Tuesday, February 9, 2016

Staffing shortages in LTC: no breakfast or support for residents

It's a terrible story. It is most difficult in more northern communities, where it is difficult to maintain staff when illness strikes. Such homes need to keep spare staff, but, like replacing a teacher, staff have to be able to earn a living.

A section of Hogarth Riverview Manor was short-handed for two hours after a staff member ...

Staffing shortage left several residents without breakfast on Saturday at Hogarth Riverview Manor

According to Meaghan Sharp, vice-president of senior’s health and chief nursing executive at St. Joseph’s Care Group, overall staffing ratios at the new facility are lower than they were at the city-run Dawson Court and Grandview Lodge, where many of the residents formerly lived.
Each unit at the new Hogarth Riverview Manor houses 32 residents. During the day there are three personal support workers assigned to each unit.

Each unit also has a complement of registered practical nurses and there is a registered nurse on duty to oversee the entire operation. The numbers are lower in the evenings and overnight.

Sharp said they are at the mercy of the funding they receive through the regional Local Health Integration Network.

300 Lillie Street
Thunder Bay, P7C4Y7
Tel : (807) 625-1110
Fax : (807) 623-4520

Thursday, February 4, 2016

Have national smoking bans worked in reducing harms in passive smoking?

The most robust evidence yet, pu
pregnant smoker on public beach
blished today in the Cochrane Library, suggests that national smoking legislation does reduce the harms of passive smoking, and particularly risks from heart disease.

 The updated Cochrane review containing more up-to-date research found that countries who imposed smoking bans found their populations benefited from reduced exposure to passive smoke, specifically cardiovascular disease.

Researchers found that of the 44 observational studies which specifically assessed cardiovascular disease, 33 of these studies reported evidence of a significant reduction in heart disease following the introduction of these bans. Researchers also found that the greatest reduction in admissions for heart disease following smoking legislation were identified in populations of non-smokers.

 Review author, Professor Cecily Kelleher, from University College, Dublin, said: “The current evidence provides more robust support for the previous conclusions that the introduction of national legislative smoking bans does lead to improved health outcomes through a reduction in second hand smoke exposure for countries and their populations. We now need research on the continued longer-term impact of smoking bans on the health outcomes of specific sub-groups of the population, such as young children, disadvantaged and minority groups.”  

Full citation: Frazer K, Callinan JE, McHugh J, van Baarsel S, Clarke A, Doherty K, Kelleher C. Legislative smoking bans for reducing harms from secondhand smoke exposure, smoking prevalence and tobacco consumption. Cochrane Database of Systematic Reviews 2016, Issue 1. Art. No.: CD005992. DOI: 10.1002/14651858.CD005992.pub3. 
URL Upon publication: http://doi.wiley.com/10.1002/14651858.CD005992.pub3

Wednesday, January 27, 2016

The Ontario Liberal Government Has Quietly Scrapped the PSW Registry

PSW helping my dad
This headline is a shock. Maybe not.
The registry was virtually useless, since they outsourced it, and no one confirmed the qualifications of the personal support workers (PSW) who registered.

We are short PSWs, as well as nurses, who can earn more money, depending upon their employer. The terrible PSWs make the news, but can be hired elsewhere. Some are fired, with no recourse for wounded families.

They didn't enforce basic qualifications, they didn't regulate the workers, they did NOT ensure that all who provide intimate care in private homes, retirement homes, long-term care or hospitals, were trained consistently.

Some felt it was a first step, but no one wants to invest dollars is improving the delivery of these services, for workers who make between minimum wage and $20/hour, depending upon where they worked and for whom. Some don't get travel time between private homes.

Liberals quietly scrap PSW registry

Four years after Ontario’s Liberals promised to protect patients by creating a registry for personal support workers, the Kathleen Wynne government has pulled the plug on the registry, flushing away more than $1 million spent to create it, an opposition critic says.
But Ontario Liberals instead have perpetuated a system in which PSWs make less than minimum wage, their modest salaries eroded by travel time for which they’re poorly paid, Gelinas said. The result has been high turnover and compromised care. A revolving door of PSWs doesn’t know the needs of their patients, who in turn, feel uncomfortable dealing with new faces, Gelinas said.
Former health minister Deb Matthews trumpeted the registry when it was launched in 2012.

Home Healthcare Industry Is Big Business

When you consider how many long-term care and retirement homes are for-profit, this isn't a
surprise.  (In Ontario alone, 500+/ 600 long-term care homes.) It is HUGE in the US.

Home Healthcare Market Will Reach $355.3 Billion, Growing At An Estimated CAGR Of 11.7% Till 2020: Grand View Research, Inc. 

Shareholders want dividends

The Home Health Care Industry Expected to Reach $355 Billion in Annual Revenue by 2020
It's no surprise that the home health care industry is expected to grow ... and prevalence of chronic conditions requiring long term care is also expected to ... Increasing numbers of seniors are preferring to remain within the comfort of ... On top of these factors, as hospital face increased pressure to reduce ...

Welltower Inc to Issue Quarterly Dividend of $0.83 on November 20th (HCN)
Welltower Inc., previously Health Care REIT, Inc., is a real estate investment trust (NYSE:HCN). The business 's ... The Company's hospitals and seniors home -net properties are leased to operators under long term operating leases.
Welltower (HCN) Announces Quarterly Earnings Results, Beats Expectations By $0.02 EPS
Institutional Investors own 90.82% of Health Care REIT, Inc. shares. During last six ... The Company's hospitals and seniors housing triple-net properties are leased to operators under long-term operating leases. Its medical office ...

Friday, January 22, 2016

PART XLIX: CT Scan #5 result and consult

#49 CT Scan results

 8:45 left home, saw  5 Belgians standing still in the sunshine, a lovely sight,

and a neat truck/tank. An Argo XTV. JB says we can't have one, since Buster wouldn't use it responsibly!
Argo XTV
Traffic busy, passed 4 times, a truck nearly cut us off, but I braked.

Parking lot nearly full, squeezed into a spot. Several cars over the lines, and taking two spots. Sigh. Here in good time to park, $13 max, lower than Toronto = $20 maximum. The government is going to limit the daily max. to $10, so hospitals are going to have to find funding elsewhere.

10:42 Both of us powdered our noses, and were in our chairs, ready to go for our 10:45. Looked at DVD yesterday. Nurse mentioned sticker needs help! :-)
Full waiting room (18 peeps), but moving constantly, cheery staff.    Another doctor greets his patient, patient replies: "How are you?"
  "I'm great!"

Magazines from 2014! Should have brought some...
Note to self: this is visit #49 - why did I forget something to read?

11:36 Still waiting... An hour behind! Everyone needs more than the allotted time with the man.

11:46 we made it into the waiting room, 1 person just before us now. Our appointment was for 10:45!

11:59 Dr. Cagionnis finally arrived. He's on the run all day.
PSA= 1.7 was 1.4 CT Scan not so much different, still nodes. Another 1 cm lymph node down in the pelvis. Upper limit of normal is 0.9 . They sent us home from CT Scan #5 with a DVD to give to the doctor. I copied it!

Yes, PSA up a bit, and there is a third cloudy image on the scan. It could be new, or it could be that it was 0.9mm on the previous scan, and has gone to 1.0mm now. They might not have mentioned the third spot in the original report.
Yes, I've been graphing his PSA count! A nice, slow rise.

 Hubby is still taking his immunity boosters.

"You're both bright people." :-) Hormones not chance of cure, radiation would have been, but side effects would have been horrible. PSA moving slowly therefore good response. Injections between 5 and 10. Radio graphic disease a factor, intermittent, for lower disease, same as continual: Bone loss, somewhere in middle. Rational way to make a decision. Weighed pros and cons. Check PSA in 6 mos. no scan, only if PSA jumps.

We have reprieve for another 6 mos.(= July), then we do the PSA test again! JB was stressed about the scan. A relief to find it's a slow curve.
  The 100km drive is almost worse than waiting for tests!

Good news: we're home safe after a late lunch outside the city at The Swan Pub. This school bus failed to see the red light on Riverside Dr., and stopped halfway into the T-intersection.

Monday, January 18, 2016

WEBINAR: Implementing a frailty measure for older adults with intellectual and developmental disabilities

Meeting Invitation: From research to practice: Implementing a frailty measure for older adults with intellectual and developmental disabilities
Date:Wed, Feb 24, 2016
Time:11:00 AM EST
Duration:1 hour

Meeting Description: 
Past research has demonstrated that adults with intellectual and developmental disabilities (IDD) are twice as likely to use home care services and experience higher rates of frailty than the general population—and at much younger ages. There is a recognized need for better collaboration among health and developmental services providers to improve policies and practices to support aging in the community.
This interactive webinar will provide information on:
Frailty among adults with IDD
Development and validation of a frailty index for persons with IDD
Opportunities to implement the frailty index in Ontario’s home care system

Saturday, January 16, 2016

Institute for Life Course and Aging 2015-2016 Noon-Hour Seminars

 the University of Toronto’s 
Institute for Life Course and Aging is pleased to present
2015-2016 Noon-Hour Seminars
The CHAPS-EMS Study: Effects of a Community Health Program on Well-Being and Community Cohesiveness in a Subsidized Senior’s Building in Hamilton

Gina Agarwal, 
Associate Professor, Department of Family Medicine,
Principal Investigator CHAP-ems (funded by CIHR and HAHSO)
McMaster University
Thursday, January 21st, 2016
12:00 pm – 1:00 pm
This talk will describe an innovative community program that ran for one year in a subsidised seniors' housing building. Though the program was designed to assess participants' health and their risks of chronic disease, un-anticipated effects occurred. Qualitative work explored participants' experiences and perceptions of the program and the analysis revealed some interesting 'spin-off' effects of the CHAP-EMS Program. 
Dr. Gina Agarwal works as an Associate Professor in the Department of Family Medicine at McMaster University and is the Principal Investigator of the CHAP-EMS study or Community Health Assessment Program with Emergency Medical Services which is funded by CIHR.
Seminars are free, held at the Institute, 
263 McCaul St., 4th Floor Classroom
Please RSVP
 as seating is limited

This seminar will be filmed and archived on the Institute website approximately one week after the presentation.
Live webcasting is no longer available.

Canadian Hospice Palliative Care Association's Learning Institute

Learning Institute

The only event of its kind on hospice palliative care in Canada

From June 3 - 5, 2016 at the Banff Centre | Banff, AB

Registration is now OPEN
lick here to view the full program and faculty

After a highly successful year in 2012 and 2014, the CHPCA is proud to once again host its biennial Learning Institute in the beautiful town of Banff, Alberta!

We would like to cordially invite you to attend three days of learning, workshops, and opportunities to share skills and expertise with a variety of professionals within the Hospice Palliative Care field. 

The CHPCA’s Learning Institute brings together health care professionals from across the country for an intense learning weekend.  The program is directed towards intermediate and advance learning levels and is facilitated by the best faculty in Canada along with recognized international leaders to make up a most sophisticated caliber of educators and mentors.
The Canadian Hospice Palliative Care Learning Institute concentrates on six intermediate and advanced learning streams:
The Learning Institute will take place June 3-5 2016 in Banff, Alberta, at the Banff Centre. It will provide the best and brightest in the Hospice Palliative Care field and other allied healthcare professionals with the opportunity to advance their skills and share their expertise. The weekend will include intensive workshops that will be attended by doctors, nurses, pharmacists, researchers, spiritual care advisers and social workers.

This session is currently pending review by the College of Family Physicians and will be valid for for 13.5 Mainpro-M1 credits.



Please click here for more information and guidelines!

*Please note that the Learning Institute is in English only 

Saturday, January 9, 2016

The Province is making a mess of home care

In an auditor general report, released in December, they found high CEO salaries, high administrative costs and a level of care that varies widely across the province of Ontario. Having given authority to individual LHINs to make decisions in local regional care, there is much discrepancy.

Special Report: Community Care Access Centres ...(PDF)

• Between 2009/10 and 2013/14, CCAC expenses increased 26% to provide more hours of care to patients with more chronic and complex health needs.
• Costs that CCACs considered to be for “direct patient care” included items that did not involve direct interaction with patients, such as service providers’ overhead and profit.
• CCAC CEOs’ salaries up 27% between 2009 and 2013.
• Not all CCAC CEOs followed the common compensation framework designed specifically for them; service-provider CEOs followed different frameworks.
• CCAC nurses and therapists were better paid than their service-provider counterparts in the year ending March 31, 2014.
• No cost/benefit analysis of CCAC nurses directly providing services under three new programs (rapid response, mental health and addiction, and palliative care) was prepared before the programs were launched, and the effectiveness of these programs has not been evaluated.
• Billing rates for the same service categories varied by service provider and CCAC.
• Service providers use a variety of clinicalcare protocols; use of outcome-based pathways do not always result in cost savings.

I seldom agree with Denley, but he makes some excellent points.
We lack staff, they are hard to find: PSWs, nurses, and palliative physicians, for example.

Province giving only the appearance of fixing home care

Unfortunately, the provincial government’s latest proposals are closer to tweaking than they are to the fundamental change the sector requires. The biggest change on offer is eliminating the Community Care Access Centre boards and transferring their responsibilities to the boards of the Local Health Integration Networks.