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Two reports this fall from Ontario Auditor-General Bonnie Lysyk found as little as 61 cents out of every dollar spent by the agencies went to face-to-face client services, and few improvements had been made to correct problems identified years before. Health Minister Eric Hoskins, in a statement Wednesday, said the government "wants to reduce bureaucracy and administration in home and community care."

Even so, the policy paper introduces the idea of a smaller, local organization to co-ordinate the delivery of home care and primary care - something those familiar with the plans have been calling a "sub-LHIN." Several sources stressed that unlike the discredited CCAC model, these organizations would not mean the creation of another layer of bureaucracy. The job could be given to existing organizations such as community health centres, some speculated, and will allow for better planning. There will be no change in the relationship between the government and doctors, who will not report to the new organizations, one source said. "Our goal is to make it easier for patients to find a primary health-care provider when they need one, see that person quickly when they are sick, and find the care they need, closer to home," the Health Minister said in a statement.

There has been widespread speculation about how far the reforms would go and how the province can restructure primary care at a time when it is waging an increasingly bitter battle with doctors, who have been without a fee agreement for more than a year. After the government imposed two across-the-board fee cuts this year, the Ontario Medical Association, which represents the province's doctors, began a public campaign criticizing the measures that it argues are hurting patient care. Senior government officials stressed that the plans mapped out in the paper would be the basis of consultations in the new year, and that no changes would be "imposed" on doctors. An OMA spokeswoman said the organization would not comment until it saw the paper.

The bad news is that after years of inattention and chronic underfunding, significant issues still need to be addressed. We need a broad public discussion about our expectations and priorities to ensure we get future continuing care right: These are community decisions that ought not to be left entirely to our health bureaucrats, able though they are. As we enter this discussion, we should focus on the real issues and not waste time on red herrings. For example, recent research by the Health Quality Council of Alberta (HQCA) has confirmed that quality of care is not affected by whether the provider is private, non-profit, faithbased or public, or whether the staffare unionized. There is plenty of evidence that all types of providers are responsible, committed and caring. On the other hand, the report identified five concerns of families and residents: the need for more staff; timely help and supervision for basic needs; cleaner and bettermaintained facilities; access to related services; and quality, varied and nutritious food.

This is a telling list because these concerns are primarily driven by funding and continuing care is falling behind. Current rates of funding are actually below what was received in 2011, after inflation and cost increases are factored in. For the past three years, funding increases for continuing care have been zero, between zero and two per cent, and zero. At the same time, overall healthcare funding has increased at six per cent a year.

Just as schools need teachers, funding for spaces has to come with funding for care. In Alberta, continuing care is funded at 19 per cent below the national average. In comparison, acute health care in Alberta gets 33-percent more than the national average. Under these conditions, the HQCA conclusion that there has been "no significant change" in quality of continuing care is a credit to the commitment of our care providers.

It's not just the quantity of funding that needs to be addressed. Our current patchwork system of funding, program models and regulations needs to be revisited. Changes are needed - not to reduce standards, but to allow the system to be more client-and resident-centred, giving providers the flexibility to innovate and respond to the changing needs of clients and residents, and to reflect changes in the scope of practice of our health-care professionals. We need to ask ourselves whether a 30-yearold model of care is acceptable for our loved ones. The NDP government has taken some initial steps toward getting things back on track, but there is urgency to tackling these issues as quickly as possible. The number of Albertans needing home care, supportive living or long-term care is going to increase significantly. Will we be ready? Continuing care providers want to work with the government and all Albertans to build the best possible system. The Alberta Continuing Care Association looks forward to working with government as it takes its next steps to strengthen care and supports.

Tammy Leach is CEO of the Alberta Continuing Care Association.

The reality is that, when a loved one is in hospital, you cannot schedule your meals at normal hours. You need access to nutritious food, not to mention to the relief from the stress of sitting by the bedside of a loved one who is ill, whenever it is convenient, for example when your ill loved one is being looked after by the medical staff or when they drift off to sleep. It is therefore an important public service to provide the members of the public who have to make use of the hospital with access to good, nutritious food beyond the normal hours when the rest of us have breakfast, lunch, and dinner. These cafeterias are not really "commercial operations" but part of the public service of a hospital; as CUPE local President Norma Robinson pointed out, nutritious food is a necessary part of a patient's recovery. It is also a necessary part of a patient's family members' continuing health.

Alternatively, maybe the smart thing for Horizon Health to do is to accept that food service is part of the public service that our hospitals provide and therefore get on with providing food services to those who use our hospitals as a public service, not as "commercial operations." This means that the health network needs to accept that providing adequate food services, including by investing in new equipment and putting the cafeterias in better locations to increase visitorship, will cost the health network money. The harsh truth is that trying to balance Horizon Health's and the provincial government's books by reducing the hours of cafeterias that, in total, are losing $350,000 a year is the public finance equivalent of trying to get rich by looking for loose change behind your couch cushions.

If the government of New Brunswick wants to have the health care system contribute to reduced government expenditures and a balanced provincial budget, reducing the hours of hospital cafeterias is simply a side-show; it will have no meaningful effect on the provincial budget. If the provincial government wants to reduce expenditures on the health care system in a meaningful way, it and the health networks should engage in real health care reform.

As part of these reforms, they should either close or downgrade a number of hospitals to basic health care and triage centres and build the health-care system around a few full-service, high-quality regional hospitals. If the evidence of other provinces that had a plethora of small rural hospitals but rationalized their health care service delivery as part of a health care reform agenda is anything to go by, these reforms will also have valuable side-effect of providing New Brunswickers with better health care and making them healthier. As well as not saving any significant amount of public money, closing cafeterias in hospitals or substantially reducing their hours, on the other hand, will not do anything to make people healthier, either. If it cannot make a serious contribution to either public sector cost containment or health reform and will harm people in the process, why do it?

an Peach has worked in senior positions in federal, provincial, and territorial governments and at universities across Canada; he also served as vice-president, Policy for the New Brunswick NDP between 2012-15. His expertise is in constitutional law, federalism and intergovernmental relations, Aboriginal law and policy, and the policy-making process.

One big problem with the proposed summit: it could lead to increased tensions if the feds try to attach strings to how the provinces should spend any new money. The provinces have reason to worry: In the 1980s and nineties, as the federal fiscal situation deteriorated, Ottawa contributed less and less to the public health-care system, while prohibiting provinces from pursuing private-sector alternatives.

In the first years of the last decade, as the fiscal situation improved, the Liberal federal government was prepared to offer more robust funding, but insisted on new national standards for health-care delivery in exchange. Provincial governments resisted that federal intrusion in their jurisdiction. The struggle culminated in that 2004 first-ministers meeting in which the premiers browbeat the new Martin government into those massive increases in spending.

If Mr. Trudeau attaches conditions to increases in federal health care transfers, expect Quebec to demand that it be allowed to opt out of any program, but still get all the money. Expect Alberta to demand the same. It's called asymmetrical federalism, and it can quickly get ugly. Another major problem is that, given other Liberal spending commitments in infrastructure, fighting global warming, postsecondary education and so much else, the finance minister, whoever he or she may be, might not be able to balance the federal budget by the end of the mandate, as Mr. Trudeau has promised.

The Liberals have also promised to work with the provinces on a pharmacare strategy, which would inevitably involve funding for subsidized prescription drugs for low-income seniors.

If increased health-care commitments - along with everything else in the Liberal platform - cause federal finances to deteriorate to the point that Ottawa is running an entrenched structural deficit, the national debt will increase. At the same time, Canada's credit rating will start to decay, interest payments on the debt will consume more of the budget, and people will start saying, "Like father, like son."

To avoid that, Mr. Trudeau will have to rein in provincial expectations. But there is a political price to be paid for convening first-ministers conferences and then failing to meet the premiers' demands. It's why Stephen Harper avoided them.

a safe seniors' strategy, a national prescription drug program, developing a health human resources plan, and committing to a strong publicly-funded health care system.

It was also a trauma his family would face again, a coroner’s inquest into the 45 suicides in Nunavut in 2013 was told when the inquest began Sept. 14. Three months after Rex’s death, yet another brother — 15-year-old Peter — killed himself. Rex was living with as many as 23 family members in his grandmother’s four-bedroom house in Naujaat, a community of about 1000 people. The family shared eight beds and one bathroom while they waited for subsidized housing.

The evening before he died, Rex played with his cousins and stayed overnight at their home. His aunt and uncle found him and tried to revive him. His family reported not knowing the immediate triggers for Rex’s decision to hang himself. “I don’t know what was wrong with him,” Martha Uttak, Rex’s mother, testified. “He was my baby and he hugged me all the time.”

Five years ago, four partner organizations came together and released a suicide prevention strategy that was visionary and evidence-based in its design. The Government of Nunavut, the Embrace Life Council, the Royal Canadian Mounted Police and Nunavut Tunngavik Inc.’s goal was to reduce the territory’s suicide rate to one commensurate with, or lower than, the rest of the country.

Nunavut coroner Padma Suramala, a registered nurse who presides over death investigations in Canada’s newest territory, called the inquest to examine the rate of suicide that has seemingly left no one here untouched. “Nunavummiut are soaked in unresolved grief,” testified Jack Hicks, an expert witness at the inquiry and Nunavut’s former suicide prevention advisor. Hicks helped with a landmark follow-back study interviewing the families and friends of 120 people who committed suicide in Nunavut from 2003–2006 and 120 control subjects.

The widespread unresolved grief surfaced again when testimony from Shuvinai Mike, a senior government official who was called to talk about her department’s involvement in cultural activities, devolved into a description of the impact of her own daughter’s suicide. When someone kills oneself, the news spreads rapidly, often via social media, throughout this vast territory of only 36 000 people. Parents live with the constant fear that one of their children will be next

The inquest, which ran Sept. 14 to 25 and included testimony from about 30 witnesses, touched on many underlying issues: poverty, high rates of child sexual and physical abuse, housing shortages, unemployment, educational deficiencies, food insecurity and historical trauma that are the reality for too many Inuit families. It is also exposed the deep divisions among the territorial government and organizations coping with the population-wide damage that suicide inflicts.

But as the inquest heard, Rex was living with many of the risk factors for suicide that researchers have identified, including repeated exposure to the suicide of others. From 1999 until 2014, Nunavummiut took their lives at a rate of 111.4/100 000 population — nearly 10 times the rate of other Canadians, which stands at 11.4/100 000 according to the most recent Statistics Canada data (2000–2011).

A year later, in 2011, the territory released and began to implement an action plan with specific goals, assigned responsibilities and time frames in eight different areas. Those areas, including early childhood education and school curriculum programs, gatekeeper prevention training, and mental health and addiction supports, are intended to address the root causes or risk factors that trigger suicide. The need for a strategy is undeniable. Between 1999 and 2014, 436 Inuit completed suicide. Like Rex, 22 of them were children between the ages of 10 and 14.

Before the implementation plan was tabled in the legislature, however, the territorial government stripped out the column stipulating the financial resources required to implement each item, Hicks testified at the inquiry. None of the other partners was consulted. Not only did the Government of Nunavut never allocate a specific pocket of resources, it never asked the federal government for money to tackle this critical public health issue. As a result, “we’ve had to cobble together funding from various sources,” Natan Obed, Nunavut Tunngavik’s director of social and cultural development, testified.

Nunavut has made progress on implementing pieces of the strategy, according to an independent evaluation. The government’s lack of capacity, poor communication with the other partners and inadequate resources have retarded success, the evaluation states. Nunavut has not yet achieved its overall vision for decreasing suicide rates, denormalizing suicide and keeping children — like Rex — safe.

"In our view, recent proposals for a universal pharmacare plan under which governments would pay essentially all drug costs with only very limited patient charges, are not realistic," Busby and Blomqvist argue. "We believe it is time to start moving toward a model that makes important inroads into the biggest shortcomings of the expensive and flawed system we have today." They point to five critical deficiencies:

Too many low-income people can't afford to fill their prescriptions. All Canadians pay too much for essential medications. The provinces have no common formulary, meaning the list of insured drugs varies across the country. People with rare diseases who need exceptionally expensive drugs have to beg the government or the manufacturer for help.

Fortuitously, the report - written before this week's election - dovetails nicely with the approach of Canada's new Liberal government. Prime minister-designate Justin Trudeau has promised to "improve access to necessary prescription medications" and "work with the provinces and territories to buy drugs in bulk." That isn't quite pharmacare, but it is similar to what Busby and Blomqvist are recommending. Under the C.D. Howe plan, Ottawa would top up health transfers to the provinces allowing them to ensure that drug costs do not exceed 3 per cent of family income anywhere in Canada. (For a single working parent with two children earning $30,000, the ceiling would be $900. For a two-earner family with two children with an income of $115,500 - the national average - the maximum would be $3,450).

There is no mechanism to improve the quality of prescribing by physicians. The key to addressing all these problems, the authors say, is an increased role for the federal government in drug financing. Ottawa wouldn't run the program or deliver the drugs; it would provide the cash and co-ordination to bring the existing provincial programs up to an acceptable national standard.

All of the provinces currently have upper limits but they vary from 3 per cent to 12 per cent of family income. Ontario's is 4 per cent. Ottawa would become a partner in the Pan-Canadian Pharmaceutical Alliance launched by the premiers and territorial leaders in 2010 to bulk-purchase prescription drugs. This would increase its financial muscle - the federal government supplies medications to the prison population, First Nations, soldiers and veterans - when negotiating drug prices. It would also allow the federal government to play a co-ordinating role in creation of a single national drug formulary, based on transparent clinical evidence of cost-effectiveness.

Ottawa would work with the provinces to design a national strategy for rare and high-cost diseases. Similarly it would help them build incentives into their drug plans for doctors to take responsibility for the cost of the prescriptions they write. There would be no fundamental restructuring. A substantial share of drug costs would continue to be privately funded. The disruption would be minimal. Work could begin immediately. Politically the stars are as well-aligned as they are likely to be. The provincial premiers invited Ottawa to join the Pan-Canadian Pharmaceutical Alliance in June. Their health ministers agreed that Ottawa should play a role in improving access to prescription drugs and coverage for low-income Canadians. Trudeau has promised to negotiate a long-term health accord with the premiers and budgeted an additional $415 million for health care next year rising to $1 billion by 2019. And more than 90 per cent of Canadians support universal access to prescription drugs.

"Canadians need improvements to the existing arrangements," Busby and Blomqvist point out. "What we propose would go a long toward achieving the same objectives as those of the federally funded universal drug plan." The question facing Canadians who have waited decades for a national publicly funded pharmacare program is: Do they settle for watered down version or hold out for the gold standard? They could wait a very long time. Carol Goar's column appears Monday, Wednesday and Friday.

The CDC is launching a public education campaign for nursing homes aimed at preventing more bacterial and viral infections from starting and stopping others from spreading. A similar effort was rolled out for hospitals last year.

"One way to keep older people safe from these superbugs is to make sure antibiotics are used appropriately all the time and everywhere, particularly in nursing homes," said CDC Director Tom Frieden in announcing the initiative. Studies have estimated antibiotics are prescribed inappropriately 40 per cent to 75 per cent of the time in nursing homes. Here's why that worries the CDC: Every time someone takes antibiotics, sensitive bacteria are killed but resistant bacteria survive and multiply - and they can spread to other people. Repeated use of antibiotics promotes the growth of antibiotic-resistant bacteria. Taking antibiotics for illnesses the drugs weren't made to treat - such as the flu and common colds - contributes to antibiotic resistance.

Antibiotics also wipe out a body's good infection-fighting bacteria along with the bad. When that occurs, infections like Clostridium difficile can get out of control. C. diff. leads to serious diarrhea that each year puts 250,000 people in the hospital and kills 15,000. If precautions aren't taken, it can spread in hospitals and nursing homes. Health-care facilities already have infection-control procedures in place, such as providing private rooms and toilets for infected individuals. But the CDC is pushing them to do more on the prescribing side, advising nursing homes to track how many and what antibiotics they prescribe monthly and what the outcomes were for patients, including any side-effects.

Other recommendations include placing someone, such as a consulting doctor or a pharmacist, in charge of antibiotics policies and training other staff in following them. Some of the CDC's suggestions could challenge nursing homes' culture and how staffs, residents and their families interact. While nursing home residents and staff are among the people most at risk for the flu, annual shots aren't mandatory. Nor do homes always track who gets them.

That's starting to change at Evangelical Lutheran Good Samaritan Society, a nonprofit that provides a spectrum of senior care services in many states. Starting this year, it will collect data on staff vaccinations at one of its 167 nursing homes and share the pilot project's results with other homes, said Victoria Walker, chief medical officer. But better handling of antibiotics in nursing homes may also require tactful communication with residents' families and nursing home doctors accustomed to treating antibiotics as a default remedy.

"There's a real fear of undertreatment and that it is better to err on the safe side, and that means treating with antibiotics but forgetting about all the harms. But giving antibiotics can be just as harmful as not," said Walker. Family members may push for an antibiotic treatment when they visit a loved one in a nursing home who seems sick, even if they don't know precisely what's wrong. Doctors and nurses may go along because they don't know either and it's easier to treat than not. "The family will check in and ask what the doctor did and the nurse will say 'nothing' because they don't see monitoring as doing anything," said David Nace, director of long term care at the University of Pittsburgh, who contributed to the CDC guidelines.

"Practitioners are guilty of saying, 'it's just an antibiotic.' ... We don't appreciate the real threat," he said. Antibiotics are routinely prescribed to treat urinary tract infections, which are common in nursing homes, but too often when a UTI is only suspected, not confirmed, studies have found. The Infectious Disease Society of America is developing guidelines to help institutions implement programs to better manage antibiotics. In addition to fostering antibiotic resistant bacteria and causing C. diff infections, antibiotics also can produce allergic reactions and interfere with other drugs a nursing home resident is taking. Those risks aren't always fully considered, says researcher Christopher Crnich, who has published articles on antibiotic overuse. He is a hospital epidemiologist at William S. Middleton Veterans Hospital in Madison, Wisconsin. "Bad antibiotic effects don't come until weeks or months later, and frankly all we [prescribers] see is the upside when we're dealing with a sick mom or dad," Crnich said.

The Centers for Disease Control in the United States has raised concerns about the use of antibiotics in nursing homes.

Concern is growing about the implications of rising drug prices for individuals and health systems around the world. With little transparency around the costs of drug development, Narcyz Ghinea and colleagues call for greater accountability from drug companies to ensure a fair price for new medicines

With the exception of Prince Edward Island, no province or territory guarantees a minimum number of paid sick days for employees. Across the country, young people, seniors and low-wage workers are the hardest hit

San Francisco, a city many associate with high-tech start-ups and the innovation economy, has been a leader on using paid sick days to keep its residents healthy.

Despite being eligible for five or nine paid sick days per year, the typical employee used only three, and a quarter used none.

In Ontario, the provincial government has commissioned a review of the Employment Standards Act, legislation that has seen no major revisions since the end of the Second World War. There, a coalition of doctors, nurses, researchers and workers, have launched a campaign for change along the lines of the San Francisco model.

and has been estimated to cost Canadian businesses $15-25 billion per year.

The phenomenon of presenteeism (people coming to work despite being sick) is endemic in our work culture

It’s high time we had policies guaranteeing sick time for Canadian workers.

They allocated billions of dollars for five kinds of procedures, all disproportionately afflicting seniors who, after all, vote in elections more than young people and use the health-care system more. The procedures were: hip and knee replacements, hip-fracture repairs, cataracts, and radiation. More than a decade and billions of dollars later, how are we doing? What did all that money and effort produce? In a nutshell: middling results. Initial data were released in 2006. From then until 2015, some improvements occurred, according to a recent report (www.cihi.ca») from the Canadian Institute for Health Information (CIHI). Between 2011 and 2015, wait times shrank for some procedures in some provinces, but increased for other procedures elsewhere.

One challenge is obvious: the population is aging. Ergo: more need for cataracts, more falls causing hip fractures, more joints giving out, more youthful athletic injuries becoming painful in later years. Aging puts governments on a treadmill. More money and improved allocation of medical resources result in more procedures but demand keeps growing. For example, between 2011 and 2015, 25 per cent more hip-replacement operations were done, but the number of patients being treated within "benchmark" time frames actually fell.

What are these benchmark time frames? Governments establish them to measure progress or lack thereof, based on what medical experts think are appropriate times to wait before procedures are undertaken. The benchmarks are rather generous and can be irritating to patients in pain. They are also somewhat misleading. The hip and knee benchmarks are six months. That period measures only the time between when surgery is recommended and the surgery occurs. It does not measure what is often the most aggravating part of the health-care system: getting an appointment with a specialist who might then recommend surgery.

Combine the two waiting times - see a specialist, have surgery - and Canada's record looks less than average compared with other advanced industrialized countries. One challenge plaguing the Canadian system for joint-replacement surgeries is the endemic fight for operating time in hospitals. Orthopedic surgeries have to be slotted into ORs, which are needed for emergencies, life-threatening problems, very complicated surgeries for cancer or neurological procedures. Orthopedic surgeries, except for hip fractures that have to be repaired swiftly, can wait, and wait.

Here's a telling irony. A surplus of orthopedic surgeons now exists in some parts of Canada. There's not a surplus of surgeons versus demand for their services but rather versus the OR time they are allocated. In other words, more surgeries could be done because surgeons are available but operating-room time is not. The result is that some young surgeons are going to the United States or working part-time. Trying to fit surgeons and patients into hospital OR allocations on a timely basis is made more difficult by the straitjacket of the Canadian system or at least the view, bordering on secular theology in some quarters, that everything must be done in a public hospital rather than in private clinics operating under funding arrangements with the state.

Saskatchewan has used this method - private delivery of publicly funded and regulated services - which partly explains why that province finishes first in the CIHI report for timeliness of procedures. Quebec also used this system, until the Liberal government, led by a neurological surgeon (current Premier Philippe Couillard), ended the experiment.

If the results are so-so in recent years for the five procedures identified in 2004, CIHI numbers suggest backsliding for diagnostic imaging. For six provinces that provided data, waiting times for MRIs increased "significantly" as they did for CT scans. Waiting times for cancer surgeries have remained stable.

Dryly and accurately, CIHI repeats what everyone who thinks about the future of health care knows: "With a growing and aging population in Canada ... demand for priority procedures will likely continue to increase."

On Tuesday he said whether Switzer collects the entire amount is unknown at this point, because the LHIN recently learned that Switzer was hired at the Alzheimer Society but hasn't learned how much he'll be paid. According to Switzer's contract, if he lands a job during the 23 months that pays at least 75 per cent of his former pay, the LHIN will pay out 50 per cent of the balance owed. If he makes less than 75 per cent, the LHIN owes him a lump sum equivalent to the balance owed, less statutory deductions. "So the amount he's going to get in terms of severance isn't determined yet," said Girash, who described the 22-month provision as "generous." But he explained it was part of Switzer's original contract from 10 years ago. Last year, when the LHIN board was negotiating a new contract for Switzer, members really wanted to get rid of some costly provisions, particularly a 14 per cent performance bonus. "We wanted to eliminate that, which we were successful in doing," said Girash.

He said to get that bonus provision eliminated, the board felt it had to agree to continue with the 22-month severance clause. "It looks big but it was, I think, a good stewardship of what we were dealing with from 10 years ago and moving to make it better," said Girash. "The 22 months is really almost a safety net if the individual can't get anything else, but obviously he has." The board agreed to the one-time $16,150 payment in 2015 during negotiations in order to eliminate the 14 per cent bonus clause, he said. Switzer started working at the Alzheimer Society on Aug. 15. Attempts to reach him Tuesday - to ask what he makes - were not successful. He was replaced at the LHIN on an interim basis by the second in command, Ralph Ganter, who remains the acting CEO. The LHIN is a planning agency that co-ordinates health care in the Windsor/Essex, Chatham-Kent and Sarnia-Lambton region. It's responsible for almost 100 different agencies - including hospitals - doling out more than $1 billion annually in Ministry of Health funding. Girash wouldn't say what Ganter makes but indicated it's less than what Switzer made, and because Ganter's old job hasn't been filled, the actual cost of Switzer's termination amounts to the topup Ganter receives. Ganter made $201,920.69 in 2015 when he was senior director at the LHIN. Girash said the board isn't going to decide on a permanent CEO at this time because the LHIN is in the midst of planning for big changes expected when the Ontario government passes its Patients First legislation. Patients First would see LHINs take on big new roles, including co-ordinating primary care (family doctors) and home care.

It's very, very demanding and takes a lot of stafftime, a lot of board time," said Girash. "So it wouldn't be fair to lay on top of everyone a recruiting process." bcross@postmedia.com twitter.com/winstarcross © 2016 Postmedia Network Inc. All rights reserved. Illustration: • Nick Brancaccio, Files / Former LHIN CEO Gary Switzer, right, sits on a panel with David Musyj, Dave Cooke and Janice Kaffer at a hospital town hall meeting in November 2015. Switzer was terminated in May. His severance of more than $500,000 is being described as "one hell of a golden parachute."