Tag: home care

Bioethics Blogs

Whatever Happened to Long-Term Care Reform?

From the Trenches: A Prescription for Change

I have enjoyed looking at the pictures of protestors being arrested in our nation’s capital. I concur with many commentators who credit the civil disobedience of the protestors – many of whom are members of the disability rights activist group ADAPT – with the defeat of the Senate bill to abolish the Affordable Care Act. It’s also been fun because I know so many people in the photos.

The Affordable Care Act was a massive piece of legislation. The complexities and moving parts are best understood by people who have very closely followed or implemented the law. I generally think of the ACA as three things:

1. Reform of the private insurance market with the goal of providing greater access to insurance coverage;

2. Changes to Medicare, such as closing the prescription drug donut hole; and

3. Changes to Medicaid. 

Mike Oxford, Executive Director for Policy at the Topeka Independent Living Resource Center and a member of the national chapter of ADAPT, was one of many who protested against the Senate bill to repeal the Affordable Care Act.

Community Services Optional?

The Medicaid issue that has drawn the most attention is the matter of expanding access, appropriately called “Medicaid expansion.” But the law contains other Medicaid provisions as well. It provides incentives for states to continue to “re-balance” their systems of providing long-term care. “Re-balance” is often mentioned in quotation marks because states were never in balance. Nonetheless, through the ACA, states were provided additional federal matching funds if they would transfer more long-term care to community services and away from institutions, such as nursing homes.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Whatever Happened to Long-Term Care Reform?

From the Trenches: A Prescription for Change

I have enjoyed looking at the pictures of protestors being arrested in our nation’s capital. I concur with many commentators who credit the civil disobedience of the protestors – many of whom are members of the disability rights activist group ADAPT – with the defeat of the Senate bill to abolish the Affordable Care Act. It’s also been fun because I know so many people in the photos.

The Affordable Care Act was a massive piece of legislation. The complexities and moving parts are best understood by people who have very closely followed or implemented the law. I generally think of the ACA as three things:

1. Reform of the private insurance market with the goal of providing greater access to insurance coverage;

2. Changes to Medicare, such as closing the prescription drug donut hole; and

3. Changes to Medicaid. 

Mike Oxford, Executive Director for Policy at the Topeka Independent Living Resource Center and a member of the national chapter of ADAPT, was one of many who protested against the Senate bill to repeal the Affordable Care Act.

Community Services Optional?

The Medicaid issue that has drawn the most attention is the matter of expanding access, appropriately called “Medicaid expansion.” But the law contains other Medicaid provisions as well. It provides incentives for states to continue to “re-balance” their systems of providing long-term care. “Re-balance” is often mentioned in quotation marks because states were never in balance. Nonetheless, through the ACA, states were provided additional federal matching funds if they would transfer more long-term care to community services and away from institutions, such as nursing homes.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

In the Journals – June 2017, part two by Aaron Seaman

The first part of the In the Journals post for June 2017 can be found here. And now, for part two…

 

Medical Humanities

SPECIAL ISSUE: Communicating Mental Health

Introduction: historical contexts to communicating mental health

Rebecca Wynter and Leonard Smith

Contemporary discussions around language, stigma and care in mental health, the messages these elements transmit, and the means through which they have been conveyed, have a long and deep lineage. Recognition and exploration of this lineage can inform how we communicate about mental health going forward, as reflected by the 9 papers which make up this special issue. Our introduction provides some framework for the history of communicating mental health over the past 300 years. We will show that there have been diverse ways and means of describing, disseminating and discussing mental health, in relation both to therapeutic practices and between practitioners, patients and the public. Communicating about mental health, we argue, has been informed by the desire for positive change, as much as by developments in reporting, legislation and technology. However, while the modes of communication have developed, the issues involved remain essentially the same. Most practitioners have sought to understand and to innovate, though not always with positive results. Some lost sight of patients as people; patients have felt and have been ignored or silenced by doctors and carers. Money has always talked, for without adequate investment services and care have suffered, contributing to the stigma surrounding mental illness. While it is certainly ‘time to talk’ to improve experiences, it is also time to change the language that underpins cultural attitudes towards mental illness, time to listen to people with mental health issues and, crucially, time to hear.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Canada’s Biggest Health Problem: Indigenous Health

Alison Reiheld calls attention to André Picard’s assertion that Indigenous health is currently the most urgent issue in Canada.

__________________________________________

In a recent interview in Chatelaine with André Picard, a well-known Canadian health columnist for the Globe and Mail, Picard discusses the deficits and merits of Canada’s healthcare system. For anyone working on Canadian healthcare or on health policy anywhere, it is worth reading. He discusses dental care, home care, long-term care, the effect of an aging population, and more. One of his takeaway quotes no doubt is “Nearly 40 countries in the world have universal healthcare, and it’s all more universal than ours.” But something interesting, important, and under-attended is raised when the interviewer asks Picard, “What is the most urgent issue in Canada right now?” Picard’s answer:

Indigenous health. It’s been a problem for more than 100 years. There’s a real opportunity to make a dramatic difference, quickly. The indigenous community is young and the fastest growing by far – more than 50 percent of indigenous people in Canada are under the age of 15. This is the time to stop generation after generation of disaster, poverty, isolation, addiction and suicide – we’ve created all that. We have an apartheid system designed to oppress people and it’s given the exact results it was designed to produce. Take away their culture, their language, their ability to earn money, their ability to have land, and then, oh, we’re surprised they’re the most unhealthy people in our country? It’s not a surprise at all.

Island Lake, First Nations Community

The problems are many for Canada’s indigenous people (Aboriginals, including First Nations, Métis, and Inuit).

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

The Good of the Body

The December 2015 United Nations meeting on climate change was an historic moment for global efforts to reduce harmful carbon emissions. While it gained the agreement about the future good of the planet, it made clear that there is a long and hard road still ahead. Yet another global challenge is showing itself more visibly of late, overshadowed by global warming—that of the good of the body, our health as a species.

A telling place to begin that story is with China’s decision last year to eliminate its one-child limit, rescinding a policy put in place with much criticism in 1980. The initial motive of the policy was to slow or stop the rapid population growth in China, seen as a threat to its goal of eliminating poverty and endangering its fast-rising economic growth. Reduction of population growth, led by the U.N. and various NGOs—and popularized by Paul Ehrlich’s book The Population Bomb–had been an international movement in the 1960s and 1970s. Initially it was heavily focused on developing countries with very high birthrates and pervasive poverty, but it was gradually picked up by environmentalists as well for two reasons. One of them was anxiety about the projected future number of people on earth, dangerously straining natural resources. The other was the disproportionate climate harm done by heavily industrialized affluent countries even with much lower population growth.

With the exception of sub-Saharan Africa and Southeast Asia—where family sizes still remain in the six-to-eight children range–rising affluence, women’s education, and effective family planning programs brought about a significant decline of global birth rates.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

In the Journals, January 2016 by Aaron Seaman

In addition to our regular roundup of journal offerings, the current issue of Medical Anthropology is a special issue, entitled “Diversions of Biomedical Technologies in a Globalized World,” on which we have posted here.

Critical Public Health

Blood and the public body: a study of UK blood donation and research participation

Simon Cohn

This paper draws on interview and ethnographic data to describe donor accounts of blood donation in England, and how this contrasts to their responses when invited to also participate in two associated public health research studies. Donor views about usual blood donation combine the general, if flexible, theme of altruism with powerful notions of the social collective, giving rise to the sense that they are making tangible, physical ties and constructing a social body through the act of donation. However, their accounts of research participation are more open and ambiguous. At the core of this is the sense that they do not know what exactly they are ‘giving’, since the research is ultimately about collecting information, rather than substance. Equally, the donor-participants are not sure who they are giving it to, since they have no sense of the social collective that potentially might benefit from the research. The paper argues that the concept of ‘the population’ in public health is not only a term that is alien and abstract for the blood donors, but increasingly is a post hoc category for large-scale epidemiological studies. As a result, rather than supporting the obvious assumption that individual bodies make up populations, in practice, particular population renderings determine the nature of individual bodies.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

WRINKLES – Fear of Alzheimer’s and Aging

Timothy M. Krahn and Walter Glannon reflect on the graphic novel Wrinkles and what it teaches us about fears of Alzheimer’s and aging.

__________________________________________

Alzheimer’s disease, the most common form of dementia, has become the most feared disease—more so than stroke, heart disease, or even cancer. The fears associated with Alzheimer’s are a complicated mix of medical, social, familial, and personal factors.

For example, we fear that we will lose our autonomy under the threat of disease and aging with subsequent vulnerability to social neglect and exclusion. We worry that we may not be cared for when we are elderly and become less capable. We are afraid of having to confront questions about dying and death.

These fears are incredibly daunting. When one of us (Krahn) was an impressionable youth, a very intelligent, middle-aged professor said: “If ever I end up like that [meaning demented] just throw me over a cliff.” This sort of statement is not uncommon among persons who fear dementia. But it’s likely that far fewer persons who say something like this would actually deal with their fear through some form of assisted suicide. The more problematic interpretation of the professor’s statement is his perception that such a life is necessarily a burden to oneself and others.

These days researchers are challenging some of the fears and stereotypes by moving “beyond the individual level and focus[ing] on the importance of strengthening communities.” They are “attun[ing] us to the fact that people with dementia (or other significant cognitive or physical impairments), given the right social and community supports, are capable of resilience and can continue to live meaningful lives and maintain a sense of personhood.”

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Singapore Case Notes: Reframing “Family” Caregiving in the World’s Fastest Aging Society

A previous post described theSingapore Casebook project, a collaboration among the Centre for Biomedical Ethics at the National University of Singapore, The Hastings Center, and the Ethox Centre at the University of Oxford. The first edition of this online casebook, Making Difficult Decisions with Patients and Families, is widely used in undergraduate and professional health care education in Singapore and is available to the public and to professionals and scholars in other countries. Our team is now developing the second edition, Care Transitions in Aging Societies.

Our recent project meetings in Singapore coincided with “the Haze,” the transnational smog produced by profitable slash-and-burn land clearing in Indonesia coupled with climate change. Discussions about the public health consequences of the Haze were the backdrop to a week of site visits across this densely populated city-state of 5.5 million people, as we sought to better understand how care transitions worked – or failed – in the world’s fastest aging society.

 Again and again, we heard versions of the problem common to all such societies: what aging people need so often confounds familiar categories such as “medical” versus “social,” or “institutional” versus “family,” especially during the long trajectory of frailty and dementia. Geriatricians described the challenge of respecting the preferences of people who want remain independent but whose progressing dementia compromised their safety in and outside the home. Geriatric social workers, rehabilitation specialists, and health educators described efforts to improve hospital-to-home discharges through investments in caregiver training and closer attention to signs of caregiver burnout.

We also saw innovative uses of Singapore’s ubiquitous public housing – the multistory HDB block, home to 85 percent of citizens – to bring services for aging residents into neighborhoods.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

A LIGHT BENEATH THEIR FEET Bridges Between Mental Health, Home Health Workers and Bioethics

A Light Beneath Their Feet is a coming of age story for both a daughter and a mother. Valerie Weiss’s directorial skill is remarkable. She uses a spotlight halo soft focus to keep the viewer tied to the amazing performances of Tayrn Manning (Gloria, the mother)  and Madison Davenport (Beth, the daughter). It is fortunate for the viewer that the director is able to keep up with the sophistication of the script and actors she has chosen to direct. Writer Moira McMahon Leeper has brilliantly clarified an inverted mother and daughter  relationship, occurring against the backdrop of mental illness. This film makes stressed family, clinicians, home care workers, and those with labile mental illness, feel less alone.

This film premiered at the 38th Mill Valley Film Festival, October 10, 2015. This is an intimate film about the continuum between mental illness and mental health. The bridge between these two entities is always in sway for everyone, the issue is extent.  Director Valerie Weiss came to her full film career after completing her doctorate in biophysics at Harvard. As such, she well understands the concept of elementary forced resonance, and that understanding has transferred to the subtleties of  her movie. It’s the subtleties that make this film great for  expanding bioethics consciousness. 

Every science student learns about the Tacoma Washington Narrows Bridge collapse in 1940. It is a bedrock tale in physics. Aeroelastic flutter, caused by high wind, unable to pass through the construction’s unbending side walls, caused the bridge to “catch the breeze.”  The arc of the bridges sway increased in magnitude,  eventually over taxing the elastic capacity of the materials used to build the structure.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Code Gridlock

Chris Simpson rants about the crisis in Canada’s hospitals.

__________________________________________

Last month at the Canadian Medical Association’s (CMA) annual meeting, Dr. Chris Simpson called for a dramatic reshaping of the Canadian healthcare system in order to address the healthcare needs of Canada’s ageing population. He introduced a policy framework guideline that outlines senior-friendly changes in areas including wellness and prevention, primary care, home care and community support, acute and specialty care, long-term care, and palliative care. Dr. Simpson also called for politicians to commit to a national seniors strategy to meet the care needs of Canada’s ageing population in the upcoming federal election.

In a short video that is a part of the CMA’s video series on senior care, Dr. Simpson explains “code gridlock” and calls upon all Canadians to demand a national seniors strategy.

Here’s a transcript of Dr. Simpson’s video:

Welcome to that great symbol of Canadian healthcare—the hospital. The hospital is kind of like Canada’s Statue of Liberty. It’s where you’ll find our tired, our poor, and our huddled masses yearning to breathe free. Make no mistake, miracles happen here everyday. But far too often these days the miracle is if the patients can actually get a bed. Or, if you’re a senior who’s recovered from their illness and waiting to go home, actually getting out of their bed.

The crisis in Canada’s hospitals has led to the creation of a new medical code, code gridlock. Just think of downtown traffic snarled on a Friday afternoon. We have emergency doctors treating patients in hallways because there are no beds.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.