Bright Wings

Sick idea for sick staff

Insisting on a doctor's certificate from an employee who's had one day's sick leave smacks of an idea that hasn't been thought through.

I've managed staff in organisations where,  if you were absent for more than three days, a doctor's certificate was required.  So, staff with really bad flu turned up at work on day four - as sick as the proverbial parrot - only to be sent straight home again by me, but not before they'd distributed potent viruses round the office.

Insisting staff get a doctor's certificate, even for three days, means the person has to spend time in the doctor's waiting room (more germs) for an illness that the patient knows has to run its course.  

GPs are run off their feet at this time of the year so a consultation merely to get a certificate wastes time and money.

Presenteeism

I agree with James Adonis, writing in Stuff, that presenteeism is a much bigger problem than absenteeism.  You get more points for soldiering on at work with colds and flu, ensuring that you share the viruses with not only your colleagues, but their families as well.  

Managing staff with health problems

1. Insist that staff who are obviously ill - particularly if they are coughing and sneezing - go home. This gives them a chance to recover and reduces the likelihood of spreading germs.
2. Staff who are ill and at work are likely to make mistakes which may be expensive to remedy.
3. Staff may be well enough to work a few hours from home, using webmail, etc, without having to travel and indulge in more germ sharing.
4. Parents with sick children are better off at home with them: although they may be physically present at work their mind is with their child and mistakes are possible.
5. If staff have exceeded their sick leave allocation, and are having frequent days off, it can be a symptom of other problems.  Are they being bullied?  Are there problems at home?  Do they need some additional support?

Problems with Palmerston resthome symptom of untrained staff

Images of a 105-year-old woman tied by a sheet to her bed sends a powerful message about a major problem within the resthome industry - poorly funded, poorly trained staff.

While the resthome sector remains underfunded by the Ministry of Health problems like this are likely to continue. Caregiving staff, along with their managers, are not well paid.

Caregiving - both in resthomes and in-home care -  needs to be seen as the highly-skilled job it actually is.  At the moment it is regarded as a menial job for the underskilled. Caregivers are typically untrained older or migrant women.

Residents in rest homes have emotional, as well as physical needs, which often go unmet. In order for an organisation to remain viable staffing levels are kept to the absolute minimum. Caregivers and nurses, rushing to attend to the unending physical work involved in maintaining a resthome, are unable to spend meaningful time with each of the residents.

The Government needs to look at Australia, where caregiving is regarded as a career.

Measures that would help improve this sector include

• provision of appropriate tertiary courses,
• sufficient government funding to ensure caregivers receive an adequate wage, and
• requirement that a resthome staffing includes a minimum percentage of certificated caregivers.

Time to review the ACC model

Every few days we are told another ACC service has been axed, or severely reduced, so ACC can fund long-term liabilities. There doesn't seem to be a considered plan for doing this.

Like someone let loose in a garden with a machete, the ACC appears to be indiscriminately lopping off funding branches without pausing to consider the longer-term cost of such funding reductions.

A couple of short-sighted examples:

• Cutting out funding for modifications to homes and cars that allow newly-injured people to function as normal, productive members of society. People who have suffered disabling injury are not usually in a position to pay for necessary modifications (such as wheelchair access).
  
  The consequence for such people may be longterm incarceration in a nursing home instead.  How can that possibly constitute a cost-saving?
  
  
• Removing travel payments for the first 20km for in-home support workers. These people are paid close to the minimum wage and are in no position to absorb travel costs.
  
  Rural Women New Zealand believe this will have a severe impact on home care workers supporting rural New Zealand, an area subject to a high rate of accidents because of the outdoor nature of their work.
  
  Many of these support workers already drive very high mileages to visit clients in rural areas. Recruitment is already difficult because of the low pay and high mileage.  If workers desert these jobs because they are simply uneconomic injured people will have to remain in hospital, incurring far greater costs.

It is high time the Government - and its technical advisors - had another look at the original ACC funding model, conceived in the 1970s, looked at what worked and what didn't.  Until the "insurance model" was applied by the previous National government who were hellbent on selling ACC off, ACC didn't have longterm liability funding issues.

New Zealanders don't want ACC sold to private providers. They want what was the best - and first in the world- no-fault accident funding scheme to stay within the Government.

Otherwise we are in a worse position than in other countries. With a sustained attack on ACC services in an effort to prune costs we may well end up with a service that is unaffordable by people on low incomes.

Don't forget - we gave up the right to sue for accidents when ACC was introduced. The way things are going we may have the worst of all worlds.

Film exposes dark side of American food industry

Food, Inc. exposes America's industrialized food system and its effect on our environment, health, economy and workers' rights.

The Wairarapa Farmers' Market is holding a premiere of this excellent movie on Wednesday, 14 October, at 8.30 pm.

If you care about the environment, about what you eat, the epidemic of junk food, diabetes and obesity, factory farming, the global food crisis and genetic engineering, you must see this film.

Further background material on the on the issues covered in the film

Earlier post on Wairarapa Farmers' Market.

Care for the dying

MacDoctor looks at the Liverpool Care Pathway for the terminally ill, currently being piloted by the Canterbury DHB.

It is a means to transfer the best quality for care of the dying from the hospice movement into other clinical areas, so that wherever the person is dying there can be an equitable model of care.

Read the full post: Care For The Dying.

Robots to care for elderly

An alarming post on American blog Our Parents suggests that robots could be taking over some aged caregiving duties within the next three years.

Through a combination of speech, gesture, and touch recognition caregiver robots will aid elderly people in a variety of ways.

Rest home caregivers struggle to provide meaningful interaction with elderly in their care now as underfunding of the sector means that resthome staff are very stretched.

Although a robot may remove the risk of human error when administering medicines, for example, they will also lack the personal connection that we, as humans, need. And attempts to make the robots too human-like may backfire because of a phenomenon known as the “uncanny valley:” when a robot or animated character is too lifelike people will react with revulsion. Psychologically, we cannot handle machines that are too perfect and lifelike.

I hope no-one suggests bringing this to New Zealand.

Cherish case highlights rural ambulance difficulties

The sad case of Cherishsiliala Tahuri-Wright highlights the challenges the St John Ambulance Service - and rural GPs - face every day.

MacDoctor provides useful insight into the difficulties - and dilemmas - rural ambulance crews (who are often volunteers) face.

Many rural people - and far too many young people - owe their lives to ambulance crew who turn out at all hours of the night to attend accidents on lonely, dark country roads.

Sobering statistics on alcohol use

We are seeing younger and younger people binge drinking alcohol with the sole aim of "getting totalled". New Zealand has a huge problem with binge drinking, unfortunately embedded in our culture.

Over the weekend Accident and Emergency departments are often inundated with intoxicated people and people injured as a result of their own or others’ drinking. This can mean other sick people face long waiting times.

The Law Commission is looking at ways future law changes could help reduce our appalling statistics.

In case you didn't know how dire this is, here are some sobering statistics:

635,000 adults drink at least once a week and ‘binge’ drink (consumes 7 or more standard drinks in a session)

785,000 adults drink regularly, often every day, and with equal regularity, 'binge' drink

450,000 of us were binge drinking on our last drinking occasion. That’s the population of the entire Wellington region.

In 2008, alcohol importers and manufacturers made 9.5 litres of pure alcohol available for every New Zealander aged 15+.

44% of all alcohol is consumed in "heavier drinking sessions".

New Zealanders spend an estimated $85 million a week on alcoholic beverages.

Of the 62,000 violent offences in 2007/2008, more than 20,000 involved alcohol.

Injury accounts for over a third of alcohol’s total contribution to the global burden of disease and disability.

The Law Commission has some excellent background reading and resources on their Talklaw site, and are seeking submissions from the public.  

Information retrieval in older people

Fitbrains have provided an interesting observation on my recent post, Brain Fitness and Alzheimers

First, the memory changes associated with normal aging are not a disease. The typical pattern of memory change with advanced age is a deficit in retrieval. A healthy older brain can encode information because the hippocampus is relatively healthy. This permits new information to be encoded. The older adult has some difficulty retrieving that new information, but with cues and prompts they retrieve the information as well as those in their thirties.

In contrast, a brain with AD has a damaged hippocampus that prevents new information from being encoded. This means that new learning does not take place and that cures and prompts do not help because the information is not there to be prompted.

In general, a healthy older adult encodes new information, but needs some help in retrieving what has been encoded. A brain with AD does not encode new information and therefore cues and prompts will not help with retrieval.

www.fitbrains.com is a website full of brain games to keep your brain at peak condition, together with some initial five-minute tests to see how you stack up on areas which affect brain fitness. They also offer a personalised brain fitness programme as well. 

Note: the information on my earlier post was taken from the Alzheimers' New Zealand site, to mark Alzheimers' Awareness Week.

GP home visits

Up until the 1970s home visits by the family doctor were the norm.  If your children were sick you phoned the doctor and he called to see you. There was no need to bundle all the children - sick or otherwise - into the car and keep them entertained in the waiting room until it was your turn to see the doctor.

Now days GP home visits are rare and expensive, reserved mainly for the elderly and people with terminal conditions. The rest of us bundle ourselves up and stagger into the surgery, sharing our germs with the rest of the waiting room.

One benefit of a GP home visit is an opportunity to view a family or individual more holistically. Is a young mother with several pre-schoolers coping, or she overwhelmed by domestic responsibilities?  The family have a lot of respiratory problems - is the house damp and cold?  Do the parents lack basic parenting skills? Is there something about the family dynamic which suggests abuse or addiction?  Does a recently-widowed man have sufficient social networks and support to prevent loneliness and isolation?

A GP is in a unique position to act as both confidant for the patient and their family, as well as providing a coordination role for other helping agencies, should they be needed. They are normally the entry point to the health system for both treating sickness and future disease prevention.  With the current vogue for outsourcing of health sources to several different agencies, the central role of the GP becomes even more important.

The need to get through a full appointment book reduces opportunities for meaningful interaction between GP and patient. A patient's real problem may be hidden behind a myriad of small health problems and symptoms, not easily discovered in a short appointment.

I believe the benefits accruing from funding general practice home visits - particularly to young families - would more than cover the cost.  It would be difficult to implement this overnight as our existing pool of GPs is overworked and struggling to get through their existing appointment schedule and the bureaucratic morass of required paperwork.

There are various initiatives underway to increase the pool of GPs, particularly in rural areas. At the same time I would like some thought to be given to making home visits affordable, particularly for young families.

Brain fitness and Alzheimers

Those of us who are a little past the first flush of youth often worry whether we're on the slippery slope to Alzheimers when we

    * Walk into the kitchen and forget what we went in for
    * Misplace our keys
    * Forget the names of people
    * Don't remember a specific place or brand name("Tip of the tongue" experience)

Rest assured, these experiences are normal and don't indicate a Alzheimers/dementia problem.

However, there is a cause for concern when memory loss starts to affect the daily life of a person.

Common signs of dementia:

    * Recent memory loss that affects job skills
    * Difficulty performing familiar tasks
    * Problems with language
    * Time and place disorientation
    * Problems keeping track of things
    * Repeatedly misplacing things and putting them in inappropriate places
    * Changes in mood
    * Personality changes

There's a strong focus these days on brain and physical fitness and social interaction as a way of reducing the likelihood of Alzheimers. Keeping your brain fit can be as simple as doing a crossword each day.

Vibrant and healthy aging: tips for brain health and successful aging is full of interesting stuff on the importance of physical and brain fitness, how to improve your memory, etc.

Alzheimers New Zealand has a wealth of interesting material and resources on Alzheimers and other dementias, assistance available, etc, and is essential reading for anyone caring for a family member diagnosed with Alzheimers. 

Folic acid

Every news report about the folic acid debate is accompanied by footage of thousands of loaves of white bread on their way through the factory.

One of the better health initatives of the Churchill government during the Second World War was to ban flour refining. Everyone had to eat wholemeal bread/cakes, etc.

While the beleaguered British were doggedly chomping through wholesome wholemeal products, they were also getting their share of folate, and other nutritional goodies.

Up and down the country nutritional experts decry white bread as "empty calories."  How about a long-term programme to encourage people to eat wholemeal bread?

Over 20 years the culture of smoking has changed from being acceptable everywhere, to the miserable few huddled in the cold at outside tables.  Changing eating habits will probably take as long.

For a start, how about suggesting to pregnant women that they try Vogel's instead of sliced white?

Swine Flu Update

MacDoctor provides an update on the impact of Swine Flu in New Zealand. With some concerning statistics.

Caregiving as a career

The Institute of Public Policy is recommending development of a low-skill migrant programme to address the increasing requirement for resthome caregivers.

Caregiving - both in resthomes and in-home care -  needs to be seen as the highly-skilled job it actually is.  At the moment it is regarded as a job of last resort if all other career options are exhausted.  Pay rates are very low.

Caregivers are typically older baby boomers or migrants and the work has little appeal to young people embarking on a career.

The Government needs to look at Australia, where caregiving is regarded as a career.

Two measures that would help include provision of appropriate tertiary courses, and sufficient government funding to ensure caregivers receive an adequate wage.

Loud music leads to more drinking

Loud music played in bars appears to encourage drinking according to the results of a study published on Psyblog.

As the music volume increases (as a deliberate strategy by bar owners to increase consumption) it becomes more and more difficult to carry on a conversation. People give up talking and get busy drinking instead.

Because everyone is shouting, the bar becomes even noisier and soon people start to give up trying to communicate and focus on their drinking, meaning more trips to the bar, and more regrets in the morning.

Of course this is exactly what bar owners are hoping for. People sitting around quietly nursing their drinks for hours are no good for profits. Talkers aren't the best drinkers. At least that is the received wisdom in the industry. And this received wisdom turns out to be accurate according to field studies conducted in French bars by Professor Nicolas Guegen and colleagues.

Stuff's feature, Young, at risk and out of it confirms the disturbing and increasing binge drinking problem among young people. 

Research shows that 70 percent of these young people are drinking in bars. Would controlling the decible rating of music in these bars help reduce this drinking?  Or would those hellbent on self-destruction simply drink elsewhere?

Children need to learn to cook

Many New Zealand children don't know how to boil an egg or cook a potato, the result of working parents too busy to teach them basic skills and the closure of school cooking kitchens in the 1990s.

There's some examples of excellent Wellington initiatives to get children interested in cooking in this Stuff article. 

Potatoes New Zealand are also launching a Calling all Grandparents campaign to encourage grandparents to teach their children to cook. As Alison Holst points out, a baked potato is a good place to start.

Poor timing for Wairarapa District Health Board Restructure

Jamie Morton in the Times-Age reports another round of restructuring at the Wairarapa DHB.

Big changes are set to transform Wairarapa District Health Board and whether that will mean job cuts is yet to be revealed.

DHB chief executive Tracey Adamson said 29 reviews expected to be complete by August would indicate what could be improved at the DHB, which has forecast deficits of $2 million this year and $900,000 next year.

To announce a restructure at the same time as hospitals nation-wide are struggling to cope with the seasonal influx of admissions caused by winter ailments - including swine flu - seems spectacularly poor timing.

"There will be big changes but we don't know what they will be, and it's expected that people will be concerned. That's why we've involved them in the decision making."

Any restructure announcement creates anxiety and uncertainty among staff: fear of their job changing or even disappearing.  Mistakes occur when staff are distracted and unhappy.  And often "involving" people in the decision-making means receiving written submissions which are often ignored.

It seems a pity to have to turn a "top performing" DHB on its head when the problem appears to be impossibly low levels of government funding.

Meat preservatives and fertiliser use linked to Alzheimers

Preservatives added to meat and processed food may be contributing to a huge increase in diseases such as Alzheimer's, Parkinson's and Type II diabetes, according to research released today by the Journal of Alzheimer's Disease.

A report in Perth Now quotes scientists as saying that

sodium nitrite, which is added to meat and fish to destroy toxins, reacts with proteins in the meat, damaging human DNA cells similar to aging.

The problem is compounded by an increase in human exposure to nitrogen-containing fertilisers from soil run-off and water contamination.

Study author and professor of pathology and lab medicine at Rhode Island Hospital in the US, Suzanne de la Monte,

found that a massive rise in fertiliser and processed food sales coincided with an increased prevalence of Alzheimer's, Parkinson's and type 2 diabetes in the US.

``In essence, we have moved to a diet that is rich in amines and nitrates, which lead to increased nitrosamine production. Nitrites and nitrates belong to a class of chemical compounds that have been found to be harmful to humans and animals,'' Ms De la Monte says.

``The relatively short time interval for such dramatic increases in death rates associated with these diseases (Alzheimer's, Parkinson's and type 2 diabetes) is more consistent with exposure-related causes rather than genetic changes.''

If this study is correct we can look forward to ever-increasing numbers of Alzheimer's and Parkinson's sufferers. Both these diseases create great suffering, both for patients and their families, and create a huge burden on the health system.

Small portions, please

Portion size is credited as one of the reasons we are joining much of the western world in becoming a nation of fat people.

Go to any cafe and you will be greeted with texan-size muffins (often made with commercial cake-mix, rather than proper muffin mixture) and you munch your way through almost a cup of muffin mixture.

There's endless research that demonstrates we are programmed to avoid famine by eating everything in front of us. Thus, we mindlessly eat large muffins when a small one would have met our needs for a calorie fix.  Watch the hordes of office staff descending on cafes at morning tea time for their coffee and texan muffin. Then they're not hungry at lunchtime and are starving mid-afternoon, when they have a Mars bar from the vending machine.

For cafes, there might well be a financial benefit to serving mini muffins. Customers might choose a couple of small items - at a higher unit cost.

Reducing muffin size probably isn't going to save the world, particularly with the unending deluge of fast foods and sugar-intensive soft drinks.  But it's a start.

Milk too dear

There is much debate about milk being more expensive than soft drinks and the implications for health and welfare.

Richard Long reminds us about the school milk scheme, set up to ensure even the most deprived children had a nourishing drink at morning break.

My recall isn't one of enjoying a nourishing drink, rather more enduring revolting, warm, sometimes curdled milk. Opting out wasn't an option. The shed in which the crates of half-pint bottles was stored was always optimally sited to take full advantage of the morning sunshine, to ensure the milk was at least tepid by morning tea time.

When we grew up there were two drinks available: water or milk. Soft drinks were reserved for special treats, such as birthday parties.  Milk (in bottles) was supplied by town milk supplying dairy farmers, cost roughly 5 cents a bottle, and was delivered by the milkman.

Now we have the situation of mothers eschewing milk for their children in favour of cheaper soft drinks.  This reflects ignorance of the pernicious effects of wholesale consumption of softdrinks and resultant addiction to sugar, and is unfortunate testimony to the outstanding marketing of such products, particularly in supermarkets.

Richard Long suggests that food stamps might be the answer to getting parents to buy nourishing food, instead of sending the kids to school with a fizzy drink and chippies.  I'm not too sure about that.

Couldn't we start by encouraging kids to drink plain old water?  And supporting and extending breakfast at school schemes to ensure kids at least start the day with an adequate level of nutrition.

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Frank Newman of Living off the smell of an oily rag has researched the price of milk and finds wide variation in milk price across the country. The Milk Report makes interesting reading.