor  Get away from the place of tension  Walk around the block  Write down feelings, in a diary or journal  Take a deep breath  Count to 10  Exercise

Respite Care - When You need a rest

Respite - is a delay or cessation for a time; especially of anything distressing or trying; an interval of relief. An interval of relief is a break or interruption in the continuity of work involved in fulfilling a responsibility.

Definition - break, time-out or relief from the caregiver responsibilities - not a service to the Care Receiver - should provide support to the Caregiver

Respite Care - provides short-term care or temporary care in the home to allow Caregivers of the frail, elderly or disabled, who need constant supervision, some free time from family and responsibilities. If a person requires help with personal care, he or she may be eligible for some hours from Community Care Access Centre (CCAC).

Type of Respite: - in-home care – 2 to 3 times/week for several hours - day program – 1 to 3 times/week - overnight and short-stay services

Seniors’ Caregiver Handbook

List of agencies providing education & training for caregivers

Counselling services for the caregiver

Agencies providing caregiver respite

Who provides it 1) Baycrest Day Care Services for Seniors 416-785-2500

2) Circle of Care 416-635-2860

3) Senior Peoples’ Resources in North Toronto (SPRINT) 416-481-6411

How to apply: Respite care is applied for through the Intake Department of the local Community Care Access Centre. A Long-Term Care Admission Form may be obtained from this Centre.

Many Retirement Homes, Homes for the Aged, Nursing Homes, and Chronic Care Hospitals provide vacation and respite care for a period of 2 to 4 weeks. Apply well in advance through a CCAC application or directly to the facility. Some respite care services require a fee. Retirement homes, which are private, can be costly. In long-term care facilities, respite costs are approximately $29.00 per day (subsidized through the Ministry of Health and Long-term Care). The Care-Receiver is allowed to stay for up to 90 days at a long-term care facility with 30 days permitted each time. Adult Day Programs are another means of providing respite to Caregivers who are taking care of people with Alzheimer’s Disease and dementias. These programs are not for all frail seniors.

Indicators of the need for respite that can alert caregivers to begin to plan for respite.  anxiety  fatigue  exhaustion  illness  feelings of isolation, hopelessness

Seniors’ Caregiver Handbook

 depression, feeling sorry for oneself  sleeplessness or sleep deprivation  health status of the care receiver  caregiver role expectation – confused or uncertain  extensive length of care-giving period  intensity of care-giving  relationship of caregiver  overwhelmed  emotionally numb or explosive  unable to focus or concentrate  resentful  feeling inadequate (to the task)  feeling a need for an increased use of alcohol or stimulant  experiencing sudden weight changes

Respite could be:  enjoyment of friends  a trip  a good night’s sleep  an aerobics class  sitter/companion  housekeeping  adult day care  peer support group  facility respite  physical modifications  information re: resources  transportation services  personal emergency system  counseling  full-time short-term home care  outdoor maintenance  meal program  spiritual support  longer facility stay  family counseling

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Seniors’ Caregiver Handbook Section 4

Where to Start

Helpful Information You Should Gather About The Care-Receiver

 Date of Birth

 Social Insurance Number

 Birth Certificate or Document of Citizenship

 Marriage Certificate

 Name of Doctors: Family/Specialist(s)

 List of Medication(s) person is taking

 Drug Allergies

 Other Allergies

 Health Card Number

 Drugs/Dental/Health plan - Policy Number

 Name of Accountant

 Income Tax records - location

 Name of Bank Manager

 Bank Accounts: location of bank accounts

 Bank address and phone number

 Debit Card Number

 Safety Deposit Box and Key - location

 Name of Broker or Financial Planner 14

Seniors’ Caregiver Handbook

 R.R.S.P.s (Registered Retirement Savings Plans) or G.I.C.s (Guaranteed Income Certificates) – Trading Authorization (Limited Power of Attorney). This document provides a representative of a financial service with the authority to act on behalf of the Care-Receiver, in giving investment instructions for purchase of plan/assets or exchange of plan/assets within the same family of funds.

Institute of Chartered Accountants of Ontario offers free tax clinics for seniors - 416-962-1841 Revenue Canada publishes a pamphlet entitled Tax Information for People with Disabilities. For all income tax information, contact the local district Revenue Canada taxation office listed in the Blue pages of the telephone directory. Human Resources Skills Development Canada (HRDC) has developed a booklet called Overview & Income Security Programs, outlining in detail all pensions and benefits offered by the government. Call during mid-months to receive immediate attention 1-800-277-9914

 Credit cards – any outstanding balances

 Car Insurance

 Life Insurance

 All pensions & benefits - Canada Pension Plan (C.P.P.), Old Age Security (O.A.S.) and employment pensions

 Household Insurance

 Drivers’ licence and car ownership papers

 Rental payments

 Lease or Home Ownership Agreement

 List of family, friends as contacts

 Funeral plans and wishes - discuss openly with Care-Receiver

Seniors’ Caregiver Handbook

 Organ Donations - where are they documented?

 Name of Lawyer, address and telephone number Will - location of will, copies on hand - personal wishes and wishes in respect to property distribution - make sure will is current and is in good order - living will - contains instructions of the grantor with respect to organ donation - discuss these issues early on and be clear who has Power of Attorney

Helpful Information You Should Gather - * Toll-free in Ontario only

GOVERNMENT OF ONTARIO INFORMATION – TELEPHONE NUMBERS AND WEBSITES General Information on 1-800-267-8097* Ontario Programs and 416 326-1234 www.gov.on.ca Services 1-888-910-1999* Seniors’ Information 416 326-7076 www.gov.on.ca/citizenship/seniors General Health 1-800-268-1154* Information 416 314-5518 www.gov.on.ca/health Guaranteed Annual 1-800 263-7965*

Income System TTY: www.gov.on.ca/FIN (GAINS) 1-800 263-7776 Office of the Public 1-800 366-0335* Guardian and Trustee www.attorneygeneral.jus.gov.on.ca 416 327-6683 (Power of Attorney Kit) Phonebusters and SeniorBusters Supported by the Ontario Government to report 1-888 495-8501 www.phonebusters.com phone fraud and elder abuse GOVERNMENT OF CANADA INFORMATION – TELEPHONE NUMBERS & WEBSITES General Information fro 1-800 622-6232 Canada Programs and TTY/TDD: www.canada.gc.ca Services 1-8—465-7735

Seniors’ Caregiver Handbook 1-800 622-6232 Seniors Canada TTY/TDD: www.seniors.gc.ca/index.jsp 1-800 465-7735 Canada Pension Plan, Old Age Security, Guaranteed 1-800 277-9914 www.hrdc-drhc.gc.ca Income Supplement, Disability Benefits Information on Traveling 1-800 267-6788 www.dfait-maeci.gc.ca Abroad

Ontario Seniors’ Secretariat Seniors’ INFOline Ministry of Citizenship Toll-free: 1-888-910-1999 77 Wellesley Street West Local Calls: 416 326-7076 6th Floor Ferguson Block TTY: 1-800 387-5559 Toronto ON M7A 1R3 Web site: www.gov.on.ca/citizenship/seniors

The Ontario Seniors’ Secretariat has two primary tasks

1. To develop and support government initiatives which improve the quality of life of Ontario seniors. 2. To undertake and support public education efforts for and about Ontario’s seniors.

Telehealth Ontario 1-866-797-0000 free access to registered nurses 24 hours a day, 7 days a week.

OHIP information 1-800-664-8988

Assistive Devices 1-800-268-6021

Trillium Drug Plan 1-800-575-5386

Flu Shot Program 1-866-358-6968

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Seniors’ Caregiver Handbook

Section 5

Power of Attorney

There are four types of Powers of Attorney in Ontario:

1) General Power of Attorney for property. This Power of Attorney can be given by the Care-Receiver if someone is needed to help manage finances of the Care-Receiver or, for example, assist in the sale of a property. The Care- Receiver must be mentally capable to execute this type of document. The provincial Public Guardian and Trustee is the substitute decision-maker of last resort if there is no other appropriate person. A Guardian of the Person is someone authorized by a court to make personal decisions for a Care-Receiver upon his/her becoming mentally incapable. The Guardian must stay in contact with and consult with the Care-Receiver and make decisions that are best for the Care-Receiver. Family and friends can apply to the Consent and Capacity Board to become the substitute decision-maker for medical treatment admission to a long-term care facility and personal assistance services in a long- term care facility. They become a board-appointed representative that ranks above spouse, partner and other family members. As well, family and friends can apply to the Superior Court of Ontario to be appointed as Guardian of the person with authority for treatment. A Guardian of the Person ranks highest on the hierarchy of substitute decision-makers named in the law.

Consent and Capacity Board: Phone – 416 327-4142 Web site – www.ccboard.on.ca

Office of the Public Guardian & Trustee: Phone – 416 314-2800 Web site – www.attorneygeneral.jus.gov.on.ca

2) Continuing Power of Attorney for Property is a legal document that gives someone the power to act as an agent for legal actions with property. This person becomes an “attorney”. A Continuing Power of Attorney for property lets the “attorney” 18

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go on acting for the Care-Receiver when that person becomes mentally incapable. To be “mentally capable” means that a person must have the ability to understand information relevant to making a decision and the ability to appreciate the reasonably foreseeable consequences of a decision or lack of decision. The document must be called a continuing Power of Attorney, or state that the “attorney” can act when the Care Receiver becomes mentally incapable. It is wise to chose someone trustworthy as Continuing Power of Attorney for Property while the Care- Receiver is mentally capable. 3) Power of Attorney for Personal Care is a legal document giving someone the power to make personal care decisions for the Care-Receiver when they become mentally incapable. This person is also called an “attorney”. Personal Care decisions are those made about health care including medical treatment, diet, housing, clothing, hygiene and safety. A Power of Attorney is needed for residents of long-term care facilities.

4) Banking Power of Attorney is a form issued by Care- Receiver’s bank to name someone who will manage financial affairs. This document applies to the bank only and does not overrule the legal Continuing Power of Attorney. Have a lawyer verify the document.

Kits for Powers of Attorney for Personal Care and for a Continuing Power of Attorney for Property are available free of charge from the office of the Public Guardian and Trustee - Telephone 416- 314-2800.

The Advocacy Centre for the Elderly (ACE) has prepared a booklet on Continuing Powers of Attorney. It is available by calling ACE at 416- 598-2656.

The “attorney” acting on behalf of the Care-Receiver is entitled to payment. Consult a lawyer to determine the amount if it has not been specified in the document.

Have a number of copies made of original documents of Power of Attorney since they will be required for many of the services needed.

Seniors’ Caregiver Handbook

If the Care-Receiver is incapable of executing a Continuing Power of Attorney for Property, then it is necessary to look at the finances and property, and the need for financial management. If the Care-Receiver’s only income is from public pensions, and that person has no other assets than personal items of nominal value then a relative or friend may apply to become a trustee to manage the individual’s pension cheques. This is done by providing Human Resources Skills Development Canada - Income Security Programmes with forms: “Certificate of Incapacity” and an “Undertaking to Manage Finances”. These forms are available from Human Resources Skills Development Canada at 1-800- 277-9914.

Community Legal Education Ontario (CLEO) has publications on other areas of law as well. Most are free and can be ordered by calling 416-408-4420 or by visiting www.cleo.on.ca on the internet.

Centralize all banking and payment of bills, and consider supervising finances.

The Health Care Consent Act

This Act was enacted to establish a framework for health care decision-making. Decisions with respect to treatment, admission to long-term care facilities and personal assistance services in long-term care facilities are all covered by the Health Care Consent Act. This Act allows other substitute decision-makers to make some personal care decisions when the Care-Receiver does not have a Power of Attorney for personal care, and becomes mentally incapable.

Advance Care Planning – Power of Attorney Advance Care Planning is about the care-receiver making choices now about how they wish to be cared for in the future if they become incapable of making decisions. The Care-Receiver gives someone who is trustful the position of substitute decision- maker. This person gives informed consent for health care, nutrition, shelter, clothing, hygiene or safety. It is the Care- 20

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Receiver’s choice whether to do advance care planning or not. The health care providers are required to take direction from your substitute decision-maker. This person makes decisions when the Care-Receiver becomes incapable of doing so. The personal care wishes expressed while capable are legally binding. The care wishes can be expressed to the substitute decision- maker in any form of writing or face-to-face or with a recording device. Then the appointment is made in writing through a Power of Attorney for Personal Care. This document must be signed and dated by the Care-Receiver with 2 witnesses who then co-sign it. The health care provider decides whether the Care-Receiver is capable of making decisions about medical treatment, admission to a long-term care facility or personal assistance services in a long-term care facility.

An Advance Care Directive or living will is used to document the care wishes so the substitute decision-maker can refer to it when making care decisions in the future.

A Power of Attorney for Person Care may be used for the same purpose as an advance care directive or living will but it also appoints the substitute decision-maker. A lawyer is not required to prepare documents for advance care planning but might be helpful in explaining options.

When there is no substitute decision-maker through a Power of Attorney for Person Care, a health care provider must turn to the hierarchy of substitutes named in the law to make health decisions. The highest-ranking person on this list who is available, capable and willing to make these decisions, will become the substitute decision-maker.

1. Spouse, common-law spouse or partner 2. Child (16 yr. or older) or parent of Care-Receiver 3. Parent with right of access only 4. Brother or sister 5. Any other relative by blood, marriage or adoption

Advance Directives is the opportunity to tell the doctor, facility staff and family how you would like the care managed when the Care-Receiver cannot make decisions. Advance Directives help

Seniors’ Caregiver Handbook

ease some of the burden for the caregiver by providing a documented record for future treatment. The directives can be done before the Care-Receiver becomes unable to do so. The choices are written down to eliminate any risk of confusion, and provide a range of treatment options. The options could include the transfer to a hospital or receiving antibiotics or cardiopulmonary resuscitation (CPR).

There are four levels of intervention or treatment options: Level one - supportive/comfort care - no CPR Level two - limited therapeutic care - no CPR Level three- transfer to acute care hospital - no intensive care unit Level four - transfer to acute care with CPR - Intensive care unit

The success of CPR in an emergency situation is based on the age and health of the person involved. The nursing home and doctor will explain the Advance Directives process and will give the caregiver a copy of the Advance Directives form to review, and to be filled out. This form will be filed as part of the health care record. The doctor will review the Advance Directives with the caregiver on an annual basis as part of the interdisciplinary care conference. The Advance Directives can be changed at any time. The nurse in charge is informed and makes sure the Advance Directives form is updated and the doctor is informed of the changes. If a Living Will has been created, the Director of Care of the nursing home will translate the wishes into the Advance Directives.

(Source: For Section 5 - Long-Term Care Facilities in Ontario: The Advocate’s Manual - Advocacy Centre for the Elderly)

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Section 6

Community Care Access Centres

The Role of the Community Care Access Centre

The first number to call when becoming a Caregiver is the Community Care Access Centre which corresponds to the Care-Receiver’s geographic location.

 Toronto Community Care Access Centre 416-506-9888  East York Access Centre for Community Services 416-423-3559  Etobicoke & York Community Care Access Centre - Etobicoke Site 416-626-2222 - York Site 416-780-1919  North York Community Care Access Centre 416-222-2241  Scarborough Community Care Access Centre 416-750-2444

Community Care Access Centres (CCAC) are non-profit agencies, funded by the provincial government, responsible for assisting people to find in-home and community care, and to find placement in long-term care facilities.

The Community Care Access Centres:

 Plan, coordinate and ensure delivery of a full range of in- home services to support clients and their caregivers. This may include respite care/nursing, occupational therapy and physiotherapy, bathing assistance with personal care, toileting, dressing, shaving, etc.  Provide information and referral to a wide range of community-based health and support services  Provide health support services for children in Toronto schools  Provide palliative care  Provide special services for persons with Acquired Brain Injury (ABI)

Seniors’ Caregiver Handbook

 Help clients with their applications and admission to long- term care facilities in Ontario  Serve people regardless of age, diagnosis or financial circumstances

A Care Plan is a written document that outlines how a person should be cared for in order to maximize independence, and physical and mental health.

Clients may self refer or referral may be by someone else (family member, friend, doctor, hospital discharge planner).

A person must be eligible and complete an application for admission to a long-term care facility. The CCAC Care Coordinator will assist with this process.

Six Steps in Admission Process to Long-Term Care Facilities:

1. Contact the local Community Care Access Centre

2. Receive initial information from Placement Co-ordinator or Intake Worker

3. Visit from Care Coordinator/Case Manager for assessment

4. Determination of eligibility for admission by the Community Care Access Centre

5. Application completed if eligible and sent to specific facilities of choice

6. The applicant is admitted to a facility or placed on a waiting list

Seniors’ Caregiver Handbook

List of Application Forms and Documents 1. Consent form 2. Application form 3. Medical form 4. Functional Assessment 5. Social Assessment 6. Facility Choice sheet

These forms are all completed by medical professionals or a certified social worker, together with the patient/SDM.

A long-term care bed is only considered available when you have applied for admission to a long-term care facility:  a Community Care Access Centre has decided that the individual is eligible for a bed  the facility has accepted the patient  a long-term care facility has offered a bed and  the individual has accepted the offer

Health Card Numbers will be verified by the CCAC and applicants may be asked to produce a Health Card and evidence of Canadian citizenship or landed immigrant status as a convention refugee in special circumstances.

In a crisis situation, the CCAC will place the individual in the first available bed in a long-term care facility, but the individual’s name will still remain on the waiting list. If a bed for a patient in the community is refused, the applicant will be removed from all waiting lists. An application cannot be resubmitted for 6 months unless the patient’s condition changes. When a bed becomes available at a higher choice facility, they can be transferred from the placement where placed

Seniors’ Caregiver Handbook

LHINS - Ontario Local Health Integration Networks

TORONTO CENTRAL LHIN is responsible for planning, co-ordinating and funding key health-care services in the Greater Toronto Area for approximately 1.14 million people.

LHINS funds 177 health-service providers including:  hospitals  the Toronto CCAC  community support services  community health centres  mental health and addiction services  long-term care homes

LHINS also provides special health services to a large number of Ontarians who live in other LHINS.

Find your closest LHINS - maps are available on their website indicating location, address and telephone numbers. www.lhins.on.ca

LHINS INITIATIVES:

HOME FIRST: A partnership between the Toronto Central Community Care Access Centre, hospitals and community agencies. Home First is helping patients to safely return home from hospitals and long-term care.

AGING AT HOME: was launched in 2008/09 to expand seniors’ access to home-care and community support services and create locally-driven approaches to enhance seniors’ independence and respond to different care needs. Over 11,000 seniors have benefitted from this initiative improving the well-being of caregivers, families and communities and generating new ways of caring for older adults.

Seniors’ Caregiver Handbook

Your Notes - Section 6

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Seniors’ Caregiver Handbook

24 Seniors’ Caregiver Handbook

Section 7

Support Services for Caregivers and Care-Receivers

What to watch for:

 A senior may have a drinking problem if this person:  Drinks to calm nerves or reduce depression  Lies to hide drinking habits  Loses interest in food  Feels irritable, resentful or unreasonable when not drinking  Has medical, social or financial problems caused by drinking  Check for signs of financial insecurity  signs of depression  disappearance of valuable possessions  concern expressed about the ability to pay for health care and other essentials for daily living

Depression is a condition that exists in the senior population. Despair, loneliness, frustration, the inability to perform certain tasks and a feeling of being unwanted and unneeded are the basis of mental health problems with seniors.

What to watch for:

 A sad mood  Ongoing pessimism about the past, present & future  Loss of interest in other activities  Lack of energy  Irritability  Difficulty in making decisions  Loss of weight  Decreased appetite  Disturbed sleep patterns  Depressive dreams  Thoughts of suicide

Seniors’ Caregiver Handbook

Community Resources Federal/Provincial governments can provide information on their specific programs and resources for seniors. Check the Blue Pages in your phone book or call Reference Canada - referral and basic information service on federal government program and services at 1-800-667-3355.

Homemakers and nurses will visit elderly, physically disabled or convalescent persons so they can remain in their homes. Live-in or live-out homemakers are available on a commercial basis at a set fee. This is an expensive service but it may be the most appropriate arrangement.

Local police and fire departments can provide information on fire safety and in some communities will arrange for home safety checks.

Pharmacies can provide information on medications, their side effects, and the way they should be taken.

Public Health offices and Community Health Centres can provide information on fall and injury prevention, nutrition, medication use and issues about living independently.

Ethno-cultural organizations may provide services to seniors in their own language.

Senior citizens’ organizations can provide information on recreational and exercise programs as well as other services in the community.

Local libraries may help you access documents and information that you may require.

POINT Community Information Service (CIS) provides information and referrals to assist individuals to find the appropriate service or program that addresses their needs.

Seniors’ Caregiver Handbook

Community Support Services Adult Day Programs Dining Clubs Escort Service Friendly Visiting and Security Checks Home Help Homemaking Meals-on-Wheels Caregivers Support Respite Care and Vacation Care

Support Services  Advocacy Centre for the Elderly (ACE) 416-598-2656

 ARCH - Legal Resource Centre for Persons with Disabilities 416-482-8255

 Assistive Device and Home Oxygen Program Ministry of Health and Long-Term Care 1-800-268-6021

 Find Help Toronto 416-397-4636

 7641

 Family Interpreters call: 211 for accessing information on services in specific languages YMCA of Greater Toronto 416-928-9622 c) City of Toronto 416-338-0338

 Family Service Association of Toronto 416-977-0559

 Guaranteed Annual Income System (GAINS) 1-800-263-7965 Ontario Ministry of Finance

 Guaranteed Income Supplement (GIS) 1-800-277-9914 Government of Canada Income Security Program 30

Seniors’ Caregiver Handbook

 Health Care Programs 416-327-8952 (Ministry of) Health and Long-Term Care

 Canadian Medic Alert Foundation 1-800-668-1507

 Old Age Security (OAS) 1-800-277-9914

 Ontario Disability Support Plan 416-325-5666

 Ontario Drug Benefit Program 416-327-8109

 Ontario Seniors’ Secretariat 1-888-910-1999

 Ontario Works - General Welfare Assistance 416-392-8623

 Canadian Institute for Health Information 416-481-2002

 POINT Community Information Service 416-487-2427 (Trained volunteers and staff can provide information and referrals on organizations, programs and services)

 Senior Caregiver Information 416-392-0983

 Services for Seniors - Community Hellene 416-397-4636

 Spouse’s Allowance (SPA) 1-800-277-9914

 Telehealth Ontario 1-866-797-0000 TTY 1-866-797-0007 Telehealth Ontario is a free, confidential telephone service you can call to obtain health advice or general health information from a Registered Nurse.

 Toronto Home Library Service 416-395-5557  Toronto Public Health Department 416-392-7641  WheelTrans (TTC) 416-393-4111

Seniors’ Caregiver Handbook

 Widowed Spouse’s Allowance 1-800-277-9914

 Veterans Affairs Canada-Sunnybrook & Womens’ College Health Sciences Centre 416-973-1966

 Veteran Affairs Canada 1-800-387-0930

Support Groups and Workshops Available

 Caregivers’ Support Group 416-785-2500 Baycrest Centre for Geriatric Care

 Central Eglinton Community Centre 416-392-0511

 Circle of Care 416-635-2860

 Fairlawn Neighbourhood Centre 416-488-3446

 Family Support Group 416-480-4215 Sunnybrook and Womens’ Health Science Centre

 North Toronto Memorial Community Centre 416-392-6591

 SPRINT 416-481-6411

 Sunnybrook Cancer Clinic 416-488-5801

 The Anne Johnston Health Station 416-486-8666

 The Temmy Latner Centre for Palliative Care 416-586-8594

Internet Service/Links

. Computers available for internet use at POINT & free training sessions 416-487-2427 . P.O.I.N.T - www.pointinc.org . The Caregiver Network Inc. - www.caregiver.on.ca -www.howtocare.com

Seniors’ Caregiver Handbook

Pastoral Care - Churches - Offers: - support for family & caregivers - access to special programs - referral to community institutional programs

Caregiver Support and Counselling Services for Caregiver

Alzheimer Society of Toronto Address: 2323 Yonge St. Ste. 500 Toronto ON M4P 2C9 Phone: 416 322-6560 Fax: 416 322-6656 Email: [email protected] Website: www.alzheimertoronto.org

Baycrest Centre for Geriatric Care Address: 3560 Bathurst St. Toronto ON M6A 2E1 Phone: 416 785-2500 ext 2730 Fax: 416 785-2378 Website: www.baycrest.org

Bernard Betel Centre for Creative Living (Emphasis on Alzheimer’s Disease) Address: 1003 Steeles Ave. W Toronto ON M2R 3T7 Phone: 416 225-2112 Email: [email protected] Website: www.betelcentre.org

Seniors’ Caregiver Handbook

Canadian Hearing Society Address: 271 Spadina Road Toronto ON M Phone: 416 964-9595 Email: [email protected] - Hearing care counselling – communication and hearing care support services (priority to seniors 55 & over) - Home visits for clients, their families and caregivers - Hearing help classes – supportive group environment for hard of hearing individuals - Technical devices 1-800-537-6030 - Serves Italian, Chinese, Portuguese, Russian for seniors

Catholic Family Services of Toronto – North Branch Address: 5799 Yonge St. Ste. 300 North York ON M2M 3V3 Phone: 416 222-0048 Fax: 416 222-3321 Website: www.cfsofto.org

Family Services Association of Toronto Address: 355 Church Street Toronto ON M5B 1Z9 Phone: 416 595-9230 Fax: 416 595-0242 Website: www.fsatoronto.com

Seniors’ Caregiver Handbook

Your Notes - Section 7

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Seniors’ Caregiver Handbook

Section 8

Services that can be Available in the Home

When chores become difficult for seniors, there are services available so they may stay in their own home as long as possible.

They are:  Banking  Bathing  Fire Information - working smoke and CO detectors and fire prevention inspection  Foot Care  Friendly visiting, adult day care  Gardening  Home safety assessment  Housekeeping  Lawn cutting  Lifeline Programs  Meals on Wheels  Recreation, outings  Shopping - groceries, clothing  Snow shovelling  Telephone Reassurance  Telephone Security Checks  Transportation and Escort Service

Call POINT Community Information Service 416-487-2427 for information on In-Home Services and referrals to appropriate community services or visit ww.pointinc.org.

Organizations Providing the Services

Alzheimer’s Society of Ontario 416-967-5900

AJHS (The Anne Johnston Health Station) 416-486-8666

Arthritis Society – Ontario 416-979-8366

Association of Ontario Health Centres 416-236-2539

Seniors’ Caregiver Handbook

CCAC - Community Care Access Centre 416-506-9888

Canadian Cancer Society – Ontario 416-488-5400

Canadian Hearing Society – Toronto 416-964-9595

Canadian National Institute for the Blind 416-486-2500

Canadian Red Cross Society 416-236-3046

COTA (Community Occupational Therapists) 416-785-8797

Heart & Stroke Foundation of Ontario 416-489-7100

Homemaker’s and Nurses Services 416-392-8545

National Pensioners & Senior Citizens Federation 416-251-7042

Red Cross 416-480-2500

Red Cross Equipment Rentals 416-224-2202

SAINTS (Student Assistance in North Toronto for Seniors) 416-481-6284

Shoppers Drug Mart - Free Delivery at Every Store 1-800-363-1020

Shoppers Home Health Care - Assistive Devices 1-800-363-1020

SPRINT (Senior People Resources in North Toronto) 416-481-6411

St. Elizabeth Health Care (Nurses) 416-498-8600

Telehealth Ontario 1-866-797-0000

Toronto Human Society - can refer to pet emergency clinics 416-392-2273

Toronto Ride - available through SPRINT or 416-481-6411

Seniors’ Caregiver Handbook

VHA Visiting Homemakers’ Association 416-489-2500

VON (Victorian Order of Nurses) 416-499-2009

Yorkminster Meals on Wheels 416-482-0549

Emergencies

If a person falls, leave them where they are and phone for help. Do not lift or move them. Reassure them that you are in control and are seeking assistance. Falls Prevention programs are given by Public Health, COTA, and CCAC. Speak to the doctor and health care team about whom should be called for what type of emergency. Keep a list of the appropriate doctors and their telephone numbers by the telephone.

An emergency first aid course or family health care program would be useful to take so you would feel more comfortable in an emergency situation.

Do not call 911 if someone has died a natural expected death at home. Instead call the family doctor who can tell you what you should do next.

Emergency Numbers Water and Sewer 416-392-7737 (Emergency - 24 hrs.) Water mains & sewer lines 416-392-8211 Hydro 416-599-0735 Enbridge Consumers Gas 416-447-4911 Emergency Health (24 hrs.) 416-392-7149 No or low heat 416-392-7149 Ambulance, Emergency, Fire, Police (24 hr). 911 Non-Emergency Ambulance 416-808-2222 Poison Information Centre 416-598-5900 Medvisits - doctors on call 416-631-3000 Doctors Housecall Service 416-631-3000 Distress Centre 416-598-1121

Seniors’ Caregiver Handbook

For information not listed, please call the:

POINT Community Information Service Monday-Friday – 9:00 am – 5:00 pm 416-487-2427 Multilingual Information 24 hour service 211 Social services and counselling referrals – www.211toronto.ca City of Toronto resources 24 hr., 7 days a week 311 Non-emergency city services, programs and information TTY service for hearing impaired is also available. Email: [email protected] or call

Your Notes - Section 8

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Seniors’ Caregiver Handbook

Section 9

Health Care Resources

If you cannot locate the health card for the Care-Receiver, call 416-327- 7567 or visit their website.

When a Care-Receiver is diagnosed with a particular illness or condition, learn all you can about the symptoms, treatments and prognosis.

Contact the specific Association or Society for information and support:

Alzheimer’s Society for Toronto (for Dementia also) 416-322-6560 Arthritis Society 416-979-3760 Canadian Cancer Society Information Line 1-888-939-3333 Canadian Hearing Society 416- 964-9595 Canadian National Institute for the Blind - CNIB 416-486-2500 Cystic Fibrosis Foundation 416-932-3900 Drug Benefits (seniors) 416-314-7444 Heart and Stroke Healthline 416-631-1557 Multiple Sclerosis Society of Canada 416-922-6065 Ontario Naturopathic Association 416-233-2001 Osteoporosis Society of Canada 1-800-463-6842 Parkinson Foundation Caregivers’ Support Group 416-444-3486

Hospital Information RGP Geriatric Outreach Team 416-480-6111 The Anne Johnston Health Station 416-486-8666 The Doctor’s Office (for the nearest walk-in clinic) 416-488-1455 Sunnybrook & Women’s Health Sciences Centre 416-480-6100 Toronto Rehabilitation Institute 416-597-3422

Hospital Discharge

After a hospital stay, if the patient must move from his/her present home, facility information and an application form can be obtained through the Community Care Access Centre. It is important for the patient’s family or Caregiver to visit a few facilities to allow an informed decision to be made.

Seniors’ Caregiver Handbook

Be part of the hospital discharge plan for the Care-Receiver

 Connect with the CCAC (Community Care Access Centre) representative at the hospital.

 Respect the wishes of the Care-Receiver when planning for hospital discharge

Under the Public Hospitals Act, a member of the medical staff designated by the physician shall make an order that the patient be discharged when the patient is no longer in need of hospital treatment. It is then communicated in writing to the patient. The patient shall leave on the date set out in the discharge order although there is a provision for a 24-hour grace period. A hospital cannot discharge the patient unless there is a facility that can give the care needed. The Ministry of Health and Long- Term Care can give advice and assistance at 416-327-8952.

Health Care Resources

Visiting and Shift Nursing: Visiting nurses provide up to two hours service while shift nurses provide service over a three to twelve hour period.

Registered Nurses and Registered Practical Nurses will:  Provide palliative care for a person living with a life-threatening, chronic or terminal illness  Assist an individual recovering from an acute illness, injury or surgical procedure  Offer respite care for caregivers  Assist in adjusting to home life following discharge from a hospital or institution  Assist with a chronic or debilitating illness  Certified Health Care Aides and Personal Support Workers will:  Provide homemaking services including laundry, grocery shopping, light housekeeping, meal planning and preparation  Provide personal care including bathing, skin care, dressing, grooming, feeding, exercise, medication supervision  Provide respite care and relief for family members or friends who are the caregivers

Seniors’ Caregiver Handbook Special care can be provided for the frail elderly, people recovering from surgery, injury or illness, people with cognitive impairment, and terminally ill individuals. All services are available for a reasonable fee.

Healthy eating is essential to everyone but the elderly are particularly at risk for malnutrition, which is associated with a variety of medical risk factors. These include disease complications, poor healing, pressure ulcers and longer hospital stays. Malnutrition can be treated and prevented. Symptoms of nutritional problems can include:

 Pale skin  Sunken eyes  Poor skin  Minimal muscle and fat stores  Weakness, fatigue  Irritability  Change in functional status  Dehydration  Fluid retention

The “DETERMINE” nutrition checklist for warning signs of malnutrition. D Disease E Eating poorly T Tooth loss/mouth pain E Economic hardship R Reduced social contact M Multiple medications I Involuntary weight loss/gain N Needs assistance in selfcare E Elder years above age 80

The Caregiver can ask for a home care dietitian to make an assessment. In the meantime, the caregiver can:  Arrange Meals-on-Wheels or congregate dining  Buy canned foods for convenience  Buy nutritional supplements as snacks or part of a meal, such as Ensure or Ensure Plus

Regular meals, nutritious snacks, healthy eating out and appropriate use of nutrition supplements may help to improve the quality of the Care- Receiver’s diet. 42

Seniors’ Caregiver Handbook

Factors that affect nutritional risk are:  Physical – difficulty preparing food, loss of teeth  Physiological – diseases, changes in taste or appetite  Socio-economic – financial, isolation  Psychological - depression

Health Care Resources

Chronic Illness – chronic diseases are the leading causes of death in Ontario. Common chronic diseases include heart disease, stroke, cancer, chronic lung diseases such as emphysema, diabetes, osteoporosis.

Regional Geriatric Programs (RGPs) of Ontario

Toronto – 416 480-6026 Web site – www.rgps.on.ca

For further assistance on resources POINT Community Information Service 416-487-2427

Your Notes - Section 9

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Seniors’ Caregiver Handbook

Section 10

Nutrition

Nutrition and Aging:

Nutrition plays an essential role in maintaining immune competence in the elderly, which contributes to keeping elderly individuals living independently at home for as long as possible.

Malnutrition weakens the immune system and increases disease complications, poor healing, risk of falls, increased hospitalization and risk of death.

Proper nutrition in the elderly prevents malnutrition.

Signs and symptoms of malnutrition:  pale skin  sunken eyes  weakness, fatigue  irritability  change in functional status  dehydration  fluid retention

Healthcare providers should be performing early risk assessments and be aware of signs and symptoms of malnutrition. The diet of seniors should include a variety of foods based on Canada’s Food Guide to Healthy Eating. The use of nutritional supplements may be useful for some elderly. These supplements can be used as a high energy, nutritional snack or as a meal replacement for the elderly having trouble meeting their daily energy needs. Ensure Plus is a supplement with an excellent source of calories and protein.

Some physiological age-related changes that may impact nutritional status:  anorexia  chewing problems 44

Seniors’ Caregiver Handbook

 constipation  decreased smell & taste  diarrhea  dry mouth  hearing & vision impairment  iron deficiency  lactose intolerance  physical inactivity  swallowing problems  weight loss  weight gain

Public Health Nutrition Information

The nutritious Food Basket is a food-costing tool that measures the cost of healthy eating based on recommendations set by Canada’s Food Guide to Healthy Eating. It is a list of foods based on nutrient value and cost calculated by Toronto Public Health. The Food Basket includes 66 basic food items from the four food groups of Canada’s Food Guide to Healthy Eating. It generally does not include processed foods, snack foods or restaurant/take-out foods - 4 – 5 servings daily fruits & vegetables - 4 – 5 servings daily breads & cereals - 2 servings daily milk & milk products - 2 servings daily meat, fish or poultry Older persons must have the same variety from each of the four food groups but will need smaller quantities. Some seniors lose interest in eating, grocery shopping or preparing meals. Some suggestions that might help are: . place food attractively on the plate, set a pretty tray, sit at a favourite window, watch TV or read a book. Pleasant music helps enjoyment and relaxation . take a lunch to a park . invite a friend to share a potluck but keep it simple . plan a walk or other exercise . have a small glass of sherry before dinner . eat 5 or 6 small meals a day rather than 3 large . try a new food or recipe at least once a month . enjoy a different breakfast, leisurely . fresh air helps appetite and digestion 45

Seniors’ Caregiver Handbook

With healthful eating one can often decrease reliance on medications and reduce stress, the risk of disease and risk of over-medication. If there are allergies or intolerance of some foods, seek professional advice.

Your Notes – Section 10

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Seniors’ Caregiver Handbook

Section 11

Transportation

For emergency service call 911 for ambulance, police and fire.

911 is used for emergencies where health or safety of people or property is at risk such as medical emergency, heart attack, difficulty in breathing or choking, a fire or crime in progress. Always indicate which emergency service is required.

An ambulance dispatcher, is a medical emergency, will ask: - What is the problem? - What is the location, address & major intersection? - What is your name & telephone number?

The ambulance dispatcher will need more information about your emergency and is trained to help with your medical emergency until the ambulance arrives.

If necessary, the 911 dispatcher will connect you to a translator if you speak a different language.

The ambulance will transport you to the hospital that can best manage the medical condition at the time. If possible, the ambulance will take the patient to the hospital of choice.

911 calls are free, including pay or cell phones from any phone in Ontario.

Provincial Health care covers the majority of the ambulance bill when the patient is transported in a licensed ambulance. Ontario residents receive a bill only for that portion not covered by health insurance. This fee is normally $45. The receiving hospital will bill the patient on behalf of provincial health.

Some medical information should be available: 1. a list of medical conditions 2. all prescription and over-the-counter medications, dose and strength 3. a list of patient’s name, doctors’ names, date of birth, health card number 4. patients should wear their medical alert bracelet to inform the ambulance paramedics of their medical condition

Seniors’ Caregiver Handbook

Drivers’ License A senior’s driving license may have to be removed when driving becomes a danger. Make sure the car keys are removed. Help arrange a medical and eye appointment with the Care-receiver’s doctor, who will then document the inability to continue driving. It will require tact to remove the drivers’ licence respectfully. There is not a driving examination for seniors on a regular basis; only a written test. A family member can anonymously report that the senior should have a driving examination.

The DriveABLE competence screen has been launched in Toronto by Saint Elizabeth Health Care - 416-498-3805 ext. 2266 or 2295. The computer test costs $250.00 and is considered a medical expense for income tax purposes. The road test is an additional $75.00 and is also deductible and has been endorsed by the Ontario Gerontology Association. To take the test, clients obtain a referral form from Saint Elizabeth Health Care and have it filled out by their family doctor.

1 WheelTrans 416-393-4111 (TTC) Seniors with mobility problems may qualify for this type of transportation. Persons who qualify have a long-standing physical limitation and are unable to use public transit. An application is completed and an interview is arranged.

If a senior is denied the Wheel-Trans transportation, they can appeal the decision. 416-598-2656

Inquiry into TTC rates for seniors 416-393-4636

2 Toronto Ride is a partnership of community agencies that provide transportation for seniors and the disabled

Rides can be accessed through - SPRINT 416-481-6411

Canadian Red Cross (switchboard) 416-480-2500 (intake) 416-236-3180 There is a fee for this service.

Seniors’ Caregiver Handbook

3) Burt Transportation Service Ltd. is part of 416-282-4869 Toronto Ride, providing ambulatory and wheelchair transportation.

4) Royal Taxi Service 416-221-1187 Has clean, well-maintained cars and is a taxi service that is particularly sensitive to seniors’ needs. They will take people in wheelchairs. The caller should inform the company of the wheelchair request. Vouchers for the cost of the service can be purchased.

5) Celebrity Taxis 416-398-2222 Have clean, well-maintained modified mini-vans for people in wheelchairs. Same day service is available if booked early in the day.

Ministry of Transportation - Driver & Vehicle Info. 416-235-2999

Your Notes – Section 10

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Seniors’ Caregiver Handbook

Section 12

Accommodation

When it is necessary for the Care-Receiver to move, there are many options. Changes or moves are difficult for the elderly. The decision to move is the most difficult one for the senior and caregiver to make. Possibly with the help of a counsellor, social worker, family member, or other informed person, select one or two appropriate types(s) of housing and two or three specific facilities that might meet the Care-Receiver’s needs, preferably in the neighbourhood of their choice. You and/or your family member(s) must visit the facilities to consider which would be a suitable facility for the Care-Receiver.

Suggested Steps to take:

Recognize and accept your abilities and limitations as a Caregiver when choosing a facility  If possible, discuss housing facilities with your Care- Receiver, long in advance  Contact the Community Care Access Centre and arrange for an assessment - Downtown Toronto – 416-506-9888 - North York – 416-222-2241 - East York – 416-423-3559  Make sure your Care-Receiver is eligible for a Long-Term Care facility  Contact your local community support service agency that deals with seniors - SPRINT - 416-481-6411  Gather information on long-term care facilities through the CCAC and acquire the Ontario Residential Care Association free book called “The Care Guide” for retirement and care homes – 1-800-975-9736  Remember the community which the Care-Receiver has been used to has changed, and they will be part of a new community

Seniors’ Caregiver Handbook

 Acquire the booklet - “Every Resident - Bill of Rights For People Who Live In Long-Term Care Facilities”. It is available free of charge from CLEO (Community Legal Education Ontario - 416-408-4420. CLEO has published a number of booklets on housing.

 POINT Community Information Service has a North Toronto Seniors’ Housing ,Directory outlining all Senior and Long- Term Care facilities - 416-487-2427  Arrange to tour a few facilities. These tours are usually at specific times and organized as group tours

Types of Accommodation Available:

Ontario’s care continuance offers progressively more support:  Living at home and receiving support from family and friends  Home care  Retirement Home Living  Long-term care  Chronic care

The Housing Connections is the housing registry (of the Toronto Housing Company) for social housing. WHO WE ARE Housing Connections was formed in June 1998. It was set up as a centralized body to make it easier for applicants to find out about social housing in Toronto and how to gain access to it. WHAT WE DO Housing Connections maintains a centralized waiting list and provides this service on behalf of the City of Toronto under an Operating Agreement with Toronto Community Housing Corporation. On July 30, 2003 the Board of Directors of Toronto Community Housing Corporation approved a plan to establish a stand-alone subsidiary, Access Housing Connections Inc (Housing Connections) that will be responsible for providing coordinated access for all social housing in Toronto.

Seniors’ Caregiver Handbook

Housing Connections operates as a citywide and multi-tiered network, including agencies, housing providers and the Housing Connections office. More than 250 housing providers can accept applications and provide vacancy information related to their respective locations. In addition, nineteen Access Centres provide services in a variety of languages and supplement the efforts of Housing Connections by assisting applicants with their housing search. Our client group is low to moderate income families, singles and seniors. Applicants for housing complete an application form, have a basic eligibility assessment and are placed on waiting lists for any participating housing providers for which they qualify. Although Housing Connections maintains the waiting lists, housing providers continue to be fully responsible for their own tenant/member selection. This system allows funders to more accurately assess the demand for affordable housing in Toronto. Housing Connections does not make offers of accommodation or provide emergency housing, but can provide information about emergency shelters across Toronto. Housing Connections 365 Bloor St. East, 7th Floor (Bloor/Sherbourne) Toronto, ON Canada M4W 3L4 Phone: (416) 981-6111 Fax: (416) 981-6112 Office Hours: Monday to Friday 8:30 a.m. to 4:30 p.m.

North Office East Office 3050 Bathurst Street 2425 Eglinton Avenue East, Suite302 North York, Ontario, M6B 4K2 Scarborough, Ontario M1K 2P6 Fax (416) 397-7092 Fax: (416) 391-9373

South Office West Office 365 Bloor Street East, 7th Floor 1901 Weston Road, Unit 6 Toronto, Ontario, M4W 3L4 Weston, Ontario M9N 3P1 Fax (416) 392-9275 Tel: (416) 245-4395

Seniors’ Caregiver Handbook

Seniors’ Apartments are self-contained units primarily for people aged 55 years and over who can live independently, care for themselves and maintain their own home.

A Retirement Home is a tenancy under the Tenant Protection Act where older people who are in relatively good health and need minimal care can live. Some homes offer assistance with activities of daily living. The size and cost of a room or apartment varies between facilities. Amount of furniture that can be taken varies between facilities. Tour the facility before the selection is made and, if possible, arrange a trial stay for the Care-Receiver. Retirement residences let the resident choose what assistance they would like. Accommodation rates are subject to rent control Retirement homes in Ontario are affected by the Tenant Protection Act, the Health Protection & Promotion Act, the Building Code, the Fire Code and Municipal by-laws.

Assisted Living or a Care Home is a place to live where you can get health care services, attendant care, meals or help with everyday living. All Care Home tenants must have a written agreement or lease. Tenants must be given a Care Home Information package before the lease is signed. Reading the package will help you make the choice. A Care Home can provide nursing care, supervision of medications prescribed by a doctor, an emergency response system, help in getting from place to place, incontinence care and assistance with daily activities such as eating, bathing, dressing and personal hygiene.

Assisted Living facilities are for people needing assistance with activities of daily living but wishing to live as independently as possible for as long as possible. Assisted living is an intermediate level of long-term care between independent living and a nursing home. Assisted living facilities offer help with eating, bathing, dressing, laundry, housekeeping and assistance with medications. Assisted living facilities create a service plan for each individual upon admission. The plan is updated regularly to assure that the resident receives the appropriate care.

Seniors’ Caregiver Handbook

The Ontario Residential Care Association (ORCA) is a voluntary, non-profit association that sets standards and inspects and accredits their member retirement homes in Ontario. ORCA operates a Home Complaints Response and Information Service phone line 1-800-361-7254. This service applies to all retirement residences in the province and gives help in resolving retirement home complaints and provides information about the services provided and options available. ORCA has an information book “the care guide” which includes information about long-term care residences, assisted living, retirement homes, home health care, independent supportive living, Alzheimer care and hospice in south central Ontario, the GTA, Simcoe County and Hamilton and Niagara regions. The book is free and available by phoning 1- 800-975-9736.

ORCA standards for Retirement Residences include:  quality of resident care  safety & security  emergency planning  building & property maintenance  recreation opportunities  food & meal service  housekeeping & laundry  compliance with Tenant Protection Act

Supportive Housing refers to a living unit where services such as meal preparation and homemaking are offered by on-site staff. This allows people to remain in their community. A 24-hour emergency service may be available.

Long-term care supportive housing services provide personal support services and essential homemaking to frail and/or cognitively impaired elderly person. Supportive housing services are available on a 24 hour on-site basis. These services are available at a number of housing provider locations across Toronto. Access is through CCAC. Toronto Community-Based Services and Supportive Housing 416-392-8545 Independent Living Services 416-480-2500 Canadian Red Cross (Housing) 416-593-7499 Long-Term Care Facilities include Nursing homes, municipal Homes for the Aged and charitable Homes for the Aged. These 54

Seniors’ Caregiver Handbook facilities provide care for individuals who cannot live independently in the community because they require more nursing or personal care than can be provided at home or in supportive housing.

These facilities are accessed through the CCACs only. Long-term care facilities are listed in the Ontario Residential Care Association Housing Directory.

Long-term care facilities are designed to care for very frail people that are not able to care for themselves and have numerous health care requirements. Application must be made through the local Community Care Access Centre (CCAC) where an assessment of the individual’s is undertaken to determine eligibility for placement. Placement Coordination Staff (PCS) at the CCAC will provide you with information and advice and application forms. The Ministry of Health & Long-term Care sets the types of accommodation and rates. The resident can be income tested for subsidy.

A Continuing Care Retirement community is a combination of Assisted Living facilities connected with independent living residences and nursing homes. The resident can take advantage of the full range of services available and the ease of transfer to a different type of facility is made easier without moving to a new facility and adapting to a new setting. All three facilities cover fees for shelter, amenities, residential services and any short- term and emergency care. The contracts differ in the amounts of entrance fees and monthly fees.

Independent Living is for people who want to and are able to live independently but do not want to maintain a home. Many people prefer to live in a community with others of the same age and similar interest. An independent retirement community allows for a great deal of social activities and trips. Many independent living facilities also offer prepared meals and provide a wide range of amenities.

Seniors’ Caregiver Handbook

A nursing home is either: a) commercially owned and operated individually, or b) as part of a chain or non-profit, operated by religious, cultural or charitable organizations. It is licensed and regulated by the Ontario Ministry of Health & Long- term Care for people who need greater nursing care than can be provided at home, but who do not need hospitalization. The Ministry pays for the programs and services provided by long- term care homes and residents are responsible for paying the cost of accommodation at rates that are set annually by the Ministry.

The Ontario Long-Term Care Association has information on nursing homes: 416 327-7126

Chronic Care Hospitals provide care for those who need regular medical assistance and ongoing nursing care. They may be private or non-profit. Checklist when touring to guide the Caregiver and Care-Receiver in choosing the appropriate residence:

 The visiting arrangement for family and friends  The access to TTC and proximity to visiting members of family & friends  If the Care-Receiver will feel at home in the environment  If the facility has comfortable furniture and suitable decoration  If the resident are allowed to bring personal articles or furniture for decoration  If there are a variety of activities to meet the needs of individual residents  The cultural/religious affiliation  If smoking is allowed  If alcohol is allowed  If there are outdoor facilities for residents’ use  If there is a selection of food at meals  If the food is attractive and tasty and if snacks are available  If the facility has contact with outside groups and volunteers  If residents are dressed appropriately  If the residence smells of urine  If the residence is in good repair, clean & well-maintained and housekeeping neat and tidy 56

Seniors’ Caregiver Handbook

 If there is a Cognitive Impairment Unit and what is their definition of cognitive impairment  If there are regularly scheduled care reviews with the staff  If there are frequent baths  The number of residents on each floor  The number of staff per shift on weekends  Qualifications of staff  If resident needs more support than offered, what is available  If the interaction between staff and residents is positive  Is there a volunteer program in place in-house  Is there a safe place for residents to keep personal belongings  Are pets allowed or is there a pet-visiting program  Can the facility meet the Care-Receiver’s religious, cultural and language needs  What happens if the resident requires hospitalization

No matter where the Care-Receiver resides, the following should be considered and monitored:  Health care services available on-site  Physical facilities and the food  Quality of life and atmosphere  Administrative policies of facility

Alzheimer’s Homes Many people in the early stages of Alzheimer’s Disease live safely at home with memory cues like lists and notes. The care guidebook produced by ORCA lists the facilities catering to this disease. When looking for this type of residence, make sure it feels like the Care-Receiver’s own home. It should allow personal touches and offer meals, family-style in a dining room or kitchen.

The Waiting List Most facilities have waiting lists and they are managed in different ways. It is important that you keep in contact with your selected facility and keep them informed if the Care-Receiver no longer needs admission. The Toronto Housing Connections keeps waiting lists for social housing. Senior citizen apartments and retirement homes will put your name on a waiting list and notify you when they have a vacancy. 57

Seniors’ Caregiver Handbook

Facilities will admit couples when both people need the same level of care, but you may have to wait for the appropriate space to become available. The Chronic Care Hospitals often have lengthy waiting lists; so keep in touch with them. Their waiting lists consist of seriously ill people living at home and patients transferring from acute care hospitals, Nursing Homes or Homes for the Aged.

POINT - Community Information Service has lists and books outlining all Senior and Long-Term Care facilities - 416-487-2427 Available Facilities in North Toronto area:

Salvation Army – Meighan Retirement Residence 416-481-5557 Ewart Angus Homes 416-440-0574 Dorothy Klein Seniors 416-783-2679 Janet Magee Manor 416-392-6000 Joseph Brown Manor 416-392-6000 Montgomery Place 416-392-6000 Moore Place 416-392-6000 Saranac Apartments 416-392-6000 The Sherwood 416-392-6000 Belmont House 416-964-9231 Teddington Park Seniors Residence 416-481-4988

Long-Term Care Costs

Facilities’ income is derived from payment for four main areas of resident care and services:  nursing and personal care  special programs and support services  accommodation  food

Accommodation Fee: Accommodation fee is defined as:  lodging in a room in the facility  housekeeping services  maintenance and use of the facility  dietary services and food  laundry and linen services  administrative services 58

Seniors’ Caregiver Handbook

Insured services that are guaranteed include medical and nursing care. A fee is charged for accommodation, cleaning and upkeep of rooms. Residents occupying private or semi-private rooms pay an additional charge. The costs of private nurses and personal attendants are the responsibility of the resident. There are sometimes additional fees for dry-cleaning, drugs not covered by the drug benefit card, dental and eye care, tobacco and alcohol, transportation, escort service, telephone, hairdressing, laundry. Fees are set by the Ministry of Health and Long-Term Care. Further information can be sought from the Ontario Ministry of Health and Long-Term Care - 416-327-8952.

The only mandatory payment by residents is for accommodation. Residents also pay for any optional goods and services that they wish to use. Facilities are not permitted to charge a resident for nursing care, or for programs and support services, as these are funded by the government.

Basic charges are the same for all long-term care facilities throughout Ontario. A Nursing Home operator received a set fee for the care of each resident. This fee is called a per diem and is established annually through legislation. The total per diem is made up of the resident’s portion and the government portion. There are three fee rates:  basic or ward rate  semi-private  private

Retirement Home Complaints Response and Information Service Phone 1 800 361-7254 Web site www.orca-homes.com

This service applies to all retirement residences in the province. Anyone can call the number above to get help resolving retirement home complaints.

Trained staff will take complaint calls about any retirement home in Ontario and help callers resolve problems.

If a complaint remains unresolved, then the name of the retirement home and the nature of the complaint will be posted

Seniors’ Caregiver Handbook on the Complaints Response and Information Service website for the public’s information.

The Move

Select a real estate agent who is knowledgeable of the senior’s situation. The Caregiver should be involved with the sale of the Care-Receiver’s house - as a mediator, helping with packing, cope with buyers looking through the house, helping to distribute possessions they are not taking with them, organize the movers.

Make the move as stress-free as possible. Include as many family members or friends as you can in the move.

Goodwill - Toronto 416-362-4711, ext. 2456 has volunteers who will organize and advertise a sale of contents. They will sort, arrange and price all goods and staff and manage a one or two day sale. They will also pack and remove the contents of an apartment or small home when a sale is not feasible and contents are donated to Goodwill.

Furniture Bank - 416-934-1229 - takes unwanted furniture and supplies to hostels

(Source: For Section 12 - Long-Term Care Facilities in Ontario: The Advocate’s Manual - Advocacy Centre for the Elderly)

Seniors’ Caregiver Handbook

Your Notes - Section 12

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Seniors’ Caregiver Handbook

Section 13

Elder Abuse

Elder Abuse - an act or threat of harm to an elderly person caused by a family member, friend or anyone on whom the victim relies for basic needs.

Someone who commits elder abuse usually has control or influence over the older person and is trusted by the older person. Most victims of elder abuse depend on the people who hurt them, sometimes for food, shelter, personal care, or companionship. A family member, friend, neighbour, or staff in group residential settings or long-term health care facilities can cause the abuse. Many victims of abuse are isolated from their friends, neighbours, and other family members. There are community resources available for victims of elder abuse.

There are four categories of abuse:

1. Institutional maltreatment 2. Alcohol, drug abuse 3. Verbal, physical & psychological 4. Exploitation and financial abuse

The extent of abuse in elderly populations is scant. The elderly are particularly at risk of abuse in institutions such as hospitals, nursing homes and other long-term care facilities. Abusive acts within institutions for the elderly include physically restraining patients, depriving them of dignity and choice over daily affairs and providing insufficient care.

For older people, the consequences of abuse can be especially serious because their bones are more brittle and convalescence takes them longer.

Social isolation is a significant risk factor for a senior to suffer mistreatment. Many seniors are isolated because of physical or mental infirmities, or through the loss of friends and family members. 62

Seniors’ Caregiver Handbook

A range of abusive behaviours can occur. These include physical and sexual abuse, emotional or psychological abuse, financial abuse and neglect.

Abuse can result from: - caregiver stress - impairment of the senior - existing violence in a family - personal problems of the abusers

Sources of Help

 Abuse Prevention Protocol Toronto- CCAC 416-222-2241  Advocacy Centre for the Elderly 416-598-2656  Community Care Access Centre 416-504-9888  Community Legal Clinics - Legal Information Ontario 416-929-5500

Seniors’ Caregiver Handbook

 Community Policing Support Unit: a) Elder Abuse and Mental Health 416-808-7044 b) Victim Services Program of Toronto 416-808-7066  Family Doctors - College of Physicians and Surgeons 416-967-2600  Geriatric Day Hospital and Outreach - Sunnybrook and  Women’s College Health Sciences Centre 416-480-4033  Home Support and Respite Care Services - SPRINT 416-481-6411  (Income Security Programs) 1-800-277-9914  Human Resources Development Canada  Law Society of Upper Canada –  Lawyer Referral Service 416-947-3330  Office of the Public Guardian and Trustee 416-314-2800  POINT Community Information Service 416-487-2427  Toronto Public Health 416-392-0962  Visiting Nurses - VON - Toronto/York Region 416-499-2009

To report abuse in nursing homes and Homes for the Aged, call the Central Regional Office - 416-327-8952 - Long Term Care Division, Ministry of Health or Concerned Friends - 416-489-0146.

Under the Criminal code, persons can be charged with fraud, theft, neglect, assault, and abuse of power of attorney. Some signs and symptoms of abuse are:

 changes in dress  poor hygiene  rashes, pressure sores  depression  fear, anxiety  change in behaviour

Guidelines for Management of the Suspected Abuse

1. Assess the severity of the situation 2. Determine the presence of other forms of abuse 64

Seniors’ Caregiver Handbook

3. Assess whether there is a crime being committed - does the victim need temporary shelter? Is the victim in need of protection? 4. Determine the need for counselling or seek consultation as needed 5. Establish competency of the victim through formal assessment 6. Determine the ability of the Caregiver to provide care 7. Determine if the act is intentional

Procedure as used by the Community Care Access Centre

1. Advise victim about options. The victim must agree to the action plan and be willing to participate in the plan. Educate and provide support to the Caregiver 2. Collect evidence thoroughly before initiating actions 3. Assess the necessity to freeze victim’s bank account in consultation with the bank or financial planner 4. Advise and inform victim about all alternative actions - legal aid, trustees and legal options 5. Enlist support of family, friends, neighbours or witnesses to provide protection. 6. Inform victim about relevant community resources i.e. education, and advocacy and provide support 7. Consider placing victim in a safer environment 8. Determine whether victim needs accompaniment or a transportation service 9. Monitor situation until abuse stops

The Metro Toronto Police Elder Abuse Co-ordinator advises:

1. Know the rights granted under the Ontario Human Rights Code, the Canadian Human Rights code, the Nursing Home Act and the Hospital Act. 2. Check with a lawyer or with the Public Trustee’s office on all matters related to the power of attorney 3. Have pension cheques and other income deposited directly into Care-Receiver’s bank account 4. Anticipate possible problems of moving care-receiver into your home 65

Seniors’ Caregiver Handbook

If you think abuse is occurring, seek help from a public health nurse, social worker, doctor, lawyer, clergy or the police.

Some public agencies for help: Emergency - police – 911 police communications – 416-324-2222 Legal services – advocacy centre for the elderly 416-487-7157

Referral & Information - POINT 416-487-2390 - Seniors’ Information Service 416-480-1393

Counselling - Family Services Association 416-480-1393 - Jewish Family & Child Services 416-638-7800 - Catholic Family Services 416-362-2481

Toronto Public Health - 416-338-7600

Public Health Nurses – Toronto 416-392-7641

Seniors’ Caregiver Handbook

Your Notes - Section 13

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Seniors’ Caregiver Handbook

Section 14

Advocacy

1. Every resident in a Long-Term Care facility has a Bill of Rights. They are:

2. Every resident has the right to be treated with courtesy, respect, and dignity, and be free from mental and physical abuse.

3. Every resident has the right to be properly sheltered, fed, clothed, groomed, and cared for in a manner consistent with his or her needs.

4. Every resident has the right to be told who is responsible for, and who is providing the resident’s direct care.

5. Every resident has the right to privacy.

6. Every resident has the right to keep personal things in their room.

7. Every resident has the right to be informed of medical conditions, treatment and proposed treatment.

8. Every resident has the right to have medical records kept confidential.

9. Every resident has the right to get help to become as independent as possible.

10. Every resident has the right to get information about restraints if being considered for them.

11. Every resident has the right to meet and talk with people and consult in private.

12. Every resident has the right to have family present when health is critical.

Seniors’ Caregiver Handbook

13. Every resident has the right to choose a person to be contacted when resident is transferred or hospitalized.

14. Every resident has the right to raise concerns or recommend policy, or service changes to the residents’ council.

15. Every resident has the right to form friendships, enjoy relationships and to participate in the residents’ council.

16. Every resident has the right to be alone with his/her spouse.

17. Every resident has the right to pursue social, cultural, religious and other interests.

18. Every resident has the right to be told of increases in the care facility’s basic fee or changes of law, rule or policy affecting the long-term facility.

19. Every resident has the right to manage his/her own money while in the facility. 20. Every resident has the right to live in a safe and clean environment.

21. Every resident has the right to go outside as long as it is safe for him/her.

Source: CLEO (Community Legal Education Ontario)

Ensure that the Bill of Rights for residents in a long-term facility is followed particularly in:

 participating and sharing information  right to refuse care  second opinion  notice and access to plan of care

Ensure the facility confers with you and keeps you informed of the Care- Receiver’s status on a regular basis.

Seniors’ Caregiver Handbook

Resident Council - Residents have the right to form and participate in a residents’ council in the facility. These councils can assist residents to continue to exercise control over their lifestyles and to contribute as fully as possible to their home.

Family Advisory Committees - a growing number of facilities have instituted committees consisting of residents/family members and members of the community who become involved in the activities of the facility.

The Tenant Protection Act required landlords to give all new tenants a Care Home Information Package or (CHIP) which includes the tenancy agreement and care home provisions. Residents in long-term care facilities do not receive this package. Order of Complaint - general complaints should be discussed with a staff member responsible for the subject matter of the complaint. Then if the facility, through its internal process does not address the issue, the complaint can be raised with the Ministry of Health.

A notice must be given to all residents outlining the hierarchy for complaints.

For serious complaints, call Specialty Services Unit – Toronto Region 416- 327-8952 and ask for a Compliance Advisor of long-term care facilities.

If your serious and legitimate complaints are not solved in this way, there are services available to act on your behalf.

Advocacy Centre for the Elderly (ACE) 416-487-7157 This is a service funded by Legal Aid by providing legal advice over the phone or by appointment.

Other advocacy agencies are:

Canadian Pensioners Concerned 416-368-5222 Care Watch Toronto (complaint process) 416-590-0455 Concerned Friends of Ontario Citizens in Care Facilities 416-489-0146 (answering service) United Senior Citizens of Ontario 416-252-2021

Ontario Coalition of Senior Citizens 416-785-8570 69

Seniors’ Caregiver Handbook

You have the right to transfer to another facility if the facility does not match up with your expectations and those of your Care-Receiver. It takes time and can be done through your local CCAC (Community Care Access Centre).

Your Notes - Section 14

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Seniors’ Caregiver Handbook

Concluding Comments

Ten commandments for Caregivers (from the New Zealand Huntington’s Disease Association)

1. Thou shalt not be perfect or even try to be 2. Thou shalt not try to be all things to all people 3. Thou shalt leave things undone that ought to be done 4. Thou shalt not spread thyself too thinly 5. Thou shalt learn to say no 6. Thou shalt schedule time for thyself and thy supportive network 7. Thou shalt switch off and do nothing regularly 8. Thou shalt be boring, untidy, inelegant and unattractive 9. Thou shalt not even feel guilty 10. Thou shalt not be thy worst enemy but be thy best friend

Source: The Caregiver, the newsletter of How to Care and Caregiver Network

To help other caregivers, pass along this handbook to others when you are no longer care giving.

A donation to POINT would ensure this resource will continue to be available and updated.

You have taken on an important responsibility as caregiver. Remember that telephone numbers and information become out of date. Call P.O.I.N.T. Community Information Service - 416-487- 2427 if you find that the information is no longer current and/or if you require any further assistance.

Seniors’ Caregiver Handbook

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Seniors’ Caregiver Handbook

Caregiver Handbook

Your Notes - Section 16

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POINT (People and Organizations in North Toronto) is a long- established “grass roots” organization in North Toronto.

Every effort has been made to provide accurate information in the Seniors’ Caregiver Handbook. Any errors or omissions can be brought to POINT`s attention, and will be amended in the online version of the Handbook on www.pointinc.org.

For additional copies of the POINT Seniors’ Caregiver Handbook, contact us at point pointinc.org or 416-487-2390.