Tag: Health / Medical

09 Mar

Plan Well Guide’s Toolkit for Legal Practitioners: Helping You Help Your Clients Plan for Incapacity

Arielle Di Iulio Capacity, Elder Law, Health / Medical, Power of Attorney Tags: , , , , , 0 Comments

Last year, my colleague Nick Esterbauer blogged about the Plan Well Guide – a free online tool to assist individuals with their advance care planning. An advance care plan sets out how a person wishes to be treated during a serious illness or health crisis. The Plan Well Guide helps users to create a ‘Dear Doctor’ Letter explaining their values and preferences with respect to their future medical care, which can then be given to their physician and substitute decision-makers to ensure that their wishes are known. For a more in-depth look at the Plan Well Guide and the process of creating a Dear Doctor letter, you can read Nick’s blog here.

Recently, the Plan Well Guide launched a new toolkit designed for legal practitioners. This free online toolkit is intended to help lawyers help their clients become better prepared for future serious illness and incapacitation. In addition to various educational resources for both lawyers and their clients, the toolkit includes:

  • a sample power of attorney for personal care;
  • a sample advanced health care directive;
  • a sample personal directive;
  • a sample ‘Dear Doctor’ letter; and
  • a step-by-step guide on how lawyers can incorporate the Plan Well Guide into their practice.

Of course, the sample legal documents contained in the toolkit should be amended to reflect the client’s specific set of circumstances and the laws of the applicable jurisdiction.

What I like most about the Plan Well Guide’s new toolkit is that it highlights the importance of a multidisciplinary approach to advance care planning. An effective advance care plan – that is, a plan which facilitates medical substitute decision-making that is consistent with the incapable person’s actual values and preferences – depends on the collaborative efforts of a person’s lawyers, doctors, and substitute decision-makers. The Plan Well Guide and its new toolkit offer accessible ways for legal professionals, health care professionals, and their clients/patients to coordinate their efforts to make serious illness planning more effective. If a lawyer is interested in improving the quality of future medical decision-making and patient outcomes for their clients, the Plan Well Guide’s toolkit for legal practitioners is certainly worth looking into.

Thanks for reading!

Arielle Di Iulio

21 Dec

Second Interim Report from Ontario’s Long-Term Care COVID-19 Commission

Sanaya Mistry Elder Law, Health / Medical Tags: , , 0 Comments

Jennifer Philpott’s blog post on the Initial Recommendations from Ontario’s Long-Term Care COVID-19 Commission explains that the mandate of the Ontario Long-Term Care COVID-19 Commission (the “Commission”) is “to investigate how and why COVID-19 spread in long-term care (“LTC”) homes, what was done to prevent the spread, and the impact of key elements of the existing system on the spread.”

As noted in our previous blog post, Hull & Hull LLP recognizes and commends the Commission, led by the Honourable Justice Frank N. Marrocco, with John E. Callaghan and Kate McGrann as Commission Co-Lead Counsel, for their hard work and efforts towards protecting some of the most vulnerable citizens in our province.

Since the Commission’s First Interim Letter dated October 23, 2020, over 100 homes are experiencing an outbreak and more than 300 residents have died. On December 4, 2020, the Commission released their Second Interim Letter which focuses on resident care and on in-home leadership, and provides the Ministry of Long-Term Care (the “Ministry”) with various the following recommendations:

  1. Leadership and Accountability in Long-Term Care Homes

The Commission notes that the fundamental principle in the Long-Term Care Home Act states that

“A home is primarily the home of its residents and is to be operated so that it is a place where they may live with dignity and in security, safety, and comfort and have their physical, psychological, social, spiritual and cultural needs adequately met.”

The Commission emphasized that leadership matters. They found that in homes where leaders were visible and provided clarity around staff roles and responsibilities fared better than those where the leadership was less engaged.

Amongst other things, the Commission found that there was confusion around who was responsible for maintaining resident quality of care in LTC homes during the pandemic and that it was unclear as to whose responsibility it was in the LTC home’s leadership team of the Executive Director, Director of Nursing and Personal Care and Medical Director. The Commission also found that these leaders were not always accessible or on-site.

The Commission recommended that there should be a clear lead for quality of care amongst the leadership team of the Executive Director, Director of Nursing and Personal Care and Medical Care in each LTC home, and that this individual must be on-site each day in a full-time position and should be held accountable for resident quality of care. Further, the Commission noted that the Province should provide the financial resources necessary to effectively support the lead for quality of care in carrying of their role and responsibilities.

  1. Performance Indicators

The Commission recommended using performance indicators to assess each home’s readiness to prevent and manage COVID-19 outbreaks. Specifically, the Commission found that while the current six clinical indicators tracked in the LTC home performance reports are a good first step in advancing transparency and flagging issues in LTC homes, this data does not provide other important insight on the quality of care received by residents and their experience in the home.

The Commission noted that indicators in areas of staffing (such as staffing mix, ration of residents to staff and ration of residents to staff with clinical expertise, level of staff engagement, etc.), PPE supplies and resident and family satisfaction with care at the home should be monitored and publically reported.

The Commission recommended that the LTC home performance reports should include performance metrics such as resident and family satisfaction, staff engagement, staging levels, and supply of PPE, as well as recommended that the home performance reports be publically posted in a single and centralized location and be updated more frequently, so that the public and other homes can assess and compare homes to one another as well as search and access a comprehensive picture of each home’s performance.

  1. Inspections

The Commission also recommended focused inspections to assess compliance with measures known to reduce the impact of the virus. Specifically, several issues have surfaced that the Commission believes require urgent attention, including:

1. The discontinuance of Resident Quality Inspections (“RQIs”) in all LTC homes

Although in 2013, the Ministry of Labour, Training, Skills and Developed (“MLTSD”) recognized that comprehensive inspections would help identify systemic issues and committed to completing an RQI in every home by the end of 2014, in response to the Auditor General’s 2015 recommendation “to prioritize comprehensive inspections based on LTC homes’ complaints and critical incidents and other risk factors”, in order to clear a backlog of almost 3,000 complaints and critical incident inspections, the Ministry introduced a risk-based approach to inspection. Although all LTC homes were still to be inspected every year, 329 LTC homes received an RQI in 2018, 27 homes received an RQI in 2019 and from March 1 to October 15, 2020 only 11 LTC homes received a proactive inspection. This reduction in RQIs, which are intended to provide a holistic review of operations in the homes, left the Ministry with an incomplete picture of the state of Infection Prevention and Control (“IPAC”) and emergency preparedness.

The Commission recommended to reintroduce annual Resident Quality Inspections for all LTC homes and require all reactive inspections occurring during the pandemic to include an IPAC Program review. The Commission also recommended that the Ministry request an appropriate funding in the upcoming 2021 provincial budget to hire and train inspectors to implement annual RQIs.

2. Enforcement

The Commission was also concerned with the lack of enforcement and follow-up verification of compliance with Orders issued by the Ministry. From 2018 to 2020, Plan of Care has been identified as the top area of non-compliance identified from complaint inspections. The Commission noted that IPAC issues rarely made it to the list of the top ten areas of non-compliances, showing that it was rarely a focus of any inspections.

The Commission recommended that the Ministry improve enforcement by prioritizing timely responses to non-compliance with IPAC and Plan of Care Orders. 

3. Coordination of Inspections

The commission noted that there was an absence of a cohesive approach to inspections completed by the MLTC, MLTSD and Public Health Units, which likely occurred because inspectors from all three organizations tend to carry out their duties independently. This disjointed approached proved detrimental for IPAC in LTC homes and with the near elimination of RQIs and minimal inspections initiated by IPAC complaints or critical incidents, LTC inspections provided little help in proactively identifying and dressing aps in infection control inside homes.

The Commission recommended that steps be taken to eliminate the siloed approach to MLTC, MLTSD and Public Health inspections through cross-training, the establishment of a centralized system of report sharing and inspector teams to address specific cross-cutting issues.

Thank you for reading.

Sanaya Mistry

 

 

08 Dec

Initial Recommendations from Ontario’s Long-Term Care COVID-19 Commission

76admin Elder Law, Health / Medical Tags: , , 0 Comments

Ontario’s Long-Term Care COVID-19 Commission (the “Commission”) was formed in July 2020. The Commission’s mandate is “to investigate how and why COVID-19 spread in long-term care homes, what was done to prevent the spread, and the impact of key elements of the existing system on the spread.”

The Commission’s work is unique as it is conducting inquiries and providing recommendations to the Government of Ontario on an ongoing basis. Led by The Honourable Justice Frank N. Marrocco and Commission Counsel, John E. Callaghan and Kate McGrann,  the Commission has met with over 200 individuals including experts, associations, unions, long-term care home operators, residents, families, and government officials. The Commission’s final report is due in April 2021.

The Commission’s First Interim Letter was released on October 23, 2020 and provided the following recommendations for the Ministry of Long-Term Care (the “Ministry”) to consider:

(1) Increase Staffing

Prior to the COVID-19 Pandemic, staffing challenges in long-term care facilities were well documented (for instance, in The Honourable Justice Eileen Gillese’s 2019 report of the Public Inquiry into the Safety and Security of Residents in the Long-Term Care System). The Commission recommends that the Ministry ensure that recruitment of long-term care staff focuses on diverse hiring practices to meet it’s residents’ acuity and complex care needs.

Further, the Commission recommends that more full-time care positions are created to increase stability amongst and retention of staff, which would further the continuity of care for residents. The Commission suggests that the Ministry implement the findings of its Long-Term Care Staffing Study, which was released in July 2020. These findings include providing at least four hours of direct care per resident per day and increasing funding to hire more nurses and PSWs to increase the staff to resident ration in long-term care facilities.

The Commission acknowledged that family members and caregivers play an essential role and provide “not just physical care needs but the psycho-social well-being of residents.” In that regard, the Commission recommends that long-term care facilities provide family members and caregivers “ongoing, safe and managed access to long-term care residents.”

(2) Strengthen Healthcare Sector Relationships and Collaboration

From its inquiries, the Commission uncovered that communities where long-term care facilities had pre-existing relationships with hospitals and public health units were better equipped to prevent or control COVID-19 outbreaks. On this basis, the Commission recommends that long-term care facilities likely to encounter difficulties (i.e. high infection rates in the community; past outbreaks; etc.) should implement a “collaboration model” between the facility, local hospital(s), and public health unit(s). The Commission’s letter urges the Ministry and the Ministry of Health to take a proactive approach and facilitate the collaboration model through defined supports and surge capacity for each long-term care home.

(3) Improve Infection Prevention and Control (“IPAC”) Measures

The Commission’s investigation revealed that adherence to IPAC measures is key in order to prevent community spread of COVID-19 into long-term care facilities and between staff and residents. The Commission recommends that long-term care facilities designate an IPAC lead. The IPAC lead would be responsible for monitoring, evaluating, and ensuring compliance with protocols. The IPAC lead would provide training to staff and access the local IPAC centre of expertise as necessary. The Commission strongly recommends that in the short term, inspectors from the Ministry, local public health unit(s), and others who can be trained should be sent into long-term care homes to ensure that proper IPAC protocols are being followed.

Residents of long-term care facilities are at a greater risk of contracting severe illness and death from COVID-19 than other populations. Consequently, the Commission suggests that residents and staff receive priority access to testing and faster results. If residents test positive for COVID-19, the Commission recommends that long-term care homes, hospitals, and public health units formulate plans to allow residents to transfer to an alternative setting in order to isolate from others and recover from the virus.

Hull & Hull LLP commends the efforts of the Commission for its proactive efforts towards protecting the most vulnerable citizens of our province. A follow-up blog will be released in the coming weeks summarizing the Commission’s recommendations from its Second Interim Letter.

Thank you for reading.

Jennifer Philpott

15 Jan

A Gift to Consider: The Importance of Proper Advanced Medical Care Planning

Ian Hull Elder Law, Estate Planning, Health / Medical Tags: , , , , , 0 Comments

Estate planning lawyers have both the privilege and the responsibility of providing guidance and advice to clients while they are at key stages in their lives. A good lawyer’s role involves turning a client’s mind to the future and planning for turbulent times before they arise. As one grows old and the risk of serious illness increases, it is important to consider difficult medical decisions that will need to be made, and the impact those decisions might have on your loved ones. Lawyers can help in this preparation, for example with naming a substitute decision-maker who can help direct doctors when the patient becomes incapable, as well as by drafting advanced care directives that lay out the wishes of the patient regarding treatment of serious illness and the extent that life-prolonging measures should be used. While such “advanced care directives” have no legal standing in Ontario, they are still important in that they can provide crucial guidance to decision-makers and medical practitioners when drafted correctly. On the other hand, they could be confusing to decision-makers and hinder medical professionals when drafted in an inflexible manner.

The Lawyer’s Role

Firstly, the language of these directives should be directed to the patient’s decision-maker, and not to the medical practitioner. They should be drafted as advice and guidance to the decision-maker, and not as rigid rules that a medical professional might feel obligated (but not legally compelled) to follow. This is crucial as any lawyer drafting such a document should appreciate the “shared decision-making” model between patient and doctor. Important medical decisions are not made in a vacuum and the availability of different treatment options as well as the weight of their risks and benefits can vary with changing circumstances. It is difficult for a rigid legal document to accommodate the nuances of such a complex situation, but one that supports and guides a decision-maker in their conversations with medical professionals can be extremely valuable. With skilful drafting, the two-way decision-making process between doctor and substitute decision-maker can be facilitated, instead of hindered.

The drafting of advanced care directives should be centered around the values and preferences of the patient as opposed to specific treatment options. The American Bar Association advises that there should not be a focus on specific clinical intervention for “distant hypothetical situation” but rather on the patient’s “values, goals, and priorities in the event of worsening health”.

Finally, the planning process for important medical decisions regarding serious illness requires input from both doctors and lawyers to ensure treatment directions can be drafted with the nuance required for complex medical situations. The ABA suggests that “lawyers and health professionals should aim for greater coordination of advance care planning efforts”, and such collaboration will help clients and decision-makers be as prepared as possible to make informed decisions.

The Client’s Role

When it comes to what clients can do, while preparing a legal document is an important step, it should be reinforced by candid conversations with decision-makers, family, and friends. This significantly eases the burden on decision-makers, as they can carry out their role in stressful situations with the peace of mind that they are not second-guessing their loved one’s wishes when it comes to treatment.

Another way clients and their decision-makers can prepare for the future is by consulting resources that facilitate the planning process. An example of such a resource is planwellguide.com,  which provides guidance on important issues from choosing a substitute decision-maker, to elaborating on the pros and cons of different care options, to specific factors to consider when making an advanced care plan.

A Gift of Great Value

While the lawyer’s skill in drafting is important to making an effective plan, a lawyer’s role can extend past legal documents and into transmitting a forward-thinking approach to clients. This approach requires careful consideration and reflection on the part of the client regarding their values and priorities when faced with serious illness, as well as having frank conversations with loved ones. While having these types of conversations may not be the most merry activity over the holiday period, giving a loved one that peace of mind is a gift of immeasurable value.

Thank you for reading!

Ian Hull and Sean Hess

16 Oct

“Hacking” Dementia

Umair Capacity, Elder Law, General Interest, Health / Medical Tags: , , , , , , 0 Comments

Here are some sobering facts: according to the Alzheimer Society of Canada, 747,000 Canadians were living with Alzheimer’s disease and other dementias in 2011. If nothing changes in Canada, this figure is expected to rise to 1.4 million people by 2031.

Beyond the economic costs, dementia can put immense pressures on family caregivers. According to the Alzheimer Society, family caregivers spent 444 million unpaid hours in 2011 towards the care of someone living with dementia, a number that could rise to 1.2 billion unpaid hours per year by 2040.

Given the increasing prevalence of dementia, many sectors – including the legal community – are thinking about how to improve the quality of life for people with dementia and create a more dementia-capable society. For example, I recently came across an interesting event called DementiaHack, a hackathon that will be taking place in Toronto from November 7 to 9, 2015.

For those who are unfamiliar with the concept, a “hackathon” is an event that allows tech types – such as computer programmers and software developers – to work collaboratively on new projects over a short timeframe. Now in its second year, DementiaHack brings together leading medical experts on dementia with developers and designers, challenging them to develop new and innovative products to address the needs of individuals living with dementia, as well as family caregivers, institutional caregivers and researchers.

For this year’s event, hackathon teams will work intensively over the weekend to develop innovative solutions to the challenges of dementia. The weekend will culminate in science fair demos on Sunday, November 8. Then, on November 9, the hackathon finalists will show off their wares to an audience of potential investors and customers. The most successful teams will be eligible to receive a number of different prizes, including a grand prize that consists of a business trip to the United Kingdom to pitch their project at a health conference.

It is exciting to see the work that is being done to support the needs of people living with dementia. If you are interested in learning more about DementiaHack, visit their website for more information about this year’s event. And be sure to check out the Youtube video for the demonstration for last year’s grand prize winner, CareUmbrella, a project that used smartphones and Near Field Communication (NFC) tags to help improve the lived experience of people living with dementia.

Thank you for reading and have a great weekend.

Umair Abdul Qadir

29 Jul

Lucid Intervals?

Suzana Popovic-Montag Capacity, Health / Medical Tags: , , 0 Comments

In a forthcoming article to be published in The Journal of the American Academy of Psychiatry and the Law, Ian Hull and Dr. Kenneth Shulman, among others, explore the concept of the lucid interval. A lucid interval is a legal concept invoked by those propounding a will to claim that a testator, suffering from some cognitive decline, experienced a moment of cognitive clarity sufficient to make a valid will. The medical term associated with this phenomenon is a “cognitive fluctuation.” Or in layman terms, we often refer to a person, who suffers from significant cognitive decline (such as dementia), as having “good days” and “bad days.”

However, recent medical findings on the subject of cognitive fluctuations suggest that this legal defence may have some challenges, namely, with regard to duration, significance and superficiality.

First, medical data suggests that any cognitive fluctuations are extremely short in duration, often in the realm of seconds or minutes. Such short-term changes in mental state are unlikely to allow a testator to appreciate all the factors needed in order to make a valid will. Second, medical data suggests that even if a testator could achieve some degree of mental lucidity, the fluctuations are so small and insignificant that no formerly incapable person could become temporarily capable so as to make a valid will. Finally, Hull and Shulman contend that higher level cognitive functions—such as memory and executive functioning (the ability to identify, evaluate and discriminate among various options)—are necessary to achieve testamentary capacity. And even when cognitive fluctuations occur, they occur in the area of alertness and attention—which are more superficial, lower level cognitive functions.

However, it is important to keep in mind that testamentary capacity is a legal concept that focuses not on a testator’s general mental state but on their mental state in the context of making a will. As such, it remains uncertain as to how courts will treat this data.

Regardless of which way courts interpret the new medical data, it is important that clinical realities inform legal decisions as they can and do enlighten courts with regard to this complex issue.

Thank you for reading.

Suzana Popovic-Montag

16 Dec

Dementia: The Hot Topic of Healthcare

Hull & Hull LLP Health / Medical Tags: 0 Comments

It comes as no surprise that with the global demographic shift towards an aging population and the prevalence of baby-boomers now reaching retirement age, the worlds of estate planning and healthcare are becoming ever more intertwined.

While estate planner’s awareness of the effects of dementia on testamentary capacity moves to the forefront of issues to be outlined during initial discussions with clients, the healthcare sector is battling the condition by analysing both preventative and post-diagnostic care options.

The concerns over dementia have become so ubiquitous that the first G8 dementia summit in London was held, which focused on ways in which to prevent this condition which is expected to affect 1.4 million Canadians by 2040. The summit hopes to develop a co-ordinated global action on dementia, with leading nations pledging to develop a cure, or at the very least a treatment, by 2025.

On the home front, in British Columbia, Premier Christy Clark is hoping to redesign health care facilities to better respond to the needs of dementia patients, calling for specialized beds and training for health care workers. Clark’s statements follow in the wake of the tragic death of 76 year-old Joan Warren in North Vancouver who, suffering from dementia, wandered away from her health care facility and succumbed to the elements earlier last week.

While global and local political attention mounts, and efforts to tackle this terrible affliction escalate, all signs point to a growing social issue worthy of attention from both national leaders as well as individual citizens. Beyond prevention and treatment, it should be quite apparent that those of us who are concerned about being afflicted by such an ailment in the future should properly plan for their prospective incapacity by having Powers of Attorney for Property and Personal Care as well as a well-crafted Will drafted. Such planning may help to ensure that families are aware of their loved one’s last wishes well in advance of the onset of such a debilitating condition.

Thank you for reading.

Ian Hull

11 Dec

Asthma Inhalers in the Principal’s Office: Rampant Rulitis

Hull & Hull LLP Estate & Trust, General Interest, Health / Medical, In the News Tags: , , , , , , , , , 0 Comments

At present, there is no legal framework in Ontario governing the storage of asthma inhalers within schools. The absence of such a framework shifts the decision-making into the hands of the individual school administrators and/or school boards. What has evolved as a result of this legal vacuum is a patchwork of asthma management plans.  Many of these plans lump asthma inhalers with other medications (incl. antibiotics, medications used to treat symptoms of ADHD, etc.), thus requiring them to be locked in the principal’s office. This inappropriate one-size-fits-all approach to medication storage in schools is a textbook example of ‘rulitis’: ‘a slavish adherence to rules and regulations that goes beyond common sense’ (with credit to André Marin, Ontario Ombudsman, for coining that apt phrase).

Within schools, the placement and storage of rescue inhalers in a secure, centralized location is problematic for a number of well-documented reasons, including: i) Storage of inhalers away from the person precludes the immediate use of the medication at the onset of symptoms. Centralized storage of asthma inhalers flies in the face of the fact that an inhaler delivers a dose of rescue medication, and thus should be considered a life-saving measure, not unlike an epinephrine auto-injector. It is impossible to overstate the differences in outcomes between immediate use of an inhaler and delayed use after symptoms have progressed; and ii) Students are apprehensive about asking for help accessing a centrally-stored inhaler due to embarrassment around being considered ‘medically vulnerable’ and the fear of being deemed disruptive by staff and/or peers. 

Sandra Gibbons and MPP Jeff Yurek (Elgin-Middlesex-London) have been collaborating on a private members’ bill which, if passed, will force every school board in Ontario to implement a comprehensive asthma policy, each of which must also permit a student to carry his or her own asthma medication on their person. On October 9, 2012, Gibbons’ son Ryan died after suffering a severe asthma attack during recess at his school in Straffordville.  Ryan’s attack evolved quickly, his classmates carried him to the principal’s office where his inhaler was kept, but Ryan was already unconscious. Ryan’s school, with tragic consequences, had a zero tolerance policy against inhalers, and had gone so far as to confiscate spare inhalers that he had brought to school just in case he suffered from an attack.  

        

In contrast to Ontario, the U.S. has three prongs of federal legislation in place allowing students to carry inhalers on their person: the Individuals with Disabilities Education Act, Section 504 of the Rehabilitation Act of 1973, and Title II of the Americans with Disabilities Act.  Approximately 6 million American children have asthma, and 200 of them die each year as a result of an asthma attack. The federal legislation is in place as much to save those 200 lives as it is to reduce outpatient visits to doctors and hospital E.R. visits (~4.6 million and 700,000 visits per yr, respectively). Across Canada, over half a million children are affected by asthma and approximately 20 children die each year as the result of an asthma attack. The Lung Association of Ontario estimates that 1 in 5 children have asthma in this province.

This week’s media coverage of Yurek’s proposed private member’s bill (“Ryan’s Law") has raised corollary questions regarding epinephrine auto-injectors (EpiPens) at schools, since they also deliver a rescue medication. Just last month, the U.S. passed the School Access to Emergency Epinephrine Law which encourages schools to carry ‘stock’ epinephrine (i.e. an undesignated supply).  Encouragement is in the form of financial incentives; schools that carry stock supplies will get preference for receiving federal grant monies. While Sabrina’s Law requires all school boards in Ontario to establish an anaphylactic policy, there is currently no provision in the province to allow schools to stock an undesignated supply of auto-injectors.  

Ryan’s Law passed second reading with all-party support at Queen’s Park on December 5, 2013 and will return for third reading some time in the spring of 2014.

Jenn Hartman, Medico-Legal Consultant 

* photo of Ryan Gibbons, from Tillsonburg News

Legal aside: It should be noted that both Sabrina’s Law and Ryan’s Law (as it has been tabled) include ‘Good Samaritan’ language which provides immunity from lawsuits for ‘any act done in good faith’ in response to an anaphylactic reaction or an asthma attack, respectively.

 

27 Nov

A Lesson from Abroad in Long-Term Caregiving

Hull & Hull LLP Health / Medical Tags: 0 Comments

In Canada, many aging residents struggle to cover the costs of long-term care, forced to remain at home without adequate assistance.  With the rising costs associated with long-term caregiving, families are often burdened to take on the care or financial support of an aging loved one.

Several European countries, however, are making elder care a priority, on the basis that healthy citizens provide for a stronger economy.  In Denmark and Sweden, almost all long-term care costs are paid for through municipal taxation and government grants.  The belief is that the higher taxes are accomplishing long-term benefits for the entire country as its population ages.

In terms of population dynamics, Sweden is now where the Canadian population will be in the next twenty years.  There, patients who suffer from Alzheimer’s and dementia are separated from those who do not have such a condition.  The support provided to Swedish facility residents reflects that which is actually needed, and they are permitted to otherwise remain relatively independent.  Support workers at long-term care homes where patients with Alzheimer’s disease are present receive extra, also publically-funded, training.

The focus of the system in Denmark is on choice and prevention.  After reaching age 67, seniors are entitled to free around-the-clock home care.  Public health nurses visit biannually to ensure that the senior is in good physical and mental health, in regular contact with family and friends, eating enough, and taking any prescribed medication.  Once a senior chooses to move to a long-term care facility, they are able to retain supervised freedom in a facility with a “home-like feel”.

Humanitude is a French caregiving philosophy, in which eye contact, touch, and verbal communication are used to show respect for patients.  Humanitude has recently been gaining attention in Japan with respect to the treatment of patients with dementia.  So far, the results have included calmer and more cooperative patients.

Halifax, Edmonton, and Victoria are the first Canadian cities to implement a new model of long-term caregiving, influenced by Danish and Swedish principles.  Those cities have seen better connection of physicians to care facilities and significant decreases in visits by seniors to the emergency room.  Still, on a national level, some believe that Canada is in need of a complete overhaul of its long-term care system to render it adequate to meet the needs of seniors as our population ages.

Thank you for reading!

Suzana Popovic-Montag

06 Nov

Cancer Insurance Comes to Canada

Hull & Hull LLP Health / Medical Tags: 0 Comments

 According to the Canadian Cancer Society, Canadians have a 40% chance of developing cancer during their lifetime and a greater than 25% chance of ultimately succumbing to the disease.  Cancer insurance has recently been introduced in Canada to provide individuals who are insured with a lump sum payment, to be spent as the patient chooses, if ever diagnosed with cancer. 

The direct and indirect costs of cancer treatment are extreme, especially in the United States, where the many procedures and hospital-administered medications are not covered by any government health insurance plan.  Even in Canada, where we benefit from provincial health insurance plans, the costs of prescription medications required to continue with cancer treatments can be significant and a barrier to access to treatment for individuals without additional coverage.  The treatment may also interfere with employment  and limit future earning potential.

The concept of cancer insurance may sound familiar.  Cancer insurance shares many similarities with critical illness insurance, but is more specific in its scope and its eligibility criteria are relatively relaxed.  Cancer insurance is much newer to Canada than critical illness insurance, which is a well-established planning tool that pays out following a heart attack, stroke, or cancer diagnosis.  No Medical Life Insurance.ca claims to be the first provider to offer this type of insurance to Canadians.  In the United States, cancer insurance is better established and is sometimes recommended to supplement health insurance for individuals who are at high risk of developing cancer. 

Although it may be more accessible than critical illness insurance, anyone who has received cancer treatment or screening within two years of applying for coverage will not be insured.  Further, the amount of coverage offered to individuals with an immediate family member who has received a cancer diagnosis at any point in the past will be limited. 

One drawback to critical illness insurance and cancer insurance alike is that coverage does not normally begin until three months after a policy is purchased.  This means that if the insured receives a cancer diagnosis within three months (or suffers a heart attack or stroke, in the case of critical illness insurance) of deciding to obtain coverage, proceeds will not be distributed. 

When it comes to insurance planning, the emphasis still seems to be on life insurance.  Typically, individuals spend more time planning their estates than planning for potential (mental or physical) incapacity and how various expenses will be paid during their lifetime.  With cancer diagnoses on the rise worldwide, and approximately 187,600 Canadians receiving a cancer diagnosis every year, cancer insurance and critical illness insurance may be worthy of greater consideration.

Thank you for reading.

Suzana Popovic-Montag

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