Choosing Wisely

CARP NS supporter Kevin McNamara wrote this for publication
      Choosing Wisely is a campaign to help clinicians and patients engage in conversations about unnecessary tests and treatments.
It is a program under the leadership of Dr. Wendy Levinson, Professor of Medicine at the University of Toronto ably assisted by a team of leading Canadian physicians. It is also supported by the Canadian Medical Association and all provincial medical associations.
As has been stated recently by Dr John Ross and Dr David Zitner in recent columns in this paper, patients need to be engaged if we are to improve health and use resources appropriately as well as making informed decisions about their own healthcare.. The campaign entitled " More is not always Better" helps patients learn about tests and treatments and when they are necessary or not.
Every patient and perhaps every individual should go to the site : www.choosingwiselycanada.org and review the list of tests and treatments commonly used that are not supported by evidence and/or could expose patients to unnecessary harm. I would hope that every clinician would also view the site and use the information to best treat their patients as well as an education tool to inform them of the choices and the reasons .If these were followed as appropriate, wait lists would be reduced,, those who truly require the test or procedure would be seen quicker and our resources would be available for where it is most needed.
Finally every provincial Department of Health should promote this widely to clinicians and the public as well as all politicians.
      - Kevin McNamara

CARP Nova Scotia Chapter Budget Reaction – April 19, 2016

“If this is an election budget, why has the government forgotten who actually voted for them?”
      -- CARP Nova Scotia reacts to NS Budget.

Older Worker Retraining
     Some of the expenditures in the Budget are of money that is coming from the Federal Government so it not new dollars from the Province but will provide new benefits for some seniors. Two examples are the $940,000 for “Targeted Initiative for Older Worker Program which raises the eligibility age for retraining from 54 to 64 years of age. In CARP’s opinion, cutting off a person’s eligibility for retraining at 65 years of age is unfair and, in fact, outright ageism. Many seniors must work after the age of 65 and need retraining to continue to be productive for many more years. The 64 age cap is unacceptable.

Home Support and Nursing, the Caregiver Benefit and Wheelchair program
     Another item where the money is actual coming from the Federal Government is the $14.4 million dollars listed in the budget for “Home Support and Nursing, the Caregiver Benefit and Wheelchair program”. Officials agreed that this is money funneled from the Federal Government and not new Nova Scotia dollars. And these increases will not provide any new programs or services but will simply keep up with the budget accesses that were incurred in the previous years.

Seniors Pharmacare
     That here is no more money being budgeted for seniors’ pharmacare is not surprise since no changes are expected until next year. The 3 million dollars reduced savings for some seniors quoted in the budget is welcome by low income seniors, but is a drop in the bucket towards the real need.
     In addition, specialized drugs are being reduced by $1 million yet the Health Minister said last week, he was concerned that because there had been no increase in pharmacare premiums, there would not be enough money for new, special drugs.
     CARP continues to encourage the Province to push the Federal Government for action on a National Pharmacare Plan. That is the only way to ensure that all Canadians can access needed medications regardless of income and postal code.

Increase in Income Assistance
     The $20 a month increase in monthly payments for those on Income Assistance, many of who are seniors, is welcome. But the $240 a year more does not raise the recipients’ income to anywhere near what the Low Income Level should be for them to live appropriately in an expense province like Nova Scotia. There was nothing in the Nova Scotia Budget or Government Business Plan that would create a clear pathway to retirement security with the goal of ensuring that no one faces poverty in old age.

Mental Health
     Mental health issues are a growing concern for those of us working with Seniors. More and more, CARP is hearing how isolation and low income is creating mental health problems for seniors. CARP was very disappointed that mental health spending was moved to the DHA (what will that movement cost?) but no new funds were directed to the problem.

Department of Seniors
     Although the 50+ population in Nova Scotia is growing faster than any other demographic, the Provincial Government has not returned the Department of Seniors staffing to 9 where it was a few years ago. There are still only 7 staff members. 5 are in Administration and 2 are in Program. Although two of the administrators are actively involved in a good deal of program and senior service activities, it is concerning that the Province with the highest percentage of seniors in the country does not have more staff dedicated to them. There is also no increase in the budget for grants to seniors groups in support of local programing…programs that often deliver needed services at a much lower cost than when delivered by the government itself.
     CARP Nova Scotia believes this is totally insufficient to meet the expanding needs of our seniors. We are coming to believe that the true concerns and issues for seniors in our Province are being ignored. The Government seems to now recognize we exist in huge numbers (an improvement over just a few years ago) and they seem to know that almost 70% of seniors actually vote, but it is still not "hearing" us or dealing constructively with seniors’ concerns and suggestions.

No Mention in Budget of Dementia Strategy
     After great promises and consultations on a Dementia Strategy, there is no new money – in fact hardly a mention – of the vaunted “one of the first in Canada” Dementia Strategies. Very disappointing to CARP members and their families.

Additional observations
     CARP is very much that rather than increase the budget to employ more doctors, physician fees are being reduced by $635000.
     What will be the effect of Long Term Care is being reduced by $3million.
     The Department of Health, overall is basically keeping the status quo for operations – if they can, that will be a miracle.
     CARP does give credit to the government for the tobacco tax increase... a proven way to reduce smoking for all ages.
     But gaming revenues are another source of increased revenue. CARP continues to be concerned that that money to a larger extent than most people realize comes from lonely seniors who end up at VLT machines or casinos.

     Seniors will find no joy in this budget and will wonder what happened to all the pre-election promises. If this is an election budget, it is hard to see where the government expects to engage seniors with it.

Would You Like to Share Your Opinions on Helping the Primary Care System Identify, Plan, and Care for Seriously-Ill Older Adults?

If you answered yes to the above question, you may be interested in being part of the Nova Scotia Health Authority study on helping primary care providers (e.g., family doctors) identify and care for older adults who are frail and/or living with serious illness.
We are looking for older adults 70 years of age and older who are experiencing a loss of energy, physical ability, cognition, or health issues and family/friend caregivers of older adults who want to share their views on the following subjects:
• Whether or not a computer-based method to identify older adults at risk of declining health and dying is acceptable to older adults and family/friend caregivers of older adults.
• How healthcare providers should approach the issue of identification and engage patients and their families in care planning discussions once patients have been identified as being at risk of declining health and dying.
Participation in this study would involve a one (1) hour interview with a researcher from the Nova Scotia Health Authority.
If you are interested in participating and want more information, please contact Margaret Jorgensen at 902-473-7290 or through e-mail at margaret.jorgensen@ccns.nshealth.ca

Research Summary
We all have opinions about the health care we would like to receive. As we get older and become more likely to see our health decline, it is important to talk to our family members and doctors about our future goals and wishes for care. It is also important that these conversations occur before we become seriously ill. One way to help make sure this happens is to improve the ability of doctors to spot patients that may be at risk of declining health. This would help doctors make sure that they talk to patients about their care wishes before they become ill.
As part of a larger research study, we would like to speak with people age 70 years and older who have a loss of energy, physical ability, cognition (thinking), or other health issues. We are also interested in talking to family/friend caregivers of these people. There are two things we would like to learn more about: 1. How should doctors and other healthcare providers start conversations with patients and their family/friend caregivers about declining health and planning for the future care? For example, how should these discussions begin, who should be involved, and when?
2. How do older adults and caregivers feel about doctors using a computer-based method to spot older adults who are more likely to see their health deteriorate in the next 12-18 months?
The research team includes researchers, doctors, policy leaders, students, citizens, and community partners. The information gained from this study will be used to improve care for older patients who are likely to see their health decline in a way that meets their needs, aligns with their goals and wishes, lowers stress on their family members, and improves their care experience.

CARP NS Wins Round #1 in Seniors Pharmacare Battle

On January 15, 2016 CARP was surprised and concerned to find that provincial government announced changes to the Seniors' Pharmacare Program would negatively and severely punish many CARP members. To add to the problem, the letter sent out to many seniors was viewed by many of our members as “threatening and punitive”. The communications to seniors and the responses from the Pharmacare call centre were, in many seniors’ opinions very inadequate, curt and unhelpful.

Fortunately the province announced that the Pharmacare premiums for seniors will not increase on April 1, and the maximum premium payment will remain at the current rate of $424.00 a year per person. It was too big an increase, it didn't cover the right kind of people and it wasn't fair to couples, it wasn't fair to people who receive GIS.

We were very involved in the process that led to that decision. CARP Nova Scotia has received more phone calls, letters and emails on this issue than any other since our Chapter was created. CARP members were VERY upset.

The plan as to raise premiums on April 1, based on income rather than the current one-price-for-all model. How much a senior citizen would pay also depends on whether they are single or part of a couple.

When CARP NS had originally been contacted last fall about the changes to Seniors Pharmacare we had been told that, after 8 years of no increase in premiums it would be necessary to do so. We were told the increased costs were going up 4.4% to 7.6% . CARP NS responded that we could support small, incremental increases if the minimum income levels at which seniors paid no premiums were raised from the current $18,000 to $25,500. Based on that previous agreement, we were shocked by the Government’s actual plan.

In response, CARP NS made the following requests.

1. Do not double and triple the premiums for thousands of NS seniors. Instead, provide for a gradual 5 – 7% per year premium increase over a number of years to keep up with increased costs of program.

2. Allow more low income seniors to be premium free. Raise the income levels for those who do not have to pay a premium to $24,500/yr.

3. Lumping couples incomes together is unfair and does not reflect today’s economic realities of family life. Do not us a different formula to determine premiums for seniors living as a single as opposed to living as a couple.

4. Assure anyone legitimately receiving GIS is not paying a premium. If the Province has a difference of opinion on the validity of GIS recipients with the Federal Government. Don’t put seniors in the middle of the disagreement.

5. There is no current appeal process. Implement a formal appeals process for seniors who feel their payment level is unfair.

6. Improve the communications process for any changes. Consult with the CARP NS and other seniors groups re the communications plan. Improve the poor and inappropriate call centre responses.

7. In the past few months, Government discussions with CARP and other seniors groups have often been tele-conference and not printed material or notes have been provided to us. Provide better information for our feedback and give CARP NS time to analyze the policy before it is announced and implemented.

Conclusion…for now

Although the changes have been mostly cancelled, one change will remain. Low-income seniors will have their premiums reduced or eliminated. The province estimates 12,000 people who paid a Pharmacare premium in 2015 will not pay in 2016.

Seniors on a guaranteed income supplement will continue to be exempt from paying premiums and the co-payment will remain at 30 per cent per prescription to a maximum of $382 per year.

CARP Nova Scotia will now be working hard to make sure the government gets Seniors Pharmacare right. Seniors understand there must be some sort of increase, but it should be fair to everyone. CARP will help government do it right. Our view of this is that it is a hybrid government assistance/insurance program for which there has not been a change in the cost for eight years so there will need to be some pricing adjustments.

There has not been a timetable set for future meetings. We will keep their feet to the fire.

Protection of Blue Mountain – Birch Cove Lakes

The CARP NS Environment Committee and its Chair, James Boyer, invite you to visit the website and, if you agree, contact your local councilor and ask her/him to support the protection of Blue Mountain – Birch Cove Lakes, the magnificent wilderness located on the edge of Metro Halifax.

Silver Donald Cameron receives CARP Environment Stewardship Award

The 2015 CARP Annual General Meeting featured a talk by Silver Donald Cameron. Following his speech, he was presented with the CARP Environment Stewardship Award by Keith McMaster a member of the CARP Environment Committee in recognition of his significant contribution to a greener world. Bill VanGorder reiterated that we, as CARP members, can make a difference. One way is to write to politicians at various levels.
[left to right, Keith McMaster, Silver Donald Cameron, James Boyer, Environment Chair and Bill VanGorder, CARP NS Chair]

The suggestion was made that all candidates in the upcoming federal election be asked what they can do for the environment and for other issues important to CARP members.

Hike The Greenbelt with CARP Environment Committee

Just a reminder to take advantage of the Hike the Green Belt events that are happening around metro. Hike, Bike, Canoe, Kayak, Swim, Sail, Run and Camp to show Halifax the nature we have—and what we can protect.

The Halifax Greenbelt exists, and it is beautiful. Halifax’s Green Network Plan, currently in development, is our chance to keep it. This plan is an opportunity to create an inspiring system of protected natural landscapes, but to achieve its full potential, the plan will need widespread public support.

Let’s show Halifax the incredible natural world it has. We are leading a series of hiking, biking, canoeing, swimming, running, and camping trips in a giant loop through the Greenbelt, from the Porters Lake Canal to Saint Margaret’s Bay, to raise awareness about the lands we want to see protected.

CARP NS supports the efforts of the "Hike the Greenbelt Activities" as they seek to create a buzz by attracting the greatest possible diversity of people to each leg of the trip.

You can find more information at: Hike the Greenbelt.

Debate: Age Friendly Homes vs Long Term Care

Bill VanGorder of CARP NS interviewed by CBC's Tom Murphy.

Nordic Pole Walking benefits all

| instruction | Nordixx poles | order |


Nordic Pole Walking (NPW) is an excellent low-impact exercise that offers the highest benefits for health, wellness and fitness for seniors. Nordic Walking Poles enable you to incorporate over 90% of all your body muscles.
CARP NS has teamed up with industry-leader Nordixx Pole Walking Canada Inc to offer top-quality Nordic Walking Poles as well as free beginner instruction in Nordic Walking.

Not only do Nordixx Nordic Walking Poles benefit your health, but when you purchase a pair, they will benefit CARP NS, which will receive 15% from each sale. Funds are used by CARP NS to hold events for our members and the general public on a wide range of topics including health advocacy, financial security, the environment and living well.

Visit our Nordic Walking page for more details and to order Nordixx poles.

Celebrating our Award-Winning Nova Scotians

As if celebrating the 25th anniversary of CARP (and the first anniversary of our Nova Scotia Chapter)  wasn't enough, almost 100 members gathered on December 1, 2009, at Royal Ashburn to cheer on the five Nova Scotian winners of the national "Top 25 Canadians Award".

The winners were: Redvers Cainey (Halifax), Keith Cameron (Halifax), Riet Vink (Halifax), Carol Welch (Brier Island), and Charlotte Wilson-Hammond (Clam Harbour).
[CARP NS board member Alex Handyside accepted the award for Redvers Cainey, who was unable to attend]

The Honourable Mayann E. Francis, Lieutenant Governor of Nova Scotia, told the crowd she was especially pleased that FIVE of the 25 national awards were presented to Nova Scotians.

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