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Navigating long-term care

How to choose the right option for your loved one

Lora Ritchot with therapy dog Nola.
Lora Ritchot, a resident at Fred Douglas Heritage House, spends some time with Nola, the therapy dog. Nola visits the residents once a week to provide company.
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Long-term care resources

BY HOLLI MONCRIEFF
Winnipeg Health Region
Wave, January / February 2017

IAll the signs were there.

Sherry Heppner’s mother was starting to forget things, and it didn’t seem to be the “normal” absent-mindedness that comes with age.

Food that had supposedly been eaten was discovered rotting in the microwave; tins of soup were found in the linen closet.

Heppner’s mother was diagnosed with Alzheimer’s disease in 2002, and when a bad fall landed Heppner’s father in the hospital, her mother’s mental and health issues rapidly deteriorated.

Heppner found herself in the same situation that thousands of Manitobans face: When your parents need care beyond what you can give them, what do you do? Who do you talk to? Where can you turn for help?

“You fly by the seat of your pants,” says Heppner. “You really don’t know who to contact or where to go. Thankfully, there always seems to be a friend who’s gone through the same process, and I was blessed to have a wonderful family physician who sent me to the right places,” she says. “You can never move fast enough and you’re making decisions on behalf of someone else. Realizing you’re going to have to play God with your parent’s life is not an easy thing.”

Heppner’s mother received home care starting in 2003, then moved into supportive housing in 2006, and finally to a personal care home in 2012. She passed away from Alzheimer’s-related complications in late 2016.

“On the day of her admission to the personal care home, I was a basket case. The most challenging thing is relinquishing the care of your loved one over to someone else. Will they know how she likes her tea? How she likes her toast?”

Heppner will never forget what the nurse at the admission desk told her.

“She said, ‘It’s time for you to go back to being a daughter again and just love her as your mom. You don’t have to be a caregiver anymore – that’s our job,’” Heppner recalls. “She was an angel in a nurse’s uniform.”

Jan Legeros, Executive Director of the Long Term and Continuing Care Association of Manitoba (LTCAM), understands the challenges families face when a loved one needs support. As she explains, family members often find themselves in a crisis situation, and many aren’t prepared to make these critical decisions on behalf of their loved ones.

“They don’t look for the information until they’re in a crisis, and then the biggest challenge they have is not knowing where to go to get the information they need,” says Legeros. “They’re feeling vulnerable and out of control.”

The LTCAM tries to provide families with the information they need. “We encourage people to plan ahead,” says Legeros. “Information is power.”

There are several long-term care options available in Manitoba. Choosing the right one depends on the amount of care and type of care a family member needs. The information on the following pages provides a brief summary of services that are available and how they can be accessed.

Home Care

Home care services in Manitoba are among the most comprehensive in Canada. They are offered to Manitobans of all ages, based on their individual needs at no cost.

In Winnipeg, home care services are provided through the Winnipeg Regional Health Authority, says Vikas Sethi, Regional Director of Home Care for the Region. As he explains, home care helps people live independently and safely in their homes. “We have both professional and support staff to help people live independently and safely in the community for as long as possible,” he says.

Home care is a great option if loved ones struggle with personal care and day-to-day activities or maintaining their home, or if family members are finding it difficult to provide enough care and support.

Services can include:

  • Personal care assistance: bathing, dressing, toileting
  • Home support: meal preparation, light housekeeping and laundry
  • Health professional services: such as nursing care
  • Assistance with taking medications
  • Respite care
  • Other specialty services and clinics

Providing care for a loved one can be exhausting, and the Region’s home care respite services support family caregivers by giving them a much-needed break so they can recharge and take care of themselves. At any given time, the Region’s home care program will serve as many as 15,000 clients in the community. 

Assisted Living

Assisted living offers services such as housekeeping, meals, recreation and more.

Services vary from place to place, so touring the different residences will help you find the right place to meet your loved one’s needs.

“Assisted living is offered in a private building. Anyone is eligible to go there and rent a suite. Assisted living landlords are free to charge whatever they think is appropriate,” explains Legeros.

Costs typically range from a minimum of $1,800 to $5,000 per month, depending on the site and the services provided.

Assisted living services are provided through a direct relationship with the landlord, and eligibility assessment through the Winnipeg Regional Health Authority is not needed. LTCAM has a check list on their website that can help you determine which questions are important to ask assisted living landlords.

“Assisted living is one of the few options we have available for couples. We’re seeing more and more demand for couples’ accommodation,” Legeros says.

Supportive Housing

Supportive housing is community-based housing that offers access to 24-hour on-site supervision and additional assistance in a secure environment. Home care services can be provided in a supportive housing community for those who need extra help.

This option is the right choice for people who require access to 24-hour supervision and need assistance in managing physical limitations or ongoing health conditions, such as dementia, but who don’t require the level of care provided in a personal care home.

Residents receive support and prompting with activities of daily living such as bathing, dressing and medication reminders.

“The seniors living in supportive housing are fairly independent, and we want to promote that independence as much as possible,” says Kathy Taylor, Director for Community Housing, Long Term Care with the Region. “These are people living in their own homes in a communal setting with services available to support them.”

Taylor explains that one difference between assisted living and supportive housing is that assisted living is a direct landlord-tenant relationship, whereas eligibility assessment for supportive housing is done through the Winnipeg Regional Health Authority.

“Supportive housing has staff on-site 24 hours a day, seven days a week, who can provide reminders to eat meals, get dressed, etc. Supportive housing promotes socialization as well as providing assistance,” she says.

“People are encouraged to take part in various activities, which addresses some of the social isolation seniors can face.”

Costs for supportive housing typically range between approximately $1,200 and $2,700 per month.

Of the 10 supportive housing sites in Winnipeg, four offer income-based rental suites, and a total of 35 rental subsidies are available.

“Supportive housing sites vary and there’s an array of choices. Some sites can accommodate couples. People are encouraged to visit the sites before making a decision,” says Taylor.

Virtual tours of some supportive housing sites can also be found on the LTCAM website.

Personal Care Homes

A personal care home is also referred to as a nursing home, where nursing care and services are provided in a secure environment 24 hours a day.  

“Personal care homes are an option once community services and supports have been exhausted. We know we’re all going to get older, so it’s a question of how we plan prior to care being needed or prior to a crisis situation,” says Hana Forbes, Executive Director of the Region’s Long Term Care Program. “Early conversations with loved ones are important, so you know their wishes.”

There are approximately 125 personal care homes with approximately 9,600 beds in Manitoba, so wait times can vary. Within the Region, there are currently 300 people waiting for a personal care home bed in the community, and approximately 100 people waiting in a hospital.

There are costs associated with personal care homes, something that often surprises people, says Legeros. The costs are calculated using a resident’s income, and may range from $34.90 to $81.60 per day

“It can be a burden, especially when one spouse needs a personal care home and the other doesn’t,” she says. For extenuating circumstances, an appeal process is in place to initiate a review of the assessed residential charge. More information regarding residential charges can be found at www.gov.mb.ca/health/pcs/docs/guide.pdf.

Children often find it stressful and feel guilty when considering a personal care home option for a loved one, says Legeros.

“It helps to know that we have committed teams who strive to provide high quality and dignified care,” she says. “Your loved one will be assured to receive care from a team of registered nurses, licensed practical nurses, and health-care aides.”

As someone who has navigated her mother’s way through the system, from the initial home care service through to the personal care home, Heppner says she has learned some important lessons. Her best advice: ask for help, and keep asking until you get the information you need.

“I referred to myself as the daughter from hell. You have to be an advocate for your loved ones because they can’t speak for themselves. Our parents deserve the optimum of care.”

Her experience with her mother, who often paced the hallway at the personal care home because she was bored, led Heppner to change careers. She went from working in financial services at Investors Group to becoming a recreational facilitator.

“I saw an absolute need for recreational activities to keep the mind and body active. There’s still much improvement that can be done,” she says. “It comes down to knowing the resident and what makes them happy, calm, and confident. This has changed my life.”

Holli Moncrieff is a Winnipeg writer.

Wave: January / February, 2017

About Wave

Wave is published six times a year by the Winnipeg Health Region in cooperation with the Winnipeg Free Press. It is available at newsstands, hospitals and clinics throughout Winnipeg, as well as McNally Robinson Books.

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