Your elderly client, Mrs. Smith, has suffered a fractured hip and is facing a period of rehabilitation. She’s worried.

Will she be able to return home? Will she need assistance to continue living there? Will her home have to be modified to accommodate her physical needs, or will she have to move to a long-term care facility? And what can she afford to do?

It could be a stroke or a heart attack. Regardless of the cause, these issues carry both emotional and financial implications to which financial advisors need to be sensitive. The rehabilitation period is a time to offer support by allaying your client’s financial concerns and helping him or her make decisions about the post-rehab future.

Health-care professionals and social agencies can offer assistance, both physical and monetary, and it is in your client’s best financial and lifestyle interest to take full advantage of what is offered in order to become as independent as possible.

Suffering a bad fall is one of the most common reasons a senior client may end up in rehab. In 2003, 88.6% of all hip fractures in Canada occurred in the 65-plus group, and 75% were women, according to the Canadian Institute for Health Information. Of the 28,580 individuals 65-plus who fractured a hip, 2,451 died soon after their fall. Many of those who made it went through a rehab program in a hospital or in a specialized rehabilitation facility.

Rehab patients also include amputee, stroke, burn and cancer victims. According to CIHI data, 20,821, or 71%, of the 29,345 Canadians who entered a rehab program in fiscal 2004-05 were 65 or older.

Wudneh (Woody) Baileyegn, a social worker at St. John’s Rehabilitation Hospital in Toronto, calls rehab the “bridge” between hospital and home. This transition phase following surgery or an acute illness prepares the patient to return to the community, although not necessarily to the family home. It involves physical, emotional and spiritual recovery. It may mean learning to use new equipment and learning new ways of doing things.

CIHI data show that the majority of seniors 65 and older were able to return home upon completion of their rehab program. In 2004-05, 15,753, or 76%, returned home; 3,470, or 17% required some kind of residential care following discharge. Less than 1% died in a rehab facility.

“I’ve seen people in their 80s and 90s take unbelievable falls, go through surgery and, after a time in rehab, they’re up and about again,” says Barbara Carter, president of Papillon Consulting Services, a Toronto seniors’ housing consultancy.

Treatment at provincially funded rehab centres are covered under provincial health insurance. Length of in-house stays vary according to a patient’s condition. A patient may stay as little as seven days for a joint replacement, Baileyegn says, while patients who are recovering from burns may stay much longer. Therapy may continue in an outpatient clinic after a patient’s discharge.

Initially, rehab patients may be terrified — usually because of the trauma of the accident or illness that put them in hospital — but the fact they have been referred to rehab means they are on the mend. The terminally ill are not sent to rehab.

“We stress that rehab is the route to going home, and we give them the opportunity to maximize their potential,” Baileyegn says. “When people see the positive changes that occur on a daily basis — when they start transitioning from bed to wheelchair on their own, start using the bathroom on their own, start wheeling around by themselves — their confidence grows.”

Rehab also provides your client with a team of specialists — an attending physician, nurses, physiotherapist, occupational therapist, psychologist, social worker and dietician — to help him or her and the family consider options for the future. You may want to alert your client’s family to the opportunities this will give them to voice their concerns and resolve issues surrounding the senior’s future housing and care.

At St. John’s, families are encouraged to visit and attend therapy sessions, and at least one family team meeting is held during a patient’s stay. Because the centre serves the entire province of Ontario, families of out-of-town patients can rent accommodation at a guest house on the property or the centre can arrange for preferred rates at hotels; if travel is not possible, the meetings are held by conference call.

@page_break@In family/team meetings, the patient, family members and rehab team discuss the patient’s goals, his or her present capabilities and discharge plans. “Many elderly people are very protective of their children,” Baileyegn says. “A woman may say her daughter is too busy to help her when she returns home. But when we talk to the daughter, we find this is not at all the case. A meeting of this kind gets a lot of issues on the table and resolved. At its end, we’re all on the same page, and we follow up with phone calls to family members.”

Of course, if your client is assessed as cognitively capable, he or she has the right to choose where to live. “If living at home is unsafe, we will voice our concerns,” says Baileyegn, “but in the end, the person can do as he or she chooses.”

Health-care professionals’ suggestions often carry a lot more clout with seniors than those offered by their adult children.

On a personal level, despite the safety concerns raised by her son and daughter, my mother-in-law was adamant about remaining in her home. But after hip-replacement surgery a few years ago, her rehab team at St. John’s convinced her of the advantages of moving to a seniors’ residence.

“It sometimes takes something like a bad fall to make Mom realize that she would be happier in a seniors’ residence or even in long-term care,” Carter notes. “And the people in the white coats wield a lot of power for people of that generation.”

As a team social worker, Baileyegn also discusses financial issues with patients and their families. “The Ontario government covers up to 75% of the cost of prostheses and wheelchairs, but that can mean that the patient or family has to come up with a couple of thousand dollars,” he says. “Funding may be available through the province’s social services department, and I’ll guide them to the appropriate offices. The War Amps provides funding for prosthetic devices, and you don’t have to be a war veteran to be eligible.

“Or, because of their condition, patients may become eligible for unemployment insurance, welfare or funding under the Ontario disability support program,” he adds. “Many people don’t know that they have to file a request for the guaranteed income supplement — it doesn’t come automatically. And funding for home renovations is available for people with disabilities through programs such as Ontario March of Dimes and Canadian Mortgage and Housing Corp.” IE



Support is available



> The war amps. This registered charity’s adult prosthetics program offers financial assistance toward the purchase of artificial limbs. Visit www.waramps.ca for more information.

> Canada mortgage and housing corp. The residential rehabilitation assistance program for persons with disabilities offers forgivable loans to homeowners and landlords to modify dwellings to accommodate people with disabilities. Visit www.cmhc-schl.gc.ca and look under “consumers” and “programs & financial assistance.”

> Ontario march of dimes. Ontario residents with disabilities that restrict mobility can apply for grants for modifications to their homes and vehicles under the Ontario March of Dimes’ home and vehicle modification program. Applicants with annual family income greater than $35,000 may have to contribute to the cost of their modifications. Applications can be downloaded at www.dimes.on.ca. The OMD also offers partial funding for the purchase and maintenance of mobility devices; applications can be downloaded from the Web site.

> Ontario disability support program. Ontario residents with disabilities can obtain financial assistance under this provincial program. For more info, visit www.children.gov.on.ca/CFCS/en/programs/IES/OntarioDisabilitySupportProgram/Publications/IES_officeListing.htm.