Long Term Care, who pays?

I recently had an insurance agent phone and talk to me about insurance. Now I am not talking about life insurance, but I am talking about Long Term Care insurance. His point was that if I had to have long term care, who would pay for it and what would that do to my family. Sol, I went and found out some stuff.  First, every jurisdiction is different, and each has its rules about who pays so what I say here about who pays only applies to my area of Canada which is British Columbia. In B.C., some publicly subsidized home and community care services are provided free of charge. For others, the cost is shared between the Ministry of Health and you, the person receiving services. The amount a person is required to pay is called the client rate. The client rate may be based on an individual income or set at a fixed rate, depending on the home and community care service a person receives. If payment of the assessed client rate would cause a person or their family serious financial hardship, they may apply to their health authority for a temporary reduction of their client rate

Long-term care is the provision of personal services and medical care to someone who is cognitively impaired or can’t perform two or more of the six Activities of Daily Living (ADLs).

The ADLs are dressing, bathing, eating, walking, toileting, and transferring (such as moving from a bed to a chair without help). Despite the name, some people need long-term care relatively briefly, such as when they are recovering from surgery or an accident. Others need care for months or years, such as when they have chronic disabilities or illnesses or are declining due to age.

Long-term care services provide 24-hour professional supervision and care in a protective, supportive environment for people who have complex care needs and can no longer be cared for in their own homes or in an assisted living residence. Long-term care services in BC include:

·       standard accommodation.

·       development and maintenance of a care plan.

·       clinical support services (e.g., rehabilitation and social work services) as identified in the care plan.

·       ongoing, planned physical, social and recreational activities (e.g., exercise, music programs, crafts, games);

·       meals, including therapeutic diets prescribed by a physician, and tube feeding.

·       meal replacements and nutrition supplements as specified in the care plan or by a physician.

·       routine laundry service for bed linens, towels, washcloths and all articles of clothing that can be washed without special attention to the laundering process.

·       general hygiene supplies, including but not limited to soap, shampoo, toilet tissue, and special products required for use with facility bathing equipment.

·       routine medical supplies.

·       incontinence management.

·       basic wheelchairs for personal exclusive use.

·       basic cleaning and basic maintenance of wheelchairs; and

·       any other specialized service (e.g., specialized dementia or palliative care) as needed by the client that the long-term care home has been contracted to provide.

If you require long-term  care services, supportive and compassionate care is provided in long-term care homes with the goal of preserving an individual’s comfort, dignity and quality of life as their needs change, and to offer ongoing support for family and friends.

The cost of long-term care services

If a person in BC receive publicly subsidized long-term care services, they will pay a monthly rate of up to 80 percent of their after-tax income towards the cost of secure, supervised housing and care services, subject to a minimum and maximum monthly rate. Your monthly rate is calculated based on your “after-tax income in one of two ways:

1.    If your after-tax income is less than $19,500 per year, your monthly rate is calculated as your after-tax income less $3,900 and divided by 12 (Formula A).

a.     Note: The $3,900 deduction ($325 per month X 12 months) is set to ensure that most clients have at least $325 of income remaining per month after paying their monthly rate.

2.    If your after-tax income is equal to or greater than $19,500 per year, the monthly rate is calculated as your after-tax income multiplied by 80 percent and divided by 12 (Formula B).

The maximum charge for long term care is $3 198.50, adjusted every year on January 1, by the percentage increase, if any, of the consumer price index for the 12-month period ending on July 31 of the previous year.

The minimum charge is the monthly maximum total amount of Old Age Security and Guaranteed Income Supplement to which a person is entitled under the Old Age Security Act (Canada) as of July 1 of the previous year, minus $325, adjusted every year on January 1.

So, in BC, if you have an income of over $19,500 you will pay for your own long-term care with the government taking 80% of your income after taxes. If you earn less than $19,500 you will give the government, your Old Age Security, and your Guaranteed Income Supplement but you will keep $325 a month for spending.

No matter where one lives long-term care is expensive and you should compare all the options and the rules available to you and develop a plan to pay for long-term care.

Dementia prevention, intervention, and care

Be ambitious about the prevention of dementia is one of the ideas coming out of a report “Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. Worldwide around 50 million people live with dementia, and this number is projected to increase to 152 million by 2050. Back in 2017, the Commission found that there was a growing body of evidence that supported the fact that there are nine potentially modifiable risk factors for dementia reported in  Lancet Commission on dementia prevention, intervention, and care. These are

1.    Little or no education

2.    Hypertension

3.    Hearing impairment

4.    Smoking

5.    Obesity

6.    Depression

7.    Physical inactivity

8.    Diabetes,

9.    Isolation or low social contact.

Since 2017, the Commission has found three more risk factors for dementia with newer, convincing evidence that points to 3 more preventable dementia risk factors which are:

1.    Head injuries

2.    Excessive alcohol consumption in midlife

3.    Air pollution exposure in later life

To prevent or delay dementia, the commission recommended that primary and elementary education programs, take steps to modify these 12 risk factors might prevent or delay up to 40% of dementias. Specifically, the Commission recommended that governments take action to fund programs to prevent obesity and diabetes, and to reduce air pollution and to reduce second-hand smoke exposure. They also recommended programs to help people prevent smoking initiation, hearing loss, and head injuries. They also recommended that there be programs to encourage hearing aid use and smoking cessation amongst adults

Governments should actively encourage people to maintain systolic blood pressure of 130 mm Hg or lower in midlife, and to limit alcohol to fewer than 21 servings per week, and to maintain an active lifestyle.

Taking steps to fund and run programs aimed at preventing dementia is more fiscally responsible from a government's perspective as well it is positive from an individual perspective. If a person is diagnosed with dementia, they have more complex problems and symptoms in many domains. Interventions should be individualized and consider the person, as well as their family carers. Evidence is accumulating for the effectiveness, at least in the short term, of psychosocial interventions tailored to the patient’s needs, to manage neuropsychiatric symptoms. Evidence-based interventions for carers can reduce depressive and anxiety symptoms over years and be cost-effective.

Keeping people with dementia physically healthy is important for their cognition. People with dementia have more physical health problems than others of the same age but often receive less community health care and find it particularly difficult to access and organize care. People with dementia have more hospital admissions than other older people, including illnesses that are potentially manageable at home. They have died disproportionately in the COVID-19 epidemic.

Hospitalizations are distressing and are associated with poor outcomes and high costs. Health-care professionals should consider dementia in older people without known dementia who have frequent admissions or who develop delirium. Delirium is common in people with dementia and contributes to cognitive decline. In the hospital, care including appropriate sensory stimulation, ensuring fluid intake, and avoiding infections might reduce delirium incidence. Acting now on dementia prevention, intervention, and care will vastly improve living and dying for individuals with dementia and their families, and thus society.

Grieving in the time of COVID

Grieving in the time of COVID. I have discussed the issue of grief many times, but our current pandemic is causing people problems with grieving. So far (September 3, 2020) COVID-19 has caused more than 894,000 deaths to date and left several million people mourning since the virus was first reported in December 2019.

The following is taken from the McMaster Optimal Ageing Portal and may be of interest to those who are grieving or know of those who are grieving?

Globally, health and social systems are facing an unprecedented challenge: supporting those who are grieving, while continuing to treat those infected and preventing the virus from spreading exponentially. It is also a time of great uncertainty, as the consequences and the course of the disease are not yet clearly defined.

Grief and bereavement during a pandemic remain complex due to public-health measures aimed at reducing the spread of the virus and protecting vulnerable people. Physical distancing requirements mean that funerals are limited and those who have lost loved ones may have to grieve alone. The inability to say goodbye, the loss of social and community networks, living in confinement, and all the other social and economic impacts of the pandemic may exacerbate the grieving process. In recent months, people have voiced their concerns that the COVID-19 pandemic is depriving people of the possibility of grieving. A Canadian coalition has also called for a national strategy to better support grief and bereavement which are currently "distorted" by the pandemic.

What strategies could help to deal with mass grief and bereavement? What programs and services could be put forward during a pandemic?

What research tells us

A recent rapid review of 12 articles examined service delivered in the context of mass grief and bereavement following natural disasters or man-made disasters (for example, oil spills, transportation accidents, or terrorist attacks), but also following pandemics. (6) Although these events differ from the current pandemic, there have similar characteristics: the sudden and massive loss of human life, the lack of access to relatives after death and disruption to customary funeral rituals, job losses, social disruption, as well as intense media coverage of the events and their consequences.

None of the studies reviewed provide strong evidence on the effectiveness of programs and services in supporting mass grief and bereavement. However, relevant measures in the context of COVID-19 have been identified:

·        a highly coordinated, proactive, and a multi-pronged approach to providing support to bereaved populations while avoiding promoting formal intervention with people who demonstrate resilience.

·        information and practical advice provided through multiple channels from the onset of the crisis, then moving to an open and centralized communication channel in the longer term.

·        an integrated local approach aimed both at raising awareness of support services and at communicating with people who are grieving (especially those living in rural and remote regions).

·        specific training for front-line workers on grieving and bereavement experiences, funeral rituals that must be changed and the effects of the intense media coverage during the pandemic.

·        psycho-educational approaches that focus on understanding reactions to loss, normalizing grief, improving family and social relationships and promoting individual coping skills.

·        risk assessments that take into account the impact of COVID-19 on other roles in life such as social isolation and unemployment to identify people likely to experience complicated grief and bereavement or to develop a mental health problem (or exacerbate pre-existing mental health problems); and

·        culturally sensitive approaches (that is, focused on the cultural needs of individuals, or that take into account the cultural and linguistic barriers of minority groups who are over-represented in COVID-19 death rates).

But until national strategies to support mass grief and bereavement are adopted, some programs and services exist to support you. Crisis Services Canada provides a list of crisis and counselling centers across the country (including local bereavement support groups). These centers are there to help you.

Did you get your Flu shot?

I just received an online notice to get my flu shot. I think I will this year. I have never had the desire or the inclination to get a flu shot. I am not an anti-vaccer but I have found that for the most part, the flu shot they give is not for the strain of flu that is making the rounds. They do, I know, get it right sometimes, but I have been lucky and never have had the flu so bad that it stopped me from doing what I needed or wanted to do, so I never saw the need or a flu shot.  This year is different and so I am going to get a flu shot and hope it works and I advise you to get your shot if you have not done so already.

The email I received is below:

Flu season is just around the corner and flu shots are coming soon.

Why get a flu shot?

A flu shot is the best way to protect yourself and your family against the flu and prevent its spread. The Public Health Agency of Canada recommends the flu shot for everyone over the age of 6 months, including those who are healthy, and especially young children, adults aged 65 and over, pregnant women and those with a chronic health condition.¹

A flu shot at or drug store is administered by a Certified Injection Pharmacist and can be administered at all locations for ages 5 years and up in BC, Alberta & Saskatchewan, and 7 years and up in Manitoba. With every flu shot given, a life-saving vaccine is donated to a child in need in partnership with iBoost Immunity and UNICEF.

How to book a flu shot appointment

Flu shot appointments must be booked online due to COVID-19 transmission prevention practices and physical distancing measures. Flu shots are anticipated to be available early to mid-October in BC and Manitoba, and on October 19th in Alberta and Saskatchewan.

Be Notified First

You can sign up to be notified by email and we will inform you as soon as you can book an appointment online at your selected store location. This will ensure that you have the opportunity to schedule a convenient appointment time once flu shot bookings are made available at your location.

Sign up to be notified when you can book a flu shot appointment online.