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The senior journey

By Lilianne Fuller

Seniors are living longer. Most seniors will say that it’s important to them to live out their golden years in their own home. If they can, they want to age in place. To accomplish this, aged seniors (85+) must make or consider lifestyle changes.

Bill and Margaret are 87 years old and have been married for over 54 years. The couple enjoys reasonably good health and live independently in a seniors’ manufactured home park. Earlier this year Bill was hospitalized with a nasty bladder infection and it prompted the couple to consider moving into an assisted living facility or onto a campus of care. It was not something the couple had thought about and they feared being separated if they moved into an assisted living situation.

Once Bill was released from hospital, his doctor referred him to the Fraser Health Authority’s Home Health Program.

Bill was assessed, and it was found that in addition to recovering from his bladder infection he needed help with his weight loss and lack of balance.

At the same time, Margaret was assessed. Home Health assisted Margaret with physiotherapy for the arthritic pain in her knee and recommended special insoles for her shoes. For now, this is the extent of Home Health’s involvement, but Bill and Margaret know that more help is available when they need it. “No other specific services have been advised, but they (Home Health) are most open to listen to any concerns we may have,” said Bill.

In 2015 British Columbia’s Ministry of Health chose twelve communities to redesign seniors’ care. It was mandated that this care must be closer to the senior’s home, community based, and patient centered. Langley was one of the communities chosen and the Langley Integrated Network of Care (LINC) was founded. Seniors LINC is a partnership between Fraser Health, the Langley Division of Family Practice, and community agencies that serve seniors.

LINC was developed through a dialogue between seniors, community members and various service agencies. Planning was based on two slogans: ‘Nothing about me, without me’ and ‘Every door is the right door’. This means that not only does LINC want seniors to direct their own lives and care decisions, they want to ensure the senior is able to easily access what they need. “No matter what number they call, they will get referred to the right service, the first time,” said Shannon Ediger, Project Planning Leader for Langley’s Senior LINC.

In just two years LINC has developed into an expanding network of agencies and services working together to support seniors to identify their needs, their plans to age well, and to connect to services in their communities.  This is good news for people like Bill and Margaret.

One of the supports provided by LINC is the Geriatric Response Team. “The Geriatric Support Team (GRT) is a community based team that provides seniors support in many areas such as nutrition, nursing, occupational and physical therapy, social work, spiritual health and pharmacy,” explained Ediger.

The couple love their home and have decided against moving into Assisted Living. “We had thought about it but decided that with the continued financial assistance from Veterans Affairs, and the great physical assistance given by our wonderful park neighbors and friends, we should continue to live in our cherished home,” he said. Veterans Affairs provides financial support for yard work, housekeeping and prepared meal delivery. “DVA extends some measure of help that allows us to keep our home clean and presentable both inside and outside,” said Bill.

When an ambulance or a firetruck arrives at someone’s home, challenges include identifying the patient, compiling their medical information and then ensuring their health care wishes are followed. A number of years ago, a tool was developed provincially to help alleviate these challenges. Greensleeves is a slim green folder with magnetic strips designed to be affixed to the fridge. Information in the Greensleeves Folder includes directions regarding substitute decision makers, advanced care planning, and may also include important information such as medications, illnesses, and emergency contacts to assist professionals in carrying out their tasks.

Bill and Margaret are relatively healthy and with community supportsthey can remain in their home for a while yet.

Margaret still drives and with Bill’s assistance can do the grocery shopping. If this became problematic, they could turn to the United Way’s Better At Home Program for supplemental assistance. Better At Home provides non-medical support such as transportation assistance, grocery shopping and friendly visiting. There is a fee for these services, but the fees are based on a sliding scale depending on the family income.

Seniors’ golden years are increasing and with community support like LINC, Home Health and Better At Home, seniors are not only living longer, they are also living well. Just ask Bill and Margaret.

Resource List

Seniors LINC 604-513-5462

Better At Home 604-530-3020 ext 302

Community Resource Guide 604-539-4328 (booklet) Also available online www.langley.fetchbc.ca

Veterans Affairs Canada 1-866-522-2122

Home Health Services 604-532-6500

Nurse Line 811, Information line Area Services 211

In the next issue and final article in this series we will look at moving into a campus of care.

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