OMG, we’ve been given what Dr. Ken Dychtwald, North America’s foremost visionary on aging-related issues, calls “a longevity bonus”, which translates into a fabulous opportunity to decide what we want to do as we live longer.   Being a senior in Canada today represents the potential for ‘a new exciting chapter in our lives’.

However there’s a wee catch! Because of this bonus most of us will undoubtedly reach our old-old years (~85 plus) and so experience a care-years stage of life. 

But we shouldn’t live in fear of this stage because even though we can’t predict, we can prepare (of course, if we don’t do so while healthy, then someone else will be forced to make decisions for us, when we no longer are able to do so). 

Today’s column then is Step # 1 in that preparation—seeing the big picture.  I liken preparing for our care-years to planning a trip.  First, we need a map.  It’s only then that we can anticipate possible stops, discover the costs attached, look at how to cover expenses, learn the language, think of questions to ask and so on. 

Our map, in this situation, is called our ‘care continuum’. In order to have successful care-years, we need to begin by becoming aware of how our care-journey could unfold, should we have an accident or become ill (wildcards as we age), if a chronic condition worsens and/or as we naturally advance in years.  

As we view this continuum, what should we keep in mind?

• ‘Care’ is not a one-off event. It’s a continuous series of needs over months and years that blend together gradually and seamlessly so that we hardly recognize where one need for assistance becomes the next 
• Care-years usually have some sort of start or ‘turning point’, such as an accident (dad’s fall breaking a hip); an advancement into old-old years (mum’s increasing frailties); a serious event, (mother-in-law’s heart attack and colon cancer); or a medical condition (husband’s metastasized oesophageal cancer)
• Care-journeys require managing. As I’ve said often, I believe a trusted family member should assume the on-going care-manager role, but not the role of daily care-giver (in the weeks after Dad’s fall, acknowledging that both parents needed increased care now, I met with geriatric teams; asked questions of health units and doctors; undertook essential paperwork; applied for government assistance; reviewed respite accommodations; arranged for rehabilitation plus home-care services; organized live-in care by writing newspaper ads, interviewing candidates, short-listing potentials, drawing up contracts, hiring live-in caregivers and overseeing renovations of my parents’ house for a care-giver suite)
• Travel along the continuum is never a straight-line, where we stop and for how long is dictated by the type and degree of our numerous physical-mental needs (my mother-in-law jumped from assisted living to nursing home living)
• Care driven by medical needs only (my husband’s) versus age-related needs will have vastly different maps
• Care is described in terms of: medications, equipment, care-givers and care-locations
• Care is considered ‘a family issue’ as its touches everyone, emotionally, financially and organizationally.  Care is frequently categorized as a woman’s issue too.
• Family assistance starts undetected (accompanying to appointments, house-cleaning), but grows dramatically and unexpectedly (part-time caregiving)
• Government subsidized care programs are developed as a support system, but are not a given.  Beginning with geriatric assessments, they must be applied for individually
• Each stop on the continuum will contain a combination of family caregiving/care-management, private pay hired care and government subsidization (my mum’s mixture remaining at home consisted of:  government weekly home care, private-pay 24/7 live-in care, shift caregivers, a special government subsidized funding program, family respite caregiving one-week-a-month I flew in, and unwavering care-management)
• Stand-alone federal government assistance programs are available for set purposes  (e.g. home adaptation programs)
• Two or more journeys can occur simultaneously (both my parents; my husband’s and mother-in-law’s)
• ‘Involuntary separation’ happens (a couple in a married relationship is separated due to care needs, one person moves out of the primary residence and one person stays or both live in separate care residences); government pensions are affected
•  Emergencies crop up along the continuum (I flew to Kelowna to evacuate mum from her house during the 2003 forest fire disaster; closure of a care-home)
• If a reliable child is to be designated as a care-manager, then discussions are a priority
• Couples are often not on the same page with their assumptions so husband-wife communication is crucial
• Strong, vigilant advocacy by loved ones is an absolute must as we travel the continuum

Our goal should be to enjoy our bonus and think positively by becoming informed about our care-years, since fear can only hold us prisoner.

Good wishes, Patty

Next, Part #2 in the series: How to delay the start of care-years.
Patty Randall is widely considered a leading authority on care-years planning in Canada.  She is a professional speaker, media commentator, and author of “Let’s Talk—The Care-Years...Taking Care Of Our Parents/Planning For Ourselves” a first-of-its kind guidebook, written by a Canadian, for Canadians. For more information, visit her website www.longtermcarecanada.com or contact her at pattyr@telus.net