Showcasing what's happening in healthcare ... around the corner and around the world
Awaken To Your True Self updated August 1, 2010 7 Things you can do to get in touch with your Self Life is a story we weave together from the thoughts, feelings, and emotions we experience each moment. Yet we live the majority of our life in the memories of our past and the expectations of the future. Rarely do we live in the purity of the present. These past memories and future expectations that we embrace throughout the course of our lives are what breed the stress we feel each day. In fact, the average person is a bundle of conditioned reflexes and nerves, constantly triggered by situations and circumstances. Often the circumstances are simply the ups and downs of living each day. But there are times in our lives when the stresses, pressures, disappointments, and anxieties can become overwhelming. As we weave through life, some people find themselves in relationships that have become toxic or end unexpectedly; in other instances, life-long careers stop being nurturing or stop all together; and there are even times in our lives when imbalances in our health and well-being can suddenly start to manifest themselves as states of dis-ease. So often we have defined ourselves as the roles we play in particular relationships or jobs. For example, “I am a mother,” “I am a wife,” I am a manager,” “I am a vice president.” When, for whatever reason, these roles and aspects of our lives – which we have used for so long to identify ourselves and bring us self-esteem – stop satisfying our needs, we can feel a sense of loss, emptiness or confusion. No matter how lost we have become in the stories our ego-mind is telling us, there is always a way back to our true Self. In truth, we can never actually lose our connection to our Self because our essential nature is pure consciousness. The real Self exists outside the boundaries of time and space, has no beginning or ending and is therefore immortal. Each of us exists as a ripple in the conscious intelligence field that gives rise to everything in the universe – our bodies, the stars, the galaxies, and all else. Since we are an inseparable part of this underlying field of intelligence, we are also the source of all reality. In every moment, we are co-creating our world with God, the universe, or spirit. dr. deepak chopra Who Is ? on this topic Medicine Wheel Energy And Medicine Awaken Your Inner Pharmacy Understanding Integrated Medicine on related topics The Journey Bounce Back Epigenetic Healing Humor For Health What Good Lovers Know Healthy Mind, Healthy Body Moving From Wrong To Right Relationship Both the ancient wisdom traditions and modern science tell us that our bodies, our minds, and the physical world are projections of our consciousness. Only consciousness is real; everything else is its projection. The ancient Vedic scriptures say, “You are not in the world; the world is in you.” It is only the veil of illusion – known as maya in the ancient yogic tradition – that keeps us from seeing that everything is pure consciousness. When we pierce the veil, we discover the spirit in everything and have access to unlimited creative potential.   Practices for Awakening Intuition, attention, imagination, intention, inspiration, creativity – these are the raw materials of consciousness. With them we can mold our personal reality, and shape our collective reality as well. The following universal principles will help you become aware of how you create your reality, and will empower you to transform or let go of whatever is no longer serving you. Choose one principle to focus on each day and commit to applying it in your life: 1: My true self is pure, unbounded consciousness. I will remember that thoughts come and go, but the core of consciousness is forever. Today I will experience myself beyond limitations. I will set aside time to be present with myself in silence. I will experience myself as love, as a light that flows from my heart and spreads out into the universe as far as my awareness can reach. 2: The events in my life reflect who I am. I will choose one thing that happens today and see how it mirrors my self. If I feel angry at someone, I will consider if what I dislike about that person actually exists in me. If an overheard conversation grabs my attention, I will take those worlds as a personal message. I will look at the world inside me. 3: The people in my life reflect aspects of myself. Today I will look at my friends, family, and everyone I meet as a group picture of me. Each person stands for a quality I want to see in myself or want to reject. I learn the most from those I intensely love or intensely dislike. 4: Whatever I pay attention to will grow. I will take an inventory of how I’m using my attention. I will keep a log of my activities to find out how much time I spend on television, the Internet, hobbies, gossip, work I love, work I dread, activities that fulfill me, or escapist fantasies. I will ask myself, “What do I want to grow in my life?” The answer will tell me how my attention needs to shift. 5: Nothing is random – my life is full of signs and symbols. I will look for patterns in my life. They could be anywhere – in what others say to me, the way I react to situations, how I am treated. I will open my awareness to hidden beliefs that shape my reality. Do I meet opportunities for success or failure? These are signs of whether or not I believe I have personal power. I will look for signs about my belief in whether I deserve love – or not. 6: The universe always gives me the best possible results. Today I will focus on the gifts in my life. I will show gratitude for what it working rather than dwelling on what is not. I will notice how my own level of awareness shapes my perception of the world I am co-creating. 7: My inner awareness is always evolving. Today I will ask myself how far I’ve come on my chosen path. Where do I stand right now? Where am I going? Even if I don’t see immediate external results, do I feel that I am growing inside? I will set my intention on moving from constriction to expansion. Do you know a colleague who would be interested in this ? Click on the button (top left) What are your thoughts? Send us your comments using the postform below:
A Case for Action on Chronic Health Conditions updated March 1, 2010
Do you know a colleague who would be interested in this ? Click on the "share" button (top left)
The first International Rare Disease Day was February 29, 2008. As the headline in the National Post pointed out on February 28, rare diseases are “rare” in name only. The article states that there may be as many as 7,750 types and some will affect as few as 20-30 Canadians but “taken as a group, however, at least one in 10 Canadians suffers from a rare disorder, and that is only the tip of the iceberg. The numbers may be much higher. Many go undiagnosed for years, so little is known of them.” With the evolution of genomics it is becoming clear that these rare diseases sometimes referred to as “orphan diseases”, are becoming a force to be reckoned with. Even the recent federal budget included funding for genome work. Dr. Durhane Wong-Reiger, president of the Canadian Organization for Rare Disorders (CORD), has suggested that these rare disorders, when considered as a class, have a far greater impact than common serious diseases such as diabetes, heart disease and even cancer. Those who suffer from disorders such as Gaucher’s, Guillain-Barre, Fabry’s or sickle cell anemia seem to be the forgotten ones. Few have a cure and often treatment is so costly that provincial drug benefit plans refuse to pay. CORD is the voice of Canadians desperately needing help facing their disorders but it is developing some clout when it comes to newborn screening for genetic diseases and advancing made-in Canada orphan drug policy. Although Europe and the United States have had success with national orphan drug and rare disease policies, Canada is lagging. In the US, orphan drug legislation has helped 310 new products come to market to save the lives of millions of people. In Canada, there is opportunity to attract research and development here which could lead to more treatments for more people. But in Canada, the money still goes where the votes are and the sad fact according to Dr. Steve Arshinoff, an opthalmologist with the Canadian National Institute for the Blind’s Ontario Medical Mobile Eye Clinic, is that we have limits on health care budgets. He says, “Money goes to diseases suffered by the many, not the few. If more money is available to treat cataracts, that usually means less is available for cornea transplants.” Canada’s lack of a national comprehensive strategy toward diagnosis and treatment of rare diseases means there is no mechanism to pay for the expensive treatments patients will need, he says. As our knowledge of genetics and genetic disease increases, so will the demand for research funding, new diagnostic modalities and new treatments. According to an article in The Medical Post by Celia Milne, February 22, 2008, “Navigating the murky waters of genetic testing” the numbers of genetic tests available-well into the thousands- is exploding. She writes that, “Soon molecular testing will predict what diseases patients will get, how their bodies will metabolize drugs and what foods they should avoid.” With spotty access and limited resources in Canada, some patients are turning to private facilities in the US but without doctors as gatekeepers, information can be ambiguous or “even dangerous” she writes, “breaking families apart, jeopardizing careers and insurance coverage, and making patients scared and even suicidal.” As much as knowledge is empowering, we need to identify when these genetic tests are valuable to patients and when the testing can truly make a difference to a patient’s life. Canada does not have a national system of genetic testing. Once again, just like cancer medication funding, provinces fall into “haves” and “have-nots”. Resource pressures are not likely to go away with new frontiers opening up in genetic testing. Not only are there more genetic tests appearing, sometimes with daily reports on new discoveries including genetic links to autism, diabetes, breast cancer, Alzheimer’s disease to name just a few, but genetic counselling is growing rapidly in importance. Most recently as reported in the Ottawa Citizen February 29, 2008, Edmonton researchers have discovered a gene that may block HIV from spreading and which could prevent the onset of AIDS. More genetic testing, more genetic based medication and more human resources to make sense of the genetic picture will be required. Although there are only 250 genetic counsellors across Canada, the demand is huge. They help couples decide family planning issues and can screen entire communities for susceptibility to common diseases such as type 2 diabetes. Some rare disorders affect the elderly more than the young and with an aging population we can expect rare diseases to be a growing problem. How will we fund the genetic testing or the medication that may be life-long and likely expensive? How will we regulate this huge emerging industry? Who will be the providers to make sense of the myriad of genetic information that will be available? How will our system provide for more chronic disease treatments related to rare disorders that exist now and that will be identified in the future? How can our system cope with even more long term treatments for diseases that are neither preventable nor curable?
Do you know a colleague who would be interested in this ? Click on the "share" button (top left)
Family physicians have been and will continue to be the cornerstone of our Canadian health care system. On behalf of the Ontario College of Family Physicians, I wish to deliver a key message that: Ontario's family doctors are ready willing and able to integrate with Community Care Access Centers and other community agencies to improve the health of our patients and our communities. There are many challenges which face us in delivering quality healthcare in the community. I will outline some of these challenges in this article, but first I want to provide some background and illustrate how we came to be where we are today. In the early days, after World War II, our current health care values of social justice for all were firmly established. In those days, most Canadians had a personal family doctor and family doctors were the main providers of care throughout the system. With the growth of our population, and rapidly expanding technology, more and more emphasis was placed on hospitals and specialist care. Gradually, it became obvious that this was a hugely expensive way to deliver care and efforts to control costs were introduced. These included reduction in the numbers of physicians and hospital restructuring. The reduced number of physicians that we trained and an exodus of family physicians to the United States have led to a critical shortage of family physicians and other physicians within our system. Thus, the first challenge facing our delivery of quality primary care is the shortage of family physicians. This critical challenge has to be corrected. The College of Family Physicians of Canada's position statement is that: all Canadians should have access to a personal family physician. Ninety-five percent of Canadians should have access to a personal family physician by 2012. The College of Family Physicians of Canada's position statement is that: all Canadians should have access to a personal family physician. Ninety-five percent of Canadians should have access to a personal family physician by 2012. The best possible health outcomes can be achieved by the above plus enhanced access to collaborative care with other health professionals. This statement is backed by strong evidence. At the University of Western Ontario, studies have shown that patients who have family physicians and have good relationships with those physicians recover faster from illness, require less testing and experience fewer consultations. They are also more satisfied with care than those who do not have such a relationship with the family physician. Studies done internationally by 1 Barbara Starfield from Baltimore have shown that those countries with the strongest primary care systems in place have the best population health outcomes and spend less health care dollars achieving those outcomes. 2 With hospital restructuring, there was a requirement for more people to be treated in the community. Patients were being discharged from hospital earlier and sicker than before. In addition there was a substantial increase in our geriatric population. This continues to be an increasing challenge as the baby boomer generation faces retirement. Currently, 12% of the population is over 65. This group counts for one third of the hospital admissions, two thirds of the hospital days, and their length of stay is double that of the younger population. The frail elderly, which represent 3% of the population, are using 30% of the healthcare resources, 25% of emergency department visits and 53% of the admissions through the emergency departments. These patients also have a high incidence of co morbidities. The chances of two or more disorders, existing in the same patient, over age 65 is 50%, and 75%, if they are over 75. These patients, with multiple co morbidities, utilize a lot of our resources and stretch our wait times. As illustrated above, managing older and sicker patients with multiple co morbidities is a second major challenge for our system. With the shortage of family physicians, these challenges have to be met with a team-based approach to care. Primary care reform has provided us with a potential solution to this problem. The Family Health Team, at least in Ontario, is the mechanism by which allied health professionals work together with family physicians delivering care to a defined group of enrolled patients. Currently, over 8 million people in Ontario are enrolled in a primary care model. This is one way of meeting the vision of the College of Family Physicians of Canada regarding interprofessional care: All Canadians will have access to a family practice/primary care setting, where there is opportunity to have care provided by a personal family physician and a registered nurse and/or nurse practitioner. Other health professionals, including pharmacists, physiotherapists, occupational therapists, dietitians, social workers, physician and medical office assistance, may also be part of the practice.” The Ontario College of Family Physicians has made this a key initiative: to provide support for family physicians practicing in primary care enrolled models. We believe that this is one of the most effective methods to deliver strong primary care to a large and needy community. The Ontario College of Family Physicians has made this a key initiative: to provide support for family physicians practicing in primary care enrolled models. We believe that this is one of the most effective methods to deliver strong primary care to a large and needy community. We are supporting family physicians in these endeavors by enhancing the opportunities to acquire leadership skills, and the skills required for collaborative and integrated care. Once again there is good evidence to support this mode of care delivery. The Integrated Physician Services in the Home, (IPSITH) was a pilot project in London, Ontario, through which patients who might otherwise have required hospitals admission were provided home-based services for up to two weeks by a multidisciplinary team, including a case manager, nurse practitioner, family physician and other health professionals as required.  Evaluation of this project was carried out by the Center for Studies in Family Medicine at the University of Western Ontario.3 Patients enrolled in the project were compared with patients utilizing home care services that were not part of the project. The findings were: Costs were more than those requiring usual home care services, but less than what would have been experienced had the patients been hospitalized. The patients involved were sicker than those requiring usual home care services. The patients treated in IPSITH utilized emergency services less. All participants in the model reported excellent satisfaction levels. This model provided a framework for integrating nurse practitioners with family physicians and providing community care. We believe that appropriate information technology will enhance the quality and safety of patient care by having the right information available to all health providers at the right time. In order to function efficiently, safely and collaboratively, the Family Health Team requires quality information technology. This is another major challenge facing those endeavoring to deliver quality community care, and, is a strategic initiative of the Ontario College of Family Physicians. We believe that appropriate information technology will enhance the quality and safety of patient care by having the right information available to all health providers at the right time. An integrated electronic patient record, with one record per patient that is shared by all health professionals would provide the best quality health care in our opinion. We do have some concerns however that this goal will be difficult to reach for several reasons. There appears to be the lack of an E-health strategy in some current government policies. Only 26 % of physicians in Canada were using an electronic medical record in 2007. Canada lags behind many other countries in providing information technology systems to support primary health care. In Ontario, there is a move to establish chronic disease registries. While this initiative is laudable, we don't want it to deflect attention from the goal of an electronic health record for all. Canada lags behind many other countries in providing information technology systems to support primary health care In Ontario, there is a move to establish chronic disease registries.In summary, the challenges facing our primary care health system today include lack of family physicians and increased complexity of care in the community. The strategies that will help us deal with these challenges include: Strategies to increase the number of family physicians to meet the goals outlined by the College of Family Physicians of Canada. Strategies to promote the Family Health Team and other methods of family physicians collaborating with other health professionals to meet the challenges of complexity of care in the community. Strategies to improve the quality and availability of appropriate information technology such as the electronic health record for all patients. Attention to the strategies outlined above will go a long way towards helping Ontario's family physicians meet our goal: to integrate with Community Care Access Centers and other community agencies to improve the health of our patients and our communities.   references: Stewart M. Reflections on the doctor-patient relationship: from evidence and experience. British Journal of General Practice 2005; 55(519): 793-801. Starfield, Barbara. http://bostonreview.net/BR30.6/starfield.html Stewart M. et al. Evaluation of an Organization for Integrating Physician Services in the Home. June 2002. http://www.chsrf.ca/final_research/ogc/pdf/stewart_final.pdf   Want to send a colleague a link to this page ? Click on the "Tell a Coll" (tell a colleague) button below.   What do you think ? Dr. Wetmore would like to hear from you ... Please use the "comment" box below to respond ...
I'm sure the vast majority of Canadians would take a fair and practical approach to this issue. They would have no interest in paying privately and out-of-pocket for health services already included on the publicly funded, provincial health plan schedule of benefits. They would be far more interested in having discussions about expanding and updating the range of services on those schedules of benefits. The vast majority of Canadians support the guarantee of universal access to medically necessary health services irrespective of ability to pay. And their support would be given knowing they could not likely afford to pay either out-of-pocket or through private insurance premiums for the type of catastrophic medical care that could devastate them or their loved ones. And their support would be given in the belief that access to health services shouldn't be determined by employment status; pre-existing health conditions; wealth or and any other individual factor, but health need. The vast majority of Canadians continue to support collaborative initiatives and essential reform within the existing health system to enhance access and quality; whether through public re-investment to create additional capacity to eliminate wait lists; ensuring greater integration and coordination of care; or enhancing 'upstream' preventative health measures or health promotion. The vast majority of Canadians have no vested interest in allowing "credit card" medicine; where personal wealth determines the speed or quality of access to medically necessary services. The vast majority of Canadians have in fact consistently rejected any regressive user fees; patient co-payments or "flat rate" health premiums that impede access to essential primary care or medical treatment. And this after decades of campaigning by the likes of the Fraser Institute or Canadian Taxpayers Federation to restore our fiscal well-being at the expense of our social health; of a determined and relentless assault on public deficits or debt, while only providing meager re-investment in public programs. The loudly trumpeted deep fundamental cuts to corporate and personal tax rates only created greater poverty and social inequality in the midst of record profits and obscene corporate salaries. The vast majority of Canadians realize we can both afford to ensure universal access and remain capable of inspiring and sustaining collective action and common purpose across this land to ensure quality care is provided those requiring health services. The vast majority of Canadians, I suspect, find the shrill attack on Medicare to be over-wrought; a campaign that simply rings hollow and contrived when compared to their own personal experiences and interactions with health providers or the actual care their family or friends received in Canada. They realize that through our progressive income tax system, they have already bought and paid for universal access to health services. All that is required is to hold both government and health providers accountable for the services provided. But there is a small, vocal minority of Canadians for whom two-tiered private health or queue jumping has appeal. Private payment would, in fact, allow them to purchase something quite radically 'new' and different. They would purchase 'first class' rather than 'economy' health services; or 'front of the line' queue jumping priority in public health queues. What they want to purchase would trump the medical needs of others; what they want precludes or excludes others by restricting resources or lowering priority for other Canadians potentially in greater need. The vast majority of Canadians would find it illogical to argue that private payment or insurance, rather than increased public resources would be the balm to sooth our maligned health system; rather than imperil it. There is simply no evidence to suggest to these Canadians that a single-payer model means less access or lower quality and more expense than dual, competing for-profit insurance models. The vast majority of Canadians would appreciate, on the other hand, that the pursuit of profit inevitably entails monopoly rather than competition; that individuals cannot and do not stand as market equals with multi-national insurance corporations. The vast majority of Canadian would appreciate that the negotiation, writing, adjudication and enforcement (let alone rescinding) of insurance policies does not favour them; that marketing; advertising; administering; profit and regulating ensures only adds costs without tangible health benefits. The vast majority of Canadians are willing to consider international comparisons for lessons in search of necessary reform to enhance our health system. We could certainly learn from the Australian example of permitting private financing for in-patient hospital services. The claimed reduction in wait times or costs did not occur as promised. The experiment was clearly rejected by the Australians in their recent national elections. A small minority of Canadians remain prepared to abandon any notion of egalitarianism in favour of elitism; consenting to private markets and personal income as arbiters of access rather than citizenship and health needs. The benefits of opting out for this small group may lie in tax avoidance of the costs of universality. The impact is to deny others public access to care as much as enhance their own privileged or private access. The struggle to build our universal, publicly funded single payer health system through Medicare was waged in connection with a fundamental debate around the nature and character of Canadians and the vision of a future for our country as more just and equitable. There were concessions along the way to the medical fraternity but the enterprise was never directed at solely making the scheme palatable to wealthy Canadians. It was also never about simply scoring ideological points; about defiling the mythical beauty or theoretical sophistication of perfectly functioning 'markets'. Canadians know from direct personal experiences what "market failure" represents in terms of pain, suffering and untimely death. We don't need to see "Sicko" to be reminded of the inequity and inefficiencies of private markets delivering essential health services. The vast majority of Canadians long ago recognized health care services as "public goods" providing significant social benefits and essential to the exercise of citizenship. The vast majority of Canadians will realize that the Charter challenges making their way through the courts in various provinces seek not just the ability to pay privately out-of-pocket for health services. Rather, these individuals want public tax dollars to finance their private choices and preferences in terms of the scope, timing and/or location in which they receive health services. The real and important challenge of improving our public system; of reducing wait times for all, should not come at the expense of Canadians of low income or ill health; those likely to be hurt most by parallel private insurance. That is not the health care that the overwhelming majority of Canadians support.   links to other presentations on this or related topics   Want to send a colleague a link to this page ? Click on the "Tell a Coll" (tell a colleague) button below.   What do you think ? Buzz Hargrove would like to hear from you ... Please use the "comment" box below to respond ...
The future of public health care in Quebec is in the balance as politicians debate Bill 22 during this fall session of the National Assembly. The bill is the government's response to the Supreme Court's Chaoulli decision of June 5, 2005, concerning unreasonable wait times for some services in the Quebec health-care system. The Supreme Court ruled that Quebec law prohibiting private medical insurance violated the Quebec Charter of Human Rights and Freedom , opening the door, some believe, for an increased role for private health care in Canada. Beneath a benign façade, Bill 33 sets up fundamental changes to core principles of Quebec's approach to health care. Up to now, the system has ensured that the great bulk of financial and human resources is channeled toward the public health-care system and grants minimized public support for a private system that caters to only a small portion of the population. Bill 33 does offer some positive change, with the introduction of centralized wait lists for specialized services and with management of service corridors inside the health-care network. However, other features of the bill are far less reassuring for the future of public health care. Below are four main issues raised by Bill 33 : First, the bill will legalize "private hospitals," called "Specialized Medical Centers" in the jargon of the bill. These centers will be able to offer what today is delivered by Ambulatory Care Centers (for authorized one-day surgery), hospitals (for authorized services with overnight stay) and private clinics, as we know them across the system. There are two types of these new proposed private hospitals. The first, where services are paid for by taxpayers, will become some sort of a "private extension" of the current hospital. Exclusive five-year contracts will be signed between the private hospital and the current hospital. The centre then becomes what the bill calls an "Associated Medical Clinic." Private laboratories and private doctors can also sign exclusive contracts with hospitals. This delivers, by contract, the provision of public services to for-profit private corporations. This is not benign. The second type of "private hospital" envisioned by the bill is also a private corporation — but services will have to be paid for out-of-pocket. This hospital will be staffed by opted-out physicians who, from then on, will be able to offer (legally) authorized surgical services, including overnight bed stay. Other aspects of Bill 33 establish conditions that will assist the growth of private hospitals. One provision states that the list of authorized surgical services that may be carried out in Specialized Medical Centers (restricted in the bill to knee and hip replacement and cataract surgery), can be extended in future by simple regulatory changes by the minister of health. Bill 33 will allow private insurance for services carried out in the second type of Specialized Medical Centers (with opted-out physicians). The list of such services could be extended to cover some, or all, of the authorized surgeries in the private hospitals by simple government regulation after discussion by a committee of the National Assembly. Importantly, the private insurance contract will cover both physicians' costs and hospital services associated with overnight stays. This is a major departure from current public policy. Finally, Bill 33 envisions that compliance with the wait-list guarantee may result in publicly insured patients being sent to private hospitals staffed with opted-out physicians. The Quebec government would like to stress those aspects of the bill that limit, for the time being, the extent of the introduction of private health insurance and the scope of cross subsidization of public and private healthcare systems. No one will be fooled by this. Such drastic changes in the course of health-care delivery and financing could only be done incrementally anyhow. The structure set in place by Bill 33 lays the cornerstone on which two-tier health care can gradually develop.  We must bear in mind that the argument that Quebec has no other option following the Chaoulli decision is highly debatable. This argument profoundly confuses the roles of the judiciary and parliaments. This, like Bill 33, should be a matter of serious concern to every Canadian citizen.   This article was originally written for and published by the Toronto Star on Nov. 17, 2006. We would like to take this opportunity to thank Prof. Prémont and the Toronto Star for giving us permission to reproduce it here for the benefit of our participants.   links to other presentations on this or related topics Want to send a colleague a link to this page ? Click on the "Tell a Coll" (tell a colleague) button below.   What do you think ? Prof. Prémont would like to hear from you ... Please use the "comment" box below to respond ...    
Refreshing, and well written!
In an article from the Globe and Mail this past week, “Quality, not just quantity, of care matters”, Andre Picard writes about how we spend a great deal of effort, time and money measuring wait times and gathering various statistics on human resources and procedures done but very little on determining whether patients are satisfied with the care they have received while being treated in our medical system. He links patient satisfaction to good communication which he suggests is empowering to patients and providers. At a time of constrained resources, both material and human, when communication can be limited, strained or rushed, the Canadian Medical Association has launched its physician/patient health portal, mydoctor.ca. It has the potential to change the way some health care is delivered, improve chronic disease management and to enhance communication between physicians and patients. During a speech to the Vancouver Board of Trade on April 1, CMA president, Dr. Brian Day, announced the CMA’s vision for a patient-focused health system. With the click of a mouse, access and quality of care for patients can be improved through the use of this internet communication tool. With a 400% rise in health costs between 1984 and 2005 and a rise in population of 25% it is evident that Canada needs to find sustainable mechanisms for providing access to patients that will improve their health care experience. Empowering the patient through improved contact with their physician and associated providers through this new health portal, mydoctor.ca, there is opportunity to improve the management of patients with chronic illness as well as enhance communication overall. In a patient-centered system where asking and listening should be integral to care, and where new technologies are changing delivery, we can look forward to engaging patients in an active way that will ultimately provide them with improved satisfaction. At this time no exact funding arrangement has been established but it may be reasonable to assume that the value of this tool may be left to the consumer to determine. If a patient believes this type of enhanced communication with their provider is valuable and even convenient for them, possibly saving them trips to the doctor’s office including travel time, parking fees and even wear and tear on the environment, then it is reasonable to attach some dollar value not necessarily borne by the health care system alone, but rather by the patient or in combination with government. To keep the patient central in the health care system, their needs including their need for improved communication should be valued.
Should Canadians be able to use after-tax dollars to purchase health services that are already covered under the provincial health plans schedule of benefits? The answer to this question we must consider the two major stakeholders who stand to win or lose from its outcome: healthcare consumers (patients) and healthcare suppliers. Under suppliers, I include provincially funded hospitals/clinics and for-profit businesses including private clinics, insurance companies, and other supporting businesses. Like many Canadians I fall into both stakeholder groups. I'm a consumer (a patient) and I run a medical communications business that produces education and marketing materials for the healthcare industry. I consider privatization in terms how it will affect my family and myself, as well as the opportunities it may afford my business. There is a tendency to discuss healthcare privatization only in terms of what's best for consumers without asking how much of the debate is driven by profit motive. This makes me wonder who the stakeholders are that actively call for privatization in healthcare. Are they consumers, suppliers, or both? It would be useful to know how much of the pressure is from private citizens, doctors, and nurses genuinely concerned with quality of care and how much pressure is from suppliers with a financial stake in a competitive healthcare industry. The answer, if it can be found, would help focus the overall debate, since the question of Canadians using after-tax money to purchase health services should be centered squarely on consumers, not suppliers. Addressing the original question then from the consumer's point of view, I ask why would Canadians want to purchase services that are already covered under provincial health plans? The answer is most likely that they could purchase better and/or quicker services than are offered by the province. One problem with this scenario—and it's by no means a new argument—is that some Canadians can afford to purchase better services via private insurance or out-of-pocket while others cannot (just look to the US healthcare model for an obvious example). Those who can't afford better services will continue to rely on provincially funded suppliers. What then will opening healthcare to competition mean for suppliers, public and private? From the supplier's point of view, privatization would in many cases be perceived as a positive move. The insurance industry would enjoy new markets. Those of us who service healthcare providers would undoubtedly find new sources of revenue. And private clinics providing diagnostic, surgical, and treatment procedures would thrive in a competitive healthcare industry. But whom would they compete against (besides one another)? The answer is: provincially funded suppliers. As in any competitive market, much of the top talent—doctors, nurses, management, and others—would quite naturally gravitate to the better-equipped private facilities and more competitive wages. At the very least, there would be strong incentive to perform procedures in private clinics instead of public ones. This would serve to deplete provincially funded hospitals and clinics, thereby further weakening the public system. Therefore, privatization would be good for insurance companies, good for private service providers, good for top-tier healthcare workers, and potentially bad for provincially funded hospitals. This covers many of the "supplier" stakeholders in the privatization debate. But where does it leave our healthcare consumers? Particularly those without the after-tax dollars to buy private health insurance or to pay out-of-pocket for services. It means the provincially funded services they rely on will potentially be worse off than before privatization. And these consumers are the stakeholders who should be best served by changes to the healthcare system. In conclusion, I don't believe Canadians—i.e. only those who can afford to—should be able to use after-tax dollars to purchase health services. Not when it means weakening the publicly funded system we all depend upon. The challenge, therefore, is to achieve and maintain a standard of excellence in provincially funded healthcare that rivals or exceeds what the private sector could offer. This is not a small challenge, and will require commitment, innovative thinking, and strong leadership from healthcare practitioners and administrators to academics and politicians. While privatization will benefit many of us—consumers and suppliers alike—an improved public healthcare system will benefit all Canadians in the long run. Want to send a colleague a link to this page ? Click on the "Tell a Coll" (tell a colleague) button below.   What do you think ? Jason Sharpe would like to hear from you ... Please use the "comment" box below to respond ...
This current discussion about health care is an ethical one. From our perspective, this discussion is fundamentally about what form of justice will prevail as we wrestle with who we are, what we owe each other as citizens and neighbours, and what legacy we will leave for future generations of people in Canada. Working to promote health and well-being is not only about curing symptoms; it also is about confronting the causes of suffering and injustice in our society. A basic moral test of any society is how the weak and poor in its midst are treated. At the end of February 2002, the Ecumenical Health Care Network, with the support of the Canadian Council of Churches , organized a Canadian Churches’ Forum on the Future of Health Care. More than 100 health care advocates, guest speakers and politicians gathered to discuss health care concerns in light of the Kirby and Romanow Commissions. The most impressive presentation came from Dr. Nuala Kenny who developed her key message that “the health care encounter is a place of moral meaning.” Dr. Kenny also indicated that health needs are different from other needs; they are experienced at a time of great vulnerability. In sickness we lose control and we become dependant. Medical care is not a commodity; it is not like buying socks. The values that we must defend all deal with justice… In health care issues, Canadians do not allow only a market response; Canadians believe in equity. We must ‘privilege’ those who have the greatest needs. She challenged us by saying "If we hold so few values in common, we are not any longer a community.” She also reminded us that there is a prophetic role for policy: policy can support justice, fairness and compassion. The Ecumenical Health Care Network approved a Health Care Covenant for All People in Canada. A copy of this covenant is attached as a pdf file with our intervention in this on-line discussion. In that covenant, we pledged to “uphold a health care system through which all people in Canada share the benefits of health and the burdens of illness with particular compassion for the weak, caring for the vulnerable, solidarity with our neighbours, and a commitment to social justice for all”. We submit this Health Care Covenant as part of the churches’ contribution to the debate about the future of health care in Canada. Values Increasingly, the values in our society (and indeed in the world) are shaped by the values of the market. Return on investment, commercialization, commodification and globalization are the primary factors that are shaping our social relations today. Dr. Nuala Kenny further challenged us – and all Canadians - at the Church’s Forum on the Future of Health Care in Canada by saying that “We’ve got to put our money where our values are!!”. We believe that the key values of solidarity, community, equity, compassion, and efficiency (which under gird Medicare today) are the values that should take priority over a market driven approach to health care. Dr. Kenny writes in Ethical Dilemmas in the Current Health Care Environment (as part of Do We Care? Renewing Canada’s Commitment to Health: “Without an explicit reflection on the values Canadians hold in common there can be no good judgment as to which new values to incorporate and which to reject. And certainly, without attention to values there can be no good policy.” We believe that a commitment to social justice, as expressed in the key values above and which currently are at the heart of the five principles of Medicare, should continue to help direct our future vision for health care in Canada. In March 1 of 2002, we said that patients are not simply consumers, and, echoing Dr. Kenny, we said that health care is not like purchasing socks. Health is one of the most basic human goods; without health, other goods will simply not be available to us. It is therefore not surprising that health care has become for Canadians one of the defining characteristics of our national identity, an expression of our commitment not only to ourselves, but to the communities to which we belong and of which we are a part. The Medicare system is an expression of our belief that medical needs are too fundamental to be responded to solely on the basis of market forces and for reasons of profit. We urge that you hold the key values of solidarity, community, equity, compassion and efficiency at the centre of your policy deliberations. These values should enable you to see clearly that (1) health care is a public good, not a market good, and that (2) health should be seen as holistic, including physical, emotional, spiritual and social well-being. Canadian churches are working together to contribute an ethical voice to the ongoing dialogue and debate about the future of health care in Canada.   Read the Report "A Health Covenant For All People In Canada" click on the above link to read the report   The Ecumenical Health Care Network is a project of the Commission for Justice and Peace of the Canadian Council of Churches. The Network seeks to engage the churches in ongoing support for the common good through education and advocacy within the churches, in the broader community and by engagement with government as appropriate. The Network includes representatives from the Anglican Church of Canada, the Evangelical Lutheran Church in Canada, the Presbyterian Church in Canada, the United Church of Canada, the Canadian Catholic Health Association, the Salvation Army, and the Canadian Council of Churches. Current members of the Ecumenical Health Care Network Linda Nicholls, (co-chair) The Anglican Church of Canada Peter Noteboom (secretary), The Canadian Council of Churches Stephen Allen, The Presbyterian Church in Canada Kester Trim, The Salvation Army James Roche, Catholic Health Association of Canada Jim Armstrong, The Presbyterian Church in Canada Bill Jay, The United Church of Canada Jim Marshall (co-chair), The United Church of Canada John Dossetor, The Anglican Church of Canada Want to send a colleague a link to this page ? Click on the "Tell a Coll" (tell a colleague) button below. What do you think ? The Ecumenical Health Care Network would like to hear from you ... Please use the "comment" box below to respond ...
November 11, Remembrance Day is upon us once again. What better time to “remember” than by listening to what a veteran has to say on the issue of public – private healthcare? This is not a war story, nor is it even really a story. What it is, is a short collection of thoughts of one man who has committed his life to saving those of others after putting his own life on-the-line to save the freedom we enjoy today. Dr. Michael Warrington has undoubtedly seen and experienced more of life's trials and tribulations than the average person ever will, both as a doctor and as a combatant in Normandy and Northern Europe during WWII. He has lived the life of a “prairie” doctor with 3,000 patients spread out over an area of 500 sq.mi. Later on, he practiced family medecine for thirty years in Victoria and North Vancouver. As a family physician with many aging patients he sees things he'd rather not (and which in many cases don't always seem to make sense!). He shares with us a few anecdotes as they relate to the public – private health care issue. We publish here today a letter from Dr. Warrington, one in which he shares some candid thoughts on the quality of health care both in Canada and the United Kingdom. Some may disagree but few, if any, will accuse Dr. Warrington of being motivated by anything other than a deep and intense desire to see that those in need receive the care they need. Should Canadians have the right to use their after tax dollars to purchase essential healthcare services in Canada?The answer is unequivocally - Yes. Everyone has heard the horror stories. Here are just a couple that I know personally. A lady in her 80's - a neighbour - lives alone and cannot walk due to painful knee arthritis. She was told she would have to wait a year for knee surgery, so she bought a $2000 scooter because "I have to get out and I take my dog with me on a leash" - a small Scotch terrier. I know another lady, otherwise in good health though she's 93, cannot get around due to knee arthritis and was told by the orthopaedic surgeon that the waiting list for her to get a new knee here in Vancouver would be three years. Stories like this abound. Yet there are Government Health Authorities, right across Canada with numerous grossly overpaid lay administrators, all in charge of Medicare. One may well ask - what use are they? Former Prime Minister, Paul Martin, was once quoted as saying "Medicare is a jewel." Some jewel. Can anyone imagine Paul Martin having to buy a scooter to get around because of a long wait for something like knee surgery - or Ujjal Dosanjh, former Federal Minister of Health, having to go around on a scooter while waiting for surgery? Where did Jack Layton go for his hernia operation? To a private clinic, of course - the Shouldice Clinic in Thornhill, Ontario. What's good enough for you isn't good enough for me - but if Medicare is so wonderful, why not use it? Government run health care is inefficient. The Government has enormous amounts of money at it's disposal but has no idea on how to spend it wisely. Lay administrators, health economists and health planners close good working hospitals and are allowed to do so by the Government in the name of economy "....you'll get better care in the long run." Far from it - this tactic has made long waiting lists even longer. The problem with Medicare has been drastically worsened due to the critical shortage of doctors. In 1991 a report by two health economists, Morris Barer and Greg Stoddart, came up with the theory that unless something was done there would be too many doctors in Canada. The Government listened to these two experts and mandated a reduction in Medical School enrolment right across Canada. We are suffering from the effects of this extremely unwise decision to this day. In the 1970's, when I worked at Lion's Gate Hospital in North Vancouver, the nurses were talking about there being too few places for the numbers who wanted to do nursing training. So - cutting back on Medical School enrolment and Nursing training - closing hospitals (in this area alone - Delta Hospital, Shaughnessy Hospital, St. Vincent's Hospital) has placed a strain on the remaining hospitals, which are busy already - and created even longer waiting lists. The hospitals are dirty. People are literally worried if they have to go into hospital for fear they may contract a life threatening infection, such as MRSA or Clostridium Diffivcile. Private Hospitals are cleaner and better administered. I've seen this in England. Prior to the NHS, the London Hospital where I trained and worked was always spotlessly clean. I visited the hospital in 2003 and it's now like a third rate hotel, a dirty one at that - and I'm not exaggerating. In spite of the NHS there are now 200 private hospitals in the UK - responding to public need. Canada needs freedom of choice. Faced with intolerably long waiting lists Canadians should be allowed to opt for private care, paid for by themselves or through private insurance.   Do you know a colleague who would be interested in this ? Click on the "share" button (top left)
The main theories of Traditional Chinese Medicine - TCM The main characteristics of clinical practice of TCM The main characteristics of elderly people from a view of TCM and Western Medicine - WM. How we treat and prevent the hypertension of the elderly patients by IM in our clinical practice   Abbreviations used in this lecture: TCM: Traditional Chinese Medicine; WM: Western Medicine; IM: Integrated Medicine; EH: Essential Hypertension; Part One: The way we believe, the main theories of TCM which are mainly based on the Traditional Chinese Philosophy of Taoism I: Qi theory: About the original substance of the nature and body According to the Qi theory of TCM, we consider that the Qi of human body comes from the nature, which means that human body is one part of the nature; This is the most fundamental evidence of the holistic theory of TCM. What is Qi: Qi is a gas-likeenergy which has both substance and function. It is  necessary for transformations and energy exchange between nature and the human body and is our main life force. if the energy exchange stops or the function separate from the substance, it means the life circle of the systems stops; We can not feel the existence of Qi, like…the fish in the aquarium that they might not feel the existence of water; Qi the so subtile and invisible, therefore, most people might ignore its function and importance to us; Actually, Qi the most important substance we need at every moment, which not only maintains our basic life activities, such as: breathing, heart beating, but also the energy exchange between the nature and the human body; Because, even our mother earth need to breath also, just human body could not feel it; The types of Qi inside of our bodies: Qing Qi – the fresh Qi from the air; Yin Qi – the nutrition Qi from the food and drink; Jing Qi – the prenatal essential Qi inherited from our parents; Zhuo Qi – the waste Qi after the metabolism of the 3 different kinds of Qi above; The types of Qi outside of our bodies: Six normal climate Qi of the nature, such as: Wind, Summer / Heat, Humidity, Dryness, Cold These six normal climate Qi might become the pathogen that cause the sickness of human bodies, due to the different condition of the human bodies; Li Qi : epidemic Qi from nature; Ancient TCM specialists also noticed that there was a very strong and different kind of Qi from the nature could cause many people become sick with same symptoms almost at the same time, and sometimes it was very fatal to the health of human bodies, or sometimes it would disappear very quickly; Where the Qi circulate inside of our bodies? Blood vessels; Channels or meridians; The Function of Qi: circulating inside of the blood vessels, to form the blood, to calm and nourish the body; circulating inside of the channels, to warm and protect of the body from the attack of pathogen; to push and lead the circulation of the energy flow, blood current, body liquid, excretion of the waste, which maintain the life activities of the body; The meaning of Qi in TCM: every life activity, such as: we not only take in the nutrients from the food, beverage we take everyday, but also the Qi; every disease; the mechanism of the medical therapies of TCM, such as: using the Qi of herbal medicine to regulate the Qi of the human body; there is also Qi exchange between the Patients and practitioners Other Approaches to Balance the body “Still” Qi-gong (Qi Exercises): breathing, meditation “Active” Qi-gong: Tai-ji (Tai-Chi), breathing exercise with movement Pathological condition of the Qi of human bodies: being deficient, such as: a state of malnutrition; chronic overwork or overloading the stress; a fatigue condition (primary or secondary); later period of chronic condition of diseases; rehabilitating state after a serious disease; being excessive, such as: Diabetes, high cholesterol, gout condition; acute inflammation/ infections condition; slow Qi circulation, such as: the high density of blood current condition for the patients before or after the heart attack, or stroke; blocked Qi circulation inside one part of the body, such as: chronic or acute pain of the body; chronic or acute depression of the body; Type of herbal Qi: Warm Qi; to warm/ boost / stimulate the body; Cool Qi; to cool down the over-heated / functioning or hypersensitive condition of the body; Function of herbal Qi: Bu Qi : to tonify / promote the Qi of the body; Xie Qi: to reduce / inhibit the pathological / abnormal Qi of the body; II: Yin-yang theory What is Yin-yang? The original concept of Yin-yang: Because our earth spins around the sun all the time, and there is always one side of earth is facing to the sun, which forms the day, while the opposite side to the sun forms the night; that is the original concept of Yin-yang, and gradually, people classify the two different properties of the things on the world into two main categories, according their two different characteristics of property; Yang: Warmth / Heat; Active; Daytime; Bright; Positive; Rapid; Loud Yin: Cool; Inactive; Night; Dark; Negativ; Slow; Quiet The meaning of Yin-yang theory: Yin-yang are two different properties of one same things, while usually the Yang property is equal to the condition of function, while the Yin is similar to the material side of one living organs. Therefore, we can see, we can separate the function from the material, the reversed one does not work either; there is balanced situation According to Yin-yang theory, the property of the body can be classified into Yin-yang categories, for instance: Physiology: excitement/ rest; contraction/ relaxation (for all muscle tissue) ; inhale/ exhale; in-take/ excretion; Nervous system: sympathetic nerve/ parasympathetic nerve; Immunology: excessive immune reaction/ immunodeficiency; Pathology: injury, inflammation/ rehabilitation; Traditional Pharmacology: based on the above discovery develop and invent the drugs; Pathological  / unbalanced condition of Yin-yang: Deficiency (one or both); Excess (one or both); the key is: we need to find out which is the primary and which is the secondary; Herbal examples are good for Yin part of body: American Ginseng Herbal examples are good for Yin part of body: Ginger; Cinnamon III: Five Elements theory It comes from Five geographical theory of Feng-shui, gradually, it develops a unique theory of the relationship of the nature and human body; Five different geographical location à Five different condition of the Qi from the sun à Five different climates à Five different properties (elements) à Five different characteristics à Five different functions à Five different appearances In general, this panel, listed below, is the example to show the classic classification of the elements, appearance of the nature and human body:   Five elements: with five different inherent qualities, characteristics, and states of nature and human bodies East Spring Wood ( with the characteristics of being able to bent and stretched); South Summer Fire ( with the characteristics of heat, flame and flare upward); West Autumn Metal (with the characteristics of being able to be melted, purified and harden) North Winter Water (with the characteristics of moistening, and moving downward like water) Middle  Late Summer Earth (with the characteristics of being able to be loaded, carry, grow and reap) The relationship of our organic system: Generating relationship: Wood generates Fire; Fire generates Earth; Earth generates Metal; Metal generates Water; Water generates Wood; Controlling relationship: Wood controls Earth; Fire controls Metal; Earth controls Water; Metal controls Wood; Water controls Fire; The relationship of generating and controlling is still based on the theory of Yin-yang;   Part Two: The way we train and practice of TCM The main characteristics of clinical practice of TCM Holistic view: a unique methodology -  Zang Xiang : the image of organ TCM practitioners believe that the appearance of the body on the surface has a close connection with the internal condition of organ in the deep part of the body; for instance, from the appearance of the lotus, we can tell the quality of the earth of the pond; because, the whole systems of the body is connected by the meridians from the internal to the external; What is the external appearance of a human body? The appearance of tongue, pulse, hair, nail, excretion, etc can tell the function /condition of the internal organs; Differential diagnosing methodology: another unique concept of TCM diagnoses -- Zheng Hou (the syndromes of TCM) The component of Zheng-hou (TCM syndromes): Patient’s complaint, symptoms &signs (external) Qi, blood and body fluid condition of the human body (internal) The pathogen that causes disease (externally or internally) How IM specialists view the patients TCM Consultation; Physical examination: such as, feeling the pulse, meridians, reading the images of tongue etc; Combining with the WM’s approaches, relying on the high technologies, to focusing on the diseases and analyze: the etiology the state of pathology change the laboratory tests the conclusion of the diseases ( Diagnosis) the management for the diseases; Therefore, we can read and understand both of body and diseases;   Part Three: The main characteristics of elderly people from an IM perspective In general, elderly people’s organic function becomes slow down systematically, physically and mentally. From a view of TCM, elderly people may have some characteristics such as: Reduced function of digestive system; Reduced storage of essential substances (Qi, blood etc) inside organic systems; Reduced function of self-healing systems;   Part Four: How we treat hypertension in elderly patients using an IM approach in clinical practice By WM classic and golden standard, there are: Diuretic; B-blocker; Ca-channel blocker; a-receptor blocker; Vasodilator; ACEI, Angiotensin converting enzyme inhibitor; ARB, Angiotensin Ⅱ receptor antagonist; The variety of drugs for treating EH indicates that the mechanism for causing the EH is also very broad; By TCM analyze, EH in elderly people manifests as: Yin deficient condition of Liver and Kidney systems; elevated level of Yang in the liver system; By the internal medicine of TCM For nourishing Yin; For depressing Yang; For promoting blood circulation; For boosting Qi; For promoting water circulation; For promoting the process of excretion of the body; With the aim is… To balance the function and material; To balance the Yin-yang of the body; To balance the organic system; To help the body to regulate and treat by itself from multiple aspects; And we can combine with other natural approaches, such as: Acupuncture; Moxibustion; Chinese massage; Cupping; And, combined with a new healthy life of the patient Diet; Meditation; Tai-chi exercises; Music; With the awareness of side effect from: Smoke; Coffee; Alcohol; Drugs; Overload stress & irregular sleeping pattern; Therefore, by using these integrated medical care approaches from diagnosis to treatment, the result will be: management of the disease as well as balancing the body and stimulating the self healing process   Part Five: The main Challenge of IM at the present and future Mutual-understanding; Different world views with respect to health (holistic vs reductionist); No sufficient data base to rely on; Lack of facilities / right platform to practice; Individual variability – practitioner and patients reaction / responses / acceptance; Quality control of herbal material, process technology, and its products (including the herbal medicine); Policy, regulation, financial, standardization, administration of IM; Equitable access by all patients Part Six: Summary For the health of public, we need more people to join in…to think, to train, to practice, to share… And, I believe that a Good Medical Care system is an art for helping people to be in the middle. (Being in the middle = being in the balanced situation)   links to other presentations on this or related topics Want to send a colleague a link to this page ? Click on the "Tell a Coll" (tell a colleague) button below.   What do you think ? Dr. Xu would like to hear from you ... Please use the "comment" box below to respond ...    
American Association of Pediatrics updated April 18, 2010 Updated Policy Statement on Media Violence
John G. Abbott updated April 29, 2010 John G. Abbott is currently Interim Chief Executive Officer with the Health Council of Canada. In addition, he is a management consultant with The Institute for the Advancement of Public Policy, Inc., a private consulting firm specializing in public policy analysis and development. Previous to this, John was Deputy Minister of Newfoundland and Labrador’s Department of Health and Community Services. John brings a depth of experience and working knowledge of the Canadian health care system to the Health Council. John served with distinction as a senior executive with the provincial government for which he was recognized in 1999 with the Lieutenant Governor's Award for Excellence in Public Administration by the Institute for Public Administration of Canada. Between 1996 and 1999, he held a number of senior positions:  Associate Deputy Minister of Health and Community Services, Chairman and CEO of the Newfoundland and Labrador Housing Corporation, Deputy Minister of Works, Services and Transportation and Deputy Minister of Municipal and Provincial Affairs. John has a B.A. in Political Science and Economics from Memorial University of Newfoundland and an M.A. in Public Administration from Carleton University (Ottawa). John is also active in community affairs, has an interest in heritage property re-development and enjoys hiking. conference presentation Value for Money
Do you know a colleague who would be interested in this ? Click on the "share" button (top left)
Abuse and Victimization updated March 30, 2010 Experiences of abuse and victimization beyond age 60 in Germany In the years 2004-2008, we conducted a study “Crime and Violence in Older People’s Lives” which was funded by the German Federal Ministry of Family, Seniors, Women and Youth (see Bundesministerium für Familie, Senioren, Frauen und Jugend, 2009; Görgen, Herbst, .Kotlenga, Nägele & Rabold, 2009). The study aimed at providing data on criminal victimization and experiences of domestic violence among Germans aged 60 years plus. Our approach to this topic was via a population based victimization survey, the analysis of police crime statistics and of police files on selected offences. A second, equally important aim was to provide data on abuse and neglect of older care recipients in domestic settings. Since this topic is hardly accessible via the abovementioned approaches, we conducted qualitative interviews in family caregiving arrangements and surveys among family caregivers and home care nurses. thomas goergen Who Is ? on this topic Hardiness in Older Victims of Abuse Police Investigations Into Elder Abuse Elder Abuse in Ontario on related topics Psycho-social Factors Affecting the Elderly Thus, we ended up with a broad range of data sources: German Police Crime Statistics 1994-2006 Police files on frauds / scams against people 60+ (n=303) A nationwide survey among persons aged 40-85 years (n=3.030) A survey among home care nurses (n= 503) A survey among family caregivers of care recipients 60+ (n=254) Qualitative interviews with care recipients, family caregivers and nurses (178 interviews and 4 group discussions; interviews referring to 90 family care arrangements) I briefly summarize some results from our study and start with findings on criminal victimization and domestic violence after age 60. German Police Crime Statistics show that adults beyond age 60 have a far lower risk of becoming a victim of violent offences than adults aged 21-59 years. This holds true especially for men. In recent years, the annual risk of a man ages 21-59 of becoming a victim of a police-recorded completed violent offence has been in the range of 800 per 100.000 persons; for men beyond age 60, the ratio was about 50:100.000 per year. The nationwide representative survey conducted in 2005 shows a similar tendency of declining risk in older age. Whereas in the age range 50-54 years, about 30% of men and women reported having been a victim of at least one violent, sexual or property offence during the last five years, this proportion fell below 15% after age 70. About one in four subjects aged 60+ reported experiences of verbal aggression by family and household members within a 12 month period, whereas only 1.3% of older men and 1.6% of women beyond age 60 reported physical violence. Prevalence of both physical and psychological victimization by family and household members was about twice as high among middle-aged adults (ages 40-59) than among those beyond age 60. So, at first sight the emerging picture appeared fairly clear: German adults aged beyond age 60 are victimized less often than younger adults. This applies to police recorded as well as to unrecorded (self-reported) experiences of crime and to stranger-perpetrated offences as well as to domestic violence. However, self-report data on experiences of victimization are available only up to age 85 and are – of course - limited to older people capable of standing a lengthy standardized survey. Up to now, German Police Crime Statistics report victim data only for violent offences (including robbery) but not for property offences. There are multiple victimologically relevant effects of being very old, frail and dependent upon care. These characteristics diminish a person’s capacity to defend against attempts to victimize her or him. They reduce that person's capacity to report an offence to the police and in many cases her or his willingness to do so. If a person is dependent upon someone else's help, if he/she fears retaliation in case he/she reports, he/she will think it over twice before contacting the police - provided he/she has the capacity to do so at all. Being frail also affects a person's capacity to complete a victimization survey. Putting these pieces together, the picture that emerges is one of heightened vulnerability on the one hand and of probable underrepresentation in official and survey data on the other. Care recipients can and must be considered "potentially invisible victims" – for law enforcement, for health, nursing, and social professions, and for research. This status of "potentially invisible victim" does not necessarily imply that prevalence and / or incidence of victimization are higher than in other social groups. It rather marks possible underestimation in different data sources which thus cannot be used to cross-validate findings. A low level of police-recorded crime against care recipients can hardly be used to validate findings from population-based victimization surveys if both share the same blind spots – not seeing those who are severely ill, unable to speak, cognitively impaired. A closer look at some of the findings (and at the difficulties of collecting data on victimization in very old age and among care recipients) shows that – while the majority of older people in Germany live safely most of the time – there are areas of heightened danger. I will turn to two of them. (a) Property offences / financial exploitation targeted at the very old: There is a considerable number of types of frauds and scams (like the infamous "it's me scam" where a perpetrator pretends being a family member via the telephone and then asks for money), and cases of deception burglary and larceny-by-trick that are specifically targeted at very old persons, and predominantly at those living alone. Perpetrators select victims because of characteristics they associate with very old age (being weak, being slow, being easy to deceive, living alone). In many cases, they pretend trust relationships by posing as relatives (via telephone), craftsmen etc. Figure 1 shows the age and gender distribution of police-recorded victims of deception burglary and larceny-by-trick per 1.000 inhabitants of the respective group per year in the German federal state of Bremen. Contrary to the general distribution of police-recorded crime risks, very old females – many of whom live alone – bear the highest risk. (b) Abuse and neglect of older care recipients: Since this topic is hardly accessible via standardized victim self-reports, alternative and additional approaches have to be considered, like surveying possible perpetrators and witnesses, including qualitative approaches, and integrating multiple perspectives upon a specific family care arrangement (care recipient; family caregiver; nurse). In our research, we tried to combine different methodological approaches: A survey amongst home-care nurses in the German city of Hanover found that 39.7% reported having abused or neglected at least one patient within the last 12 months. Psychological abuse/verbal aggression (21.4% of all respondents) and neglect (18.8%) were the most common forms. Figure 2 displays some results. Serious problem behaviour could be predicted by patients’ aggressive behaviour, the number of clients suffering from dementia, subjects’ use of alcohol as a means of alleviating work-related stress, and nurses’ general judgments of quality of care delivered by the respective home-care service. In a survey of 254 family caregivers, 53.2% reported one or more incidents of problem behaviour towards care dependent elderly during the last 12 months. Again, psychological abuse/verbal aggression was most common (47.6% of all respondents), followed by physical abuse (19.4%). There was a higher risk for significant problem behaviour towards care recipients in the last 12 months if the caregiver judged the development of his or her relationship to the care recipient as negative, if he or she used reported using alcohol to combat care-related stress, if he or she reported frequent assaults by the care recipient, and if the care recipient was severely limited in his functional capacities and highly dependent upon care. In our qualitative interview study in 90 family care arrangements we conducted interviews with care recipients, family caregivers and nurses in three German regions in 2005/2006. We identified several factors linked to abuse by family caregivers: a low quality of the pre-caregiving relationship; a motivation to care which is mainly financially based; the constellation of a stressed caregiver attributing the care recipient‘s challenging behaviour to „bad intentions“ (and not to his or her illness); a caregiver‘s bad physical and mental health status; substance abuse by the family caregiver; a caregiver‘s missing knowledge about illnesses; poverty and lack of financial resources, and the care recipient‘s challenging behaviour. In conclusion, it can be said that for most older people in Germany, 3rd age (or “early old age”) is a stage of life rather untroubled by experiences of violence and crime – especially if compared to other stages of adulthood. However, large-scale victimization surveys and police crime statistics as our main data sources run the risk of selectively ignoring the very old and the care dependent. These latter groups face specific risks regarding property offences targeted at "suitable old victims" and abuse and neglect by family and professional caregivers. In general, becoming old does not expose people to a heightened risk of crime – but being very old bears specific risks and some groups of offenders are ruthless enough to search for the most vulnerable victims. For future research, this implies that studies on elder abuse must go beyond victim self-reports in order not to collect data on abuse and neglect mainly from 3rd agers who are hardly at any risk of these offences. With regard to prevention of victimization in old age it means that measures should focus upon identified specific danger zones. Beside the two mentioned above, this includes the problem of non-detection of non-natural deaths (including homicides) among the very old. We see special need for action also in the lack of infrastructure for older (female) victims of intimate partner violence. While helping institutions for IPV victims have grown and developed a lot over the last two or three decades, specific help for older victims is largely missing. German government is taking measures to tackle these specific security problems in old age. Together with our colleagues from Zoom - Society for Prospective Developments, Göttingen, Germany, my department at German Police University (Muenster) is coordinating a 3-year programme “Secure life in old age” (November 2008- to October 2011), focussing upon specific problem areas where preventive action is deemed necessary: Abuse and neglect of older care recipients in family settings (strengthening the preventive potential of in-home nursing services) Intimate partner violence in old age (making domestic violence services and other relevant institutions elder-ready) Property offences specifically targeted at old people (providing information on frauds, scams, financial exploitation of seniors; training bank employees to better detect and handle cases of financial abuse) Homicide in old age (sensitizing physicians regarding risk of non-detection of non-naturals deaths among very old care dependent people) The programme is being funded by the German Federal Ministry for Family, Seniors, Women, and Youth (BMFSFJ). It runs under the acronym SiliA (“Sicher leben im Alter”).   references Bundesministerium für Familie, Senioren, Frauen und Jugend (Ed.) (2009). "Sicherer Hafen" Oder "gefahrvolle Zone"? Kriminalitäts- und Gewalterfahrungen im Leben alter Menschen: Ergebnisse einer multimethodalen Studie zu Gefährdungen älterer und pflegebedürftiger Menschen. Berlin: Bundesministerium für Familie, Senioren, Frauen und Jugend Görgen, T., Herbst, S., Kotlenga, S., Nägele, B. & Rabold, S. (2009).  Kriminalitäts- und Gewaltgefährdungen im Leben älterer Menschen - Zusammenfassung wesentlicher Ergebnisse einer Studie zu Gefährdungen älterer und pflegebedürftiger Menschen. Berlin: Bundesministerium für Familie, Senioren, Frauen und Jugend Do you know a colleague who would be interested in this ? Click on the button (top left) What are your thoughts? Send us your comments using the postform below:
Hi I had a very bad week with a PSW mistreating and hurting my grandmother who is going to be 100 years old. The agency is trying to play the game of he said she said and not addressing the issue. I am trying to get a hold of the police to file a report and going to put a verbal complaint through. When one of the managers came to view everything and hear our side of the story she was very sorry about the damage she caused on my grandmother's arm but now my mom said they are changing their story. I want to make sure I take care of this and this PSW does not give care to any other elderly person. My grandmother is going back to the family doctor to fill out a report because her arm is hurting and that is a sign of an infection. We also noticed marks on her arm that we assume was left by this unprofessional PSW who did not touch her careful and was rough with her. Can you direct me to the right source and how to deal with this issue. I think there are too many cases where elderly get mistreated and every article I have read my the government agencies discuss about providing better and quality care but no one wants to address this issue. I am ready to take it to the media if this issue is not dealt with. I have pictures and witnesses who one of them was my 5 yr old daughter who has been telling the story of what she saw to anyone that listens and talks about how upset she is and she wants to sleep with us. Please help. Thank you
I am sorry to hear about the emotional and physical mistreatment that has happened to your grandmother. It is unfortunate that we have to hear about stories of older adults being abused and the lack of response and reporting that takes place not only from older adults who encounter the abuse but also by co-workers,family and agencies. There are many factors that need to be considered in how and whom to make a report when abuse is witnessed or identified. Depending on where the older adult lives - in their home, a retirement home or Long Term Care Home and depending on the Province/State/County the reponse may differ based on laws and services available with the region they live. It is important to document the incident and report it to someone whether that is the police, the director of care, Community Agency Executive Director, etc. to ensure action is taken to protect the older adult. As mentioned, often seniors are reluctant to come forward to report for a number of reasons such as fear of reprisal, lack of knowledge of the legal system, ashamed, feel it was their fault, etc. Supporting the older adult to come forward to tell what happened can also be an empowering experience as they are standing up for their rights. The older adult may also want counselling services to help them deal with the experience they encountered. In Ontario, PSW's are not a regulated health care profession so they do not have a Professional College where people can directly report inappropriate conduct for an investigation to occur. Although in saying this, reporting is being done to police who investigate suspected abuse by PSW's and others including family. In some cases the police have been successful with PSW's being charged and convicted. We are now seeing in the media more reports of convictions taking place. If reporting is not done, then like you indicated, the PSW then proceeds working other seniors who may be vulnerable to being abused. Agencies are starting to make all new staff complete a 'Criminal Records Check" including a check to ensure they can work with 'Vulnerable Persons' prior to being hired. The police are becoming better trained and educated on abuse of older adults and learning how to investigate incidences of elder abuse. In fact many Police Services now have dedicated officers and Speciality Senior Crime Units to respond to crimes against seniors including elder abuse. The response process may take time so be patient. It is good to have people like yourself advocating for the rights, dignity and safety of older adults.
Dr. Susan Ackland updated April 29, 2010 Dr. Susan Ackland is a family practitioner and HIV physician based in Vancouver, British Columbia. A member of the B.C. Centre for Excellence in HIV/AIDS, Dr. Ackland is also a founding board member of Vancouver HIV Doctors Overseas, an organization of HIV expert physicians committed to volunteering in HIV care in Africa. Dr. Ackland’s career since the 1980s has involved a focus on primary care, HIV care, Hepatitis C treatment, Inner City Medicine, and Addiction Medicine, and she is actively involved in teaching medical students on a weekly basis. Her current medical practice includes work at the Immunodeficiency Clinic, B.C. Centre for Excellence in HIV/AIDS, the British Columbia Cancer Agency Dysplasia Clinic, and the Commercial Health Clinic (methadone clinic). She is as a member of the Consulting Staff at Saint Paul’s Hospital in Vancouver. Dr. Ackland is a member of the British Columbia Medical Association and a certified member of the American Society of Addiction Medicine. Since 2007, Dr. Ackland has been a volunteer with the Clinton Foundation and OHAfrica assisting with HIV services and mentoring in the African country of Lesotho. conference presentation OHAfrica
Do you know a colleague who would be interested in this ? Click on the "share" button (top left)
Do you know a colleague who would be interested in this ? Click on the "share" button (top left)
Do you know a colleague who would be interested in this ? Click on the "share" button (top left)
Acute Care House Calls to Long Term Care Homes updated June 8, 2010 Background In Ontario, emergency department (ED) overcrowding has become a real concern. A report from a nation-wide database indicated that about 15% of ED visits are made by seniors (Ackerman et al., 1998). Furthermore, long term care home (LTCH) residents use the ED at higher rates than seniors living in the community (Drummond, 2002). Unfortunately, at times, the current health system involves unnecessarily sending LTCH residents to the ED when a non-emergent health condition arises. These transfers cause resident anxiety and other clinical risks as well as care path inefficiencies due to disruptive travel to hospital, long ED wait times and complex discharge planning to go home. In order to address these issues, the Nursing Secretariat of the Ministry of Health and Long-Term Care (MOHLTC) funded an innovative pilot project, entitled the Long Term Care Emergency Mobile Nursing Program at the Toronto Western Hospital (TWH), University Health Network. mary jane mcnally Who Is ? on this topic Geriatric Emergency Network Initiative Emergency Department Process Improvement Program on related topics Nursing Informatics The Eden Alternative Dementia Beyond Drugs The Global Nursing Shortage Relationships In Care Homes   Objective The goal of this program is to reduce unnecessary ED visits by long term care home residents, thereby reducing ED wait times and improving quality of life of LTCH residents. In addition, this program has created an innovative system of nursing peer to peer consultation between acute care and long term care nurses who have created opportunities for shared learning and knowledge transfer, ultimately building nursing capacity in the LTCHs.   Project Overview Pilot funding of 250K was received in April 2009 with the program being fully operational by October 2009. The first 6 months of planning included identifying LTCH high referrers to the TWH ED, initiating an invitation to that group to participate, engaging in joint planning through a TWH / LTCH Partner Steering Committee and developing an implementation and communication plan. Highlights of the implementation plan include full orientation to Partner LTCHs, LTCH Family Council meetings, LTCH Director of Care and Physician consultation, development of Affiliation Agreements, union Memorandum of Understanding, and determination of equipment and supply needs. Great effort was made to build trust and respect partner expertise, unique processes and need for appropriate pace and boundaries. Other partners included representatives from Community Care Access Centres, Regional Geriatric Program, Psychiatric Outreach Program, Emergency Management Services (EMS) and other internal departments, like Human Resources, Legal Affairs, Infection Prevention and Control. The program is based on a nurse consultation model and consists of a team of ED trained registered staff nurses who take their expertise in acute care nursing directly to the LTCH resident’s bedside. When the LTCH nursing staffs are considering a resident transfer to the ED, the mobile nurses are contacted first, unless it is an urgent or emergent situation. This nurse-to-nurse consultation either occurs over the phone or in person. Together, with guidance from the LTCH physician, the nurse supervisor and the most responsible nurse for the resident, the mobile nurse will assess, suggest interventions and will initiate treatment either directly or in partnership with the LTCH nurse right in the resident’s home. However, if the resident or a family member of the resident prefers an ED transfer, their wishes have priority. There are currently 12 LTCHs participating in the program: Belmont House, Castleview Wychwood Towers, Christie Gardens, Fairview Nursing Home, Fudger House, Hellenic Home, Kensington Gardens, Leisureworld St. George, Cedarvale Terrace, Maynard Nursing Home, O’Neill Centre and Vermont Square. The Program is a Four Focus Model: Prevention (Proactive Rounds) Monday to Friday, 9am to 5pm Mobile RNs will visit all partner LTCHs based on pre-defined schedule (when possible) proactively identify residents that may require emergency care establish relationships with LTCH staff work with LTCH liaison to ensure supplies are available and requirements are being met share knowledge with and provide coaching at the point of care with LTCH nursing staff facilitate necessary resident transfers to the ED as needed liaise with Psychiatry Outreach Program Avoidance (Urgent Response) Monday to Sunday, 9am to 7pm Mobile RNs will answer phone calls from LTCHs in a timely manner review consultations from previous day and follow up with residents as necessary share knowledge with and provide coaching at the point of care with LTCH nursing staff facilitate necessary resident transfers to the ED as needed liaise with Psychiatry Outreach Program Rapid ED Engagement Mobile RNs will Link with Geriatric Emergency Management (GEM) Advanced Practice Nurse (APN) or other Geriatric APNs Establish and access quick specialty services including Interventional Radiology, Video Fluoroscopy and Blood Transfusion Services Followup Mobile RNs will Followup within 48hrs when resident from Partner LTCH has been discharged from TWH inpatient unit back to LTCH to ensure that discharge plans are sustainable.   Communication It was crucial that the staff at the long term care homes knew that the Mobile RNs were available to provide consultation. Several materials were developed to help communicate the program to LTCH staff including, laminated badges, posters and brochures. Figure 1: Decision Making and Communication Algorithm   Results Nurse to nurse consultations In the first seven months of the project, there were a total of 388 calls and visits made by the Mobile RNs. 265 of these interactions were nurse-to-nurse consultations. Of the consultations made by the Mobile RNs, 209 (79%) were for residents who without the program, would have been sent to the emergency department. The mobile nurse was able to provide care for 159 long term care home residents who would have otherwise been transferred to an emergency department for care, a 76% success rate. Figure 2: Number of consultations and aversions (October 2008 to April 2009)   The majority (70%) of consultation requests in the first 7 months of operation were for hydration concerns, tube problems, pain, breathing concerns or infection issues. Figure 3: Top five requests for consultation   The majority of calls were spread throughout the week confirming need for 7day week service but prompted a reduction of hours of urgent response service from 9am to 9pm to 9am to 7pm Figure 4: Needs for Service   Ambulance transfers in the Toronto area The number of transfers to the hospital made by Toronto Emergency Medical Services from original 7 of the LTCHs participating in the project decreased by 10% between the 4th quarter of 2007 and the 4th quarter of 2008. There were fewer transfers from 5 of the 7 LTCHs, indicating that there may be an opportunity to increase marketing at Fudger House and Belmont House in the future. Figure 5: Toronto Emergency Medical Services (EMS) Transfers   One on one interviews with the Directors of Care Interviews were conducted with the Director of Care (DOC) of seven of the twelve LTCHs: Belmont House, Castleview Wychwood, Christie Gardens, Fudger House, Kensington Gardens, Leisureworld – St. George and Vermont Square. From the interview, the DOCs had strong opinions on what they thought were the strengths of the program. One strength identified was the program’s ability to safeguard the quality of life for LTC residents. Care in the home was deemed better than receiving care in the ED since the ED tends to focus more on acute issues and does not attend to other concerns. This improvement was seen especially in residents with dementia who tend not to do well in emergency settings. DOCs also noticed a reduction in emergency visits or waiting times. Other strengths include: promoting continuity of care, fostering collaborative relationships and enhanced communication between LTC and TWH especially providing a second opinion, encouraging problem solving and critical thinking among LTC staff. “It gives the nurses another professional to bounce an idea off or just to get a second opinion… there always was a tendency when anything happens to just phone the doctor and panic and send the person to hospital… now that the mobile ED nurses are coming in they are helping our staff to think more critically… maybe there are other things we can do rather than just sending somebody to hospital” The DOCs also expressed their opinions on some improvements to the program. Some improvements include: augmenting mobile ED nurse skills, formalizing the teaching/mentoring role, assisting with direct admissions to ambulatory care units, having the program led by Nurse Practitioners, expanding the hours of operation and expanding the program to include retirement homes and/or assisted living facilities. Furthermore, the DOCs have seen an interactive learning relationship among the mobile nurses and the LTC staff. They have seen that the mobile nurses have a wealth of knowledge and a passion for geriatric care. Focus group with the Mobile RNs Interviews were conducted with the four Mobile RNs from the Toronto Western Hospital (TWH). The Mobile RNs believe that the strengths of the program include: reducing emergency visits or wait times, promoting continuity of care, fostering understanding and enhanced communication between LTC and TWH, bridging the knowledge gap between acute and long term care, providing support for residents and families and expanding nursing opportunities and scope of practice. The Mobile RNs believe that there are some current challenges to the program that need to be addressed including: ambiguity about the role of the mobile ED nurse and the program and the need to augment skill sets. Although there was some initial resistance from the staff RNs, the Mobile RNs have been recognized as a significant support because of the large LTC staff RN workload. The Mobile RNs understand the different skills and knowledge involved in this role including: communication skills, openness to sharing and learning, team work and commitment to each other as nurses and to the advancement of the nursing profession. Interviews with physician stakeholders Interviews were conducted with two physicians – one LTC physician and one hospital Interventional Radiologist. The physicians see many strengths in this program including: reducing emergency visits or wait times, advancing quality of life for LTC residents, and bridging the knowledge gap between acute and long term care. The physicians have seen an improvement in care. Issues that previously presented challenges are no longer present. They have seen a great collaborative relationship develop between the LTC staff and mobile nurses. Physicians are also impressed with the skills and knowledge that the Mobile RNs possess and would be pleased if this program were to continue. Interviews with LTCH nursing staff Interviews were conducted with nursing staff of seven of the twelve LTCHs: Belmont House, Castleview Wychwood, Christie Gardens, Fudger House, Kensington Gardens, Leisureworld – St. George and Vermont Square. The LTCH nursing staff believe the strengths of the program include: reducing emergency visits or wait times, facilitation of the appointments and hospital transfers, timely response, fostering collaborative relationships and enhanced communication between LTC and TWH, providing support and follow-up for LTC staff, providing support for families, and saving resources. The staff members of LTC would like to see this program continue. “They do allot of teaching while they are here…. I believe we also appreciate that because it’s like we’re learning an added skill almost… we really benefit from them… actually enjoy finding out about the new things that are coming out, new techniques and so forth” According to the staff members, some improvements that can be made include: augmenting mobile ED nurses skills, providing routine IV medication treatments and increasing hours of operation. The staff members are pleased with the supportive and respectful relationships that have been formed with the Mobile RNs. LTCH staff RNs are pleased with the extra knowledge and skills they have been acquiring from the Mobile RNs, the excellent communication skills of the Mobile RNs and the preparedness of the Mobile RNs. Cost effectiveness analysis The cost of a visit with the Mobile Team is $126 (21%) less than a visit to the emergency department. Assumptions Mobile consultation costs based on 1.6 aversions per day (results from January, first month with 12 homes). Mobile consultation clinical costs based on $34.26 per hour salary + 25% benefits (9 to 9 Mon to Sun and 9 to 5 Mon to Fri) Mobile consultation transportation costs based on 82 visits in January * $20 round trip / 31 days Emergency visit clinical costs based on Case Costing Data for 75+ yr old pt (direct and indirect) from Toronto Western Hospital, 2007-08 Emergency visit transportation costs based on EMS and Ambutrans costs Figure 6: Cost of a mobile consultation compared to an ED visit   Future Directions Next steps will include negotiation of base funding through Toronto Central Local Health Integrated Network (TCLHIN) planning process. Once ongoing funding is secured an additional 5+ LTCHs will be added to the service roster with consideration of including more residential and assistive living facilities. Further work is required on establishing co created medical directives and expanding scope of nursing practice, building on point of care coaching and teaching, addressing shared electronic documentation as well as exploring easier, more environmentally and ergonomically safe bike transportation.   Conclusion Focusing on key factors of Partnership and Innovative Service Delivery the Long-Term Care Emergency Mobile Program has been a success. The program is not only less costly than a traditional ED visit for a 75+yr old patient but has also significantly decreased ED transfers. In addition, anecdotal evidence supports improved quality of life for residents and enhanced nursing knowledge and expanded scope of practice. Stakeholders including Mobile RNs, LTCH Directors of Care, nursing staff and physicians all report positive results.   references Ackermann, R., Kemle, K., Vogel, R., & Griffin Jr, R. (1998). Emergency Department Use by Nursing Home Residents. Annals of Emergency Medicine, 31(6), 749-757. Drummond, A. (2002). No room at the inn: overcrowding in Ontario's Emergency Departments. Canadian Journal of Emergency Medicine, 4(2), 91-97. Do you know a colleague who would be interested in this ? Click on the button (top left) Nursing has an opportunity to influence care delivery horizontally along the continuum of care. Where could you see this type of mobile nursing model facilitating the care experience within as well as outside of your health care organization? - Mary Jane McNally What are your thoughts? Send us your comments using the postform below:
Years of stigma towards mental illness drove the topic into the shadows where people suffered alone in isolation. Attitudes towards discussing mental illness have shifted in recent years but we still have a long way to go. It is hard enough to talk about the topic and it is even harder for people experiencing the confusing symptoms and feelings associated with mental illness to put words to their experience.
Adrian is 13. He's the kid (red shirt) in the picture with the pretzel on his head at the MobilizeYouth Summer Boot Camp! Last summer (August 2008), he weighed in at 328 lbs; by October he was 312 lbs with a waist reduction from 59 to 50 inches. Adrian came to MobilizeYouth in late June; stayed for the July camp; continued the fitness program with other MobilizeTeens 3 times weekly in August; and continued with the MobilizeYouth program again in September. Adrian's Family thinks Mobilize Youth is a great program.When they initially registered Adrian, they thought their biggest challenge would be to have him attend the program 3 days a week and to stay committed. But the program was structured in a way that the children enjoyed working out and being part of a team. This allowed Adrian to be with peers that shared the same weight challenges. And, there were enthusiastic trainers in every session. All of this made the program much easier to attend. Adrian now has an understanding of the importance of healthy meals and a well-balanced lifestyle. He is more than happy to work out 3 days a week and meet with his coaches and new friends. This program has encouraged Adrian to become more active on a daily basis and it has given him the opportunity to join the school sport teams this year. His family is proud of his weight loss and his dedication towards the program. Even his doctor has been impressed with Adrian's progress and weight loss! MobilizeYouth has reached out to so many others like Adrian. MobilizeYouth is much more than a kids' fitness program. They address issues that all overweight kids and teens ages 8 to 16 feel. Those who register in the program are ready for change – even the youngest. They want to feel good, look good, get fit and understand how to incorporate new approaches to eating into their life. At MobilizeYouth, participants learn how to take charge of their health, which has positive effects on their school performance and helps with other aspects of socialization – like bullying and fear of competition. The MobilizeYouth team of passionate, caring and skilled coaches meet with each family, providing an initial assessment and recommend a customized fitness & nutrition program. Commitment is key to success, attendance the means to achieving goals. MobilizeYouth supports both. Their hands-on approach motivates and encourages youth and teens to achieve their goals which then leads to weight loss and stronger self-esteem. Do you know a colleague who would be interested in this ? Click on the "share" button (top left) - key words - mobilizeyouth, program,  weight, family, fitness, coaches, loss, school - links to - Exhibitors - Consultants - Books - Blog - Forum - Wiki - Who Is? What do you think ? Dina Lieberman would like to hear from you ... Please use the "comment" box below to respond ...
Advancing the Arts as Integral to Healthcare updated May 17, 2010 Over the past 50 years, there has been a growing movement in North America and elsewhere toward a more integrative healthcare model. This holistic paradigm of healthcare recognizes the essential connection of body, mind, and spirit (Sperry, 1995). It is in this setting that creative activities and the arts therapies are finding their long overdue place in modern Western healthcare (Sonke, Rollins, Brandman, & Graham-Pole, 2009). The purpose of this paper is to illustrate the unique and significant contributions the arts have made in healthcare. Much of this paper is excerpted from the State of the Field Report: Arts in Healthcare 2009, which includes an overview of the research supporting the vast array of benefits the arts offer patients, their family members, and caregivers. Arts in Healthcare is a diverse, multidisciplinary field dedicated to transforming the experience of healthcare by connecting people with the power of the arts at key moments in their lives. This rapidly growing field integrates the arts, including literary, performing, and visual arts and design, into a wide variety of healthcare and community settings for therapeutic, educational, and expressive purposes. Throughout recorded history, we see evidence that pictures, stories, dances, music, and drama have been central to healing rituals. Today’s renewed focus on humanistic care is leading to resurgence in the knowledge and practice of incorporating the arts into healthcare services. Increasing numbers of clinicians and other professionals from the medical community are working side by side with arts professionals in both healthcare and community settings, and around the world the arts are emerging as an important and integral component of healthcare. In two recent surveys conducted by the Society for the Arts in Healthcare, The Joint Commission, and Americans for the Arts (2004, 2007), nearly half of the healthcare institutions reported having arts in healthcare programming. The majority of these programs are in hospitals, with smaller percentages reported in long-term care and hospice/palliative care organizations. The three most common types of arts programming are permanent display of art, performances in public spaces, and bedside activities. report anita boles Who Is ? on this topic Crazy Humor for Health Music Therapy in Palliative Care on related topics What Good Lovers Know What has design got to do with it? Understanding Therapeutic Clown Research demonstrates the benefits of the arts in healthcare in hospitals, nursing homes, senior centers, hospice, and other locations within the community. Arts in healthcare programs and creative arts therapies have been applied to a vast array of health issues—from post-traumatic stress disorder to autism, mental health, chronic illnesses, Alzheimer’s and dementia, neurological disorders and brain inquires, premature infants, and physical disabilities—to improve patients’ overall health outcomes, treatment compliance, and quality of life. New evidence is emerging that demonstrates that these programs also have an economic benefit. Data show that such programs result in patients requiring shorter hospital stays, less medication, and having fewer complications—all of which translates to a reduction in healthcare costs. However, much of the research focused on the economic benefits of arts in healthcare is anecdote rich and data poor. It is hoped that future analysis of the economic benefits of arts in healthcare programs will advance policy conversations about using the arts to simultaneously reduce health costs and raise the quality of care. Conversely, there is a rich and growing body of research connecting arts in healthcare programs to improved quality of care for patients, their families, and even medical staff. Studies have proven that integrating the arts into healthcare settings helps to cultivate a healing environment, support the physical, mental, and emotional recovery of patients, communicate health and recovery information, and foster a positive environment for caregivers that reduces stress and improves workplace satisfaction and employee retention. Areas of focus include: Patient Care - The incorporation of the arts into the healthcare experience has a positive impact on patient health outcomes. The arts benefit patients by aiding in their physical, mental, and emotional recovery, including relieving anxiety and decreasing the perception of pain. In an atmosphere where the patient often feels out of control, the arts can serve as a therapeutic and healing tool, reducing stress and loneliness and providing opportunities for self-expression. Art also has the power to communicate and educate, giving it a growing role of significance in healthcare institutions. In addition, research shows that the arts can reduce patients’ use of pain medication and length of stay in the hospital, and improve compliance with recommended treatments—offering substantial savings in healthcare costs. Healthcare Environments - The arts create safer, more supportive, and functional environments in healthcare facilities. From architectural design to art on the walls, from access to natural lighting to the inclusion of nature through landscape and healing gardens, the physical environment has a significant impact on reducing patient and caregiver stress, improving health outcomes, enhancing patient safety and overall quality of care, and reducing costs. The physical environment also plays an important role in improving the health and safety for staff, increasing effectiveness in providing care, reducing errors, and increasing job satisfaction. Caring for Caregivers - Caregivers, such as family, friends, and healthcare providers in hospitals, hospices, and other health facilities, are faced with the realities of human suffering, illnesses, and death on a daily basis. Arts programming for caregivers creates a common, more normative environment, and offers caregivers an opportunity for creativity and self-expression that allows them to healthfully integrate their experiences and emotions instead of carrying them home or into the workplace. In addition, the arts give medical professionals new tools for improving diagnostic and communication skills and can be used to better communicate health and recovery information. The arts help overcome barriers by embracing diversity, reinforcing family members’ supportive role in the healing process, and changing the culture within the healthcare facility to one that is more supportive and humane.   The Benefits of the Arts in Healthcare: A Sampling of Research Findings Perhaps at no other time in history has quality assurance in healthcare been more paramount than today. Traditionally, clinical decision-making has been based on intuition, opinions, assumptions, and experience. In today’s healthcare world, with approximately 30% of all healthcare spending going toward ineffective, redundant, or inappropriate care; capital resources scarce; the economy sagging; and the cost of healthcare becoming a hot political issue, healthcare decision-makers are demanding that decisions be based on evidence (Hayes, 2008). This strategy, called evidence-based medicine, supports the clinician’s individual clinical expertise, and combines this experience with the best available external evidence and the values and needs of the patient, in making medical decisions. As an integral part of healthcare, arts in healthcare must be held to the same standards. Researchers have found evidence of the benefits of the arts in healthcare in hospitals, nursing homes, senior centers, private homes, or other locations within the community. Quantitative and qualitative research from across healthcare disciplines—and documented in peer-reviewed journals—provides evidence of both instrumental and intrinsic benefits of arts in healthcare. A growing body of research indicates that a physiologic process may actually take place through contact with certain images and other forms of the arts. In a very early study, Goldstein (1980) described “thrills”—tingling sensations individuals may experience when exposed to emotionally arousing stimuli. His findings showed a relationship between these experiences and the release of endorphins—the body’s own pain reliever, “relaxer,” and mood enhancer. An emerging science that is part of this physiologic research is psychoneuroimmunology (PNI), which is concerned with the correlation between stress and health. Specifically, PNI is the study of the interaction between psychological processes and the nervous and immune systems of the human body (Vedhara & Irwin, 2005). Researchers also are interested in the effects of art in the environment and arts programming on family members and healthcare staff. For example, most hospital artists in residence programs serve families as well as patients, and often provide special workshops for staff. We know that not only can such activities help staff deal with the stress of caregiving, but also that healthcare providers who share an interest in the arts with a patient can build a relationship through the art medium itself, using it to help a patient tell his or her life story and find a place of connection with a caregiver (Penn, 1994). Also, many medical schools, recognizing the arts as a powerful education tool, are incorporating the arts and humanities into medical curriculum (Bertman, 2007). Increasingly, nursing and other healthcare disciplines are following suit. We have only recently begun to look at the economic benefits of the arts in healthcare. Quality of life outcomes for arts program participants are being translated into cost saving outcomes, such the need for fewer doctor visits and medication (Cohen, 2009). Other researchers are considering the impact of an active arts program integrated into the healthcare environment on healthcare staff seeking employment or considering whether to remain in their current position (Staricoff, Duncan, Wright, Loppert, & Scott, 2001; Staricoff & Loppert, 2003). With the rising healthcare cost, coupled with the need to retain nurses—the single largest group of people hospitals employ—research of this nature can have a tremendous impact on struggling healthcare systems. “Measuring” is occurring on two levels: evaluation and what is often referred to as “traditional” research. Evaluation typically is undertaken to measure the effectiveness of a particular project or program. The purpose of basic research is broader, with interest in building theory and the knowledge base of the field. Program and project evaluation has progressed at a faster pace than traditional research activities. Nevertheless, paralleling the evidence-based medicine movement in the larger healthcare field, quantitative research in arts in healthcare is now being carried out throughout the world (State of the Field Committee, 2009). The following provides some examples of research on the various arts that support their benefit to patients.   Visual Arts Research indicates that the visual arts also have many intrinsic and instrumental benefits in healthcare. For example, research with children with cancer indicates that engaging in drawing and painting is an effective method for dealing with pain and other disturbing symptoms of illness and treatment (Rollins, 2005a). Also, the visual arts offer a means of non-verbal communication, often bringing order and clarity to mixed-up, poorly understood feelings. While providing a vehicle for catharsis, the artwork itself offers a tool to monitor the individual’s emotional and/or developmental state and progress (Rae, 1991; Sturner, Rothbaum, Visintainer, & Wolfer, 1980). Visual arts also serve as a diagnostic tool; asthma symptoms may be revealed in children’s illness drawings (Gabriels, Wamboldt, Adams, & McTaggart, 2000). And, as with all of the arts, engaging in the visual arts provide opportunities for individuals to make choices and to be in control at a time when many things in their lives are beyond their control, an important factor in reducing stress (Rollins, 2005b). Some of the documented benefits of participating in visual arts or art therapy activities include: Decreasing symptoms of distress and improving quality of life for women with cancer (Monti et al., 2006); Improving depression and influencing fatigue levels in cancer patients on chemotherapy (Bar-Sela, Atid, Danos, Gabay, & Epelbaum, 2007); Reducing acute stress symptoms in pediatric trauma patients (Chapman, Morabito, Ladakakos, Schreier, & Knudson, 2001); Increasing support, psychological strength, and providing new insights about their cancer experience for individuals who participated in an art therapy/museum education program (Deane, Fitch, & Carman, 2000); and Strengthening positive feelings, alleviating distress, and clarifying existential/spiritual issues for adult bone marrow transplant patients in isolation (Gabriel, Bromberg, Vandenbovenkamp, Kornblith, & Luzzato, 2001).   Music A good amount of the research literature on the benefits of the arts in healthcare with patients concerns music, which has been found effective in: Increasing comfort level post-operatively (Pölkki, Vehviläinen-Julkunen, & Pietilä, 2001); Decreasing use of sedatives during procedures (Loewy, Hallan, Friedman, & Martinez, 2005; Walworth, 2005); Decreasing anxiety in children receiving casts for orthopedic injuries (Brice & Barclay, 2007); mproving depression, anxiety, and relationships in psychiatric patients (Choi, Lee, & Lim, 2008); Increasing heart rate and improving behavioral score in preterm infants in the neonatal intensive care unit, resulting in a deeper sleep (Arnon et al., 2006); Decreasing incidence of respiratory pause in premature infants, where breathing ceases for 10 seconds or less (Arnon et al., 2006; Shepley, 2006); Increasing quality and length of life for individuals diagnosed with terminal cancer (Hilliard, 2003); Increasing or decreasing the growth of neoplastic and normal human cells (Sharma, Kauffman, & Stephens, 1996); Shortening the length of stay by three days for premature infants in an intensive care unit as compared with a control group (Coleman, Pratt, Stoddard, Gerstmann, & Abelm, 1994); Lowering the heart rates, respiratory rates, and myocardial oxygen demand for patients recovering from myocardial infarction (White, 1999); Reducing blood pressure levels in pregnant women waiting to be seen in a high-risk prenatal clinic (Staricoff & Loppert, 2003); Reducing pain during intramuscular injection (Fowler-Kerry & Lander, 1987), pain during bone marrow aspiration (Pfaff, Smith, & Gowan, 1989), pain after surgery (Steinke, 1991), pain from heel-stick procedures with neonates (Bo & Callaghan, 2000), and pain associated with serious illness (Bailey, 1986; Nolan, 1992); Reducing the perception of pain in people with rheumatoid arthritis (Schorr, 1993); and Reducing nausea and vomiting in adults undergoing bone marrow transplant (Ezzone, Baker, Rosselet, & Terepka, 1998), after treatments or surgery (Standley, 1992; Steinke, 1991), and after anesthesia or chemotherapy (Keller, 1995). Several studies have dealt with the use of music for coping with stress. For example, Ryan-Wenger and Walsh (1994) reported that school-aged children with asthma have identified listening to music as one of the four most effective and frequently used strategies for coping with their disease. Music also has been found effective in: Deducing stress behaviors in infants and toddlers who were hospitalized (Marley, 1984); Reducing stress among visitors in hospital surgery/intensive care unit waiting rooms (Rothieaux, 1997); Producing relaxation during cardiac catheterization (Micci, 1984); and Decreasing anxiety before surgery (Kain, Wang, Mayes, Krivutza, & Teague, 2001) and in outpatients undergoing flexible sigmoidoscopy (Chlan, Evans, Greenleaf, & Walker, 2000). Some important research deals with adherence to medical regimes. For example: Grasso and colleagues (2000) reported on the benefits of music in establishing routine chest physiotherapy—an important component of prophylactic therapy for children with cystic fibrosis—as a positive experience for children and their families. In a study of adults with chronic obstructive pulmonary disease (COPD), Bauldoff, Hoffman, Thomas, Zullo, and Sciurba (2002) found that listening to music promoted adherence to a walking regimen following completion of a pulmonary rehabilitation program. Other researchers report music’s effectiveness in significantly increasing salivary immunoglobulin A (IgA), an antibody that provides defense against various infections (Lane, 1990) and infants’ oxygen saturation levels, an indicator of respiratory regularity directly affected by the individual’s behavioral state and degree of pain (Collins & Kuck, 1991; Standley & Moore, 1995).   Dance The literature shows that most of the experimental research about dance and movement has been done in the therapy field. Studies on the benefits of dance and dance/movement therapy for women with breast cancer include the work of Serlin and colleagues (Serlin et al., 2000), Sandel and colleagues (2007), and Dibbel-Hope (2000). All three show improvement in variables related to psychosocial functioning, self-image, and quality of life. Other work on the impact of dance/movement therapy on quality of life variables in people with medical illness include Goodill’s randomized controlled study with adults with cystic fibrosis, showing improvements in adherence with self-care regimens (Goodill, 2005a), and a large multi-site controlled study of group dance/movement therapy for older adults with neurological disorders (Berrol, Ooi, & Katz, 1997). The latter study documented strong patient satisfaction and improvement in social interaction parameters and psychomotor functioning. An early study by Westbrook & McKibben (1989) used a crossover design to compare dance therapy with exercise for Parkinson’s patients and found that only dance therapy improved psychosocial functioning. Work in pediatric medical settings includes that of Cohen and Walco (1999) where the creative arts are integrated fully into hemotology/oncology services for developmental support, group therapy, and enhancing coping. Other studies on dance interventions with medical patients are summarized by Goodill (2005b, 2006). The effectiveness of dance/movement therapy to reduce anxiety and improve mood, social functioning, and self-concept were analyzed in a meta-analysis by Cruz and Sabers (1998), which revealed effect sizes comparable to that of other mainstream psychotherapy approaches. More recent findings regarding the benefits of dance include: Being number one on a list of leisure activities that most contribute to the delay in onset of Alzheimer’s disease for those at risk of the disorder (Verghese et al. 2003); Increasing mobility in individuals with fibromyalgia (Bojner-Horwitz, Theorell, & Anderberg, 2003); and Improving balance and mobility in individuals with Parkinson’s disease (Hackney, Kantorovich, Levin, & Earhart, 2007).   Literature, Creative Writing, and Storytelling Studies using creative writing as an intervention report: Improved quality of life for people with cancer after a single, 20-minute writing session while waiting for their clinic appointment (Morgan, Graves, Poggi, & Cheson, 2008); Improved lung function in high school-aged students, college students, and adults with asthma after written emotional expression (Bray et al., 2003); Decreased visits to physicians and reduced symptom complaints (Pennebaker, 1997, 2004); and Increased health and emotional well-being (Pennebaker, 2002). Stories can provide a means for individuals to deal indirectly with difficult fears and realities (Freeman, 1991). Some individuals may use the story to discuss their issues and situations; others may simply enjoy a story as a fantasy escape that need not be analyzed. According to Heiney (1995), people take from a story only what they are ready to find, and what they find often may be meaning in their experiences and renewed hope. Levels of depression in individuals who were guided to read selected fiction, poetry, or literature were reduced in comparison to individuals in a control group who did not participate in the guided reading. Storytelling has resulted in a greater level of relative well-being for individuals with mild to moderate dementia that participated in group reminiscence therapy as compared to those participating in group activities or unstructured time (Brooker & Duce, 2000). Storytelling also has been used to help children deal with both mental and physical pain (Heiney, 1995). For example, Kuttner (1988) employed a hypnotic method using the child’s favorite story and found it more effective than behavioral distraction and standard medical practice in alleviating distress, pain, and anxiety during painful bone marrow aspirations. The power of story to distract should not be taken lightly. In 1794, before the use of anesthetics, a young boy had surgery to remove a tumor. During his operation he was told such an interesting story that it absorbed his attention and removed pain from conscious awareness. This true believer in the power of story, Jacob Grimm, wrote Snow White 18 years later (Hilgard & LeBaron, 1984).   Drama Of all of the arts disciplines, drama has been extremely effective in creating understanding. For example, Sinding, Gray, Grassau, Damianakis, and Hampson (2006) explored audience reactions to the research-based drama Ladies in Waiting? Life After Breast Cancer. Quantitative findings indicate an overwhelmingly positive response, with approximately 90% of those who saw the production agreeing that they benefited from seeing it and indicating that they would recommend it to others. As is often the case, qualitative data revealed a more complex picture of the range of reactions, allowing researchers to describe the most valued aspects of the production, such as how it eased isolation, normalized the difficult aspects of survivorship, and provided better understanding of the few reports of distress. Participating in drama also has garnered positive outcomes. Noice and Noice (2004) investigated the benefits of a short-term intervention for older adults that targeted cognitive functioning and quality of life issues important for independent living. Participants (124 community-dwelling persons ages 60 to 86 years) took part in one of three study conditions: theater arts (primary intervention), visual arts (non-content-specific comparison group), and no-treatment controls. After four weeks of instruction, those given theater training made significantly greater gains than did no-treatment controls on both cognitive and psychological well-being measures. A comparison of theater and visual arts training showed fewer benefits in fewer areas for visual arts.   Design Implications Much arts in healthcare research has focused on architecture or design issues. This growing body of research confirms that the physical design of healthcare settings can contribute to either positive or negative outcomes for patients. A movement toward thoughtful evidence-based design is bringing the patient, staff, and families into the center of the health care experience; increasing patient safety; and enhancing the overall quality of care provided (Sadler & Joseph, 2008). Environmental psychologist Roger Ulrich’s classic study of patients recovering from gall bladder surgery found that those individuals with views of a small park with trees and flowers had better nurse evaluations, took less medication, and had shorter hospital stays than individuals with a view of an adjacent brick wall (Ulrich, 1984). A later study further confirmed that visual exposure to natural environments is more effective in fostering reduction of anxiety and stress than comparable visual exposure to urban environments (Ulrich et al., 1991). More recently, Ulrich and colleagues conducted a study that exposed 166 patients in intensive care units to one of six visual stimulation conditions: two nature pictures dominated by water and trees respectively; two abstract pictures similar in complexity to the nature conditions; and two control conditions (Ulrich, Lunden, & Eltinge, 1993). Individuals exposed to the view of water experienced less postoperative anxiety than patients assigned to the other five visual conditions. Further, they required fewer doses of strong pain drugs during the ward phase. Findings from this research suggested that placing photographs of certain natural environments in hospital settings might have positive influences on postoperative recovery. Nanda, Debajyoti, and McCurry (2009) provide evidence that visual stimuli undergo an aesthetic evaluation process in the human brain by default, even when not prompted; that responses to visual stimuli may be immediate and emotional; and that aesthetics can be a source of pleasure, a fundamental perceptual reward that can help mitigate the stress of a healthcare environment. Also provided are examples of studies that address the role of specific visual elements and visual principles in aesthetic evaluations and emotional responses. They conclude with a discussion of the implications of these findings for the design of art and architecture in healthcare. The topic of healing healthcare environments is becoming increasingly popular in healthcare publications. For example, Modern Healthcare magazine has addressed design in several issues. The 12 winning facilities in a design award competition that the magazine sponsored in 1996 featured indoor courtyards and gardens (Pinto, 1996). Similarly, in 2001, the magazine focused on hospital healing gardens (Tieman, 2001). Not only providing restorative or calming nature views, hospital gardens also can reduce stress and improve outcomes through other mechanisms, for instance, fostering access to social support and providing opportunities for positive escape and sense of control with respect to stressful clinical settings (Ulrich, Zimring, Joseph, Quan, & Choudhary, 2004).   Summary of Research Evaluations, observations, and research findings demonstrate that there are both instrumental and intrinsic benefits to the arts in healthcare. Research in the field is limited but rapidly growing. Conducting research requires experience in arts in healthcare research techniques and methods and funding from sources that recognize the potential of arts in healthcare. Another issue is a lack of clarity about what to measure and sometimes a lack of awareness about the distinction between curing and healing. To move forward with a research plan, there first needs to be clarity about what effects are intended by integrating the arts in healthcare. This clarification will drive the development of tools and methods for researching both the instrumental and intrinsic benefits of the arts in healthcare. Both quantitative and qualitative research methods have a role in this endeavor. Patton (2002, p. 53) writes: “It is crucial for validity—and consequently, for reliability—to try to picture the empirical social world as it actually exists to those under investigation, rather than as the researcher imagines it to be, thus the importance of such qualitative approaches as participant observation, depth interviewing, detailed description, and case studies.” And further, regarding artistic criteria in qualitative research, he says, “Artistic expressions of qualitative analysis strive to provide an experience with the findings where ‘truth’ or ‘reality’ is understood to have a feeling dimension that is every bit as important as the cognitive dimension” (p. 548). Writing in the Journal of Epidemiology and Community Health, Hamilton, Hinks, and Petticrew (2003) note: In the health field, proper recognition of the health effects of interventions and resources, are likely only to follow from good evidence that they achieve their intended health and well-being outcomes. In the absence of evaluation there always will be much uncertainty over benefits, harms and value for money. A scientific approach to evaluating the arts may help move the debate about the arts and health beyond anecdote and opinion (p. 402). The scientific approach is well underway, and with it, mounting evidence that the arts are truly making a difference in people’s lives in hospitals, nursing homes, senior centers, private homes, or other locations within the community. Evidence also is emerging regarding economic benefits. Thus, research findings indicate that the arts can play a significant role in humanizing healthcare for individuals, families, and the healthcare providers that serve them; and can become part of the solution to our current healthcare challenges.   Moving Forward The field of arts in healthcare is steadily moving forward. Increasingly, healthcare administrators are not only welcoming but also financially supporting arts programming in their institutions. Medical and nursing schools see the value in incorporating arts in healthcare courses or content to help their students develop their observation, communication, and other essential skills. Arts organizations, schools, and colleges are partnering with healthcare organizations to provide arts programming as well as health promotion experiences in community settings. Architects and designers are creating healthcare institutions that are not only beautiful, but also built upon a solid foundation of evidence about what supports safe delivery of care and provides the most positive outcomes for patients, families, and staff. The State of the Field Report: Arts in Healthcare 2009 verifies that the benefits of arts in healthcare are not limited to a select group of privileged individuals. Illness has a very leveling effect and the very nature of the arts means that everyone—regardless of ethic group, race, age, economic status, or geographical region—can enjoy all that the arts can bring to healthcare experiences. Although continued research explaining the positive outcomes of the arts in healthcare for patients, families, and staff is paramount, our current economic crisis demands that research demonstrating the financial benefits must parallel these efforts. Evidence of monetary benefits can provide the arts in healthcare field a seat at the table when tough decisions are made. With the launch of the Society for the Arts in Healthcare’s journal, Arts & Health: An International Journal for Research, Policy and Practice, and The International Journal of the Creative Arts in Interdisciplinary Practice (recently renamed from The Canadian Creative Arts in Health, Training and Education Journal), a true sense of professionalism of the field is settling in. Professionalism also is reflected by organizations and institutions of higher education’s development of coursework to prepare individuals to provide safe and effective arts in healthcare services. Beginnings of certification and credentialing are in the air. From the beginning of recorded history, the arts have been central to the human experience. In times of illness, our world is stripped of what civilization has added to our primal core. In the 21st century when our expansion of knowledge out paces our ability to understand and utilize it, we are beginning to pay attention to our basic human needs for safety, community, art, and music—and to unlock their meaning and harness their power. This is at the heart of the arts in healthcare movement. To view the entire report, go to State of the Field Report: Arts in Healthcare 2009 http://www.thesah.org/doc/reports/FieldReport2%206.pdf   About the Society for the Arts in Healthcare: The Society for the Arts in Healthcare is an international non-profit organization dedicated to advancing the arts as integral to healthcare. Although the Society is based in the American capital, its vision is to be the foremost global resource uniting the arts and healthcare. As a convening organization, the Society offers an annual international conference (in 2005, the University of Alberta Hospital program hosted the conference in Edmonton) and periodic symposia throughout the U.S. and Canada. The Society provides an extensive array of supportive and professional development services to the field, including a comprehensive website, grant opportunities for members, organization of special interest groups, and its CREATE Services, which encompasses a Clearinghouse of information, Re-granting and awards, Educational events, Arts in healthcare networks, Technical assistance, and Exhibits—all designed to aid in professional and organizational development. The growth of the Canadian arts in healthcare industry received a boost in 2005 when the Canadian Forum on the Arts and Health was sponsored by the British Columbia Arts Council. The conference participants favored and spurred the creation of a networking organization as a national priority (Cooley, 2005), hence the movement to develop the Canadian Arts and Health Network (Sonke, Rollins, Brandman, & Graham-Pole, 2009). In February 2009, a new network, the National Network for Arts in Health Canada (NNAHC), was formed. NNAHC is a non-profit online organization that aims to bring together artists, clinicians, researchers, and others who are either working in the arts in health field or have an interest in it. It is about building a strong, open, and sharing community across the country. The website includes events, links, and a forum for discussion.   references Arnon, S., Shapsa, A., Forman, L., Regev, R., Bauer, S., Litmanovitz, I., et al. (2006). Live music is beneficial to preterm infants in the neonatal intensive care unit environment. Birth, 33(2), 131–136. Bailey, L. (1986). Music therapy in pain management. Journal of Pain Symptom Management, 1, 25–28. Bar-Sela, G., Atid, L., Danos, S., Gabay, N., & Epelbaum, P. (2007). Art therapy improved depression and influenced fatigue levels in cancer patients on chemotherapy. Psychoonocology, 16, 980–984. Bauldoff, G., Hoffman, L., Thomas, G., Zullo, T., & Sciurba, F. (2002). Exercise maintenance following pulmonary rehabilitation. Chest, 122, 948–954. Berrol, C.F., Ooi, W.L., & Katz, S.S. (1997). Dance/movement therapy with older adults who have sustained neurological insult: A demonstration project. American Journal of Dance Therapy, 19(2), 135–160. Bertman, S. (2007). One breath apart: Facing dissection. Cambridge, MA: Digitalclay Interactive. Bo, L.K., & Callaghan, P. (2000). Soothing pain-elicited distress in Chinese neonates. Pediatrics, 105(4), E49. Bojner-Horwitz, E., Theorell, T., & Anderberg, U. (2003). Dance/movement therapy and changes in stress-related hormones: A study of fibromyalgia patients with video-interpretation. The Arts in Psychotherapy, 30, 255–264. Bray, M., Theodore, L., Patwa, S., Margiano, S., Alric, J., & Peck, H. (2003). Written emotional expression as an intervention for asthma. Psychology in the Schools, 40(2), 193–207. Brice, J., & Barclay, J. (2007). Music eases anxiety of children in cast room. Journal of Pediatric Orthopedics, 27, 831–833. Brooker, D.J., & Duce, L. (2000). Well-being and activity in dementia: A comparison of group reminiscence therapy, structured goal-directed activity, and unstructured time. Aging and Mental Health, 4(4), 354-358. Chapman, L, Morabito, D., Ladakakos, C., Schreier, H., & Knudson, M. (2007). The effectiveness of art therapy interventions in reducing post traumatic stress disorder (PTSD) symptoms in pediatric trauma patients. Journal of The American Art Therapy Association, 18, 100–104. Chlan, L., Evans, D., Greenleaf, M., & Walker, J. (2000). Effects of a single music therapy intervention on anxiety, discomfort, satisfaction, and compliance with screening guidelines in outpatients undergoing flexible sigmoidoscopy. Gastroenterology Nursing, 23(4), 148–156. Choi, A., Lee, M., & Lim, H. (2008). Effects of group music intervention on depression, anxiety, and relationships in psychiatric patients: A pilot study. The Journal of Alternative and Complementary Medicine, 14(5), 567–570. Cohen, G. (2006). The creativity and aging study: The impact of professionally conducted cultural programs on older adults. Retrieved December 17, 2008, from http://www.nea.gov/resources/accessibility/CnA-Rep4-30-06.pdf Cohen, G. (2009). New theories and research findings on the positive influence of music and art on health with ageing. Arts & Health: An International Journal for Research, Policy and Practice, 1(1), 48-62. Cohen, S.O., & Walco, G.A. (1999). Dance/movement therapy for children and adolescents with cancer. Cancer Practice, 7(1), 34-42. Coleman, J.M., Pratt, R.R., Stoddard, R.A., Gerstmann, D., & Abelm, H-H. (1994). The effects of the male and female singing voices on selected physiological and behavioral measures of premature infants in the intensive care unity. International Journal of Arts Medicine, 5(2), 4–11. Collins, S., & Kuck, K. (1991). Music therapy in the neonatal intensive care unit. Neonatal Network, 9(6), 23–26. Cooley, N. (2005). Canadian Forum on Arts and Health 2005: Forum summary report [On-line report on Forum proceedings]. Retrieved January 20, 2009, from http://www.bcartscouncil.ca/healthcanadaforum/program/ Cruz, R., & Sabers, D. (1998). Dance/movement therapy is more effective than previously reported. The Arts in Psychotherapy: An International Journal, 25, 101-104. Deanne, K., Fitch, M., & Carman, M. (2000). An innovative art therapy program for cancer patients. Canadian Oncology Nursing Journal, 10, 147–157. Dibbel-Hope, S. (2000). The use of dance/movement therapy in psychological adaptation to breast cancer. The Arts in Psychotherapy: An International Journal, 27(1), 51-68. Ezzone, S., Baker, C., Rosselet, R., & Terepka, E. (1998). Music as an adjunct to antiemetic therapy. Oncology Nursing Forum, 25(9), 1551–1556. Ferszt, G., Massotti, E., Williams, J., & Miller, J. (2000). The impact of an art program on an inpatient oncology unit. Illness, Crisis, & Loss, 8(2), 189–199. Fowler-Kerry, S., & Lander, J. (1987). Management of injection pain in children. Pain, 30, 169–175. Freeman, M. (1991). Therapeutic use of storytelling for older children who are critically ill. Children’s Health Care, 20(4), 208–215. Gabriel, B., Bromberg, E., Vandenbovenkamp, J., Kornblith, A., & Luzzato, P. (2001). Art therapy with adult bone marrow transplant patients in isolation: A pilot study. Psychooncology, 10, 114–123. Gabriels, R., Wamboldt, M., McCormick, D., Adams, T., & McTaggart, S. (2000). Children’s illness drawings and asthma symptom awareness. Journal of Asthma, 37(7), 565–574. Goldstein, A. (1980). Thrills in response to music and other stimuli. Physiological Psychology, 8(1), 126–129. Goodill, S. (2005a). Research letter: Dance/movement therapy for adults with cystic fibrosis: Pilot data on mood and adherence. Alternative Therapies in Health and Medicine, 11(1), 76-77. Goodill, S. (2005b). An introduction to medical dance/movement therapy: Health care in motion. London: Jessica Kingsley Publishers. Goodill, S. (2006). Dance/movement therapy for people living with medical illness. In S.C. Koch, & I. Brauninger (Eds.), Advances in Dance/movement therapy: Theoretical perspectives and medical findings (pp. 52-61). Berlin: Logos Verlag. Grasso, M., Button, B., Allison, D., & Sawyer, S. (2000). Benefits of music therapy as an adjunct to chest physiotherapy in infants and toddler with cystic fibrosis. Pediatric Pulmonology, 29(5), 371–381. Hackney, M.E., Kantorovich, S., Levin, R., & Earhart, G.M. (2007). Effects of tango on functional mobility in Parkinson’s disease: A preliminary study. Journal of Neurological Physical Therapy, 31, 173179. Hamilton, C., Hinks, S., & Petticrew, M. (2003). Journal of Epidemiology and Community Health, 57, 401–402. Hayes, W. (2008). Evidence-based medicine restores focus on roi. Quality Digest. Retrieved February 1, 2009, from http://www.qualitydigest.com/inside/health-care-article/evidence-based-medicine-restores-focus-roi.html Heiney, S. (1995). The healing power of story. Oncology Nursing Forum, 22(6), 899–904. Heiney, S., & Darrr-Hope, H. (1999). Healing icons: Art support program for patients with cancer. Cancer Practice, 7(4), 183–189. Hilgard, J., & LeBaron, S. (1984). Hypnotherapy of pain in children with cancer. Los Altos, CA: William Kaufman. Hilliard, R. (2003). The effects of music therapy on the quality and length of life of people diagnosed with terminal cancer. Journal of Music Therapy, 40, 113–137. Kain, Z.N., Wang, S.M., Mayes, L.C., Krivutza, D.M., & Teague B.A. (2001). Sensory stimuli and anxiety in children undergoing surgery: A randomized, controlled trial. Anesthesia & Analgesia, 92(4), 897–903. Keller, V. (1995). Management of nausea and vomiting in children. Journal of Pediatric Nursing, 10(5), 280–286. Kuttner, L. (1988). Favorite stories: A hypnotic pain-reduction technique for children in acute pain. American Journal of Clinical Hypnosis, 30(4), 289–295. Lane, D. (1990). The effect of a single music therapy session on hospitalized children as measured by salivary immunoglobin A, speech pause time, and a patient opinion Likert scale. Unpublished doctoral dissertation. Case Western Reserve University, Cleveland, OH. Loewy, J., Hallan, C., Friedman, E., & Martinez, C. (2005). Sleep/sedation in children undergoing EEG testing: A comparison of chloral hydrate and music therapy. Journal of PeriAnesthesia Nursing, 20(5), 323–332. Marley, L. (1984). The use of music with hospitalized infants and toddlers: A descriptive study. Journal of Music Therapy, 21, 126–132. Micci, N. (1984). The use of music therapy with pediatric patients undergoing cardiac catheterization. The Arts in Psychotherapy, 11, 261–266. Monti, D. Peterson, C., Kunkel, E., Hauck, W., Peawuignot, E, Rhodes, L., et al. (2006). A randomized, controlled trial of mindfulness-based art therapy (MBAT) for women with cancer. Psychooncology, 15(5), 363–373. Morgan, N., Graves, K., Poggi, E., & Cheson, B. (2008). Implementing a expressive writing study in a cancer clinic. The Oncologist, 13(2), 196–204. Nanda, U., Debajyoti, P., & McCurry, K. (2009). Neuroesthetics and healthcare design. Health Environments Research & Design Journal, 2(2), 116–133. Noice, H., & Noice, T. (2004). A short-term intervention to enhance cognitive and affective functioning in older adults. Journal of Aging and Health, 16(4), 562–585. Nolan, P. (1992). Music therapy with bone marrow transplant patients: Reaching beyond the symptoms. In R. Spintge, & R. Droh (Eds.), Music/medicine (pp. 209–212). St. Louis, MO: MMB Music. Patton, M. (2002). Qualitative research & evaluation methods (3rd ed.). Thousand Oaks, CA: Sage Publications. Penn, B. (1994). Using patient biography to promote holistic care. Nursing Times, 90(45), 35–36. Pennebaker J.W. (2002). Writing about emotional events: From past to future. In S.J. Lepore, & J.M. Smyth (Eds.) The writing cure: How expressive writing promotes health and emotional well-being (pp. 281–291). Washington, DC: American Psychological Association. Pennebaker, J.W. (1997). Opening up: The healing power of expressing emotions. New York: Guilford Press. Pennebaker, J.W. (2004). Writing to heal: A guided journal for recovering from trauma and emotional upheaval. Oakland, CA: New Harbinger Publications, Inc. Pfaff, V., Smith, K., & Gowan, D. (1989). The effects of music-assisted relaxation on the distress of pediatric cancer patients undergoing bone marrow aspirations. Children’s Health Care, 18, 232–236. Pinto, C. (1996). Going natural by design. Annual design awards show facilities are emphasizing integration of the indoors with the outdoors. Modern Healthcare, 26(45), 39–42. Pölkki, T., Vehviläinen-Julkunen, K., Pietilä A-M. (2001). Nonpharmacological methods in relieving children’s postoperative pain: A survey on hospital nurses in Finland. Journal of Advanced Nursing, 34(4), 483-492. Rae, W. (1991). Analyzing drawings of children who are physically ill and hospitalized using the ipsative method. Children's Health Care, 20(4), 198–207. Rollins, J. (2005a). Tell me about it: Drawing as a communication tool for children with cancer. Journal of Pediatric Oncology Nursing, 22(4), 203–221. Rollins, J. (2005b). The arts in healthcare settings. In J. Rollins, R. Bolig, & C. Mahan (Eds.), Meeting children’s psychosocial needs across the healthcare continuum (pp. 119–174). Austin, TX: ProEd, Inc. Rothieaux, R.L. (1997). The benefits of music in hospital waiting rooms. Health Care Surgery, 16(2), 31–40. Ryan-Wenger, N., & Walsh, M. (1994). Children’s perspectives on coping with asthma. Pediatric Nursing, 20(3), 224–228. Sadler, B., & Joseph, A. (2008). Executive summary. In Evidence for innovation (pp. 2–15). Alexandria, VA: National Association of Children’s Hospitals and Related Institutions. Sandel, S., Judge, J., Landry, N., Faria, L., Ouellette, R., & Majczak, M. (2005). Dance and movement program improves quality-of-life measures in breast cancer survivors. Cancer Nursing, 28(4), 301-309. Schorr, J.A. (1993). Music and pattern change in chronic pain. Advances in Nursing Science 15(4). 27–36. Serlin, I.A., Classen, C., Frances, B., & Angell, K. (2000). Symposium: Support groups for women with breast cancer: Traditional and alternative expressive approaches. The Arts in Psychotherapy: An International Journal, 27(2), 123-138. Sharma, H.M., Kauffman, E.M., & Stephens, R.E. (1996). Effect of different sounds on growth of human cancer cell lines in vitro. Alternative Therapy in Clinical Practice, 3(4), 25–32. Shepley, M. (2006). The role of positive distraction in neonatal intensive care unit settings. Journal of Perinatology, 26, S34–S37. Sinding, C., Gray, r., Grassau, P., Damianakis, & Hampson, A. (2006). Audience responses to a research-based drama about life after breast cancer. Psychooncology, 15(8), 694–700. Sonke, J., Rollins, J., Brandman, R., Graham-Pole, J. (2009). The State of the Arts in Healthcare in North America. Unpublished article. Sperry, R.W. (1995). . Journal of Humanistic Psychology, 35(2), 7, 34. State of the Field Committee. (2009). State of the field: Arts in healthcare 2009. Washington, DC: Society for the Arts in Healthcare. Standley, J. (1992). Clinical applications of music and chemotherapy: The effects on nausea and emesis. Music Therapy Perspectives, 10, 27–35. Standley, J., & Moore, R. (1995). Therapeutic effects of music and mother’s voice on premature infants. Pediatric Nursing, 21(6), 509-512, 574. Staricoff, R.L., & Loppert, S. (2003). Integrating the arts into healthcare: Can we affect clinical outcomes? In D. Kirkland, & R. Richardson (Eds.), The healing environment without and within (pp. 63–79). London: Royal College of Physicians. Staricoff, R.L., Duncan, J., Wright, M., Loppert, S., & Scott, J. (2001). A study of the effects of visual and performing arts in healthcare. Hospital Development, 32, 25–28. Steinke, W. (1991). The use of music, relaxation and imagery in the management of postsurgical pain for scoliosis. In C. Maranto (Ed.), Applications of music in medicine (pp. 141–162). Washington, DC: National Association for Music Therapy, Inc. Sturner, R., Rothbaum, F., Visintainer, M., & Wolfer, J. (1980). The effects of stress on children’s human figure drawings. Journal of Clinical Psychology, 36, 325–331. Tieman, J. (2001). Healing through nature. Modern Healthcare, 31(2), 34–35. Ulrich, R. (1984). View through a window may influence recovery from surgery. Science, 224, 420–421. Ulrich, R., Lunden, O., & Eltinge, J. (1993). Effects of exposure to nature and abstract pictures on patients recovering from open heart surgery. Psycholophysiology: Journal of the Society for Psychophysiological Research, 30, suppl 1, S7. Ulrich, R., Simons, R., Losito, B., Fiorito, E., Miles, M., & Zelson, M. (1991). Stress recovery during exposure to natural and urban environments. Journal of Environmental Psychology, 11, 201–230. Ulrich, R., Zimring, C., Joseph, A., Quan, X., & Choudhary, R. (2004). The role of the physical environment in the hospital of the 21st century: A once-in-a-lifetime opportunity. Concord, CA: The Center for Health Design. Vedhara, K., & Irwin, M. (2005). Human psychoneuroimmunology. Oxford, England: Oxford University Press. Verghese, J., Lipton, R., Katz, M. Hall, C. Derby, C., Kuslansky, G., et al. (2003). Leisure activities and the risk of dementia in the elderly. New England Journal of Medicine, 348, 2508–2516. Walworth, D. (2005). Procedural-support music therapy in the healthcare setting: A cost-effectiveness analysis. Journal of Pediatric Nursing, 20(4), 276–284. Westbrook, B., & McKibben, H. (1989). Dance/movement therapy with groups of outpatients with Parkinson’s disease. American Journal of Dance Therapy, 11(1), 27–38. White, J.M. (1999). Effects of relaxing music on cardiac autonomic balance and anxiety after acute myocardial infarction. American Journal of Critical Care, 8(4), 220–230. Do you know a colleague who would be interested in this ? Click on the button (top left) What are your thoughts? Send us your comments using the postform below:
The content and focus of care are far from clear. Indeed, care itself is controversial. There is not one ethic or bioethics of care. This is the case because morality, caring, and views of human flourishing are located within diverse moral and metaphysical understandings. This moral pluralism divides societies across the world. It constitutes an impediment to the discovery or creation of a substantive, common global bioethics of care. We do not agree about what and how we should care. Relations of care and caring acts are particular. Care is not undertaken from nowhere, but from a particular somewhere. Caring is structured and directed by how we appreciate reality, including moral reality. An affirmation of an ethic of care is rendered ambiguous by the moral pluralism that characterizes the human condition. An ethic of care divides as much as it unites. Our diversity of moral and metaphysical views creates a diversity of bioethics of care, a diversity of what it is to care for others. Consider the gulf between theists and atheists. Theists recognize reality as having ultimate meaning, while atheists regard reality as ultimately coming from nowhere, going nowhere, and for no ultimate purpose. That about which one should care and how one should care will look quite different, depending on whether one’s horizon of concern is set within the horizon of the finite and the immanent, or whether it is aimed at transcendent concerns, as recognized by traditional Christians and Jews. Major cultural fault-lines separate massively divergent moral and metaphysical views of reality, as well as of the bioethics and the ethics of care. The collision of these moral and metaphysical visions led to the genesis of bioethics and then to its fracturing into a plurality of bioethics and into a plurality of understandings of the content and focus of care. In assessing the conflicts characterizing contemporary bioethics and the ethics of care, it is important to distinguish among individuals who have particular moral views, communities of persons who share a morality along with a common, content-full view of care, societies spanning diverse moral communities, and states that are often temporarily under the control of one dominant community and its morality. In short, a state is not one moral community, and moral communities are separated by diverse moralities and bioethics of care. There are usually also intermediate institutions that may more or less be nested with a moral community or be marked by a struggle between communities and their moralities. For example, should an institution in caring for those in need encourage an internal or an external locus of responsibility? Should a hospice encourage final repentance for one’s sins? There will be institutions with very particular moral identities. Their integrity will be tied to a particular vision of caring, as with an Orthodox Jewish nursing home or a Roman Catholic hospital. Again, all caring is particular: it is shaped by particular concerns. This presentation gives an account of why there is not a single, canonical bioethics of care; why bioethics supported a false expectation of consensus about the nature of care; why bioethics cannot deliver on its promises to provide a common bioethics of care; how we might go to the future while recognizing our controversies about the nature of care. I. Moral pluralism and its intractability A. Taking moral diversity seriously: we do not agree about the proper focus for our commitments of care or about what it means to care for others, because we do not share one morality, one account of human flourishing, or one account of the meaning of life. To care is to care about the good of others, and about the nature of the good there is much dispute. For example, is it a caring act to provide abortion, artificial insemination from a donor, and/or euthanasia? 1. What counts as a morality? A morality is a generally coherent set of settled judgments about what it is to act rightly, about how to pursue the good, and about what it means to be virtuous as well as have a good character. 2. Do we really face a plurality of moralities and a plurality of bioethics of care? Polarized political-moral disagreements across the world reflect our diversity of moral and metaphysical views and constitute the culture wars (James Davison Hunter, Culture Wars, 1991). Moralities are separated by substantive foundational disagreements regarding such issues as the moral propriety of abortion, homosexual acts, social-welfare states, capital punishment, physician-assisted suicide, and the importance of repentance and absolution before death. Moralities are different when they support discordant views about cardinal elements of human life, such as when it is obligatory, permitted, or forbidden to take human life, have sex, and re-distribute property. For example, is it an act of real care to offer abortion and euthanasia to the impoverished or to those in intractable pain, or are such acts acts of maleficence, not true acts of caring? 3. We are separated by different moralities and accounts of the content of care because a) within divergent moralities, key human goods are differently ordered. Depending on how one ranks liberty, equality, prosperity, and security, one will endorse a social-democratic polity such as Canada, or one will endorse an elitist, capitalist-Confucian polity such as Singapore. Each will sustain a different view about what it is to care in a health care system. Different moralities are also often separated by different right-making conditions and by ranking common right-making conditions differently. b) some moralities along with accounts of care may even involve special values or concerns, such as holiness and obedience to God, which are not shared with other moralities. c) different rankings of goods and right-making conditions will ground substantially different bioethics of care, different views of what it means rightly as well as wrongly to show care to others. Such rankings fashion the particularity of a view from somewhere. 4. Why do we face a plurality of bioethics and of ethics of care? Because there is a plurality of moralities, there is a plurality of bioethics and a diversity of ethics of care. There is, for example, a growing Chinese bioethical literature that focuses on nurturing a bioethics of care that recognizes the ontological priority of the family over that of isolated, atomic individuals. This care recognizes one’s life within an integrated family to be more important than individual autonomy. 5. Does moral diversity entail a moral relativism? No! In the face of moral pluralism, there can still be moral truth. It may only be that secular moral reflection is unable to determine the nature of that truth. One may be forced to accept a secular epistemological moral skepticism but not a metaphysical moral skepticism. There may indeed be a canonically right way to care. B. Moral pluralism and the culture wars: the roots of the plurality of the bioethics of care 1. Agrippa, a 3rd-century philosopher, observed that there are five reasons (his pente tropoi) to hold that philosophical argument will not resolve foundational moral disputes: after 800 years, no one had succeeded in conclusively resolving the disputes at hand, disputants argue from their own perspective and therefore past each other, and disputants argue in a circle or beg the question or engage in an infinite regress, absent common basic premises and rules of evidence. 2. Bioethics (including the bioethics of care) is irreducibly plural, and 3. we are destined to live in the culture wars, because the advocates of disparate positions in major moral and public policy controversies do not share common moral and metaphysical premises or rules of evidence. We therefore disagree about what is compassed in showing rightly-directed care. C. From at least the 18th century, a gulf opened in Western European cultures, further separating the traditional Christian cultures of an already fragmented Europe (e.g., fragmented by the Reformation, the Third Years’ War [1618-1638], and the Civil War [1642-1649]) from a secular, post-traditional culture framed inter alia by the Enlightenment, the French Revolution, the Napoleonic interventions, and, finally, by mid- to late-20th-century secularizing changes in constitutional law (North American and West European). The public forum in the West was recast from being normatively Christian to being normatively secular so that the dominant culture of the West now bears the marks of being shaped after the disestablishment of Christianity. This disestablishment helped both engender bioethics and define the contemporary culture wars in Europe and the Americas. In addition, there is no one secular moral vision. Consider the conflict among libertarian, classical liberal, and social-democratic moral perspectives on what it is to care for others. These differences compound the differences that separate those whose appreciation of care is limited by the horizon of the finite and the immanent, and those whose concerns for care are directed by transcendent concerns. D. Although we disagree about foundational moral and metaphysical issues, there are nevertheless passionate declarations of consensus. There are assertions of a common moral agreement, evidence to the contrary notwithstanding. Why, given moral pluralism, would consensus be affirmed? 1. The assertion of consensus may in part be due to a self-deception on the part of those who embrace a supposed consensus; they may be captured by their own ideology or false consciousness. 2. Consensus may in part be invoked because claiming the existence of a consensus can serve as a rhetorically useful device to give moral and political authority to one’s views. 3. Consensus may also seem to be possible, given the logic of the creation of ethics committees and commissions that favors appointing persons who already share substantial overlapping points of agreement. A committee marked by real moral difference would produce endless debates. 4. Consensus may also be expected because the original bioethics had its roots in a Roman Catholic institution (Georgetown University) where the universalist claims of natural law were recast in terms of Enlightenment commitments to human rights and human dignity, leading to the illusion that there could be a unitary bioethics of care. II. Bioethics emerged in the early 1970s to provide secular moral guidance for health care and the biomedical sciences. The bioethics movement was tantamount to an attempt to realize Enlightenment hopes to establish a universal human morality binding all humans in one community. It was taken for granted that rationally grounded moral consensus could be achieved. A. Although the term bioethics is at least eighty years old with roots in a concept of a moral obligation to living things (Fritz Jahr, “Bio-Ethik. Eine Umschau über die ethischen Beziehungen des Menschen zu Tier und Pflanze,” Kosmos. Handweiser für Naturfreunde 24.1 [1927]: S. 2-4), with Van Rensselaer Potter re-engaging the term in 1970, bioethics took on its contemporary significance in 1971 with the beginnings of the Center for Bioethics at Georgetown University. The bioethics of the 1970s was made in America in response to local socio-cultural circumstances. 1. Medical ethics in the USA had been marginalized as the medical profession was transformed from a guild to a trade through US Supreme Court decisions and through a suspicion of elites. 2. The professional standard for the disclosure of information for consent to treatment was replaced by the reasonable-and-prudent-person or objective standard, so that the authority of individuals gained salience over that of medical professionals. 3.Christianity’s de jure and de facto establishment was abolished and attempts were made to secularize the public forum and public policy. Traditional moral, religious, and social structures were brought into question, challenging the moral authority of priests, ministers, and rabbis. B. Bioethics promised to fill the moral vacuum as government bodies, hospitals, health care professionals, patients, their families, and society as a whole called for moral guidance about how properly to engage medicine and the biomedical sciences. There was a call for a moral vision, as well as for a concrete view of what is involved in giving care. 1. The secular equivalent of a theology, a moral vision, was produced for cultural orientation. Bioethics offered a moral framework for intellectual guidance as well as a foundation for secular culture, public policy, individual choices, and an understanding of care in health care. 2. The secular equivalent of a cadre of priests and chaplains was created to provide bioethics consultation, serve on ethics committees, and direct ethical care in health care. New secular chaplains were produced to direct and support care. III. The failure of Enlightenment hopes: Bioethics and the ethics of care are plural A. Bioethics, including the bioethics of care, is fragmented by an intractable moral diversity. Bioethics cannot keep its earlier promises. 1. As a secular field, diversity, not consensus, is ever more salient. 2. Given our moral diversity, clinical bioethics provides relatively little actual content-full normative guidance about what it is to care properly for others. That is, clinical bioethicists relatively infrequently give normative moral guidance. Instead, they usually a) provide legal advice, Straightforward normative b) mediate conflicts, and advice would often be c) clarify concepts and analyze arguments. disruptive. B. Moral disputes about what it is to care properly in matters of life and death, from abortion to euthanasia remain. The bioethics of care is inevitably a battleground in the culture wars. IV. Care in the battlegrounds of the culture wars: Where do we go from here? A. We should honestly face our moral diversity and the circumstance that changes are taking place that undermine the illusions of a possibility of consensus. Across the world, bioethics projects are emerging that are grounded in moral visions different from that which was at the roots of the original American bioethics. Even persons such as John Rawls recognized that reasonable humans do not and will not share one comprehensive doctrine that can sustain a single substantive bioethics of care. Even Rawls retreated from strong claims that were in, or could be read into, A Theory of Justice (1971). 1. Rawls, for example, retreated from speaking of the morally rational to speaking of the politically reasonable: he abandoned the hope of a common comprehensive moral viewpoint. 2. Even this default position of Rawls is more expansive than is justified, given what Agrippa recognized some 1700 years ago. There is not one sense of a proper bioethics of care. B. In the face of intractable moral diversity: 1. as a point of prudence, one should avoid totalizing approaches by engaging such devices as conscience clauses and the avoidance of all encompassing bioethical policies that preclude particular hospitals and health care institutions from maintaining their own views of care. 2. One will need to explore how the sparse morality that can bind moral strangers can also allow persons with diverse bioethics of care to collaborate in the face of real moral differences. C. Among the tasks to be faced is the need to recognize and explore how religiously affiliated hospitals and health care institutions are properly shaped and directed by specific particular visions of proper caring that transcend the horizon of the finite and the immanent, which visions are core to the moral identity and integrity of these institutions.   references For a more detailed presentation of the issues sketched above, see H. Tristram Engelhardt, Jr., The Foundations of Bioethics (Oxford, 1996), The Foundations of Christian Bioethics (M & M Scrivener, 2000) and Global Bioethics: The Collapse of Consensus (M & M Scrivener, 2006) http://philosophy.rice.edu/faculty http://orthodoxwiki.org/H._Tristram_Engelhardt links to other presentations on this or related topics Dr. Margaret Somerville - Doing Ethics Prof. Allan Irving - The Welfare State in Canada Prof. Dennis Raphael - Health Status and Use of the Healthcare System Want to send a colleague a link to this page ? Click on the "Tell a Coll" (tell a colleague) button below.   What do you think ? Prof. Engelhardt would like to hear from you ... Please use the "comment" box below to respond ...
African American Grandmothers Raising their Grandchildren updated April 18, 2010 Stepping Up to the Plate While Facing the Challenges Description In the United States, there is a growing number of grandmothers who are assuming the role of primary caregivers to their grandchildren. Grandmothers as caregivers are often referred to as providing kinship care. It is a unique form of intergenerational parenting and differs from parenting by birthparents (McGoldrick, 1999). All experts agree that kinship care continues to grow exponentially. The result of the last US Census found 4.5 million children in kinship caregiving arrangements; of these, more than a half million were African American children (U.S. Census, 2000; Minkler & Fuller-Thomson, 2005). It is evident that the African American community is disproportionately represented. The percentage of children in kinship care is higher than in the child population (Hill, 2006). Kinship caregivers have been described as older African American women who are single and have limited incomes and a low educational level (Cuddenback, 2004). Despite their income, they have decided to assume the role of primary caregiver. Kinship care is beneficial for children. It allows them to maintain ties with their cultural community (Scannapieco, Hegar, & McAlpine, 1997), is less traumatic than being in foster care with strangers (Scannapieco & Hegar, 1999), and supports their well-being (Solomon & Marx, 1995). dr. priscilla a. gibson Who Is ? on related topics Caring for Caregivers   Today, I’m going to talk about the growing phenomenon of African American grandmothers as primary caregivers to their grandchildren. This type of caregiving has occurred for centuries and continues to increase but is facing some difficult contemporary challenges. The focus of my presentation is African American Grandmothers in kinship care. I will discuss the following aspects of on kinship care: Definitions History Rationale for assuming the role of caregiver Benefits to grandparents and children in care Challenges to grandparents and children in care   Definitions Kinship care is defined as the caregiving of a dependent child by a relative or close family friend when biological parents are unavailable, unwilling, unable, or cannot care for the child (Child Welfare League of American (CWLA), 1994). It is described as “the full-time nurturance and protection of a child” (Simpson & Lawrence-Webb, 2009). There are basically two types of kinship arrangements. One type is called formal, kinship foster, or public kinship care, which is facilitated by the public child welfare system or courts. The other, informal or private kinship care, results from agreements among family members with or without the involvement of the courts. This type exists without the supervision from the public child welfare system. In addition, outside the foster care system, there are large numbers of children in private or informal kinship care. The majority of children in kinship care are in informal arrangements (Simpson & Lawrence-Webb, 2009). More research exists on formal than informal kinship care (Simpson & Lawrence-Webb). The type of arrangement is seen as influential to the level of services received. Most researchers concur that caregivers in private kinship care receive less services than those in public kinship care (Letiecq, Bailey, & Porterfield, 2008).   History Kinship care is a traditional practice in the African American community. Historically, children were taken into the homes of other adults when parents were sold into slavery (Wilson, 1989). Later, during the Great Black Migration in which adults moved from the South to the North to obtain better jobs and for upward mobility led to a large number of grandparents caring for grandchildren (Wilson, 1989). Contemporarily, more children of color than their White peers are entering the public child welfare system. African American grandmothers seem to cope better with their caregiving responsibilities than their counterparts in other racial groups (Caputo, 2001; Goodman & Silverstein, 2001).   Rationale for assuming the role Grandmothers who assume the role of caregivers are overwhelmingly seen as making a huge sacrifice. Gleeson and his colleagues (2009) found that relatives’ assumption of the role could be explained by three overlapping factors (a) the reasons that the children’s parents were unable to care for them, (b) the caregiver’s motivation for assuming responsibility for the child; and (c) the pathways or routes that children took to the caregivers’ home. In a sample of African American grandmothers, Gibson (2002) listed six interrelated reasons for making the role shift from grandmother to caregiver: (a) tradition of kinkeeping; (b) relationship with grandchildren; (c) distrust of the foster care system; (d) grandmother as the only resource; (e) strong relationship with the Lord; and (f) refusal of the grandchild’s other grandmother to assist with caregiving.   Benefits to grandmothers Many authors have found that kinship care is beneficial to grandmother caregivers. African American grandmothers are more satisfied with life and less negative than grandmothers in other racial groups (Goodman & Silverstein, 2001). Knowing that their grandchildren are safe results in peace of mind. Jendrek (1993) found that caregiving provided a purpose for living.   Cost to grandmothers Despite the benefits, grandmothers must change their lifestyles to assume the care of young children when they are older and not in the child bearing stage of life. For some, caregiving has a negative influence on health, well-being, and finances (Burnette, 1997; Fuller-Thompson & Minkler, 2000; Kelley, Whitley, Sipe, & Yorker, 2000). Challenges: There are four major challenges faced by grandmothers in their role as caregivers. They are discussed in no particular order. Governmental financial assistance. Kinship care arrangements occurs at all socioeconomic levels. Some caregivers do not need financial assistance from the government but many do. The Temporary Assistance for Needy Families (TANF) child-only grant is the only cash assistance available to all caregivers based solely on a non-biological child being in the household. It does not consider the assets of the caregiver. Yet, the limited numbers of caregivers receiving it leads to the assumption that they are unaware of such provisions (Nelson, Gibson, & Bauer, 2010). Contact and interaction with the birthparents. Grandparent caregivers continue to want to support the parents of their grandchildren but must also manage the accompanying intra-family conflict (Gibson, 2002). Gleeson and Seryak (2010) found that birthparents care for and are concerned about their children in kinship care. However, issues of authority in the face of who is in charge may surface with the return to the birthparent if only for a brief visit. In rare situations, the relationship between the grandmothers and birthparents do not change, allowing active support of non-residential parenting (Gibson, 2002). Custody issues in private or informal arrangements. Grandmothers in informal arrangements accept the responsibility of their grandchildren without legal rights (Kroll, 2007). The lack of legal rights allows birthparents to retrieve their children at any point regardless of the amount of time invested and financial resources used for caregiving. Depending on the state of residency, the lack of legal custody acts as a barrier to school enrollment and obtaining medical services for children in care (Albert, 2000; Bruce, 2004). In many states, the Defacto Custodian legislation allows grandparents to have equal standing with birthparents before a court. However, the definition of this legislation and its’ provisions continue to be challenged and varied among states. Informal or private kinship care arrangements. While the literature on caregivers in this type of arrangement continues to grow, it remains sparse. One reason points to it being out of the public child welfare system (Simpson & Lawrence-Webb, 2009). Another reason may be the tendency of caregivers in informal arrangement to stay from under the radar of professionals for fear of being questioned about circumstances surrounding the arrangement. Regardless of the rationale, the prevalence of informal arrangements demands more attention.   Conclusion It is clear that African American grandmothers in the kinship caregiving role act as a resource to the birthparents (their adult children) and to the society at large as well. These older women give of themselves for the betterment of their grandchildren without much in return. They have “stepped-up to the plate” and changed their life style to help another generation succeed. Should we as a society also do our part to help them?   references Albert, R. (2000). Legal issues for custodial grandparents. In B. Hayslip & R. Goldberg-Glen (Eds.), Grandparents Raising for Custodial Grandchildren: Theoretical, Empirical, and Clinical Perspectives (pp. 327-340). New York: Springer. Bruce, E.A. (2004). A parent’s rights under the fourteenth amendment: does Kentucky’s de facto custodian statute violates due process. Kentucky Law Journal, 92, 529-550. Burnette, D. (1997). Grandparents raising grandchildren in the inner city. Families in Society, 78, 489-501. Caputo, R. (2001). Depression and health among grandmothers co-residing with grandchildren in two cohorts of women. Families in Society, 82(5), 473-483. Child Welfare League of American (CWLA). (1994). Kinship Care: A Natural Bridge. Washington, DC: Child Welfare League of America. Cuddeback, G. (2004). Kinship family foster care: a methodological and substantive synthesis of research. Children & Youth Services Review, 26(7), 623-639. Fuller-Thomson, E., & Minkler, M. (2000). African American Grandparents Raising grandchildren: A national profile of demographic and health characteristics. Health & Social Work, 25(2), 109. Gibson, P.A. (2002). Caregiving affects family relationships of African American grandmothers as new mothers again: A phenomenological perspective. Journal of Marital and Family Therapy, 28(3), 341-353. Gleeson, J., Wesley, J., Ellis, R., Seryak, C., Talley, G., & Robinson, J. (2009). Becoming involved in raising a relative's child: reasons, caregiver motivations and pathways to informal kinship care. Child & Family Social Work, 14(3), 300-310. Gleeson, J., & Seryak, C. (2010). ‘I made some mistakes . . . but I love them dearly’ the views of parents of children in informal kinship care. Child & Family Social Work, 15(1), 87-96. Goodman, C.C., & Silverstein, M. (2001). Grandmothers who parent their grandchildren. Journal of Family Issues, 22(5), 557-578. Hill, R.B. (October 2006). Synthesis of research on disproportionality in child welfare: An update. Casey-CSSP Alliance for Racial Equity in Child Welfare. Jendrek, M. (1993). Grandparents who parent their grandchildren: Effects on lifestyle. Journal of Marriage & Family, 55(3), 609-621. Kelley, S.J., Whitley, D., Sipe, T.A., & Yorker, B.C. (2000). Psychological distress in grandmother kinship care providers: The role of resources, social support, and physical health. Child Abuse & Neglect, 24(3), 311-321. Kroll, B. (2007). A family affair? Kinship care and parental substance misuse: some dilemmas explored. Child and Family Social Work, 12, 84-93. Letiecq, B. L., Bailey, S. J., & Porterfield, F. (2008). ‘‘We have no rights, we get no help’’: The legal and policy dilemmas facing grandparent caregivers. Journal of Family Issues, 29, 996–1012. McGoldrick, M. (1999). Women through the family life cycle. In B. Carter & M. McGoldrick (Eds.), The Expanded Family Life Cycle: Individual, Family, and Social Perspectives (3rd ed., pp. 106-123). Needham Heights, MA: Allyson & Bacon. Minkler, M., & Fuller-Thomson, E. (2005). African American grandparents raising grandchildren: A national study using the Census 2000 American Community Survey. Journals of Gerontology Series B: Psychological Sciences & Social Sciences, 60B(2), S82-S92. Nelson, J.G., Gibson, P.A., & Bauer, J.W. (2010). Kinship care and “child-only” welfare grants: Low participation despite potential benefits. Journal of Family Social Work, 13(1), 3-24. Scannapieco, M., & Hegar, R. L. (1999). Kinship foster care in context. In R. L. Hegar & M. Scannapieco (Eds.), Kinship foster care: Policy, practice, & research. New York: Oxford University Press. Scannapieco, M. & Hegar, R. & McAlpine, C. (1997). Kinship care and foster care: A comparison of characteristics and outcomes. Families in Society 78(5), 480-488. Simpson, G., & Lawrence-Webb, C. (2009). Responsibility without community resources: informal kinship care among low-income, African American grandmother caregivers. Journal of Black Studies, 39(6), 825-847. Solomon, J.C. & Marx, J. (1995). “To grandmother’s house we go” : Health and school adjustment of children raised solely by grandparents. The Gerontologist, 35(3), 386-394. U.S. Bureau of the Census. (2000). Grandparents living with grandchildren. Retrieved March 26, 2010, from http://www.census.gov/prod/2003pubs/c2kbr-31.pdf Wilson, M.N. (1989). Child development in the context of the Black extended family. American Psychologist, 44(2), 380-385.   Do you know a colleague who would be interested in this ? Click on the button (top left) Are you willing to change your lifestyle to help a loved one? Suppose that loved one was a young dependent child? 2. Actually, what if that loved one was your grandchild whose parents could not or would not care for him or her? - Dr. Priscilla Gibson What are your thoughts? Send us your comments using the postform below:
Great presentation, putting public policy and civic participation into practice. How do we share this with the decision makers, how do we improve the literacy of citizens and empower them to ask and demand change.
Ageing updated march 25, 2010 presentations on "Caregiving & Dementia" exhibitors Long-Range Scenario Planning Supporting Caregiving into 2033 One in five Ontarians is a family caregiver, contributing to more than 70% of total caregiving needs. In 2011, there will be 1.4 million women in Ontario aged 25-44 of whom 4 in 10 will become caregivers at an age when they have to juggle work, family and social life. These caregivers are our invisible healthcare partners. They are tired and hurting. Without family caregivers and other informal caregivers, Ontario’s health care system will not be sustainable... more caregiving dementia Caring about caregivers Caring for ourselves R-E-S-P-I-T-E spells respect Caring for an increasing number of elderly patients Working together to improve care Innovating to adapt I wish I had known Dementia incidence among elderly women The Alzheimer knowledge exchange World Alzheimer Report Dementia: a rising tide Creating a multimedia Alzheimer biography Caregivers and Dementia Ageing, Ageism radio Dr. Brian Goldman ... on his CBC show ‘White Coat, Black Art’ looks at the scenario of  2 patients in the ER both with heart attacks needing angioplasties. He asks the question: If one patient is 42 and the other 92 does it make the question of who gets the procedure done first easier. He suggests that to answer yes to that question would be considered ... listen to the podcast The Grey Tsunami politics Dr. Carolyn Bennett ... There is no question that the ageing demographics are now part of every discussion on the future of health and health care in Canada. Phrases like ‘The Grey Tsunami’, ‘Silver Tsunami’, ‘avalanche of boomers’ are part of all conversations on dealing with the sustainability of our cherished health care system ... view the slide presentation more presentations on "Ageing" Dr. Howard Bergman - The Canadian Initiative on Frailty and Aging Dr. Lynn McDonald - NICE: Knowledge Transfer in the Field of Aging Dr. Gerald Hodge - Responding to the Local Impacts of Baby Boom Aging Dr. Elizabeth Podnieks - Hardiness in Older Victims of Elder Abuse Prof. Ariela Lowenstein - Psycho-Social Factors Affecting the Elderly Marcia Carr - GENI: Geriatric Emergency Network Initiative a few of the "Ageing" presenters "Your Aging Parents" books on ageing Maureen Osis ... Are you worried about your parents as they grow older? Are you concerned about doing the right thing as you take on new roles as their caregiver? "Your Aging Parents" is a Canadian guide for busy adults with ... more "Treasured Legacies" books on ageing Irene Borins-Ash ... Meet our great treasures. These individuals are breathing new life into the tired phrase aging graciously. In fact, far from being gracious about accepting traditional roles for older people, they are often revolutionary... more Karyn Buxman speakers - humour Karyn Buxman... A highly sought humorist and internationally recognized expert in applied and therapeutic humor, Karyn Buxman, RN, MSN, CSP, CPAE shows people how to harness the power of thought (Amazed) and the spirit of humor (Amused). Through her years of ... more Yee Hong Centre for Geriatric Care Thousands of seniors benefit from our long-term care, senior housing, medical and rehabilitation services and community-based programs every day ... more With a century of experience and a dynamic talent team of nearly 4,000, SEHC delivers three million home care visits annually and has been recognized as one of the 50 Best Employers and Best Workplaces in Canada ... more Osteoporosis Canada At least 2 million Canadians suffer from a disease without symptoms. It could be someone you know, it could even be you ... more Reliable real-world monitoring integrated in the Smart Rollator enables remote monitoring and point-of-care solutions ... more Elaine K. Sanchez speakers - caregiving Elaine K. Sanchez... Her keynotes and workshops for caregivers are based on real life experiences and totally original stories from her book, Letters from Madelyn, Chronicles of a Caregiver. She helps caregivers understand the importance of caring for themselves through the use of stories that touch their hearts and tickle their funny bones ... more Creating Excellence in Care advanced practice nursing services Maryanne Brown offers assistance in analyzing and clarifying issues, exploring options, facilitating change and creating new possibilities ...more If you are interested in showcasing your work, product or service ... call416 - 525 - 5465 - Toronto, ON, Canada or e-mail Gloria Lattanzio Do you know a colleague who would be interested in this ? Click on the button (top left)
Long-term care inadequacies, work-force shortages, incontinence strategies, health literacy issues and bans on smoking in cars with children have made headlines in the past week. Plenty of time and energy is spent by many people and organizations to make life better for others - noble work indeed. The common factor in all of these areas is the fact that people want to help people. But it is strange to observe that as our society has more organized groups than ever before to advocate for patients and charities to raise funds for various institutions, we seem to have lost sight of “the need for families to help their own family members”. With long-term institutions bulging at the seams, and resultant Emergency Room wait times for patients waiting in acute care facilities for a more suitable long-term care bed, I’ve come to the realization that building more hospitals or even long-term care institutions isn’t going to solve the access problem. Without the staffing required for these institutions to function safely and efficiently, there would be little point. The question really becomes: How to allow more aging patients to be cared for in their homes or in their relatives’ homes? A relatively new program, Aging at Home, has been created to keep patients in their homes and out of hospitals, when possible. Its success is likely to come only if we have the work-force available to provide care in this manner. Many patients would like to stay as autonomous as possible in their own familiar surroundings but often a crisis of some kind, a fractured hip, difficulties with dementia, or other health problem, winds up pointing them toward hospitals or long-term care institutions. As we have seen with end-of-life care, it is possible to have government strategies that support family members acting as care-givers for patients in their last months. However, with the fastest growing demographic being the over 85 year olds, we should be considering significant mechanisms that allow family members to be supported through government funding while they care for their relatives at home. Part of the issue with this approach is that care-givers often have to leave their jobs to care for elderly relatives. With the increasing health care costs of institutional care, it makes more sense to provide employers with some incentive to have employees working part time or even part-time from home while they care for their elderly family member. Financial support for families willing to take on this care is reasonable since the cost of caring for the elderly patient in hospital on a chronic basis is very significant. Not all families would be able to manage this but families who are interested in attempting this sort of family care should be encouraged and supported with more options for respite care, more options for day hospital visits and more employer supported mechanisms for part-time work. Trouble is that many families are spread across the country. Children leave for jobs and better prospects in other jurisdictions and we should not forget that a 90 year old may have 70 year old children. These are stumbling blocks for many families, but not all. Families must be encouraged to support their elderly and more mechanisms to support care-givers must be established. Knowing that respite is close at hand, that their employer is supportive of their life/work balance, and that government sees their efforts as valuable to society, it is possible that more family members would choose to provide ongoing long-term care to their loved ones.
Aging Is Living is about men and women who have found meaning, purpose, hope and joy in life while living in a long term care home. They are not just waiting to die- they are very much connected to life despite numerous challenges. Hopefully the book will help take away some of the fear that people have about spending the latter part of their life in a nursing home. I travelled around the province interviewing and photographing people who are actively engaged with the future- as well as the present. The book is really the residents voice as told to me. Their thoughts need to be shared with the public. Hopefully this book will give these men and women a much needed presence and a dignity. So much of the media coverage that long term care homes receive is negative but as a social worker who has worked in the different levels of care I was a likely person to tell the other side of the story. I feel that Aging Is Living is timely and an important piece of work as the baby boomers are the next generation of elders and many of the boomers are caring for aging parents while being very involved in their children’s lives as well as the lives of their grandchildren. Hopefully the book will help my generation, my parent’s generation and social work and gerontology students as well. Staying at home when care needs are round the clock and a person is housebound creates social isolation which is bad for your physical and mental health. Aging Is Living illustrates how people in nursing homes can thrive because their care needs are provided for, along with being offered a variety of social programs. The family of the resident can also be released from survival mode to mend relationships and enjoy each other’s company. images/stories/books/iash/iash_starticle.png click on the image above to enlarge it The images and the stories are candid, hopeful, inspiring and myth shattering Dear Mrs. Ash, Your book is beautiful and such a necessary book. Thank you for it. I hope many, many may read it and find comfort and hope. Yes, the ideal is to stay at home. But so many cannot do this. So let us make nursing homes for aging people places of joy and happiness! Your book can help many. Thank you for writing it. I am so late in answering - please forgive. May your heart be full of peace. Love Jean (Dr. Jean Vanier) click on the image below to enlarge it images/stories/books/iash/iash_agingislivingcover.png   links to other books by Irene Borins Ash: Treasured Legacies: Older and Still Great Aging Is Living Myth Breaking Stories From Long Term Care Dundurn Press $26.99 - 200 pages A portion of the authors’ proceeds from this book will be donated to Pat’s Place, a program operated out of Family Service Toronto that helps abused seniors. Please check the website: ireneborinsash.com Irene Borins Ash (the author) Do you know a colleague who would be interested in this ? Click on the button (top left) What are your thoughts? Send us your comments using the postform below:
I want to mention Donna Eden and David Feinstein for their pioneering work in Energy Medicine and Energy Psychology! As a licensed counselor who came into the field as an intuitive with a focus in the metaphysical healing arts as a background, I see energy, and truly, it is what we are - consciousness! Where trauma is held in the energy, it will eventually (if chronic and deep enough) show up in the physical. I see energy systems – in the chakra, grid, and aura, I see the stories of why and how this pain was disrupted in the energy systems. The results can be depression, anxiety, addiction, immune system breakdown, and so on. We as a culture need shift to acknowledging that the medical approach does not and cannot do it all!
HIV / AIDS among Aboriginal people in Canada, is a serious health issue with an ever increasing need for action and strategic planning. As infection rates continue to rise, more and more Aboriginal people, their families and communities are faced with the many and complex challenges that go with this disease. Although new medications are helping people live longer - there remains no cure. Aboriginal Leaders are called upon to speak publicly about this serious health issue. There is an urgency that requires political support, so that HIV/AIDS among Aboriginal people is properly addressed. Further examples of how Aboriginal Leaders can support this cause, is found at the beginning of the nine strategic areas, which could include council resolutions ensuring respect for individual human rights, lobbying for increased funding, etc. Access to adequate care, treatment and support can be a huge task when many Aboriginal people live below the poverty line: some are incarcerated, while others yet are dealing with issues that complicate prevention methods, such as injection drug use or the Residential School Legacy. Northern communities also face sub-standard health with little access to healthcare because of their isolation. As well, different health care coverage exists within Aboriginal populations depending on the status of individuals including residency and system involvement. From what is known through epidemiological evidence, between 1996-1999 both cumulative (91%) and new (19%) HIV infections continue to be quite high. Although infection rates vary among Inuit, Métis, and First Nations people, there is an over-representation for Aboriginal people in terms of HIV/AIDS, who make up approximately 4.4% of the Canadian population, yet are seeing HIV/AIDS figures continue to rise. There are wide gaps in the data, and more research with the full involvement of Aboriginal people, is needed to accurately reveal how this disease is impacting Inuit, Métis, and First Nations people. This strategy will offer a vision for Inuit, Métis and First Nations (status or non-status, on or off-reserve) people to respond to HIV/AIDS. It will outline and describe (1) key issues and nine strategic areas which can be taken to ensure that a range of programs and services are in place to meet the needs of Aboriginal PeoplelLiving with and affected by HIV/AIDS. The following nine strategic areas were selected after researching all Provincial/Territorial Aboriginal HIV/AIDS strategies, some mainstream HIV/AIDS strategies in Canada, and the National Australian HIV/AIDS Strategy. Common ground made its way into this document, as each strategy reviewed essentially were stating the same issues, just in different language and formats. These nine key strategic areas are: Coordination and Technical Support Community Development, Capacity Building and Training Prevention and Education Sustainability, Partnerships and Collaboration Legal, Ethical, and Human Rights Issues Engaging Aboriginal Groups with Specific Needs Supporting Broad-based Harm Reduction Approaches Holistic Care, Treatment and Support Research and Evaluation The title was chosen to reflect the need to create stronger ties, at any level. By doing so, HIV/AIDS work will not operate in isolation of other health and social issues. Whether it is creating a Community Wellness Team, a Regional Network, or bringing together groups on a national level - the potential exists to strengthen the response to HIV/AIDS among Aboriginal communities. The Aboriginal Strategy on HIV/AIDS in Canada (ASHAC) is not about competing with regional and local efforts - it is more about offering support and national coordination that can strengthen ties and strengthen Aboriginal communities. By doing so, it will identify and support measures which can take Aboriginal people that much closer to meeting and overcoming the many challenges related to HIV/AIDS. In some parts of Canada, Provincial/Territorial Aboriginal HIV/AIDS Strategies are in existence. The ASHAC will build upon these regional strengths to support and encourage other regions to develop strategies, create and maintain effective networks, and where needed, assist in the development of frameworks, action plans, protocols and other tools. Much of the early advocacy and prevention efforts around HIV/AIDS started in urban areas. However, there have also been good examples from on-reserve and isolated populations. One example was the establishment of the Atlantic First Nations AIDS Task Force (now Healing our Nations), which mobilized from a regional perspective. Another is the Canadian Inuit HIV/AIDS Network, which has actively engaged its members to raise the profile of HIV/AIDS among Inuit. Numerous other resources have been developed in other regions, for First Nations on and off-reserve, as well as with Inuit and Métis rural HIV/AIDS response teams exist in some regions. It is with these in mind that the ASHAC will seek to provide broad strokes that will bring together current efforts and resources. This Strategy is not about prescribing a vision. It is about building common ground that can enhance, guide, support and complement work in all regions so that Aboriginal people can continue to find innovative ways of taking control of a disease that has taken far too many lives. Aboriginal people are not a special interest group, and have been impacted differently by HIV/AIDS, resulting in varied responses based on a number of reasons. The last section will offer glimpses into issues and factors that may be affecting a diverse listing of groups, such as injection drug users, women, men, etc. There is also an appendix D, which is the Consultation process used which reached 173 Aboriginal and non-Aboriginal people across the country.   This document will use the term "Aboriginal", which is meant to include Inuit, Métis and First Nations (On or Off-reserve, Status or Non-Status) people.   Read the Report "An Aboriginal Strategy on Hiv / Aids" click on the above link to read the report   links to other presentations on this or related topics Want to send a colleague a link to this page ? Click on the "Tell a Coll" (tell a colleague) button below.   What do you think ? Kevin Barlow would like to hear from you ... Please use the "comment" box below to respond ...
Occupational Assistance: An Integrated Model updated July 11, 2010 The Next Step Introduction As has been discussed and illustrated, the workplace is a salient venue through which to address personal difficulties and to assist family functioning and community health directly. Yet, what is the responsibility of counsellors to the workplace? Since the beginning of the industrial revolution in North America an antagonistic relationship has existed between labour and management. Responsibilities of occupational counsellors have ranged from ensuring that young single women were living in virtuous Christian environments to bringing widespread use of critical incident stress debriefing to Employee Assistance Programs. These initiatives by professional counsellors supplanted self-helpers in the workplace who had become active through groups such as Alcoholics Anonymous as early as the 1940s (Brandes, 1976; McGilly, 1985; Popple, 1981; Thomlinson, 1983). Throughout the evolution of workplace-based counselling, clinicians have retained the aura of being agents of social control (Corneil, 1984; Csiernik, 1996; Pace, 1990; Roman, 1980). However, it is hypothesized that by applying an ecological orientation to occupational assistance, and thereby attempting to create both worker and workplace wellness, Employee Assistance can be moved from being a mechanism of social control to one of active social change in order to enhance workplace wellness. This process would entail integrating core practices, crisis and short term individual and family counselling, with mutual aid initiatives and organizational change based theories. Taking an ecological orientation is critical due to the reciprocal relationships that arise in workplace including including both life style issues and the social organization of the workplace. workplace wellness other presentations Wellness In The Workplace prof. rick csiernik Who Is ? on related topics Mental Health is a Complete State Partnering With Families When the Body Says No Renewing Mutual Aid in the Workplace Environment Self-help groups acted as a primary support in the development of the occupational assistance movement (Csiernik, 1993). The industrial revolution brought with it dramatic changes in the structures of business, industry, and the state leading to the depersonalization and dehumanization of social life, increased feelings of alienation and powerlessness and the decline of community (Robinson & Henry, 1977). With the changing pattern of industrialization and family and social relations, new forms of mutual aid emerged to replace weakened social connections, especially in North America. Self-help groups began to respond to the depersonalization in society and became an integral aspect of cooperation between people (Katz & Bender, 1976). As self-help evolved throughout the 20th century from having primarily a treatment and normalization orientation to taking on a greater social change direction, it has played a central role in transforming the focus of the occupational assistance movement from tertiary to primary prevention. The growth of mutual aid/self-help outside the workplace occurred as a response to the pervasiveness of technology, the unavailability and increasing unresponsiveness of human services, the complexity and size of institutions and the increasing dehumanizing and depersonalizing aspects of the work-place (Matzat, 1989). Mutual aid has also been partially responsible for beginning to shift scrutiny from individual to organizational stressors that cause ill health and employee problems. Self-help has the capacity to assist and direct the evolution of occupational assistance programs to their next plane of maturation: wellness. It has an active role in preventing occupational assistance from slipping back to being predominantly a mechanism of social control through activities such as mandatory drug testing and managed care (Ansel & Yandrick, 1993; EAPA, 1992). Self-help groups can also be one mechanism for enhancing workplace participation and democracy. They can assist in modifying the emphasis of occupational assistance from being solely worker centered to focusing more upon problems created by the design of the workplace and the nature of the work, itself. Those influenced by mutual aid principles have the capability to act as catalysts for positive social change in the workplace and for enhancing employee wellness but whether that capacity will be utilized is still in question.   Workplace Participation Formal employee participation in workplace decision making is not a new concept as it has existed in a variety of forms for decades. Different organizational methods of enhancing employee participation in the workplace have emerged throughout the world. Some of the better known initiatives include: Total Quality Management (Deming 1938; 1950; Ishikawa, 1985; Juran and Gryna, Jr., 1970), Quality Control Circles or simply QC Circles (Crocker, Chiu, & Charney, 1984; Dewar, 1980), Theory Z of Management (Ouchi, 1981), Quality of Working Life (QWL) enterprises (Ferman, 1985; Giordano, 1992; Ingle & Ingle, 1983; Kolodny & van Beinum, 1983) and the broader industrial democracy movement (Davies, 1979; Emery & Thorsrud, 1969; Obradovic & Dunn, 1978; Prasnikar, 1991). While the introduction of worker participation schemes implies and requires a change in the distribution of power within a work setting the primary, if not exclusive, theme of these exercises has been on production issues. The focus of the majority of participation plans has tended to highlight more rudimentary changes such as profit sharing schemes, job enlargement, job rotation and improving communication pathways, all of which involve minimal transfers of power between labourers and management. To date, participation plans that could change the nature of control over the actual decision making processes and the work environment itself have been much less evident. As occurred during the Gomperism era of the American labour movement, labour groups have primarily focused upon economic factors. For example, many "enlightened" European Works' Councils have still targeted their efforts on enhancing the pay packet. While this is a valid use of their energies it has come at the cost of further enhancing the physical, psychological, social, intellectual and spiritual health needs of the workforce. Increases in democratic initiatives do not necessarily eliminate workplace let alone societal inequalities. Organizational methods of worker participation are still primarily examples of representative rather than direct democratic endeavours. Individual employees in most systems make little contribution beyond their immediate work environments with minimal attention heeded to anything beyond their basic needs. Worker participation has been espoused as the next great step forward but generally remains limited in its scope. The social and psychological elements of work have had some attention focused upon them but the other elements of wellness still remain largely neglected. Worker participation needs to be expanded so that it examines an employee's total life. This is a vacuum the Integrated Model of Occupational Assistance begins to address.   The Integrated Model of Occupational Assistance The Integrated Model of Occupational Assistance draws upon the existing practice models of occupational assistance while placing a renewed importance on self-help. Worker participation is incorporated within an ecological framework to create an organizational plane to complement the historical emphasis upon the individual worker. The proposed model consists of two axis. The first focuses on the target. Individual wellness is balanced with organizational wellness, taking into account the needs of the range of stakeholders that exist in the immediate and extended workplace environment. The second axis is the method of intervention. It is divided into the categories of professional intervention and mutual aid/self-help. By combining both forms of assistance four quadrants are created allowing for a greater range of access points and prevention alternatives and moving EAP away from being only an agent of social control (Figure 22.1).   figure 22.1 - Model Quadrants   i. Professional - Individual Quadrant The first quadrant of the Integrated Model Of Occupational Assistance is the individual-professional intersection. It consists of activities that are or should be currently provided by the majority of main stream programs and workplace health promotion programs. These activities include ongoing health promotion programming together with an increased emphasis on the provision of counselling and preventative services to family members of employees and retirees. This inclusion is an acknowledgement of the fact that workplace stresses are brought home and that home stresses brought to work by employees further intensify organizational stresses. This interrelationship manifests itself at the worksite through decreased performance and productivity. Highlighting the importance of the family within occupational assistance programming can be done in a variety of ways. Simple promotion activities such as sending information about the program to family members or sponsoring seminars and activities for families are standard mechanisms. Another option is actually changing the name of this component of occupational assistance. Organizations such as the Canadian Pacific Rail, the City of Saskatoon, MacMillan Bloedel and the Canadian Graphic Communications Workers Alliance have already changed the name of their EAPs to "Employee and Family Assistance Programs"(EFAPs). The specific individual components of this quadrant are: provide one-to-one counselling by formally trained counselling professionals off site or on-site, depending upon organizational needs and preferences; retain as the primary focus crisis intervention, brief solution-focused counselling and case management; promote and extend assistance to family members so that the service becomes Employee and Family Assistance Programming; provide proactive educational seminars and workshops to the workforce by social workers and other health and counselling professionals; develop and promote activities that enhance wellness such as voluntary health screenings conducted by occupational health staff and voluntary worksite-based fitness appraisals and programs; promote self-care activities for physical, psychological, intellectual, social and spiritual wellness; respond to critical incidents with specially trained professional debriefers; provide 24 hour crisis intervention and consultation accessible through a toll-free number if warranted; and, incorporate a supportive care component so that employees absent from work for an extended period of time receive contact from the workplace to inquire if any additional, non-financial, assistance is required.   ii. Mutual Aid / Self-Help - Individual Quadrant Mutual aid initiatives have a greater potential to span the gap between wellness and traditional one-to-one counselling than do professional, individually-focused counselling services. It has been stated by various EAP stakeholder groups that peer social support could be the best potential bridge between health promotion, prevention programming, and Employee Assistance Programming (Csiernik, 1995). While the issue of confidentiality will always arise when discussing EAPs, this has not been a hindrance to many existing programs with very active self-help components (Bisgona, 1992; Csiernik, 2002; Eisman, 1991; Grant, 1992; Windsor, 1988). Self-help can be introduced through a variety of means. If there is uncertainty on how a mutual aid initiative will be received by a workforce, it would be judicious to initially begin with a physical health related or psycho-educational focused group. Treatment orientated groups could be considered if a specific request occurs from members of the workforce, or, of course, if a group arises spontaneously. For many organizations, on-site mutual aid/self-help groups will be much easier to support if they are focused upon wellness themes or upon issues of daily living such as child care or dealing with the demands of ageing parents. Components of this quadrant are: use of peers, union counsellors, referral agents, peer resource teams and/or peer advisors, to aid employees access appropriate forms of assistance and to provide on-going social support; use of community-based self-help groups as an adjunct to individual assistance and to further enhance social support; develop on-site self-help groups that deal with traditional problem areas and with wellness-related topics if the employee population is large enough or distinct worksite-specific problems arise and requests emerge; and, respond to any critical incident situation with trained peer debriefers who understand the culture of the organization and the nature of the routine stresses as well as the potential range of stress reactions produced by a critical incident.   iii. Professional - Organizational Quadrant The third quadrant now moves occupational counselling into a new realm. It offers increased possibilities for organization-wide primary prevention and more proactive initiatives including acting as mediators between individuals and between work units in an alternative-dispute resolution process. The activities within this quadrant recognize that workplace health does not simply relate to employees' engaging in healthy behaviours but also includes making the work environment healthier. This would enhance the probability that both individual risk factors and broader environmental and structural issues would be integrated into program undertakings. This quadrant also introduces the idea that occupational assistance can and should enter into the broader context of policy change and advocacy beyond the workplace. There is a place for workplace wellness to be discussed and debated at societal and political levels. While the immediate impact of this aspect of the model may be minimal, in the long term it could be the most important dimension in creating not only well workplaces but also healthier communities. Advocacy efforts may come from researchers or professional associations as well as from groups with vested interests in the workplace. Examples of these are Chambers of Commerce, the Canadian Labour Congress and government mandated health and safety associations such as the Industrial Accident Prevention Association (IAPA) along with professional associations such as the Canadian Association of Social Workers. Aspects of the third quadrant are: provide on-going worksite wide health promotion, safety and critical incident awareness and related wellness education programs; provide consultation and training for ongoing organizational intervention, development and change including team-building initiatives; enhance the health of work units through the provision of technical assistance including mediation or conflict-resolution services on both individual and organizational issues; and, collaborate with individuals and groups external to the work-site in advocating for policy initiatives to increase the wellness and productivity of the workforce, to enhance the healthy functioning of workplaces, and to increase the profile of occupational assistance.   iv. Mutual Aid / Self-Help - Organizational Quadrant The fourth segment of the model is the organization-mutual aid/self-help dimension. Programming arising from this quadrant reflects the needs of labour and management to work conjointly to define, identify and diagnose organizationally created problems. The two groups need to work together to find and implement solutions that can counter organizationally-produced reductions in both productivity and wellness. There are two primary options for these types of support groups; either broad organization wide groups open to all employees or groups organized along departmental or work unit lines. The organizational culture will be the predominant factor in determining whether either or both types of groups emerge. Training and education on what teams are, which is rarely done prior to implementation, how to use them, and their strengths and limits would be essential steps in properly developing the goals identified in this quadrant. Beginning the process by providing training would be much preferable to simply telling employees that they were being placed in teams and expecting them to know not only how to function in this new manner but also how to function more efficiently. The education process that precedes this dimension could be conducted by peers or by professionals internal or external to the workplace as previously discussed in the professional/organizational quadrant. The three components of this quadrant are: engage in team building exercises and activities to acquaint the workforce with expectations, rights and responsibilities of being a team or group member; develop mutual aid group(s) open to all employees that examine stressors both internal and external to the workplace which affect individual and group wellness; develop work unit support groups to decrease work related stress and to act as problem solving and/or peer social support groups.   Conclusion The Integrated Model of Occupational Assistance is premised upon the idea that to achieve wellness, physical, psychological, social, intellectual and spiritual, the workplace needs to address both production and personal issues. The various ideas all hinge, to varying degrees, on the assumption that participatory democracy is a valuable commodity toward which all workplaces should be evolving. Locke, Schweiger and Latham (1984) claimed that participation is not simply an ethical imperative but also a core managerial technique that is appropriate in any situation. However, in occupational programming participation should not only be deemed ethically correct, it should become a professional mandate. Employee Assistance counselling professionals and peer supports need to place greater value on self-determination and regard it as one of the core foundations for all human interaction and development not only outside the workplace but within as well. The delivery of the Integrated Model Of Occupational Assistance is intended to be flexible with a range of implementation options. An organization may begin by developing a physical health promotion component before adding other health promotion or treatment elements. An organization that has a traditional Employee Assistance Program in place could easily incorporate the mutual aid/self-help dimension. These options allow for mutual aid/self-help or organization intervention dimensions to be added to mature occupational assistance programs or to be a foundation for new programming. Implementation will of course be dependent upon the nature of the workplace and workforce. Presentation of the model to workplaces may be adequately vague and generic to allow each organization to take ownership of the program's evolution and adapt the different elements to its own needs. The intent of this second-generation model of occupational assistance is to move away from the notion of intervention as social control. Its goal is not to isolate but rather to integrate physical, social and organizational aspects of the workplace with behavioural and lifestyle aspects of work. It is structured in a manner that when fully implemented, should improve the overall functioning of the workplace and health of employees and their families. Counsellors involved in occupational assistance, because of their knowledge, skills, entry points and positioning in organizations, have the opportunity to improve the quality of life for workers by becoming active change agents and encouraging participatory democratic action. However, occupational assistance is but a small subsystem of any organization. Programs and their champions cannot control all acts of employers and there are inherent limits on what can be realistically accomplished. Thus, to change workplace wellness also requires changes in our cultural norms, public and social policy, labour legislation and existing institutions. A noble goal for all involved in this enterprise.   references Ansel, D. & Yandrick, R. (1993). Building and integrated EAP-managed behavioural health care program: Tying up loose ends. EAPA Exchange, 23(3), 33-35. Bisogna, G. (1992). Surviving recession. EAP Digest, 12(3), 12; 40-41. Brandes, S. (1976) American welfare capitalism, 1880-1940. Chicago: University of Chicago Press. Corneil, W. (1984). History, philosophy and objectives of an employee recovery program. In W. Albert, B. Boyle, & C. Ponee (Eds.), EAP Orientation: Volume II - Important Concepts. Toronto: Addiction Research Foundation. Crocker, O., Chiu, J., Sik L., & Charney, C. (1984). Quality circles: A guide to participation and productivity. Toronto: Methuen. Csiernik, R. (1993). The role of mutual aid/self-help in North American occupational assistance: Past, present and future. Employee Assistance Quarterly, 9(2), 21-45. Csiernik, R. (1995). An integrated model of occupational assistance, unpublished dissertation, University of Toronto. Csiernik, R. (1996). Occupational social work: from social control to social assistance? The Social Worker, 64(3), 67-74. Csiernik, R. (2002). An overview of Employee and Family Assistance Programming in Canada. Employee Assistance Quarterly, 18(1), 17-33. Davies, R. (1979). Industrial democracy in international perspective. In G. Sanderson & F. Stapenhurst (Eds.), Industrial democracy today. Toronto: McGraw-Hill Ryerson. Deming, W. E. (1938). Statistical adjustment of data. New York: Dover Publications. Deming, W. E. (1950). Some theory of sampling. New York: John Wiley and Sons. Dewar, D. (1980). The quality circle guide to participation management. Englewood Cliffs, N.J.: Prentice-Hall Inc.. EAPA. (1992). Outcome studies. EAPA Exchange, 22(10), 48-49. Eisman, C. (1991) Is corporate America about to embrace self-help groups? Self-Helper, 6(2), 1-5. Emery, F.E. & Thorsrud, E. (1969). Form and content in industrial democracy. London: Tavistock. Ferman, L. (1985). Quality of work life programs and EAPs: The reorganization of the workplace. In S. Klarreich, J. Francek, and C. Moore (Eds.), The human resource management handbook. Toronto: Praeger Press. Giordano, L. (1992). Beyond Taylorism: Computerization and the new industrial relations. New York: St. Martin's Press. Grant, G. (1992). Workplace peer power. EAPA Exchange, 22(8), 22-25. Ingle, S. & Ingle, N. (1983). Quality circles in service industries. Englewood Cliffs: Prentice-Hall, Inc. Ishikawa, K. (1985). What is total quality control? The Japanese way. Englewood Cliffs, New Jersey: Prentice-Hall Inc.. Juran, J.M. & Gryna, Frank, Jr. (1970). Quality planning and analysis. Toronto: McGraw-Hill Book Company. Katz, A. & Bender, E. (1976). The strength in us. New York: New Viewpoints. Kerans, P., Dorver, G., & Williams, D. (1988). Welfare and worker participation. New York: St. Martin's Press. Kolodny, H. & van Beinum, H. (1983). The quality of working life and the 1980s. New York: Praeger. Locke, E., Schweiger, D., & Latham, G. (1984). Participation in decision making: When should it be used? Organizational Dynamics, 14(3), 65-79. Matzat, J. (1989). Some remarks on West Germany's health and welfare system and the position of self-help. In S. Humble & J. Unell (Eds.), Self help in health and social welfare. New York: Routledge. McGilly, F. (1985). American historical antecedents to industrial social work. Social Work Papers of the School of Social Work, University of Southern California, 19, 1-13. Obradovic, J. & Dunn, W. (1978). Worker's self-management and organizational power in Yugoslavia. Pittsburgh: University of Pittsburgh. Ouchi, W. (1981). Theory Z. New York: Avon Publishers. Pace, E. (1990). Peer Employee Assistance Programs for nurses. Perspectives on addictions nursing, 1(4), 3-7. Popple, P. (1981). Social work practice in business and industry, 1875-1930. Social Service Review, 55, 257-269. Prasnikar, J. (1991). Workers' participation and self-management in developing countries. San Francisco: Westview Press. Robin, M. (1968). Radical politics and Canadian labour. Kingston:Industrial Relations Centre. Robinson, D. & Henry, S. (1977) Self-help and health. Bungay: Chaucer Press. Roman, P. (1980). Medicalization and social control in the workplace: prospects for the 1980s. Journal of Applied Behavioural Science, 16(3), 407-422. Stephens, E. (1980). The politics of workers' participation. Toronto: Academic Press. Thomlison, R. (1983). Industrial social work: perspectives and Issues. In Perspectives on industrial social work. Toronto: Family Service Canada. Windsor, R., Lowe, J., & Bartlett, E. (1988). The effectiveness of a worksite self-help smoking cessation program: A randomized trial. Journal of Behavioural Medicine, 11(4), 407-421. For more information on this topic please see Csiernik, R. (2005). Wellness and Work: Employee Assistance Programming in Canada. Toronto: Canadian Scholars Press Do you know a colleague who would be interested in this ? Click on the button (top left) What are your thoughts? Send us your comments using the postform below:
Born from the Wisdom of Hindsight In the good old days of 8% GICs and socially acceptable Mortgage Backed Securities providing a high investment income for Elders was a fairly easy matter. When these high rates vanished there evolved an alternative, although more risky vehicle, in the beloved Income Trust. Despite Finance Minister Flaherty’s intervention to prevent ‘tax leakage’ the Income Trusts that will continue in 2011 will likely be better tax wise in our investment account and only moderately lower in our registered retirement accounts. (More later on.) Now what can we do given the addition of a world wide credit malaise which has put financial markets in jeopardy and severely depressed our securities investments meant for our financial well being? As this is written in early February (09) most, if not all of the dimensions of the financial crisis seem quite clearly defined with monetary and fiscal stimulus well underway - such that an ultimate economic recovery is surely in the cards and we should no longer be in a ‘cliff hanger’ predicament. In fact many vital ingredients necessary to establish a market recovery are in place. We now have a strongly advancing money supply in the US not only replacing system liquidity after dramatic wealth destruction but sufficient to fuel a strong recovery once this monetary expansion ignites. As well, the market has experienced a number of ‘capitulation’ days (‘investors throwing in the towel’) such that most of the selling urgency is spent. The Advance/Decline line (number of advancing stocks over declining) has developed a positive up trend  which is believed will hold comfortably above prior lows in a ‘final event’ of stock market indices testing their November lows which now may be underway. Indeed to finish the ‘Bear Market’ we just need confirmation by an ‘ignition rally’ of several days accompanied by unusually high volume to formally launch a new ‘Bull Market’ or alternatively we might ease into a new ‘Bull’ with a period of stability by market consolidating sideways with quiet determination to slowly begin to advance signaling a pervasive shift in market sentiment. “When a stage is reached where all that’s bad that needs to be known is known, then what’s good to be known begins to be known and grows to become well known.” But what about our poor portfolios? Well, the best thing to do at a market top is to sell and liquidate almost everything or at least protect positions with ‘stop loss orders’. The worst thing to do during a market bottoming is to sell without replacement. It is prudent to retain cash reserves until completion of the bottom process is confirmed by a second rally after pulling back from that first ‘ignition rally’. Or if no ignition rally, await a rise in long term momentum indicators as mentioned below. Where individual securities are still in position each should be surveyed as to their ability to recover and attain current targets. Are they ready to participate in return to strength within their industry and how far off is that industry’s recovery and what is the history of participants’ price recovery in advance of the industry recovery. Stocks that are otherwise perfectly healthy usually strengthen with a return of general market strength and particularly when recovery of their industry is seen to be visible or even felt able to become visible. Therefore, to retain valid viable holdings, and be willing to switch out of those that are not into others that are, is a good strategy as the market bottoms out. Other than an ignition rally as I have mentioned, there are various confirming ‘momentum indicators’ such as a 200 day moving average turning up after being crossed over by a rising 50 day moving average, or an upturn by the venerable ‘Coppock Curve’ which is a combined front end weighted moving average of an 11 month and 14 month rate of change of a market index. I keep the Coppock Curve up-to-date on my website along with several other  market timing indicators. There are others provided by various websites that you can investigate too. In regard to adding new income producing positions when deploying your cash reserves there have emerged several senior grade securities with lowered price due to the market’s decline resulting in much higher dividend yields. As well there will be several good quality income trusts of mature stable companies that will carry on as trusts. My understanding is: while their distribution will be lower in result of the taxable portion of distributions paid by trusts being taxed at the trust level - income less deductions can result in tax very much lower than the nominal 25% corporate rate. Funds remaining for distribution to unit holders will be taxed in their hands in non-registered accounts at the rate applicable to Canadian dividends and hence will benefit from the standard dividend tax credit when legislation takes effect in 2011. While many trusts will have converted to corporations their dividend payout will remain at an attractive level. Additionally, a goodly number of Energy Income Trust Funds have large ‘tax pools’ available to apply against future taxable income hence will very likely be able to maintain their relatively high payout for several more years beyond 2011. So all is not lost from the attraction of Income Trusts as an investment option. Relatively new alternatives have arrived in products invested in portfolios of mutual funds that guarantee the highest value attained by the fund during a specified period to maturity... notwithstanding a lower stock market at maturity. Also, insurance companies have introduced an annuity product that pays based on the higher of highest market value of the underlying fund or total of deposits plus annual bonuses (ranging from 5 to 7 percent). “No one rings a bell at market tops!” Well, this is not quite true. Actually there are all sorts of bells ringing. There develops a widespread euphoria in all our sentiments reinforced by market commentators. There are a series of ‘corporate takeovers’ of senior companies. Stories of dramatic price rises by several junior mining stocks abound, and often there is a bubble such as the ‘tech’ bubble in 2000. Finally, moving averages of major market indices flatten out and eventually turn down, or alternatively, there is an event or breaking news item having long term implications that results in a sharp steep sell off. Often the ‘Advance/Decline line’ has turned south for a few months in advance of all this. Of course the largest risk is the interpretation that a sell off is just a correction and there’s still more upside. When the upside is attempted and it fails to achieve a new high or does so just barely and turns down again you can suddenly find yourself unexpectedly in a ‘bear market’ caught with a portfolio of declining stocks ! What should one do when a topping out is occurring? Sell or protect all stocks. It is as simple as that... “Well, I’ll just keep my preferred shares and bank stocks as they are pretty safe, aren’t they?” NO they are not. They will decline along with the rest of the market. Actually, bank stocks are about as volatile as they come. Oh yes, another ‘leading’ market top indicator after an extended rise in bank and insurance shares is the standard response with authoritative conviction by well regarded conservative money managers... “ Well, we like financials here...” Take care when you hear that! Your only guaranteed safe harbour once the market has topped is short term government bonds or treasury bill money funds. The really important reason to sell out a top, over and above protecting against loss, is having a strong cash position ready to deploy once the market has matured its bottoming process. This is the real way to invest for the long term. The old adage of ‘buy and hold for the long term’ has lost its luster and lost a lot of investors’ loot to boot! Sincerely, Tom Rogers February 12, 2009 Opinions contained in this message are those of the author and are not given or endorsed by his employer, Beacon Securities Ltd.   click here to go to Tom Rogers' Exhibitor showcase   Do you know a colleague who would be interested in this ? Click on the "share" button (top left)    
The Brampton Civic Hospital’s woes may have a silver lining. Reports indicate that Ken White takes over as supervisor following several unfortunate events. This means that Ontario’s Ombudsman, Andre Marin, now has jurisdiction in this hospital to investigate complaints. There are several other hospitals in Ontario currently under provincial supervision and according to a report in the Brampton Guardian, January 2, 2008, a total of 228 complaints were received about hospitals in 2007 - not many relative to total services provided, but for those patients involved still too many. Ontario is the only province in Canada without mandate to oversee hospitals but with a government appointed supervisor all of this changes. In a transformation in health care that hopes to achieve some transparency and honest information about wait times, health care error and even productivity, one would expect to have a provincial ombudsman available to investigate the basis for complaints and to make recommendations. This third party would offer objective assessment and potential solutions. It is a wonder that Ontario lags behind other provinces in ombudsman involvement. The Ontario Ombudsman has done a superb job in my opinion in other areas of health care including assessing the drug review process that denied some cancer patients timely access to much needed medications. It may turn out that Brampton Civic is not too different from most other hospitals that suffer from difficulties with staffing and overcrowded emergency facilities and a variety of day to day pressures. Attempting to understand the issues at Brampton Civic may serve to help understand what changes will need to be made not only there but elsewhere. With various supervisors being appointed at hospitals across Ontario, the problem is likely greater than anything more team work can solve although this is frequently the favoured mantra. When patients have poor outcomes for a variety of reasons and when multiple hospitals are having difficulties requiring government appointed supervisors, the bigger picture needs to be considered. I look forward to hearing more from Ontario’s Ombudsman on healthcare in the future and hope that this involvement will bring more clarity to the very complex world of Ontario hospitals.
Lisa Anselme updated April 29, 2010 Lisa Anselme RN, BLS, HN-BC, CHTP/I is Executive Director/Nurse Consultant for Integrative Health Care for Healing Touch International, Inc. Lisa is a Certified Holistic Nurse and Certified Healing Touch Instructor and Practitioner. She was a nurse clinician specialist at the University of Iowa Hospitals and Clinics for 20 years and has expertise in pediatrics, nephrology, transplantation and biomedical ethics. Lisa has been a co-investigator and consultant on several NIH studies and published & presented nationally on nephrology, CAM, Healing Touch, ethics and holism. conference presentation Healing Touch
Anti-ageing Medicine: Myths & Chances updated June 6 2010 A State of the Art and International Survey of experts and clinics conducted Federal Department of Education and Technology of the Swiss Government, the Swiss Academy of Medical Sciences and the Swiss Centre for Technology Assessment (TA-Swiss) Astrid Stuckelberger, PhD Institute of Social and Preventive Medicine, Faculty of Medicine, University of Geneva President, Geneva International Network on Ageing Member of WHO Ethics Review Committee Chair, NGO Committee on Ageing, United Nations Geneva Representative of the International Association of Gerontology and Geriatrics (IAGG).   Evolution of the ageing concept: from irreversible decline to anti-ageing Until last century, the medical perspective on ageing has been predominated by the strict view that human physical and mental abilities decline with age and defined as such: “Ageing is an aggregate of biological change beyond the point of optimal maturity. It is the point at which development has ceased and any subsequent change is usually seen as decline or deterioration.” (Buhler, 1968). dr. astrid stuckelberger Who Is ? on this topic What Is Resveratrol? on related topics Free Radicals & Antioxydants Food Guide To Unhealthy Eating Diatribe On Eating In A Healthy Way Since the 80s, a new trend began to modulate this concept with the life-span developmental perspective which defends first, that development occurs at all points across the life-span and is not limited to prematurational processes, but extended to postmaturational processes as well; secondly, that development and ageing is influenced by the past (what has gone on before) and the future (what is expected or perceived to come) of the individual (Baltes et al., 1980; Baltes et al., 1977). Following those pioneering work from social sciences, the concept of ‘successful ageing’ was also demonstrated in medical sciences through large longitudinal and cohort studies that revealed that ageing with a high quality of life is possible through the maintenance of an active and healthy life free of disabilities and with minimum ailments (Rowe and Kahn, 1998). Recently, with the galloping progresses of medical (bio)technology, the ageing concept has seen a radical shift with a “new health care paradigm” with the emergence of anti-ageing medicine: pathological ageing and decline is the expression of an avoidable and reversible “system failure”. Anti-ageing medicine finds its niche in many biological theories on ageing. Currently, the 19th Century Reliability Theory applied to ageing and death is one of the most relevant and used for anti-ageing. Gavrilov and Gavrilova (2001, 2006) describe ageing and death as a phenomenon of increasing risk of failure for a system with the passage of time (age): “Reliability theory predicts that even those systems that are entirely composed of non-ageing elements (with a constant failure rate) will nevertheless deteriorate (fail more often) with age, if these systems are redundant in irreplaceable elements. Aging, therefore, is a direct consequence of systems redundancy.” (2001). Anti-ageing medicine is precisely addressing interventions aiming at avoiding or reversing the risk of system failure.   What is Anti-ageing medicine? The term “Anti-ageing medicine” was created in 1993, with new scientific advances recognizing that the age-related mechanisms of frailties and physical and mental failures associated with normal ageing are caused by physiological dysfunctions and system failure, in many cases, can be ‘repaired’ and anticipated by appropriate medical interventions: “Anti-ageing medicine is a medical specialty founded on the application of advanced scientific and medical technologies for the early detection, prevention, treatment, and reversal of age-related dysfunction, disorders, and diseases” (Klatz and Goldman, 2003, founder of the anti-ageing movement). Anti-ageing medicine bases its approach on biotechnological progress aiming at countering the effects of disease, but furthermore preventing and intervening on micro-components of the ageing process, from the cellular level on to the global functional and mechanical level. It covers a vast array of domains from therapeutic cloning, stem cells, genomics, to dietary supplements, brain enhancement, bionic devices, bio- and aesthetic surgery, smart environment and robotics (see graphic 1). Graphic 1: Areas covered by Anti-Ageing Medicine According to their protagonists, anti-ageing medicine is an extension of preventive health care: “If you have had your cholesterol tested, taken a lipid-lowering drug, had a mammogram, or taken hormone replacement therapy with thyroid, testosterone, oestrogen, melatonin, or DHEA, you have experienced anti-ageing medicine.” (Klatz and Goldmann, 2003). It aims not only to prevent and reduce the severity of age-related diseases – arthritis, dementia, cataracts rheumatisms, parkinson – but also to prevent and reduce the severity of ailments which are due to the natural process of ageing, such as skin ageing, and the loss of muscle tissue and bone density, and so maintain some of the characteristics of youth. Through the appropriate transfer of the newest medical technology, not only is the early detection process improving but also the interventions measures in ‘fine tuning’ of body imbalances. For example, functional decline is countered by either supplementing the organism with depleted metabolic substances or by surgical interventions to replace defectuous body parts. Anti-ageing medicine uses the classical preventive measures such as alternative regimes in an integrated approach, nutrition, physical and mental training, but moreso it aims at preventing future age-related health problems at the earliest stage possible or reversing metabolic inbalances causing physical and mental diorders. Therefore anti-ageing medicine is not merely geriatric medicine which treats and takes care of old people who are ill, but aims at all ages by preventing any age-related problems throughout life and to maintain health into old age. It includes advances in diverse disciplines such as biochemistry, biology and physiology, but also in bioengineering, biosurgery, molecular genetics, and emerging medical technologies. For this reason, anti-ageing medicine integrates all specialities and often a transversal approach of medicine, while promoting a different outlook on ageing. The founders have clearly marked a change with the classical model of ageing and health care for healthy ageing people and assert anti-ageing as a new true revolution: “Anti-ageing medicine is the newest clinical medical specialty, the "optimum" of wellness and longevity, and employs extensive therapies and treatment in the preventative health care field far beyond just cholesterol testing and mammograms. A profound paradigm shift is now underway on how the medical establishment views ageing and age-related disease” (Klatz and Goldmann, 2003). The fact that anti-ageing medicine claims to be a branch of medical science and applied medicine, aiming at treating the underlying causes of ageing and at alleviating any age-related ailment and signs, with the ultimate goal of extending the healthy lifespan of humans is creating a surge among geriatric establishment. The term ‘anti-ageing medicine’ itself has been subject to controversial opinions and other terms are today used such as “interventive biogerontology”, “preventative interventions” or even “ strategies for engineered negligible senescence (SENSe)”. The latter term basically means to artificially slow down ageing to almost zero (Aubrey de Grey). Anti-ageing medicine while still not officially recognized by most national medical boards and academies in the world is a fast growing field in subspecialties such as gynaecology, dermatology, surgery and cosmetology. One of the interests lies in the advances made in differentiating biological age from chronological age through the development of different types of “biomarkers” which up to date have only found consensus in “functional biomarkers”.   The TA-Swiss Study on Anti-Ageing Medicine[1] TA-SWISS Centre for Technology Assessment has just completed a study on anti-ageing medicine which aimed at studying the future perspectives of better ageing and anti-ageing medicine. It strived to identify and classify the interventions, treatments and products as well as assess their evidence-based risk or security for the medical practice and for the patient and consumer (Stuckelberger, 2008; Stuckelberger, Wanne and So-Barazetti, 2008). Extracts of the analysis and results are presented here. The analysis shows that while the traditional view of ageing sees an irreversible decline, “Better Ageing” as a medical concept offers different prevention tools than Anti-ageing medicine. Going beyond “classic prevention”, anti-ageing medicine considers itself as an extension of preventive health care, pushing prevention to the limits of detection and intervention (graphic 2 and graphic 3). On one hand, the metabolic age-related changes, usually identified by medical doctors in classic prevention (i.e. hypertension, cholesterolemia), are taken a step further by anti-ageing medicine through more refined indicators for doctors, but going further technology is transferred to the home through self-measurement devices (i.e. hypertension device, cholesterol home testing devices)[2]. On the other hand, biomarkers for specific modifications are being developed and advocated by the anti-ageing medicine movement (i.e. levels of homocysteine[3]), which allows practitioners and the anti-ageing medicine market to propose, beside nutritional changes, a list of dietary and speciality supplements to compensate for the age-related decline in metabolic measures. For example, for each age-related decrease in specific hormones, a targeted speciality supplement is proposed. The interventions can take place at many levels: internal (i.e. biomolecular or pharmacological interventions) or external (i.e. surgery, resurfacing skin techniques, wellness, etc.). Graphic 2: Ageing Patterns According to 3 Prevention Models Source: Stuckelberger (2008) Results shows a variety of level of evidence: while some interventions have been thoroughly studied in animals (i.e. caloric restriction positive effect on longevity and a disease-free life), others have not been demonstrated at the population level but successful cases are reported in private practices. All so-called anti-ageing medicine interventions studied have some level of proof in humans, but with specific targeted groups (i.e. retina replacement with stem cells, statins, growth hormone, dietary supplements) or in case of deficit of a metabolic compound. It can be noted that, in contrast to geriatric medicine, anti-ageing medicine is not primarily targeting the oldest old or centenarians, but rather a wide range of ages among the healthy population starting at an ever earlier age. While the users are demanding anti-ageing medicine and visiting numerous clinics and internet site to buy promising anti-ageing medicine, substantive research and technologically development are still required to generalize the efficiency and safety its application. The book on Anti-Ageing Medicine develops the results for a number of interventions and technological solutions while analysing the level of evidence and subsequent risk for the population. Each section starts with a background explanation of the technological intervention and ends with a risk assessment, ethical considerations and recommendations. The last chapter offers a set of 7 detailed recommendations which can be applied to each nations in the word through informing informed analysis for policy-makers, legal departments, researchers, medical and paramedical professionals, private sector and last but not least for the consumer.. This book hopes to provide information and tools to advance in a safer and healthier world while contributing to quality of living throughout the time of our life. Graphic 3: Differences between “Better Ageing” and “Anti-Ageing” Perspective Dr. Stuckelberger is interested in hearing your responses to her work. In particular, Dr. Stuckelberger would like to hear your answers to a few "anti-ageing medicine" questions. Yor responses will help her in her continuing work on in this area.   [1] See: http://www.ta-swiss.ch [2] Cholesterol, Home Testing Devices: Several devices are on the market. Some measure only total cholesterol. Others measure total cholesterol and high-density lipoprotein (HDL) or "good" cholesterol. One measures low-density lipoprotein (LDL) or "bad" cholesterol, HDL cholesterol and triglycerides (blood fats). The American Heart Association is discussing this new trend but has not yet taken a position on cholesterol home testing devices. [3] Homocysteine is an amino acid, elevated levels of homocysteine (Hcy) has been shown to increase the risk for several disease states. Homocysteine levels can be accurately determined from a small sample of blood which can be done in medical practice. S   references Buhler, C. (1968). Old Age as a Phase of Human Life. Human Development. 11, 53-63. Gavrilov L.A. and Gavrilova N.S. (2001). The reliability theory of ageing and longevity, Journal of Theoretical Biology, 213: 527-545. Gavrilov, L. and Gavrilova, N. (2006). Reliability theory of ageing and longevity. In: Handbook of the Biology of Aging. Academic Press, 6th edition (pp.3-42). Baltes P. B. (1997). On the incomplete architecture of human ontogeny, American Psychologist, 52(4):366-380. Baltes P. B. and Baltes M.M. (1990), Successful Aging: Perspectives from the Behavioral Sciences, Cambridge, UK: Cambridge University Press. Rowe J.W. and Kahn R.L. (1998), Successful Aging. New York: Random House. Klatz R. and Goldman R. (2003), The new anti-ageing revolution. Basic Health Publications. Stuckelberger A. (2008). Anti-Ageing Medicine : Myths and Chances, results of an global and national study for the Swiss confederation innovation and technology Department, the Swiss Medical Academy of Science and the Center for Technological Assessement (TA-Swiss). Verlag, ETHZ, Zurich, Switzerland Stuckelberger A., Wanner Ph. And So-Barazetti B. (2008). Mettons notre vieillesse de côté pour plus tard/Das Altern sparen wir uns für später auf/Lets save old age for later, Synthetic publication of the « Anti-Ageing Study » conducted for TA-Swiss, Technological Assessment Switzerland, TA52A/2008. Bern Do you know a colleague who would be interested in this ? Click on the button (top left) Did you know what anti-ageing medicine is? Do you buy anti-ageing products or use anti-ageing interventions? Would you use anti-ageing medicine? What type would you choose? Do you feel you can buy safely anti-ageing labelled products? Do you think you need to be better informed? Do you think you will age as your grand-parents? - Dr. Astrid Stuckelberger What are your thoughts? Send us your comments using the postform below:
We don't prohibit our citizens from paying for life saving medications to treat coronary disease or cancer. It would be unconscionable to do so. So why then single out surgery or other interventional medical procedures as being unavailable to Canadians who are perfectly willing to pay for them?      
Arts in Healthcare updatedMay 7 , 2010 2009 / State of the Field Report
Irene Borins-Ash updated April 29, 2010 Irene Borins Ash - is a social worker, photographer, speaker and author who helps people 50 and beyond develop a healthy attitude towards aging despite life’s difficulties. She earned a M.S.W. at Yeshiva University in New York City in 1987 and she is a Registered Social Worker. Irene has worked in several health care facilities in Toronto including York Community Services, the Baycrest Centre for Geriatric Care, Providence Centre and St. Clair West Services for Seniors. While working, Irene met hundreds of seniors.  Some were depressed, leading painful existences, but others were dynamic, filled with vitality and truly revolutionary in their approach to life.  There were voices to be heard and for Irene, previously being a tapestry weaver for 25 years, turning to the camera to tell those stories and capture the inner essence of each person was a natural progression.  Irene’s first book was entitled “Treasured Legacies:  Older & Still Great” Second Story Press, 2003 and told the stories of people aging well despite life’s difficulties. Irene’s second book, which is entitled “Aging Is Living: Myth-Breaking Stories From Long Term Care” Dundurn Press, will be available in March, 2009 sponsored by the Ontario Long Term Care Association.  People living in long term care homes are invisible and forgotten members of our society and most of the focus of the media regarding nursing homes is negative. But there is a very real and positive side to life in long term care and the new book will tell the other side of the story. conference presentation Heroes books Treasured Legacies Aging is Living
International Comparative ACT Study Process and Data How ACT teams compare in Toronto, Birmingham, Nashville and Auckland When the International Initiative for Mental Health Leadership (IIMHL) was developed, one of the hopes was that the exchange visits among international sites would stimulate the development of collaborative working relationships. This article reviews one such collaborative project, the development and implementation of a comparative study of assertive community treatment teams, or assertive outreach teams as they are called in the UK and New Zealand. Key words leadership; IIMHL; exchange visits; collaborative working relationships; assertive community treatment teams; assertive outreach teams Neil Deuchar and Katie Saunders Birmingham and Solihull Mental Health NHS Trust, Birmingham, UK Jane Vanderpyl Te Pou, The National Centre of Mental Health Research, Information and Workforce Development, Auckland, New Zealand Thomas W Doub and Jules M Marquart Centerstone CMHC, Inc., Nashville, Tennessee, US Steve Lurie, Angela Da Silva and Heather McKee Canadian Mental Health Association, Toronto Branch, Toronto, Ontario, Canada Verity Humberstone Intensive Community Treatment Team, Counties Manukau District Health Board, Auckland, New Zealand Stuart Moyle Mental Health Services, Counties Manukau District Health Board, Auckland, New Zealand Assertive community treatment teams provide treatment and support to people living with severe and persistent mental health problems through a team of professionals from a variety of disciplines, including: psychiatry, nursing, social work and other health professions and paraprofessionals. ACT teams have been shown to reduce hospitalisation for people living with schizophrenia who experience significant disability and co-occurring disorders such as substance abuse (Ontario Ministry of Health and Long Term Care, 2006). We review the development and implementation of the study, some of the findings and implications for future collaborative work in this and other areas. One of the features of the IIMHL site matches is that sites invariably have similarities and differences, given the different policy and funding frameworks in the various IIMHL member countries. One of the benefits of these exchanges is the opportunity to examine a particular service delivery issue and find out what the similarities and differences are across sites. The four sites in this study all provide services to people with serious and persistent mental health problems. The size and range of services offered by each organisation differ although some services, such as assertive outreach, were thought to be similar. The partner sites are: Centerstone in Nashville, Tennessee, United States, Birmingham Solihull Mental Health Trust, United Kingdom, Counties Manakau District Health Board Mental Health Service, Auckland, New Zealand, and the Toronto Branch of the Canadian Mental Health Association in Ontario, Canada. Two sites provide both inpatient and community mental health services (Auckland and Birmingham) and two sites provide community mental health services only (Nashville and Toronto). The lens for this analysis is bifocal: the story of a multi-site collaborative research study, and the comparison of assertive outreach (ACT) teams, client characteristics and outcomes across sites. Dewa and colleagues (2002) note that while the fundamental goal of the mental health system is to provide integrated community-based services, there is limited empirical evidence for planning and a lack of standard evaluation methods. They argue that a multi-site study can address this gap by using the same study design and instruments to measure characteristics and outcomes. While this concept appears straightforward, successful implementation is dependent on the active participation of all sites, valuing informal participation, communication, trust, flexibility and commitment. In a subsequent article (Dewa et al, 2004) they note that learning to communicate in a common language is critical. Our partnership experienced many of the same dynamics. There is an emerging literature regarding multi-site comparisons of assertive community treatment. Salyers and colleagues (2003) evaluated the fidelity of 51 ACT programs and 36 case management programs in the United States using the 28 item Dartmouth Assertive Community Treatment Scale to measure structure and process of assertive community treatment teams. They were able to establish normative measures. Gehrs and colleagues (2004) note that fidelity measurement is an evolving field and that the structure and process of programs can be shaped by the contexts in which they operate. During the Nashville site visit, Centerstone leaders described their continuous treatment teams (CTT) which seemed similar to assertive outreach. Discussions began on the feasibility of comparing CTT to assertive outreach, and a proposal was agreed to following the Auckland visit in 2005. It was agreed that each site would identify team participants who would represent their site in the study. Toronto was represented by the CMHA Executive Director, one of the agency’s program directors, and the research and evaluation coordinator. The Toronto site was also able to recruit a researcher from the Centre for Addiction and Mental Health, who had experience conducting multi-site studies. Nashville was represented by the Vice President of Research. Birmingham was represented by the Chief of Psychiatry of the Birmingham Solihull Trust and Auckland was represented by the Manager of the County Manakau’s mental health research and evaluation unit. It was agreed that Toronto and the IIMHL administration would co-ordinate monthly teleconferences to develop and implement the study. Initial teleconferences focused on options for gathering comparative information and scope. It was decided that the study should describe system characteristics, team characteristics, client characteristics and outcomes. The study questions were framed as follows How do team characteristics compare across the sites? How do teams compare across client characteristics and outcomes? A program comparison questionnaire was developed to examine system characteristics such as the broader community setting, team age and target population. The Dartmouth Assertive Community Treatment Scale (DACTS) was chosen to measure team characteristics (Teague et al, 1998). DACTS is able to distinguish between assertive outreach and other types of case management and fidelity measures similar to DACTS have been shown to correlate positively with improved outcomes (Salyers et al, 2003). Data was entered by the teams and sent via email to Toronto for analysis in the fall (autumn) of 2005. A prospective study was ruled out given the length of time it would take to enroll new clients in the study. A snapshot study using a point in time was felt to be most feasible. Each site agreed to extract information on clients enrolled in services as of 31 March 2006, and clients discharged from 1 April 2005 and 31 March 2006 from their clinical data bases. Initially Birmingham proposed using the HoNOS survey which is used in the UK (Wing et al, 1996). The HoNOS set of scales measures a range of psychiatric symptoms, physical health, and social functioning problems associated with mental illness and are designed for routine use in clinical settings. After a dry run attempt at scoring, it was agreed that use of the HoNOS would require training at each site, and since there were varying degrees of familiarity with the instrument, the study team began to search for a simpler option. Fifty-five ACT teams in Ontario had been using the CDS (common data set), a variation on the PSR toolkit since 2001 (Lurie et al, 2007) to submit aggregate data on client characteristics and outcomes. After reviewing sample reports from Ontario, it was decided that it would be possible to use the CDS to extract client information from clinical databases, but the study team would also have to develop common definitions which mapped to the CDS domains, as each site/jurisdiction had different ways of reporting on domains such as hospitalisation, justice system involvement, school attainment, and ethnicity. Client data was entered into a SPSS spreadsheet developed by the Auckland site and sent via email to Auckland for analysis in the spring of 2006. All identifying client information was removed from the data files before transmission. Local ethics approval was obtained for each site. System and program characteristics Auckland: Intensive Community Treatment Teams at Counties Manukau District Health (CMDHB) Board Mental Health Service CMDHB’s target area comprises a large urban area in South Auckland and extends south over a large rural catchment. The total adult CMDHB population numbers approximately 300,000. The population served is ethnically diverse with high levels of deprivation. CMDHB provides a range of services including: adult and older adult inpatient and community mental health services; secure inpatient rehabilitation services; and community child and youth mental health services. The two CMDHB ACT teams are government funded, serve approximately 200 clients (at any one time) with an Axis 1 diagnosis (typically a psychotic illness) or a severe personality disorder. Clients reside in the Counties Manukau DHB catchment area, and are between the ages of 16 and 65 years old. Core care is provided by nurse case-managers (CMs), each caring for 20 clients, shared with community support workers (CSWs). Case-managers see their clients approximately weekly, varied according to need. The team is multidisciplinary and also includes a daily medication dispensing nurse, forensic liaison nurse, consultant psychiatrist, junior doctor, occupational therapist and a clinical psychologist. Medical and other multidisciplinary review is carried out in the community. At times of crisis, the team can increase consumer support, and will organise any additional resources such as respite or hospitalisation, thus providing continuity of care. Birmingham: Assertive Outreach Team at Birmingham and Solihull Mental Health Trust Birmingham and Solihull comprise two populations. The former (circa 1 million people) is richly diverse and contains some of the highest areas of psychosocial morbidity in the UK. The latter (circa 200,000 people) is a more suburban, middle class environment. The Trust currently deploys eight assertive outreach teams, concentrated in the areas of most need. Three of these teams participated in the current study. The Trust serves a major black and ethnic minority population. The principles of the teams centres around the prevention of admission of ‘revolving door’ patients (that is those who have had several admissions under the Mental Health Act in the past) and the management of enhanced risk (particularly as this may relate to risk to others). In addition, caseloads almost exclusively comprise people with psychosis, although dual diagnosis (psychosis with substance misuse) and triple diagnosis (the former plus personality disorder) are disproportionately represented among the teams’ caseloads. Nashville: Homeless Outreach Partnership and Empowerment (HOPE) at Centerstone HOPE serves Montgomery County, Tennessee, a metropolitan area positioned adjacent to the Fort Campbell Army Post and saturated with active duty and retired military individuals and families. This area is culturally diverse and contains pockets of high and generational poverty, as well as a significant population that is homeless or at-risk of homelessness. In partnership with a local homeless shelter, HOPE utilises a modified ACT model to conduct outreach and engage individuals in behavioural health treatment. The HOPE program entry criteria include: age (adults 18 years and older); diagnosis of serious mental illness; presence of a co-occurring substance use disorder; homelessness (or at risk of homelessness). In addition to their behavioural health and housing problems, this population frequently has serious challenges in the domains of physical health, employment, social/family supports, and criminal justice. HOPE focuses on outreach, engagement and screening, assessment, treatment, and recovery/ maintenance. The program offers: low staff to client ratio; flexible service delivery; comprehensive services; case management; psychoeducational groups; 24/7/365 crisis assistance. The HOPE team helps clients find housing, jobs, psychiatric treatment, medication management and obtain money for day-to-day expenses. Rental assistance/housing support funds would likely refer to rent down payments such as first and last month’s rent and household supplies. Since 2004, the HOPE has enrolled 111 people into services. Toronto: West Metro, East Metro and New Dimensions Assertive Community Treatment Teams at the Canadian Mental Health Association Toronto Branch The three Toronto ACT teams, part of the Canadian Mental Health Association, serve an urban population in the central and east parts of the city of Toronto. The city is ethno-culturally diverse, with immigrants representing almost half (49.5%) of its total 2.5 million population. Toronto has a low unemployment rate (7%) and nearly two-thirds of the population have at least a high school education. The mental health service environment is changing as regional health funding authorities are developed. There are two tertiary hospitals and 18 general hospitals with psychiatric departments serving Toronto, along with 80 community mental health and addiction programs and 13 ACT teams currently operating in Toronto. ACT is a voluntary health service for people who have: persistent symptoms of serious mental illness which include: a diagnosis of a chronic psychotic illness; both frequent and long-term hospitalisations; serious functional impairments affecting activities of daily living, work, and housing; inability to meet survival needs from community sources, including housing, social and healthcare services. These services also target people with co-existing substance abuse disorder and a history of involvement in the criminal justice system (or are at high risk of involvement). ACT teams in Ontario are governed by provincial standards that have been developed with the service expertise of ACT practitioners and provincial system stakeholders. The standards specify client characteristics, team composition, client to staff ratios (1:8), requirements for service plans, intake process and other operational issues pertaining to team functioning. The standards do not prescribe the nature of services to be offered, beyond setting staffing from specified health professions and the high frequency/intensity (>2 sessions of 1 hour each/weekly, up to multiple daily contacts) in community venues. Service plans are flexible and individualised to meet the assessed needs of clients on an on-going basis. Teams offer 24/7/365 service availability. Team characteristics The DACT Scale was used to measure and compare team characteristics across the sites. This scale is a 28-item tool which measures the fidelity of ACT programmes to the ACT model (Salyers et al, 2003). It has been successfully used to compare teams internationally (Gehrs et al, 2004). It assesses the function and structure of teams in three subscales – human resources (HR), organisational boundaries (OB) and service intensity (SI). The higher the score, the more concordant the teams’ structure and function are to the original ACT model. HR refers to client/clinician ratio, the numbers of various professional staff in the team, the clinical role of the team leader and specialist roles. OB refers to the ability of the ACT to deal with crises, take full responsibility for all the treatment needs of their clientele, tendency to initiate hospital admissions and intake and discharge rates. SI includes data around frequency of contact, ability of the team to manage concurrent disorders and inclusion of clientele in case management. High fidelity is a score of 4.0 or more, medium fidelity is a score of 3.0–3.9 and low fidelity is a score of 2.9 or below. Table 1: Overview of program characteristics images/stories/fotos/slurie_table1.png click on the image to enlarge There was some variation in the length of time each team had been established, ranging from 1997 (ICT-T and Birmingham) to 2004 (Nashville). The ratio of clinician to clientele averaged 1:10, there being a slightly lighter caseload for each clinician in Toronto and a heavier caseload per clinician in Nashville. The average caseload per team was 85, noting that the Birmingham data relates to three teams. Birmingham, therefore, had more teams per capita than some of the other sites but the teams were smaller (less staff and less clientele). A total of 765 ACT clients were included in the study from nine teams in four countries. The largest group were from the three ACT teams based in Toronto (35%), another 28% were from Counties Manukau two ACT teams and 25% were drawn from three ACT teams based in Birmingham. Only 11% of the group were from Nashville’s ACT team (see Figure 1). Patients were less likely to be discharged from Birmingham teams than any other site, the percentage of clientele having been discharged from their teams over the study period being 3% compared to an average of 12%. Nashville discharged most frequently but it is noted that their target clientele were different from that of the others. Even if Nashville is excluded from this metric, however, Birmingham appears to discharge significantly less frequently than the other two sites. Accordingly, Birmingham retained more clientele in assertive outreach than any of the other sites, some 60% of patients having been in receipt of services for five years or more and a further 15% for three to five years. Time registered with services varied across the services (see Figure 2). The four sites showed wide variation with Birmingham having the largest proportion of clients in the service for more than four years (60%). At the opposite end of the spectrum was the Nashville team where most clients had been with the service less than one year (88%). This may be due to Nashville having only been established in 2004. However, Nashville also had the highest proportion of discharges from the service (see Figure 2). Nashville had discharged 26% of their clients in the previous year, while Birmingham had only discharged 3%. Of the 21 clients discharged by Nashville ACT team, 19 had been with the service less than a year. DACTS scores were compared within and across teams in the four sites. As can be seen from Table 2, the lowest concordance across the teams was in the service intensity domain, the highest concordance being in the organisation boundaries domain. The greatest variability was in the human resources domain and the lowest in service intensity. This suggests that lower adherence to the service intensity domain of the DACTS is a commonality across the four sites, although most sites report medium fidelity. Commonalities across the teams in terms of HR included having small clinician to clientele ratios,having nurses on the clinical staff and programme size. The greatest variabilities related to the team leader having a clinical role and the presence of substance misuse and vocational specialties roles. Commonalities across the teams in terms of organisation boundaries included a generally high level of fidelity with the exception of crisis services and full responsibility for treatment, Nashville representing something of an outlier in respect of demonstrating a much higher turnover of clientele than the other sites. Commonalities across the teams in terms of service intensity included a generally lower level of fidelity with only a third of teams offering individualised and Value organisation HOPE group substance misuse treatments. Few teams included consumers in case management roles. Client group characteristics Males averaged 66% of ACT clients across all four sites, and there were only small variations (see Table 3). The average age across the group was 41 years (SD 11 years). Each of the sites varied in their racial/ethnic distribution. Whites made up the largest racial/ethnic group at all sites (43%), ranging between 34% at Counties Manukau and 54% at Nashville (see Table 3). Toronto, Birmingham and Nashville ACT teams all had a high proportion of clients identifying as black. In contrast, 57% of Counties Manukau ACT clients identified as either Mãori or Pacific peoples. Major diagnostic categories consisted of schizophrenia 77% (n = 583), and mood disorders 17% (n = 128). Nashville ACT team differed significantly from the other three siteswith nearly three quarters of ACT clients having a diagnosis of mood disorder (74%). Counties Manukau also had a small group without any Axis I diagnosis (2%). Of this group, six had a diagnosis of borderline personality. Across the four sites, 31% of ACT clients had a concurrent diagnosis of substance misuse. However, Nashville ACT clients (89%) and Counties Manukau ACT clients (52%) were much more likely to have a concurrent substance misuse diagnosis than the other two sites. Also included in the study were a subset of 267 continuing treatment team (CCT) clients from three teams in the Nashville mental health service. The CTT clients showed some key differences from the ACT clients. The majority of the Nashville CTT clients were female (64%) compared to only 34% of the ACT clients. A very high proportion of the CTT clients were white (84%) compared to only 43% of ACT clients. The majority of CTT clients had a diagnosis of mood disorder (54% compared to 17% of ACT clients). However, over 30% of both CTT and ACT clients had a diagnosis of substance misuse disorder (39% CTT and 31% ACT clients). Patterns of service use and discharge varied dramatically for the two groups. Most CTT clients had only been in the service for a year (63% CTT clients compared to 19% of ACT clients). Almost all CTT clients were discharged within two years of entry into the service (92%). Education, employment and living status on entry to ACT teams A high proportion of ACT clients had not completed high school (51%, n = 387). However, compared to the other sites Birmingham had the highest proportion of clients who had completed high school (71%) and a university degree (13%) (see Table 4). All sites reported high levels of unemployment among their clients on entry to the ACT team (81%) and low levels of permanent employment (7%). Birmingham and Toronto both had a high proportion of clients living alone on entry to the ACT team. In contrast Nashville and Counties Manukau differed, Nashville had a high proportion of clients who were homeless (see Table 4), while Counties Manukau had a high proportion of clients living with family members. Client and service outcomes ACT client outcomes were examined in the areas of employment status and hospital bed use by length of time in service for each participating site. Few clients who were unemployed at the time of entry into the ACT team became employed, irrespective of length of time in the ACT service (see Figure 6). Only Counties Manukau ACT teams showed a consistent increase in the proportion of clients obtaining employment by length of time in service. Of the group who had been in the service more than four years and unemployed at entry to ACT team, 23% were now in some type of paid employment. Both Toronto and Counties Manukau ACT clients showed large reductions in acute psychiatric hospital bed use from the year prior to entry into the ACT team. Both sites showed similar patterns of continuing decreases over a number of years post entry into the ACT programme (see Table 5). Discussion The DACTS data shows that assertive outreach teams are similar in terms of fidelity measures across jurisdictions, although levels of funding may explain some differences and systems contexts explain others. The fact that none of the teams were providing group programming for concurrent disorders may be illustrative of the difficulties mental health systems are having developing integrated treatment strategies for persons with concurrent disorders. While Auckland and Nashville had higher rates of substance abuse than Toronto or Birmingham, none of the sites were using group based interventions with this population, even though it has been identified as an evidence-based practice. This same phenomenon is being identified in a study of 70 ACT teams in Ontario currently under way. Similar to the Salyers study (2003), ours found a range of scores for DACTS items among study sites. The average DACTS score for the teams across sites was 3.8, suggesting medium fidelity to the model. Our study showed that it is possible to compare team characteristics internationally, using the DACTS. The client data shows that service system contexts and community contexts influence demographics and outcomes. Ethnicity varied across sites as did educational attainment, employment and housing. For example, 45% of Auckland clients live with their families while over 50% of the clients in Toronto and Birmingham live on their own. Auckland was the only site to show consistent improvement in employment outcomes over time. The teams in Toronto, Auckland and Birmingham served a majority of clients living with schizophrenia, while Nashville clients were more likely to have mood disorders and a high rate of substance abuse. Despite the differences, all sites were serving client populations with serious and persistent mental health problems. Length of stay in the program was similar in Toronto, Auckland and Birmingham, while Nashville had shorter stays that may be driven by the funding available. The question of how long clients should stay in ACT merits further exploration and is to some degree dependent on the ability of service systems and teams to flex levels of support. Since the ACT model was developed to provide longterm community support to clients outside of hospital, it is not unreasonable to assume that some clients may require this level of support for a long, or indefinite period. While outcome data on hospitalisation was limited to two sites, the declines in hospitalisations are consistent with the ACT literature. Nashville’s use of an ACT-like model for their continuous treatment teams is consistent with international interest in developing variations on the ACT model (van Veldhuizen, 2007). With regard to client data collection itself, the project team was able to generate common data definitions, which allow for meaningful comparisons across jurisdictions. The sharing of comparative data among teams can facilitate meaningful reflection about the program model in all jurisdictions. Summary of project learnings It is possible to do a comparative, exploratory study of mental health programs across jurisdictions without funding. Key ingredients include leadership, sharing of the labour, multiple means of communication, and regular communication. Keeping the study design relatively simple and leveraging data capture instruments already in use, can minimise complexity. All sites found that the study exposed limitations in their data collection systems. This reinforces the need to continue to focus on data quality as well as data capture in our various systems. The experience gained in the comparative ACT study may lead to the development of a similar project on early psychosis intervention. Finally, using the IIMHL meetings and other conferences to present the findings and study as it developed over a two-year period imposed deadlines, which resulted in things being done, as well as opportunities to reflect on the data and the collection process itself. As Dewa and colleagues note, a multi-site study builds relationships (2004). This reinforces the mission of IIMHL itself and can only lead to a richer relationship among participants.   please click on any of the following links to view the associated document in .pdf format ACT Data Summary 2006-07 ACT Report Final 2006-07 ACT International Comparative Study Process   references Bond GR & Drake RE (2007) Should we adopt the Dutch version of ACT? Commentary on ‘FACT: A Dutch version of ACT’. Community Mental Health Journal 43 (4) 435–438. Dewa CS, Durbin J, Wasylenki D, Ochocka J, Eastabrook S, Boydell KM & Goering P (2002) Considering a multisite study? How to take the leap and have a soft landing. Journal of Community Psychology 30 (2) 173–187. Dewa CS, Butterill D, Durbin J & Goering P (2004) No matter how you land: Challenges of a longitudinal multi-site evaluation. The Canadian Journal of Program Evaluation 19 (3) 1–28. Gehrs M, Smith Fowler H, Rouke SB, Smith M & Bradley Cousins J (2004) Inside the black box: Challenges in implementation evaluation of community mental health case management programs. The Canadian Journal of Evaluation 19 (3) 109–133. Lurie S, Kirsh, B & Hodge S (2007) Can ACT lead to more work? The Ontario experience. Canadian Journal Community Mental Health 26 (1) 161–171. Ontario Ministry of Health and Long Term Care (MOHLTC) ACT Technical Advisory Panel (2006) 2004/05 Ontario ACT Data Outcome Monitoring Report. Toronto: Author Salyers MP, Bond GR, Teague GB, Cox JF, Smith ME, Hicks ML & Koop JI (2003) Is it ACT yet? Real-world examples of evaluating the degree of implementation for assertive community treatment. The Journal of Behavioral Health Services and Research 30 (3) 304–320. Teague GB, Bond GR & Drake RE (1998) Program fidelity in assertive community treatment: Development and use of a measure. American Journal of Orthopsychiatry 68 216–232. van Veldhuizen JR (2007) FACT: A Dutch version of ACT. Community Mental Health Journal 43 (4) 421–433. Wing JK, Curtis RH & Beevor AS (1996) HoNOS: Health of the Nation Outcome Scales: Report on Research and Development July 1993–December 1995.London: Royal College of Psychiatrists. We thank the authors and publisher of this report as well as its sponsors for allowing to reproduce it here in its entirety for the greater benefit of all Conference participants. 2006/07 Ontario ACT Data Outcome Monitoring Report Ontario Technical Advisory Panel Ministry of Health and Long-Term Care February 2008 Want to send a colleague a link to this page ? Click on the "Tell a Coll" (tell a colleague) button below.
Samar Assousa updated April 29, 2010 Samar, Assousa - is the Senior Director for International Health Development at Health Partners International of Canada. Her focus is to develop strategic partnerships with Canadian healthcare professionals and non- governmental organizations, in order to collaborate on the provision of medicine and healthcare to impoverished communities in the developing world. She has a background in molecular biology and a graduate degree in cardiothoracic nursing. Prior to joining HPIC, Samar worked in clinical nursing, particularly in the field of cardiovascular surgery as well as in oncology/hematology. She has extensive teaching experience in clinical oncology. Since coming to HPIC, Samar has travelled to several projects overseas to evaluate the needs in medicine and health care. conference presentation Your Next Medical Mission
On “getting” prostate cancer There is nothing particularly heroic about getting a disease like prostate cancer. Now in writing that first line, I tinkered with various alternatives to “getting.” None seemed to fit. One doesn’t earn a disease; it’s certainly not something I ever saw as compensatory for a lifelong affiliation with good health. I didn’t obtain it either. It’s not as if I chalked up loyalty points like an airline card and was rewarded with prostate cancer. I also didn’t acquire it, inherit it, procure it, or snag it. I was neither smitten nor afflicted. The former makes me sound dead and the latter sounds sickly, which I wasn’t, unless you count the stomach rumblings from appalling hospital food. My prostate cancer merely got me one day, discovered after biopsy three. It might have got me at biopsy one or two except the doctor’s aim was off-target and the needles missed their mark. Not that I can blame him. The tumor was just one millimeter in diameter and contained to the gland. Easy to miss, although my urologist felt enough of a ridge to call for the biopsy in the first place. In the four months between diagnosis and the decision to undergo surgery, a radical prostatectomy, there was little about prostate cancer I didn’t learn. Once I opted for surgery, I took umbrage with its rather offensive name. Radical. Of course it was radical. I was placing my nether regions in the hands of complete strangers and allowing them to tinker with thread thin nerves. Indeed, removing a cancerous prostate is radical. It’s also tricky, delicate, dangerous, and risky. But I don’t suppose an official name like Risky Prostatectomy would do much for the onco-urologists union. From surgery I went to a catheter; from catheter to feminine pads to absorb post-op drips; from post-op drips to dark pants for a trip to Europe; from Lyon and Turin to home and trying to regain some semblance of conditioning lost over four months of non-activity. Now, two and half years later, with every PSA test indicating no sign of anything, I contend with just regaining full function of the nerves that control, well, you know, that guy thing related to his member. So I wrote about it all. This was a strange thing to do and not heroic either. I wrote for me and because I hoped my style, approach and story might appeal to fellow prostate cancer survivors. It began with monthly articles in the Prostate Cancer Association Ottawa newsletter The Walnut. The first one was entitled Assume the position, for the obvious reason men of a certain age are familiar with. As the months wore on, PCAO members were telling me they rather liked the articles. There hadn’t quite been such an approach before, which I knew. During my own edification on the subject, I’d found countless medical books, articles, journals and videos. Most were interesting, some thick with jargon, and each played a role in making me more cancer-astute. None though seemed too personal, let alone light. They were rather morbid, come to think of it. Months later, my brother in Toronto congratulated me on writing, he said, some of the best stuff I’d done. I wanted to take it as a compliment, though with our regular mutual ribbing, I couldn’t be sure. He also suggested there might be a book in it. The book takes shape In the summer of 2007, I set out to expand the articles and add chapters that chronicled my journey from early diagnosis, when I first assumed the position, to the current. I approached the PCAO with the idea of a book, asking if they’d consider underwriting its publication. With barely a hint of objection, and after my setting out a detailed marketing and publishing agenda, the group agreed to go ahead with the project. On April 17, 2008, Assume the position: One guy’s journey through prostate cancer came off the press. Allan Rock, the former federal cabinet minister and UN Ambassador, provided one of the book cover endorsements. "Richard Bercuson has made a real contribution to awareness and men’s health by tackling an important subject with wit and flair.” The next night, at the PCAO’s regular monthly meeting, I read an excerpt. We sold over 30 copies that first night and sales across Canada and into the U.S. have not abated since. The book was given a resoundingly positive review by health columnist André Picard in the Globe and Mail. There were subsequent stories about it in Ottawa papers as well as numerous radio and TV interviews. The response to the book’s tone and message has been uniformly positive. One interviewer referred to it as being a funny book. It isn’t. It has its droll,perhaps witty, moments, but I can’t imagine setting out to write an intentionally funny book about prostate cancer. There’s not much funny about it. Globe and Mail health columnist André Picard. “…Mr. Bercuson has made a delightful contribution to the literature with his own little war story about the walnut-sized gland called the prostate…It is witty, chock full of practical information and, at times, even fun… Laughs and tears. Joy and pain. Fear and survival. In the end - pardon the pun - the reader is left with a unique perspective on prostate cancer.” I’m quite at ease to joke about my own experiences. Perhaps that bent for a light-hearted, self-deprecating message has resounded with readers. Cancer survivors have come to call ourselves that because each of us has undergone a highly personal, intimate journey with varying degrees of pain, suffering, and sometimes humiliation. For me, that humiliation was in different forms: being helped into a shower the day after surgery by a male attendant, with my penis attached to a catheter, or trying the first time to select the right size female absorbent pad. We survive these experiences because, essentially, we are a resilient lot. Heroism of a different sort, I suppose. I’ve been asked what my message is in Assume the position. I honestly don’t know. Readers have written to me with a myriad of things they gleaned from the book. One woman said her teenage son read it and wants to do a high school project on prostate cancer. Another lady gave it to a friend who was about to have the same surgery so that he’d cope with it better. One gentleman had already undergone treatment for some time and claimed he just needed an emotional lift. Men need to come to grips with some realities of our impending middle and older years. I still haven’t for most things, except for understanding a disease that will afflict about 1 in 7 Canadian men each year. Without ever knowing why or how, they, too will just get prostate cancer. We ought to do something about it, right? Want to send a colleague a link to this page ? Click on the "Tell a Coll" (tell a colleague) button below.   What do you think ? Richard Bercuson would like to hear from you ... Please use the "comment" box below to respond ...
Awaken Your Inner Pharmacy for Mind-body Health updated June 13, 2010 The healing system of Ayurveda teaches that good health depends on our body’s ability to metabolize all aspects of life. This includes not only the food we eat, but also our experiences, emotions, and sensory impressions. The metabolic power responsible for extracting nourishment and releasing toxicity is known as agni – a Sanskrit word meaning fire. Linguistically, agni is the etymological root of the English words ignition and ignite, and we can think of agni as our digestive fire. When our agni is robust, we’re able to digest food efficiently and easily assimilate our daily experiences. We absorb what is nourishing and let go of that which doesn’t serve, enabling us to make healthy blood cells, muscle tissue, bones, and nerves. Just as a roaring blaze in a fireplace creates warmth and heat, burning even a damp log down to fine ash, a strong agni produces vitality and enthusiasm, completely “cooking” the experiences of our lives. When our agni is weak, however, we can’t extract value from even those substances and events that are potentially nourishing. A weak fire generates an excessive amount of smoke, leaving behind charred pieces of wood that – to continue the analogy – is similar to the toxic residue that remains when our digestive power is poor. This accumulated residue weakens our health and blocks the flow of energy and information throughout our body, making us feel dull and listless. Ayurveda considers this build-up of toxins the underlying cause of all disease. A common example of this is the accumulation of saturated fat and cholesterol that is beyond the body’s capacity to metabolize. Over time, this leads to the blockage of the blood vessels and arteries and, ultimately, to heart attacks. dr. david simon Who Is ? on this topic Medicine Wheel Energy And Medicine Awaken to Your True Self Understanding Integrated Medicine Diatribe On Eating In A Healthy Way on related topics The Journey Bounce Back Epigenetic Healing Humor For Health What Good Lovers Know Healthy Mind, Healthy Body Moving From Wrong To Right Relationship While it’s easy to understand agni in terms of food, it’s important to remember that your mind and heart are continually digesting energy and information as well. If the concept of agni is new to you, your mental digestive powers are working right now to break down the idea into components your intellect can assimilate. Similarly, your emotional agni processes your experiences and feelings, including the beautiful smile of a loved one, the unexpected criticism at work, or the excitement of a new relationship. If your emotional agni is strong, you are able to extract whatever is nourishing and eliminate the rest. The inability to metabolize emotions, on the other hand, produces just as much toxic residue as undigested food. In fact, pent-up anger, long-held sadness, and lingering guilt are more debilitating for most people than problems with physical digestion.   Tending Your Inner Fire Given the crucial role of agni to health and well-being, how do we tend to our inner fire, keeping it burning brightly? The essential step is living life more consciously, making choices that nurture the flow of life energy, while minimizing those that deplete it. A simple way to evaluate the value of an experience is to ask yourself whether you would encourage someone you unconditionally love to have it. Consider the example of a conscious, loving mother who only wants her child to eat nourishing food, engage in loving relationships, and avoid situations that create unnecessary distress. If you treat yourself with this same loving intention, you will naturally minimize experiences that disturb your mental peace and physical well-being ? while favoring those that increase your freedom and joy. To maintain a healthy fire, you have to have the right balance of air and wood. Too much air (change) will blow out the fire. If you throw a heavy piece of wood (stability) onto a weak fire, you will extinguish the flames. If you have too much change and turbulence in your life, you won’t be able to metabolize everything on your plate. This may manifest physically as anxiety, insomnia, irregular elimination, or fatigue. On the other hand, your inner fire is weakened by having too much wood or “stuff” in your life ? too much debt, too many financial commitments, too many complicated, demanding relationships, and too much clutter in your home. When you ingest more than you can digest, the consequences may be weight gain, depression or other health problems. Take care of you inner fire. Look at your choices and see if there is a way to simplify. Balance your activity with rest by meditating and getting replenishing sleep each night. Ask yourself, “What am I carrying with me from the past that is no longer serving me, and what would I like to bring into my life that I have previously neglected?” Making choices that awaken your digestive fire will serve you and those around you in all aspects of your life.   How strong is your inner fire? Ayurveda characterizes the net effect of an experience as producing either ojas or ama. Ojas is the essence of nourishment that supports every cell in the body and thought in the mind. Ama is the byproduct of incomplete metabolism leading to stagnation and distress. Review the signs of ojas and ama in the charts below. If you recognize that you’ve been accumulating more toxicity than nourishment, make the commitment now to make choices that reflect the self-love that you, as an expression of the sacred, deserve.     Creating Nurturing Mealtimes Our experience while we’re eating is just as important as the kinds of foods we’re consuming. If we’re having a fight with our spouse over the dinner table, our stomach cells are aware of the upset and send distressed chemical messages throughout the body, preventing complete digestion and creating toxic residue in our body. To stoke our inner fire, we need to create a nurturing atmosphere for our meals, paying attention to all of the senses: taste, sound, sight, touch, and smell. Here are a few tips for making your body happy while you eat: Eat in a settled and quiet atmosphere. When you eat, your attention should be on the food, so that you can enjoy the delightful flavors and fully activate your digestive system. Don’t eat meals in front of the TV or computer or while you are driving. Don’t eat when you’re upset. If you are feeling angry or distressed, your digestion will be weakened. Postpone your meal by going for a short walk or doing something you enjoy until you feel calm again. Always sit down to eat. Even if you are just going to eat a few grapes or a cracker, take the time to sit down at a table. Pay attention to what you are doing and don’t rush. Only eat when you’re hungry. Putting food in your body when you’re not really hungry dampens the digestive fire and creates toxic residue. Avoid ice-cold food and drinks. Cold beverages and foods tend to freeze the digestive fire, preventing complete digestion and absorption of nutrients. This is especially true of ice-cold food and drinks. You may be in the habit of drinking ice-water or other cold drinks, but if you eliminate them, within a few weeks you will find that your body feels much better and that you no longer miss them. Sit quietly for a few minutes after your meal. This allows your body to settle effortlessly into its digestive rhythm. Include all six tastes (sweet, sour, astringent, bitter, salty and pungent) at each meal.Ayurveda tells us that each of the tastes has a unique effect on our mind-body physiology and provides the flavor that makes eating a pleasure and aids digestion. Including all six tastes in a meal will give you the nutrients you need and make you feel completely satisfied and energized. Do you know a colleague who would be interested in this ? Click on the button (top left) What are your thoughts? Send us your comments using the postform below:
CAASA Newsletter Do you know a colleague who would be interested in this ? Click on the "share" button (top left)  
AXS Studio key words - biomedical, animation, illustration, interactive content   Got a science story to tell?   We’re AXS Studio —artists who speak the language of science. We create award-winning animations, illustrations, and interactive content for the healthcare industry. With a team comprised entirely of trained medical illustrators, our specialty is explaining complex concepts in science and medicine with engaging and accurate visuals. We create content for: Mechanism of Action (MoA) videos CME presentations Investor and public relations E-learning Medical device sales & training Surgical training and more … click on the image to view the video images/stories/exhibitors/AXS/axsalbum/*.jpg click on any photo to view it full size To discover how we can help tell your science story, contact: Jason Sharpe Creative Director jason.sharpe@axs3d.com 416-673-6698 Do you know a colleague who would be interested in this ? Click on the "share" button (top left)   - links to - Conference - Exhibitors - Documents - Who Is? - Other MaRS Centre 101 College St. # 300-332 Toronto, ON M5G 1L7 Jason Sharpe, VP, Creative Director tel  -   416 . 673 . 6698 fax -   416 . 673 . 8181

<< Start < Prev 1 2 3 4 5 6 7 8 9 10 Next > End >>
Page 1 of 15


Powered by AlphaContent 4.0.15 © 2005-2010 - All rights reserved