Within the next decade, Canadians over the age of 65 will make up a quarter of the country's population, becoming the most diverse group of older generations the country has ever seen.
There's a growing awareness among eldercare specialists that a one-size-fits-all approach does not work. An individual's ethnicity, religion, gender identity or sexual orientation are among some of the many elements that should factor into how best to care for older Canadians.
Industry professionals say it's important not only for our institutions, laws and healthcare practices to evolve to meet the needs of diverse backgrounds and lived experiences, but also to ensure one has legal protections and planning in place when those systems are slow to change.
During a recent panel discussion, Diversity and aging: Honouring our identities, health care and estate planning specialists described how service providers need to create safe and comfortable environments for patients and clients to speak up. This includes using inclusive language, recognizing their own limitations and being mindful of making assumptions.
Creating a safe environment for diverse communities
“This is about vulnerability and the importance of why we need to be able to provide culturally safe and culturally competent care so that people can be themselves,” Dr. Samir Sinha, director of Health Policy Research at the National Institute of Ageing, told the panel, hosted by Leanne Kaufman, president and CEO of RBC Royal Trust.
The disproportionate way with which COVID-19 has devastated older Canadians—especially in long-term care settings—has also raised the basic question of how our institutions care for our elderly.
“It strikes me how different societies and different communities value aging more than others,” says Sinha, pointing to Indigenous communities and the way they prioritize and protect their elders.
Sinha's own patients have included Holocaust and residential school survivors. Knowing a patient's background, he says, is incredibly helpful not only from a compassionate viewpoint but also in identifying issues that might reappear as dementia progresses, such as reliving past trauma. These details also influence how you care for older Canadians and respect their own preferences and choices as they age, explains Sinha, who's also the director of Geriatrics at Sinai Health System and the University Health Network in Toronto.
Using a power of attorney to map future care
Having legal documents in order can also help support the care you need in the future. “Maintaining control is an important factor in aging in keeping with your identity,” notes Kaufman. “The way to do that is to document your wishes for your property and your care in powers of attorney.”
Some people may think a power of attorney for personal care is a document that only kicks in when they become incapacitated. But it can also include decisions around where a person will live and what type of home care they'll receive when they become sick. The key question to ask is: who would you want to make decisions on your behalf should you become incapacitated through health?
“It's a very powerful document that gives the person in charge a lot of control,” Darren Lund, a partner with Miller Thomson LLP who specializes in estate planning, estate administration and private client matters, told the panel.
“The implications can be very significant if the wrong person is making decisions.”
Older members of the LGBT+ community, in particular, may have serious concerns as they age, including the question of whether they can continue to live openly and comfortably should they become dependent on others for care. Who'll be responsible should they become incapacitated?
“One of the issues we've seen is that people sometimes feel they have to go back into the closet; they no longer want to disclose their sexuality because they're afraid that the people coming into their home to care for them will actually not treat them well,” Sinha says.
“So for people who've been trying to live independently and freely, they now feel they could be victimized in their own home and might not feel safe. It's that notion of having to go back into the closet, which can be incredibly damaging and concerning.”
When there's inadequate preparation and protection in place, the fallout can be costly, not just from a financial point of view, but also from an emotional and mental wellbeing point of view, the panelists explained.
In the absence of adequate estate planning, for example, the law often defaults the decision-making priority to the next of kin. The assumption is the person in charge will understand your wishes and needs. But unless you've gone through the planning process with them and documented those wishes, they may go unfulfilled.
You could end up with the wrong people making critical life decisions on your behalf. Will your burial wishes be respected? Will you get culturally appropriate care? What if you have a fractious relationship with your family or are estranged from them? And if you're part of the LGBT+ community, what if you're not out to your family?
This can lead to damaged relationships and expensive legal challenges, says Lund.
“I hear stories of clients who were quite devout during their lifetime and then in their burial, their wishes were not fulfilled because the wrong executor was in charge,” he explains.
Legal rights vary across Canada
There are some aspects of LGBT+ law that still need work. Each jurisdiction is different across Canada, but in Ontario, for example, common-law spouses are not automatically included in the distribution of an estate if a person dies without a Will, according to Lund.
“I think this comes as a surprise to a lot of clients,” Lund adds, noting the disproportionate impact that can have when two-thirds of same-sex relationships remain common-law.
“For a lot of older LGBTQ-plus clients, their relations were formed before same-sex marriage was even an option.” He says despite marriage equity, many don't want to get married and this can have a huge impact when it comes to estate planning.
Lund has also seen instances where a common-law spouse is the first in line to make decisions, but the family doesn't recognize the relationship and there's no power of attorney in place.
“You can get enveloped in a dispute about whether that person really is a spouse and whether they do have control. So, even though the laws are on your side … if you have that extra layer of family conflict, that can slow the process down and it can lead to a situation where you're going before an administrative tribunal to sort out who's going to be the decision-maker.”
These delays can be extremely harmful to the person at the centre of the dispute, especially in cases where decisions about care are urgently required.
Sinha recalls an encounter with a couple who came in with freshly signed powers of attorney and tried to claim they were attorneys for one of his patients, who was living with dementia. Sinha had already helped the patient undergo a licensed capacity assessment and activated her previously declared, long-standing powers of attorney for property and for personal care. Sinha was able to protect the patient's legacy and wishes that were clearly articulated to him and documented over the course of several years.
Plan ahead for unforeseen circumstances
“I always say to my patients a great defense is a brilliant offense. And planning ahead just protects you from the things that you sometimes don't believe could happen, but sadly sometimes do.”
“It's important to think about and voice how we will live and be cared for as we age, and how we want to leave things for our loved ones when we are gone,” says Kaufman. “Individualized pre-planning is critical in this, taking into account our backgrounds and the way we choose to identify when it comes to all aspects of our lives.”
The pandemic has highlighted the vulnerability of the unexpected, but this is particularly true for older Canadians. Getting compassionate care and advice can go a long way in reassuring our needs and wishes will be met as we age.
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