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Liberals get it right with focus on home care - Infomart - 1 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|246199|ntgm|20160128|238915949

from heather federal home care

shared by Govind Rao on 28 Jan 16 - No Cached

The Globe and Mail Thu Jan 28 2016
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The Liberal government has made so many ambitious promises that a mixture of relief and surprise greets the discovery of promises it could have made, but did not. Take health care, an important area of social policy where the Liberals, being Liberals, made a host of smallish promises. However, several big promises the party did not make are as interesting and important as the ones it did.
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For example, the Liberals did not promise a national pharmacare program, as did the New Democrats, and as advocated by Ontario's Liberal government. The Liberals did not promise, as do the NDP and health-care unions, to restore annual 6-percent increases in federal transfer payments to the provinces for health care. The Liberals did not mention by how much the transfers would rise, but it will be something less than 6 per cent. The final number will emerge from tug-of-war negotiations with the provinces.
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Those negotiations have not yet begun. At last week's meeting of provincial health ministers, to which federal Health Minister Jane Philpott was invited, she shooed away any mention of money, which, at this stage of the game, is the correct approach. Meanwhile, the provincial health ministers said they would work on what a national prescription-drug plan would look like and cost - the cost having squelched the idea of national pharmacare in the past. Several academics, often quoted in the press, believe that national pharmacare would save money. Almost nobody else does, which is why the idea has never got off the ground. Quebec has discovered that its public plan, more elaborate than any other, costs a lot more than anyone had anticipated. Prime Minister Justin Trudeau's instructions in Dr. Philpott's mandate letter are much more limited. Since Ottawa spends in the order of $1-billion on drugs for aboriginal people and the military, let Ottawa join the provinces in more bulk drug purchases to lower costs. She is also to "explore" the idea of a national formulary - an excellent idea since no logical reason exists for every province to have one. Again, though, this is far from national pharmacare.
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What the Liberals do want is directed spending on home care. Here, the federal-provincial negotiations will be fascinating, and perhaps consequential for patients. The federal Liberals are always tempted to put strings around the health-care dollars Ottawa sends to the provinces. Ottawa doesn't deliver health care to Canadians (except the military and aboriginal people) and it's paying a smaller share of overall health-care spending than years ago.
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Yet the Liberal itch to influence, if not direct, how federal transfers should be spent never dies. The trouble is that every time previous Liberal governments pulled out string to wrap around the transfers, at least some of the provinces said: Just give us the cash and stuff the strings away. We do health care; you write cheques. We set priorities; you help pay. This time, though, the provinces are aware of their burgeoning number of older citizens, an increasing share of whom need or prefer to be cared for at home rather than in institutions. Provinces need to save money, too, and care at home costs less than care in a hospital bed. Home care also keeps some patients from emergency rooms and reduces calls to paramedics.
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The strategic health-care plans of almost every province underscore the importance of home care. So do provincial health-care budgets, which are giving new money to home care and little or none to hospitals. Now, along comes a federal government willing to hand over money - how much remains to be seen - in what the minister's mandate letter describes as a "long-term funding agreement" that would "support the delivery of more and better home-care services."
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Beefing up home care is what Ottawa wants. It seems to be what the provinces want. But will the provinces sign an agreement that binds them to spend at least some of the federal money for this purpose only? Or will the provinces offer vague assurances that cannot be monitored? Perhaps some (hello, Quebec) will say: Give us the money to spend as we wish, health care being provincial jurisdiction. Maybe home care; maybe not. We'll decide. Home care is the correct priority in a health-care world with endless priorities and incessant demands. Can the often-disputatious Canadian governments pull together around this common objective?
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New thinking needed on emergency medical services for Canada's aging population | Toronto Star - 0 views

www.thestar.com/..._canadas_aging_population.html

EMS

shared by Doug Allan on 12 Mar 13 - No Cached

Details emerged last month about the case of an 87-year-old Toronto woman who lost her life in December. This shocking incident raises difficult questions that need to be answered if a similar tragedy is to be avoided.
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Worse still, paramedics would have reached the scene when she was still alive but were redirected no less than seven times to other emergencies considered to be more critical.
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Emergency medical services throughout Canada are struggling to cope with the demands placed on them by an aging population. Because they so often find themselves alone, many elderly citizens often rely on paramedics for help when something goes wrong,
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Yet there is no guarantee that a hiring blitz will improve things, particularly because hospitals are releasing elderly patients faster than ever.
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This is why Halifax, and its Extended Care Paramedic (ECP)Extended Care Paramedic (ECP) program, is so important.
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Here, a paramedic — trained in the health needs of seniors — is assigned to a nursing home.
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The presence of a paramedic onsite means that calls which once led to emergency rooms visits — falls, wounds and issues relating to palliative care are prime examples — are now dealt with at the nursing home
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What is also important is that the ECP program has not required an extra infusion of money. Instead, the system was simply reorganized to give existing paramedics a new responsibility.
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While impressive, this is only a pilot project, one that is based on a long-standing policy used in the United Kingdom, and the city of Sheffield in particular
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The results proved so successful that an expanded program is now used throughout the U.K.
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As a result, well over half of those seen are not sent to the emergency room or even the hospital.
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And because of this, in the areas it is practised, ambulances are able to meet the U.K. standard call response time of eight minutes in the vast majority of cases. In Canada, nine minutes is the benchmark for cities but this is often missed.
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As for costs, here, too, reorganizing the system rather than hiring a vast number of new staff has helped keep expenses in check. In fact, because emergency room and hospital admittances are down, money has actually been saved.
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Doug Allan on 12 Mar 13

Placing paramedics in nursing homes as a way to reduce ER pressures and hiring more paramedics

<div class="cArrow"> </div><div class="cContentInner">Placing paramedics in nursing homes as a way to reduce ER pressures and hiring more paramedics</div>

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Comparative Performance of Private and Public Healthcare Systems in Low- and Middle-Income Countries: A Systematic Review - 1 views

www.plosmedicine.org/...10.1371%2Fjournal.pmed.1001244

privatization quality costs excellent

shared by Irene Jansen on 31 Mar 13 - No Cached

Studies evaluated in this systematic review do not support the claim that the private sector is usually more efficient, accountable, or medically effective than the public sector
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Irene Jansen on 31 Mar 13

Summary by Anna Marriott, Oxfam Access and responsiveness * Studies that measured utilization by income levels tended to find the private sector predominately serves the more affluent. In Colombo, Sri Lanka, where a universal public health service exists, the private sector provided 72% of childhood immunisations for the wealthiest, but only 3% for the poorest. * Waiting times are consistently reported to be shorter in private facilities and a number of studies found better hospitality, cleanliness and courtesy and availability of staff in the private sector. Quality * Available studies find diagnostic accuracy, adherence to medical management standards and prescription practices are worse in the private sector. * Prescribing subtherapeutic doses, failure to provide oral rehydration salts, and prescribing of unnecessary antibiotics were more likely in the private sector, although there were exceptions. * Higher rates of potentially unnecessary procedures, particularly C-sections, were reported at private facilities. In South Africa for example, 62% of women delivering in the private sector had C-sections, compared with 18% in the public sector. * Two country studies found a lack of drug availability and service provision at public facilities, while surveys of patients' perceptions on care quality in the public and private sector provided mixed results. Patient outcomes * Public sector provision was associated with higher rates of treatment success for tuberculosis and HIV as well as vaccination. In South Korea for example, TB treatment success rates were 52% in private and 80% in public clinics. Similar figures were found for HIV treatment in Botswana. Accountability, transparency and regulation * While national statistics collected from public sector clinics vary considerably in quality, private healthcare systems tended to lack published data on outcomes altogether. Public-private partnerships also lacked data. * Several reports ob

<div class="cArrow"> </div><div class="cContentInner">Summary by Anna Marriott, Oxfam Access and responsiveness * Studies that measured utilization by income levels tended to find the private sector predominately serves the more affluent. In Colombo, Sri Lanka, where a universal public health service exists, the private sector provided 72% of childhood immunisations for the wealthiest, but only 3% for the poorest. * Waiting times are consistently reported to be shorter in private facilities and a number of studies found better hospitality, cleanliness and courtesy and availability of staff in the private sector. Quality * Available studies find diagnostic accuracy, adherence to medical management standards and prescription practices are worse in the private sector. * Prescribing subtherapeutic doses, failure to provide oral rehydration salts, and prescribing of unnecessary antibiotics were more likely in the private sector, although there were exceptions. * Higher rates of potentially unnecessary procedures, particularly C-sections, were reported at private facilities. In South Africa for example, 62% of women delivering in the private sector had C-sections, compared with 18% in the public sector. * Two country studies found a lack of drug availability and service provision at public facilities, while surveys of patients' perceptions on care quality in the public and private sector provided mixed results. Patient outcomes * Public sector provision was associated with higher rates of treatment success for tuberculosis and HIV as well as vaccination. In South Korea for example, TB treatment success rates were 52% in private and 80% in public clinics. Similar figures were found for HIV treatment in Botswana. Accountability, transparency and regulation * While national statistics collected from public sector clinics vary considerably in quality, private healthcare systems tended to lack published data on outcomes altogether. Public-private partnerships also lacked data. * Several reports ob</div>

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Why society's most valuable workers are invisible - Infomart - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|246199|ntgm|20161031|259524904

ltc

shared by healthcare88 on 31 Oct 16 - No Cached

The Globe and Mail Mon Oct 31 2016
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Economists have, traditionally, paid little attention to women such as Shireen Luchuk. A health-care assistant in a Vancouver long-term-care residence, she trades in diapers and pureed food for those members of society no longer contributing to the GDP. She produces care, a good that's hard to measure on a ledger. She thinks about cutting her patients' buttered toast the way she would for her own aging parents, and giving a bath tenderly so she doesn't break brittle bones. She often stays past her shift to change one more urine-soaked diaper because otherwise, she says, "I can't sleep at night."
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Last week, a resident grabbed her arm so tightly that another care worker had to help free her. She's been bitten, kicked and punched. She continues to provide a stranger's love to people who can't say sorry. This past Monday, as happens sometimes, she did this for 16 straight hours because of a staff shortage.
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But let's not be too hard on those economists. The rest of us don't pay that much attention to workers such as Shireen Luchuk either - not, at least, until our families need her. And not until someone such as Elizabeth Tracey Mae Wettlaufer is charged with murdering eight residents in Ontario nursing homes. Then we have lots of questions: Who is overseeing the care of our seniors? Are our mothers and fathers safe? Will we be safe, when we end up there?
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The question we might try asking is this: If the care that Luchuk offers is so valuable, why don't we treat it that way? Dr. Janice Keefe, a professor of family and gerontology at Mount Saint Vincent University and director of the Nova Scotia Centre on Aging, says "the emotion attached to these jobs removes the value."
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Caregiving, Keefe says, is seen "as an extension of women's unpaid labour in the home." Those jobs are still overwhelmingly filled by women. And, while times are changing, the work they do is still mostly for women - whether it's the widows needing care who are more likely to outlive their husbands, the working moms who need child care or the adult daughters who are still most likely to carry the burden of aging parents.
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Yet it's as if society wants to believe that professional caregivers should do their work out of love and obligation - as if care would be tainted by higher pay and better benefits. That's an argument you never hear for lawyers and accountants. It's certainly not one that Adam Smith, the founding father of political economy, made for the butcher or the baker.
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In last year's book, Who Cooked Adam Smith's Dinner?, Swedish writer Katrine Marcal argued that the market, as Smith and his fellow economists conceived it, fails to accept an essential reality: "People are born small, and die fragile." Smith described an economy based on self-interest - the baker makes his bread as tasty as he can, not because he loves bread, but because he has an interest in people buying it. That way he can go to the butcher, and buy meat himself. But Smith missed something important. It wasn't the butcher who actually put the dinner on his table each night, as Marcal points out. It was his devoted mother, who ran Smith's household for him until the day she died.
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Today, she'd likely be busy with her own job. But care - the invisible labour that made life possible for the butcher and the baker (and the lawyer and the accountant) - still has to be provided by someone. Society would like that someone to be increasingly qualified, regulated and dedicated, all for what's often exhausting, even dangerous, shift work, a few dollars above minimum wage. One side effect of low-paying, low-status work is that it tends to come with less oversight, and lower skills and standards. That's hardly a safe bar for seniors in residential long-term care, let alone those hoping to spend their last days being tended to in the privacy of their homes. We get the care we pay for.
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It's not much better on the other end of the life cycle, where staff at daycares also receive low wages for long days, leading to high turnover. "I am worth more than $12 an hour," says Regan Breadmore, a trained early-childhood educator with 20 years experience. But when her daycare closed, and she went looking for work, that's the pay she was offered. She has now, at 43, returned to school to start a new career. "I loved looking after the kids. It's a really important job - you are leaving your infants with us, we are getting your children ready to go to school," she says. But if her daughter wanted to follow in her footsteps, "I would tell her no, just because of the lack of respect."
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It's not hard to see where this is going. Young, educated women are not going to aspire to jobs with poor compensation, and even less prestige. Young men aren't yet racing to fill them. Families are smaller. Everyone is working. Unlike Adam Smith, we can't all count on mom (or a daughter, or son) to be around to take care of us. Who is going to fill the gaps to provide loving labour to all those baby boomers about to age out of the economy? Right now, the solution is immigrant women, who, especially outside of the public system, can be paid a few dollars above minimum wage. That's not giving care fair value. It's transferring it to an underclass of working-poor women. And it doesn't ensure a skilled caregiving workforce - all the while, as nurses and care assistants will point out, the care itself is becoming more complex, with dementia, mental illness and other ailments.
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Ideally, in the future, we'll all live blissfully into old age. But you might need your diaper changed by a stranger some day.
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Maybe robots can do the job by then. Rest assured, you'll still want someone such as Luchuk to greet you by name in the morning, to pay attention to whether you finish your mashed-up carrots. When she's holding your hand, she will seem like the economy's most valuable worker. Let's hope enough people like her still want the job.
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RQHR plans layoffs; Union leaders say reductions will affect front-line staff, patient care - Infomart - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|245142|relp|20160917|256320275

Saskatchewan cupe cuts

shared by Heather Farrow on 19 Sep 16 - No Cached

The Leader-Post (Regina) Sat Sep 17 2016
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The Regina Qu'Appelle Health Region (RQHR) will be issuing layoff notices after a two-year review of staffing in 117 round-the-clock care units. To get to a balanced budget, the region must reduce 120 full-time equivalent positions, but much of that will be accomplished by cutting casual work from part-timers and attrition. Fewer than 20 people are expected to lose their jobs, but all positions are being considered, said Keith Dewar, CEO of the RQHR. "(Attrition has) been our commitment all along," Dewar said. "Our interest here is providing quality, safe care. Our second obligation to the public is to do so in a way that shows responsibility for the funds that we've been entrusted."
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The RQHR's annual budget is more than $1 billion. As of August, it had a $4.7-million deficit. The RQHR has 11,000 staffand an eight per cent attrition rate, which means roughly 800 employees leave yearly. "By the time we have the meetings with the unions and go through the formal process, we don't believe in some cases some of the numbers we're looking at right now would be given layoffnotice," Dewar said. While some front-line healthcare workers will be among those receiving layoffnotices, they will be able to bump to another position under their collective agreements.
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Dewar couldn't estimate how much money will be saved by the layoffs because staff numbers change constantly. Three full-time and two part-time management positions will not be filled and savings will be re-directed to front-line services in long-term care. For some time, the Saskatchewan Union of Nurses (SUN) has raised concerns that registered nurses (RNs) are being replaced by licensed practical nurses (LPNs). When asked if this could happen, Dewar replied: "For RNs or LPNs, what's really important is how you organize that care team to deliver quality care and there is a substantive overlap between the two professional groups."
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He emphasized it's important to assess what care is required by patients and who can best deliver that care. CUPE Local 3967 president Scott McDonald said Friday's announcement was news to him. The local represents most RQHR workers who aren't RNs, including those in housekeeping and maintenance, dietary professionals, technicians and LPNs. CUPE has had brief conversations with the health region, but McDonald didn't think the layoffs were a firm thing until he heard Friday's announcement.
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He said CUPE's 5,500 members are already overloaded. "These layoffs are going to affect patient care. I don't see any way of getting around that," said McDonald. SUN president Tracy Zambory agreed. There are already "huge challenges" when it comes to staffing, said Zambory. She pointed to the 28 per cent increase in critical incidents as reported in the Health Ministry's annual report released in July. That includes errors in medication and diagnosis. "Regional health authorities have been told they have to come up with efficiencies; that translates down always to the front-line staff," Zambory said. Realigning staff won't impact services, bed numbers or programs, Dewar said. On Thursday, the Saskatoon Health Region issued 70 layoff notices.
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Numerous factors could explain the difference in the number of layoffnotices the province's two largest health regions are handing out - including the SHR's larger deficit, Dewar said.
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CUPE urges paramedics to take part in important health and safety survey | Canadian Union of Public Employees - 0 views

cupe.ca/rtant-health-and-safety-survey

cupe ems survey

shared by Heather Farrow on 02 Jun 16 - No Cached

Jun 1, 2016
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Paramedics are being invited to participate in a survey on issues of health, safety and wellness. This will help CUPE improve our vital health and safety work in the EMS sector.
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Denley: Health care is far too important to leave to government | Ottawa Citizen - 0 views

ottawacitizen.com/...portant-to-leave-to-government

Ontario privatization doctors fees

shared by Heather Farrow on 04 Aug 16 - No Cached

It’s a good question, and it takes us to a place where politicians and most Ontarians are unwilling to go. We probably can’t sustain, and certainly can’t improve, our health care without access to more money than our governments are willing to spend. That suggests either co-payments or a private health-care stream that could utilize some of the excess surgical capacity we have, but can’t afford to deploy.
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Unfortunately, that conversation always leads to people talking about paying for health care with their OHIP card, not their credit card. Sounds great, but government’s got to do the paying. The fact that it can’t cover physicians’ costs without cutting doctors’ pay is a clear sign that government is unprepared to meet the health costs of an aging population.
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Expecting doctors to work for years without a real raise is not a sustainable approach to health care. Neither is tightening up the rationing that already has Ontarians waiting a long time for many services. We can do better, but not if we continue to leave the job to government.
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Randall Denley is an Ottawa commentator, novelist and former Ontario Progressive Conservative candidate. Contact him at randalldenley1@gmail.com
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Indigenous health: Time for top-down change? - 0 views

www.cmaj.ca/E247

aboriginal cma

shared by Heather Farrow on 08 Aug 16 - No Cached

CMAJ August 9, 2016 vol. 188 no. 11 First published July 4, 2016, doi: 10.1503/cmaj.109-5295
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Lauren Vogel
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A year after the Truth and Reconciliation Commission’s call to action, public health experts say indigenous health won’t improve without major system change. Last June, the commission issued a comprehensive treatment plan for healing the trauma inflicted on indigenous communities under Canada’s residential schools system — but not much has happened. Eight of the commission’s 94 recommendations directly addressed health care. So what’s the hold up on high-level change?
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That question dominated the recent Public Health 2016 conference in Toronto. Speakers described persistent inequity and inaction across the health system, from research to medical training to hospital care. “The common response is to deny that the problem lies in the structures,” said Charlotte Loppie, director of the Centre for Indigenous Research and Community-led Engagement at the University of Victoria in British Columbia.
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She argued that it’s a mistake to see “colonization” as something that happened in the past. “It’s about the control that some people have over other people, which obviously continues today in the health policies and programs that are developed and expanded on indigenous communities, rather than with those communities.”
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Research Loppie spoke at a panel hosted by the Canadian Institutes of Health Research (CIHR), which faced criticism in February for awarding less than 1% of funding to Aboriginal health projects in its first major competition since restructuring. “We know we have to work to get this right and get this better and I think we’re learning as we go,” said Nancy Edwards, scientific director of the Institute of Population and Public Health at CIHR.
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According to Edwards, Aboriginal health is now a “standing item” at science council meetings, which bring together CIHR top brass every four to six weeks. There has also been “a lot of consultation” with indigenous researchers and communities. There isn’t a single barrier standing in the way. “It’s not that simple,” she said.
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Speakers at the Canadian Public Health Association’s annual conference urged structural change to improve indigenous health.
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Loppie said she considers Edwards an ally, but noted that CIHR has “a long way to go” to correct the disadvantage to Aboriginal health research under the new funding structure. “Change is a difficult point,” particularly at the most senior levels of administration, she said.
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Medical education Australia’s experience integrating indi genous health education into medical training shows how change at that level can help transform a system. Australia’s version of a Truth and Reconciliation Commission recommended compulsory courses for all health professionals in 1989. But this didn’t become reality for doctors until 2006, when the Australian Medical Council set standards that the indigenous health training schools must provide.
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With accreditation on the line, change was rapid and meaningful, said Janie Smith, a professor of innovations in medical education at Bond University in Australia. “If you don’t meet the standards, you can’t run your program, so it’s very powerful.” Bond’s medical program overhauled its case-based curriculum to include indigenous examples to teach core concepts. Students also complete a two-day cultural immersion workshop in first year and a remote clinical placement in fifth year.
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“It’s a really important principle that this is the normal program and it’s funded out of the normal budget,” Smith said. Integration in core curriculum teaches students that cultural sensitivity is fundamental to being a good doctor, like understanding anatomy. It also protects indigenous health education from “toe cutters” when budgets are tight. Although Canadian medical schools are expanding their indigenous health content, some educators noted that it’s still peripheral to core training.
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Lloy Wylie teaches medical students as an assistant professor of public health at Western University in London, Ontario. She recalled one indigenous health session that only a third of students attended. “When it’s voluntary, only the people who don’t need the training show up.”
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Hospital care Wylie said she encountered the same indifference among some medical colleagues at Victoria Hospital in London, Ont., where she is appointed to the psychiatry department. “There are still some very unsettling things that I see going on in our hospital system.” She shared stories of “huge jurisdictional gaps” between the hospital and reserve, of patients with cancer denied adequate pain medication because of assumptions about addiction, and of health workers “woefully unaware” of indigenous culture and services.
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People in the hospital weren’t even aware of the Aboriginal patient liaison that was in the hospital,” Wylie said. There are some recent bright spots; for example, British Columbia and Ontario are boosting cultural sensitivity training for health workers. But Wylie noted that the same workers “go back to institutions that are very culturally unsafe, so we need to look at changing those institutions as a whole.”
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Brock Pitawanakwat, an assistant professor of indigenous studies at the University of Sudbury in Ontario, cited the importance of creating space for traditional healing alongside clinical care. In some cases, it’s a physical space: Health Sciences North in Sudbury has an on-site medicine lodge that provides traditional ceremonies and medicines.
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These services are as much about healing mistrust as any physical remedy, Pitawanakwat said. “Going into a hospital after attending a residential school, there’s still that negative emotion,” he explained. “If you look at these buildings in archival photos, they’re almost identical.”
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Wylie suggested that the fee-for-service model could also be changed to support physicians building better relationships with patients. “Anything we do to make our hospitals more welcoming places for Aboriginal people will be good for everybody,” she said. “Right now, they’re really alienating for everybody.”
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Not just justice: inquiry into missing and murdered Aboriginal women needs public health input from the start - 0 views

www.cmaj.ca/...E78

from heather aboriginal gender violence

shared by Govind Rao on 15 Mar 16 - No Cached

CMAJ March 15, 2016 vol. 188 no. 5 First published February 29, 2016, doi: 10.1503/cmaj.160117
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On Dec. 8, 2015, the Government of Canada announced its plan for a national inquiry into murdered and missing indigenous women and girls, in response to a specific call to action from the Truth and Reconciliation Commission.1 On Jan. 5, 2016, a pre-inquiry online survey was launched to “allow … [stakeholders an] opportunity to provide input into who should conduct the inquiry, … who should be heard as part of the inquiry process, and what issues should be considered.”2 We urge the federal government to be cognizant of the substantial knowledge, skill and advocacy of those who work in public health when deciding who should be consulted as part of this important inquiry.
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A recent report from the Royal Canadian Mounted Police3 confirmed that rates of missing person reports and homicide are disproportionately higher among Aboriginal women and girls than in the non-Aboriginal female population. As rates of female homicide have declined in Canada overall, the rate among Aboriginal women remains unchanged from year to year. This is troubling, and the need to seek testimony from survivors, family members, loved ones of victims and law enforcement agencies in the inquiry is clear.
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...9 more annotations...
However, we should avoid diagnosing this problem merely as a failure of law enforcement. Murders represent the tip of an iceberg of problems related to endemic violence in communities. Many Aboriginal women and girls, and indeed men and boys, live each day under the threat of interpersonal violence and its myriad consequences.
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Initial statements from the three federal ministers tasked with leading the forthcoming inquiry — the ministers of Indigenous and Northern Affairs, Justice and Status of Women — suggest that its purpose is to achieve justice, to renew trust between indigenous communities and the Canadian government and law enforcement bodies, and to start a process of healing.
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The inquiry surely must also endeavour to lay the groundwork for a clear plan to address the broader problem of interpersonal violence, which, in turn, is rooted in several key determinants. Addressing interpersonal violence is not merely an issue of justice; it is also a public health concern.
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Factors associated with both the experience and perpetration of interpersonal violence are manifold. They include but are not limited to mental health issues, drug and alcohol misuse, unemployment, social isolation, low income and a history of experiencing disrupted parenting and physical discipline as a child. The Truth and Reconciliation Commission’s report has highlighted that many of these factors are widespread in the Aboriginal populations of Canada.4 Many of the same factors contribute to disparities between Aboriginal and non-Aboriginal peoples in areas such as education, socioeconomic circumstances and justice. T
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here is also substantial overlap with identified determinants of poor health in Aboriginal communities both in Canada and elsewhere.5,6 These are the factors associated with higher rates of youth suicide, adverse birth outcomes and tuberculosis, and poorer child health. It’s clear that a common web — woven of a legacy of colonization and cultural genocide, and a cumulative history of societal neglect, discrimination and injustice — underlies both endemic interpersonal violence and health disparities in Canada’s indigenous populations. There is no conversation to be had about one without a conversation about the other — if the aim is healing — because the root causes are the same.
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The World Health Organization (WHO) is currently engaged in developing a global plan of action to strengthen the role of health systems in addressing interpersonal violence, particularly that involving women and girls.7 A draft report by the WHO acknowledges interpersonal violence as a strongly health-related issue that nevertheless requires a multisectoral response tailored to the specific context. Evidence from Aboriginal community models in Canada gives hope for healing.
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A recent report from the Canadian Council on Social Determinants of Health highlighted important strides that some Aboriginal communities have made to address the root causes of, and to mitigate, inequities through efforts to restore the people’s connection with indigenous culture.8 Increasing community control over social, political and physical environments has been linked to improvements in health and health determinants.
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The public health sector in many parts of Canada has embraced the need for strong community involvement in restoring Aboriginal people to the health that is their right. In many community-led projects over the past few decades, the health care sector has worked with others to address common proximal and distal determinants of disparities.
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We are presented with not just an opportunity for renewing trust between indigenous communities and the Government of Canada but also for extending the roles of public health and the health care sector in the facilitation of trust and healing. There is much that the health sector can contribute to the forthcoming inquiry. Health Canada should be involved from the start to ensure that public health is properly represented
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Paramedicine expands to rural communities in B.C. - Infomart - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|245142|bccp|20160427|245817592

bc ems cupe rural

shared by Heather Farrow on 02 May 16 - No Cached

Williams Lake Tribune Wed Apr 27 2016
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Alexis Creek, Anahim Lake, Bella Bella and Bella Coola have been named as remote B.C. communities that will welcome community paramedicine. Alexis Creek, Anahim Lake, Bella Bella and Bella Coola have been named as some of the 73 rural and remote B.C. communities that will welcome community paramedicine, a program that offers residents enhanced health services from paramedics. Health Minister Terry Lake made the announcement Wednesday.
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"The Community Paramedicine Initiative is a key component of our plan to improve access to primary health-care services in rural B.C.," Lake said. "By building upon the skills and background of paramedics, we are empowering them to expand access to care for people who live in rural and remote communities, helping patients get the care they need closer to home." The program is just one way the Province is working to enhance the delivery of primary care services to British Columbians. The services provided may include checking blood pressure, assisting with diabetic care, helping to identify fall hazards, medication assessment, post-injury or illness evaluation, and assisting with respiratory conditions.
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Under this program, paramedics will provide basic health-care services, within their scope of practice, in partnership with local health-care providers. The enhanced role is not intended to replace care provided by health professionals such as nurses, but rather to complement and support the work these important professionals do each day, delivered in non-urgent settings, in patients' homes or in the community. "As a former BC Ambulance paramedic, I understand the potential benefits of community paramedicine," said Jordan Sturdy, MLA for West Vancouver-Sea to Sky. "Expanding the role of paramedics to help care for the health and well-being of British Columbians just makes sense." Community paramedicine broadens the traditional focus of paramedics on pre-hospital emergency care to include disease prevention, health promotion and basic health-care services. This means a paramedic will visit rural patients in their home or community, perform assessments requested by the referring health care professional, and record their findings to be included in the patient's file. They will also be able to teach skills such as CPR at community clinics.
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"Community paramedics will focus on helping people stay healthy and the specific primary care needs of the people in these communities," said Linda Lupini, executive vice president, BC Emergency Health Services. "This program also allows us to enhance our ability to respond to medical emergencies by offering permanent employment to paramedics in rural and remote areas of the province." "Community paramedicine brings improved patient care and more career opportunities to rural and remote areas," said Bronwyn Barter, president, Ambulance Paramedics of BC (CUPE 873). "Paramedics are well-suited to take on this important role in health-care provision." Community paramedicine was initially introduced in the province in 2015 in nine prototype communities. The initiative is now expanding provincewide, and will be in place in 31 communities in the Interior, 18 communities in northern B.C., 19 communities on Vancouver Island, and five communities in the Vancouver coastal area this year.
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At least 80 new full-time equivalent positions will support the implementation of community paramedicine, as well as augment emergency response capabilities. Positions will be posted across the regional health authorities. The selection, orientation and placement process is expected to take about four months. Community paramedics are expected to be delivering community health services in northern B.C. this fall, in the Interior in early 2017, on Vancouver Island and the Vancouver coastal area in the spring of 2017. BC Emergency Health Services has been co-ordinating the implementation of community paramedicine in B.C. with the Ministry of Health, regional health authorities, the Ambulance Paramedics of BC (CUPE 873), the First Nations Health Authority and others. Copyright 2016 Williams Lake Tribune
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Superbugs versus Outsourced Cleaners - 1 views

ilr.sagepub.com/...0019793916654482.abstract

hai hospital infectious disease cleaning cleaners

shared by Heather Farrow on 23 Jun 16 - No Cached

Published online before print June 22, 2016, doi: 10.1177/0019793916654482 ILR Review June 22, 2016 0019793916654482
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*Adam Seth Litwin is an Associate Professor at the ILR School, Cornell University. Ariel C. Avgar is an Associate Professor at the School of Labor and Employment Relations, University of Illinois, Urbana-Champaign. Edmund R. Becker is a Professor at the Rollins School of Public Health, Emory University.
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On any given day, about one in 25 hospital patients in the United States has a health care–associated infection (HAI) that the patient contracts as a direct result of his or her treatment. Fortunately, the spread of most HAIs can be halted through proper disinfection of surfaces and equipment. Consequently, cleaners—“environmental services” (EVS) in hospital parlance—must take on the important task of defending hospital patients (as well as staff and the broader community) from the spread of HAIs. Despite the importance of this task, hospitals frequently outsource this function, increasing the likelihood that these workers are under-rewarded, undertrained, and detached from the organization and the rest of the care team.
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Cleaners important to health care - 2 views

www.vancouversun.com/...story.html

privatization hospitals bc housekeeping cleaning c.diff HAI op-ed Bonnie Pearson HEU

shared by Mike Old on 03 May 12 - No Cached

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Mike Old on 03 May 12

The recent revelation about out-of-control C. difficile infection rates and the breakdown of the infection prevention and control programs at Burnaby and Royal Columbian hospitals should surprise no one.

<div class="cArrow"> </div><div class="cContentInner">The recent revelation about out-of-control C. difficile infection rates and the breakdown of the infection prevention and control programs at Burnaby and Royal Columbian hospitals should surprise no one.</div>

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Mike Old on 03 May 12

Op-ed published in Thursday's Vancouver Sun detailing some of the warning signs that preceded a major C. diff outbreak at Burnaby General.

<div class="cArrow"> </div><div class="cContentInner">Op-ed published in Thursday's Vancouver Sun detailing some of the warning signs that preceded a major C. diff outbreak at Burnaby General.</div>

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Cleaners important to health care. HEU. Vancouver Sun. - 2 views

www.vancouversun.com/...story.html

hai cupe scotland bc contracting out

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Scotland banned the contracting out of hospital housekeeping in 2008 and brought cleaning back in house. The result? According to the latest figures from Health Protection Scotland, cases of C. difficile have dropped dramatically.
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Can We Cure Hospital Food? | Reader's Digest - 0 views

www.readersdigest.ca/...can-we-cure-hospital-food

hospital food quality contracting out environment

shared by Irene Jansen on 30 Mar 12 - No Cached

Health-care administrators— who believe their first priority is treating patients, not feeding them—have long viewed the food budget as the first place to slash. Ontario hospitals, for example, spend a daily average of less than $8 per patient on three meals and two snacks.
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more than 30 per cent of those low-budget meals boomerang back to the kitchen; one recent audit by a Nova Scotian health authority put the figure as high as 40 per cent.
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Around the world, organizations are trying to change the way hospitals source, prepare and deliver food. The Soil Association, the U.K.’s largest organic food and farming trade group, has aggressively campaigned against the “rotten” quality of British hospital food for more than a decade and has scored some victories. Last year, the group released a detailed report called “First Aid for Hospital Food,” which boasted that dozens of health-care institutions now “leading by example” have, without raising costs, embraced wholesome, seasonal and local ingredients.
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In 2005, Health Care Without Harm, an international group of health-care professionals, put together the Healthy Food in Health Care Pledge to give hospitals guidance in improving the food they served in cafeterias and to patients. By the end of 2011 more than 350 U.S. hospitals had signed on. Almost all managed to substantially reduce their use of processed foods and saturated fats and to increase their offerings of local fruits and vegetables when available—one hospital even subsidized prices so that the healthiest choices were the least expensive. It’s still too soon to assess the pledge’s full effect, but given that some of these facilities have 600 to 1,200 beds and can cook as many as 10,000 meals a day, the impact—on patient health, on local economies—is likely to be profound.
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The Canadian Medical Association and Canadian Healthcare Association both have policies on the importance of food and nutrition, but to date neither has taken a position on the issue of hospital food as a public-health tool.
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rethermalization system that reheats pre-cooked food prepared in factories off-site. A money-saving measure that North American hospitals adopted en masse a decade ago, the method can cut labour costs by more than 20 per cent when compared to conventional scratch cooking. “Retherm” is largely responsible for hospital food’s present image—and taste—problem.
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one percent of the institution’s global budget
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“Many products don’t retherm well. It’s not as easy as it sounds.”
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Quigley tells me it would take a huge investment to dismantle the existing system and bring back a conventional kitchen, not to mention the expense of retraining staff.
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St. Mary’s has also devoted more of its budget to crops grown closer to home, buying cherry tomatoes and Ontario peaches at peak season to take advantage of lower prices.
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Maharaj is a 35-year-old chef and health-food activist who, for the last seven months, has been feverishly working alongside staff at Toronto’s Scarborough Hospital to reinvigorate its patient menu with locally sourced ingredients and homemade dishes. With a $191,000 grant from the Broader Public Sector Investment Fund (a partnership between the Ontario government and Greenbelt Fund), Scarborough hired Maharaj to shake things up in their kitchen.
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At the end of her one-year tenure, patients will be able to choose their meals from a carte du jour offering more than 20 dishes, such as salmon with a yogourt-dill sauce, Moroccan chicken and Greek roasted vegetables with fava beans.
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Maharaj is quick to point out she has a major advantage: Scarborough still has a working kitchen (almost half of Ontario’s hospitals no longer do).
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“Not a lot of money is devoted to hospital food, but there are ways we can make what we’ve got work better. The best way is to trim waste, and that means giving patients a real choice.”
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hospitals across the U.S. have been holding farmers’ markets for more than a decade. And as it happens, the Kitchener- Waterloo area is home to some of Ontario’s oldest and busiest food markets. Putting up stalls at St. Mary’s seemed a natural extension
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Canadian Coalition for Green Health Care (CCGHC)
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Last year, the Ontario government awarded public institutions $1.5 million in grants to help with local food purchasing, which CCGHC hopes will inspire hospitals still lagging behind.
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food quality is the primary objective driving St. Michael’s Hospital, a retherm facility in downtown Toronto, to introduce Ontario fruits and vegetables into its menu. Alex MacEachern, who heads up the hospital’s local food program
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Since 2011 the hospital has in- creased its use of local produce by more than 30 per cent.
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while St. Michael’s can’t prepare patient meals on-site, MacEachern and her team have nonetheless developed their own version of scratch cooking. They bring in fresh ingredients they assemble raw and cook on the hot side of the retherm cart, to create dishes such as blueberry crisp, baked apple crumble and red pepper frittata.
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Almost 50 percent of the new Ontario items are actually less expensive than the imported item
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In Ontario alone, more than 115 million meals are served every year in long-term-care homes and hospitals
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hospitals have begun hosting regular farmers’ markets—Winnipeg’s Seven Oaks General Hospital and Cape Breton Regional Hospital among them. The Vancouver Island Health Authority debuted a new meal-delivery program, called Steamplicity, which steam-cooks raw ingredients inside sealed, heat-resist- ant packages. The method is quick— meals are ready in less than six minutes—and allows food to keep its flavour and texture.
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Food is not seen as crucial to recuperation and healing. This is where Maharaj thinks doctors like me should do more. “You have an influential role to play in patients’ lives— you need to start advocating for people to eat better food. The bottom line is we need to find the political will to repurpose all those misspent dollars on a national scale.
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The Challenges of Improving Hospital Food - 1 views

healthydebate.ca/...hospital-food

food hospital ontario

shared by Irene Jansen on 01 Jun 12 - No Cached

Ontario’s hospitals feed patients 3 meals a day, and 2 snacks, on an estimated budget of less than $8 per day per patient , excluding labour costs.
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Research suggests that hospital food is an important part of the patient experience
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Anne Marie Males, VP of Patient Experience at Scarborough General Hospitals says “Food service is not considered a key department of most hospitals. It’s a service that it has to be there. A lot of people don’t give it much thought, but when you talk to patients, its amazing how important food is to them.” Males, who is leading the introduction of more fresh and home-cooked foods at the Scarborough General Hospital through a grant from the Ontario Greenbelt Foundation
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St. Michael’s Hospital serves 97 different diet types, and has 47 different diets to respond to allergy restrictions
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Fletcher notes that efforts to add fresh, local foods to the hospital menu meant that the hospital had to engage in conversations and partnerships with suppliers, including farmers and help them learn how to participate in hospital food procurement processes
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Companies such as Compass Group and Aramark specialize in food preparation for hospitals at large, off-site industrial kitchens.
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The “kitchenless” hospital has been described as an innovation that can save hospitals about 20% of food services costs.
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Many hospitals have adopted an approach, known as ‘rethermalization’
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the Sioux Lookout Meno Ya Win Health Centre located in Northwestern Ontario and serving the needs of primarily First Nations communities was required to have specific legislative authority in order to serve traditional foods, such as game meats and fish, which are non-inspected foods
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The Scarborough Hospital is also aiming to improve the cultural appropriateness of food services, through their pilot project.
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