Archives for category: health care provision patient centred health provision

The only mention made of death in our society is usually through the old saying that taxes and death are the only two certainties in life. The rest of the time it seems to be a taboo subject. The only certainty about it is that it will happen, yet for most of us the how, where and when are not only complete uncertainties but not discussed.

I’m trying to work out how long I will last, given my current age, life expectancy for my age group and restrictions such as chronic illness. This sounds really potent yet seems to be the medical name for diabetes and other common diseases which affect life expectancy. I felt really doomed when I first heard the expression, but life has gone back to normal since then!

For older people it probably makes life a bit easier if we can work out a rough, probably inaccurate time limit. It gives us a bit of a time-line for things we would like to achieve before then, such as tidying up and sorting through possessions (called rather cutely ‘downsizing’!). It doesn’t seem to work for me, having recently passed on a whole lot of books I knew I would never read to charity, then restocking with other books I thought I might read!

The other uncertainties we face are the how  and where. Most people say they would like to die at home but few do. I suspect that this could be caused by medicos trying to use their new devises and medications on us when we would prefer to just quietly leave this world.

The big problem is the current discussion we are currently having in Australia about being allowed to do have a hand in our death and allow us to advance it when medication is not currently available to so painlessly. Euthanasia has almost been a taboo topic and is often described as murder. There are quite a few countries intelligent enough to allow it under very strict conditions and it seems to work well, with the conditions imposed preventing abuse. The opponents to this practise seem to base their objections on reasoning which is not based on intelligence and knowledge. These are often the same people who oppose same-sex marriage and abortion. The problem is that although their ranks are being reduced because more people are applying reason and logic to arguments, based on modern knowledge, these groups still have a traditional influence which they inflict on all of us.

If people oppose those of us who want to be able to die to escape excruciating pain, why should this minority be allowed to dictate what we choose to do? If I still looked at the world through religious eyes I suspect I would think that if God hadn’t yet released to us the knowledge to reduce all pain to a bearable level, then why shouldn’t we use the God-given knowledge we already have to choose to end our suffering? How heartless are these people if they are prepared to force their own families to have to watch them suffer needlessly, often for weeks and months? Not my idea of a Christian, loving world in which we really care about those we love, as well as our neighbours, in its full definition.

Dying would be less of a worrying uncertainty if people didn’t have to face the possibility of unrelieved excruciating pain accompanying it. Lets at least make this a certainty.

I seem to have become involved in a jigsaw recently which I would rather not have participated in.

It started when I read an article about the importance of management in the success of a company. If management don’t appreciate their staff, and make them aware of how much they are valued, it has disastrous consequences. This shows in a high rate of ‘sickies’ among staff and high staff turnover rates. With the former it means carrying extra staff where their presence is necessary, such as in hospitals and nursing homes. For all businesses having to regularly replace staff who resign is expensive, thus raising operating costs.

The second part of the jigsaw was learning that our local public hospital has the highest sickie rate of any of the comparable facilities in the area. The person in charge blamed the nurses, apparently unaware that research shows that the blame in such situations lies with management. Worse still I have since been told that their figures have deteriorated further this year.

The third and final puzzle piece was when the safety officer of a major hospital in the U.S. was quoted as saying that the greatest threat to the safety of the patients was the relationship between the staff. Put these pieces together and I hope that neither I, my family or my friends have to be admitted to this local hospital.

The situation was brought home to me recently when a family member went into hospital, fortunately to another one, a private one. What struck me was the wonderful relationship between the staff, from the nurse in charge of the ward to the trainee nurse doing a university placement there. Both said how much they enjoyed their work. The older one said she had worked there for 17 years. What impressed me even more was that this was 21st century care as it wasn’t just the medical care that was done as a team but they also included patients and visitors who were given the impression that they were also part of the team. This is commendable as of course they all have a role to play in patient recovery.

This recognition of team work, rather than the hierarchical model which characterised the last century, is valuable knowledge to enable all organisations to reach the highest standards in all aspects of their work, leading to higher productivity. It is absolutely necessary in all businesses, but particularly where people’s lives and well-being are at risk.

 

 

This week I listened to a discussion about a new report on the adequacy of the pension in Australia. It is a very complex problem which is probably why it is a rarely tackled. The last attempt I am aware of was by a university researcher who ended up having to make so many assumptions the end result wasn’t really meaningful. This time the authors set themselves plenty of time and enlisted the help of a number of organisations involved with the elderly, such as the Council for the Ageing (COTA). The main value of the exercise to me was the inclusion of someone with many years of experience with ageing groups and is himself celebrating his 85th year this year. He was a member  of a three person panel speaking about the issue. It was a refreshing change to see a panel not just discussing an age related  topic but with one member actively, personally involved. They were not just studying the ageing but involved with us. It took away the weakness of so many discussions on ageing which talk about us, not with us.

So what emerged from the study? As expected it is a particularly complex issue but some problems cropped up frequently, particularly the topic of good dental health. Not having the money to pay for dental treatment leads to older people having to mash their food as their teeth are too painful for them to chew, or are none existent due to the expense of dentures. To me, this should be a separate issue. We have a free health system in Australia so I can’t see why this can’t be extended to dental health. The other issue which was not raised was the health costs of not taking action. If people are unable to eat properly for whatever reason, including inadequate money for food, then their general health will suffer, a situation which the health system will have to cover, particularly if they end up in the hospital system.

Another major issue was that of the family home not being included in a person’s assets. This problem arises when someone has lived in the family home for decades and its value has risen greatly. The person may not want to leave because, for example, it holds many memories. They also may feel that this is a legacy to leave their children who may be looking forward to it. The problem arises when maintenance costs rise and the older person is obliged to pay out of their pension. They may be left to live in poverty in a hugely valuable home.

These are among the many complex issues the study group looked at. There is obviously much discussion on the issue ahead. At least it is good to know that future talks will be held with older people. not just about us.

I liked the suggestion that the issue of the value of the pension be set by an independent body. The politicians’ response that the country couldn’t afford it was met by ‘but that’s how your salary’s are set”!

Those are just some of our problems in Australia.  What about those countries which don’t have any pension?

 

For years I have been advocating that older people are a bonus in our society, not merely an expense and finally parts of Australia seem to be waking up to this, albeit from the expense aspect. The recently retired government appointed advisor on ageing advocated that employers be encouraged to retain older people and to do so pointed out their value to society. Unfortunately her research didn’t extend to the fact that people retire because they are bored in their jobs and don’t feel appreciated, a fact which is unlikely to improve the situation.

To really tackle the problem of people retiring at 65, and possibly living for another 40 years with no purpose in their lives, we need to try to offer purposeful alternatives, such as encouraging the rising group of seniorpreneurs. To avoid joining the list of failed businesses these people need professional mentoring, preferably provided by the government. Another fruitful area could be provided by established volunteer organisations listening to the ideas their older volunteers have. It is no use trying to persuade employers that their older workers are valuable employees if the government itself is not providing a good example through projects it supports. I am continuously upset by the fact that the two main organisations who receive huge amounts of government funding in Australia to provide for, and involve, older people don’t themselves employ older people and therefore so often get things wrong about ageing. How insulting for older people. In contrast the organisation which does provide successfully for this age group, U3A, is self funded (it is run by older volunteer members) and is much more successful at the grass roots level.

Professional organisations are not necessarily any better. I would have liked to have stated our case at the World Congress on Public Health to be held in Melbourne next year. Most similar organisations offer a discount for pensioners but in spite of having ‘Life Stages’ as one of their themes, they apparently haven’t heard of, or don’t recognise, the later stage of life and don’t want to hear of it, in spite of having this discrepancy brought to their attention. Most conference attendees are paid for by their employers, including travel and accommodation costs, so affordability is not an issue for them. I hate it when an important organisation such as this suffers from ageism, particularly as the numbers of older people are growing rapidly, a factor they should be aware of. This organisation should be providing leadership in this field, not dragging their heels.

We shouldn’t be complaining about huge national debts, which most countries seem to have, if at the same time we ignore the contribution the most rapidly growing section of the population could make if its talents, experience and knowledge weren’t ignored. I don’t think it is just a question of ignoring us, I think this attitude contributes to ‘the problem’ by making us feel a burden and useless. As we think, so shall we become.

It is about 10 years now since I first became interested in ageing yet I still come across areas I haven’t yet investigated. Recently I was invited to join a group of people investigating homelessness in the city where I live. It was the first time I had considered the plight of older people for whom everything has collapsed.

I had previously heard a talk by someone from a large city in Australia who was describing his involvement in building a group of units for homeless older people. The units were fairly small but big enough to satisfy the needs of those living there and were extremely sensitive to the needs of their new inhabitants. For example, each unit had a balcony attached to it. The balconies overlooked a walkway which enabled the residents to choose to sit outside and chat to people out for a walk (and get some beneficial fresh air), or stay inside if they wanted to be alone. One lady commented that it was the first time in her life she had a key to her own place. She was thrilled! It occurred to me that what she was actually saying was  that this was the first time in her life that she, and her possessions, were safe. A sobering reminder of the constant danger the homeless are faced with.

The group’s research of course will involve those who don’t have that security. It must be a frightening situation for anyone but for older people, aware of their frailty and their vulnerability to illness or violence, it must be even more difficult. The problem is that homeless people tend to hide themselves away from public view for safety so that the only way we can be aware of them is through the wonderful people who go looking for them. These people are among the angels of this world. Those they look for are most likely to be dirty and smelly, out of necessity, yet these angels look beyond that and offer them help. I assume that this is a problem which exists throughout the world, with the size of the problem depending very much on the number of people who go looking for them and are enabled to offer them help. This help currently cannot always be in the form of shelter, food and necessary medications, due to financial restrictions.

So what is this new group I recently joined hoping to do about it? Firstly we need to know how big the problem is and we need to contact those with knowledge in this field to get this information. The next step is to make people living in our city  aware of the problem. I suspect that many, hopefully most, will be prepared to lobby their politicians to provide the money to address the problem. With an election a few months away this is an ideal time to be highlighting the problem.

Will a solution to this problem through provision of low cost shelter and access to health professionals be the answer to the problem and nothing more? I suspect not. It is easy to dismiss the homeless as no hopers but I suspect that this is not always the case. I suspect that we will find that many of them will be in this situation through no fault of their own, bowed down by numerous disasters in their lives. We could end up as the beneficiaries of solving the problem if those assisted are enabled to lead useful and rewarding lives. At least those who are assisted will have the opportunity to live better lives. Well worth researching the problem and solving it.

 

Tomorrow I leave for a conference run by two regional associations in the field of ageing, the gerontologists and the aged care services. It is being held in a country town in Australia.

My big criticism of the gerontologists across the world is that they think they know all about ageing because they have read about, completely ignoring the fact that it will have been written by other younger people. It is likely to include inaccuracies because of this. This is reflected in the research papers they write and the papers they present at conferences. It is also reflected in the fact that so few older people take part in conferences these professional groups organise and therefore these events lose even more credibility.

The advantage of combining with aged care workers is that this group is in daily contact with older people and therefore are aware of at least some of the problems (and positives) associated with ageing. The other advantage is that these people are the treasures of not only the aged scene but of the workforce in general. Older people are not the easiest to work with, not only because of lack of, or reduced control over, our bodies and lives but also the lack of status amongst the community. This is reflected in the low pay and low esteem of their professional helpers. Sadly we, and they, don’t recognise the tremendous contribution they make to what is becoming an ever greater portion of our lives.

From a personal point of view these people are terrific company, not only because they are such interesting people but because having a great sense of humour seems to be a quality they all possess. If I manage to sit with them at the conference dinner not only will I have a very entertaining evening but I will learn so much about community care, particularly in country areas. On the other hand the gerontologists have read a lot about their topic but have little real experience of ageing and tend to discuss theoretical issues.

Visiting country towns is always an interesting experience. There is such a different atmosphere there. The pace of life seems to be much slower and they have time to talk if you want to. Last week I visited a different town and there I learned what life can be, and should be, about. A group of women of all age groups, including one with a pre-toddler, were playing tennis together. They were from different towns in the area and were participating in a tennis competition for teams from each area. What impressed me was that they were there to enjoy and benefit from each other’s company, in spite of the huge age range. One lady looked as if a walking stick would be more beneficial to her than a tennis racquet!

This is the type of community our ancestors lived in. They didn’t have all the tension and stress, and accompanying problems, we have in our lives. The big challenge now is to combine our modern lifestyle with the old approach. That way all age groups could live in harmony and peace and hopefully we could all still achieve, with a resurrection of the role older people had in the community in the past.

Meanwhile I look forward to meeting lots of interesting people with different ideas, including over dinner which is being held in the relaxing environment of the regional zoo!

I have attended 2 functions this week which were dealing with the way older people are treated, in very different ways. One was  research from two universities, the other by people researching care both in the community and in residential care. The different contributors showed very different approaches.

The two University studies were about intergenerational interaction. The first proudly described a project in which children’s play areas are built near aged care facilities. I got the impression that the older people had not even been consulted. Given that some older people, particularly the fragile, do not like boisterous children around them, I felt that this is very much a ‘client’ program.

The second study was from the University of Queensland. It linked older native foreign language speakers, in this case Chinese, with students in years 11 and 12 who are learning this language. It meant that the students heard the language from native speakers and also learned about their culture. For their part the older people felt that their lives were suddenly more meaningful. They had an important purpose in their lives. A win/win for both groups.

The second function united researchers looking at assistance for older people, with older people using these services, particularly those living in the community. It provides a link between the bureaucrats and the customers or clients. One person in the group objected to these words, pointing out that we are actually ‘people’.

The main problem in Australia seems to be the ability of older people to access information, finding out what help is available. Given that home care is much cheaper than nursing home care it is a major problem. There were complaints about telephones not being answered, and web sites that were hard to use. This is easily blamed on the lack of computer knowledge on the part of older people, not considering that it may actually be a problem. From my own limited experience the fault lies with the on-line programmes which are usually very badly written, making them inaccessible. As long as older people, not the programmes, are being blamed little is likely to change.

Some of the comments described older people who needed help showering at home having to wait long hours, in one case until 5pm, for the provider to arrive. Another was of a newly arrived resident in a nursing home being told to go to bed at 7.30pm. She protested that this was not her custom. She was told she had to because they all had to be in bed before the carer could end her shift and go home. The carer settled the impasse by turning the light off. This was appallingly dangerous. Let’s not rush to blame the carer. The fault is with management which created this rule. There are so many stories of inadequately trained, uncaring management it is time such problems were addressed. Where management in any workforce situation does have the necessary knowledge and attitude, sick days and staff turnover are greatly reduced. It is more profitable!

Meanwhile the voices of older people must be heard in any situation in which we are involved. We are people! Such an attitude creates a better, more efficient, happier  and cost-effective world for all involved.

 

Centuries seem to be a convenient measuring unit for our history with each being accredited with specific human progress. The 19th century was the breeding ground for the industrial revolution, the 20th for two world wars followed by remarkable progress in technology which led to all parts of the world being instantly connected.

Are we now sufficiently civilised and knowledgeable to decide what we would like to achieve in the 21st century (we are now well into it) or will we just randomly move in whatever direction fate takes us? I would argue that since the whole world is connected in terms of easy communication we should be able to move from the selfish ‘I want’ of each country to a worldwide ‘We want’ of the world population. Diseases (pandemics) and climate change are making it very evident that the latter view is the only one that will work. If we accept this argument then can we take human history into our own hands and set goals to try to achieve it? It’s not a new idea, after all that is what the United Nations was set up to achieve, but that was in a different time, with different communications restrictions and different world values, particularly in terms of equality.

Is this early part of the 21st century an appropriate time for the world to decide that the legacy today’s people should leave is one of thinking in terms of a shared earth and setting goals for what we as its inhabitants want to leave for the generations who come after us? Do we want to set the agenda, as far as we can, for the 21st century and our legacy for our grandchildren, great-grandchildren etc.? Given the enormous skills, knowledge and abilities we have inherited from those who have gone before us let’s use them to create a unified, shared planet. Let’s not leave the legacy of the 21st century to chance but rather decide that this is the way to go to benefit the whole world population and plan to achieve that.

Wars, such as those currently in several parts of the world, benefit no-one except a few people’s ego’s and this is usually short lived. The damage to people’s lives lasts for far longer. The current situation where there are millions of displaced people across the world is a sad reflection on our skills as global population managers. We can do better than this. We just need a few people with a genuine passion for a better world for all to unite to push for new goals. In the 21st century we have the knowledge, skills and ability to achieve it. What are we waiting for?

 

The other day I was reminded of an incident when I was teaching College students in their last couple of years of school. One of the students came up to me to tell me she was quitting. When I asked why she said that everyone was picking on her and she couldn’t take it any more. Today we would recognise it as bullying but fortunately we weren’t using that word then otherwise there would have been a standard response. Instead I told her to take a good look at herself. Her head was down and her shoulders scrunched over; I imitated her. I told her to hold her head up high, hold her shoulders back and look people straight in the eye. About a month later she bounced up to me with a big grin on her face to tell me that it had worked! She was enjoying life again.

I was reminded of this the other day when I heard a comment that as we age our spines can take on a new configuration, referred to as stooping. My own back was starting to hurt so I remembered some exercises I had been given a few years ago and started doing them again. It certainly helped.

I began to wonder if, as we age and begin to stoop, we become like my student, feeling that people are looking down on us. If the rest of our bones lose their strength then it makes sense that our spines are likely to do the same. Worse still, our early ancestors moved with a horizontal spine!

I have long advocated that there should be clinics for older people so that we know what to expect as the years take their toll, and do something about it if possible. Almost 10% of patients over 65 in hospital are there because of falls so why aren’t fall prevention measures available to all in this age group, just to mention one aspect of ageing. Preventative medical care would appear to be much cheaper among older people than the current system of dealing with a problem when it happens but those responsible for our health don’t seem to be able to work this out. Meanwhile is stooping as a result of ageing, and the public reaction to it, just another contributor to ageism?

It reminds me of a lovely story I heard some time ago. A young lady was out with her mother who was muttering “hold your shoulders back” at which the irritated daughter said “Mum, I’m an adult now”. The mother’s reply was “I’m talking to me, not you”.

The end of the year is traditionally a time to look back at the pluses and minuses of the old year and look ahead at what we are hoping for in the new one. As we get older there are plenty of past years to think about!

The event in 2015 which impressed me most was a government world wide determination to work together to save the world’s climate. I don’t remember a previous occasion when the nations of the world got together to work as one to save the planet we all share and depend on. My only concern is that it seems to have been an issue for governments only, without any recognition that they have limited ability to control pollution. The main polluters are the human inhabitants of the world. Some of the damage each of us does is inevitable but what a difference it would make if every inhabitant made a conscious effort to control our individual contribution beyond this, particularly in the developed world. I was made aware of this one day when a colleague talked about where she and her husband would go for their overseas holiday this year, apparently completely oblivious to the fact that the flight alone would add enormously to their personal pollution contribution.

My concern for 2016 is also the lack of recognition of ageism which seems to be part of government unwritten policy in at least 2 countries. In Australia, many pensioners are getting letters informing them that their pensions have been reduced. No explanation is given nor are the way pensions are calculated transparent. This does not happen in other areas of society; indeed in the workplace each item is carefully listed and legally addressed. Worse still, media reporters have discovered that many of the private superannuation companies are run by the highly profitable top banks who are taking up to 25% in fees.

Whilst this to me is completely unacceptable the situation in the UK is even worse. One elderly lady waiting for a heart operation has realised that she seems to have been dropped off the waiting list, something that has happened to her twice before. The thinking is apparently that old people are going to die anyway so health money is better spent on younger people. Apparently those who make these policies are incapable of figuring out that  this way health costs are likely to rise with the additional care required, as well as the increase in human suffering. They can only reason that it looks better for them if waiting lists are reduced. I’m sure that there are similar stories to these from other countries.

These are some of the battles we face in the year ahead. We need to be vigilant and speak out when we see a wrong in any area. That way at the end of the year we will be able to look back with pride and satisfaction. I hope we can also have an enjoyable year, buoyed by our successes in making the world a better place.