On December 4, 2019, the Economic and Community Development Committee considered a proposal to improve senior services and long-term care in the city of Toronto, which is set to be considered by City Council on December 17, 2019.
The proposal is based on a Report from the Interim General Manager, Seniors Services and Long-Term Care which recommends ways to improve life for residents in long-term care facilities. The proposal sheds light on certain shortcomings of the current institutional model of long-term care facilities. Under the current system, after tending to basic care needs such as eating, bathing, and safety, and ensuring that they have met government mandated reporting requirements, staff are left with little free time. As a result, residents spend the majority of their days alone, without any form of genuine human interaction or purpose.
The proposal will revamp and hopefully reinvigorate the city’s 10 long term care homes by shifting the model of care to one that is emotion-centred. The key components of an emotion-centred approach to care would see increased staffing (with up to 281 new staff by 2025), more hours of care per resident per day, increased funding from the provincial government, and improved bedding.
More importantly, an emotion-centred approach emphasizes the emotional needs of residents, understanding that human connection leads to enjoyment of life. The new approach is based wholly and substantively on an understanding of ageing, equity, diversity and intersectionality.
If adopted, the city of Toronto will be the first to integrate diversity, inclusion and equity directly and comprehensively into an emotion-centred approach to care framework.
If you are interested in learning more, read this article from the Toronto Star. I also recommend reading this 2018 Toronto Star series called “The Fix” about a bold initiative to change care in a dementia unit in a Peel nursing home.
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Many of us are familiar with the concept of “elder abuse” or “elder neglect”, however, it is not always clear what that entails. WEL Partners consulted with the Toronto Police Services in developing an information guide for officers, on this very topic. It is now a guide that has been distributed to officers in the field.
Elder abuse/neglect “is any action or inaction, by a person in a position of trust, which causes harm to an older person”, as the guide indicates. As Toronto Police Services officers are often the only point of contact for older adults with the “outside world”, they are also often their only real chance of getting the help they need.
The guide lists various reasons as to why elder abuse/neglect is often under reported by the older adults that are the victims of such treatment:
- dependence on abuser/family member
- rationalization/minimization of the abuse
- denial of the abuse
- lack of recognition of abuse
- physical inability to report abuse
- feelings that they will not be believed
In the absence of victim/witness statements that are often relied on as evidence, the officers investigating these situations should be able to recognize some subtle warning signs of potential abuse of older individuals.
Some common types of abuse are noted as follows:
- Financial abuse
- Physical abuse
- Psychological abuse
The report describes various red flags for each of the categories listed of the common types of abuse. It further describes some additional considerations such as the mental capacity of the senior adult and the following questions to consider in assessing whether capacity is present:
- ability to understand the information needed to make a decision; and
- ability to appreciate the consequences of making, or not making, a decision.
For more information on this valuable resource in assessing whether the circumstances at hand show signs of elder abuse/neglect, see the Elder Abuse & Neglect: A Guide for Police Officers.
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We’ve seen it too many times in our estate litigation practice. An adult child moves in with an elderly parent and looks after them in the years leading up to the parent’s death. The parent wants to acknowledge the help the child has given and the sacrifice they’ve made so, before they die, they amend their will to include an additional gift or percentage share of their estate to the caregiver child.
When the parent dies, the other children in the family are crushed. They all loved their parents equally and were expecting an equal division of the estate. An estate that’s divided 60-20-20 amongst three siblings hardly seems fair to them.
But what if it is? What if the caregiver child gave up their career early to look after the parent? What if they put their own social life and outside interests on hold to perform the daily tasks that needed to be done? Isn’t that child entitled to some recognition for these sacrifices?
The issue is a simple one: fairness and equality can be two different things. When fairness trumps equality, and requires an unequal division of an estate, that’s when the problems begin, because fairness means different things to different people.
The solution? Talk
Eldercare provided by one of several children is a common situation and, in my experience, family members should discuss estate expectations, and the earlier the better. So much can be gained by talking while the parent is still alive and able to express their thoughts and wishes.
The children too have a chance to express their thoughts. For example, what if one child actually wanted to contribute more to eldercare but didn’t want to usurp the role of the child currently giving care? The only way that will come out is through a family discussion.
Yes, it can be awkward starting a conversation about eldercare and estate issues. No one wants to appear needy or greedy. But the last thing the parent wants after they die is family disharmony and bitter relationships. To avoid that, take the bull by the horn, swallow hard, and start talking. Even if bad feelings emerge, it’s better to air the issues now while there is still time to resolve them.
This recent Globe and Mail article reinforces the need for professional advice in drafting a will, but also has a good discussion on the fairness versus equity issues.
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