Healthier You Fraser Health Winter 2016

Healthier You Winter

Are you at risk for dementia?

DIET & HEART DISEASE What I Do Matters: Emergency Nurse How to Plan for Future Health Care Costs

Healthier You

2016

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Numbers

every senior needs

UNPLUGGED Amelia & her friends share their favourite off-screen activities

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Volume 1, Issue 4

coverstory

unPlugged

Winter

2016

Kids share their favourite off-screen activities.

By Amelia & friends, as told to Tasleem Juma

18

p.

My Health Coach The Perks of Coffee

p.33

It tastes so good and a well-prepared cup may even be good for your health.

By Cathryn Smith

inside Lighten Up ������������������������������������������������� Page 7 10 ways to beat the winter blahs.

By Jacqueline Blackwell She’s at Risk for Dementia ������������� Page 9 What about you? 11 risk factors and a doctor’s prescription for each.

By Dr. Leena Jain & Bonnie Irving Job Satisfaction ������������������������������� page 15 Helping people who are seriously ill or injured is what I get to do every day.

By Anna Abaya Extreme Measures �������������������������� page 20 Neil M. was desperate for an alternative after his doctor told him he needed quadruple bypass surgery. Rather than face the scalpel, he chose to try to eat his way to health.

By Jake Adrian

Who Cares? ��������������������������������������� page 29 How we support the families who care for and support loved ones with a mental illness.

By Diane Wild 7 Numbers Every Senior Needs ��������������������������������������������������� page 27 A handy reference for every senior in the Fraser Health region, which stretches from Burnaby to Hope.

Compiled by Bonnie Irving Count the Costs ����������������������������� Page 35 The cross-your-fingers-and-hope-for-the-best style of retirement planning might not work when you’re 80 and faced with in-home medical costs. The solution: Good financial planning.

By Bonnie Irving

winter 2016

Healthier You

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CEOmessage

Better care for our seniors Fraser Health has the largest number of seniors of any health authority in the province. With over 250,000 seniors, we have a lot of collective wisdom to draw from as we face two big challenges related to the aging population: how to provide services to seniors already in our system or poised to enter; and how to encourage healthier lifestyles

By Michael Marchbank that prevent chronic diseases President and CEO from starting, or delay them from Fraser Health worsening.

One thing we know for sure: seniors want to remain independent in their homes and access services in their communities whenever possible.

In response, Fraser Health is adopting a more community-minded focus so there are options for care in communities and at home, and not just when people are so ill they require a hospital.

To do it right, we need to collaborate with other community organizations, both medical and non-medical. We need to include seniors, too.

To get us started, we’re partnering with seniors, doctors and other organizations to deliver care and services in new ways. This work, initiated by the B.C. Ministry of Health, is letting us re-imagine how care should be delivered to seniors, and the new models our clinical staffs have developed are remarkably innovative.

Over the next year, we’ll be sharing more details about those and other important changes we are making to improve how we care for seniors.

There’s no map for much of this work and it will necessarily feature a lot of trial and error, but with seniors at the table I know we will come up with good solutions.

I hope you enjoy all the articles in this issue of Healthier You. If you’re a senior, or the son or daughter of a senior, I highly recommend the article 7 Numbers Every Senior Needs on page 27. Of course it’s not an exhaustive list, but it certainly is a handy tool for any senior living alone.

As always, please let our editorial team know what you liked about this issue, and what you would like to see in coming issues at feedback@fraserhealth.ca.

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Healthier You Volume 1, Issue 4 – Winter 2016

published by:

www.glaciermedia.ca

PUBLISHED BY FRASER HEALTH & GLACIER MEDIA

Copyright ©2015. All rights reserved. Reproduction of articles permitted with credit.

Fraser Health

Editor / Bonnie Irving Content Advisors / Samantha Tong, Population and Public Health; Dr. Grace Park; Dr. Gerald Simkus; Dr. Leena Jain

Contributors / Amelia & Friends, Anna Abaya, Jake Adrian, Jacqueline Blackwell, Dr. Leena Jain, Tasleem Juma, Bonnie Irving, Susan Seto, Cathryn Smith, Lisa Thibault, Diane Wild, Wendy Young Glacier Media Group

Sales & Marketing Kevin Dergez Director of Special Projects kdergez@glaciermedia.ca Ellyn Schriber Newsmedia Features Manager BC eschriber@glaciermedia.ca Keshav Sharma Manager Specialty Publications ksharma@glaciermedia.ca

Creative Director / Eric Pinfold Advertisements in this magazine are coordinated by Glacier Media.

Fraser Health does not endorse products or services. Any errors, omissions or opinions found in this magazine should not be attributed to the publisher. The authors, the publisher and the collaborating organizations will not assume any responsibility for commercial loss due to business decisions made based on the information contained in this magazine. Speak with your doctor before acting on any health information contained in this magazine. No part of this publication may be reproduced or transmitted without crediting Fraser Health and Glacier Media. Printed in Canada. Please recycle.

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lighten up

10

ways to beat the winter blahs

By Jacqueline Blackwell

Winter in British Columbia is a far cry from what our counterparts across the country experience. While the rest of Canada braves sub-zero temperatures and a seemingly endless snow season, we West Coasters rarely see the thermometer drop below zero – making a true Canadian winter uncommon for those of us fortunate enough to call the Lower Mainland home.

That said, it isn’t all sunny days over here on the left coast. With our mild climate comes a tendency for long stretches of rain, and as soon as the clocks fall back in late October, the ‘winter blahs’ can become all too familiar.

For some, the onset of dark, rainy weather can trigger Seasonal Affective Disorder (SAD), a type of depression that occurs during the fall and winter, possibly due to the lack of sunlight that Canada endures in the winter months. 

winter 2016

Healthier You

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You might be suffering from SAD if you’re feeling sad, moody or anxious, losing interest in activities you typically enjoy, craving carbohydrates and ‘comfort foods’, gaining weight, and feeling drowsy during the day.

If you’re suffering from SAD, or simply a case of the winter blahs, small lifestyle adjustments can help you cope with the symptoms.

Keeping that in mind, here are 10 ways to help keep you or your loved ones from singing the winter blues: 1 Go play outside: Bundle up and head outdoors for some brisk activity during daylight hours – even if it’s just a quick walk during your lunch break. Make it a social event and invite along coworkers if you’re in the workplace. If you’re at home, head outside with your children to explore.

Studies have shown that exercise can help ease the symptoms of depression, so anything that gets the heart pumping – whether it’s a jog, cycle or gym session – can help you feel better if you’re feeling low. Spending time outdoors also helps boost your exposure to sunlight, the lack of which can contribute to depression during the winter months.

2 Let the light in: Maximize your sunlight exposure and find ways to let light into your home or office. Open the curtains, rearrange furniture, trim shrubs that are covering the window – whatever it takes to let the sunshine in.

3 …or make your own: Light therapy is a commonly used treatment for SAD, and research is continuing to determine the most effective way to use it. It can include bright light treatment, in which you sit in front of a ‘light box’ for a certain amount of time, typically in the morning. Another option is dawn simulation during which a lowintensity light is timed to go on in the morning before you wake up, gradually getting brighter. If you have been diagnosed with SAD or believe you have the symptoms, speak to your doctor about your treatment options, which could include light therapy.

4 Head for the sun: If you have the means to do so, consider strategically planning a vacation to a sunny destination during the winter.

5 Don’t forget about Vitamin D: Known as the ‘sunshine vitamin’, Vitamin D is integral for helping the body to absorb calcium and build strong, healthy bones and teeth. However, since we don’t always get all of the Vitamin D we need from sun exposure – particularly during the winter – we often need to find alternative sources which include fortified foods (i.e. cow’s milk), fatty fish and eggs.

Vitamin D supplements may also be beneficial. As always, consult your doctor before taking them.

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6 Get plenty of zzz’s: A symptom of SAD and, to a lesser extent, the winter blahs, is a feeling of drowsiness during the day and a constant desire to sleep. Getting on a regular sleep schedule may help you feel more energetic throughout the day and ease that general feeling of listlessness. An added bonus to getting more exercise is a tendency to sleep more soundly – all the more reason to work up a sweat.

7 Avoid too much caffeine and alcohol: Anyone who has tossed and turned all night due to an ill-advised evening cup of coffee or nightcap can attest to the impact these beverages can have on sleep quality – and consequently, mood. Avoid them when possible to encourage restful sleep and a brighter overall outlook.

8 Eat well: While cravings for comfort foods such as pizza or pasta might be difficult to resist, eating healthier might also help ease the symptoms of SAD and the winter blahs. Complex carbohydrates such as whole grains, spinach, beans and lentils take longer for your body to digest and don’t cause the spike in blood sugar that can negatively impact your mood. Websites such as healthyfamiliesbc.ca offer many great recipes using seasonal ingredients.

9 Stay social: If you’re feeling low, spending some quiet time alone at home might seem like a good idea, but make a concerted effort to stay connected to your social circle. Interacting with those we care about – however briefly – can help boost your mood.

10 Don’t be afraid to reach out: If you’re feeling the effects of the winter blahs or think you might be exhibiting the symptoms of Seasonal Affective Disorder, don’t be afraid to ask for help.

Family and friends can provide much-needed support while a physician can help you develop a treatment plan. You may benefit from counselling, medication or referral to a psychiatrist if your symptoms are severe enough. Always remember: you’re not alone.

More info: For more tips on staying healthy this winter, check out Fraser Health’s My Healthy Westcoast Winter toolkit at www.fraserhealth.ca/your-health/ seasonal-health/my-healthy-westcoastwinter-guide

she’s at risk for Dementia What about you?

11 risk factors and a doctor’s prescription for each

By Dr. Leena Jain & Bonnie Irving

One thing is clear – dementia is not ‘just a normal part of aging’, and it is not inevitable. Yes, some types do tend to run in families, but genetic makeup does not account for all dementias.

And while some evidence suggests women are more prone to it than men, there’s nothing definitive on that yet.

Regrettably, the biggest risk is age, something none of us can do anything about. The older you get, the more likely you are to develop dementia.

That’s why the disease is starting to be described as an epidemic – as the baby boomers age, the number of cases of dementia is escalating. Short of researchers finding a new drug in the next couple of years to reverse dementia, the number of cases will continue to grow.  winter 2016

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Dementia describes a decline in cognitive functioning caused by progressive changes in the brain which impact day-to-day activities. There are many kinds of dementia but the most common is Alzheimer’s. The probability that someone over the age of 85 will have dementia is 35-50%.

But there is hope if you know what the risks are and start early to address the ones you have. Researchers believe that abnormal changes in the brain may begin about 20-25 years before the memory problems in Alzheimer’s start surfacing. So, if you’re in your 40s, 50s, or younger, now’s the time to tackle the factors identified as ‘modifiable’ risks.

Consider this article your primer on how to decrease your risk of developing the disease that is the fear of seniors everywhere.

Diabetes If you have type 2 diabetes, you are twice as likely to develop dementia compared to those without diabetes.

Dr. Jain’s Prescription: Keep your blood sugar well controlled with your hemoglobin A1C less than 7.

High Blood Pressure If you have high blood pressure in your 40s and 50s, you’re more likely to develop dementia, particularly vascular dementia, because of the impact high blood pressure has on your arteries, blood circulation and heart. Treatment is important.

Dr. Jain’s Prescription: Diet and exercise as well as other lifestyle modifications can be effective if your blood pressure is just slightly on the high side, around 130/80-90.

But higher than 140/90 you will need medication to lower it to that. People with diabetes should target 135/80.

High Cholesterol If you have high total cholesterol in your 40s and 50s, you are more likely to develop dementia, as well as impact your heart health. Therefore, treatment is important for both your brain and your heart. Blood tests can determine the need for medication and your doctor will need to refer you for testing of total cholesterol, as well as LDL (the ‘bad’) and HDL (‘good’) cholesterol levels.

Dr. Jain’s Prescription: Your total cholesterol should be in the normal range, under 5.2. However, of particular importance is your LDL – if you are at high risk, or there’s evidence of coronary artery disease, your target should be an LDL of less than 2. If you are at moderate risk, aim for less than 3.5, and at low risk, less than 5. For even more protection, an HDL of more than 1.5 is beneficial.

Research has shown that those treated for high cholesterol with drugs called ‘statins’ have a lower risk of dementia.

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NEED A REASON TO QUIT SMOKING? Evidence shows that smokers are 45% more likely than non-smokers or ex-smokers to develop Alzheimer’s.

Obesity Carrying a lot of extra weight in your 40s and 50s may increase the risk of dementia.

Dr. Jain’s Prescription: A waist circumference of 35+ inches for women and 40+ for men points to a potential problem. Ask your doctor to measure your Body Mass Index (BMI) – a BMI of 25-29.9 means overweight; a BMI of 30+ indicates obesity. For Asians and South Asians, obesity is pegged at 25+. Eating the Mediterranean diet way (https://en.wikipedia.org/wiki/Mediterranean_diet) and starting to exercise are the first steps in a successful weight management program.

Smoking There is strong evidence that smokers are 45% more likely than non-smokers or ex-smokers to develop Alzheimer’s; they are also at a higher risk of developing vascular dementia and even other forms of dementia.

Dr. Jain’s Prescription: Quit smoking. Research shows that the increased risk of dementia can be avoided by quitting and that the benefits start right away. Talk to your doctor about the myriad aids to assist you.

Depression Is a history of depression or depression in later life a symptom of dementia or a risk factor?

Researchers disagree but believe there is some connection between depression and a higher risk of dementia.

Dr. Jain’s Prescription: While there is no definitive proof anti-depressant drugs or therapy erase the risk of dementia, the benefits of early treatment for depression are wellknown. Depression may also be an early sign of dementia so it’s important to share concerns with your doctor to receive treatment early.

Low levels of formal education/cognitive inactivity The more education, the lower the risk of dementia. How much and what kind of education has not been clarified.

Down Syndrome and some other learning disabilities also increase the risk.

Dr. Jain’s Prescription: Your brain is like a muscle, which needs to be fed well, rested and exercised. One way of exercising it is through reading and learning. Maintain an inquiring mind and ensure your kids stay in school and get as much education as they can. Watch for the growing

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Physical inactivity If you sit at a computer all day and in front of the TV all evening, with little other exercise, you are at risk for just about every chronic condition you can think of, and that includes dementia.

Dr. Jain’s Prescription: Try to get 30 minutes of strenuous activity daily, or at least three days a week. For older adults, a brisk 30-minute walk daily is fine.

Diabetes Hemoglobin A1C – under 7 High blood pressure Aim for BP under 140/90 High cholesterol Total cholesterol – less than 5.2 – With high risk of heart disease – LDL less than 2 – Moderate risk – LDL less than 3.5 – HDL – above 1.5+

Alcohol Some research has shown that mild to moderate drinking may lower your risk of dementia slightly. Moderate drinking is defined as one drink per day (the equivalent of 12 fluid ounces of beer OR 5 fluid ounces of 12% wine OR 1.5 fluid ounces of distilled spirits) for women and two for men. But if you drink excessively, you increase the risk.

Dr. Jain’s Prescription: Alcohol is a risk factor for so many health problems that it is difficult to recommend anything other than occasional drinking. In fact, new evidence shows that any amount of alcohol consumption boosts cancer risk. The World Health Organization reports that no amount of alcohol is safe. More than 2.5 drinks daily is likely to increase the decline of all your faculties and increase the risk of young onset dementia.

Obesity or Overweight Waist circumference under 35” BMI less than 25 Smoking Quit Depression

Poor Hearing New research shows that if you neglect your hearing, your brain can actually become smaller. Another way of exercising your brain to keep it healthy is through using your senses. When you quit using one of your senses, such as hearing, that part of your brain shrinks.

Dr. Jain’s Prescription: Ask your doctor to refer you for a hearing test if you suspect you are not hearing as well as you used to. This research shows you should take action before brain shrinkage occurs rather than wait till you’re nearly deaf.

Get treatment Cognitive inactivity Exercise your brain – read, learn Physical inactivity 30 minutes of strenuous activity daily, or at least three days a week Alcohol Drink on occasion only Hearing Loss Get tested & use hearing aid if needed

Head Injuries If you play a lot of rough sports, ski or snowboard, or ride a bike or skateboard, you are at more risk if you have experienced severe or repeated head injuries. It is possible that deposits that form in the brain as a result of the injury may be linked to the onset of dementia.

Dr. Jain’s Prescription: Always wear the best helmet you can find if you are going to do these activities.

See your doctor for more information if you suspect you are at risk of developing dementia.

Dr. Leena Jain is a Geriatrician at Fraser Health’s specialized seniors clinic in New Westminster.

More resources: Alzheimer’s Society of BC www.alzheimer.ca/bc/

12 Healthier You

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WhatIDoMatters

Job Satisfaction

By Anna Abaya

I’m an Emergency Room nurse at Royal Columbian Hospital and I’m fortunate to have a job where I can help save lives.

About five years ago I had a patient in his mid-50s in full cardiac arrest; his heart had stopped. I was the nurse in charge, but I was still caring for patients and I was helping direct things. We were doing CPR, we got him into the trauma room, where we treat the most serious illnesses and injuries. He was this grey-blue colour, but we got him back.

Three days later, I passed this gentleman walking in the hall. I thought, ‘That’s him, alive.’ My mouth must have dropped open because he said, ‘Do you know me?’ I explained what he’d looked like in the ER. He asked if he could give me a hug. ‘I’m so thankful you saved me,’ he said. He had children. His dad had died young. He told me he had a lot of responsibilities and it wasn’t his time to go yet. It was amazing. I asked him to come back to the ER so the staff could meet him – we don’t often get to see what happens after we save a life.

Those are the moments when you know you’ve done your job. It’s the satisfaction of being able to help somebody. Almost all patients who come into the ER don’t know what’s wrong with them. They just need help. It’s my job to help them and advocate for them.

I once wanted to be a doctor, and I thought I’d start in nursing to make money while I studied. I graduated from Douglas College with a nursing degree in 1996 and went to work in Royal Columbian Hospital’s general medicine department. I discovered I really liked nursing, I liked the patient contact. So I earned an Emergency Nursing Specialty Advanced Certificate from the British Columbia Institute of Technology.

It’s a great job for a nurse who’s looking for a dynamic place to work. ER nurses have a lot of autonomy. You have to be calm, quick on your feet and able to take control of a situation. Because the ER is ever-changing, you’ve got to be able to change just as quickly.

continued on next page

winter 2016

Healthier You

15

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Amelia & her friends share their favourite off-screen activities

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The ER is my second family. I’ve been there since 2000 and we spend 12 hours a day together. It’s a challenging job, but the people you work with make it easier. If I ever got sick, these are the people I’d want to save me.

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16 Healthier You

winter 2016

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Unplugged Kids share their favourite off-screen activities

By Amelia & friends As told to Tasleem Juma

My name is Amelia, and I’m eight years old. I’m like most kids my age – I like to have fun with my friends, do arts and crafts, and watch TV and play on the computer.

My mom is pretty strict about how much screen time I get. She thinks it makes me sit around too much and says that’s unhealthy.

Anyway, we often have no-screen weekends where we don’t watch TV or play on our tablet or computer at all– not even for one second!

I thought it would be really hard to go a WHOLE weekend without TV or YouTube videos, but it’s a lot of fun, and it turns out my mom is really cool to hang out with.

One of my really, really favourite things to do is face painting, especially when I get 18 Healthier You

winter 2016

to do my mom’s face. But I like to do mine too. We buy lots of different colours from craft stores, and you can find some really cool stuff around Hallowe’en.

I also love to play with FIMO clay and make little figurines. We buy it from Michael’s and they have a million different colours!

I really look forward to my no-screen weekends now. Who would have thought we could have so much fun without TV or YouTube?

My friends’ moms make them stay away from their screens too, so I asked them what they do instead. Here’s what they told me. I hope my mom reads this because I want to try what Ava does really soon.

Face time

Amelia It’s so much fun to paint my mom’s face. It’s easy to wash off so we can do it over and over again!

Stick Handling

Trevor I like to play road hockey because it gets you active, you don’t need a lot of materials and you can play it anywhere.

Air Teagan

Teagan I like to play basketball because it’s really fun and you get exercise at the same time. I get to use the hoop in the neighbours’ yard and we can play whenever we want.

Tea for Two

Khaliya & Aleisha We got this tea set as a gift and we got to paint it ourselves.

Everyone in our family painted one part of the set, so when we use it, we remember how much fun we had doing it together. Now we buy canvasses and paint from the Dollar Store and do lots of art projects with mom and dad.

Ava

Will Climb Anything I love to climb trees, but in the winter it’s too wet. Funtopia is our new favourite place for playdates. I can climb all the different walls whenever I want. It’s so much fun and I never get bored!

winter 2016

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extreme measures

Neil M. was desperate for an alternative after his doctor told him he needed quadruple bypass surgery. Rather than face the scalpel, he chose to try to eat his way to health.

By Jake Adrian

Huffing and puffing on his brisk morning walk in the hilly neighbourhood where his son lives in southern California, Neil felt the first grip of tightness in his chest and shortness of breath that forced him to stop to catch his breath. Alone on an unfamiliar street, he knew he had to get back on his own. When the pain lessened, he continued on. These symptoms continued periodically throughout the rest of his visit, but it never occurred to him that it might be heart-related.

Returning to his home in Abbotsford 10 days later, still worried about the pain in his chest and not wanting to wait for an appointment with his doctor, he went to Emergency. He was immediately scheduled for further testing. What he didn’t know was that the pain he had experienced was angina, which occurs when one or more arteries in the heart are blocked. An x-ray confirmed that he had a 100% blockage of a major artery. He was put on

20 Healthier You

winter 2016

a list for bypass surgery, which was scheduled for four months later.

In many cases, heart disease is a silent killer where the first warning sign is death. According to the Heart & Stroke Foundation of Canada, heart disease is the leading cause of death in this country, ending more than 33,000 Canadian lives each year.

Most of these deaths occur outside of a hospital.

Neil’s diagnosis came as a shock to him; there was no history of heart disease in his family and at 70 he was still physically active, swimming lengths in the pool and walking regularly. “Nothing about my health made me think I might have heart disease,” he says. Although he carried a few extra pounds, he had grown up on a farm and inherited the farm work ethic. His blood cholesterol level and blood pressure readings, potential warning signs of heart disease, were a little high, but until this diagnosis, had not really been a concern.

Action required Neil lives with his wife Ann in a townhouse surrounded by photos of their family and extended family.

An entrepreneur at heart, his careers as a college music instructor and educational sales consultant, as well as a strong connection to the Mennonite community, have brought him in contact with a wide network of friends.

Faced with his grim prognosis, he turned to his faith and Mennonite community for guidance.

According to the Heart & Stroke Foundation of Canada, medications, cardiac catheterization and surgery are the main treatment options for heart disease, and all have risks. Medications are critical for preventing further blockages. If a blockage or blockages are severe enough to warrant immediate attention, the least invasive option is catheterization. This treatment uses a ‘balloon’ threaded through an artery, for example in the groin, to open blocked arteries and then inserts a ‘stent’ to keep them open. The most invasive option is bypass surgery in which a piece of blood vessel (artery, vein) from elsewhere in the body is used to create a detour or bypass around the blocked portion of the coronary artery. The heart is stopped and the body kept alive by a machine. Depending upon the number of blockages, several bypasses may be created.

Are you at risk?

Nine in 10 Canadians (24 million)have at least one risk factor for heart disease and stroke. Two in five have three or more of these risk factors.

Many of these warning signs are silent, meaning you won’t know there’s a problem unless you have regular checkups by a doctor. How can you prevent heart disease?

Your best defense is controlling these risk factors that could lead to heart disease: • high blood pressure • high cholesterol • diabetes • smoking • excessive alcohol consumption • physical inactivity • being overweight • excess stress

“I now know I will shorten or extend my quality and length of life by my food choices.” –Neil M.

However, none of the treatments cures the underlying heart disease.

As Neil pondered his options, he heard from a longtime friend and internal medicine specialist practicing in Winnipeg. His advice: ‘Come and spend a week with me in my home, and I’ll teach you how to fix the cause of your heart disease.’ He suggested Neil cancel the surgery, unless it was considered an emergency, and focus on his eating habits. Neil took his advice and spent a week with him learning about a diet described by Dr. Dean Ornish in his well-known book Reversing Heart Disease.

It advised sharply cutting the amount of fats, meat and dairy, but increasing the amount of fruits, vegetables, grains and legumes in his daily meals. Meat and dairy, normally the centre of Neil’s meals, were now the smallest portion on his dinner plate. And in other meals, they disappeared entirely.

During the next several years, his intake of meat at dinner continued to shrink. He took a series of cooking classes to learn to make vegetarian and plant-based meals. The pain in his chest was gone; he was swimming regularly, and generally feeling much better. He assumed his worries were over.

Not so. About eight years later, the squeezing chest pain he had experienced earlier gradually returned. His normally high energy level declined and his regular activities tired him. In July 2014 a second angiogram showed three additional blocked arteries – one at 90% and two at 40%. This was in addition to the first blocked artery. His diet change had been helpful to minimize further buildup, but had not reduced the blockage.

Now Neil found himself a candidate for quadruple bypass surgery. winter 2016

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This diagnosis was a wakeup call, maybe even a death sentence. He had a choice between risking a severe heart attack or open-heart surgery. He knew that either choice would change his life.

Neil’s Favourite Vegan Recipe: Spaghetti Squash Lasagna Bake Cook time – 1 hour 20 mins

Extreme action required Through a set of fortunate circumstances, Neil was introduced to the teachings of Dr. Caldwell Esselstyn, a former internationally renowned surgeon, researcher and clinician at the world-famous Cleveland Clinic, who explains in his book How to Prevent and Reverse Heart Disease that heart disease can be prevented, reversed and even abolished. Dr. Esselstyn argues that conventional treatments focus only on the symptoms of heart disease, not the causes.

The book lays out a strict four-step plant-based eating formula: no meat, no dairy products, no eggs, no oils. Only fruits, vegetables, whole grains and legumes are allowed.

After reading the book, Neil says: “I drew a line in the sand and made a promise to myself that I would stick to this diet plan for a year. This was something I could do to help myself.”

This decision would challenge him and his wife in ways they never expected, test his power of resolve to the core and forever change his relationship to the foods he loved.

Although he had already been eating mostly vegetarian meals for eight years, meat was still part of some meals. He now vowed to eat only plant-based ‘vegan’ dinners – no meat, no dairy, no eggs and, in a departure from the vegan diet, absolutely no oils, including plant-based oils such as olive. He promised to cook at least 50% of the dinners and asked his wife of 56 years to share the rest. She agreed, but was less certain this was a change she could embrace.

The transition wasn’t easy and meant that no meat would be served even when guests came to dinner. It meant standing firm in the face of doubt from others. It meant finding new foods and new ways to make satisfying meals fit for guests.

After only three months on the program, Neil met with his heart surgeon, who was apparently pleased with his progress. He advised him not to have surgery, but to “keep on doing what you’re doing.” At the end of their conversation, Neil asked him: “If I was your father, is this still the advice you’d offer me?” His response: ‘Yes. I wouldn’t recommend surgery for you. Your situation is no longer an emergency.’

In the face of that confidence booster, Neil took up the cause full time – spending all his time learning to shop, cook and eat plant-based foods. He researched recipes and bought the necessary ingredients. He made an agreement with his wife to ban cheese, one of his favourite foods, and all other dairy products in addition to meat products. At home Ann dined with Neil, but when she went out she ate meat and other ‘banned’ foods. As a dinner guest, Neil either stuck with the vegetables or brought his own veggie burgers. winter 2016

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Squash • 2 large spaghetti squash (3-4 pounds each) Tofu Filling • 3-4 Tbsp (45-60 ml) extra virgin olive oil, plus more for squash • Sea salt + black pepper, to taste 1/2 tsp each), plus more for squash • 2 lemons, juiced (1/3 C or 80 ml) • 12 ozs (340 g) extra firm tofu, drained and pressed dry for 10 minutes • 3 Tbsp (9 g) nutritional yeast • 1/2 C (30 g) fresh basil, packed • 1 Tbsp (3 g) dried oregano • 1/4 C vegan parmesan cheese, plus more for serving For Serving • Vegan parmesan cheese • 25 ozs (708 g) favorite marinara/red sauce • optional: Fresh basil, chopped; Red pepper flakes Instructions 1) Preheat oven to 400 degrees F and line a large baking sheet with foil.

2) Halve the spaghetti squash lengthwise using a sharp knife.

3) Scrape out the seeds and stringy parts.

4) Brush the interior with oil and sprinkle with a little salt and pepper. Place cut-side down on baking sheet. Roast for 45 minutes, or until a knife easily pierces the skin and flesh.

Remove from oven and set aside to cool slightly. Also reduce oven heat to 375.

5) In the meantime, add all tofu filling ingredients to a food processor or blender and pulse to combine semi-pureed mixture. Taste and adjust seasonings as needed, adding more salt and pepper for flavor, nutritional yeast for cheesiness, and lemon juice for brightness.

7) Once fully baked and slightly cooled, use a fork to scoop out spaghetti squash into fine strings. Set aside.

8) Lightly grease a 9x13-inch baking dish and lay down 1/3 of the squash. Top with several spoonfuls of tofu ricotta, ending with sauce. Repeat until you have about 3 layers.

9) Loosely cover the dish with foil and bake for 20 minutes at 375 degrees F. Then remove foil and bake for an additional 10-15 minutes, or until the sauce is bubbly and the top is golden brown. Cover with foil if the squash is browning too quickly.

10) Let cool briefly, then serve with desired toppings (listed above).

Author: Minimalist Baker

Soy products replaced cheese and butter, and even some meats. Dinners centred on squash, potatoes or legumes, which are high in protein. He only eats when he’s hungry, and never skips breakfast, which is often a bowl of oatmeal with seeds and fruits. A mid-afternoon snack might be fruit and soy cheese, and a slice of whole-grain bread.

The payoff Since he began this diet change, Neil says the improvement in his health has been remarkable. His cholesterol and blood pressure are down and his energy level up, so he can continue his regular swimming and walking. The biggest change is the absence of the stomach heaviness meat gave him, he says. He has lost about 20 pounds, is very close to his ideal weight and his body feels lighter. He no longer experiences chest pains and has been told he no longer needs bypass surgery. He doesn’t take any medications. Vegan dinners are now commonplace at his home and even friends make an effort to cook meatless dishes when inviting him for dinner.

Neil considers himself living proof that diet and exercise can cure severe heart disease. Says Neil: “I now know I will shorten or extend my quality and length of life by my food choices.”

Dr. Gerald Simkus, head of cardiology for Fraser Health, was interested to hear of Neil’s success. “Lifestyle changes are often prescribed,” he says, “but it takes a very committed individual to make the changes that will reverse heart disease, although it does and can happen.”

Most often, patients use a variety of methods to try to overcome heart disease, Simkus says, from active participation in cardiac rehabilitation programs that teach prevention activities such as healthy eating, exercising, and quitting smoking, to getting regular tests and taking low-dose aspirin.

What makes the best diet? Dr. Simkus notes there are lots of discussions and opinions about what makes the healthiest diet, from low carb, low fat, low glycemic and Mediterranean, to mixed/balanced (DASH), Paleolithic, and strict vegan. “We do have a few more reputable studies confirming that, in general, diets that include minimally processed foods, are caloriereduced and include more fruit, nuts and vegetables, like the Mediterranean-type diet, seem to be the most common elements and most important to achieve health promotion and disease prevention.”

“It’s really up to each individual and their doctor to decide what kind of diet works best for them,” says Simkus.

Good for your heart.

Good for your brain.

• Health Canada recommends 2 x 75g servings of oily fish, such as salmon, per week.

• Salmon is high in Omega-3s, which helps prevent heart disease and stroke – two of the leading causes of death in Canada.

• 80% of premature heart disease and stroke is preventable.

coastfresh.ca winter 2016

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sponsored content

Salmon - light, healthy and fresh Layered Salmon Cocktail Ingredients:

Chef Dave Ryan shows how to capture the essence of West Coast cooking by showcasing fresh, locallygrown ingredients. Chef Ryan prepared this culinary creation with the intention to deconstruct a sushi cone and expose the different colours and textures that make up each layer of this dish. “I wanted to bring together local products that are appealing to look at,” said Chef Ryan. “I think that this dish represents how we like to eat on the West Coast – light, healthy and fresh.”

Winner of ten Provincial trophies, 26 medals within North America, and two Olympic Grand Gold medals – the highest honour in a national world culinary competition – Chef Ryan now spends his time passing on his knowledge to the next generation of chefs as a culinary arts instructor.

He says that he tries to teach his students how to maintain the integrity of each ingredient. “If I’m making salmon, I want to taste the salmon first, and then any other flavourings after. The goal is to use ingredients to enhance the salmon’s natural flavour.”

• Seasoned Rice Salad with dressing mix (recipe below) • 1 piece Nori leaf – cut into 2” strips & Julienned • Cucumber Salad (recipe below) • 1½ lbs cooked or candied salmon, cut into cubes

Assembly: To create the layers, spoon the seasoned rice salad generously into cups, then add some of the Nori leaf strips, followed by the cucumber salad. Top with diced cooked or candied salmon and drizzle some reserved dressing over the fish. Serve immediately.

Enjoy.

Seasoned Rice Salad Ingredients: • 4 cups cooked rice of your choice

Seasoning Mix: • 3 tbsp rice vinegar • 3 tbsp water • 2½ tbsp soya sauce • 4½ tbsp sugar

Method: Whisk together seasoning ingredients in bowl and let stand for 20 minutes, mixing occasionally. Cook rice to taste and sprinkle half of the dressing into rice. Mix quickly. Reserve other half of the dressing for the assembly stage.

Cucumber Topping Ingredients: • ½ English cucumber

Method: Leaving the skin on the cucumber, cut sheets from outside the cucumber, careful not to use the seed. Dice. Season to taste.

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1-855-412-2121

Fraser Health Service Line

How To Get Help For Any Health Concern

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When: 8:30-4:30, 7 days/week

1

8-1-1 (healthlinkbc.ca)

Why: To find out if you qualify for in-home personal care, home care nursing or rehab, palliative care, day programs for adults or respite services for caregivers.

What: Trained phone staff will identify your needs and refer you to the services you need. Some services may be free, based on your income.

HealthLink BC When: 24 hours/day, 7 days/week Why: If you’re feeling unwell or have a minor injury and are unsure about what to do. Or if you just have a health question or need advice about a health issue.

What: Health advice from a nurse; nutrition information from a dietitian; advice about drugs and pills from a pharmacist; where to find health services in your community. th personal heal

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YOUR DOCTOR’s # ___________________________ Nearest walk-in clinic # _______________________

Mental health

Why: Your doctor is your health expert. Call if you have an urgent concern you think needs to be seen to soon.

If you don’t have a family doctor a walk-in clinic may be a good option. Otherwise, call 8-1-1 for advice.

604-268-1312

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(betterathome.ca) Better at Home When: Office hours vary by community Why: If you need friendly visiting; transportation to appointments; light yard work; minor home repairs; snow shoveling; light housekeeping; grocery shopping (services vary by community). Some services may be free, based on your income.

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604-951-8855 1-877-820-7444 Fraser Health Crisis Line When: 24 hours/day, 7 days/week Why: For anything that’s causing you concern, worry or distress, for example suicide thoughts or feelings, mental health problems, addictions, family violence, abuse, relationship conflicts, loss, or just plain loneliness.

What: Free confidential emotional support, crisis intervention and community resource information.

When: Office/clinic hours

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rvices

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2-1-1 (bc211.ca) When: 24 hours/day, 7 days/week Why: If you need a service and aren’t sure what it’s called or where to find it. One call connects you to an information and referral specialist with numbers for all community, social and government services. rvices

emergency Se

9-1-1

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When: 24 hours/day, 7 days/week Why: Any serious emergency. An ambulance will arrive with attendants to assess whether you need to be transported to the local Emergency department.

8-1-1 winter 2016

Healthier You

27

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who

cares?

How we support the families who care for and support loved ones with a mental illness.

By Diane Wild

Brent Poley was a teenager when he began to go through manic periods followed by crashes into depression. At first, neither he nor his family knew what was wrong. Was it teen rebellion? Hormones kicking in? The behaviour seemed uncharacteristic for the caring boy with above-average intelligence, but then he was prescribed a number of medications that didn’t relieve his symptoms either.

When he was finally diagnosed with bipolar disorder five years later, his mother Renee recalls being relieved. Though their journey wasn’t over – he still had full-blown manic episodes every year, with 13 hospitalizations in 14 years – at least now they knew what path they were on.

Back then, there were fewer resources for people with mental illness, never mind their friends and families. Brent’s family had to ask a lot of questions and dig for a lot of answers.

“I’ve had tremendous support from them,” says Brent, who adds that support has grown to encompass others as well. “My mom has been an excellent advocate for people diagnosed with mood disorders.”

More than 25 years after his diagnosis, and with a new medication that has been effective for him, Brent lives independently, works, has coled support groups with Renee, and is an active

participant in his community, including spending time at Langley’s Stepping Stone’s Clubhouse – a welcoming, supportive place for people with mental illness. Brent points out that it allows for a muchneeded routine, and social connections.

Renee has continued to facilitate information and support groups, sometimes with her son. They, along with other families who struggled through the years of piecing together information and support the best they could, have helped spark an explosion of more awareness and practical support.

“I had the kind of career where I was a problem solver,” Renee, a former union negotiator, says. “I was used to finding resources and pushing for more resources.” She now counsels others to get educated on the major symptoms of their loved one’s illness and on where to get the answers and the support they need.

Len Polak is the family support specialist with Fraser Health who works with family members like Renee to create additional supports for those with a loved one with a mental illness – and he points out that ‘family’ means the client’s natural support system, related or not. continued on page 30 

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People in the Fraser Health region now have access to a Family Support Coordinator (1-877-717-5518) who can help them navigate the often-complex mental health care system, and learn how to take care of themselves so they can better support their loved ones.

“Often people need to sort out the difference between caregiving and supporting,” says Len. “Someone who has just come out of the acute stage of an illness is vulnerable and may not be up to functioning to the point they might be in three months or six months into recovery,” he says. “That’s Renee and where family members tend Brent have to take on full responsibility helped spark without knowing a lot of an explosion times whether they are of more doing the right thing or not. awareness Family support coordinators and practical support can help them sort out for for victims themselves what they can of mood take on and what they can’t, disorders. and envision a time where they’ll move away from a caregiving role to more of a support system.”

The family support coordinators can help with guidance around the legal issues involved in trying to arrange treatment for someone who may not recognize they need it, how to convey any concerns to a case manager, where to find emotional support, and what options exist for self-care.

“When we meet with some families they may be feeling burnt out and need a break,” Len adds. “For their own health and for the health of the relationship with their loved ones, they might need time away, or time at home alone, so the family support coordinators will work with them to come up with an individualized plan.”

Fraser Health has a small amount of funds available that family support coordinators can use to facilitate time off for caregivers, though often a successful break doesn’t require that funding.

A meet and greet service for families whose loved one is admitted to a Fraser Health hospital’s inpatient psychiatric unit for the first time is provided by a family peer facilitator – someone who has been in their shoes and who can provide encouragement, emotional support, insights into the recovery journey, and talk about available resources.

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Family and friends information groups as well as support groups are also available, offering emotional support and collective wisdom. Renee has helped facilitate some of these groups and has impressed Len with her dedication and compassion. With Len, Renee along with other family members also co-facilitate learning exchanges with staff on the impact of mental illness on the family, and the role family play in recovery.

“Great gratitude goes out to family members,” Len says. “Everyone writes their own story in their own particular way, and where we’re at right now, with more resources for families, has a lot to do with family members and people with lived experiences. Look at the clubhouses for example – they were created based on their voiced needs.

We are able to ask what works, and from their perspective, what did you need when you were coming through the doors the very first time?”

Though she’s not done advocating for more mental health resources and information sharing, Renee sees a vast difference from the days when she was going to the library and bookstore developing the tools she needed herself.

“If the Early Psychosis Intervention program had existed back then, we would have been so much better off,” she says of one example, referring to the provincial program to detect conditions that cause people to, at times, be unable to tell the difference between what is real and what is in their minds. The program also includes families as part of the treatment team right at the get-go.

Len credits Renee with helping build resources for those with mental illness and their loved ones, and Renee in turn credits her son with supporting her through the process of providing support to him and, as time went on, others facing similar circumstances.

“Brent has helped me help him. I think something that gets forgotten is that your own loved one helps you hang in there through the difficult times. You become a team,” Renee says.

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Yes. Dental implants are one of the greatest advances in dentistry. Since their introduction, the success rate has continued to improve, and currently clinicians expect that 90-95% of all implants will be successful.

There are only a few conditions that adversely affect the success rate of implants: poor oral hygiene, smoking, uncontrolled periodontal disease, uncontrolled diabetes and autoimmune disorders. The experience level of the surgeon can also impact the expected success rate of the implant.

What happens if a problem develops in the gum and bone tissue around the dental implant?

This is called peri-mucositis, for problems in the gum tissue, and peri-implantitis, for changes in the bone surrounding the implant. Fortunately, in most cases, the problem can be treated, although the implant will need careful monitoring after the appropriate treatment.

In some very extreme cases, the implant must be removed. This can be performed in a very simple manner. Often, the new implant can be placed immediately, once the site has been thoroughly cleaned out. If necessary, the site can also be left to heal and the gum and bone can then be prepared as needed.

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How do I care for my dental implants?

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Dental Check-ups Teeth that are supported or assisted by implants require regular maintenance visits with your dental team to maintain healthy gums and bone around the dental implant. X-rays taken periodically are critical to monitor the health of the implant. Screws used to tighten the appliances also must be checked regularly to prevent screw loosening. Even with careful appliance removal, routine replacement of these screws can prevent screw breakage since forces are placed on the implant components during both function and appliance removal. It is very important that the dental team monitors all aspects of the implant supported restorations on a regular basis.

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MyHealthCoach

The Perks of Coffee

By Cathryn Smith

It tastes so good and a wellprepared cup may even be good for your health.

O

ne of the first things I think about when my alarm goes off is my cup of java to start the day. I love the ritual I have created where all my senses seem to come alive as I get that first smell of freshly ground beans, watch the water as it seeps through the filter and finally taste that first sip – Aaahhh. It’s the best part of my day.

There’s no definitive research showing that increasing your coffee intake increases your risk of death, and according to the Mayo Clinic, it’s safe to consume up to 400 mg of caffeine a day. There is also evidence that the high amount of antioxidants in coffee may protect against Parkinson’s disease, liver cancer, and heart disease. But wait for more evidence before you start drinking it if you don’t already.

After a bit of research, I have ‘filtered’ out some of the ‘perks’ of drinking coffee as long as it’s in small to moderate amounts: A ‘cup’ of coffee is 8 oz. with 100 mg of caffeine, not the 16 oz. size most people order, which has about 330 mg of caffeine.

How the coffee is prepared will also determine whether its health effects are good or bad. Limit the sugar and cream you add to your coffee. Having some coffee with your sugar is not a healthy option. The research is typically based on coffee that is black or with very little sugar and or milk. That 24 oz. Mocha Frap with whipped cream can land you 500 calories and more sugar than should be consumed in a day. This can lead to weight gain, which can lead to an increased risk for type 2 diabetes.

Use a paper filter to make your coffee. Coffee contains a substance called cafestol, which is a stimulator of LDL (‘bad’) cholesterol. Using a paper filter will catch the cafestol; using a French press won’t.

Caffeine can make you feel more awake, but it can also give you the jitters. Caffeine can cause a short, but dramatic increase in your blood pressure and an increase in urination. It can also increase the amount of acid in your stomach. So if you’re feeling unaccountably nervous, it may be the coffee. Try switching to decaffeinated to see if that helps. winter 2016

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S ome studies suggest that drinking coffee, caffeinated and decaffeinated, may actually reduce your risk of developing diabetes. If you already have diabetes, however, the impact of caffeine on insulin action may be associated with higher or lower blood sugar levels.

On the other hand: Despite the mostly good news about drinking coffee, there are a few cautions about caffeine: I t can cross the placenta and affect a baby’s heart rate so if you’re pregnant either avoid it or reduce your intake to one cup a day.

It can create a physical dependency. If you want to reduce your coffee intake, do it slowly over several weeks or you may end up with a headache.

I t has a half-life of five hours. If you drink a cup with 100 mg of caffeine at noon, at 5pm you will still have 50 mg in your system.

If you are dealing with anxiety or sleep disorders, caffeine can make things worse.

It’s possible to overdose on it – symptoms include confusion and hallucinations.

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count the

costs

The cross-your-fingers-and-hopefor-the-best style of retirement planning might not work when you’re 80 and faced with in-home medical costs. The solution: Good financial planning.

By Bonnie Irving

My friend Matthew, 68, is planning to retire in the next year or so. He’s a healthy divorced man, in a good frame of mind and anticipating life without work. His plans? To travel, to play more golf, to read all the books he’s not had time to get to, to take some courses, and to spend several months at his cottage enjoying the summers. Nowhere in this scenario is there room for illness. Or of the consequences should it occur.

He hasn’t saved a lot of money, but he thinks he’ll have enough with his small company pension plus his regular government benefits and RRSP. If he does get ill, he says, he assumes the public health care system will take care of him. As to what he might need, and the associated costs, he has no idea.

I suggested that what he may be doing could be likened to crossing his fingers and hoping it will all work out.

winter 2016

Healthier You

35

Illness is ‘free’

Planning for care costs

Matthew is correct to assume that if he gets ill, the health care system will kick into high gear and get him back on his feet. At no cost. But a hospitalization for a senior can quickly become life-changing. Long hospital stays for seniors often result in deficits that weren’t there before as a result of the enforced immobility, if not the illness itself.

To help a senior continue their recovery at home, the publicly funded system may provide short-term (currently about two weeks) no-cost home health care support – personal care such bathing, toileting, dressing and medication management. However, ongoing home support in our public system is feebased and dependent on income. And non-medical support for tasks such as housekeeping, laundry or grocery shopping is private-pay only.

Most seniors want to remain in their own homes as long as they can. To do so, they will likely need more and more support as they age. Here, for Matthew and readers of Healthier You – those of you still in your 40s or 50s with time to save more money – is a sampling of the kinds of costs a senior may face if and when their health deserts them and their employer-sponsored health insurance has ended.

They are very approximate and err on the low side in most cases. Do not rely on any for specific planning.

Care by the numbers Medical Supplies • Tub bar $55

According to Tyler Saito, regional manager, investments and insurance, at Coast Capital Savings in Surrey, people often overlook health care costs when planning for retirement. At 40, we take health for granted; travel plans and leisure activities are front and centre. This is why it’s important, says Saito, to put together a financial plan that includes basic living and lifestyle expenses and also outlines risks. A Certified Financial Planner can help prepare a realistic plan to meet individual needs.

So, how much will you need to retire comfortably given that life expectancy has increased and your money has to go further to cover potential health care costs?

Saito says an overall retirement plan must cover basic living expenses such as shelter, food, heat, clothing, and transportation; lifestyle expenses such as golf fees, cottage maintenance and travel; and capital expenses or income such as a new car or selling your home (don’t forget you will need a new place to live if you downsize).

As part of your planning, potential risks to your savings or spending goals should be considered. For example, leading up to retirement, illness or injury could decrease your working-and-saving years, and in retirement, any illness or injury could increase expenses significantly.

How can you manage those risks? Saito suggests three main ways: try to reduce the risk by leading a healthy, active lifestyle and hope your health will hold as you age; “retain” this risk by planning to

Professional services/products

•* Hearing Aid $700-$4,000+/per ear

• Visits to your doctor – no cost

•P odiatrist (orthotics) $700+/pair

• *Basic dental exam & cleaning $250

•P sychologist $100+/hr

• Dentures $1,500-$3,200+

•C hiropractor $80 per session (1/2 hr)

• *Prescription Eyeglasses $500-$800+/pair

•R egistered massage therapist $95/hr

• Outdoor wheeled walkers $300-600+ • Indoor walker $100 • Lift chairs $1,700-$2,000

Medications

*Manual wheelchair $200+

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*Motorized wheelchair $2,000+

• Net income over $30,000 – you pay for prescriptions up to 3% of income ($900 on $30,000); Fair PharmaCare covers 70% of the balance, provided your drugs are on the list of covered drugs. Over your ‘family maximum’, Fair PharmaCare pays the balance for those drugs it covers.

• Acorn Stairlift $3,600 • Shoprider scooter $1,800

36 Healthier You

winter 2016

pay any health care expenses out of your retirement income; or transfer the risk of illness or injury by buying insurance.

If you’re diagnosed with a serious illness or injured in an accident, the loss of income for an extended period of time or the expense of long-term care could add up quickly, says Saito. If you think there’s a good chance this might occur, insurance could ease the impact, he says. He points to three types of insurance: Critical Illness Insurance, Disability Insurance or Long Term Care Insurance.

Critical illness insurance provides a lump sum of cash if you’re diagnosed with specific serious illnesses. The cash could replace work income, pay for treatments not covered by MSP, provide medical equipment, or allow a partner to take time off to provide support.

Disability insurance replaces a portion of your monthly income if you’re no longer able to work due to an injury, illness or mental fatigue. Once retired, with no working income to protect, the need for this insurance disappears.

Long-term care insurance provides a monthly benefit to cover some or all of your long-term care needs once you’re not able to care for yourself. Some policies provide a defined income to help with inhome care, which increases if facility care is needed.

There is also the option to pay the equivalent of those premiums to a savings account or taxfree savings account instead of to an insurance company. However, according to Saito this is a high-risk decision as serious illnesses and chronic

conditions become more likely as we age. The costs of managing such conditions can add up to many thousands of dollars – even hundreds of thousands of dollars. That’s a substantial risk when you are on a defined income, he points out.

He adds that the money put towards insurance premiums can sometimes be used for legacy planning too. “It’s not uncommon for insurance policies to return all or part of the premiums at the time of death if the insurance has not been collected,” says Saito.

What should Matthew do?

In Matthew’s case, Saito points out that the risk of needing long-term care may require more income than his pensions and RRSPs will provide.

He could sell his properties to pay for that care, or purchase insurance. For people with partners, selling properties may be more difficult as a partner may require that home as their shelter. It may also take the majority of the family income to pay for longterm care. With that in mind, buying insurance may be more appealing than crossing your fingers, he says.

Says Saito: “Retirement income planning and retirement risk planning should be started well in advance of retiring, with a financial planner qualified to discuss insurance.” Discussions with a financial planner should occur, he says, at all major life events – new job, marriage, children, divorce, major purchases, retirement – and plans reviewed regularly.

In-home support

Nursing home/residential care

• Private home care (personal care plus some light housekeeping) $26-$34/hour

• Public (subsidized) care home operated by health authority (must have complex health issues needing 24/7 nursing services to qualify) – 2015 price range is $991.50-$3,157.50/month (fee based on 80% of net income)

– 15 hours/week for a month @$29/hr =$1,740/month • Subsidized long-term home support (personal care for those who qualify) – Daily fee based on net income regardless of task and hours. Rough example: net income of $32,500=$30/day or $900/month; net income of $25,000=$20/day, $900/month. At net income of $40,000+ fee based on tasks and hours • Private cleaning services: $20+/hr; Example: 2 hours weekly/month=$160 • Better at Home (non-medical tasks such as transportation and cleaning) – sliding fee based on income, max. $25/hr, low income seniors may qualify for free services • Subsidized caregiver relief if you qualify (respite bed for your spouse in a facility for up to 30 days) $32.50/day, $975/ month • Personal Alarm Service such as LifeLine $35-$45/month for basic service

• Private care home (all-inclusive but depends on level of care and amenities provided) $4000-$6000+/month • Public (subsidized) assisted living home (must be unable to live independently to qualify) $906.80-$4,121 for singles, $1,462-$6,160 for couples’ care (2015 rates include costs of care, 70% of net income) • Private assisted living home $3,000-$8,000/month (depends on level of care and amenities provided) *BC currently subsidizes wheelchairs, dental care, eyeglasses and hearing aids for those who, prior to turning 65, were living on a disability pension or on social assistance because they were unable to work. **Net income=line 236 of income tax return.

winter 2016

Healthier You

37

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