Health Care Management

Original Air Date: April 12, 1998

Why is it important that people in caregiving situations be effective advocates?

  • When a parent becomes ill, the adult child must realize that that parent's world has been turned upside-down. It's a time of significant stress for the parent.
  • In many cases, the parent is trying to cope with an ailment that, by its very nature, makes coping more difficult (loss of vision or hearing; incontinence).
  • The "normal" way of dealing with health care professionals is not an option; somebody has to be behind the elderly person, running things and making sure they are getting the help that's required.

What does a caregiver/advocate need to know from health care professionals when a senior is diagnosed or falls ill?

  • Find out as much as you can about the disease. Ask what things can be investigated, what tests should be done. If you're dealing with a frail elderly person, ask, "If my mother were 50, would you still stop treatment there?" If the answer is no, then push them to proceed further (if it's a reasonable thing to do).
  • Ask to be informed of all the resources you can be tapping into to help you. For example, when someone refers you to one resource (i.e. home care), ask that resource what other resources you should be seeking out. If you're in a small town and resources are few, check into the nearest large centre and tap those resources.
  • Ask what could happen. Don't assume the way things are is the way they're going to stay. So Dad's had a stroke and is recuperating and you're dealing with itbut Dad could have another stroke, he could become incontinent, etc.

How can caregivers ensure they'll have access to a parent's medical records?

  • Make sure you've gained consent before the person becomes ill. A signed letter (advance directive) from the parent stating they want you to have access to all medical records should be sufficient.
  • If you encounter difficulties, be a "squeaky wheel." You're not out to make enemies, but you can't back down at the first sign of resistance: the problem won't go away.

How important is it for caregivers to keep records?

  • It's very important. Keep a log of the person's "normal" day (shameless plug: join the Caregiver Club so you can use the resource binder for this). Record things like how best to approach Mom about things, what are her good times of the day, and when she's not so good. It ensures consistency when the little "secrets" about Mom are known to all family members.
  • For example, if the primary caregiver wants to get out for a day and someone else is coming to relieve her, the fact that Mom likes to always have a sweater on the back of her chair, or her sandwiches in triangles with the crusts cut off, is a big deal to Mom. If that doesn't happen, she might make a fuss, and the "relief" caregiver gets stressed out and is discouraged from helping out again.
  • Secondly, the log is useful to health care providers to uncover "patterning" behaviors. If Mom does "X" (becomes weepy, aggressive, whatever) at a certain time every day, the log can provide clues to doctors about what might be causing it.

How important is it for caregivers to keep records?

  • It's very important. Keep a log of the person's "normal" day (shameless plug: join the Caregiver Club so you can use the resource binder for this). Record things like how best to approach Mom about things, what are her good times of the day, and when she's not so good. It ensures consistency when the little "secrets" about Mom are known to all family members.
  • For example, if the primary caregiver wants to get out for a day and someone else is coming to relieve her, the fact that Mom likes to always have a sweater on the back of her chair, or her sandwiches in triangles with the crusts cut off, is a big deal to Mom. If that doesn't happen, she might make a fuss, and the "relief" caregiver gets stressed out and is discouraged from helping out again.
  • Secondly, the log is useful to health care providers to uncover "patterning" behaviors. If Mom does "X" (becomes weepy, aggressive, whatever) at a certain time every day, the log can provide clues to doctors about what might be causing it.

How important is communication among all the parties: patient, caregiver, other family members?

  • It's extremely important but not easy.
  • Between the patient and primary caregiver, it goes back to the issue of what the relationship has been like historically. If it's always been a superficial relationship where the parties didn't really "talk," then it's hard to deal with the "deep" issues now.
  • This is where families most often need direction. This is where counselling or support groups are very helpful: getting outside help to teach them new communication skills and help them to stay objective about the situation.
  • Listening is a problem for people in these stressful situations. Don't say, "I know what you're going through." Others can never know what a frail older person is going through; ask them, and listen to what they say.

Do seniors get the same level of care as younger people?

  • No. Ageism applies to all aspects of care for the elderly. People are "ping-ponging" between acute care and long-term care. LTC facilities don't have enough resources to go around. For example, a physiotherapist in a nursing home may be expected to treat a much larger number of people than one in another type of setting.
  • Society will have to change to allow people more resources at the end of life than at the beginning because of the pressure of the size of our aging population.
  • This is where families most often need direction. This is where counselling or support groups are very helpful: getting outside help to teach them new communication skills and help them to stay objective about the situation.
  • Until very recently we haven't had a very vocal group of seniors. But now, as the boomers are aging, their sheer numbers and demands mean these issues are starting to be addressed.

How do you deal with dismissive or otherwise difficult health care professionals?

  • If it's a matter of a health care professional "talking past" your parent to you, say, "You should ask my mother that." Not only does your parent have the right to be dealt with directly, if she has an unpleasant experience the first time she deals with a certain hospital or other facility's personnel, you'll have a hard time getting her to go back there again.
  • There's a fine line between being realistic and being passive in situations where you believe you're not getting the answers or treatment you're entitled to. If the situation is not immediately life-threatening, be persistent without being belligerent. Ask, "What's happening here? What else could we be doing to help my mother?" or "If I can't get this from you, then who can help me?"
  • Figure out how you can decrease the stress on your parent, and pursue those things above all else.

At what point do you complain to "higher-ups"?

  • When all else fails in your attempts to have the matter dealt with, ask, "Who's your supervisor?"
  • Document everything.
  • Don't lose control. Be reasonable and professional.
  • If you have to, take it all the way to the Ministry.

What about communication with personnel if you've had to place someone in a long-term care facility?

  • You have every right to know exactly what the care team is doing with a loved one in a LTC facility.
  • There's an onus on families to let LTC personnel know who Mom wasnot just who she is now. That's why it's so important to bring personal effectslike a photo album or other such mementoswhen moving someone to a facility.
  • Likewise, it's crucial to let them know about the person's likes and dislikeswhat they like to eat and so on.

What is the role of pharmacists in our health care system?

  • The role has changed a lot over the past few years. Pharmacists have evolved from being people who just sell the drugs to being good, approachable resources and intermediaries who look after all of a person's drug-related needs.
  • That includes:
    • getting the right drug;
    • providing information to help people make informed choices about what they're taking;
    • informing people re side effects;
    • informing people re consequences of taking/not taking a certain drug;
    • making sure people are taking the right mix of drugs; and
    • being a resource to other members of the health care community.

What things should you ask a pharmacist when he's filling a new prescription for you?

  • The generic and trade names of the drug.
  • Why you're taking the drug.
  • How you should take the drug.
  • What to watch for while you're taking the drug.
  • How you'll know when it's working.
  • When you'll be able to stop taking the drug.

Is compliance a problem with seniors?

  • In most cases, it's not that seniors don't want to comply with their medication instructions, but that health care professionals haven't educated them properly.
  • Sometimes, it seems to seniors that the cost of complying is worse than the cost of not complyingwhether it's pain (i.e. insulin injections), cost (for people on fixed incomes), inconvenience, simple inability to adhere to multiple daily doses, or other barriers.

What things can a pharmacist do to make taking medications easier for seniors?

  • A pharmacist can perform a comprehensive medical review in which the senior brings all his/her medications to the pharmacist, who will go through them to make sure no unnecessary medications are being taken. (This is why it's good to stick with one pharmacy for all your prescription drugsthey can keep an eye on everything you're taking.)
  • They can substitute a liquid solution or suspension for pills in the case of a person who has trouble swallowing.
  • Many people are reluctant to speak with their family doctor about herbal and natural remedies because they fear the doctor will be skeptical and dismiss them out-of-hand. A pharmacist won't mind taking the time to explain the different substances.
  • They can explain and monitor the use of over-the-counter (OTC) products.

Are OTC (over the counter) products a big problem with seniors?

  • Yes. Many people feel that if they can buy something right off the shelf, it's harmless, but that's not the case.
  • Example: a senior who takes his prescription medications with a meal and then takes a couple of swigs of an antacid as a matter of habit. First, the antacid can coat the stomach so that the prescription drugs aren't absorbed as well. Secondly, taking an antacid regularly can mask symptoms of an ulcer or other stomach ailment.

Does the way in which we react to a drug change as we age?

  • Yes. As we age, changes occur in the way we metabolize, the way we absorb things into our system, and in the way we eliminate things from our system. As a result, a drug that a person once took with no problem, could become a problem for that person as they age.

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