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February 28, 2023

Hospices

In the past few years, two family members who had terminal illnesses, and were nearing the end of their days, found comfort and support and a peaceful death in a residential hospice. One was in Richmond Hill, the other in Barrie. If I were in the same situation and wanted to end my life in a residential hospice in Toronto, could I do it? Probably not.

We don’t like thinking about death, much less planning for it, but I think it’s one of our jobs as seniors. If we don’t have a terminal illness right now, then we can think through our preferences calmly and dispassionately and then just tuck them away in case we need them later. That’s a lot better than having to make decisions, or having them made for us, in the midst of a crisis.

If we have an illness that is life-limiting and can no longer be treated, then we need palliative care. The focus of palliative care is on providing relief from the symptoms and stress of an illness, and improving the quality of life for the patient and family. It’s usually provided by an interdisciplinary care team, centred on the needs of the patient. In Ontario, palliative care is available in a number of settings: long term care homes, your own home, residential hospices, and some acute care hospitals. If you’re already in a long term care home, your care will just transition to palliative. If you’re in an acute care hospital, aggressive and invasive treatments may continue unless the hospital has a palliative care team to transfer you to. If you’re in your own home, you need family members or others to provide round-the-clock care, and you need funding to pay for substantial home care. Most of us won’t want to undergo aggressive hospital treatment. Many of us seniors live alone and don’t have a large support network or a lot of money for home care. So for us, the best option would be a bed in a residential hospice.

How many residential hospice beds do we have in Toronto? We have two hospices for the general public: Dorothy Ley (12 beds) and Kensington (10). There are also two hospices for special populations: Yee Hong PK Kwok, for Chinese and other Asian seniors (10), and Journey Home for the homeless (10). So that’s 42 beds for a population of 2.8 million. By way of comparison, Ottawa, with a population of 1,400,000, has 38 beds. Windsor, population 340,000, has 20. In Ontario. whether you can find a residential hospice bed is largely a question of postal code.

To make matters worse, Ontario’s funding formula for residential hospices covers just over 50% of their costs. Hospices have to make up the rest through endless fundraising, and they must rely heavily on volunteers. If donations go down, or the pool of volunteers shrinks – both of which have happened during the pandemic – then beds may be forced to close.

It is well known that specialized facilities such as residential hospices can provide better end-of-life experiences for patients and their families than acute care hospital beds do, and at a fraction of the cost. It’s time residential hospices got the support they deserve.

January 30, 2023

Senior volunteers

Let me be clear: I’m not trying to rain on anyone’s parade. I’m not telling people they shouldn’t volunteer to serve other seniors. But the literature on this is so terribly skewed. It’s overwhelmingly about all the things that volunteering can do for you: social connection, feeling useful and so on. Apparently, these days volunteering is all about you. It seems so narrow and self-serving that I decided it would be worth sparing at least a few moments’ thought to turn things around and look at this venture from the point of view of the senior at the receiving end of volunteer service.

Imagine a senior living in long term care or a retirement home, or maybe living alone in her own home. Her basic survival needs may be taken care of, but she might feel isolated and lonely. Volunteers of any age might step in to fill that gap, but volunteers who are fellow seniors can really enrich the experience. As a senior volunteer, you can approach your clients as peers, making for a more equal relationship. You may therefore more naturally treat your clients with dignity and respect. You can relate to the challenges the client faces and acknowledge the efforts the client is making to age gracefully. In this relationship, both people can feel valued and appreciated.

But volunteers are only human, and you have needs too. Maybe you’re newly retired, and missing the role and recognition your job used to offer. Maybe you’re a widow or an empty nester, and missing the companionship and connection your family used to provide. Senior volunteering can help fill those needs, as long as you are clear on what your needs and expectations are, and how to manage them. What happens if you are too needy? The client may feel that she has to keep expressing gratitude, can’t be critical, has to keep feeding the volunteer’s ego. Senior clients are often vulnerable themselves and should not have to assume an emotional burden imposed by a volunteer.

So of course you should volunteer if you want to and have something to offer. But make sure you think carefully about it first, and understand your own needs and motivations. Know thyself.

December 29, 2022

Cooking without recipes

Are you falling into a rut in the kitchen? Getting tired of the same old recipes? Try cooking by formula instead. It’s easy, it’s healthy, it’s creative, and you don’t have to buy a new cookbook.

Some of us from our generation may remember sitting in the kitchen watching our mothers and grandmothers, who often cooked without using recipes. After doing our own cooking for a while, we realize that quite a few dishes follow similar methods or formulas, that the quantities and combinations of ingredients vary substantially, and that there really aren’t very many hard and fast rules. So why not let loose and cook by formula? Then you can use whatever ingredients you like.

A few caveats, though. You need to know how long different ingredients take to cook, so that everything gets finished at the same time. If you’re roasting chicken pieces, for example, you need to know approximately when you have about ten minutes of cooking time left, because that’s when you’ll add in the green beans. You also have to decide the quantities of ingredients to include; that will depend on how many servings you want to make. Check frequently while the food is cooking, to make sure nothing gets underdone or overdone.

This is pretty rough and ready cooking, the kind you’d do if you wanted to use up leftovers. Don’t try it for company. If you like precision, this may not be for you. But if you’re game, go ahead and have fun with it. Here are a few formulas to get you started.

MASTER INGREDIENTS LIST

  • Liquid, eg broth, water, canned tomatoes
  • Protein, slow-cooking, eg bone-in chicken pieces
  • Protein, quick-cooking, eg defrosted fish fillets, boneless chicken breasts, tofu
  • Protein, no-cooking, eg canned fish, canned legumes
  • Vegetables, base, eg onions, celery, carrots
  • Vegetables, slow-cooking, eg potatoes, sweet potatoes, squash
  • Vegetables, quick-cooking, eg spinach, zucchini, broccoli, mushrooms, bok choy
  • Grains, slow-cooking, eg brown rice, barley
  • Grains, quick-cooking, eg white rice, quinoa, couscous, bulgur, pasta
  • Seasonings, eg salt, pepper, herbs, condiments

SOUP
Formula

  1. Soften base vegetables in oil
  2. Add seasonings
  3. Add slow-cooking ingredients
  4. Add liquid
  5. Simmer until everything is almost done
  6. Add quick-cooking ingredients and cook until done

Examples

  • Base vegetables + cubed potatoes + canned tomatoes + water + green beans + zucchini + kidney beans + macaroni
  • Base vegetables + quick-cooking rice + boneless chicken chunks + water or chicken broth + salt, pepper, parsley + white wine or sherry
  • Base vegetables + cubed potatoes + canned tomatoes + water + salt, pepper, bay leaf, garlic powder + canned baby clams

STIR FRY
Formula

  1. Prepare grain separately and set aside
  2. Saute quick-cooking protein until brown on all sides
  3. Add quick-cooking vegetables and sauté until they are softened
  4. Toss with seasonings and condiments
  5. Serve over prepared grain

Examples

  • Rice + boneless chicken chunks + chopped broccoli + thinly sliced carrots + garlic powder, ginger, soy sauce
  • Noodles + cooked medium shrimp, defrosted + chopped green peppers + chopped mushrooms + Worcestershire sauce
  • Rotini + onion + spinach + black-eyed peas + garlic powder, smoked paprika

SHEET PAN
Formula

  1. Preheat oven to 400⁰ F for fish, 350⁰ F for chicken or slow-cooking vegetables
  2. Pour some cooking oil into a cup, mix in seasonings and set aside
  3. Place slow-cooking protein and vegetables in a glass lasagna pan or rimmed cookie sheet
  4. Toss with some of the seasoned oil and cook
  5. In last ten minutes, toss quick-cooking ingredienets with more seasoned oil and add to the pan

Examples

  • Oil, garlic powder, pepper, rosemary, paprika + bone-in chicken thighs + potato chunks + sliced carrots + chopped broccoli
  • Oil, red wine vinegar, mustard powder, onion powder, garlic powder, pepper, parsley, thyme + potato chunks + salmon fillets + green beans + grape tomatoes
  • Oil, thyme, oregano, cumin, garlic powder, paprika + sweet potato chunks + chopped bell peppers + chopped rapini + sliced zucchini + chickpeas

November 29, 2022

Worrywart

I’ve been a lifelong worrywart. I’m not proud of it, but there it is. The problem eased up when I first retired, and no longer had to worry about job performance or cranky bosses. But now in my seventies, I’ve grown a whole new crop of worries. My memory’s getting patchy; do I have dementia? My back keeps hurting from spinal stenosis; how much worse is the pain going to get? I move slowly now and my balance is wonky; how much longer can I live independently? In the past, I did all my worrying in my head. But now it hits me right in the gut, robbing me of my appetite and a good night’s sleep. Of course I know that worrying is a waste of time and energy, but I haven’t been able to wrestle it down.

Why is this happening? I’m no psychologist, but I think it’s because, as my mind and body age, the changes make me feel more vulnerable, less in control. I’m not sure I can rely on myself now to solve my problems, trust my own judgment, run my life. In reality I’m still doing fine, and I know that if I become noticeably incompetent my Power of Attorney people will step in. But I’m not looking forward to living through that stretch from now till then.

The internet is full of tips for dealing with worry. Most of them seem to be pretty self-evident; you could probably come up with them yourself. So far I haven’t found them to be especially useful, but I’ll keep trying. It’s not a quick fix; there’s no easy way to cope with uncertainty.

October 30, 2022

Immunocompromised should take action

Back in March, I wrote a blogpost about the precarious situation of immunocompromised people in Ontario and elsewhere. Many of them are seniors with aging immune systems. Now they’re in even more danger, with the protection mandates nearly all stripped away, COVID hospitalizations climbing and new variants looming. The unstated policy is simply that people should go back to business as usual, and the immunocompromised should get out of the way.

The onus is on this high-risk, vulnerable population to protect themselves: wear masks, stay away from crowds, curtail their social activities, and muddle through on their own. Why is it up to the victims to come up with the solutions and make all the sacrifices? Government policies are restricting their freedom of action and endangering their health. Yet Canada has a Charter of Rights and Freedoms, and equality rights are at the core of it. They are intended to ensure that everyone is treated with the same respect, dignity and consideration, regardless of personal characteristics such as race, national or ethnic origin, colour, religion, sex, age, mental or physical disability, sexual orientation, residency, marital status or citizenship. Immunocompromised people are entitled to the same respect, dignity and consideration as everyone else.

Immunocompromised people are a small minority group, and a diverse one. Maybe it’s time to make them harder to ignore. Here are some concrete actions they could take or lobby for:

  • Create an advocacy group, to speak with one voice. Then people with lupus and multiple sclerosis and leukemia and transplants don’t have to fight separately for the same protections.
  • Lobby for mask mandates in all healthcare facilities. Immunocompromised people have to go to these places, and should not be put at risk when they do.
  • Mask mandates should be strictly enforced wherever they are in place. If a patient enters the doctor’s waiting room holding a Kleenex over his face, or wearing a mask under his chin – both of which I’ve seen in my own doctor’s waiting room – he should be handed a proper mask and told to put it on immediately and keep it on. If he refuses, his appointment should be cancelled and he should be sent out of the waiting room.
  • In healthcare facilities, HEPA filters should be running in all the patient areas, including the waiting rooms.
  • Social distancing should be maintained in waiting rooms; bookings should be carefully arranged to accommodate this.
  • Immunocompromised patients should have access to free antibody testing, so they can find out if they’re getting any benefit from vaccines.
  • Authentic, approved N95 and KN95 masks should be readily available at low cost to all immunocompromised patients. They should be classified as an assistive device, since they enable mobility, and they should qualify under existing programs like Ontario’s Assistive Devices Program, or the one operated by the March of Dimes. Alternatively, they should be made available on prescription.
  • Evusheld provides ready-made antibodies to immunocompromised people on a short-term basis. Ontario guidelines are still following the original FDA guidelines for 150 mg of tixagevimab and 150 mg of cilgavimab. But back in February, the FDA found evidence that this dosage was insufficient, and doubled it to 300 mg of each drug. Ontario still has not upgraded the dosage and should do so immediately. Further, the FDA now recommends that Evusheld should be administered every 6 months. Ontario needs to upgrade its guidelines to accommodate the new evidence.
  • Evusheld should be made available to all leukemia patients, not just patients in active treatment. The action of the disease itself makes leukemia patients just as vulnerable as those in active treatment.
  • Cancer centres and other facilities treating immunocompromised patients should be proactively advising their patients what they need to do, when, and where to get the treatments they need. Patients should not have to call around to find a source for Paxlovid, a medication to treat immunocompromised patients with COVID symptoms; it has to be administered in the first few days after symptoms appear.
  • If new variants emerge which evade Paxlovid and Evusheld, and replacement medications are developed, Health Canada should act promptly to approve them. Health Canada does not run tests on these medications; they just review the existing evidence, usually the same evidence that the FDA has reviewed. Vulnerable immunocompromised patients should not have to wait for months for Health Canada to approve what the FDA has already approved.
  • Try a Charter challenge. It’s a matter of social justice.

September 30, 2022

No funeral

A friend of mine lost her brother recently. I knew the family and wanted to read the obituary, but I couldn’t find one. My friend told me that her brother’s children decided to have no funeral and no obituary; they just posted a message to their Facebook friends. Funerals and obituaries, they explained, are going out of style. It took me a little while to get used to the idea of funerals and obituaries being a matter of styles and trends. I still see plenty of obituaries and notices of funerals you can even watch on Zoom. But this all got me wondering: what’s a funeral for? Do you want one?

It’s easy enough to understand why many people would want a funeral. If you have a religious affiliation, it’s an important rite. It supports and formalizes the mourning process. It’s also a way to maintain and strengthen the fabric of your family and community, and an opportunity to celebrate a life and say goodbye. Funerals tend to be highly ritualized and rife with platitudes. Every mean-spirited sourpuss suddenly becomes a beloved family member and a pillar of the community. All the mourners tell the survivors that they are sorry for their loss, and want them to find comfort knowing that the deceased has gone to a better place. So funerals can be a mixed bag, but family members and friends still often feel a strong religious, social or cultural motivation to attend.

But times have changed. Many of us live far from where we grew up and away from family and old friends. Now that people live longer, we often outlive our friends and relatives. These days lots of seniors stay single all their lives, and have no children. We may not have a religious affiliation, and don’t want an expensive ritual that we consider meaningless. Some seniors might be loners who have had a bumpy ride through life, with few good relationships, and just don’t want to give those so-and-sos one last chance to sneer at them.

It’s a kind of balancing act, between our last wishes and our survivors’ current ones. Of course, whatever we decide, we have to make sure our survivors know what we want. But in the end, if they don’t follow our wishes, well, we won’t be there to complain.