CCBI News – Independence in Old Age; Providing Good Palliative Care; Euthanasia—Extension

June 13, 2022

Dear Friends of CCBI,

Maintaining Independence In Old Age

Exercise is very important at all stages of aging. It maintains muscle and bone strength, helps cardiovascular function, and improves appetite. The Regional Geriatric Program of Toronto has an extensive list of resources available to help seniors, informal caregivers, and health professionals assist the elderly maintain their independence (www.rgp.toronto.ca). Under “resources for older adults and caregivers “and “how can I stay active at home “there is a “prescription for physical activity handout.” This states that the senior should treat physical exercise as a daily dose of medicine, and recommends elbow bends, arm raises and shoulder shrugs, practicing getting up from a chair, chair walks and kitchen sink exercises, heel lifts toe taps and side steps. There are also a series of handouts on Stretch Lift or Tap (SloT). The senior SF7mobility toolkit provides much more detail on the topic. The WHO recommends activities making the most of any opportunity for movement. It also recommends 45 minutes exercise twice weekly. Even in hospital, gentle exercises will help with recovery and prevent the complications of bed rest. Post discharge, exercise will speed recovery. On the other hand, immobilization shortens life span, doubles the risk of functional disability and increases the need for assistance in daily living

A nutritious diet is important. If the senior is having difficulty, meals may be provided through meals on wheels or other sources. Online shopping can help if the senior can no longer shop in person. Alcohol intake may need to be decreased as the elderly person may become less tolerant to it effects.

Community engagement is helpful in preventing isolation and loneliness and may take the form of continued engagement in hobbies, or new involvement in community centres or day programs. Some seniors will have specifically health related issues requiring referrals to geriatric day hospitals for care from a multidisciplinary team. Home help should be arranged when necessary. In Ontario, this may be done through the Health Care Teams. Even though the lack of home care services is recognized as a major deficit in the Canadian system, what is available should be accessed both to help the senior and support their informal caregivers. The help of a social worker is invaluable in supporting applications. For those with financial resources, such services can be augmented privately.

Transportation may become an issue, as seniors may no longer wish or be able to drive or use public transport. Many services are available to take the elderly to and from appointments. Wheel Trans, and SPRINT are examples of services in Toronto.

A safe home environment is essential. The help of an occupational therapist will be very useful regarding recommending safety measures, such as suitable grab bars for showers and appropriate toilet seats and rails. Falls are a major problem for the elderly as is fear of falling. General physical fitness can help prevent these, combined with a review of any problematic medications. Stair rails may be important. Bidet additions to toilets have become very popular in the US since the start of the coronavirus pandemic. There are many reasonably priced models on the market. These provide more control and dignity to the physically impaired patient as well as being a help to the informal or formal caregiver. These would be very helpful in long term care facilities. Chair lifts may be a solution to those have difficulty with stairs. Ramps or lifts may be necessary for wheelchair access to houses.

If seniors do not mind the invasion of their privacy, Smart homes can be organized to provide reassurance to the senior and their families. Emergency responses can be arranged in the case of falls by such means as Lifeline and other devices. Smart watches have been developed for the young but many of their functions would be very helpful for the elderly, such as O2 and pulse monitoring, ECG capability, as well as emergency response, and family links. The use of these would require the senior to be technologically adept.

Seniors have many measures available to them to maintain their independence. Unfortunately, many such measures require a financial outlay that will not be available for all seniors. These measures require constant vigilance, and the encouragement and support of informal and formal caregivers, but they will maximize the opportunity of the elderly staying in their own homes. In the meantime, it is hoped that the quality and amount of home care will be dramatically increased, and the major issues related to long term care will be addressed in a proper fashion. Seniors in Canada deserve a level of care that they are most definitely not receiving now.
Dr Rory Fisher

“It Takes a Village to Raise a Child” – It Takes a Community to Provide Good Palliative Care

The tack taken in a recent book on public health aspects of palliative care resonated with me on the level of Catholic teaching and on the important concept of supporting the common good. It struck me that many secular arguments are quite ‘Catholic’ in outlook and purpose, and fit Catholic ideals very well. If true human values are pursued, we can work with many other groups in society, reserving of course, the duty to observe Catholic teaching when proposals veer off that path. The contributors to “The Oxford Textbook of Public Health Palliative Care” make many sensible proposals which Catholics could take into consideration.

The first is that palliative care ‘includes a social, relationship paradigm.’ This is framed in the context of social ecology: “… in our workplaces, our educational institutions, our places of worship, our public spaces as well as our communities and neighbourhoods, these are all places of support, where good relationships can be developed.” Since we all undergo death, dying, loss and caregiving, Dr Julian Abel, one of the contributors, reminds us that the public health dimension of healthcare means that it is everyone’s responsibility to develop and maximize these relationships to make a difference in improving palliative (and other) care. He makes an insightful statement that aligns well with Catholic sensibilities and with Pope Francis’ teaching on joy: “This difference is not just about symptom control, it is about love and laughter, about courage and resilience, about the positive things that make life good and can arise out of the difficult circumstances found at end of life.”

Dr Abel’s second observation is that public health is population based, but ‘one size fits all’ solutions are impractical and fundamentally inadequate for pluralistic societies based on varying cultures, ethnic groups, implications for language, preferred foods, pastimes and even entertainment, all of them necessary for the comfort and wellbeing of the elderly and the dying. For example, during the pandemic, CCBI reported on some families’ attempts to ensure their loved ones were being provided with food appropriate to their culture and with care workers who spoke their language during the long period when family could not visit in person. They wanted to ensure that their parents’ final days were as peaceful and comfortable as possible. Among other matters, the pandemic highlighted the fact that if we want people to ‘die well,’ we have to put in motion the means to do so. Dr Fisher’s articles, such as the one above, aim to educate us about actual possibilities for improving palliative care that are already in place in other countries. There’s much to learn, not only for Catholic facilities.

Dr Abel’s third main observation is: “Every place has possibilities of love and support, integral to any care given.” This is an extremely positive view of working with what’s already in place in communities and provides a model whereby the relationships between community, local political provisions and both specialist and generalist care interact for mutual benefit. “It is not that symptom control is not important, but end of life incorporates life as a whole, both the positive and the negative, meaning and value, all in the context of the culture in which people live.” This is similar to Catholic teaching in palliative care which emphasizes ‘whole life care,’ including the spiritual aspect, too often ignored or glossed over these days. Pope Francis draws our attention to this stage of life as offering opportunities for growing in acceptance of God’s will and in surrender to that will. This can sometimes sound abstract and is often overly spiritualized, but writers such as Fr Ron Rolheiser also stress that this type of surrender is not weak or negative but is a sign of maturity in the spiritual journey. Hospices, palliative care units and home visitors who share these approaches are of immense ‘whole person’ value and consolation to the dying, giving meaning to death and helping people live life to the end, as Pope John Paul II encouraged in his Letter to the Elderly. Accepting death as the opening to the life to come makes a ‘good’ death possible for the dying and relieves somewhat the anxiety and concern of their families. We hear this expressed often in words such as: “My mother / father was ready to go…’ and what a difference that makes to all concerned!

Extension of Euthanasia

A few weeks ago on May 19, we reported in News the sad case of the approval of euthanasia for a woman for whom suitable housing could not be found to alleviate her suffering caused by chemical sensitivities. Yet the following week, in a similar case, another woman withdrew her application for the procedure after housing was found. Much of the media embraces the ‘choice’ of euthanasia, but in this case many journalists expressed their misgivings. As reported in The Globe and Mail, “Lack of housing is a travesty but doesn’t make people eligible for MAiD – or ineligible for that matter. The most disturbing aspect of these cases is the appallingly poor treatment of people with disabilities, and how we condemn them to live in poverty because of a lack of access to housing.” I completely disagree with the points about eligibility but agree with the rest of the statement. We know that our Catholic bishops, CCBI and other groups insisted that no safeguards could ever be strong enough to ensure that the provision of euthanasia procedures would be limited to specific circumstances, and we have been reporting over the past few months in News about newly legislated and currently proposed extensions. Opposition to these changes has been underwhelming in Canada, but, even so, the solution to this recent situation has been condemned even by proponents of euthanasia. Rightly so, since it is unconscionable that society would find it acceptable that someone would be approved for euthanasia instead of efforts being re-doubled to provide housing! Dr. Naheed Dosani ‘tweeted’ succinctly: “There is something severely wrong with a society where it is easier to die through MAiD than it is to find affordable housing.” The Globe columnist, even though a long-time proponent of euthanasia, was honest in his response that the answer is to improve social assistance with extra disability benefits and to provide better social housing. This aligns with Catholic social teaching not only on the dignity of life but also on the duty to provide the necessities of life to sustain human dignity and human flourishing.

Maintaining Independence In Old Age
The Four Palliative Care Blind Spots and How Public Health Palliative Care Helps – Dr Julian Abel – ehospice

Opinion: We must make it easier to both live and die with dignity, but denying MAiD to those living in poverty is not the answer – The Globe and Mail

Free Online Healing Conference with Leading Catholic Health Experts
When we look to the Gospels, we know that Christ came to heal not just a part of the person, but the whole person. He came not simply to cure a physical ailment but to restore relationship and identity. Join CMF CURO on June 15th at 7pm Eastern for A New Era in Health Care: Reuniting Healing and Whole Health. Learn more about how you can respond to Christ’s calling to be fully alive in your totality and why it is necessary for the restoration of our broken world. 
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Pope Francis’ Intentions for June

We pray for Christian families around the world; may they embody and experience unconditional love and advance in holiness in their daily lives.

Moira, Rory and Bambi