B.C. needs a Consent and Capacity Board to prevent seniors’ loss of liberty

Unlike Ontario, B.C. doesn’t have a Consent and Capacity Board. That means seniors, or in fact anyone, can be deemed unfit and their lives handed over to the state.

And while there are good reasons why some persons should be deemed unfit in the management of their affairs, there is little recourse once it’s done.

Once a person is declared unfit, a “certificate of incapability” is issued and their assets seized.

The prospect that I could lose my autonomy, and be institutionalized with little recourse, is not what I imagine my “golden years” to be like.

But that’s what happened to Muriel Shaw, in her eighties, of Coquitlam, B.C. It began when her son Jarvis was concerned for her health and took her to the hospital. Jarvis thought his mom didn’t seem herself: she was anxious and confused—“just acting strange (Walrus, March, 2020).”

Hospital staff decided to give her a “capacity assessment”: a common evaluation administered to people who seem disoriented. The assessment consists of questions like, “What is today’s date?” and “What problems are you having right now?”

Muriel failed the assessment. She was deemed to be incapable of making her own decisions and a certificate of incapability was issued.  From that moment on, Muriel Shaw’s autonomy was taken away for good.

A capacity assessment is an imprecise instrument considering the consequences -robbing someone of their liberty. You can take my temperature to see if I have a fever but no capacity assessment can accurately measure my ability to manage my own affairs.

And even if my ability could be accurately measured, it would be essentially a medical evaluation. A medical evaluation should not have legal consequences in the seizure of my property and assets.

A condition of anxiety and confusion can be temporary. Muriel, living alone and survivor of breast cancer, could have had some treatable medical condition.

Things just continued to get worse for Muriel. She wanted to go back home but wasn’t allowed. Her care workers looked to family to see if they could take her. When no suitable place was found within her family, she was placed in a long-term care facility.

When her family couldn’t agree on the management of her finances, the B.C. Public Guardian and Trustee (PGT) took over.

The PGT took control of Muriel’s finances and charged her four per cent of her income for doing so. If the PGT decides to sell one’s home, they will collect four percent of the sale price, as well. She was angry at the loss of autonomy.

B.C. needs a Consent and Capacity Board like Ontario’s. If we had one, Muriel could have taken her objections to the board and they would have convened within seven days, and met at a place convenient for her.

Bob’s case is an example of what Ontario’s board can do. “Bob” was assessed by someone who had little knowledge of his medical, financial, or personal history. The assessor met Bob in a Tim Hortons and noted that he was “vague” in his responses to questions. Bob was asked to count coins she gave him under the table. When he failed to accurately to do, the assessor unilaterally decided that Bob was incapable of handling his finances.

The board found that the assessor, while well-intentioned, made “made a number of assumptions that were proven erroneous.” Bob regained control over his bank account and his life.

Seniors in B.C. need a Consent and Capacity Board that could prevent incorrect assessments and capable seniors being made wards of the state.

Kamloops needs a homeless sleep centre

Kamloops agencies care for the spiritual and physical needs of our homeless: faith, food, warmth in the winter, air conditioning in the summer.

credit :SeanShot. Getty Images

However, there is no place to get a decent sleep.

Accommodating the sleep needs of the homeless is often regarded as a “nice to have” feature. But sleeplessness can reduce the immune system, put people at greater risk of diabetes, high blood pressure, heart disease, kidney disease, stroke, and neurodegenerative diseases such as Alzheimer’s.

The homeless are disproportionately affected. Almost one half suffer from insomnia.

Sleeplessness affects more than the physical health of the homeless. They already suffer from anxiety because of their precarious lifestyle. Mental illness further compounds anxiety. Sleeplessness adds to that.

Insufficient sleep impairs the mind, hampering decision making, memory, and mood. A recent study found that adults who stayed awake for just one twenty-four-hour period had an anxiety response 30 percent stronger than others who were allowed to sleep (Walrus, December, 2019).

Shelter staff and volunteers experience first-hand the frustration and aggression of the homeless resulting from exhaustion. Shelters are not designed to provide long, flexible hours of sleep.

Sleeping on park benches, doorways, and bus shelters is frowned on. Municipalities install “hostile” architectural elements, such as tilted benches and street spikes, which are intentionally designed to prevent people from lying down.

Social stigma and aggression from passersby can worsen the situation for anyone trying to find rest in a bus shelter or on a park bench.

I find public sleeping disturbing, except in certain circumstances such as at the beach or on a blanket in a park where a picnic is obvious. When I see someone sleeping on a sidewalk, I have mixed feelings of sympathy and offense at the encounter of an unconscious body.

Social norms determine when, where, and with whom people should sleep. Those norms are spelled out in shelter rules, loitering regulations, and policing practice. That leaves street people socially ostracized.

Street people often self-medicate with alcohol and drugs to get some sleep. But alcohol and drugs operate in a negative feedback loop. They provide the illusion of inducing rest but actually disturb sleep, leaving people more tired, more likely to feel pain, and more inclined to self-medicate.

Restaurants have varying policies regarding sleeping. The ones that I go to on the (North) Shore allow sleeping. I won’t name them because I don’t want to infer official policy. I often see a transient young person with their head down on the table, asleep. Somehow, I feel more protective of young people so obviously sleep deprived –perhaps for the same reason I feel protective of children or because I, too, have hitchhiked globally and experienced “rough sleeping,” as the Brits put it.

A good sleep for the homeless is not a trivial problem. The median cost of each homeless person to Canadian society is $55,000 per year and half of that goes to health care, more to policing and social services. In Kamloops, that amounts to $10 million for the approximate 180 homeless people here.

A good night’s sleep for the homeless would cut health and policing costs, reduce the wear-and-tear on shelter staff and volunteers, remove disturbing bodies from our streets and give the homeless what we all wish for ourselves –peaceful slumber.

Eat your vegetables, feed your microbiome

Your mother was right: vegetables are good for you. Not only do they contain essential nutrients but they also feed your microbiome with fiber.

For each of our body cells, we carry around ten microbe cells. In this light, the definition of “we” could be refined. It would be more appropriate to state that we, the microbiome, tolerate the conceit of body cells to suit our own needs. The body cells of so-called civilized societies haven’t been serving us well. Our population has declined in comparison to those in the majority world who eat more fiber and take fewer antibiotics.

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It’s counterintuitive that modern societies, while relatively free of infectious diseases that cause inflammation, suffer from inflammatory diseases. Antibiotics have reduced deadly diseases while inflammatory, autoimmune, and allergic diseases are on the rise. If infection is not causing these diseases, what is?

It seems that we (microbiome et al) have traded one disease for another. In reducing infectious disease with antibiotics, we have killed off the bacteria that suppress autoimmune diseases such as asthma.

Brett Finlay, a microbiologist at the University of British Columbia, explored this connection. He found that mice treated with the antibiotic vancomycin had an increased risk of asthma later. The antibiotic had killed beneficial bacteria that are part of the clostridial group.

The clostridial group is related the scourge of hospitals: Clostridium difficile which causes death by diarrhea. But where C. difficile prompts endless inflammation and bleeding, bacteria in clostridial clusters do just the opposite—they keep the gut healthy and soothe the immune system. Moises Velasquez-Manoff explains in Scientific American:

“Scientists are now exploring whether these microbes can be used to treat a bevy of the autoimmune, allergic and inflammatory disorders that have increased in recent decades, including Crohn’s and maybe even obesity.”

The exact cause of inflammatory bowel disease remains a mystery but the picture is becoming clearer. Finlay’s findings confirm earlier results from Harry Sokol, a gastroenterologist in Paris. He ran laboratory tests on his patients with Crohn’s disease, a chronic inflammatory disorder of the gut.

All his patients had one thing in common –a scarcity of just one common bacterium, Faecalibacterium prausnitzii. Rather than “bad” microbes causing disease, maybe a could a single “good” microbe could prevent disease. Studies suggest that antibiotics may deplete the very bacteria that favorably calibrate the immune system, leaving it prone to overreaction.

Our microbiome is more integrated into ourselves than previously thought. The state of our gut influences our state of our mind. Happy bacteria love munching on plant fiber, something we get too little of. Some of the byproducts of this munching include neurotransmitters and metabolites that act on the brain.

Our brains respond through the brain-gut connection, the vagus nerve, to help calibrate our immune system. Studies on mice with sterile guts by John Cryan, a neuroscientist in Ireland, indicate how profound the effects of our microbiome is. He found that sterile mice lacked the ability to even recognize other mice with whom they interact.

We kill off gut bacteria with antibiotics, and fail to feed them with fiber at our peril; leaving us susceptible to  anxiety, depression and even autism.