Home is Where the Heart is:Ethical Challenges of Home Based End of Life Care

A StrongSupport Systemis Crucial toStroke Recovery

Talking WithChildren About the

"D" word

Prediabetes Offersa Warning andGives us a Chanceto Changethe Future

Why It’sSo Important To Quit

Smoking When YouHave Cancer

Hospice CareRelieves Sufferingand ImprovesQuality of Life

Fall 2018

A RESOURCE FOR SENIORS AND FAMILY CAREGIVERS

The magazine Who Cares provides credibleinformation to residents of Hastings & PrinceEdward counties to help them improve theirhealth and well-being and connects familycaregivers with the information, products andservices they need to manage their caregiving role.Published by Who Cares,solely owned by Gary BuffettContributorsGary Buffett, APRCanadian Virtual HospiceDavid Campbell, PhDDr. Bill EvansMichelle Hutchison, RN BScN CHPCN(C)Joyce Wardle, RNLorraine Pyle and Tanner MurrantLysa Toye MSW, RSW, DipEXATTrenvalEdited by Susan GudmundssonGraphic Design by Fine Line Design, Stirling, ONThe magazine Who Cares is written, designed,printed and distributed in Hastings and PrinceEdward Counties. 30,000 copies are distributed through theBelleville Intelligencer, Trentonian, CommunityPress, and County Weekly News. Copies are alsoavailable at select community agencies. To joinour mailing list, contact the magazine WhoCares by mail, phone, email, or through ourwebsite listed below. To sign up to receive a digital copy, send anemail to info@whocares.care.Box 22045 Belleville Centre,Belleville ON K8N 2Z0613-403-2028www.whocares.care info@whocares.care

Publisher’s Message . . . . . . . . . . . . . . . . . . . . . . . . . . 1Palliative Care in Ontario . . . . . . . . . . . . . . . . . . . . . 2Palliative Care Defined. . . . . . . . . . . . . . . . . . . . . . . . 3Home is Where the Heart Is. . . . . . . . . . . . . . . . . . . 5Talking With Children About the D Word . . . . . . 7Prediabetes Offers a Chance toChange the Future . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9One Out of Every One Caregiveris One Who Cares. . . . . . . . . . . . . . . . . . . . . . . . . . . . 10Hospice Care: Relieves Suffering andImproves Quality of Life for Many. . . . . . . . . . . . 12Bob Wludyka is a Man Who Cares. . . . . . . . . . . . 15Foot Care: a Step Toward Good Health . . . . . . . 16A Strong Support System is Crucial toStroke Recovery. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18Edith Fox uses Animals and Natureto Teach the Cycle of Life . . . . . . . . . . . . . . . . . . . . 20Why It’s So Important to Quit SmokingWhen You Have Cancer . . . . . . . . . . . . . . . . . . . . . . 22Building a Strong Business Plan HelpedThe Fitness Guild Build Strong Bodies . . . . . . . 24

Table of Contents

| 1

Welcome to the Fall 2018edition of the magazine WhoCares. At the magazine Who Cares,we are comfortable with theuncomfortable topics such asdiabetes, stroke or evenend-of-life care. Most of us willneed to discuss theseimportant issues at somepoint in our lives. We go to thepeople in your communitywho have the information youneed so you can make betterinformed decisions. Caregivers may feel isolated attimes, but they are anythingbut alone. The article One outof Every One Caregiver is OneWho Cares highlights that oneout of every three Canadiansis an informal caregiver. Thecontributions of familycaregivers — the care, supportand enrichment that theyprovide — are significant andinvaluable. In fact, according

to the Change Foundation, 70to 75 percent of care isprovided by family caregivers,not by paid providers. InOntario, the amount of timefamily caregivers spendproviding care and supportexceeds the number of hoursof care by paid personalsupport workers by 2.5 to 4times.The magazine Who Cares iscommitted to bringingcaregivers the information,products and services theyneed to fulfill this vitalfunction.Take care,Gary Buffett, Publisherthe magazine Who Cares

Publisher’s MessagePh

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56%of people receive

home care

28%of people receive palliative-specific

home care52%23%

receive home carereceive palliative-specifichome care

60%32%

receive home carereceive palliative-specifichome care

People living in the wealthiest neighbourhoods

People living in the poorest neighbourhoods

6.4%

15.6% 16.7% 19% 19.6%24.1% 24.5% 24.9% 26.1% 26.3% 28.0% 29.1% 29.5%

31.1% 31.9%

Local Health Integration Network (LHIN) Region

South

West

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ara

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South

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North S

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57% in2011/12

54% in2015/16

DEATHS IN HOSPITALS*

hqontario.ca/qualitystandards

W H Y W E N E E D A Q U A L I T Y S TA N D A R D F O R

Less than 60% of the people who die in Ontario have a record of having received palliative care

Palliative Care in Ontario

for people with a life-limiting illness. Earlier palliative care can lead to better quality of life,1, 2

associated with a 50% reduction in the likelihood of dying in hospital.3

Home visits by a health care provider and home care services are two examples of the many important components of excellent palliative care.

1 Zimmermann C, Swami N, Krzyzanowska M, Hannon B, Leighl N, Oza A, et al. Early palliative care for patients with advanced cancer: a cluster-randomised controlled trial. Lancet. 2014;383:1721–30.2 Bacon J. The palliative approach: improving care for Canadians with life-limiting illnesses [Internet]. Ottawa (ON): Canadian Hospice Palliative Care Association; 2012. Available from:

3 Bainbridge D, Seow H, Sussman J, Pond G, Barbera L. Factors associated with not receiving homecare, end-of-life homecare, or early homecare referral among cancer decedents: a population-based cohort study. Health Policy. 2015;119:831–9.4 Health Quality Ontario. Palliative care at the end of life [Internet]. Toronto (ON): Queen’s Printer for Ontario; 2016 [cited 2016 Aug 19]. Available from: http://www.hqontario.ca/Portals /0/documents/system-performance/palliative-care-report-en.pdf5 Residential Hospice Working Group. Environmental scan for strengthening residential hospice care in Ontario, evidence and practice [Internet]. Toronto (ON): Hospice Palliative Care Ontario; 2015 [cited 2016 Aug 19]. Available from: http://www.hpco.ca/wp-content/uploads/Environmental-Scan-for-Strengthening-Residential-Hospice-Care-in-OntarioFINAL-March-16.pdf6 Tanuseputro P, Beach S, Chalifoux M, Wodchis W, Hsu A, Seow H, Manuel D. Associations between physician home visits for the dying and place of death: a population-based retrospective cohort study. PLoS ONE. 2018; 13(2):e0191322.

ISBN 978-1-4868-1722-1 (PDF) © Queen’s Printer for Ontario, 2018

Together, we can improve the quality of care for adults with a life-limiting illness who are considering palliative care.

That’s why Health Quality Ontario – in collaboration with health care providers, and patients’ families and caregivers – has developed this quality standard outlining what quality care looks like.

In Ontario, during their

Just under one quarter of Ontarians receive a home visit from a physician in the month before their death.

In 2015/16, there was up to between regions of Ontario in the percentage of people who had a physician home visit in their last month of life.

Most people in Ontario still die in hospital, although this percentage has decreased.

Most people would prefer to die at home.4,5 Physician home visits and palliative home care visits during the last year of life are associated with a lower risk of dying in hospital.3,6

*Hospital deaths include deaths in acute care beds, complex continuing care beds and emergency departments.

2 |

If you have these questions,you are not alone. Hearing thewords palliative care can beconfusing and frightening.Palliative care is a particularway of thinking about caringfor a person. This way ofthinking considers the whole ofthe person, and any of theimportant people in their lives,when diagnosed with anyserious illness. Practitionerswho work in this specialty haveexpert knowledge in their field,for example physicians, nurses,personal support workers andsocial workers, to name just afew. They also have additionaleducation that enables them toprovide support specifically tothose who have a seriousillness. It is often of benefit tohave this expertise availableearly on in the illness, evenwhen receiving treatments thatmight be considered curative innature. But, this involvementcan happen at any point duringthe illness. There is no agerestriction and care is notrestricted to any one seriousillness.Having the opportunity tospeak with someone who hasknowledge and expertise incaring for someone with a

serious illness can be of greatbenefit to both the person andtheir family, all of whom mighthave questions and might needsome help with navigating thesometimes complicated watersof treatment. In general,practitioners in palliative careare a resource for the patientand their family. People oftenhave questions about theirillness and what it can meanfor them. Because everyone isdifferent, that meaning will notbe the same for everyone. Theperson and their loved onesmay need to talk abouttreatment options that havebeen offered, to think about therisks and benefits of thoseoptions and to think aboutwhether those treatments areactually in keeping with theperson’s idea of “quality of life."

Practitioners in the field ofpalliative care have expertknowledge in managingdistressing symptoms that maybe associated with the illnessor the treatment. Expertmanagement of symptoms canhelp to prevent visits to theemergency room.Aside from the physical issues,having access to the palliativecare team allows the personand their loved ones to thinkand talk about concernsregarding coping or wellbeing.The support of a practitioner inpalliative care can help to openup communication betweenthe patient and their lovedones, allowing them the chanceto talk about topics that areimportant for all. This sort oftalking can open the door tosaying some of the things that

| 3

Palliative Care Defined“My healthcare team has suggested that we get palliative care involved.What does that mean? My friend told me that it is only for people withcancer! I don’t have cancer! I heard that it is for people who are dying! Mydoctors are still giving me treatment to make me better.”

Michelle Hutchison, RN BScN CHPCN(C)

The rate of hospital deaths ranged from ahigh of 78.9% in the North West LHIN

region to a low of 50.4% in North SimcoeMuskoka LHIN region. In our region,

64.3% of palliative care patients die inhospital in the South East LHIN.

As the provincial advisor on the quality of healthcare, Health Quality Ontario says that everyone inOntario who requires it should have access topalliative care, providing comfort and dignity forpatients and families who are living with alife-threatening illness.

About two-thirds of people in Ontario say theywould prefer to die at home, but there is amismatch between their preferences and the reality,because most people die in hospital. According toHealth Quality Ontario's Palliative Care at the End ofLife report, there is wide regional variation acrossOntario in the location of death among palliativecare patients.

Health Quality Ontario and the Ontario PalliativeCare Network have developed a set of qualitystandards that outline what high-quality careshould look like across Ontario. They focus on topicswhere there are large variations in how care isdelivered, or where there are gaps between the careprovided in Ontario and the care people shouldreceive.

To address variations and gaps in palliative care,they created a patient reference guide for peoplewho are living with a progressive, life-limiting

illness and their caregivers. It can help you to knowwhat to ask for when receiving treatment and tomake sure you receive the highest-quality care. It isbased on the best available evidence and wascreated in partnership with family, caregivers, andhealth care providers.

The guide says your care team should give you, yourfamily, and your caregivers information aboutpalliative care. They should also give youinformation about palliative care resources andsupports, such as counselling, hospice volunteers,wellness programs, spiritual care, or supportgroups. This knowledge can help you understandyour treatment and service options, how palliativecare can improve your quality of life, and how toconnect with available supports.

To access a copy of the guide visit the links sectionof www.whocares.care or speak to your palliativecare team.

The Ontario Palliative Care Network (OPCN) is apartnership funded by the MOHLTC and led byCancer Care Ontario, the LHINs, Health QualityOntario, and the Quality Hospice Palliative CareCoalition of Ontario.

Understand YourService and Treatment Options

4 |

are on one’s mind, but seldomget said. It can help people tothink about what is right forthem and what they are hopingfor. Sometimes, the patientwould prefer not to burdentheir loved ones with somedeeper thoughts. The palliativecare practitioner can give thatlistening ear.

If the illness becomes worseand cure is no longer an option,those involved in the care ofthe patient and their family willhave the contacts to bring inother specially trained teammembers who can assist withcoping, provide respite andother supports. The caringcontinues as the patient movesto the end of their life. Caring

for the loved ones continuesthrough loss and bereavement.Having a better understandingof palliative care can help makeconversations about treatmentand service options lessconfusing.

Numerous studies and surveyshave shown that most peoplewould rather die at home thanin a hospital. This makesperfect sense as one’s home isusually not only a place ofphysical comfort, but alsosignificant psychological,emotional and spiritualcomfort. However, for family memberswho provide care for a lovedone who chooses to die athome, there can beunanticipated burdens andchallenges which can poseethical dilemmas that can leadto moral distress. Moraldistress describes thediscomfort when you cannotfulfill your moralcommitments or dutiesbecause of external factorsbeyond your control. It is asituation where you know theright thing to do but cannot doit and therefore your moralintegrity of identifying as agood person is challenged andtherefore causes significantemotional strain. In the case of end-of-life care,perhaps the first and hardestethical challenge forcaregivers is to accept theirloved one’s decision to refuseongoing aggressive medicaltreatments and instead opt forsymptom management. This

decision to choose quality oflife over trying to extend lifecan be hard for familymembers to accept. Caregiversmight be tempted to try topressure their dying loved oneto “not give up” and “keepfighting.” Yet this is ultimatelyan individual choice and thereare limits to what modernmedicine can do. There is apoint where medicalinterventions are no longerbeneficial and merely prolongthe dying process. Ifcaregivers truly love theirdying family member, theyshould accept their choiceregarding end-of-life care.

After accepting a loved one’swishes to forgo aggressivemedical treatments and optfor a palliative approach tocare, probably the main cause

of moral distress forcaregivers providing care for adying family member at homeis the inability to provide thelevel of care that their lovedone needs. Managing a deathat home requires significantplanning and resources, notonly financial resources butalso mental and emotionalresources. If caregivers do nothave adequate resources andsupport from family, friends,and the community, caregiversare in danger of burning-outand endangering their ownmental and physical health. Another ethical challenge forcaregivers providingend-of-life care is to accepttheir own limits and to be ableto ask for and accept help. Toooften caregivers who havebeen in the role of being acaregiver for an ailing familymember become so immersedin their role that they thinkthey can do everything andthat only they can provide the

Home is Where the Heart is: Ethical Challenges of Home Based End of Life Care

| 5

“The virtuesof honesty

and humilitymust balancecompassion

and fidelity topromises.”

6 |

care that their family member wants or needs.Yet this attitude can be harmful, as it can lead toburnout and even physical self-harm. Forexample, a caregiver could injure their back oreven fall when trying to lift their family memberfrom the bed or toilet. A caregiver might be sooverwhelmed with trying to do everything theycan for their dying family member that they areno longer thinking straight and realize that theyneed to ask for help. This dogged determinationto “not give up” on caring for their loved onecan be based more on feelings of pride, loss, ordesperation than the objective needs of thedying family member.While it is ethically important to respect thewishes of a dying family member to die athome, it is essential to have honest discussionsabout what this might look like and to berealistic about their expectations. It is thereforebest to have these discussions early and toeducate yourself on what supports are availablein the community, what supports you mightneed, and to make sure that you are physically,mentally, and especially emotionally prepared

to fulfill this final request. The virtues ofhonesty and humility must balance compassionand fidelity to promises. Being a caregiver doesnot mean you have to be a martyr and there isno shame in knowing your limits and asking forhelp.David Campbell, PhD, is an Ethicist at KingstonHealth Sciences Centre

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Talking With ChildrenAbout the "D" wordTalking with children and youth about death isone of the most difficult tasks a caregiver mayface, especially when the person who is dying orhas died is close to the child or family. Adultscan feel ill-prepared to support children,particularly if they’re overwhelmed by theirown shock and grief. It’s common to feel unsureof what to say and how to support a child oryoung person in a way that matches their age.Often, our first instinct is to protect childrenand youth from the pain of grief by withholdinginformation. However, when someoneimportant to a child is dying or has died, thereis no way to protect them from the reality ofillness, loss and death. Experts who work with

| 7

The Basics• Have the conversation in a safe, comfortable place where you won’t be interrupted.• If the child is young, get down to eye level. • Tell them that you may be upset or cry while you talk because you’re feeling many emotions, and

that this is natural and okay.• Explain that they may have strong feelings too and it’s okay to express them. • Start with what the child or youth already knows (particularly, for example, in the case of death

caused by an addiction, physical or mental illness) and build from there. For example,o “Can you tell me what you understand about your father’s cancer?”

• Give the information in a straightforward way, using words they can understand.• Let them know their questions are welcome. Praise them for asking questions and

sharing their thoughts and feelings. • Be gentle and sensitive, giving the information they ask for and need. • Watch for cues to guide you around pacing the conversation, signs that will help you gauge

how much information to provide and when the child or youth is ready to hear it. They may:o Need a break or ask for more information or clarification. o Start to play, busy themselves or behave differently than usual.

• Does this activity:o Help them to relax while they listen?o Suggest they’ve had enough?o Suggest they’re avoiding hearing unpleasant but important information?o Represent a normal way of “checking out” for their age or maturity?

• When you’re finished, or if your child needs a break, let them know they cancontinue the conversation later, either with you or another adult.

3 |

grieving children recommend talking honestly,helping them understand what has happened,and supporting them through their naturalfeelings of grief.Although incredibly difficult, sharing the newswith a child or youth that someone close is dyingor has died is an important and essentialconversation. Children and youth, like adults,need time to process their thoughts and feelingsand to ask questions. Information will help themprepare for the physical and emotional loss ofthis person in their lives. Our courage andwillingness to discuss difficult topics teaches ourchildren that hard conversations can happensafely, and that they can talk with you aboutchallenging matters. Open and honest conversations Although it’s tempting to withhold or changedetails to soften the impact, keeping importantinformation from children and youth frequentlyincreases their anxiety. Trusting their caregiversis key to their sense of security, so it’s importantto keep them aware of what’s taking place.Children and youth are generally finely attunedto their caregivers and can feel when somethingis wrong. They pick up on dropped comments,overhear conversations and kids talking atschool. They gather information where they can,often guessing at what they don’t know orunderstand as they try to make sense of theirworld. Sharing information about a death and itscauses, and inviting questions, helps childrenand youth to feel secure. They then:• Understand the how and the why of a death. • Know there are adults they trust, who will listen to their concerns, and who will answer their questions.

Children at any age can learn new words thatdescribe what is happening. Almost any illness, medical procedure or cause of death can bedescribed in child-friendly language. Engaging a professional such as a griefcounsellor, therapist or social worker may beuseful. Children and youth, like adults, canbenefit from talking with people outside thefamily, exploring their thoughts, feelings andunderstanding of these issues over time. Whendeath is complicated, health professionals withexpertise in this area can often assist inproviding accurate information and support in away that children and youth can understand.This is an abridged version of the article Talkingwith children and youth about death, authored byLysa Toye MSW, RSW, DipEXAT.

This article was reproduced with permission fromthe Canadian Virtual Hospice(http://virtualhospice.ca).

8 |

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| 9

Prediabetes Offers a Warning and Gives Us a Chance to Change the Future

What is prediabetes?Before people develop type 2 diabetes, theyalmost always have prediabetes. Although noteveryone with prediabetes will develop type 2diabetes, many people will. Prediabetes is whenyour blood sugar (glucose) level is higher thannormal but not high enough to be diagnosed astype 2 diabetes.It is important to know if you have prediabetesbecause research has shown that somelong-term complications associated withdiabetes – such as heart disease – may beginduring prediabetes. However, there are no clearsymptoms of prediabetes, so you may have itand not know it.How can I best manage prediabetes?If you have prediabetes you should be checkedfor type 2 diabetes every one to two years. Astructured program of healthy behaviourinterventions that includes a moderate weightloss of five percent of your initial weight candelay or prevent type 2 diabetes fromdeveloping. Eating tips could include beingaware of portion size, trying not to eat too muchof any one type of food; spacing meals evenlythroughout the day; never skipping meals;limiting your intake of sugary drinks like fruitdrinks and regular soft drinks; limiting yourintake of carbohydrates and starchy vegetables;and increasing your intake of non-starchyvegetables.A registered dietitian can educate you aboutdietary changes that may help reduce your riskfor developing diabetes, as nutritional therapyand counselling are essential components of thetreatment and management of prediabetes. Regular physical activity of a minimum of 30minutes per day is also important.

Risk FactorsLike type 2 diabetes, prediabetes can occurwithout you knowing it, so being aware of yourrisks and getting tested are important. The riskfor type 2 diabetes is higher as you grow older,so Diabetes Canada recommends screening foreveryone once they reach age 40 and everythree years after that. If you have risk factorsthat increase the likelihood of developing type 2diabetes, you should be tested more frequentlyor start regular screening earlier.The good newsResearch has shown that if you take steps tomanage your blood sugar when you haveprediabetes, you can delay or prevent type 2diabetes from developing. The important thing to remember aboutprediabetes is that it does not always lead todiabetes. If you have prediabetes, taking steps tomanage your blood sugar gives you a chance tochange your future to one that does not includetype 2 diabetes.Additional Reference: www.diabetes.caBook an appointment with diabetes educatorJoyce Wardle at Guardian Stirling pharmacy bycalling 613-395-2110.

Wouldn’t it be nice if the human body had an early alert system that advised us whensomething was about to go wrong with our health?

53PERCENT

47PERCENT

23PERCENT

11PERCENT

19PERCENT

29PERCENT

An estimated 3.3 millionOntarians, 29% of theprovincial population,are family caregivers.

The majority ofcaregivers (65%)are married orliving in commonlaw relationships.

Almost three in10 caregivers(29%) have oneor morechildren underthe age of 14.

More than onein four (27%)

are single andhave never

been married.

A slight majority of caregivers, 53% (1.8 million),are women

The remainder of thesecaregivers, 47% (1.5 million),are men.

Family caregivers vary inage, with the largestproportion (23%) between45 and 54 years of age.

11% of family caregiversare over the age of 65.

19% of family caregiversare 55 to 64

17PERCENT

17% of family caregiversare 15 to 24

65%

27%

29%

Proximity to the person being cared for30% of caregivers live in the same household as those they care for,50% live in a community less than an hour away by car, and20% live in a community that is one or more hours away by car.10 |

One Out of Every One Caregiver is One Who Cares

A Profile of Family Caregivers, published by the Change Foundation in 2016offers valuable insight into caregivers and those they care for. If you are acaregiver, you will no doubt see yourself in these numbers.

Caregivers

who spend

over 100

hours per

week

are caring

for people

with

Alzheimer’s

disease or

dementia,

mental

illness,

or cancer.

9 in 10 caregivers (90%) reportedthat they help their loved ones with

emotional support and companionship.Almost eight in 10 caregivers (79%) provide

transportation assistance; 57% provideassistance with indoor domestic tasks, including

meal preparation, housecleaning and laundry; and53% help with outdoor tasks, including home and

property maintenance. Almost three in 10 caregivers(29%) report that they perform medical treatmentssuch as tube feedings, wound care and injectionsand 25% of caregivers assist with personal care

such as bathing, toileting, eating,assistance moving around and

personal hygiene.

| 11

84% of caregivers are providing care to a family member47% of caregivers are looking after parents or inlaws24% are looking after a grandparent, sibling or extended

family member7% are providing care to a spouse6% are providing care to a child13% are caring for a friend, colleague or neighbour.

Caregivers are caring for more female (57%)than male (43%) care recipients.

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Caregivers who spend two to ninehours a week are mostly caring forfamily or friends who are:

Caregivers who spend over 10hours a week, with an average of24 hours a week, are mostly caringfor people with:

51% AGING

57% Alzheimer’sdisease ordementia

54% BACKPROBLEMS

55% RESPIRATORYPROBLEMS

51% developmentaldisorders

48% ACCIDENTALINJURY

Family caregiversspend an average of 11 hours a week

providing care. Many caregivers (48% or 1.5million people) spend anywhere from two to ninehours a week providing care. Twenty-three percent

(771,000 people) spend between 10 and 99 hours perweek providing care. Twenty-one percent (702,000people) spend an hour or less per week providing

care. Two percent or 77,000 caregivers are in avery intense caregiver situation, providing

100 or more hours per week of care.

Hospice palliative care is aimed at relievingsuffering and improving the quality of life forpersons who are living with, or dying from,advanced illness or are bereaved. Palliative caremeets not only physical needs, but alsopsychological, social, cultural, emotional andspiritual needs of each person and family. All hospice services are provided withoutcharge and services are generally eitherresidential, where the patient receives care at aresidential hospice, or visiting hospice, wherevolunteers go to where the patient is to provide

support. This can include hospitals, long-termcare homes or the patient's residence.A hospice residence is where end-of-life care isprovided 24 hours a day, seven days a week, in ahome-like environment for individuals whochoose not to remain at home or in hospital.There are four hospice organizations servingHastings and Prince Edward counties.

Hospice QuinteHospice Quinte's volunteer visiting programprovides respite for caregivers by matching avolunteer to provide up to four hours ofsupport each week. Hospice Quinte volunteersare trained and understand the importance ofdignity, independence, confidentiality, beliefs,choices, faith and culture. Volunteers canprovide social, emotional, and practical supportto the patient and their family, friends, andcaregivers.

Last year, Hospice Quinte provided services to335 patients in homes, hospitals and long-termcare homes. "Anyone can make a referral," saysJennifer May Anderson, Hospice QuinteExecutive Director. "However, more than half ofour referrals come from home and communitycare providers and only eight percent of ourreferrals come directly from family members.

Hospice Care:Relieves Suffering and Improves

12 |

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Anyone can contact us if they,or someone they know, wouldbenefit from our services.Sometimes a patient or acaregiver do not want avolunteer to be involved intheir care, but they may stillbenefit from information andsupport. We are here to helpin any way we can."Hospice Quinte offersbereavement support groups

to anyone who has sufferedthe loss of a loved one. Groupsessions last for eight weeksand run several times eachyear.

Hospice Prince EdwardThe Hospice Prince Edwardcommunity residentialhospice is a comfortablehome-like setting forindividuals who areapproaching the end of theirlives and can no longer remainat home. They providepalliative care designed tomeet the needs of theindividual, as well as familymembers. The hospicefeatures private furnishedrooms with ensuitewashrooms, comfortablecommon areas, kitchenfacilities, access to an outdoorpatio and gardens, a children'sarea, and administrationoffices.The Hospice Prince Edwardvolunteer visiting programhas evolved over more than 28years. Volunteers visit withclients or caregivers in thecommunity, offering social,emotional or practicalsupport. Grief support is offered toindividuals of all ages.Volunteers and staff areavailable to help individualsthrough this difficult time andprovide support in navigatingthe healthcare system. Theyoffer eight-week grief andbereavement groups.Caregiver support includesindividual and group sessionsto help caregivers understand

what to expect, navigating thesystem, finding resources, aswell as caregiver wellnesshelp to take care ofthemselves. Complimentarymodalities such as reiki,reflexology and meditation areoffered on a weekly basis, andprovided free of charge.The Heart of Hastings HospiceHeart of Hastings Hospice hasrun a successful visitinghospice program for 26 years,serving 222 individuals in thecommunity last year alone. Hospice House, theirresidential hospice, canaccommodate two patients ata time, and has plenty of spacefor family members andfriends to spend the night,have privacy, time forreflection and share memorieswith their loved one. Staff andtrained volunteers ensure thateach patient is treated withdignity, respect and thehighest standard of care. "Ourvolunteers provide emotional,spiritual and psychosocialsupport to the individuals andtheir families as well aspractical hands on care andcomfort measures," said HeidiGriffith, Executive Director ofThe Heart of Hastings Hospice."They are a second set ofhands to support them ontheir journey."

Hospice Care:Quality of Life for Many

Caring for someone you love isa big commitment and you maysometimes feel like you have tomanage everything on ourown, but there is help. JoinHeart of Hastings Hospice forlunch and connect with othercaregivers who understand thejoys and challenges ofcaregiving. Heart of Hastings Hospicecontacts all families followingthe death of a loved one intheir care to offer support. Theform of support received isgeared to individual needs.Bereavement support can beprovided one-on-one, or in agrief support group for anyonewho has experienced loss, ifappropriate.

Heart of Hastings Hospicelends medical equipment freeof charge. You can borrowthese items for as long as youneed. Examples of medicalequipment available include:walkers, wheelchairs,commodes, bath seats, canes,hospital beds and crutches.Delivery and pick up servicesare available.Hospice North HastingsHospice North Hastings offers avisiting hospice service wheretrained volunteers provideemotional, spiritual supportand respite time for anindividual/family who has aterminal illness as well as aresidential hospice program. At the Hospice House for NorthHastings there are two rooms

that are available for residentsof North Hastings during theirfinal days. Hospice provides24hr/7 day support coverage.This is a program that is analternative to hospitaladmission and the care isbased on patient need. Familiesand caregivers are encouragedand welcome to participate inthe life and care of the patientat the hospice.Free medical equipment isavailable for residents of NorthHastings to use for short termperiods. It is stored, cleaned,repaired and monitored bystaff at the Hospice House.Please call to check availabilityof items prior to coming to theHospice House.The Heart of Hastings Hospice17 McKenzie St. P.O. Box 624,Madoc, ON K0K 2K0Phone: 613-473-1880 info@heartofhastingshospice.cawww.heartofhastingshospice.ca

Hospice Prince Edward40 Downes Avenue,Picton, ON K0K 2T0Phone: 613-645-4040 info@hospicepe.comwww.hospiceprinceedward.ca

Hospice North HastingsBox 875, 27 Bridge Street EastBancroft, ON K0L 1C0Phone: 613- 332-8014 info@hospicenorthhastings.comwww.hospicenorthhastings.com

Hospice Quinte225 Dundas St., E.Belleville, ON K8N 1E2 Phone: 613-966-6610www.hospice-quinte.ca

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Helping others seemed to bethe natural choice for BobWludyka upon his retirement."I wondered what I could do tomake money for charities," saysWludyka. "I enjoyed woodworking so I started makingthings like clocks and dollhouses to raffle. We raisedaround $80,000 for variouscharities from raffling nine dollhouses."Bob's first raffle in 1989 raisedabout $400 for the SalvationArmy. Since then he estimatesthat he has helped raiseapproximately $250,000 forlocal charities. His latest raffleis in support of Hospice Quinte."Organizations like HospiceQuinte need to be there whenpeople need them. Manyorganizations that providegreat services are required tofundraise just to keep theirdoors open. Most people buyraffle tickets as an expressionof support for the cause ratherthan winning a prize."However, many people wouldbe thrilled to win the prize inWludyka's most recent raffle.He is raffling his ownautographed Bobby Orr jersey

from the 1976 Canada Cup.Some say the 1976 tournamentwas the legendary Orr’s besthockey. He was named MVP ofthe tournament and he retiredshortly after. "I had the jerseyon my office wall for years, butmy new office doesn't have thespace so I thought I should usethe jersey to support charity."The $2 tickets can bepurchased at the DugoutRestaurant located at 514Dundas Street East in Bellevilleor by contacting Bob at613-968-3874. The draw takesplace on October17 so be sure tocall today!

"People want to help andbuying a $2 ticket is an easyway to support a cause. Everydollar counts and every personshould have the opportunity tohelp. Regardless of income, wecan all help out in some way. Ifone person gives $100 or 100people give $1, the result is thesame. Sometimes donatingmoney is the best way to helpbut sometimes what peoplereally need is some food, adrive or companionship oreven blood. I could give theCanadian Blood Services$10,000, but it wouldn’t mean adarn thing if someone needed apint of blood and they haven’tgot it."Bob is truly a man who caresand is a living testament to thepower of one. Show yoursupport for Bob and HospiceQuinte by purchasing a tickettoday and maybe that jerseycan hang on your office wall.

Show you care by purchasing a ticket before October 17 to help support Hospice Quinte.

Bob WludykaIs a Man Who Cares

613-966-440775 North Front St, Belleville, ON K8P 4Y8

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Diabetes and your feetDiabetes can cause nerve damage (also known as diabetes peripheralneuropathy) and poor blood flow or circulation to the legs and feet(also known as peripheral arterial disease). As a result, people withdiabetes are less likely to feel a foot injury, such as a blister or cut.Diabetes can make these injuries more difficult to heal. Unnoticedand untreated, even small foot injuries can quickly becomeinfected, potentially leading to serious complications.Daily foot careAs always, prevention is the best medicine. A good daily foot-careroutine and good blood sugar control will help keep your feet healthy.Start by assembling a foot-care kit containing nail clippers, nail file,lotion, and a non-breakable hand mirror. Having everything you need inone place makes it easier to follow this foot-care routine every day:• Wash your feet in warm (not hot) water, using a mild soap. Don’t soak your feet, as this can dry your skin.• Dry your feet carefully, especially between your toes.• Thoroughly check your feet and between your toes to make sure there are no cuts, cracks, ingrown toenails, blisters, etc. Use a hand mirror to see the bottom of your feet, or ask someone else to check them for you.• Clean cuts or scratches with mild soap and water, and cover with a dry dressing suitable for sensitive skin.• Trim your toenails straight across and file any sharp edges. Don’t cut the nails too short.• Apply a good lotion to your heels and soles. Wipe off excess lotion that is not absorbed. Don’t put lotion between your toes, as the excessive moisture can promote infection.• Wear fresh clean socks and well-fitting shoes every day. Whenever possible, wearwhite socks – if you have a cut or sore, the drainage will be easy to see.When to see your foot care specialistIf you have any corns (thick or hard skin on toes), calluses (thick skin on bottom offeet), in-grown toenails, warts or slivers, have them treated by your doctor or afoot-care specialist (such as a podiatrist, chiropodist or experienced foot-carenurse). Do not try to treat them yourself.If you have any swelling, warmth, redness or pain in your legs or feet, seeyour doctor or foot specialist right away.Have your bare feet checked by your doctor at least once a year. Inaddition, ask your doctor to screen you for neuropathy and loss ofcirculation at least once a year. Take your socks off at everydiabetes-related visit to your doctor and ask him or her toinspect your feet.

Foot Care:a Step Toward Good Health

For more information visit www.diabetes.ca

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DOWear well-fitting shoesThey should be supportive, have low heels (lessthan 5 cm high) and should not rub or pinch.Shop at a reputable store with knowledgeablestaff who can professionally fit your shoes.

Buy shoes in the late afternoon(since your feet swell slightly by then).

Wear socks at night if your feet get cold.

Elevate your feet when you are sitting.

Wiggle your toes and move your anklesaround for a few minutes several times a day toimprove blood flow in your feet and legs.

Exercise regularly to improve circulationInspect your feet daily and in particular, feel forskin temperature differences between your feet.

DO NOTUse over-the-counter medicationsto treat corns and warts. They are dangerous forpeople with diabetes.

Wear anything tight around your legs, such as tight socks or knee-highs.

Ever go barefoot, even indoorsConsider buying a pair of well-fitting shoes thatare just for indoors.

Put hot water bottles or heating padson your feet.

Sit or cross your legs for long periods of time

SmokeSmoking decreases circulation and healing, andsignificantly increases the risks of amputation.

Wear over -the- counter insolesThey can cause blisters if they are not right foryour feet.

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Thanks to increased strokeawareness and understandingof the symptoms, 80 percentof those who have a strokebecome survivors. Althoughthe odds of surviving a strokehave increased, so has thelikelihood of having a stroke inthe first place. With 400,000Canadians living with theeffects of stroke, this numberis expected to double in thenext 20 years. With 60 percent of survivorsbeing left with some disabilityand more than 40 percent leftwith a moderate to severedisability, a strong supportsystem is an imperative part ofany recovery plan.

The right group can not onlyallow you to learn aboutstroke recovery and hear whathas been working or notworking from other survivors,including tips on how toadjust to daily life and routinetasks, but it can also aid inmaking social and emotionalconnections to reduce isolationand the feeling of beingunsupported. Support groupscan also be a great way tounderstand and share personalexperiences and learn aboutcommunity resources. InHastings and Prince EdwardCounty there are a number ofstroke survivor and caregivergroups hosted throughCommunity Care for South

Hastings (CCSH). These groups include:Stroke Survivor Group wherestroke survivors can meet anddevelop positive, supportiverelationships in a safeenvironment; Caregiver/Survivor SupportGroup where caregivers andsurvivors meet at the sametime, in the same location butin separate rooms and eachfacilitated group has anopportunity to share theirindividual thoughts andfeelings. Younger Survivor Groupincludes facilitated discussionson family dynamics following a

A strong support systemis Crucial to Stroke Recovery

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stroke, financial advice fromexperts, and information onways to re-enter the workforce. CCSH also offers a recreationalcommunity group called LifeGoes On where a fun lovinggroup of people choose to live afulfilling life after a stroke byengaging in community outings,group dining, local events,social gatherings, groupactivities, and making newfriends. As well as; Living withStroke® which includes sixconsecutive, weekly educationalsessions, and an AphasiaConversation Group run by aspeech/language pathologistwith assistance from volunteerstrained in supportedconversation.

Aphasia refers to one of thecommunication disabilities thatcan occur after stroke, braininjury, or brain disease andeffects one out of every threestroke survivors. It may bedifficult to talk, to understandspoken words, to read and towrite. It is important tounderstand that Aphasia masksa person’s inherent competenceand that a person with Aphasiaknows what he/she wants tosay and is a competent adultwho can make his or her owndecisions. People affected byAphasia are at risk of socialisolation, depression, and evenAphasia-related abuse. Thesecan be combated by attendingsupport groups so that peoplewith Aphasia are able to meetother adults living with Aphasia

and practice theircommunication skills in a fun,stimulating environment,engage in interesting adulttopics (sports, politics, hobbies,news events) and improve theirconversation skills andconfidence. There are some small changeswe can make in ourcommunication when we areinteracting with those who areaffected by Aphasia: speakslowly and clearly, use shortsentences, give the person timeto respond, ask YES/NOquestions, and you can also usegestures, drawing, key wordsand pictographs. This information is compiled byLorraine Pyle and TannerMurrant, CCSH coordinators.

Is your hearing loss making you tired?Have you ever thought “My hearing is ok, if I just concentrate hard enough”? If your brain is not getting the right sounds to work with, it takes intense effort to create meaning. With BrainHearing™, the brain gets access to the full soundscape, allowing it to focus on the most relevant sound sources.

Call 1.866.608.9990 today to learn more about BrainHearing technology and how you can help your brain make sense of sound.

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20 |

The Edith Fox Life & LossCentre located in Picton usesnature, creative arts and thehuman-animal bond to provideclinical grief counseling. Lossmay be through death, divorce,separation or even the loss offamiliar surroundings in theevent of frequent moves fromcity to city.Everyone who forms anattachment to another suffers afull range of emotions whenthat attachment ends, nomatter how the end comesabout. Even when thatattachment is for a pet, thedevastation of loss is real.Sometimes the death of a pet isa child's first death experience.Bereavement Therapist,Educator and CEO of the EdithFox Life & Loss Centre KathleenFoster-Morgan recognizes thatthe bond between humans andanimals provides anopportunity to nurtureindividuals who are suffering. Two of the centre's coreprograms - Camp Star andLambs for Children - useanimals as part of the healingprocess.Camp Star aims to helpchildren:• gain awareness of the normality of loss, change and grief• accept the full range of anger, sadness and joy as part of life through the use

of drama or the seasons of nature• have fun and learn risk-taking while improving self esteem through drama• develop the human to animal bond through bunny visits• develop an introspective appreciation for lifeLambs for Children is an eightweek program that supportschildren who are grieving. Theprogram utilizes baby lambs orbunnies to encourage touch,discussion and awareness ofthe cycle of life through thehuman-animal bond.Each program is delivered by aRegistered Psychotherapist andLoyalist College Social ServicesWorker volunteers who remainwith the group throughout thesessions, ensuring importantand non-threatening continuityin what are often dis-continuous and shattered lives.

To learn more about the EdithFox Centre for Life and Lossvisit www.edithfoxcentre.org.

Edith Fox uses Animals and Natureto Teach the Cycle of Life

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Council on Aging is SeekingVOLUNTEERS.

Whether you have 4 hours a month or 4 hours aweek to spare. Council on Aging needs your skills.

Work from your home or our office forwardingmessages from our support line, help arrangepresentations, mail letters, conduct surveys orconduct research. We will provide training.

Contact coajohnm@gmail.comor call the council office at

1-855-542-1336and we will get back to you.

DID YOU KNOW?

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A Caregiver’s Guide:a Handbook About End-of-Life Care

was developed by the Military andHospitaller Order of St. Lazarus and the

Canadian Hospice Palliative CareAssociation.

The handbook provides guidance andassistance and addresses the many fearsand uncertainties about terminal illnessand caregiving in clear and simple terms.

Further, it focusses on the physical,emotional, and spiritual needs of

patients and their families.

Download a digital copy at the links pageon www.whocares.care or to request a

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22 |

Why It’s So ImportantTo Quit SmokingWhen You Have CancerIf you’ve been diagnosed withcancer or had a loved onereceive this news, you knowthat it can be quiteoverwhelming. There areoften multiple clinic visits andtests, new healthcareproviders to get to know andlots of information abouttreatment options and theirside effects. And there is thestress of not knowing howwell the treatments will work orwhat your prognosis will be.As a former oncologist, Iwanted the best possible careand outcomes for my patients.I knew that for my patientswho used tobacco, one of thebest things they could do tohelp their cancer treatmentwork better was to quitsmoking or remain smoke free.I realize that it is a verystressful time when youreceive a diagnosis of cancer,and the last thing you maywant to think about is quittingsmoking. But I can’t stressenough how important it is.

General health benefitsWe know that there are manybenefits to your health toquitting smoking even after acancer diagnosis.Quitting smoking helps yourheart and lungs to functionbetter and that will help youto feel better:

• Within 20 minutes of yourlast cigarette, your heart rateand blood pressure will beginto drop• Within 2-12 weeks, yourlung function will increase• Within 1-9 months,coughing and shortness ofbreath will decreaseAnd there are importantlong-term benefits. Within 1year, your risk of heart diseaseis cut in half.But what is really importantfor you as a cancer patient isthat the treatment you willreceive for your cancer willwork better and you willreduce your risk of bad sideeffects.More effective cancertreatmentsIf you’re having surgery,quitting smoking or reducingthe number of cigarettes yousmoke can make surgery saferand help you recover morequickly, with less risk ofpostoperative complicationslike wound infections orpneumonia.If you’re having radiationtherapy, the radiation worksbetter when the level ofoxygen in your body isnormal. When you smoke, thelevel of oxygen in your blooddrops, making it harder forradiation therapy to do its job.

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And if you’re havingchemotherapy, tobacco smokehas chemicals in it that canreduce the levels of somechemotherapy drugs, makingthem less effective.Keep trying and don’t give up –help is availableSmoking is not a bad habit. It’san addiction to the nicotine incigarettes. Withdrawal fromnicotine produces cravings thatmake it very difficult to quit. However, many options areavailable to you once you makethe decision to quit smoking:

• Nicotine ReplacementTherapy (NRT): There are avariety of ways you can useNRT. Combining long-actingtherapy (the nicotine patch)with short-acting products likegum, lozenges, mouth sprayand inhalers can reducewithdrawal symptoms.• Non-nicotine prescriptionmedications: Two prescriptiondrugs are available to helpreduce nicotine cravings andprevent relapse: vareniclineand bupropion. • Counselling: Many peoplefind it helpful to speak to a

smoking cessation counselloror coach in person, by phone oronline.• Self-help guides: You canget brochures and fact sheetsfrom many sources, includingyour cancer care team. The best way to quit smoking isto receive help from a smokingcessation counsellor and totake medication to reducecravings. If you do this, it cantriple your chances of success.

How can you quit smoking or stay smoke free?Start by talking to:• Your cancer care team• Your family doctor or nurse• Your pharmacist• A Quit Coach at www.smokershelpline.ca or 1-877-513-5333.• Visit the Cancer Care Ontario webpage dedicated to smoking cessation at

www.cancercareontario.ca/en/Quitting-Smoking

• Hastings Prince Edward Public Health online http://hpepublichealth.ca/healthy-living/tobacco

Dr. Bill Evans is a medical oncologist with a special interest in lung cancer. He has practised in Toronto,Ottawa and Hamilton and is currently Cancer Care Ontario's Clinical Advisor on Smoking Cessation.

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A desire to help people not justlook better, but feel betterabout themselves led JacquieBlanchette to open The FitnessGuild at the revitalized CenturyPlace in downtown Belleville. The Fitness Guild offerspersonal training programs aswell as a host of unique andchallenging group programs,and welcomes people of allages and levels of fitness.Trenval and the Small BusinessCentre played an importantrole in helping Blanchette getThe Fitness Guild up andrunning. “I got a loan from them and asmall grant and I used everypenny to get new equipment,"said Blanchette. "The processof creating the business planwith the Small Business Centreand going through theapplication process for Trenvalwas extremely helpful in itsown right. “I had to show them that Iwould be bringing in staff andcreating jobs and they reallyhelped me nail down thedetails of my business plan. Ihad to set financial goals foreach month and targets to hit,so now I know what I need tomake in order to feelcomfortable and confident thatI am going to succeed.”Overall the experience ofmoving into the new expandeddowntown location has been aboon for Blanchette and herteam at The Fitness Guild. And

as much as the bulk of the‘heavy lifting’ (if you’ll pardonthe pun) was done by her, sheis effusive in her praise forsupport she received fromTrenval and the Small BusinessCentre. “They want you to succeed, sothat’s why they wanted tomake sure I had a solid plan

and thought of everycontingency – all the littlethings you maybe don’t think ofat first that are going to be acost. They really do want tohelp.”For more information on TheFitness Guild, visitwww.thefitnessguild.com.

Building a Strong Business Plan Helped The Fitness Guild Build Strong Bodies

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