1. GRT2100B PSYCHOSOCIAL ASPECTS OF AGING CARETAKING CLASS #23 November 27, 2013 PROFESSOR: MELISSA BRASGOLD

2. GRT 2100: Psychosocial Aspects of Aging FINAL EXAM INFO Date: Tuesday, December 17 th Time: 7 pm – 10pm Location: MNT 202 (Has changed & can again!) Worth: 40% Covering class material, reading & videos from: Class #17 – Class #23 incl.

3. GRT 2100: Psychosocial Aspects of Aging READING FOR FINAL EXAM P. 17-19: Start at “the dying process”. P. 36-39: End at “Medicare”. P. 42-45: End at “Productivity & Creativity”. P. 72-73: Compression of Morbidity section only. P. 90 – 96: End at “Stress as a characteristic of the environment. P. 102-103: Coping & Aging section only P. 105-114: Exclude “Wisdom & optimal aging” section. *Readings marked in red are material that was not covered in class, but which will be tested on the exam. Any updates will be relayed via email.

4. GRT 2100: Psychosocial Aspects of Aging TODAY’S OUTLINE Institutional Care & Caretaking

5. GRT 2100: Psychosocial Aspects of Aging Canadian Institution Stats (2008/2009) 0.7 % institutionalized = 250,000 individuals. 75 % were 65+ = 238,000 individuals = 4 % of pop. 65+ (Mostly women; 2001 – 7.5%). % of Seniors Aged 65–74 % of Seniors Aged 74–85 % of Seniors Aged 85+ 2.28.231.6

6. GRT 2100: Psychosocial Aspects of Aging INSTITUTIONAL CARE: National Population health survey 2001 % of seniors living in institutions varies by province:  Quebec – 9.5%  Ont., N.B, N.S., Newfoundland – 6-7%  B.C. has lowest rate – 5.5%  National rate – 7.5%  U.S. - 4.5%  U.K. – 4.2%  Holland – 12%

7. GRT 2100: Psychosocial Aspects of Aging NURSING HOMES Nursing homes: Any institution (not a hospital) that offers medical care for chronically ill older people. Also known as: - Special Care Facilities - Homes for Special Care - Personal Care Homes Nursing homes have different levels of Care organized by intensity of care.

8. GRT 2100: Psychosocial Aspects of Aging STANDARDS OF CARE 1/4 of institutions 1+ senior gets sub-standard care. Smaller institutions (40 people or less) up to 20% have 1 individual who receives sub-standard care. High percentage of death within first 6 months = stress from moving.

9. GRT 2100: Psychosocial Aspects of Aging RIGHTS OF THE SENIOR No clear policies to protect residents’ rights in some provinces. Poirier’s 3 Types of Rights: 1. Right to take care of one’s own things 2. Right to have respect for one’s rights 3. Right to manage one’s own life

10. GRT 2100: Psychosocial Aspects of Aging NORMALIZING INSIDE What is the Normalization Principle? Should include the following: 1) Ensuring a Normal Rhythm & keeping active. 2) Treating residents as adults. 3) Allow residents to have normal social lives. 4) Allow residents sexual contact and intimacy. 5) Allow residents access to their money. 6) Allow residents to have their own possessions.

11. GRT 2100: Psychosocial Aspects of Aging CHANGING THE SYSTEM Reliance on medical model causes problems. 25-60% of doctor’s services for seniors unnecessary. In home care professionals can replace doctors and nurses. 47 Reforms to Health Care proposed in 2002 in Romanow Report to improve delivery of health care to seniors.

12. GRT 2100: Psychosocial Aspects of Aging CANADIAN GERIATRIC SOCIETY RECOMMENDATIONS Canadian Geriatric Society proposed following changes in the Romanow report: 1) Increase in number of geriatric specialized physicians. 2) Increase in geriatric expertise for general physicians. 3) Increase in home care services for the chronically ill. 4) Increase in assistance to family caregivers. 5) Increase in qualified staff in long-term care facilities. Changes will improve health care, but time frame is long (2020).

13. GRT 2100: Psychosocial Aspects of Aging LONG-TERM CARE: COMMUNITY CARE Long-Term Institutional Care, but not community care is covered. Potential move to a National Home Care system. Home care use rises with age = 85+ 5-6 times more likely to use. Ontario set-up Community Care Access Centers (CCACs) across the province.

14. GRT 2100: Psychosocial Aspects of Aging CONTINUING CARE SYSTEM: MAJOR CATEGORIES OF SERVICES & SETTINGS 1. Meals on Wheels 2. Adult Day Care 3. Homemaker Services 4. Home Nursing Care 5. Community Physiotherapy & Occupational Therapy 6. Assessment & Treatment Centers and Day Hospitals 7. Nursing Home Care 8. Chronic Hospital Care 9. Other Services

15. GRT 2100: Psychosocial Aspects of Aging MEALS ON WHEELS Home delivery of hot, nutritious meals by Volunteers usually for a minimal cost. http://www.ottawaseniors.com/links/in-home- support/meals-on-wheels/ http://www.ottawaseniors.com/links/in-home- support/meals-on-wheels/ http://manotickvillage.com/business/rideau- seniors-centre/ http://manotickvillage.com/business/rideau- seniors-centre/ ROSSS, Rural Ottawa South Support Services

16. GRT 2100: Psychosocial Aspects of Aging HOMEMAKER SERVICES: Non-professionals help with personal care or housekeeping. ROSS

17. GRT 2100: Psychosocial Aspects of Aging GERIATRIC DAY HOSPITALS Geriatric Day Hospital Some services include:  Physical Check-ups  Drug monitoring  Dental Clinics  Diagnosis  Treatment  Rehabilitation

18. GRT 2100: Psychosocial Aspects of Aging ADULT DAY CARE: RESPITE CARE Adult Day Care Relieves primary caregiver. Program includes hot meals, recreation programs and socialization. Services covered in some provinces.

19. GRT 2100: Psychosocial Aspects of Aging HOME CARE Range of coordinated and integrated social and medical services designed to help people live independently in the community.

20. GRT 2100: Psychosocial Aspects of Aging 3 GOALS OF HOME CARE 1. Substitution for more costly care of institutions. 2. Maintaining a person at home at a lower cost to system. 3. Prevention of functional breakdown that could lead to institutionalization.

21. GRT 2100: Psychosocial Aspects of Aging HOME CARE PROGRAMS PROVINCE TO PROVINCE Home care programs differ province to province, but all have some form of public home care and nursing services. Some have more services than others, but all:  Assess Clients  Coordinate Services  Manage cases

22. GRT 2100: Psychosocial Aspects of Aging HOME CARE: SMALL ROLE BECOMING BIGGER Home care: small role in Ca. health care system. Home care  97-98 Canada spent 2.1 billion on public home care = 4 % of on public health care, but Increasing. Who? 1.2 million Canadians, 15%OA. Who? 1.2 million Canadians, 15%OA. Increase in home care spending beneficial - home care costs ½ to ¾ cost of facility care. BUT, large # of hours approaches same costs = 120 hrs = week of institution costs.

23. GRT 2100: Psychosocial Aspects of Aging THCIC, 2011HHCIH Home Care Reporting System, 2009–2010, Canadian Institute for Health Information.

24. GRT 2100: Psychosocial Aspects of Aging CARETAKING (2008 STATS) 1 in 5 (20%) Canadians 45+ provide care to a senior. 2.7 million family & friends 45+ provided informal care to seniors.

25. GRT 2100: Psychosocial Aspects of Aging INFORMAL CARE - THE 70% ISSUE

26. GRT 2100: Psychosocial Aspects of Aging CONSEQUENCES OF CAREGIVING 1. Social consequences/impacts 2. Economic consequences/impact 3. Physical consequences/impact 4. Changes in living arrangements 5. Employment-related consequences http://www.phac-aspc.gc.ca/publicat/oes-bsu-02/caregvr- eng.php

27. GRT 2100: Psychosocial Aspects of Aging

29. STRESS & CAREGIVING, 2007

30. GRT 2100: Psychosocial Aspects of Aging HEALTH & CAREGIVING, 2007

31. GRT 2100: Psychosocial Aspects of Aging

32. WORK REPRECUSSIONS (2009/2010) 55% of women & 45% of men reported: Changes in work hours(big one) Declining promotions Job transfers to accommodate informal caregiving responsibilities

33. GRT 2100: Psychosocial Aspects of Aging BENEFITS OF CAREGIVING Benefits for receiver & provider. Canadians look upon care-giving duties positively. Most caregivers believe they are giving something back.

34. GRT 2100: Psychosocial Aspects of Aging

35. SOME INTERESTING READING ON CAREGIVING http://www.ncbi.nlm.nih.gov/pmc/articles /PMC2791523/

36. GRT 2100: Psychosocial Aspects of Aging GOVERNMENT AID http://www.servicecanada.gc.ca/eng/lifeevents/c aregiver.shtml http://www.servicecanada.gc.ca/eng/lifeevents/c aregiver.shtml

37. GRT 2100: Psychosocial Aspects of Aging Balancing the Caregiver’s Burden: Knowing When to Seek Support. VIDEO: http://healthline.healthology.com/hybrid/hybrid- autodetect.aspx?focus_handle=caregiving&Conten t_ID=1831&brand_name=healthline&psv=33 http://healthline.healthology.com/hybrid/hybrid- autodetect.aspx?focus_handle=caregiving&Conten t_ID=1831&brand_name=healthline&psv=33 Transcript: http://www.healthline.com/hgy-transcripts/the- role-of-a-caregiverhttp://www.healthline.com/hgy-transcripts/the- role-of-a-caregiver

38. GRT 2100: Psychosocial Aspects of Aging Till Death Do Us Part: Taking Care of a Spouse (For your info only) Video: http://healthline.healthology.com/hybrid/hybrid- autodetect.aspx?focus_handle=caregiving&Conte nt_ID=1945&brand_name=healthline&psv=33 http://healthline.healthology.com/hybrid/hybrid- autodetect.aspx?focus_handle=caregiving&Conte nt_ID=1945&brand_name=healthline&psv=33 Transcript: http://www.healthline.com/hgy- transcripts/taking-care-of-a-spousehttp://www.healthline.com/hgy- transcripts/taking-care-of-a-spouse

39. GRT 2100: Psychosocial Aspects of Aging The Zarit Burden Interview 1) Do you feel that because of the time you spend with your relative that you don’t have enough time for yourself? 2) Do you feel stressed between caring for your relative and trying to meet other responsibilities (work/family)? 3) Do you feel angry when you are around the relative? 4) Do you feel that your relative currently affects your relationship with family member or friends in a negative way? 5) Do you feel strained when you are around your relative? 6) Do you feel that your health has suffered because of your involvement with your relative?

40. GRT 2100: Psychosocial Aspects of Aging The Zarit Burden Interview 7) Do you feel that you don’t have has much privacy as you would like because of your relative? 8) Do you feel that your social life has suffered because you are caring for your relative? 9) Do you feel that you have lost control of your life since your relative’s illness? 10) Do you feel uncertain about what to do about your relative? 11) Do you feel you should be doing more for your relative? 12) Do you feel you could do a better job in caring for your relative?

41. GRT 2100: Psychosocial Aspects of Aging LAST CLASS!! Class #24 – Elder Abuse Course pack p.35