Episode title: EP #5 Your Parents’ Last Days with Dr. Mike Jones
Hosted by: Chris Raper and Brittany Pilgrim (Boomer and Gen Z)
Guest: Dr. Michael Jones, MD
Description box:
*Unbeknownst to us at the time of recording, this episode was recorded on Chris's dad's last day. This makes it all the more special to us and hopefully to you as well. *
You either have already, are currently, or will in the future navigate caring for your parents in their final chapter. Chris spent a great deal of time since January caring for his dad, who is now in his final chapter and after all the financial planning he has done for countless clients, it is not how he pictured it. As our good friend Dr. Michael Jones knows, having been the doctor to many patients in their last days, it never is. Most of us wish we had of talked through all the details before anyone got sick. From a medical, financial, and emotional perspective, this is what to expect and how to prepare for when things go south, when your parents are in their final chapter.
As always, if you have any questions or feedback, we would love to hear from you: brittany.pilgrim@raymondjames.ca & chris.raper@raymondjames.ca
Thank you to Nathan Clark for composing our podcast music! He can be reached at nathancaclark@gmail.com.
Episode:
Mike: [00:00:00] As parents are getting older, the families who've done the best are the ones with good communication, they have these conversations. This is really essential. I've seen a lot of unnecessary family conflict,
Brittany: Welcome to from generation to generation. I'm Brittany, a Gen Z daughter here, questioning her financial advisor, boomer dad for financial guidance that can help families today
Chris: And I'm Chris the dad, a wealth advisor with Aspira Wealth.
Brittany: If this is your first time listening, we think about the transfer of wealth with three distinct aspects: character, intellect, and finally the money.
Chris: And our belief is if we don't pass character and intellect from one generation to the next, we have no hope of passing the actual money from one generation to the next.
Brittany: So today we are discussing what to expect and how to prepare for your parents' last [00:01:00] days. And we recognize that that's not easy. A particularly easy thing to talk about, but recently we've had some experiences in our family that have caused us to have to process this and discuss it more openly.
So, dad, do you want to maybe give a brief overview of what's happened with my granddad and your dad?
Chris: Sure. So. I'm grateful that at my age, I still have both parents alive. They are 89 and 93. My dad is 93 years old and in January of this year, he was brushing his teeth and all of a sudden had a neck seizure for lack of a better word.
It turned out that that was a growth in one of his upper vertebrae. Long story short, we went through a number of medical delays, he's since had surgery, had a stroke after that, and is in a private care facility as we [00:02:00] speak. It's been a long haul. And so, I know that a lot of people my age, a lot of my clients are either have gone through this, are going through it, or are going to go through it.
Yeah. And so, I'm hopeful today that we're going to be of some help to you and even if you're quite elderly and listening to this, I think you're going to get some value out of it as well. And Brittany, maybe you'll get a little value out because you'll know what to do when it's your dad's turn or your mom's turn.
Brittany: Hopefully that's a way away.
Chris: I hope so too.
Brittany: So, this is an issue that's dear to us and hard to talk about. So, in order to do that, we've asked a friend who is very dear to us, Dr. Michael Jones to join us today. Is it okay if we call you Mike today?
Mike: Yes, please do that.
Brittany: Okay. Excellent. Mike Jones is a long-time friend of ours and for the listeners.
Mike is originally from Zimbabwe [00:03:00] and he's been practicing family medicine in Victoria for 32 years after five years in Saskatchewan. Is that right?
Mike: Yep, that's right.
Brittany: And so, for the discussion today, Mike is going to be our guide for the medical system, healthcare side of things. And Chris is going to be our wealth advisor guide for the money financial piece of this puzzle. And then we'll all get a chance to weigh in on our personal experiences as well. So, Mike, to start, could you just tell us specifically what your experience is with Elderly care, end of life care.
Mike: Yes, well, I've been a family physician here in Victoria for 32 years. So, I came as a young man. Basically, half my age now is when I came and took over practice.
So, a lot of the people then were about my age. And so many of them are still my patients. So, I've gone through people aging as I've aged, [00:04:00] basically. So, I had patients there who are my age and now they're in my stage where they're looking after their parents and also helping their adult kids, the sandwich generation.
But I've, I had patients then who were 50 years old and now of course they're in their mid- eighties. Right. So, I've, I've lived it through the families in my practice. Right. And it's a very tight practice. My patients have stuck with me, and I've stuck with them. And so, I have a lot of old friends in my practice. So, at the same time, I became the medical director of a nursing home here in Victoria back then, 32 years. I'm still in the same place. I feel sometimes I need to just get a room. But I have patients in four other nursing homes, which I see regularly. So, I've gone through this countless times with families before, during, and after.
And after [00:05:00] nursing home care. So, I'm quite aware of, of a lot of the, the experiences that patients and their families have to go through.
Chris: Just so I understand, are you in like say Vic General as a hospital practitioner? Or not?
Mike: I'm not in the hospital system, I'm in the community physician system, so I have my own practice. Right. But my patients will go into the hospital system, right.
At and when they are there, they're under the hospitalists and specialists, and when they come out, they're back under me.
Chris: I see. So that's how that system works. Yes.
Mike: Right. When they're a nursing home, they're under me if I go to that nursing home.
Chris: Really our family's frustration was with the delay in getting access. Not only access like when there was a medical event, like when my dad had this physical neck impairment, which [00:06:00] was a result of the growth in the vertebrae. But just getting him to a doctor's appointment and then into a hospital and then waiting for an x-ray was Waiting for an MRI, waiting for surgery.
That whole process was about five weeks in our, now we're, this is a New Brunswick case. It's not a British Columbia case, but of course, through that time we're advocating. For better, faster, quicker access for my dad. And yet, you know, you wonder sometimes, well, have we advocated so much that we are now in the pest category and that's slowing care down?
Mike: To go back to your question of access to care that is now a huge, huge problem. It's a crisis. It's got a lot of factors A lot of it was poor political decisions a decade ago or more, but we now are living it [00:07:00] and Your experience is not that unusual in that there's a delay in getting a diagnosis or just even getting access to see a doctor, unfortunately it has got worse recently and now there are signs it might over the next decade start to normalize.
It'll be slow. So, I do feel your frustration and there's a lot of frustration out there. People who still have a family doctor have Just look after that relationship, right? Because it is very valuable. If you don't, my heart goes out to you because you are in a pickle when you need help. You can still go to urgent care or walk in clinics, but it's not as good as if you have a doctor who knows you - so I understand what you're saying. Your point about, are you becoming a pest as a family member?
No, no you're not. [00:08:00] Sometimes family members, out of their own anxiety, can become a little too intrusive in terms of becoming very demanding - that does not help. That's not going to increase the access to care, but no, people don't get put in the pest pile. That's not going to happen but, you might find that a Healthcare provider becomes less responsive to someone who's just phoning constantly about something that the doctor or nurse practitioner cannot help anyway, right?
So, you know, be aware and be sensitive to the pressures that the health care provider is under as well, right? That's how I would approach that one.
Chris: Okay, that's helpful. Thank you for that.
Mike: Yeah, you need to let your anxieties be known but then once they're known they are known you don't have to keep repeating them.
Brittany: Right and dad, [00:09:00] you had been saying that there were many things that you wish you would have discussed with your dad and your mom before he had gotten ill.
Chris: Yes, and truthfully, we discussed a lot of them. It's just that you can't discuss events in advance when you don't know what those events are. And one of the things that, you know, we wrestled with is, you know, if my mom and dad had been in a retirement home living scenario in Brunswick at least, or in Fredericton where they live, there is a care facility, right, in the same building essentially.
So, it would have been an easier transition than that. My mom and dad's argument was, and there is validity to this, is that they were in their own home. They like their own home. And the fact that they're still going up and down stairs to do the laundry is good for them, you know, it's [00:10:00] physically demanding of them.
And it's probably kept them alive, so to speak. So, finding that balance is one, but yeah, I do wish, I guess, knowing the events that we know now, it would have been easier if my mom and dad had already been in a retirement facility where there is ready care available.
And if that's one piece of counsel I do have for my elderly clients or any elderly people listening: plan ahead, try and get ahead of the event because if there's a crisis and you're not already in some kind of facility then you have very limited options and you go into essentially a staging facility. Or that's what we experienced. So, Mike, maybe you can respond to that. I'm curious what Mike has to say.
Mike: Well. Different families approach this in different ways, but I've seen a lot [00:11:00] of unnecessary family conflict around the fact that they have not had a family conversation ahead of time. This is really essential.
So, Brittany when I leave you need to sit down your mom and dad and just, you know, talk about scenarios because, you know, he's a robust, strong man. I mean, however, let's talk about some, what ifs, some scenarios, what if he were to collapse and obviously something bad has happened, maybe a heart attack, stroke, something like that.
And you're the only one around. What's going to happen, Brittany? Are you going to just automatically say, well, we're going to get the paramedics and we're going to get those chest tubes in there and we're going to start pumping his heart? How do you know that's what he wanted? Now at this stage, yes, I, I think that would be a pretty good guess, but think 15 years down the road.
When he's 15, [00:12:00] when he's. He's 80, right? And perhaps he's not as robust as now, you know, perhaps he's had a few incidents. Can you assume that? It's something you just need to think ahead. And then for Chris's side, the elderly side, the obvious things are just get in touch. It's out of the way for any kind of decision making for the family.
If it's a decision you can make. So, in other words, get yourself a will. In that will, say if you want to be cremated or buried, so that there's no conflict. If you suddenly die, and now the family is struggling to decide one thing or another - you're going to have some family saying this and some family say no, they would have wanted such. So, you can take the guesswork out - talking to the elderly - just by putting it down, having a family conversation [00:13:00] Saying what you would like in terms of medical intervention. In BC we have a form called the MOST Form: Medical Orders for Scope of Treatment.
It's just advanced directives. What would you like? Would you like CPR if you were to have a bad event? Would you like to go into intensive care? Would you want to be just left to die with dignity? Right. Those decisions you can fill in the form with your family physician and then your offspring are not having to say, well, I think this and then someone else says, I think that.
And I've seen quite a lot of conflict, which was unnecessary. And it's at a time of great stress for that family.
Brittany: Yeah. Even to relieve that burden a bit, I'm sure you're emotionally stressed and totally. So how would you feel good about making a decision at that time?
Mike: Right. So, to talk about it ahead of time when you're not stressed.
You're making a better decision anyway. Right. [00:14:00] And then when the event happens, if it happens, your children are not struggling to know and, and having this disagreement one with the other. Yeah.
Chris: So, Mike, I have a question for you there. First, I want to say… the insight that you, being the middle-aged person to the elderly person, should make every decision you can while you're still healthy and still with it. I think that's really insightful in that, it really is a responsibility to, okay, I'm going to get ahead of that decision. I'm going to make that decision now.
And that applies as much to living in your elderly years as it does dying in your elderly years, right? So, thank you for that. But the, the, the technical question I want to ask you is this MOST form Is it somewhat different than a health care directive?
Mike: No, it is the health care directive that we use in BC, right?
It's the [00:15:00] one that's recognized in all health care facilities, right? You can download it. You just Google MOST form. It has great instructions as to what each designation would be so you can just go through that with your family. You can have a family meeting. This is and discuss what everyone, is everyone in agreement with these are my wishes but what are you thinking?
Right. And then you take that to your doctor. The doctor doesn't make the decision, but they do have to sign the form. Because it's a medical order. And it becomes a medical order. You have a copy; they have a copy. You make sure it goes into a hospital with you. The emergency room physicians love to see it because it takes such a lot of stress out of a stressful situation.
Chris: That's excellent. So, in the interest of full disclosure, Mike is my doctor, and Brittany, we're going to download this form. I'm going to fill it out, and the next time I come to see you, [00:16:00] you can sign off.
Brittany: Do you know if other provinces have something similar?
Mike: I believe Alberta has. I think they still, they even call it the MOST form, I think. So, I know every province would have something equivalent.
Brittany: Right.
Mike: There was another part of yeah, Chris's comments I wanted to just come back to because you asked about sort of preparing your elderly parents to perhaps go into a assisted living sort of situation before it's too late, basically and I think that's really important to de-stigmatize the idea of going into a senior's living situation. The next generation above ours, believe it or not Brittany. There is one. They are very resistant to moving out of their home because the idea of nursing homes was a very negative [00:17:00] thing. And I think, you know, 20, 30 years ago, it was different. Nursing homes were not the kind of places they are now. But I'm not even talking about nursing homes.
I'm talking about just the next level from home to assisted living. And I've had a number of elderly patients in their 80s, even 90s. They are stubborn. They are going to stay home because that's what they've always said they would do. It almost becomes a pride thing. I am going to stay home until I die.
And it might be that they're alone. Perhaps they're a widow, widower, but they've always said they'd stay home. So, they're staying home, but they are miserable, isolated, lonely, and not caring for themselves well. So those people are very difficult to care for because they are refusing care and they are frail, they're getting more frail and failing to thrive.
But the ones that we have got into, [00:18:00] just an assisted living situation. So, it's not a nursing home, but it's a place where good nutritious meals are provided. There are dining rooms where you meet your table mates, and you have socialization. There's activation, that means bus trips or things, whatever you want to get involved with there is and I've had patients come back from almost on the edge of end of life coming back to loving life and becoming healthy and enjoying life again.
So, the stigma that older people tend to have about not nursing homes, but even just moving out of home to a senior’s living situation. We need to destigmatize that because it can really improve people's living situation, and they can live longer that way because they're happy.
Brittany: Right. Wow.
Chris: And I will say, you know, we have witnessed that in our family.
My wife, Arleen, her mother, Olga you know, 10 [00:19:00] years ago, moved to a care minimum facility. That's the best way of putting it. Today and ever since she got there, she has thrived, socializing. We're going to celebrate her 90th birthday this August and she's healthier today than and much happier.
Brittany: I always joke that she has a much better social life than I do.
Chris: And you know, there's probably 200 people that live in that facility. Right. And she knows the first and last name of every one of them. Yeah. Yes. Just amazing.
Mike: Yet I can, even now in my practice, I can think of quite a few elderly people on their own, in their home, and just out of stubbornness, they're saying, no, I like it here.
But they are miserable. Yeah. And I just try and convince them, you know, just try it. Visit them. The family take them for visits, but sometimes it's just they don't want to swallow their pride and they just want to stay where they are, but they're [00:20:00] not doing well
Brittany: So, I’m curious . This might be a bit of a sidebar, but in my Grammy and Grandad's specific scenario where they were arguing it was good for them to be at home because they were happy there.
They weren't alone. So, it's a bit different, but they had each other and they had the stairs, as they said. What about for that kind of situation? Should they, is it actually good that they stay or?
Mike: Well, it's a personal decision for everybody. And I'm really. More focused on those who are alone, right? If you've got a married couple who are enjoying their lives together in their own home and they're doing okay, they are feeding themselves.
Well, they're allowing care when they need it to come in and to help of course stay in your own home as long as you can and you're enjoying it and you're not alone I would never want to and you really cannot force people out of their home. And why would you if they're [00:21:00] if it's the right place for them?
Yeah, so it's just really to take away the unnecessary stigmatization that has happened in older generations. I think the younger generations are seeing that, oh, those places are actually quite nice. Yeah. And, you know, it's quite nice not to have all the chores of, laundry and, and meal preparation, but you have all the fun of socializing, and you can come and go like it's your own place.
So, I think it's more the older people who've got this old idea of nursing homes.
Brittany: Right.
Chris: And if I can just speak financially to that, because a lot of people say, well, that's going to be $5, 000 a month or $7, 000 a month, that sort of thing. But here's what I've witnessed within my client base. Now this is referencing, you know, a BC client for the most part, maybe Alberta. When that event happens, there's typically a piece of real estate that gets sold. [00:22:00] And by the time that event happens, you're already at the stage where you're paying somebody to mow the lawn. You're paying somebody to do the gardens.
You're paying somebody to do snow removal when it's required. You're paying somebody to wash the windows. You're paying somebody to come in and clean the house. You're, you know, like there's a lot of outflow happening that didn't happen 15 years previous. And so that ceases. And then you have all this capital, let's say it's a half a million dollars even, and if it's in Victoria here, it's likely a million and a half all of a sudden, even if we go at a GIC rate of 5%, that's a fair bit of cash flow that subsidizes. So, what I have witnessed is it actually becomes net cash positive, okay, rather than net cash negative.
Mike: And also, the expense is very much dependent on what care the person needs. You can [00:23:00] have an assisted living place, which isn't, you don't have to go with the fancy, the most modern, the most expensive.
There's quite a range. Which is not as expensive. When you're getting into more nursing care or dementia care, that's getting very expensive in the private system. That's when some people transition from the private to public. Right. And there's reason for that. Could be because that can become prohibitive for some people.
Chris:So, Mike, when a person, let's say they go into a care minimum facility or a seniors living type of arrangement and the cost of private care is cost prohibitive.
Okay. So now we've had an event, and private care is cost prohibitive for the family. What we witnessed in New Brunswick was my dad was shuffled off to a hospital, which was really just a staging area. To wait to get into public care. [00:24:00] And when that became obvious to us, we moved to private care, right?
But we were sold this kind of bill of goods. He'll get better care down there. Well, no, they were going to wait until they shuffled them off to a nursing home, which there's always a big wait for. So can you talk a little bit about your experience in that and how long of a wait and what people need to expect during that Interim period.
Mike: Well, I'm sure that's a big variation across the country in British Columbia. There's quite a long wait for Nursing home care. So, this is long term care right or extended care. Yes, it just depends as well on the urgency of the situation. So, some people are prioritized Depending on what level of care they've been assessed at having.
If they're in, if they're still at home. And they're at risk and have already maximum care, they will be prioritized, and it can happen quite quickly. They won't, though, necessarily go, if it's prioritized, they won't go [00:25:00] to their choice. They'll go to the first available place. Right. At which time, if that's not where they want to stay, they can get on a waitlist for somewhere else.
But that's the situation, and it will be the situation for quite a long time, I'm sure. Because we are short of long-term care beds, like everywhere. So, in a situation where someone is in private, extended care which is very expensive and find that they cannot afford it then they've sort of got themselves into a pickle now because they're not going to be seen as a priority. They can get on a waitlist for the public system, but they'll have to wait in line in which case they are paying the price right so if you feel and The costs of these things are right up front. So, you should be able to predict these things if you feel you're only going to afford it for a year or two. Then right away get your name on the waitlist when you go into a private [00:26:00] place. When the place comes up you can say no if you don't need it.
Chris: In British Columbia, do they have that kind of hospital staging? Like, let's say you've had a medical event, you're not well enough to go home. You're waiting to get into an extended care facility. Do you kind of wait in the hospital?
Mike: We have a few places where you can go like geriatric rehab seniors rehab wards There are facilities that are used for long term care in a sort of transition way, right? So you would in order to relieve the beds in the hospital someone would be moved to one of those places which wouldn't have all the activity directors and those sort of activities that a fully fledged nursing home would have. So, we do have and you could call it a waiting area or staging area.
Yes, I've got to say some people end up staying there for a long time as they're [00:27:00] waiting for other places. The situation in Victoria is that those places are also full, so we find that people do wait in the hospital and often they will end up going to an extended care facility because that comes up before, before the transition one comes up.
Chris: So really and I appreciate your candor on that, but what I'm taking away out of this is, it’s pretty important to have your financial affairs in order if you if you want to avoid that which might even include long term care insurance.
Mike: I would say the most likely scenario right now is… Even if someone needs long term care, they're in the hospital but they need to be discharged because the hospital is over capacity. They will be sent home with maximum home care given. Especially if there's local family and the local family will be asked to help out too. And then they've got case managers who will follow [00:28:00] and if the situation is deteriorating, they will get put on a priority list for priority placement. I'd say that's the more common scenario.
Brittany: There's a few things in there I'd like to talk about, but specifically to start is that you were caring, Chris, sorry, dad, you were caring for my granddad across the country, right?
You, you live in BC, he's in New Brunswick. So, when you say my local family what is that like caring for a sick parent while being not local?
Chris: Well, in my case, and I must say that I am so grateful to my brother and sister. Yeah. My dad lives in Fredericton, my brother is in Miramichi, two hours away.
My sister is in Prince Edward Island, maybe three, three and a half hours away. And, they have carried the bulk of the load, And I'm eternally grateful But I mean, I was there seven weeks since January, [00:29:00] and you'd like to think that you function just as well on a four hour time zone difference when you're at work, but you don't.
I mean, it's challenging. I can't imagine being an only child and having your parents on the other side of the world and trying to look after them.
And I guess the other thing I took away from this is like, when my dad got sick, we all descended, all three kids. And that really is a testament of how much my mom and dad invested in us. because there was just no question. And when my dad was in the hospital.
We were by his bedside basically 24/7 for the first 8-9 weeks we were there, and some people questioned whether or not that was necessary, but we felt it was. But I saw so many other people in similar circumstances to my dad with No family around, no visitors. If somebody came, it was once a week for an hour.
And man, [00:30:00] that was hard to watch. And you definitely felt for them and tried to comfort them as best as you could.
Brittany: I imagine it must be challenging as the adult child in this scenario, to try to decipher between, in this example, New Brunswick health care system versus what you know in British Columbia and Mike, I know you've gone through this with your mother in law. Ireland. Yeah, different countries? What's that been like?
Mike: It is difficult.
It's a tough one. So, my mother in law is 97 years old, living in Belfast, Northern Ireland. And she's in an independent living, seniors’ facility, but independent living, which means they do their own meal prep and such. So, she's 97. She cannot do that. But Moira's brother has been living there in Belfast for the last seven years and that was going great until Moira's brother got cancer.
So, he's right now very ill, [00:31:00] palliative in Belfast, although the palliative treatment is working and he's stable right now. But he was doing all of the ADLs, activities of daily living. For Oma, our grandma. So, my wife has been there for 10 weeks this year already, just going back and forth to Belfast, Northern Ireland, just to help out.
And who's come up to our local heroes there are our cousins who are Irish cousins who have just risen to the front and have been just. Heroes for us. So, we are very grateful for them. But we've had to put in place as much local care as we can. People coming in to do the meal prep, people going to buy the groceries, hairdresser to come in once a week for grandma Making sure she gets up in the morning gets dressed.
She gets to go out into the lounge to play dominoes every evening with [00:32:00] her friends. So that's, she loves it there, even though it's not assisted living. She's getting as much assistance as we can curry around there. So, but it means we've got to pay them all from Canada, you know, figure out how do you pay the hairdresser from here?
And when do we go back? So, you know, we're commuting back and forth to Northern Ireland. Yeah.
Chris: That's quite a commute.
Mike: And by the way, they are having exactly, exactly the same issues as us. So, home care . They do their best, they're lovely, the Irish are just lovely people, but they have limited resources.
And they have just the same stresses as we do.
Brittany: Right.
Mike: But the issues that one goes through as a So if you're a very far away family member, you feel guilty because now we are really depending on the local cousins so you start feeling, okay, how can we, how can we repay them, you know, because we’re [00:33:00] feeling so grateful, but you know, it can't go on forever because they, they have their own lives and families.
So, it does, it does create stress that way.
Brittany: And Chris, I think I remember you feeling guilty about having to hire someone to go and visit granddad and be with him in the hospital.
Chris: Yeah. I took it upon myself when I arrived that I said, look, I'll take every night shift just because I don't have family here.
I'm here to serve was my attitude. And man, there's just points of exhaustion where I couldn't do it anymore. And so, we made the decision that we would hire someone to stay with granddad through the night sort of thing. I don't know if guilt's the right word or not, but there was a lot of relief in that for me, just physically.
And yeah, I mean, you're going to go through all kinds of mixed emotions. I don't think there's a way to avoid a lot of them.
Brittany: Yeah. So, speaking [00:34:00] of this, dad, you've explained to me a few times, some things that you might've done differently now that you've gone through it.
Chris: Well, the only thing. That I would have done differently and I think we would have had a tremendously more positive outcome Had we known At the outset that the physical affliction in my dad's neck was a result of a growth That was going to require surgery if I hadn't known that ahead of time I think we would have made the decision to load them into the car and drive them to Portland, Maine.
So go to the United States of America and have the surgery because it would have happened in the span of three days instead of three months. And therefore I seriously question whether or not my dad would have had the stroke. Because he was in so much pain, went through so much drug therapy while waiting for the surgery.
And whatever bill we would have paid would have been far cheaper than the current bills we're paying in the private care facility [00:35:00] Right. Yeah, but you don't know these things going in.
Brittany: And you don't know if it would have been different if you know, you don't know for sure. Mike, what's your experience in that?
Mike: Yes. I've had patients who've done that just because of the weight, the talking about diagnostics or maybe getting some surgery acute care, that sort of thing. And they've gone and have got it in a more timely way, and that possibly has made a difference to the outcome for them. Of course, it's not cheap. It's expensive. The quality of care, in my mind, is not better in the U. S., but the timeliness is. So, I, I can see why you would think that. It just depends on what is going on in the local hospitals and what the waitlists are like. So it would be something that you could discuss with the local, you know, the family doctor as to what do they think about The current weight for this [00:36:00] particular diagnostic procedure or surgical procedure And if they think it would make a big difference to try and get it In another way like internationally, but you've got to also take into account transporting a patient is their risk associated with that.
What's the cost of that? And Insurance if something really goes wrong. You know, in a U.S hospital. So, there's a lot of factors to take into account, but you know in your specific situation looking back I can see why you're thinking that.
Chris: Yeah, one question I have for you. When a Canadian Is in the public health care system and they opt to go to the U.S. or Mexico or wherever the case might be for treatment Is there any stigma attached to that patient when they come back and start trying to reintegrate into the public health care system here?
Mike: No. No. No. No, I've, I've had a number of people who've gone for procedures and they come [00:37:00] back and even the post surgical procedure aftercare, we do it here.
There's no stigma, we're very much respectful of the care that they would give in the U.S. So, no, it's not as though someone would be pushed aside because they rejected us, for instance. Right. Because it's not rejecting us, it's a situation where the procedure wasn't available in a timely fashion.
That's how I would look at it. And you're doing what you feel you need to do.
Chris: Yeah, good. That's good to hear because I've often wondered that, and I wouldn't be surprised if some of our listeners haven't wondered that.
Mike: Yeah, If something goes wrong with their the procedure that might be something a specialist might ask is that well, you should go back to the specialist who did this if something needs to be put right right there might be that sort of complication Right, but in terms of normal post surgical care, there would be no issue.
Brittany: So Mike before we sat down for this today, we were [00:38:00] discussing Some ways that we can support our parents as they approach their last days, as they become more elderly and go through all of these, you know, pretty stressful transitions at times.
Can you speak to that of any advice that you have gleaned over the years?
Mike: The families who've done the best are the ones with good communication, and they have these conversations. As the parents are getting older, either the parents would be open to the conversation, or the adult kids would bring it up.
That, hey, mom, dad, it's, you know, it's time we just chatted about. Things because we don't need it now, but we might in an unpredictable future. So, the conversation is really important. Whilst everything is going well. Say the scenario where there's already changes happening Like, Chris is telling you the same story again and again or forgetting things again and again. I'm thinking [00:39:00] about me and my son who says, Dad, I already told you that. What I would say, and I do say this to my patients when they come in and their adult child. Drags their parent in and frustrated, you know, my dad is asking me to repeat everything or telling me the same story again and again, basically fix him.
Yeah, this is what I'm getting and and my message to you adult child is: Get realistic. Your dad or your mom is not the same as they were 15 years ago. Don't, don't judge them though they're at their prime. This does not mean that they're not still extremely valuable and they're not still a well of experience and wisdom and love that they have shed upon you for so many years, but if they're showing signs that perhaps there's a bit of a slowdown in the memory, which is not necessarily dementia, it's just, getting older, [00:40:00] there's age related memory loss.
You need to just be kind and be respectful and be realistic, because if you keep on coming back to them, pointing it out, well, you're making them feel diminished. You're making them feel less than, whereas in actual fact, they're your parent who brought you up. And you need to see them in a very positive light in that way.
So, try not to start your judgment of them to become negative, always go to the positive. So what I like to tell people is when they come in and they're telling me basically they're describing signs of aging, not necessarily even dementia, just normal aging, I tell them, well, why don't you rather go to those wells of experience and wisdom, and why don't you say to your dad or your mom, hey, I want to learn that family recipe that you do, say, [00:41:00] your mom.
Teach me how to do that wonderful cauliflower dish you do, you know, so that you have a legacy from them. Or your dad, teach me how you do that fly, for fishing. How, how did you tie that? Or tell me how you met mum. Or tell me about your honeymoon.
Brittany: Right.
Mike: You know, do you know Brittany, you know, where your mom and dad went on their honeymoon?
Yeah, those kind of things when they're gone, you can be sharing that with your kids, right? You know, these are experiences from your own family. So try and take away the frustration when you're noticing stuff and remember, oh, this is a sign of maturity and experience said by dad or my mom and I'm going to go into that well that is in there. Instead of pointing out their little failings now go to those strengths that they still have. There are still those people with much more life experience than you have and go in and find that place and mine it for what you can [00:42:00] that's what I wish I had done With my mom and dad, both of whom have gone. By the time I wanted to know all about my family tree by then my mom could hardly remember and I can only go back maybe two generations of my family tree because I did not mine the experience and all of that wisdom that she had when she still had it.
So rather go to those positive places with your mom and dad while they're still able to give you those things.
Brittany: And to make them feel valuable in that too, right? Exactly. That they have something to contribute.
Mike: That's right. Because when you're pointing out those things, which they know, that they're not remembering great, there's no real.. We don’t need to point it out and rather go to the positive and say, Hey, let's talk about that.
Because that will make them feel much more alive, and not demeaned at all.
Brittany: Does that actually help their memory too, in any way?
Mike: Yes, [00:43:00] it does. It helps. Actually, that's a good point. There's been a lot of study in both just age related memory loss and early dementia. And there are two interventions that we can do for our elderly, which are streaks ahead of any other intervention.
You know, you can go on your computer and do mind games and play wordle and all the rest of it, but they do not compare with two things: the first thing is physical exercise. If you can get your mom or dad out on a hike regularly, well, you don't have to worry about them because they're so active right now.
But the other thing is social conversation. So, not even conversation in a sort of a formal way, but social conversation that uses a different neural pathway because people don't know what you're going to say next and then they have to find the answer to that question. So you're [00:44:00] going back and saying, hey, what did you do on your honeymoon?
What was the most fun holiday you ever had? Tell me about that. It opens up new pathways and neural pathways, which maybe have not been stimulated for a while. It is very helpful for their memories and it also helps their self esteem that you're showing an interest and you're learning too about your legacy, your family history and you can learn a lot of wisdom from them.
My dad was in the Second World War and I just wish he was more open about it. He didn't want to talk but it would have been so helpful for me. Because I ended up doing national service and I wasn't sure how to work around this, you know back in Africa. So those things for the elderly be open about sharing your life experiences. Even the negative ones because it helps us younger people know how to deal with them.
Chris: That's interesting in [00:45:00] that dad has definitely lost capacity. But what capacity has left is stuff that happened years ago.
So, we could talk about the moose hunting trip we went on when he was 80. And we could talk about the fishing trip that we went on the year that I was 13. And he took us to Newfoundland fishing and those are sort of things. And I got to spend quite a bit of one on one time with my mom when I was down on my visits, kind of caring for my dad, but I have dinner with my mom every night.
And, and I found the deeper we went back, kind of the more enjoyable that was for her. Yes. And so it's, it's interesting, thank you for pointing that out, Mike. Yeah.
Brittany: So we've talked about a few different parts of this today, but to finish up, I'm going to ask Mike, and then I'm going to ask Chris one from a medical perspective, one from a [00:46:00] financial perspective, what decisions should be made ahead of time to help families navigate?
We talked about the MOST form. What other things should I be aware of before? You know things go south.
Mike: So that's the medical directive form. Yeah, that's a basic that everyone should do but then just preferences so open the discussion about yes, it's not now because you love your home, but say it was getting too difficult. What's your feeling about the next level of care?
Maybe it's just an independent living place, but there's a senior's component there where they had some help in housekeeping or whatever. So, you've actually opened up the discussion. It actually might help them to start thinking. You might find that. And the immediate reaction is, no way, we are not going to ever do that.
But if you frame it in that, well, it's not for now, but [00:47:00] just think about, you know, how it might be if you were on your own or, or more frail, just what would your preferences be? What would you prefer in terms of living arrangements?
How much care would you like at home as opposed to going somewhere else? Right.
So whatever decisions you can make ahead of time, you should.
Chris: I encourage pretty well, all our clients do this, but across Canada, you got to recognize that there are multiple jurisdictions. So for example, your will is a provincial jurisdiction. Power of attorney is a provincial jurisdiction. The healthcare directive is a provincial jurisdiction. So they differ a little bit between Alberta, BC, Ontario, Nova Scotia, and New Brunswick. So what I'm going to say here is kind of general thought lines, but there's basically three documents:
The will, that's what controls after you're dead. It doesn't do anything before you're dead. Okay. Then you have what we would refer to as a medical power of attorney [00:48:00] or a healthcare directive. And then there is the financial power of attorney, which is, who's going to write the check when checks need to be written. So, those are three different documents, but they all touch on this end of life chapter, if you will.
Mike: Right, so power of attorney for medical conditions. That's where if you were to become incapable of making your own decisions, then they can make medical decisions for you You can do that ahead of time. Often you would do at the same time as your will.
Okay, your lawyer can do that as a separate page. Right. Who would you like to as your medical representative?
Chris: Failing to have those in place might mean that a family member has to go and become appointed as the financial power of attorney and that's great until another family member wants it. You know, like these are things that just shouldn't happen and yet they happen every day [00:49:00] You know, the good news is if you don't have a will the government's written one for you. Okay, it doesn't necessarily mean that it's gonna adhere to your wishes.
A lot of people will try and do this with the $40 will kit and I understand that if you don't have a lot of resources you know, I've got people that have net worths of 5 million dollars that want to do a $40 will kit. And that doesn't make any sense to me.
And when it comes to a financial plan, we read these documents. So we make sure that we understand them and they're fitting in with the overall program. And quite often they don't or people will tell me, well, my will says this and I'll read it. And I said, that's not what it says at all.
So it's important that maybe a second set of eyes looks at these.
Brittany: Anything else from a financial perspective that people should decide ahead of time?
Chris: The importance of having a financial projection that answers the question, am I going to be okay?
This is [00:50:00] If I have to leave my home and I don't like the prospect of waiting around to get into a public care facility I may have to go with the private option. Do I have the resources in place will I have the cash flow that will enable me to do that?
Brittany: So it almost goes hand in hand with what Mike is saying of having these discussions before things go wrong so that you're aware of what your preferences might be in the future, and then what you're saying is include your financial advisor in those decisions, even if they're not being enacted on right away.
Chris: Yeah, absolutely because if you don't have what we would call a 360 wealth strategy or a financial plan that says, you know, that is a reasonable basis as to this is how I'm going to pay for this.
Then maybe there's some things you can do now that will enable you to realize the future that you'd like as opposed to one that is going to be limited to whatever's available in the public health care system.
So another [00:51:00] thing that people kind of miss in this is typically men die seven years before women and particularly in the older generation. Women have married older men. So if there's a seven year gap there and a seven, you know, you got 14 years of widowhood. That's a long time.And it's quite typical that that happens. And I'm sure you've seen that in your practice, Mike.
Mike: Oh, yes. Yeah. And in the seniors facilities, it's a great ratio for the men. There's a lot more women around than the men. Right.
Chris: So, one needs to recognize even in a situation like my dad, like I'm grateful we have the resources, it's conceivable that one spouse could burn up all the capital and the other spouse be left destitute. If there's not a plan.
Brittany: And another thing we've talked about is involving the family. The whole couple in financial conversation so that if and when the husband leaves this [00:52:00] world the wife in this scenario feels confident, right?
Chris: Yes, and that's a good point. Particularly in the older generation.
The man of the household kind of controlled and made the financial decisions. And the woman was left in the dark. That is not a healthy scenario, so everything we can do to avoid that is very positive.
Brittany: Of course, it's not the case with everyone today. But it should be avoided absolutely. Yeah.
Mike: Yeah
Brittany: Okay to wrap up. Mike, if you could give one piece of advice to people in your demographic again caring for their elderly parents, what would it be?
Mike: I think it would be… actually, there might be more than one point. Because I'm just thinking of a few things there. The first one would be that point of realistic expectations. Go with the process that they're in. They're in a process of aging. Don't deny it. It is, it is how it is. It doesn't mean [00:53:00] that they're less of a person. Just go with it. Make it a transition… it's going to happen anyway, so be peaceful about it and stay in the positive. That'd be my first thing.
The second thing comes from some experience with many families in that there's often been water under the bridge between the parents and one or two of the children.
So, I would say reconciliation is so important before the deathbed. That's where people sometimes come and say, I'm sorry, or I forgive you. It's, I'm glad it's happening then, but just do it earlier and clean the table of any bitterness that you're holding on to. Everyone has made mistakes in parenting, we can all attest to that.
Don't wait for someone to ask for forgiveness, just forgive. If, if you're unforgiving, it's like the saying is you're eating rat poison and waiting for the rat to die, right? So, [00:54:00] just get rid of that thing that you might be holding onto against. Your parent because it's just not worth it. Once they're gone, you're going to feel even more guilty and even more regretful wishing that you had just made it right.
So, let it go. Reconciliation is important just to make sure that when the end comes, that there is peace in your heart as well as then. And one thing I've noticed is that in people in the end stage, those families with faith have such an advantage. They go through the process and there's a lot more peace.
There's a confidence that they know what's going on. So, not always, but I'm talking in a general sense. Just what I've noticed, that if you have a faith, tap into it. If perhaps your parent has a faith and you don't share it, Tap into it for their sake. Right. Because they're coming to the end of their life, so [00:55:00] what they believe for the afterlife is so important.
Even if they've not shown much interest, it's okay to bring it up because often they're thinking about it. Right. So, tap into faith. If you have a faith, you're, you have something to go to, which is very valuable. The most peaceful passings I've seen have been where people, the family is coming together, there's an acceptance of the process that's happening, and there's actually a positive, even sometimes a joyful experience.
So, it is possible. Death is a part of life. It's not a failure. So, you can have a good death. It's a death that is not surrounded by regrets, by a lack of peace. So the idea of acceptance of the death process and a confidence of acceptance… in accepting of the faith of the individual if there is a faith there. I [00:56:00] would be saying just tap into that.
Brittany: Right.
That's great. Dad, do you have a piece of advice, having gone through this a bit?
Chris: Mike just ended that so well. I really don't want to add anything to it. Yeah.
Brittany: I know, that was beautiful. Okay, we don't have to.
Chris: Yeah, I think that was just so well done. I think that's a great place to end it. I want to thank you so much. I'm grateful for you as a friend, as a client, as my doctor. This has been wonderful and I'm sure it's going to be tremendously helpful for the families that take the time to listen. Thank you.
Mike: Oh, you're welcome. Thank you. It was fun.
Brittany: Thank you to all of our listeners for tuning in and we'll see you next time.
Chris: For our audience feedback is solicited. So, send me an email if you have, be it positive or negative, including any topics you'd like us to cover in the future. And you can connect with us at AspiraWealth.com.
Brittany: And a quick thank you to Nathan Clark for composing our podcast music.
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