Seniors are at risk of not having their daily nutritional needs met. This can be a result of many factors such as decreased mobility, medication interactions or side effects, cognitive deficits, isolation, climate barriers and mental health issues.

What are some easy tips that seniors and their caregivers (or concerned family members) can due to minimize the risks of poor senior nutrition?

Make sure that your loved one is eating from each of the four food groups at least three times a day. For example:

Group 1 – Fruits and Vegetables contain natural disease fighting ingredients and can aide in healthy digestion. Try eating some that are dark green, red, orange and yellow such as spinach, oranges, bell peppers, etc.

Group 2 – Grains contain fiber which can aide in digestion. Remember to increase fiber slowly and to increase fluids at the same time. Eat some whole wheat pasta and breads, oatmeal (porridge), etc. Consult a physician if you have any concerns or any digestive problems.

Group 3 – Milk and Milk Alternatives help to prevent osteoporosis and aide in bone development. Additionally, this group gives us vitamin D, which may be less available in the winter months. You can eat milk, cheese or yogurt.

Group 4 – Meat and Meat Alternatives provide us with protein, vitamins and minerals. Enjoy some fish, poultry, lentils, chickpeas, nuts and seeds.

If a senior is not able to shop or to prepare balanced meals, you can try these tips:

• Make a little extra dinner at your house a few nights a week and put one portion in a re-heatable
container with instructions on how to re-heat the meal. Leave this in your loved one’s freezer or refrigerator;

• Invite your loved one over for one meal a week at your house;

• Look into community resources, such as Meals on Wheels, to provide one to three meals a week;

• Hire a neighbor, friend, or home care agency to prepare two-four meals a week at your loved one’s home;

• Hire a teenager in the area to have one meal an evening with your loved one. This is good for social interaction for your loved one and provides the teenager with a “job” that has lifelong learning potential;

• Call your loved one’s friends and ask them to invite your loved one to dinner or lunch once a week.

Never forget how important fluid is to our body since it is made up mostly of water. Without enough water, our body has more difficulty digesting food, transporting medication, and circulating blood to aide in healthy bone and muscle development and maintenance. In the winter time, we can become more dehydrated due to being indoors with heating systems. Add soup to your meal and drink lots of water, fruit juices (100%pure), milk, and herbal teas.

Sometimes seniors are not as active as the general population. This reduction in activity can contribute to a reduced appetite. Even light and consistent exercise such as walking, yoga, stretching and chair aerobics can stimulate one’s appetite. If you find that motivation is lacking, perhaps joining an exercise group or moving into a retirement residence where group exercise activities are organized could help. Exercise also releases chemicals in our brain that help with improving one’s mood and cognitive functioning.

Written by:Sarah Blunden, Registered Dietitian, Certified Diabetes Educator, McGill University Bachelor in Human Nutrition 2003; Stephanie Erickson, MSW, PSW, LCSW

Let me start by saying that I am a firm believer and advocate of the public system in Montreal, and in Quebec at large. I feel that the public is entitled to receive services and support from the system into which they have been paying. Unfortunately, the growing demands of the senior population are too much for the public system to support. Families are turning to private social workers more and more to fill these gaps in service.

Private social workers can offer a variety of services for seniors and their families. For example, Erickson Resource Group can complete psychosocial assessments for mandate homologations and private curatorships throughout greater Montreal and its surrounding communities. We can also complete these same psychosocial assessments for a public curatorship if a private or public facility requires this service. (http://ericksonresource.com/senior-services/)

Many hospitals and local community agency social workers are not able to provide psychosocial evaluations for mandate homologation and private curatorships because they are overstretched with the critical needs of the population. With public waiting lists for social services ranging from 3 months to eight months, Erickson Resource Group can become a family’s “safety net” during, through and after the acquisition of public services.

Erickson Resource Group private social workers can act as a liaison between the public and private systems, guiding families through the relocation or placement process, the accessing of public or private home care, and care management and/or coordination of private and public health services. In addition, Erickson Resource Group is a complete resource center for seniors and their families. We are available to advise seniors and their families as to how the public system and private system can collaborate together.

Erickson Resource Group has a team of private occupational therapists, private nurses, private dietitians and private recreation therapists to provide professional evaluations and treatment plans for seniors and their families. (http://ericksonresource.com/about-you/ ) If a senior or family requires an advocate to help them navigate the public system or to work with public and/or private health care professionals, an Erickson Resource Group team member can act as this advocate.

We are in no way attempting to replace the public system. Our intention is to supplement services when a family needs it and when the family is able to afford it. If the senior or family need help NOW, we can be there NOW. We do not have waiting lists. Call us at 514-795-7377 for further information.

To learn about Erickson Resource Group’s services: http://ericksonresource.com/senior-services/

To learn about Erickson Resource Group’s team: http://ericksonresource.com/about-you/

I am inspired to write this article because of the many family caregivers that I have met during my professional career. As a geriatric social worker, I meet spouses, adult children, nieces, nephews, grandchildren, siblings, and friends who push their own needs aside and redefine their lives as a caregiver. They no longer go to the movies, watch television, or go out to dinner with friends. Instead, they wash another load of laundry, puree foods, or give another adult a bath. These loving human beings call me for assistance, guidance and support as they try to navigate the public and private systems to obtain any and all services that will help their aging loved one. They are not even calling for themselves. No, they are calling for services for their loved one.

At an increasingly alarming rate, I am watching as our public system inherently betrays the caregiver in its attempts to meet the needs of the, for all intensive purposes, the “patient.” Let me be clear. I ABSOLUTELY believe that seniors who suffer from cognitive illnesses deserve to have their needs met. I ABSOLUTELY believe that those who are not able to protect their own rights and to advocate for themselves deserve and need representation and a voice.

I write this article as a tribute to the unsung heroes, the caregivers, who systematically have their needs placed at the back of the line. What do I mean by this?

Recently, I worked with a spouse who is the primary caregiver for her husband who suffers from a severe case of Korsakoff’s Dementia. The hallmark of this type of dementia is a history of alcoholism. In this case, this is not a remote event; this patient continues to drink excessively every day, driving under the influence, and spending large amounts of money on alcohol. Even though his cognition is severely impaired, he is physically able to ambulate, drive, and perform his activities of daily living autonomously. Because of this, the spouse was told that he had to “consent” to relocation to a permanent facility or to a respite facility. But there is a problem, he will not consent.

Subsequently, even though he cannot remember how many children he has, where his money is located, how to organize a shopping list, how to administer (or even remember) to take his medication, and even though he cannot make a doctor’s appointment, cook a meal, and literally cannot form a complete sentence, his wife cannot access help. Again, in theory, I do not believe that someone with cognitive functioning has to be relocated, or should forcefully be relocated. In fact, I have spent the last 10 years of my career advocating for the legal protection of seniors with cognitive disorders to ensure that their rights are protected even if they are deemed inapt.

My point is this: our “system” only looks at the rights of the patient and seems to ignore the rights of the caregiver. In the situation I just described, the spouse is literally falling apart. She cannot sleep, cannot eat, endures frequent bouts of verbal and physical aggression (he throws things at her) if she tries to assist her husband and redirect him. As a result, she told me she would rather, “walk into the river,” than continue living in this stressful situation. She is a senior herself and is at risk of having severe physical and mental health problems if this situation is not rectified.

She has asked for help from everyone: the police, the physician, the local community agency, the local doctor’s clinic, and myself, a private social worker. Still, no one will take responsibility and “place” him. The police say he has to be caught drinking and driving, and let us hope that it is not AFTER he has been in an accident and hurt himself or someone else. The physician says he needs to be relocated into a full care facility, but has not facilitated it and will not even commit to a letter saying he should be hospitalized at least for an evaluation period. The community agency says he must consent to move, even know he is deemed inapt, and the clinic says to drop him off at the hospital, a place where he could just walk out.

What is this caregiver to do? She literally has to put her husband in her car and drive him to the hospital and say, “I cannot care for my husband anymore.” Then she must hope that he is admitted and the “force” him to stay. Or, she can hire an attorney to petition the court for a forced placement, something for which she does not have the money to do. This is a huge responsibility for a loving wife who is already under tremendous stress.

As a private social worker, I have made my pleas with all involved professionals, but my hands are tied as well. I feel deflated that I am not able to do more than to empathize with this spouse and validate her fear, frustration and concerns. I tell her that her needs are important and that her well-being is just as valuable as her husband’s. Unfortunately, our system does not innately demonstrate its support of the caregiver.

I write this article as a tribute to my client’s wife, this family caregiver who has done all she can under the circumstances. My heart goes out to you, and all of your fellow family caregivers whose needs are not the priority in the “system.”

Written by: Stephanie Erickson, MSW, PSW, LCSW

I hear it from both sides. Some seniors telling me that they try to have discussions with their children regarding aging and planning for their future, such as living wills, mandates in the case of incapacity, funerals, illness, housing, etc., but their children don’t want to think about such unpleasant things. I also receive many phone calls from adult children, asking for advice on how to approach these same discussions with their parents who refuse to discuss their own aging process. As a result, these adult children don’t know how to help their parents, if they do need help in the future. I am also witness to both of these generations sitting across the table from one another in silence, avoiding direct conversations about these difficult topics, or fighting amongst one another as decisions are needed to determine medical and health care (non)interventions.

Example: An 84 year old widow has a mild stroke and is hospitalized. His 3 adult children arrive at the hospital to see their father. The physician informs the family that although their father has survived, he has moderate cognitive deficits (Dementia), as well as mild-paralyzation on his right side. He can return home, but only with full time care. The alternative is relocation to a full care facility. Two of the three children opt for relocation, but the other child insists that she can care for her father herself at his home. None of the children know the father’s financial resources, nor do they know what type of care he would prefer. You see, this man never signed a Power of Attorney (Mandate in the case of Incapacity) and he has always been secretive about his finances. What will happen to this man as his children battle it out? How will his children manage his finances now?

This is not the case for all families. Many families do address these difficult topics directly, honestly and realistically. No matter what the unique family situation is, it is not easy to broach these very personal and often scary topics. After all, who wants to imagine ourselves or our parents as old, invalid, or incapacitated?

It has been my experience that without these premeditated and purposeful conversations, families will experience health crises to a much greater degree than those families that communicate openly BEFORE a crisis, as shown in the example above. Planning and communication amongst families is a gift that benefits every member of the family.

Below are some tips to begin these difficult discussions:

1. Use the media: Find a story on the television, in a magazine, on the radio, in the newspaper, or on the internet. Ask your parent (or child) to view this media. You can either look at the media together, or separately. A week or so after you have this shared experience, ask your parent (or child) for their feelings about the media. Wait to see if the discussion about the “objective” media leads to a discussion about the family situation.

2. External tool: Use an external tool, such as the Erickson Resource Group “Organizing Affairs” toolkit. Complete it and then share it with your parent/adult child. Ask them if they have any questions. Encourage them to discuss its contents with you. Encourage them to begin to discuss their plans for aging as well.

3. Personal examples: If you have a friend or another family member that experienced an acute health crisis recently, share this story with your parent/adult child. Discuss the ways in which this friend’s preparation, or lack of preparation, impacted the family’s coping and overall functioning. Wait and see if your parent/adult child offers to discuss your own family situation.

4. Include outsiders: Try to involve a social worker, financial advisor, notary or attorney who can share their unbiased experience as to what the negative consequences are of not planning. Perhaps this third party can open the doors of communication within your own family.

5. Ask meaningful questions: Create discussions that enable your parent/adult child to look at their life and the meaning that it has to them. This life review cultivates the relationships within the family, which can help to increase trust and open the doors for communication. Ask questions like, “What has been your most meaningful experience? What are you most proud of? Tell me about the day I was born? What is it like to watch me be a parent?

6. Hear their story: Silence is an undervalued communication tool. Do not forget to hear your parent/adult child’s story. If we interrupt or interpret what your parent/adult child is saying, it can create communication barriers. Make sure to listen and then ask follow up questions to be sure you understand fully what was said.

7. Be conscious of terminology: The words we use to communicate give us insight into how somebody processes information. Do they use the word death? Die? Deceased? Passed on? Went with God? Respect that terminology and the distance it may or may not create for that person and that topic. Allow your parent/adult child to protect him/herself with language.

8. Take your time: If your family is not used to discussing difficult topics openly and directly, things cannot change overnight. Bite off small pieces of the aforementioned tips and let things marinate within each member of the family. Follow up every few months until you are satisfied with the depth of conversation.

9. Remember your history: All families have their unique communication styles, personal history, cultural influences, generational influences, gender influences, role expectations, etc. Work with what you have. A square peg will not fit in a round hole.

10. Be honest: Being dishonest will not get your family to a “non-crisis” mode. In fact, if we are not clear about our choices, more confusion and family dysfunction will ensue.

11. Legal, legal, legal: Discussions are fantastic, and absolutely help with facilitating and following through on your wishes. However, it is necessary to complete the legal paperwork to ensure that your wishes are met. You can always, at the minimum, just inform your parent/adult child that the paperwork is complete, and to contact the notary/attorney who assisted you in the case of an emergency.

Written by, Stephanie Erickson, MSW, PSW, LCSW

En quoi consiste un mandat en cas d’inaptitude?
Il s’agit d’un « document écrit dans lequel une personne, appelée mandant, désigne en toute lucidité une autre personne, appelée mandataire, pour voir à sa protection ou à l’administration de ses biens, ou les deux à la fois, dans l’éventualité où la maladie ou un accident la priverait de ses facultés de façon temporaire ou permanente. » http://www.curateur.gouv.qc.ca/cura/publications/mandatE.pdfpermanently.

Que signifie l’homologation d’un mandat en cas d’inaptitude?
Il s’agit d’une procédure judiciaire qui permet à un tribunal de constater l’inaptitude d’une personne et d’octroyer au mandataire désigné l’autorisation légale d’agir au nom du mandant. Sans cette procédure judiciaire, le document à lui seul n’autorise pas le mandataire à exercer de façon légale l’autorité qui lui est confiée par le mandant.

À quel moment doit-on faire homologuer un mandat en cas d’inaptitude?
Si vous avez été désigné par votre mère, votre père, votre conjoint, votre confrère, votre ami ou un proche pour prendre des décisions relativement aux soins de santé, aux traitements médicaux, au logement ou pour la gestion des finances ou encore, pour toute autre raison en lien avec le fait qu’ils sont inaptes à prendre des décisions pour eux-mêmes, il est recommandé de procéder à l’homologation d’un mandat au moment où le mandant (personne ayant signé le document) devient inapte. À titre de mandataire (personne désignée pour voir à l’administration des biens personnels et des opérations financières d’une autre personne), vous devez détenir l’autorité légale complète afin d’être en mesure de prendre toutes les décisions (personnelles, médicales et financières) à la place d’un proche dont vous êtes responsable. L’homologation d’un mandat fait partie de la démarche exigée par la loi afin de s’assurer que vous êtes apte à gérer toutes les sphères de la vie d’un proche sans complications.

Quelles sont les étapes à suivre pour obtenir l’homologation d’un mandat?

Évaluation médicale :

Un médecin (M.D.) doit remplir le formulaire médical (Rapport du directeur général – 2A) qui décrit brièvement le diagnostic et les aptitudes intellectuelles de la personne visée.

Évaluation psychosociale :

Un travailleur social du CLSC ou un travailleur social en cabinet privé est en mesure de réaliser l’évaluation psychosociale pour l’homologation d’un mandat. En général, l’attente au CLSC est de cinq à huit mois. Vérifiez auprès de votre CLSC afin d’évaluer le délai d’attente. Le CLSC offre ce service gratuitement. L’équipe de Erickson Resource Group peut réaliser une évaluation psychosociale et rédiger un rapport dans un délai de 10 jours ouvrables. Pour les cas plus urgents, il est possible d’obtenir un service accéléré. Veuillez consulter le www.ericksonresource.com pour en apprendre davantage sur les démarches particulières et les frais de ce service.

Par la suite, les rapports de ces deux évaluations sont remis à un notaire ou un avocat avant d’être déposés auprès du tribunal. Pour obtenir de plus amples renseignements relativement aux démarches légales et aux frais exigibles, veuillez communiquer avec votre notaire ou votre avocat. Si vous ne connaissez aucun notaire ni avocat experts dans ce domaine d’exercice, n’hésitez pas à communiquer avec l’équipe de Erickson Resource Group afin qu’elle vous réfère à l’un de ces professionnels.

Que peut-il advenir si le mandat n’est pas homologué?
Qu’arrivera-t-il si vous devez vendre la maison de l’un de vos proches mais que ce dernier n’est plus apte à signer les documents nécessaires? Que se passera-t-il si vous devez apporter des changements aux versements des rentes de l’un de vos proches? Si vous devez changer une adresse? Si vous devez modifier les modalités d’un compte de placement? Rien de tout cela ne peut être effectué sans un mandat homologué. Vous avez peut-être agi à la place du mandant sans pour autant être en possession d’un mandat homologué et vous n’avez eu aucune embûche. Toutefois, s’il advenait qu’une institution financière ou gouvernementale vous interroge et que le mandat n’a pas été homologué, elles seraient en droit de « geler » les comptes financiers jusqu’à ce que l’homologation du mandat ne se termine. Cette situation pourrait entraîner des délais allant jusqu’à six mois pour les membres de la famille.

Qu’est-ce qu’un régime de protection?
Si personne n’a entamé les démarches pour signer un mandat en cas d’inaptitude et qu’un besoin de protection ou d’assistance est nécessaire, il est possible d’effectuer une requête auprès du gouvernement pour représenter la personne en question et s’occuper de ses biens personnels et financiers. Il existe différents types de régimes de protection. Pour en apprendre davantage, veuillez consulter le lien suivant. http://www.curateur.gouv.qc.ca/cura/en/majeur/inaptitude/protection/index.html

Quelles sont les démarches à entreprendre pour faire une requête en matière de curatelle privée ou de tutelle privée?

Évaluation médicale :

Un médecin (M.D.) doit remplir un formulaire médical (Rapport du directeur général – 2A) qui décrit brièvement le diagnostic et les aptitudes intellectuelles de la personne visée.

Évaluation psychosociale :

Un travailleur social du CLSC ou un travailleur social en cabinet privé est en mesure de réaliser l’évaluation psychosociale pour l’homologation d’un mandat. En général, l’attente au CLSC est de 5 à 8 mois. Vérifiez auprès de votre CLSC afin d’évaluer le délai d’attente. Le CLSC offre ce service gratuitement. L’équipe de Erickson Resource Group peut réaliser une évaluation psychosociale et rédiger un rapport dans un délai de 10 jours ouvrables. Pour les cas plus urgents, il est possible d’obtenir un service accéléré. Veuillez consulter le www.ericksonresource.com pour en apprendre davantage sur les démarches particulières et les frais de ce service.

Par la suite, les rapports de ces deux évaluations sont remis à un notaire ou un avocat avant d’être déposés auprès du tribunal. De plus, votre notaire ou votre avocat peut vous aider à tenir une assemblée de parents. Pour obtenir de plus amples renseignements relativement aux démarches légales et aux frais exigibles, veuillez communiquer avec votre notaire ou votre avocat. Si vous ne connaissez aucun notaire ni avocat experts dans ce domaine d’exercice, n’hésitez pas à communiquer avec l’équipe de Erickson Resource Group afin qu’elle vous réfère à l’un de ces professionnels.

Que peut-il advenir si je n’agis pas à titre de curateur ou de tuteur privé au nom de l’un de mes proches?
Qu’arrivera-t-il si vous devez vendre la maison de l’un de vos proches mais que ce dernier n’est plus apte à signer les documents nécessaires? Que se passera-t-il si vous devez apporter des changements aux versements des rentes de l’un de vos proches? Si vous devez changer une adresse? Si vous devez modifier les modalités d’un compte de placement? Rien de tout cela ne peut être effectué sans l’ouverture d’un régime de protection. Si cette démarche n’est pas entamée avant qu’une crise ne survienne, la famille peut alors faire face à de longs délais d’attente et à des comptes bloqués de façon provisoire.

Qui peut m’aider à entreprendre ce processus?
L’équipe de Erickson Resource Group peut réaliser l’évaluation psychosociale pour l’homologation d’un mandat ou pour l’ouverture d’un régime de protection privé. Pour obtenir de plus amples renseignements, il est également possible de communiquer avec l’Ordre professionnel des travailleurs sociaux du Québec. Nous pouvons vous rediriger vers des notaires et (ou) des avocats qui seront en mesure de vous aider avec le processus judiciaire. De plus, Erickson Resource Group peut se charger de vous suggérer un médecin qui sera habilité à vous fournir une évaluation et qui vous aidera à remplir le formulaire médical, en consultation privée.

Quel est le délai de ce processus?
À la suite d’une rencontre avec le client et sa famille, l’équipe de Erickson Resource Group est en mesure de réaliser l’évaluation psychosociale requise dans un délai de 10 jours ouvrables. En règle générale, un travailleur social de ERG ira rencontrer le client et sa famille dans un délai d’une semaine après la réception de la requête. Il est aussi possible d’obtenir un service accéléré. Si vous décidez d’opter pour un organisme public (CLSC, CHSLD, etc.), vous pourriez faire face à des délais pouvant aller jusqu’à six mois. Communiquez avec un organisme gouvernemental local afin d’obtenir une estimation des délais. ERG vous offre des services en français et en anglais.

Il est également possible d’obtenir un rapport médical en privé et ERG peut vous permettre d’entrer facilement en contact avec un médecin. Si vous décidez d’opter pour un organisme public (CLSC, CHSLD, etc.), vous pourriez faire face à des délais pouvant aller jusqu’à six mois. Communiquez avec un organisme gouvernemental local afin d’obtenir une estimation des délais. Vous pouvez également demander au médecin de famille du client de remplir le formulaire requis. ERG peut vous faciliter la tâche en vous aidant à travers ce processus.

Le dépôt d’une requête auprès du tribunal ne peut survenir qu’au moment où l’évaluation psychosociale et le rapport médical sont tous deux terminés et remis au notaire ou à l’avocat. Lorsque le notaire ou l’avocat est en possession de ces documents, une requête auprès du tribunal peut être effectuée. Selon les délais de traitement du notaire ou de l’avocat et du tribunal, le processus peut prendre fin en quatre semaines et il peut se prolonger jusqu’à six mois. Des frais supplémentaires sont exigibles pour l’ouverture d’une curatelle privée ou d’une tutelle privée.

In terms of caregiving, most of the articles available discuss the “caregiver”, that is, the singular person who provides the care for an aging relative, which is most typically an aging parent. In reality, there may be one person who takes on the majority of the responsibilities for the care, but there are likely other family members who are emotionally invested in the well being of this person. This is why family caregiving including the planning, organizing and implementing of care is essential.

Many of the families I work with have difficulty working as a team. Typically, there is one main caregiver who provides most of the day to day support for their parents, such as visiting weekly, doing grocery shopping and meal preparation, arranging for and accompanying his or her parents to medical appointments, supervising their financial affairs and making daily phone calls to check in on them. In these situations, it is not uncommon for that child to feel anger and resentment towards their siblings who seem to do nothing, but offer plenty of criticism.

Caregiving is not easy. This we know. So when others, especially those who are passively involved, offer (or force) opinions about the “right” way to be a caregiver, it is not surprising that family discussions morph into battles filled with accusations and anger.

Here are some tips to foster continued family harmony and stay focused on the priorities, the well-being of your aging parent.

Call a family meeting with ALL children or other involved family members and do the following:

1. Every discussion should begin with, “Mom and dad are experiencing X,Y,Z (be specific with the factual symptoms). For example, “Mom and dad are losing weight and their physician suggests that we look into how they are shopping and preparing food.”

2. Create a “cheat sheet” of all of the symptoms that EACH family member or health care professional has identified. Take this list of symptoms and make another list of all the possible ways to fully assess and understand what may be the CAUSE of these symptoms. For example:

a. Weight loss – Make a grocery list WITH mom/dad to understand how they are calculating their needs; go shopping WITH mom/dad to see how they organize their food purchases; cook WITH mom/dad to see how they are cooking.
b. Each family member will ASSIGN THEMSELVES to carry out one of the above identified tasks to fully assess the cause of the symptoms.

3. Once the causes are identified, make another list of all of the possible solutions. In the example used above, look at the possible solutions.

a. Visit mom/dad weekly and assist them in making their grocery list and go shopping with them.
b. Bring mom/dad 2 frozen meals each week.
c. Hire a private caregiver to be with mom/dad for five meals a week to ensure that they are cooking well-balanced meals and are eating regularly.
d. Phone mom/dad during supper time to find out what has been cooked and ensure that they are eating at regular intervals.

4. Once the solutions have been identified, each family member must ASSIGN THEMSELVES to at least one of the tasks. Create a Family Schedule that designates each family member to fulfill at least one of the tasks.

5. Now the family must MUTUALLY DECIDE on how you will communicate with one another regarding any updates and changes (email, phone, letters, etc.)

These tips only touch on the variety of ways families can work together. The main “take away” is that these tips focus ONLY on the parents, and not on the “feelings” of the kids. By keeping the family discussions “symptom” based, we are minimizing the emotions that drive family arguments. In addition, this approach keeps families focused on the real priority, the well-being of their aging parents.

For more information, contact Erickson Resource Group at (514)795-7377 or at stephanie@ericksonresource.com

What is a Mandate in the Case of Incapacity?

This is a, “document in which a person, known as a mandatory, while in full possession of his faculties, appoints another person, known as the mandatary, to see to his protection or administer his property or both at once, in the event that illness or an accident deprives him of his faculties, either temporarily or permanently.” http://www.curateur.gouv.qc.ca/cura/publications/mandatE.pdfpermanently.

What is the homologation of a Mandate in the Case of Incapacity mean?

It is the legal procedure in which a person’s incapacity is proven by a Court of Law, and the designated mandatary is given the legal authority to act on the mandator’s behalf. Without this legal procedure, the document “as is” does not allow legally for the mandatary to use the authority entrusted to them by the Mandator.

When is it time to homologate a Mandate in the Case of Incapacity?

If your mother, father, spouse, partner, friend, or relative designated you to make decisions for their health care, medical treatment, housing situation, management of their finances, or for any other reason should they not be able to make decisions for themselves, it is recommended that you homologate a Mandate as soon as the mandatary (person who signed the document) is deemed incapacitated. As a mandatary (person named to manage the personal or financial affairs of another), you must have the complete legal authority to make all decisions (personally, medically, and financially) for your loved one. A homologated mandate is the legal step required to ensure that you can manage all aspects of your loved ones’ life without complications.

What are the steps involved to homologate a mandate?

Medical assessment:
A physician (M.D.) must complete a medical form (Report of the Director General – 2A) that outlines the person’s diagnosis and mental capacities. If you do not have a physician who can do this, Erickson Resource Group can refer you to someone.

Psychosocial assessment:
The CLSC social worker or a social worker in private practice can complete the psychosocial assessment for a mandate homologation. Often, the wait at the CLSC is between 5-8 months. Check with your local CLSC to assess the wait times. Erickson Resource Group can complete the psychosocial evaluation and report within 10 business days. An expedited service is available for urgent cases. Please phone Erickson Resource Group to learn more about the specific steps and fees involved in this process.

Both of these reports are given to a notary or an attorney for filing with the court. Please contact your notary or attorney for further information regarding the specific legal steps and fees involved. If you do not know a notary or attorney who specializes in this area of practice, please contact Erickson Resource Group and we can refer you to a notary.

What could happen if the Mandate is not homologated?

What if you need to sell you loved ones’ home but they are no longer competent to sign the necessary documents? What if you need to make changes to your loved one’s pension? Change an address? Change an investment account? None of this can be done without a homologated mandate. You may have been acting on the mandator’s behalf without a homologated mandate and have not had complications. However, if you are questioned by a financial or governmental institution and the Mandate is not homologated, financial accounts could be “frozen” until such time that the Mandate has been homologated. This could create delays of up to 6 months for family members.

What is a protective regime?

If someone did not take the steps to sign a Mandate in the Case of Incapacity, and it is felt that they require protection or assistance, someone can apply to the government to represent this person in financial and personal matters. There are different levels of protective regime. Please refer to the following link on the government website to learn more. http://www.curateur.gouv.qc.ca/cura/en/majeur/inaptitude/protection/index.html

What are the steps to apply for a private curatorship or private tutorship?

Medical assessment:
A MD must complete a medical form (Report of the Director General – 2A) that outlines the person’s diagnosis and mental capacities. If you do not have a physician to do this, Erickson Resource Group can refer you to someone.

Psychosocial assessment:
The CLSC social worker or a social worker in private practice can complete the psychosocial assessment for a private or public curatorship. Often, the wait at the CLSC is between 5-8 months. Check with your local CLSC to assess the wait times. Erickson Resource Group can complete the psychosocial evaluation and report within 10 business days. An expedited service is available for urgent cases. Please contact Erickson Resource Group to learn more about the specific steps and fees involved in this process.

Both of these reports are given to a notary or attorney for filing with the court. In addition, there is a “family council” that is facilitated by your notary or attorney. Please contact your notary or attorney for further information regarding the specific legal steps and fees involved. If you do not know a notary or attorney who specializes in this area of practice, please contact Erickson Resource Group and we can refer you to a notary.

What could happen if I do not become a private curator or tutor on behalf of my loved one?

What if you need to sell you loved ones’ home but they are no longer competent to sign the necessary documents? What if you need to make changes to your loved one’s pension? Change an address? Change an investment account? None of this can be done without an established protective regime. If this step is not taken until a crisis occurs, the family will experience long time delays and accounts can be frozen in the interim.

Who can help me navigate this process?

Erickson Resource Group can provide the psychosocial assessment for either a homologation of a mandate or for an application for protective regime on a private basis. You may also contact l’Ordre Professionnel des Travailleurs Sociaux du Québec for more information. We also have referrals to many notaries and/or attorneys who can assist you with the legal process. You may also consult the Chambre des Notaries for more information. Erickson Resource Group can refer you to a physician who can assist with the assessment and completion for the required medical form on a private basis. Erickson Resource Group can provide you with guidance and support throughout this process.

How long does this process take?

Erickson Resource Group can complete the psychosocial assessment required within 10 business days after meeting with the client and family. Generally, a ERG social worker can meet with the client and family within a week of receiving the request. An expedited service is also available. If you choose to go with a public agency (CLSC, CHSLD, etc.), there could be delays for up to 6 months. Contact your local government agency for an estimated time frame. ERG provides services in both English and French.

The medical report can also be completed on a private basis and ERG can assist you in connecting with a physician. If you choose to go with a public agency (CLSC, CHSLD, etc.), there could be delays for up to 6 months. Contact your local government agency for an estimated time frame. You can also request that the client’s family doctor complete the required form. ERG can assist you in facilitating this process.

The legal petitioning of the Court cannot occur until both the psychosocial assessment and the medical report are completed and given to the notary or attorney. Once the notary or attorney has these documents, they can petition the Court. Depending on the notary/attorney and the Court delays, the process can take as little as 4 weeks and up to 6 months. There are additional steps required for the opening of a private curatorship or private tutorship.

For more information, contact Stephanie Erickson at Erickson Resource Group at (514) 795-7377.

written by: Stephanie Erickson, MSW, PSW, LCSW

If you have aging parents, you are most likely concerned about their physical, emotional and cognitive health.  As your parents get older, they will have medical appointment after medical appointment with a variety of medical professionals including doctors, nurses, social workers, physiotherapists, etc.  Your parents may have difficulty remembering the details of each of these appointments, as one specialist blends into another.

It is important for you to keep track of the dates and times of the appointments in order to remind and follow up with your parents.  However, this is not the only information you need to monitor.  The following list contains suggestions on how to record the essential details of your parents’ health so in case of an emergency or hospitalization, you have their full medical history available.

1. Buy a journal or make an excel spreadsheet that records all of the names, addresses, phone numbers and areas of specialty of each of your parents’ physicians and other health care professionals with whom they have contact.
2. Include the diagnosis or problem treated by each of these health professionals, as well as the medication(s) prescribed (dose, times of day, etc.)
3. Document the emergency procedure to contact each of these physicians in a time of crisis as well as their normal office/clinic hours.
4. Encourage your parents to sign a Consent to Release Information with each professional so you have the legal authority to exchange information.  (See our website for a free form).
5. Ask your parents to bring a list of questions and concerns to each appointment and to document the answers.  Include your questions on this list. 
6. Document the pharmacy name and location for each medication prescribed so you can discuss any medication concerns or interactions with the pharmacist.  Make sure your parents sign a Consent to Release Information at each pharmacy.
7. If possible, use only one pharmacy for all of your parents’ prescriptions for better monitoring by a pharmacist of possible drug interations.
8. Make a list of all medical diagnosis, medications, surgical history, current treatment regimes, and treating physicians and ask your parents to keep this list in his or her wallet or purse in the case of an emergency.  Place a copy of this form on the refrigerator and near each phone in their home.
9. Encourage your parents to draft a Mandate, Power of Attorney and/or Living Will so they will be ensured you can act on their behalf  if necessary.

The above information is the basic information needed to assist your parents with their overall health.  It is equally important to organize all of their personal and financial affairs to ensure that you can provide comprehensive support in all aspects of their life when the time approaches. 

For more information or for organizing tools, documents and tips for medical, financial and personal affairs, see our website e-store.

Written by: Stephanie Erickson, MSW, PSW, LCSW 

As our parents age, it becomes harder and harder to feel secure that they are safe and healthy in their home.  This becomes even more difficult if we do not live nearby and are unable to “pop in” to make sure they are okay.  We are left to rely on their self-report of their situation. 

If our parents have memory problems, we wonder if they are accurately reporting what is happening.  We may also believe that they are minimizing their struggles for fear that they will be forced out of their home.  Even if our parents live in senior’s community, assisted residence or full care facility, we still worry if they are getting all the care and attention they need.

There are some things we can do from a distance to increase our full understanding of their situation, to improve the communication we have with them, and to manage the risks inherent in long distance (and close distance) caregiving.  All of these suggestions can be done via the internet and phone.

1. Ask your parent to sign a consent to release information from all of their health care providers so that you can gather collateral information about their functioning.  Get a list of the names and phone numbers of these individuals.
2. Encourage your parent to complete a power of attorney at all of their financial institutions so you can monitor their management of money.  Make sure to tell them that you do not plan on taking over; you just want to oversee to ensure they are not being taken advantage of by another and if they have questions, you can assist them. 
3. Encourage your parent to draft a Mandate/Living Will/Durable Power of Attorney for Health Care so you have the legal authority to make decisions and manage their finances if they become unable to do so.
4. Ask your parent to list all of their utility providers, their mortgage carrier, car insurance, etc. and account numbers and to give these facilities authorization to share information with you so if they are confused about their accounts, you can assist them.  (See our website for a complete list). 
5. Arrange for automatic bill pay where applicable.
6. Ask your parents for the location of all important documents (power of attorney, birth certificate, deeds, etc.). 
7. Obtain LifeLine, Medic Alert, or another type of safety system so that your parent can access help if he/she falls or has another emergency.
8. Obtain a list of individuals nearby who could stop by your parents’ home if you have an immediate concern (neighbor, friend, relative, etc.)
9. Obtain a complete and updated list of all medications, prescribed and over-the-counter.
10. During a visit to your parents, conduct a home safety assessment and make all necessary modifications to the home.  (See our website for a complete list of areas to observe).
11. Prepare a list of private and community agencies that are available to make visits to your parents for future or immediate reference.
12. If your parent is at a facility, get the names, phone numbers, and emails of at least two professional staff members (nurse, social worker, etc.) and make contact with them periodically to foster an on-going relationship.
13. If you can afford it, arrange for a monthly visit from a social worker or nurse to monitor your parents’ safety and report back to you.  The money spent will be worth the peace of mind and may prevent major crises.
14. Begin a journal of all of the above information, as well as on-going updates about your impressions of their functioning, including specific examples (i.e., my mom called me again to ask about her phone bill; I noticed she has lost weight since our last visit, etc.). 
15. Monitor the following when you visit: Physical appearance and hygiene, medication administration habits, ambulation risks and falls, home cleanliness and organization, food acquisition and preparation, driving, memory loss, ability to express thoughts, social interaction or isolation, judgment, decision-making, etc.)

For further information and more detailed toolkits that outline each of the above areas in more detail, please refer to our website. http://www.ericksonresource.com/estore/

Written by: Stephanie Erickson, MSW, PSW, LCSW

It is very scary to know that our parents are living alone in their home as they begin to lose physical and cognitive functioning.  We want to respect their decision to remain autonomous at home for as long as possible so we search for ways to make this happen.  The following is a complete list of all of the areas in your home that present a danger to your parent or loved one, outlines the factors that increase risk and offers concrete suggestions to reduce the identified risks.

Emergency Preparation:

1. Get the name of neighbor/friend/relative and phone number to contact in the case of an emergency and you are not able to get to your loved one’s home.
2. Post your name and phone number next to every phone AND give this information to AT LEAST one neighbor/friend.
3. Obtain the name of a community member, social worker, other professional to contact in the case of an emergency and/or regular updates.
4. Give an extra key to a neighbor or friend, have an extra key for yourself, and hide one outside the home (if you feel comfortable) so someone can gain access to the home in an emergency.
5. Register with Medic-Alert or LifeLine and get a bracelet for your parent so he/she can access help if there is a fall.  See our website under Resources for a link.
6. Make sure all legal documents (power of attorney, mandates in the case of incapacity, etc. are updated and complete).

Risk Factors for a Fall:

1. Over 75 years old
2. Living alone
3. Housebound
4. Use of cane/walker
5. Previous falls
6. Acute illness, chronic conditions, tremors (neurological disorders)
7. Multiple medications
8. Cognitive impairment
9. Vision and hearing problems
10. Difficulty sitting/standing from a chair/bed
11. Foot problems
12. Alcohol/drug use
13. Poor nutrition
14. Balance/equilibrium problems

Bathroom Safety:

1. Install grab bars in the bathtub or shower and by the toilet
2. Use rubber mats in the bathtub or shower
3. Use a shower chair or bench
4. Take up floor mats when the bathtub or shower is not in use
5. Install a raised toilet seat
6. Remove tub and install a shower with a minimal step-up
7. Place a chair in shower stall
8. Use a telephone shower head

Kitchen Safety:

1. Use automatic tea pot
2. Remove rugs without a non-stick service
3. Place frequently used pots and pans at waist level to minimize bending and stretching
4. Use a microwave to reduce use of oven/stove
5. Disconnect stove/oven fuses if there are memory impairments and it has been left turned on in the past

Outdoor Safety:

1. Repair cracked sidewalks
2. Install handrails on stairs and steps or install a ramp
3. Trim shrubbery along the pathway to the home
4. Install adequate lighting by doorways and along walkways leading to doors

Living Space Safety:

1. Remove throw rugs, or tape down to secure
2. Secure carpet edges
3. Avoid visually distracting patterns on flooring/carpets
4. Mark transitions from carpet to flooring with a different color paint/stripe
5. Remove low furniture and chairs that are too low to get up/down
6. Remove objects on the floor
7. Reduce clutter
8. Remove cords and wires on the floor
9. Avoid floor wax or use nonskid wax
10. Ensure the telephone can be reach while laying on the floor

Stair Safety:

1. Install hand rails on both sides of staircases at elbow height
2. Make sure an adult can wrap their hand completely around the handrail
3. Attach them securely to walls or posts
4. Secure carpet on treads of stairs
5. Install light switches at the top/bottom of stairways
6. Do not reduce lighting in stairways; in fact, increase the lighting
7. Do not place rugs at the top/bottom of stairs
8. Leave one hand free to hold the handrail when carrying objects
9. Check lighting for adequate illumination at night, especially in the pathway to the bathroom and on stairs

General safety:

1. Wear shoes or slippers that fit properly and have a non-slip sole
2. Remove reading glasses when walking up/down stairs
3. Install a telephone on every level of the home, especially in the bedroom, kitchen, and bathroom
4. Install a bathroom on each floor
5. Understand side-effects of medications, such as dizziness
6. Avoid alcohol
7. Avoid carrying large or heavy objects, such as laundry baskets
8. Get up slowly from a sitting or laying position; sit on the side of the bed before rising
9. Wear clothing with an elastic waistband for easy removal

For further information, please contact Erickson Resource Group at www.ericksonresource.com