I often wondered why she gave me the job. I was an immigrant who had arrived at her hospital four years earlier as a staff nurse. When I asked her many years later, her answer was “I needed a ‘troublemaker’ and thought you would fit the bill.” Over the past 30 years. I have learned to appreciate the lessons I learned from Mary. I also appreciated the leadership she provided in recruiting the right people at the right time to form a team that could lead the nursing services at the Jewish General Hospital forward. Just imagine how many of you would hire someone half your age and new to the country to take on one of the most important positions in your organization: I call that LEADERSHIP. Mary will be remembered by many of us for years to come. 

The passing of Helen Mussallem (pictured above) was the second huge loss. While she was 98 years old, I somehow thought Helen would be around forever. Helen is the person you read about in the history books: first nurse with a PhD in Canada, the most decorated nurse in Canada. From the VON perspective, she was the first nurse, and one of the first few women, to chair the Board of Directors after a long history of male chairs. Many of you will know about Helen. I have never worked for her but am privileged to have built a relationship with her over the last 20 years. Within VON, she set up an education fund that will commemorate her contributions and love of the organization in perpetuity. 

Helen was a trailer blazer in leading many significant national initiatives. Among them was the Canadian Nursing Foundation she established to support nursing education. In May 2012, the Foundation celebrated its 40^th Anniversary with an amazing gala (this was during my tenure as the President of CNA). Helen was in attendance and I had the privilege of recognizing her for her role in establishing the Foundation. Helen liked to be recognized and liked people to remember who she was. Many of us will remember Helen for her witty, very clever speeches and comments. 

I can go on and on about both of these great ladies, heroes of mine, but I want to leave you with one final thought. I am so pleased that I personally kept in touch with these women. Remember, leaders of all sorts give so much; when they retire they do not lose interest in the issues they worked on all their lives. They LOVE to hear and see people like us and take pleasure in watching our success. So make sure that you remember your mentors and leaders from time to time, and make an effort to keep in touch. They do care and don’t wait too long.

Types of elder abuse
Elder abuse falls into four categories: financial, neglect, physical or sexual, and psychological and emotional. Apparently, financial abuse is the most common form; this can include fraud, stealing, scams and improper use of powers of attorney. Neglect is the next most common form of abuse and can take the form of untreated medical problems, malnourishment and unsafe living conditions. Victims of emotional abuse might demonstrate low self-esteem, withdrawal, passivity, resignation, and depression. Signs of physical abuse may include unexplained depression, fear or paranoia; vague or illogical explanations for injuries; discomfort in the presence of particular people; and unusual withdrawal from family and friends.

Who are the abusers?
The most common abuser is a family member, often someone who is dependent on the older adult for money, food or shelter. (In 2009, family members were responsible for  35% of reported violent crimes against seniors.) But a service provider or anyone else in a situation of power can also inflict it. Sometimes overburdened caregivers take out their frustration on seniors who are embarrassed to admit what is happening or ask for help. It might be a one-time incident or a regular pattern. Additionally, abusers are more likely to be male, alcohol abusers, and have high levels of external stress.

What are governments doing on this issue?
In 2008, the federal  government launched the Federal Elder Abuse Initiative. It was a three-year initiative to help seniors and others recognize the signs and symptoms of elder abuse and provide information on available supports. Since then, the federal government is addressing elder abuse through the New Horizons for Seniors Program (a grant program that supports a range of senior-led projects) and continuing elder abuse awareness campaigns. In March 2012, proposed amendments to the Criminal Code to  stiffen sentencing for crimes against the elderly were announced.

Most provinces have developed an elder abuse strategy that includes various programs and a  resource line to provide information and support. For example, Ontario has a five-year elder abuse initiative that focuses on coordinating  community services, training front line staff and raising public awareness. The Ontario Senior Safety line (run by the Ontario Network for the Prevention of Elder Abuse) handles 13,000 calls a year. It operates round-the-clock in 150 languages with trained operators and now runs at 100 per cent capacity.

Elder abuse action groups and networks have also been set up in most major cities and regions across the country. In Ontario, a number of the Community Care Access Centres have elder abuse response programs. In Waterloo for example, an  Elder Abuse Response Team works in conjunction with local police to train contracted service providers to be aware of signs of abuse.

Unlike child abuse, reporting suspected elder abuse (outside of a long-term care facility) is not mandatory in Canada. But as members of the health care community, not to mention our own local communities, it is everyone’s responsibility to be aware of the signs of elder abuse and act where necessary.

Resources:
1. Elder abuse Awareness (Seniors Canada)
2. Federal Elder Abuse legislation
3. Report of the National Seniors Council on Elder Abuse (2007)
4. Ontario Network for the Prevention of Elder Abuse

In the article, I stated that Canada has three million family caregivers who provide care worth an estimated $25 billion a year. “Adult caregivers suffer from more health issues than non-care givers, they work less, their positions are more tenuous because of absenteeism, they can’t accept transfers, and often reject promotions because of the increased workload. It is generally the woman in the family who handles the majority of the care even though many work outside the home and have limited time. The problem gets worse every year. People are having children later so they are getting squeezed, meaning the kids are still at home when parents’ health begins to fail. Individuals in their 60s have children, grandchildren and older parents. It’s a very dark scenario, a recipe for disaster and it’s a growing problem. It is also true that navigating through a multitude of services from a variety of agencies can be a nightmare. It’s very confusing and what we really need is one-stop shopping.”

But there are a few things that sandwich generation caregivers can do to ease their stresses. One is ask for help from other members of the family and allocate specific tasks. Don’t keep all the burden to yourself – share it where possible. Often people just need to be asked. Another is to research and access provincially funded home and community services. The regional health authority in each province will do an assessment and – based on need – may fund home and/or community care services. This might involve the assistance of a Personal Support worker a few hours a week or a local Adult Day program. Too often caregivers don’t know what is available to them or are reluctant to use them for a variety of reasons. Again, caregivers also need to take some time for themselves even when it might seem difficult to squeeze out an hour.

I don’t even know where to start but let me begin with the basic statement that I am pleased with the growing awareness – and some action – regarding the need to increase investment in home care.  We are starting to see some discussions and action around the need for community care and support services but the investments are spotty across the country.

I was an executive in the hospital sector for many years, working in three different hospitals in Quebec and Ontario. While hospitals saw financial challenges and major cuts, I can safely say that by comparison the home care sector is a very poor, far removed cousin in several respects.  In Ontario, nurses who work for home care organizations are either paid per visit or, if they are lucky to be salaried, receive an hourly rate that is much less than their colleagues in hospitals. The financial differences don’t stop at the salary level – often the Ontario nurses and others who work in the home care sector have limited benefits and less vacation. Hospitals also have greater resources for education and technology.

There are many PSWs (personal support workers) who work in the home care sector.  Many of the provinces’ Health Authorities (HA) manage the nursing services internally but contract out the home making services, which are largely done by PSWs or other types of support workers.  Because of contracted rates of pay and conditions, a double standard exists between PSWs who work for the HAs and those who work for the contracted employers. These inequalities again disadvantage a large group of PSWs.

These differences are just the tip of the iceberg – more about it in other blogs.  Once I start, I don’t think I will be able to stop. So stay tuned but I would also like to hear your concerns and experiences.  If we are serious about wanting to build strong services so the sick and vulnerable can stay in their communities, we need to face reality and be aware of the many challenges that face home care organizations.  The challenges are linked to linkages and integration, to insufficient funding, to lack of technology and the list goes on.  Will discuss some of these issues in future blogs.

I would like to hear about your experiences with home care in Canada or abroad.

With the aging of the large baby boomer cohort, the media is full of alarmist pieces about the impact this will have on our health, economic and social systems. Some reports state that seniors (sometimes called the grey tsunami) are going to bankrupt our healthcare system and shrink tax revenues. In short, our senior population is seen by some as a drain on Canadian society.

But there is a whole other way to look at this.  Seniors make more charitable donations per capita than any other age group. According to Statistics Canada, they also volunteer more hours per year than any other age cohort – an average of 218 hours (compared to 15 to 24 year olds who volunteered an average of 138 hours annually). Forty one percent of the 55-64 age group volunteers an average of 205 hours a year. For those 65-74, 40% volunteer an average of 235 hours/year. A surprising 31% of Canadians 75 or older provide an average of 198 volunteer hours each year. This is in spite of the fact that, while seniors volunteer the most hours of any age group, only 36% of seniors volunteer, compared to almost 50% cent of other Canadians (Statistics Canada’s 2007 Survey of Giving, Volunteering and Participating).

Many organizations, VON being one of them, would be hard pressed to provide the range of services and programs they do without our older volunteers. In fact, 30% of VON volunteers are between 55-64 years old, and 44% are over 65. VON estimates that for every volunteer over 65 who leaves the organization, three new volunteers will need to be engaged to provide the same number of hours of service.

Senior volunteers are valuable to VON for a number of reasons. They are in touch with their community, understand its values and can help identify needs. They often have years of experience in the work world and can provide leadership in committee roles, as well as specific skills and knowledge. Volunteers do a lot of ‘behind the scenes’ work that allows staff to focus on clients in the programs, especially in the Community Support programs.

The main reason seniors volunteer is to make a contribution to their community (95%). Many want to use their use their skills and experience (83% of those 75+ and 77% of those 65 – 74) (National Seniors Council: Analysis of 2007 CSGVP data.) Retirees, as do Canadians in general, say the main reason they don’t volunteer is that they haven’t been asked.

According to Neena Chappell, former director of the Centre on Aging at the University of Victoria, “retirees who give their time to volunteer activity, especially if it involves helping others, are happier and healthier in their later years”. So we need to look at seniors as a valuable pool of potential volunteers, rather than the usual stereotypes.

Resources:

1. National Seniors Council Report

2. Volunteer Canada

3. Volunteer Canada: 50+ Volunteering

Various VON sites across the country hosted Undercover Boss parties.  The one in Ottawa at a local restaurant was lively, loud and fun, with people moving from laughter to tears.  It felt great to be in the room – both on the Hill and in the Ottawa party – and have the overwhelming sense of how much people are touched by what VON does and by our amazing staff.

Even before the show was over, emails started to pour in and are still coming.  Some people laughed at the comic highlights (aimed at me) about how to make toast and operate a microwave. On the more serious side, the emails talked about leadership, becoming better aware of the community sector, and the importance of volunteers. They also talked about realizing the incredible importance of the work of PSWs, volunteers, recreational therapist, nurses and how amazing people go through life giving so much to others but getting so little recognition.

My goals in agreeing to do the show were to shed light on the sector and on VON, and to gain insight.  I have to say that my goals were achieved in spades and two additional benefits were accomplished. One is that staff is transparent and honest whether I am in disguise or out and about as the CEO. The second outcome, which I am so excited about, is that VON staff loved the show and feels proud. So, all in all, it was worth the effort and time.

That’s kind of how it felt when my daughter and I sat down last Thursday and switched on the TV to watch Undercover Boss Canada. I was feeling anxious and hopeful at the same time.  I knew that the inner workings of my place of work were about to be exposed to thousands of viewers and I was hoping it would all be shown in a good light.  After all, I am realistic.  Every workplace has good things, some exceptionally so, but there are usually some things that, shall we say, could use improvement.

I have to say that I was not disappointed.  I was, in fact, exceptionally pleased to see how truthfully the filming and carefully edited vignettes portrayed ‘my’ VON.  The episode showed the caring people who work here, the level of compassion and dedication necessary to do what VON employees and volunteers do every day, and the logic behind how many decisions are made. It also showed the almost frantic need to proceed from one task to another to get the job done.   And it showed that our CEO Judith totally gets it.

In addition to this “substantiated proof,” I also have to say how surprised I was at certain points.  I was very affected by seeing Judith at home surrounded by her family and friends.  She was relaxed and happy, and totally focused on the part of life so many of us cherish and protect.  It actually felt a bit intrusive – as if I was peeking into a part of the ‘closet’ that I was not meant to see – so I think it was rather brave.

The only word I can think of to describe what I felt when hearing about the extermination camp experience of our Meals on Wheels volunteer Ann Hubert is heart wrenching.  I knew such misery existed, but had no idea it had affected one of our own. And it was pretty touching when the Thunder Bay LPN, Julian, said he had bought one of his isolated clients a Tim’s card for his birthday.

In the end, I was happy to see that our employees and volunteers were heard.  I appreciated hearing how scheduling challenges affected our wonderful front line providers, and that solutions were being put in place to resolve these issues.  I marveled at how two volunteers working in one site were so astute in seeing the bigger picture – how vital their services are for people in need, and how important it is to recruit and retain more valuable volunteers to continue this good work.

Well, I must get back at it.  I am not off on a weekend trip to New York, nor do I see a Caribbean cruise in my future. But I as I sit at my desk ready to tackle yet another assignment, I do so with a renewed sense of pride in my VON.

Post treatment, I saw some signs of concern that were only partially verbalized by my husband. As I was trying to understand it, one of the concerns was obvious – he still felt a lump and was wondering if the radiation took care of the cancer cells. The second concern was more about how he looked.  He had lost some hair and the skin was darker in the area of the radiation than the rest of his forehead. To my family and me it did not look very noticeable, but my husband was very self-conscious about it.

Lesson 1: while as a family member you have your own take on the situation, be aware of the perspective of the family member and their self-image. Often self-image, not the impact of the disease, will lead people to get depressed or withdrawn. At times, it is the reverse: the person might feel very comfortable with their new self-image and make people around them also feel comfortable.

The follow-up visit with the radiation oncologist took place six weeks after the treatment because of our availability.  It was important for both of us to be there to hear the results of the treatment and see what the next steps were. The visit was GREAT and as you can guess, it was because we were told that from all their tests it looks like the cancer is gone. The remaining lump was some scar tissue that will go away. We got our marching orders and for the next five years, my husband will need to be followed by the team regularly. So this has been our journey and I will not be writing about my husband’s cancer on the blog unless some insights emerge in the future.

Many of you have followed our journey and sent us your good wishes. We are very grateful and I hope we have been able, in a small measure, to provide some helpful lessons.

This year, Mental Illness Awareness Week (MIAW) takes place September 30 – October 6. Established twenty years ago, it is an annual national public education campaign designed to raise awareness of the level of mental illness in Canada, reduce negative stigma and promote best practice in prevention, diagnosis and medical treatment.

According to the Mental Health Commission of Canada (MHCC), the stigma of mental illness is a major barrier to preventing people from seeking help. They state, “Many people living with a mental illness say the stigma they face is often worse than the illness itself – inequality, negative attitudes, and loss of social and support network.”

In 2009, the MHCC launched their national Opening Minds campaign, which is aimed at reducing the stigma of mental illness.  The Royal Ottawa Hospital (ROH) also has an excellent anti-stigma and advocacy campaign called You Know Who I Am, designed to encourage open conversations about mental illness. According to the ROH, “our campaign has touched the lives of thousands and has had real impact in helping families and sufferers reach out and get the help they need.”

It seems to me that more people are being open about their mental health problems and looking for the help they need. A little while ago, I attended a fundraising dinner where a very pleasant 25-year old woman beside me was quite open in discussing the fact she is bipolar. A neighbor volunteers without hesitation that he suffers from depression. In a local fast food spot, I overheard two men discussing the various psychotherapeutic medications they had been prescribed and the side effects of each. When you look at this type of openness, it would seem that the ‘embarrassment’ of mental illness has decreased to a large extent in our society and that the anti-stigma campaigns have had some success.

It is wonderful that people with a mental illness feel they can be open about it. But let’s take it one step further. What if you have acknowledged that you need help but it’s not available? An earlier guest blog talked about a young man with serious depression who has waited almost two years to get into a badly needed therapy program. It took months to get a one-time appointment with a psychiatrist (who only adjusted his medications). According to a provincial database, no psychiatrists in the Ottawa region are accepting new patients. He can’t afford to pay for psychological counselling and isn’t part of a Community Health Centre where he might access it at no cost.  In a similar instance, a local man with a bipolar spouse is at his wits end looking for ongoing treatment as his wife deteriorates before his eyes. At a worst case scenario, the ER might admit her but will likely only keep her 72 hours. The neighbour with depression is going to run through the $500 his employer health plan provides for a psychologist and cannot afford to pay for it after that.

While a lot of effort is going into raising awareness of mental illness and reducing stigma, for many people the treatment they need isn’t available or involves a wait of months or even years. In 2010, the Mental Health Table Forum (see reference #1) produced a report called “Which Doors Lead to Where? How to Enhance Access to Mental Health Service”. The report concluded:  “Access to health services is a key health issue among Canadians and government. Much of this focus has been on access to health care services for physical problems. Missing among these priorities is a focus on mental health services, particularly access to a range of biological, psychological and social assessments and interventions and the health care professionals who provide them.”

In short, Forum delegates felt there is a lack of parity between mental and physical disorders when it comes to support, service and treatment. They also concluded:

• There is no systems‐level pathway when it comes to the acute or chronic care of mental disorders, i.e. fragmentation in services and treatments hinders rather than facilitates recovery.
• Consumers are limited in the services they can access and providers are limited in the time and type of service they can provide.
• While a number of effective treatments and services are available, not limited to medication, medications are often offered first when other options might be indicated but are not available.
• Those with mental health problems who have limited means get limited help. But those with more “severe” mental illnesses, being more visible, are more apt to get care.
• There is a need for more appropriately trained health care providers equipped to meet the mental health needs of the populations with whom they work.

So what’s the conclusion? While the efforts to reduce stigma and raise awareness about mental illness should be applauded, our social and health care systems, as well as the Canadian government, need to do a better of job of ensuring that people who need support (including their families) have access to integrated services and treatment when they come forward to ask for help.  Employers can also do their part, as did Bell Canada with its mental illness awareness campaign, Let’s Talk, launched in 2010.

Resources:

1. Mental Health Table Forum 2010

2. Mental Health Commission of Canada

3. Canadian Mental Health Association

4. OUT OF THE SHADOWS AT LAST Transforming Mental Health, Mental Illness and Addiction Services in Canada

4. Royal Ottawa

5. Let’s Talk (Bell Canada)

In early September 2012, I was privileged to be back in Africa for a major gathering of nurses who belong to the ECSA (East, Central and South African) countries.  This regional organization is a government-level organization; they have a section for the Health Ministers as well as a few “colleges”, one of which is Nursing (ECSACON).  The purpose of ECSACON is to advance knowledge, policy and excellence in practice.

I was invited to be a keynote speaker at ECSACON’s 10^th Scientific Meeting in Mauritius. My topic was the achievements of the Millennium Development Goals (MDGs) #4 and 5, which deal with maternal and infant health, and the role of nurses in primary health care. Over 600 nurses from the ECSACON countries attended the meeting and the papers and presentations were terrific.  The innovations being developed by nurses in the region are very powerful.

My strong impression is that this part of Africa has built capacity over the past 25 years that is hard to imagine if you haven’t experienced it first hand.  My first experience in Africa in the 80s was in Botswana, where Dr. Serarra Kupe RN, and I had an IDRC funded research project – the first nursing research project in the country at that time.  Now the University of Botswana has numerous PhD prepared faculty and offers Graduate education.  This story repeats itself across Africa.  There is no question that more work needs to be done but that is the reality everywhere.  For now, I just want to salute the nurses in Africa and celebrate their accomplishment and the contribution they make to the health of the people they serve.