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Palliative Care and Symptom Management

“Palliative care aims to improve a person’s quality of life through improved symptom management while addressing psychosocial, emotional and spiritual issues. It is care that is appropriate at all stages of a person’s illness. An interdisciplinary care team may involve medical oncologists, radiation oncologists, family physicians, palliative care physicians, social workers, dietitians, nurses, spiritual care workers and other health professionals” CANCER CARE ONTARIO

Palliative care can be separated into three stages. These stages enable the caregiver to plan and work with expected outcomes. A palliative performance scale tool was developed by Victoria Hospice Society, and is available at Cancer Care Ontario web site. Use of this tool gives the caregiver information to support and anticipate level of care required.

  • PPS level — 100% – 70% — Stable stage
  • PPS level — 60% – 40% — Transitional stage
  • PPS level — 30% – 0% — End of life stage

In each of these stages symptom management is required, the following pages cover the most common symptoms.

Pain

Pain is a common symptom in palliative or end of life care. Pain has several origins.

  • Due to the disease itself
  • Due to the investigation and treatment of the disease
  • A result of a complication of the disease or treatment
  • Unrelated to the cancer(2)

The origin of pain is not limited to the physical body, pain may be a combination of emotional and spiritual suffering, this is referred to as “total pain”. To effectively manage pain the whole person must be assessed.

A pain score, greater than 5 on a 0-10 scale requires the use pain medication, in conjunction with relaxation techniques, massage and any other therapeutic techniques that the patient and caregiver find effective. Pain medication combines opoids, anti-inflammatories, and a group of medications referred to as adjuncts in order to maintain a pain score of less than 5. In order to create a safe and effective pain relief cocktail there will be a need to involve a prescriber (Nurse Practitioner or Doctor) and a Registered Nurse to ensure effective outcomes and assess for side effects, intolerance and complications.

Emotional and spiritual pain can be a result of isolation, unresolved family and personal issues, feelings of loss, grief, alterations to independence and other changes that come with the end of life. The caregiver, should encourage communication of painful or positive thoughts and feelings, talk about contributions to life, victories in life, encourage the participation family and friends. If appropriate ask the patient how she/he wants life to end. Grief counselors are also available through palliative support groups. www.cancer.ca has links to support groups.

Spiritual pain is harder to assess as we all have varying spiritual beliefs and concepts. In the developmentally delayed population this concept may be vague therefore difficult to discuss. All humans have a concept of something greater than ourselves, understanding this concept and accepting our powerlessness to change the outcome of the life cycle may complicate pain until acceptance is achieved.

Touching, holding hands, singing and music can initiate a spiritual experience when words cannot, this connection may promote a sense of peace and serenity.

Bowels

Constipation, in palliative care is a condition that requires preventative therapies and maintenance. All cancer or palliative care patients must be on or have access to a bowel routine which includes use of laxatives and stool softeners.

Complications: unresolved constipation will lead to bowel obstruction which will require medical intervention. Constipation can occur even with reduced food intake.

Some signs of bowel obstruction:

  • Nausea and vomiting
  • Abdominal pain and distention
  • Unable to pass gas

Common signs of constipation:

  • No bowel movement after 3 days or no movement 1-2 days longer than the individual’s normal routine
  • Difficulty passing stools
  • Feeling the need to go and only producing watery stools without relief
  • Stomach distention, with stomach pain or cramping
  • Reduced appetite in conjunction with the above signs

Good bowel management starts with knowing the risks or causes. Examples of risk and causes:

  • Reduced fluid intake especially water
  • Inappropriate use or poor use of laxatives and stool softeners
  • A side effect of medications (especially opoids/pain meds)
  • A side effect of some treatments (for example chemotherapy)
  • Reduced activity
  • Part of the disease process (mechanical bowel obstruction related to a tumour)

Recommendations:

  • Daily use of laxatives and stool softeners
  • Maintain a bowel chart (frequency, type, difficulty/ease)
  • Consult with a community nurse through your GP or CCAC
  • Consult with the attending doctor or nurse practitioner

Nausea

Nausea, (and vomiting) can be caused by medications, therapies (chemotherapy/radiation), constipation and bowel obstruction. “The prevalence of chronic nausea in patients with advanced cancer varies from 20%-70%” (Alberta Hospice Palliative Care Resource Manual p.59). An accepted tool to gage the intensity of the nausea is called the Visual Analogue Scale (VAS).

Recommendations:

  • observe for nausea trends, when does the nausea occur?
  • Avoid spicy, greasy, odorous foods
  • Provide calm meal times, and small portions of food
  • Use anti-nausea medication as prescribed
  • Check for constipation, and provide good oral hygiene
  • If nausea does not improve have doctor or CCAC send in a nurse to assess

Appetite

Anorexia is a common symptom in cancer care especially in the palliative stages. There is not usually one identifiable cause, “Cancer anorexia/cachexia occurs in 80%-90% of patients with advanced cancer.” (Alberta Hospice Palliative Care Resource Manual p.55.)
Anorexia is harder on the family/caregiver than the patient. Families feel that if only their loved one will eat he/she will feel better, get stronger, live longer, support is needed to move away from these beliefs and embrace quality of life.

Recommendations:

  • Avoid forcing food. This can lead to complications such as aspiration, vomiting, abdominal distention due to poor food digestion and absorption
  • Consult with prescriber, there may be a case for an appetite stimulant
  • Encourage favorite foods in small frequent amounts
  • Use soft, pureed foods or liquid meals for easier swallowing and digesting
  • Provide good mouth care and observe mouth for evidence of thrush or ulcerations

Hydration

Hydration in palliative care is not a standard procedure or therapy. Usually there has to be a specific indication such as delirium or opoid toxicity. “Patients who develop delirium or opoid toxicity may benefit from parenteral hydration if the oral route is not feasible.” (Alberta Hospice Palliative Care Resource Manual P.48.) If hydration is ordered the most suitable route for the patient is subcutaneous, also called hypodermoclysis. Hypodermoclysis is the insertion of a tiny needle into the fat of the skin. The benefits of this method include:

  • Easier access, veins may be difficult and painful to access
  • Less invasive than IV
  • Can be given easily and safely at home
  • Site can last up to 7 days, IV sites need to be changed every 3 days
  • Less risk of systemic overload with saline (Alberta Hospice Palliative Care Resource Manual p.47)

Mood disorders

Mood disorders can include depression, anxiety, confusion, insomnia and some forms of dementia.

Shortness of Breath (Dyspnea) Cough & Fatigue

Shortness of breath (SOB) is a very distressing symptom, combined with cough and fatigue it becomes more difficult to manage and promotes anxiety in the patient and family. Mild SOB can be tolerated and may have minimal effect on the patient’s ability to be involved in day to day activities. When SOB is distressing to the individual, caregivers must engage in managing activities to promote rest and energy conservation. Often the patient’s perception of SOB is different than the observer.

“Dyspnea is an uncomfortable awareness of breathing. Like pain, it is a subjective sensation, involving both the perception of breathlessness and the patient’s reaction to it.” (Alberta Hospice Palliative Care Resource Manual p.51)

If oxygen is prescribed and available then it should be used in conjunction with rest, calm and energy conserving activities. Cough suppressants can be used (as prescribed) to reduce the cough and provide rest intervals between coughing sessions. If the cough is producing blood tinged, yellow or green sputum, there will be a need for a medical assessment as there may be a lung infection that is contributing to the SOB.

“Maintaining high fowler’s position, bed rest, good oral hygiene, and increased ventilation are all easy measures to decrease perception of dyspnea” (Alberta Hospice Palliative Care Resource Manual p.51.)

Increasing fatigue and SOB with activity and a PPS score above 50% may be an indicator of reduced hemoglobin. A PPS score of below 50% in conjunction with increasing fatigue and SOB at rest may indicate impending death. The involvement of a Registered Nurse will provide the support required to communicate with a prescriber to meet the needs appropriately.

References

    1. Cancer Care Ontario, https://www.cancercareontario.ca/en
    2. Managing Cancer Pain, The Canadian Healthcare Professional’s Reference, Copyright 2005, Perdue Pharma
    3. Alberta Hospice Palliative Care Resource Manual, 2001

Written by Aakilah Ade RN Certified Hospice and Palliative Care Consultant, 2012 aakilahade@hotmail.com

“Me in Motion” – Exercise Tips for Everyday Healthy Living

When we hear the word “exercise”, the first thoughts or images that come to mind are Health clubs, weight training and huffing and puffing our way to fitness.

BUT if you think of exercise as ‘me in motion’ what do you see—

  • Taking care of ourselves
  • Providing flexibility to prevent falls
  • Maintaining muscle tone
  • Ensuring a good blood flow to our brains
  • Boosting our moods
  • Providing a chance to meet new people and socialize with friends
  • When outdoors, providing a source of vitamin D and fresh air

As seniors, in addition to being persons with many different physical and intellectual limitations, our needs for exercise can be as individual as each of us is. Perhaps you use a wheelchair, or a walker. You might have bad knees or a knee replacement along with breathing issues, weight control issues or a pacemaker. It can really be hard for us to participate in ‘regular exercise’, so we need to look at imaginative ways to get the exercise we need.

But before we can do anything, there are a few important rules to follow.

  • Always check with your doctor. Remember to tell him what medications you are on.
  • Follow your doctor’s recommendations before starting any exercise, including checking with a physiotherapist or an occupational therapist
  • When exercising, remember to take a list of your medications and health issues so your instructor and friends know in case of any emergency.

Now that this is taken care of here are some ideas to get you ‘in motion’

  • We have many ways to get moving. We go for walks, ‘lift weights’ and do our stretches and bends.
  • A kid’s colourful parachute can be used inside or outside of the house. There are a number of websites with variations of games that can be played. This helps with our arms, stretching, breathing, and co-operation.
  • If you don’t have access to a parachute…then try things like folding pillowcases, towels, helping with bedding or folding laundry.
  • There are other chores that are part of every day living yet help with ‘me in motion’: Emptying the dishwasher (bending stretching and balance), sorting and putting away laundry, throwing folded socks into the drawer, collecting the garbage (again bending, stretching and walking.)
  • Mealtime is often a social time at home. Dinner can last a long time. It is not just about the eating. It is a time to laugh and talk about our day. It can also be a good time to get some exercise. Play a game of toss using empty medicine cups or a hacky sack ball. Don’t forget to clear the table first. This encourages stretching, arm and hand co-ordination and dexterity. Of course, there will be bouts of laughing and may require heavier breathing – both of which increases oxygen flow and relaxation).
  • During the summer months everyone can help with the gardening. If you use a wheelchair, you can help with the flowerpots (urns), hanging baskets and railing baskets. It starts with the annual trip to the nursery where everyone picks out the flowers and plants that each person wants to grow. This trip gets us a healthy dose of Vitamin D, sunshine, fresh air and walking.
  • In the cooler months and inclement weather we tend to stay indoors more. This doesn’t mean that you need to stay home though. There are plenty of malls to go to. A great chance to ‘people watch’ while you are socializing, walking and window shopping. Again, lots of exercise while having fun.
  • You do not need to buy expensive exercise equipment. There are so many things that can that be used as exercise equipment. Going to the dollar store keeps the cost down considerably. Small soft balls can be used for throwing into pails or to each other. There are many inexpensive toys available that help with co-ordination as well as stretching and bending. Those Velcro catching mitts are great for catching and throwing.

If you are not sure what activity to do, just think about all things you used to like to do. Or, you can make a list of some new activities you might like to try now.

  • But remember: be sure to wear the proper clothing and shoes for the type of exercise you choose.
  • Check to see if you need special equipment to do some activities
  • Check to see if a friend would like to join you… the buddy system makes it safer and more fun.
  • Check the area that you are using to ensure that it is well lit, clutter free and accessible to you.
  • Make sure you eat at least two hours before you exercise, drink plenty of water before and a little, if needed, during your exercise.
  • Rest when you feel the need – PAIN IS NOT GAIN!!
  • When exercising outside remember to check the weather and the air quality for your health.
  • STRETCH, STRETCH, STRETCH before and after to relax your muscles.

Here are some places to check out for ‘Me in Motion’ Links

  • Canada’s Physical activity Guide
  • Parks, forestry and recreation: Toronto parks
  • Malls for walking
  • Club 55+ in York and clubs in your neighbourhood
  • Libraries
  • Meet at the pool in your apartment building and have a group aqua fit with friends
  • Use the exercise room in the apartment building and if you need special equipment then talk to the superintendent or a committee in the building to see if they can help to get the safe equipment for you (check with ODSP too)

Submissions to ConnectABILITY.ca

ConnectABILITY News and ConnectABILITY Articles are great ways to get your information and ideas published on the internet. Here are a few suggestions that will help guide you in writing and submitting a News, Article or Tip Sheet for ConnectABILITY.

Planning your article

  • Begin by considering your audience. Who will be reading the information and how will they find it? Consider if the information may be useful to a wide, diverse range of people (age, sex, race, profession).
  • Convey the information in a way that considers the readers and their level of understanding.
  • Is the information linked to other information and tools in the ConnectABILITY library? If so, it is important not to repeat the same information. You can link the one you are writing to its partner document.
  • Begin with an efficient introduction that let’s the readers know, in a few sentences, what the article will be about. Make it known to your audience the importance of following such information and how this may lead to success.
  • All articles must be based on “best practice” and should not include personal opinions or advice.
  • As ConnectABILITY is a support to many, it is best to avoid references to specific regional services so that your information will gain a wider audience. This is just a suggestion as some articles will require specific regional information.
  • Try to narrow the theme of the article. Avoid writing lengthy articles. You can break down broader topics into several smaller articles.
  • Don’t give your audience too much information. Boil the information down for them in a short, easy to understand synopsis with enough substance to give the article value.
  • Your last paragraph should be a brief summary of the information and should also contain statements of encouragement that will help motivate the reader to try the suggestions.
  • Make sure you stick to the topic. Don’t stray off into other areas of discussion.
  • Organize the information in a logical, sequential order, as if you are describing steps. Bulleted lists are acceptable within the broader context of the article.
  • Give concrete examples to illustrate practical application of the information. This will help the audience understand it better. A picture or some type of visual may also help.
  • Speak about the reasons to take an approach to explain the thinking behind the method, and not just the method.

Adjusting the tone of your article

  • Make sure your tone of writing is conversational. Try writing like you are talking directly to another person.
  • Avoid the use of acronyms and labels, such as “client.” It is best to choose the third-person singular narrative mode, using “he” or “she” as the subject. Please do not write in the first person.
  • Make practical, friendly suggestions as opposed to being directive. Try writing about suggestions that your audience can “try” or are a “good idea” instead of a “you should”.
  • Long paragraphs are difficult and time consuming to read. Keep sentences short and make use of bullet points. Most readers tend to pass over tips that are too long.
  • Avoid jargon, short forms and acronyms. It is best to write in plain language. Think grade 5 or 6 reading level. This will make it easier for everyone to understand.

Final details

  • All sources must be referenced.
  • Include your list of links to other ConnectABILITY workshops, tools and information as well as links to other web sites.
  • The final version should be reviewed, proofed and edited by at least 2 peers with a related background within the field of expertise prior to submission. Their feedback should also take into consideration the tone and content of the article. Review by an audience member is an asset.
  • Use Canadian spelling
  • Make sure you have consent to use the visuals you have selected

Format

  1. Title case
  2. Sources
  3. Peer Reviewed By (please list reviewers)
  4. Connectability “Related information” links to existing Articles, Tip sheets, workshops etc. on ConnectABILITY
  5. External web links
  6. Disclaimer (if needed)
  7. Abstract (short 2 sentence description)
  8. Key words (related tags)
  9. Age sections your article should appear in (Kids, Youth, Adults, Seniors)

All submissions will be subject to review and final approval by the ConnectABILITY Content Committee.

ibelong.ca

Everyone needs friends
If you are a young adult with an intellectual disability who wants friends, this website is for you!

You will find videos, stories, ideas and resources about how to make friends. You will also find information for others who want to help you form lasting friendships.

www.ibelong.ca

Money Matters

Banking

What is Money?

Money is what you use to buy things. Over time we, as a society, have agreed on how many “dollars” are needed to buy each item. We know it works because we have used it over and over for all kinds of things. It is by learning these concepts and gaining experience with making transactions that we begin to learn skills that will support independence in the future. Read more >>

Money Master

How good are your money handling skills? How fast can you give change?
http://www.mathsisfun.com/money/money-master.html (Click on “Canada”)

Peter Pig’s Money Counter

Practice identifying, counting and saving money while learning facts about Canadian currency with this innovative and engaging game.
https://www.practicalmoneyskills.ca/games/peterpigs/

Knowing where you spend your money

Whether you have a disability pension (for example, Ontario Disability Support Pension – ODSP) or you receive a pay cheque from employment, the money you have available to use is likely limited. Before you can set up a budget, you need to know where you are spending your money. Most people do not have a good idea of what they are spending their money on. Read more >>

Simple Strategies to Help Save Your Money

After paying for the basics – rent, food, transportation, personal needs and clothing, there is usually not much left over. Here are some strategies that could help you save money for that trip or the new TV that you have always wanted.

Read more >>
Play

Additional Resources:

  1. Daily Money Log
  2. Expense and Income Summary Form

 

How to budget your money to cover all your expenses

When you only have so much money, it is important to ensure that you are able to pay for your basic needs, your fixed costs and still have money to save or spend on entertainment. Here are some strategies to figure out where you are spending your money, how to create a budget and how to keep on budget.

Play

 

 

Creating a Budget

Budgeting your money is important because it is a way to make sure that you have enough money for your basic needs such as food, clothing and shelter. It will help you to avoid owing money to friends, credit card companies, or banks. It can allow you to put money away for a big purchase like a vacation, a piece of furniture, or something else that you want or need. Read more >>

Additional Resources:

  1. Personal Budget Plan
  2. Download: Monthly Budget Calculator (MS Excel)
  3. www.free-financial-advice.net

Personal Banking

Personal Banking

Here are some strategies to use to be smart and safe in your personal banking including why you should have a bank account, how to choose a bank and the type of account, how to use a debit card safely, how to cash a cheque, how to be safe using online banking, and choosing a good PIN number and online password.

Play

Why Everyone Should Have a Personal Bank Account

While having someone else have control over your finances might seem to make your life easier, there are some important benefits to having your own bank account. These reasons include employment, cashing cheques, reputation, safety and accessibility. Each of these reasons is explained in more detail below. Read more >>

How To Open a Bank Account

The first thing to consider when opening a bank account is which bank you will choose. Think about what is important for you. It is important to consider how you get your money and your daily schedule and routines. Read More >>

Debit Cards, Online Banking and other Bank Account Information

When you open a bank account, you will be given a bank card that you can use to access your money. This is also called a “debit card”. When you receive the card, you will be asked to choose a four digit Personal Identification Number (PIN) that you will key in whenever you use your debit card. Protect your PIN number by not writing it down. Be sure to memorize the number and remember to never share it with anyone else. Read More >>

Making a withdrawal at the bank machine (ATM)

Bank machines make it easy to take money out of your bank account. Here are step by step instructions on how to withdrawal money from an ATM. All of these steps will be required to take money out of the ATM. However, the order you do the steps may be different depending on the ATM you are using. It is important to follow the instructions provided on the screen of the ATM each time.

 

Making a deposit at the bank machine (ATM)

Bank machines make it easy to deposit cash or cheques into your bank account. Here are step by step instructions on how to deposit money into your bank account using an ATM. All of these steps will be required to deposit money using the ATM. However, the order you do the steps may be different depending on the ATM you are using. It is important to follow the instructions provided on the screen of the ATM each time.

 

 

How to Get an Ontario Photo Card

Ontario photo card

Ontario introduced a new photo card that will provide government-issued identification to more than 1.5 million Ontarians who do not drive. The Ontario photo card makes it easier for non-drivers to perform everyday activities such as cashing a cheque or returning items and goods to a store. Read More >>

How to Cash a Cheque

When you receive a cheque, you need to cash it. The best way to do this is through your own bank account. If you do not yet have a bank account, see the article titled “How to open a bank account” for instructions. Depending on the account you have, cashing cheques will not cost you additional money. You can cash the cheque at either the teller at your bank branch or by using an Automated Teller Machine (ATM) at your bank. When cashing a cheque you need two things: 1. Your bank card 2. Identification. Read More >>

 

Spending Strategies

Spending

Spending money is something everyone does. Here are some strategies to help you be smart when you buy things and some ideas of what you can do if you find out that you have spent more money than what you have available.

Play

Different Ways to Buy Things like Goods and Services

In today’s world we have many different choices on how we can pay for something we want to buy. This section will explain many of the options people have to do this. Read More >>

Purchasing Smart

Spending money is something everyone does. Spending is a combination of things we have to pay for and things we want. Every month we have to make sure we leave enough for necessities. Making your budget is the easy part. The harder part is sticking to your budget. There are many stores and places you can spend money. Read More >>

What Happens When Everything Goes Wrong With Your Spending

Sometimes, your financial situation gets so out of hand that you don’t know what to do. You have not been watching your spending and it creeps up on you.

You might realize that there is a problem only when you get a letter from the phone company, the bank or the collection agency. In one situation, for example, a problem with unpaid taxes was only noticed when the property bills were found in the person’s drawer while she was in the hospital. Read More >>

Additional Resources

Money Matters by ABC Life Literacy Canada

Money Matters is a free, introductory financial literacy program designed for adult learners. We work with organizations like learning centres, libraries, settlement agencies and so many more, all across Canada that run Money Matters workshops in their community. https://abcmoneymatters.ca/

Simple Strategies to Help You Save Your Money

How often have you wanted something but did not have the money to purchase it? If you are receiving a disability pension or are employed in a low wage job, this probably happens quite often. After paying for the basics – rent, food, transportation, personal needs and clothing, there is usually not much left over.

Here are some strategies that could help you save money for that trip or the new TV that you have always wanted.

  • Keep a savings jar or a Piggy Bank available for your savings. You can even take a picture of an item that you are saving up for and tape it to the outside of the piggy bank to remind you why you are dropping money into the bank instead of spending it.
  • Open a savings account and deposit a set amount each month or whenever you have extra money. Some banks offer a savings account that requires you to transfer the money to a chequing account in order to take it out. This makes it more difficult for you to spend it on short notice.
  • Link your saving to the goals you have set out for yourself in your Person Directed Plan. This will help you achieve your goals as well as making sure that YOUR money is working for YOU.
  • Pay yourself first. Make it a habit to always put away a little of your income whenever you get it. Add this item to your weekly budget. This could be a percentage of your income or a flat amount – say $2.00. Put the money in a jar or a piggy bank for a rainy day. If you put away $2.00 each week, you will have $104 in one year.

    Simple savings calculator

    Tip for Staff/ Caregiver: It is never too early to start using this strategy. Over time, this becomes a habit that will serve the person well all their life.

  • Save with coupons. When you redeem coupons or purchase items on sale, don’t spend what you save – save it. Put the amount you saved into your savings jar or piggy bank.
  • If you get $20 for your birthday, save $10 and spend $10. If you have two extra loonies, save one loonie and spend the other.
  • Every evening when you come home, put any coins or change you have in the savings jar.
  • Take a look at your daily expenses. That coffee at Tim Horton’s cost you $1.50. Decide how important that coffee is to you. Would you rather have that new flat screen TV? If you put that $1.50 into your savings jar each day you would have $540 in just 1 year.
  • Check out this Spend-o-meter to see how much these habits cost you

How to be watchful and save money

  1. Instead of buying your lunch each day, bring your lunch to school, work or day activity. Put the money you save into your savings jar.
  2. It is much cheaper to make your own coffee or tea at home and use that money for something else.
  3. Take a look at your regular monthly expenses for cable or phone. Do you watch all the channels you are paying for or could a lower cost cable package be okay?
  4. Instead of buying newspapers and magazines, you can read them on the internet or if you don’t have a computer, you can go to the library and read them for free. At the library, you can also take out C.D.’s, D.V.D.’s and videos to watch and listen to.
  5. Going out to a movie can be expensive. Plan your own movie night at home with friends by getting a video from the library or renting one. If you have cable television, you can record movies shown early in the week to watch on the weekends. Make some popcorn and enjoy!
  6. Board games and card games are an inexpensive form of entertainment.
  7. Garage sales and thrift stores are good places to find bargains like board games, clothes, household items, etc. Make sure you check out the items very carefully to ensure that they are not broken or just junk.
  8. In the summer, local parks often have free entertainment like concerts and festivals.
  9. Check with your local community swimming pools and skating rinks and find out if they have free swimming or free skating at special times of the year like Christmas and March Break. Community centres may also offer free activities.
  10. Libraries, museums and galleries sometimes have exhibits that are free. Even if you have to pay for a special exhibit, there are often tickets offered at a cheaper price. Always look for discounts. For example, movie theatres may offer lower ticket prices before noon or on certain days.
  11. Dollar stores offer a large variety of items at a low cost. Make sure you check the quality of the item before you buy it. Some things may not be made very well and will fall apart quickly once you use them.

Saving Money When Grocery Shopping

  • Do not go to the grocery store when you are feeling hungry because you may buy things you don’t need.
  • Try not to buy groceries from a corner (convenience) store because they are more expensive than a regular grocery store.
  • Look for weekly specials in the grocery store. Go through grocery flyers to see which stores have deals on the items you need.
  • Make a list when you go grocery shopping and only buy the items on that list.
  • Coupons can save you money or get you items for free. Purchase items when they are on sale and have a coupon for that item to save even more money. There are many websites on the internet where you can print coupons for food as well as other things. Here are two websites:
  • Do not buy more food than you can eat, even if it is a good price. No one likes to throw food away.
  • Try generic brands of food such as “No Name”, “Equality”, “Selection” or “Our Compliments”. They are often just as tasty as name brands and are often cheaper.
  • Look at other brands for the same product. They are often the same quality but cheaper than the most popular brand.
  • Look for items on clearance that have been marked down in price. These may be located in a shopping buggy or on a shelf with a sign that says “Marked Down” or “Clearance”. On groceries or food, be sure to check the Best Before Date so that you are not buying spoiled food.
  • Buy frozen vegetables. That way, food won’t go bad if it isn’t eaten fast enough after you buy it.
  • Most products identify the cost per unit of product (e.g. per 100 grams). This is usually located on the shelf below the product. Use this to compare the cost of different brands of the product.
  • In the summer and fall, buy fruits and vegetables from the farmer’s market. They are cheaper and fresher than buying them at a grocery store.
  • Shop at a bread outlet if possible for bread, baking etc.
  • Use reusable cloth grocery bags when shopping so you don’t have to pay for plastic bags. It is better for the environment.

Creating a Budget

To budget your money means to plan out how much money you have and how much of your money you spend on certain things.

If we have money, why can’t we spend it until we run out and then wait for more?

Budgeting your money is important because it is a way to make sure that you have enough money for your basic needs such as food, clothing and shelter. It will help you to avoid owing money to friends, credit card companies, or banks. It can allow you to put money away for a big purchase like a vacation, a piece of furniture, or something else that you want or need.

In order to do this, you have to “live within your means” which means you have to make decisions about where to live and where to shop based on how much money you have. You can not spend more money than you have.

Let’s talk first about basic needs and what that means in your life:

  • Food → groceries from the store. You need a variety of food types to help you stay healthy.
  • Clothing → clothing that is suitable for the weather, your job, etc.
  • Shelter → this usually means paying rent. This is something that is very important to maintain and to pay every month. Unless you find a different living situation you cannot adjust this on a daily basis. With food and clothing, you can often shop at a cheaper grocery store, shop for things on sale or buy second-hand clothing to reduce your costs. Not paying your rent can get you evicted and you will have no where to live.

Before anything else, you need to put aside money to cover these costs.

Creating a Budget

Now that we have talked about why it is important to budget your money, let’s look at how you create a budget.

A budget is a document that lists what your income is every month, and what you spend your money on each month. Ask someone you trust to help you plan your budget. You can use the Personal Budget Plan template provided. Your monthly budget should be updated at least once a year or as changes occur.

It is simple, so keep it simple.

  1. First, at the top of the page write down all the money you bring home each month. This could be from:
    • A job
    • A disability pension (ODSP in Ontario)
    • An inheritance
    • Help or support from a family member
  2. Then, write down everything you spend money on each month. See the article “Knowing where you are spending your money” for easy instructions on how to do this.

    These include both fixed costs (things that cost the same each month, such as cable, rent and phone) and variable costs (costs that will change constantly such as food, going out). Most people remember their rent payment but often forget the newspaper they buy on their way to work each morning.

    Record how much you need for your basic needs. These include rent or other housing costs, food, transportation, clothes and phone. This can be a little more complicated than it sounds. Your basic needs are necessary for survival but how much you spend on those will determine how much money you will have left for everything else:

    • Going out – entertainment, special events
    • Hobbies/sports
    • Special items (household, personal)
    • Hygiene items – toiletries
    • Gifts for loved ones
    • Saving
    • Anything else

    Let’s apply what we know so far to an example:

    Susan has $1500.00 of regular income every month. If Susan found a place to live that cost $1200.00 in rent every month, would that be “living within her means”?

    Let’s calculate to find out: $1500.00 – $1200.00 = $300.00 – that takes care of one basic need – shelter. This would mean Susan would have $300.00/month for everything else.

    So after paying her rent, Susan needs to grocery shop and spends $150.00 at the store on food for herself for the month – this covers a 2nd basic need: food $300.00 – $150.00 = $150.00

    Susan also likes to have lunch with her friend every Saturday at the diner and spends about $60.00 a month from the remaining $150.00 – $60.00 = $90.00

    Winter is coming and Susan needs a new winter jacket and clothes so she spends her last $90.00 on that. This covered her third basic need: clothing $90.00 – $90.00 = 0

    It is now October 5th and Susan has NO more money to spend for the month.

So sometimes, you need to go over these steps again and again until you come to amounts that you are comfortable with. The exercise in step 3 of “Knowing where you are spending your money” might be helpful in figuring out how much to set aside for each of the spending areas of your budget.

The budget of a person who is living on their own or sharing an apartment and is receiving a disability pension (ODSP in Ontario) could look like this:
$20 to $30 per week in personal spending
$75 per week for groceries
$30 per month for laundry
$110 Bus metro pass per month
$30 phone bill per month
$40 cable bill per month
The remaining money is for rent, clothing and savings

Strategies to keep on Budget

Once you have your budget in writing, it is important to put it into action and make it work for you. Here are some strategies to keep you on your budget:

  • If you have problems living within your budget, ask for help from someone you trust. Money smarts is a learned skill and there are many ways you can learn how to manage your money. A trusted staff, family member, friend or the Public Guardian would be good choices.
  • Even if you can manage your budgeting yourself, it is always good to have someone take a look at your money situation every once in awhile (monthly or every 6 months) just to make sure that everything is going ok.
  • Use a ledger or note book daily to record the amounts you spend and the amount of money you have left. This makes you aware of how your daily / weekly money is being spent.
  • Be on the lookout for ways to reduce your monthly fixed costs.
    • You can bundle your cable/home phone/cell phone/internet with one provider
    • Look at your package with the provider. Do you need all the services such as call display, call waiting, or all the channels that you subscribe to on your cable?
    • Compare prices with other providers and services. Shop around for the best competitive prices in regards to interest rates and between different cable and phone companies.
  • Look for ways to save money on things you are buying. See the article “Simple Strategies to Help You Save Your Money” for ideas you could make use of.
  • Take a look at your personal spending. Is something really necessary or is it just a habit? For example: An individual shares a 2 bedroom apartment with another person. For years, both individuals would buy the same newspaper on a daily basis. After this was pointed out to them, they decided to share the cost of buying one newspaper and put the money they saved away for something else.
  • Some people need and appreciate a little more structure and help to enable them to save. Perhaps, lock up money in a box for major expenses (i.e. clothing, apartment needs, gifts, vacation) and give the key to a person you trust.
  • An option many people use to ensure that their rent is paid is to set up the rent to be paid directly to your landlord from your pension allocation.
  • Open 2 bank accounts. On one account (a co-signed account) your staff / parent would also need to sign for money to be taken out. On the other account, a personal spending account, you would be the only person who could take out money. For example, let’s say you have calculated a 4 week supply of spending money to be placed in the personal spending account. After each 4 weeks, the money would be transferred from the co-signed account into the personal spending account. This really encourages you to learn how to budget, but does not put at risk the ability to pay for basic needs such as rent and food.
  • If you make bill payments by cheque and have difficulty remembering how to complete the cheque, have someone you trust fill out a sample cheque. You can copy from it each time you need to complete a cheque. If your writing skills are poor, have your trusted helper complete the cheque each time and you can sign it.
  • Some stores and credit card companies provide an option to use a pre-paid card. You can only purchase up to the dollar amount that has been pre-loaded onto the card. This could help ensure that the needed purchase is made and the money is not spent elsewhere. A grocery store is a good place to use this.
  • Motivate yourself to spend less than the amount you have put into your budget to spend. You want to be happy about how you spend your money. Include in your budget an amount you want to save for the month. Remember to reward yourself each month you achieve your saving goal. Go out for dinner or buy a shirt that you have been looking at.
  • Some people find it helpful to use envelopes with different amounts of money that are set aside for different purposes. For example an envelope for groceries, one for clothing and another for entertainment.
  • You could buy money orders payable to yourself for your weekly expenses and you could cash one each week. That way you would not have the cash easily available. However, you will need to pay extra money to get a money order.
  • You could give your ATM card to a trusted person, without sharing the PIN number and only have access to the card once a week to do your banking.
  • Consider opening a savings account that is difficult to access such as an account where you would need to first transfer the money into your chequing account in order to take it out.
  • If you have a tendency to spend whatever you have quickly, you could divide your weekly spending money into two or more envelopes so that you are not tempted to spend it all at once. Doing this could give you money to spend throughout the week.

Whatever strategies you decide to use, they need to work for you. Everyone has different habits and ways of doing things. You need to believe that you can change that habit and that you will be better off by changing it.