Taking Care of Care in the Community
During COVID-19 many families and individuals have decided against Long-term care and older adult retirement residences. The risks of catching COVID-19 and of social isolation have been considerable over the period.
COVID-19 has also raised the curtain on long standing living and social care conditions in Long-term care. While Long-term care homes supposedly provide 24/7 care the amount of time that residents actually receive is considerably less. A 2018 study looking at data between 2014 and 2015 found an average of 2.55 hours of care a day across Ontario homes studied with little if any time allocated to meeting social and emotional needs. Numerous studies and reports have continued to find serious deficiencies in our long-term care system.
Before the crisis families who had loved ones in care often spent considerable time in care homes providing care and social and emotional support. Those who could afford would also pay for private care givers to go into the homes to provide additional care. Since the onset of the crisis visitation has been restricted and care provision has declined further in the face of staff shortages and other issues. Recent reports have documented the significant increase in medications being given to care home residents.
Other countries around the world, notably those in Europe, spend a far greater amount of their care budget on providing care in the community, allowing people to remain in their homes for longer, connected to their communities and their supportive social networks.
The question is how do families and family caregivers who might have considered putting their loved one into care make the transition to providing more care in the home? Many caregivers are already struggling and with COVID-19 they too have become more socially isolated and distanced from their social support networks.
For those persons with complex care needs the key to looking after persons in their home and community is to find a way of working with family caregivers, public health and family funded providers and to take advantage as much as possible of local community resources. Social networks and addressing the social, emotional and health needs of family caregivers is also an important aspect of the overall plan.
Public Health provides limited input over and above the limited care current funding allows so families are often forced to either go it alone or to pay for a professional social worker and other care providers to come in and develop a cohesive plan of care that addresses the wider care needs across the day to day.
At Mosaic we have a client services team staffed with nurse, social work, geriatric and counselling expertise that we use to bring to bear to develop a cohesive plan and supports to families, family caregivers and the person at the heart and centre of care. We provide case management services for our families that help address the fundamental needs of care over and above those provided by public health. We support the continuing social, emotional, cerebral, spiritual, creative, cultural and physical capacities of assets of the person. Our care is designed so the person as an intrinsic being can continue to express their unique human individuality. We look to social networks and community assets as well as public health services and clinical relationships to help determine what we can and cannot do and work with families to achieve realistic holistic goals. We also work with families to advocate for care provided in long term care homes.
Article provided by Mosaic Home Care Services.
An Update from the Principal Owners of Mosaic Home Care Services & Community Resource Centres
Nathalie and I, our Mosaic Team and front-line staff would like to wish you all a Happy New Year!
We have all experienced a difficult year. Our ability to connect eaningfully has been severely restricted. With a vaccine in the works, this year’s holiday season will hopefully be the last of the COVID-19 restrictions.
We remain vigilant with respect to infection prevention and social contact awareness. The COVID-19 policies we have had in place since March for our frontline teams and families remain in place.
Over the last six months we are seeing more families deciding to keep their family members in their homes and communities. Our client services team with its nursing, social work, geriatric, counselling and case management expertise has been working hard.
The wider supportive community that has developed during COVID remains in place; we continue to engage with the IFA’s Town Hall Meetings, The Alzheimer Society of Toronto’s Community Partner updates, Sunnybrook Health Sciences and North York Health Partners and
The Integrated Partnerships for Seniors online forums.
Given the continuing COVID environment we will be moving our Steeles community resource centre upstairs to a space available within our main offices. We will continue to run events in Centre Court at The Shops
on Steeles and 404 once the COVID risk has subsided.
Over the last few months our free online programs continue with events from Joanne Picot, the Alzheimer Society York Region, Donna Zekas, Theatre in the Web and Dr. Daren Heyland.
Finally, in November Jane Teasdale received a Recognition Award from the Elder Abuse Prevention Ontario: “Jane is recognized for her continued efforts for the committee and for always coming up with new and creative ways of offering support to the seniors in the greater community.”
On behalf of our Mosaic team and front-line staff, all the best for 2021!
Jane Teasdale and Nathalie Anderson
For information on our integrated person centered care services please contact 416-322-7002 or 905-597-7000 or www.mosaichomecare.com
Our current newsletter can be found via the following link: https://www.mosaichomecare.com/wp-content/uploads/2020/12/nov2020-mosaic-home-care-winter-2021-newsletter.pdf
Information on our online programs can be found at https://www.mosaichomecare.com/wp-content/uploads/2020/12/winter-ZOOM-Mosaic-Events-Flyer.pdf
And our activity booklet for January 2021 is available via the following link – https://www.mosaichomecare.com/wp-content/uploads/2020/12/January-2021-Activity-Booklet-Final-.pdf
Review of Theatre in The Web’s “The Quarantime Show”.
30 June saw our “First Link® Memory Café featuring “Theatre in the Web Acting Troupe” “The QuaranTime Show” 7 Actors performing on-line from the Graduating Class of Humber College Theatre Performance”. The following is a brief synopsis of the show itself:
The show starts with “She’s a Maniac” as a backdrop to a montage of the characters and actors of the show. All professionally done!
She’s a Maniac is a 1983 classic song and a nice intersect for all the generations. But is there more to the song than meets the eye? As we are introduced to the host of the show you will start to wonder.
Next up is our baking slot and everything that can go wrong does. Day time cooking shows across the generations have never been this funny. Do you have a memorable moment from the past?
Since blasts from the past seem to be a theme of the show, does anyone remember the Clairol Herbal Essence adverts of the latter part of the last century? You might wish to see the 1998 Dr Ruth advert on youtube as a primer for our next segment.
We are then introduced to our sports segment, and new meaning is given to the term “spectator sport”. We will let you decide on the “action”, but this was a wholly unexpected take and shows the depth and variety of content produced for the show.
Much of the show revolves around the host and unfortunately a postal delivery happens just as our host is disposing of……. We are not going to spill the beans, but how long is our host going to be able to hold it together?
In coronavirus times getting enough exercise is difficult. The next segment provided viewers with an opportunity to try a new exercise craze that the Theatre in the Web crew have thought up. There is also a guest appearance from a Dr Jacobs presenting the research on this important tool.
Next up our host provides us with a short gardening interlude before we slot into our pet detective story with Detective Romanov. But we will leave the plot under wraps for those who have yet to see the show.
Toilet paper was in short supply a few months ago. Along with the stress of coronavirus and the anxiety of the times we are introduced to a skit on a trip to the store for toilet roll. Many felt that this segment was especially poignant.
Our host then manages to throw in a bit of Shakespeare before introducing the show’s black and white cinema moment: “Now I shall tame the lion”.
The final segment combines elements of heaven and hell with puppetry before the credits roll.
You might be surprised to know that one of the many skillsets Humber College actors learn is puppetry.
“Stream it or skip it” is a tag line on Decider which is a site dedicated to reviews of Netflix and other online content. What is our verdict? Stream it!
The show is 25 minutes long. It is extremely funny and has an incredibly diverse subject matter. The acting is great across the board and the cast work well together. Technically the show is well oiled and transitions from segment to segment are helped by the innovative host of the show. We would stream it, it would be a crime to skip it. We look forward to more and so should our communities.
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The Theatre in the Web Troupe is self-financed and dependent on alternative sources of financial support for its events and productions. Any organisations in the community that are willing to help support creative community productions are welcomed. Please contact Theatre in the Web at Theatreintheweb@gmail.com
Theatre in the Web is the name of a group of young emergent actors recently graduated from Humber College’s highly respected three year Theatre Performance conservatory program. Three hard years of early mornings and late nights, weekends as well as weekdays later produced a band of dedicated professionally trained creative artists. The attrition rate in these programs can be 50% or more over the three year period and there are no easy passes. Not only do you need to shine and endure to succeed in acting, you also need to be able to work together, to collaborate effectively.
Acting as with all creative arts is an incredibly competitive and difficult medium to survive in. While financial success is not what drives most artists the ability to procure a basic living is important to an artist’s canon and durability. In a COVID world the ability and opportunity to both create and to survive financially is a much more challenging endeavour for all of us. We believe that there are many opportunities for the creative arts and the community to work together to transform our world for the better.
Facebook page – https://www.facebook.com/Theatre-in-the-web-102176201529390/
Black Lives Matter & Anti-Racism: Where Do We Stand?
The question we should be asking ourselves is “Why do Black Lives Still Not Matter after all this time?” After the Civil Rights Movement of the 1950s and 1960s, and much more both before and after, why are we still in this dark inhuman place? Who would not want to walk side by side with Martin Luther King on his March to Washington and breathe in his words at the Lincoln Memorial. Who would not want to walk side by side today with our fellow Black Lives?
We are proud to provide a piece on “Black Lives Matter” written by our staff. We support and endorse it fully.
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Black Lives Matter & Anti-Racism: Where Do We Stand?
The last couple of months have been a whirlwind for everyone, to say the least. I think we can all agree that 2020 has not gone the way many of us have planned or imagined. In the midst of a global health pandemic, we have simultaneously witnessed the emergence of a great social shift. George Floyd’s murder was a heartbreaking and egregious act of injustice that Black communities are, unfortunately, all too familiar with. Although the pain and numbing of this open hate is felt the same each time it occurs, something was different this time. Black communities and non-Black allies alike, said enough is enough.
Mosaic Home Care does not condone racism or hatred of any kind and we have taken it upon ourselves to create safe spaces for people from all races, ethnicities, creed and sexuality. Embedding anti-racism in our work structures and models, from the care we provide to the interactions with community members, is something we acknowledge is necessary and how we move in the right direction.
When working in careers based on and positioned in community work, it’s important to work from an anti-oppressive lens while including anti-racism, anti-colonialism, and social justice frameworks. Recognizing unearned white privilege is also important and understanding that it exists because of historic, enduring racism and biases. To know that someone automatically has an advantage just because of the colour of their skin is to recognize privilege. Providing the spaces to enhance the voice of marginalized and oppressed groups, through your unearned privilege, is essential.
You might wonder where you fit into all of this, “how can I help?”. We have seen various forms of activism and tools for change come into play recently that help advance social justice substantively in different ways.
Activism can range anywhere from personal critical self-reflection, pursuing education, expanding your community/relationship boundaries, taking part in local protests and having difficult conversations with family and friends. A dialogue around these social justice issues is not only essential but long overdue.
As a company, our staff held a guided discussion about Black Lives Matter movement and Anti-Racism. This conversation was difficult, uncomfortable, and eye-opening but it was an important conversation to have. Mosaic’s goal is to work towards ending the silence and continue the conversation. To do so, Mosaic has created a Resource Board platform for our team and we want to share some of our resources with you. These resources are a great place to start to learn more about the Black Lives Matter Movement and Anti-racism. These resources allow us to dive deeper into race issues right here in Toronto and and across the world.
If you want to share any resources with our team that you may have come across, please email us at info@mosaichomecare.com.
Thank you,
Sarah McGilvray (bio) & Beth Eshete (bio)
Podcasts:
Brene Brown and Ibram X. Kendi: How To Be an Antiracist
https://brenebrown.com/podcast/brene-with-ibram-x-kendi-on-how-to-be-an-antiracist/
9 Podcasts on Racism: Understanding The Black Lives Matter Movement
https://www.harpersbazaararabia.com/featured-news/podcasts-on-racism-black-lives-matter-resources
Movies/TV Shows:
Just Mercy
American Son
Mudbound
When They See Us
Selma
13th
Get Out
Fruitvale Station
* You can stream any of these movies online/using a streaming platform. Keep in mind that Netflix Canada has added a new Black Lives Matter category as well.
Educational Links:
Anti-Racism Voices and Resources
https://sites.google.com/tdsb.on.ca/antiracism-voicesandresources/home?authuser=1
National Museum of African American History and Culture Releases “Talking About Race” Web Portal:
https://nmaahc.si.edu/about/news/national-museum-african-american-history-and-culture-releases-talking-about-race-web
Talking about Race:
https://nmaahc.si.edu/learn/talking-about-race
75 Things White People Can Do for Racial Justice:
https://medium.com/equality-includes-you/what-white-people-can-do-for-racial-justice-f2d18b0e0234
Anti-Racism Resource Centre:
http://www.anti-racism.ca/
Welcome to the Anti-Racism Movement – Here’s What You’ve Missed
https://medium.com/the-establishment/welcome-to-the-anti-racism-movement-heres-what-you-ve-missed-711089cb7d34
Implicit Bias Test
https://implicit.harvard.edu/implicit/
Holy Sh*t, being an allly isn’t about me!
https://medium.com/@realtalkwocandallies/holy-shit-being-an-ally-isnt-about-me-ae2de5c47514
Support Black-Owned Businesses:
Black-owned businesses in Toronto you can support right now
https://nowtoronto.com/lifestyle/black-owned-businesses-toronto/
135 Black-owned restaurants and other businesses in Toronto you can support right now
https://www.blogto.com/city/2020/06/black-owned-restaurants-businesses-toronto/
Message From Jane and Nathalie to our community(from our current newsletter)
When providing care to persons and families our primary objective is to facilitate expression of a person’s physical, social and emotional abilities. Social networks and community connections remain important. Life continues, we continue to grow and learn, to connect and to be in this world of deep meaning and context.
For most of us COVID-19 has not changed who we are, or what we are capable of, at least for the moment. But it has changed how we connect and the risks of social connection. For a particularly vulnerable element of our communities, those in long term care homes, COVID-19 has been disastrous, deadly and isolating.
Because of the risks of infection, COVID-19 has added many additional layers of complexity and concern. In the last three months we have developed and implemented advanced infection prevention and control protocols governing personal protective equipment and their use, procedures for coordinating caregivers and for screening for COVID-19 risks.
Our protocols are documented, well researched and benchmarked off best provincial, national and international practices. We are also committed to educating and informing all those we work with, whether it be front line staff or families.
Our most important protocols are those focusing on contact risks: if we focus not just on immediate contacts but on the contacts of those contacts, we are better able to shut down the transmission of COVID-19 before it gets to our caregivers and our clients and families. Our contact tracing protocols remain at the heart of our defenses and are used to screen new clients and families and all visitors and other health care providers attending in the home. Mosaic was also one of the first to make wearing masks mandatory for all front-line staff because of the asymptomatic risks of transmission.
Fortunately to date we have had no COVID-19 positive clients nor COVID-19 positive front-line teams. In the last couple of months we have also delivered and sent out fabric masks, soap and sanitizer for our front-line staff and families. These are for community use, for shopping and use on public transport etc.
We have also emphasized close contact with our front-line staff through regular telephone calls and Zoom chats to provide support, elicit feedback and to let them know what we are doing.
Martha Miller our Client Services Liaison has been calling our clients and families to see how they are managing and to see if there is anything we can help with.
In a socially distanced world we have had to adapt quickly. Our community resource centers are closed and we have been developing on line programs and connections. Beth Eshete our Community Resource & Social Engagement Coordinator has been responsible for our virtual knitting and exercise programs. We have many other on-line programs through June and August including a collaboration with recent acting graduates of Humber College’s Theatre Performance conservatory program.
We will be implementing our pole walking programs in Markham & Toronto in July and August with contact tracing protocols and physical distancing in place.
We have also been advocating for families with family members in long-term care or retirement homes and have been active in social media promoting the importance of family visits. We discussed our concerns on this issue in our March newsletter. In June Jane Teasdale will be representing Mosaic Home Care on a PodCast, on this issue, arranged by Family Councils Collaborative Alliance.
Mosaic has also been invited to speak at the Sinai Health’s and University Health Network’s Covid-19 Special, Geriatrics Institute Education day.
As many of our families will know, private homecare personal support workers and nurses are not included in the provincial pandemic pay support. This is despite the fact that most care provision in the province is contracted to private companies. We have been actively advocating for pay parity across the community and have formed a caregiver advocacy group with other like-minded home care providers. We have also successfully reached out to local politicians (including Councillor Josh Matlow) on this issue and have written to numerous other senior politicians in Provincial and Federal government.
June is also Seniors Month so Mosaic will be dropping off some activity kits for our clients and a gift bag from Custodia Seniors Support.
We would also like to thank our “Mosaic in-house team who have been working non-stop in keeping our clients and caregivers safe during COVID-19. We would also like to do a shout out to Bev Crescenzi, Operations Admin and her husband Bruno who spent a weekend organizing the masks for our many front-line teams. And to Jazmyn Romano who is a student gaining her community hours. She has been working on some research and developing our programs and community resources document.
And finally, a big, big “Shout Out” to our many front-line caregivers who are selflessly working each and every day, putting the best interests of their clients first and making changes to their own lives and lifestyles so that they can safely provide the care our communities need!
MOSAIC’s Advocacy Position on Pandemic Pay: No frontline health care worker should be left behind!
From “The Forgotten Frontline: homecare during the pandemic”[1]:
“This pandemic has shone a light on the extent to which, so few people understand what homecare is. For too many there is still an outdated image of homecare as ‘mopping and shopping,’ as a set of practical activities designed to make people feel better but not much more than that. As almost like an added luxury! The truth could not be further than that”.
Every day on the radio and in social media we hear about the importance of supporting all health care workers providing care, whether this is in the home, retirement residence or long-term care home. “We have your backs” we keep hearing everyone say, but this is not the case for all workers.
On April 25th, the Ontario government made the following press release: “Ontario Supporting Frontline Heroes of COVID-19 with Pandemic Pay – Government Recognizes the Dedication and Sacrifice of Frontline Workers”.
It went on to say: “This increase will provide four dollars per hour worked on top of existing hourly wages, regardless of the qualified employee’s hourly wage. In addition, employees working over 100 hours per month would receive lump sum payments of $250 per month for each of the next four months. This means that eligible employees working an average of 40 hours per week would receive $3,560 in additional compensation. Those eligible to receive the payment will be staff working in long-term care homes, retirement homes, emergency shelters, supportive housing, social services congregate care settings, corrections institutions and youth justice facilities, as well as those providing home and community care and some staff in hospitals.”
But, the policy excluded anyone that was not contracted directly by the government. Despite the fact that most “home care” in the community is delivered by private contractors, the government decided to exclude a large portion of this health care workforce. Perhaps the many smaller providers lacked necessary political influence or more to the point private caregivers were not considered heroes or anything close?
We believe that excluding a great many people from this important gesture is discriminatory and a human rights issue. It has also insulted a great many workers and upset many families.
The government is excluding important people who are providing care to persons in long term care, in retirement residences, and in the home and the community, contrary to the public statement and promise made. The following is from one of our caregivers:
“…in April the Premier of Ontario announced a $4/hr increase on salaries of all frontline workers…it mentioned staff working in facilities, long term care and nursing homes….I agree with the Premier. Healthcare workers are first and foremost deserving of the recognition and financial reward. Now here’s the tricky question: do we as Mosaic frontline workers and PSW’s qualify for the increase? As I read the announcement there’s a line there that says and I quote….”as well as those providing home and community care and some staff in hospitals”…. unquote. I am hoping that it included privately operated healthcare providers. That added incentive will surely boost our financial situation especially at this time, amid the pandemic where commodities, rent and everyday expenses are on the rise.”
We know that our caregivers are making personal sacrifices and taking risks to provide care in the community each and every day. The personal sacrifices they are making include sleeping apart from family, taking extra precautions to avoid contracting the virus and in many instances accepting reduced hours because of the need to avoid multiple person contacts. Many health workers have underlying health conditions, yet society expects them to continue to turn up.
The personal support and nursing care that excluded care workers provide is mostly within personal and intimate space. Many will be going into known higher risk environments such as nursing homes and retirement residences. But home and community care is not without risks: homes may receive a number of visitors including health care workers from private contracted agencies who may visit multiple people and environments on a daily basis. Our frontline staff are not just responsible for providing personal care but social and emotional supports and in the current climate are often the first point of call for monitoring visitors into the home.
The care that these health care workers provide is important to a great many families as public health only provides a limited amount of care. Most of the care provided by public health is task based and of limited duration and is insufficient to keep many persons safe in their homes. Many of the issues we see with care in the home and the community are similar to those we see in long term care. Personal support work and nursing in the community is seen more as a set of rudimentary tasks that have little value. As the quotation at the start of this article says “The truth could not be further than that”. The following is from one of our PSWs currently in a long term care environment:
“It’s hard working in the LTC, even if you’re dealing with only one client….I want to highlight the PSW working one on one. We are not dealing in physical care alone. We are working on the most important aspect, the EMOTIONAL part, which I think is the most important to be taken care of. We deal with their emotions, we talk to them, we laugh with them, we stay by their side where nobody else is with them in a situation they are now.”
Without the care provided by this excluded workforce many more human beings may need to move into long term care homes at a time when it is least feasible to do so and to receive levels of care that have long been recognised to be insufficient.
But excluding the many health care workers who work in private care impacts not only a much more vulnerable work force but also the families for whom the cost of care is itself a sacrifice.
Many of our families have decided to chip in and pay the extra fee themselves. While some families may be able to do so others will not have the financial leeway. We know that families are torn between wishing to support their care providers and being able to provide care in the first place and feel the dilemma intensely. We should not be placing families and caregivers in this situation.
Many of those we speak to believe that the government is supporting all who provide care in long term care, retirement residences and home and community. Not so. There appears to be a distinction between first class citizens who are heroes and other much deserving, apparently second class citizens, who are not worthy of being spoken of in the same breath.
We believe in all caregivers and we also believe in the families they serve. We should not divide and differentiate between what are first and foremost important relationships in difficult times.
[1] https://scottishcare.org/the-forgotten-frontline-homecare-during-the-pandemic/
Social distancing is not enough, we also need social networking awareness and much more attention to basic hygiene!
As a home care provider working and collaborating with persons with complex care needs, their families and the wider community we are especially aware of the greater vulnerability that many have to the Novel Coronavirus, both young and old.
There is a lot of information on the COVID 19 virus:
– Some sources say that it can be spread without symptoms, others say that it cannot;
– Others say that while it can be transmitted without symptoms it does not transmit “much”;
– Other sources however state that while you may not transmit as much in the early stages, because there may be a lot of people who are asymptomatic (have the virus without symptoms), the risks of transmitting it are high. Some sources state that that those in the 20 to 40 age range are more likely to transmit the virus without symptoms.
How do we limit the risks of contracting the virus? There are four main options:
1 – One is social distancing, or as the WHO now calls it, physical distancing;
2 – A second is social contact monitoring;
3 – A third is social isolation;
4 – A fourth is infection prevention and control, which means hand and surface washing and a number of other routines designed to minimise viral transmission.
In reality we will likely need to use a mix of all of the above.
Social distancing
Social/physical distancing is:
a) limiting the number of people you make contact with, at any one point in time, and
b) increasing the amount of space you have between the person or persons you are connecting with.
The study of intimate, social and personal space is known as Proxemics. The actual dimensions of space can differ amongst different cultures and amongst individuals.
Intimate space is any contact or communication within 18 inches of the person: many personal support workers and nurses engage at this level for quite some time, and this applies to physicians depending on their role. Health care workers may not be able to avoid intimate contact.
Personal space is anything between 18 inches and 4 feet usually. This would be reserved for anybody you are talking to.
Social space is between 4 and 12 feet, and social space is usually reserved for groups of people.
Social/physical distancing is essentially about a) reducing our contact with groups of people and b) pushing out the intimate and personal contact we used to have to this wider area.
But just how far should we be social distancing?
With respect to actual distance, the current recommendation is to have 2 metres of space (6 feet) between people.
This appears to be due to the fact that most airborne transmission of the virus is in droplet form, and droplets are meant to fall to the ground pretty quickly. A 2 metre radius is deemed sufficient to avoid the risk of passing the virus from person to person.
However, there are differences of opinion with respect to the ability of finer particles to remain in the air long enough to be of issue in an enclosed space. In this case being 2 metres in a confined area, without protection in certain instances, with someone exhibiting viral symptoms (coughing and sneezing especially) may not be sufficient distance without personal protection equipment and without infection prevention and control protocols. Most of the research we see on this suggests that the risks are very low and are usually associated with advanced medical procedures.
Clearly for people with compromised immune systems and for people in direct contact with people with compromised immune systems, being in the same room as someone with viral symptoms, without personal protection equipment, even with social distancing, is not something we would recommend. While we are required to follow appropriate protocols in this respect, we would refer persons and families to seek appropriate clinical direction from public health and/or primary physician.
In public space (12 feet or more away), the likelihood of contamination by direct contact, is likely to be infinitesimally small. However, while a person may not be close enough to pass the virus on via a cough or a sneeze, their touch and the transmission of the virus to surfaces might be.
Public spaces therefore pose a risk for transmission via touch and we need to sanitise our hands regularly after coming into contact with high contact areas; doors into grocery stores and store produce; malls; public washrooms; elevators; transportation etc.
Why is reducing our contact with groups of people important?
Over the course of a week the average person will have had a number of different types of contacts with people; intimate, personal, social and public. We are all potentially connected to a great many others at any one point in time.
Limiting contact to smaller numbers of people at a time and to those we know allows us to limit the uncertainty with respect to our overall number of contacts.
And remember you do not need to be close to someone to catch a virus from them. You just need to touch the same surfaces they have touched.
Social contact monitoring
The fewer people we have contact with allows us to better track the contacts of those we do see.
Do you know if a prospective contact has had one or more of the following?
a) Significant one on one and/or significant group contact in the last 14 days.
b) Direct contact with anyone who has COVID-19 or suspected to have had COVID-19 in the last 14 days.
c) Direct contact with someone with influenza or cold type symptoms in the last two weeks that have not been tested to rule out COVID-19?
Do you know if your prospective contact can confirm whether any of their recent contacts has or has not developed cold or influenza symptoms? Do you ask your contacts to keep you informed of any significant developments in their health or the health of their most recent contacts?
Limiting your contacts and knowing more about your contacts helps reduce the risk of infection.
If the person you are about to meet has been in close contact with someone with an undiagnosed influenza like illness, then knowing this in advance will help you prevent exposure to this person.
If you have had contact with a person, who subsequently finds out that one of their contacts has a viral infection, then keeping a track of that person’s symptoms is also important.
How social contact monitoring works to prevent virus transmission?
It takes an average of 5 days ([1],[2]) to develop symptoms (sometimes as long as 14 days and some data suggests as early as 2).
If a contact of a contact has just developed symptoms, by having this information you theoretically have an average warning of 5 days, a fire break as it were.
If each contact in a chain of contact informs their contacts of symptoms in the chain then we create important fire breaks in the chain of transmission. We believe that screening of visitors to homes, residential communities and long term care homes should incorporate this type of advanced screening protocol.
Advanced screening protocols should be used for all health care workers (persons) who have direct contact with vulnerable people.
Social contact monitoring principles
So keep a close eye on your social and support network for the contacts they have. Especially for those who depend on personal and other supports in the home and community and who may have weakened immune systems:
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At the present moment in time limit the essential contacts you have to those who are practising social distancing (i.e. limited contacts) and good hygiene (hand washing etc).
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Make sure your essential contacts know the importance of tracking their own symptoms and those symptoms of those they have had close contact with. You should do the same for the people you know.
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Also, for the moment, it might make sense to avoid younger adults and children as the anecdotal and limited research evidence suggests that they have a higher risk of asymptomatic transmission (passing the virus to you with having symptoms themselves).
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If you are about to have contact with people, always screen them with respect to their social contacts and frequency of contact and if they are up to date on the health status of their contacts. Merely saying that they have heard nothing is insufficient. To be safe, defer all contact until the person is able to confirm the health status of their recent contacts.
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Keep track of all those you have met and ask them to provide information on their contacts, with respect to the number of contacts they have had, in particular group social contacts, and contacts with people with symptoms of viral infection.
Social isolation
Social isolation is a form of social distancing and it can be total, i.e. no visitors and no contact, or it can be selective, i.e. only health care workers and visitors practising good hygiene and social distancing protocols.
Isolating yourself from others and the outside world eliminates the risk of viral transmission by social contact and by public space surface contact.
However, total isolation for many people is not realistic. For those who rely on personal and nursing supports in the community they may need regular daily interaction and for those who do not we need to shop, work and perform essential functions.
Infection prevention and control
Infection prevention and control looks at the interaction of the person, the people they interact with and the places in which they live and interact (their home and community environment). It places additional protections against viral transmission. Many are basic and can be practised by all of us, and all of us who care for others.
Hand washing
Good hand washing techniques and procedures are an important foundation for infection protection and control important:
If visiting or providing care to a vulnerable person:
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Wash hands immediately upon entering the home. Do not touch anything or any surface until you have washed your hands. Soap and water or a healthy dose of hand sanitiser are two options – hands need to be soaking for hand sanitiser to work effectively.
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Wash hands before you touch a person, if providing assistance (bathing, toileting, moving, dressing, feeding), and after providing assistance.
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Wash hands before preparing food and drink and before passing items to a person.
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Wash hands regularly throughout the day if you are touching a person’s surroundings and/or yourself, especially if the area has high contact from others or if the number of person to environment contacts is unknown.
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Make sure that the person you are looking after also washes hands after toileting, before eating, after close (touch) interactions with other people and regularly throughout the day. Please check with a health care practitioner with respect to skin care considerations and other health issues that may impact hand washing.
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Extend washing protocols to all produce and goods that come into the house that are likely to be touched or used or consumed within say a 3 to 5 day period. Recent research on the virus suggests that it can remain active for up to 3 days on steel and plastic surfaces and up to 24 hours on surfaces like cardboard. You can easily quarantine non perishable items within a specific area.
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Appropriately sanitize the environment: if you are briefly visiting someone make sure to touch as few surfaces as possible and/or to sanitise those surfaces you touch. Sanitise all affected surfaces after toileting and bathing and before and after food preparation. Otherwise regularly sanitise contact surfaces (door/cupboard handles, countertops, taps, water jugs, kettles etc).
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Clean your cell phone regularly!
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Exercise good judgement with respect to hygiene.
Hands can be washed with soap and water or with hand sanitiser, if there is no visible sign of dirt or other contamination.
Here is instruction from Public Health Ontario, Best Practices for Hand Hygiene in All Health Care Settings.
Here is a video link to Public Health Ontario Hand Washing techniques.
Here is a link to instruction from the World Health Organisation on hand rubbing (alcohol based hand sanitizers).
Here is a link to instruction from the World Health Orgnisation (WHO) on hand washing.
Masks and other protections
In the current COVID-19 environment where it may be difficult to know when and if a person can transmit the virus, we believe that those who look after those who may be more vulnerable to the virus should wear a mask, if at all possible, when interacting closely with the person.
This does not mean that failure to wear a mask represents a high risk in all cases, just that the risks are uncertain and the costs of transmission for certain portions of the population extremely high. As a provider of health care services our objective in this environment is to manage risks to a far higher standard.
With respect to the care of persons with undiagnosed influenza and other viral symptoms as well as diagnosed COVID-19 cases, while we have our own protocols for the management of these risks, we would direct persons and families to current Public Health Ontario guidelines, recommendations and supports.
Some Resources
Ontario.ca – General Guidance https://www.ontario.ca/page/2019-novel-coronavirus#section-3
Public Health COVID-19 Resources – https://www.publichealthontario.ca/en/diseases-and-conditions/infectious-diseases/respiratory-diseases/novel-coronavirus/public-resources
When and how to wear a mask – https://www.publichealthontario.ca/-/media/documents/ncov/factsheet/factsheet-covid-19-how-to-wear-mask.pdf?la=en
COVID-19 – Health Care Resources for Health Care Professionals- https://www.publichealthontario.ca/en/diseases-and-conditions/infectious-diseases/respiratory-diseases/novel-coronavirus/health-care-resources
CDC – Cleaning and Disinfection for Households https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/cleaning-disinfection.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fprepare%2Fcleaning-disinfection.html
[1] https://annals.org/aim/fullarticle/2762808/incubation-period-coronavirus-disease-2019-covid-19-from-publicly-reported
[2] https://www.healthline.com/health/coronavirus-incubation-period#incubation-period
6th Annual Conference, European Society for Person Centered Health Care (London, UK, February 2020)
Amidst the Coronavirus storm we have managed to piece together a summary of the recent 6th Annual Conference of the European Society for Person Centered Healthcare in London, UK, from 27th to 28th February of this year.
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What a conference! Speakers and delegates from around the world, and well engaged panel discussions that overflowed into the breaks and far beyond..
Person centeredness has many perspectives and many disciplines. Whether you are an academic, a physician, a person as a patient, a patient organisation, an administrator, a social worker or home care provider, we all have input into how person centeredness is being shaped.
The central theme of the conference was one of collaboration, or as it was referred to by Dr Amy Price and others in their talks, co-production. Creating a system that can deliver person centered care requires us all to work together, to make sure that all our perspectives are shared and incorporated in the system itself. Everyone is a person, each with valuable perspective and knowledge, each with human rights and sensitivities.
The 2020 conference addressed many of the inputs, conflicts, trends and components of person centered care.
Myriam Dell’Olio (and co-workers) noted that “that while there is surging interest in person centered care, feedback from persons as patients finds that “healthcare professionals are not delivering or implementing… in a meaningful way”.
Dr Michelle Croston, a senior lecturer and advanced nurse practitioner, discussed what it meant to be person centered in the care of people living with HIV. She referenced a Wellness Thermometer that had been developed to assess the wider social and emotional and spiritual wellbeing of persons in addition to clinical and biological concerns – the inserted link refers to a previous presentation on the Wellness Thermometer.
Dr Jeremy Howick talked about the use of positive expectations, empathy and placebos in addressing some of the many ailments that clinical method seems unable to address and a link to one of his and other co-workers papers is provided. Lower back pain is one such area of attention. A UK BBC2 documentary programme did a study on placebos with the help of Dr Howick and found some interesting results.
We then considered the impact of robots, nursing culture, spirituality and artificial intelligence with presentations by Professor Marilyn Ray, Colonel (Ret.) and Colonel Dr Marcia Potter of the US Air Force. The US Air Force through the work of Dr Ray (her Theory of Bureaucratic Caring) and others has helped develop person centered care processes within the US forces medical system, addressing the interaction of formal structures and the needs of the person.
The conference was well represented by “patient” groups: The Patient’s Association (UK), Melanoma UK, Cannabis Patient Advocacy with its mental health focus, Genetic Alliance UK (Rare Diseases) and the Brittle Bone Society, and last but not least Parkinson’s Concierge, a dynamic duo, both living with Parkinson’s and both engaging widely in addressing the many aspects of the disease. The patients organisations discussed many of the barriers they face in helping the needs of persons as patients be recognised, but they also discussed the many ways they are working with health systems and other organisations.
We had a talk from a director of patient engagement at a UK National Health Service Trust (Co-production) that illustrated how bringing in patient engagement within hospitals can significantly reduce complaints and enhance person as a patient satisfaction.
We had a talk from Grace Meadows, program director Music for Dementia 2020, on the importance of music for those living dementia from the perspective of “doing with” as opposed to “doing to”. This was followed by a presentation by Samantha Hughes, a doctoral student, on some important results from one of the longest running studies on social prescribing in the UK. Social aspects of social prescribing and the need to provide ongoing social opportunities beyond the often short periods of these interventions were highlighted results.
Day two started with our own “Jane Teasdale’s” keynote presentation on some of the many complexities of home care, then moved to a presentation on behavioural science and how this impacts decision making for clinicians and persons as patients. Next, Dr. Rajni Lal, a Specialist Registrar in Geriatrics, talked about the decision making process for older people undergoing surgery and how older adults’ priorities often conflict with prescribed surgeries.
We had presentations on quality of life decision making and some of the ethical dilemmas posed by the cost of medical treatments, by Dr Vije Rajput, and a talk from Denmark on some of the pitfalls in assessing infant social withdrawal. This was followed by a light-hearted presentation on Frohlich groups, which is a form of acting therapy for both clinicians and patients.
Dr Bruno Kissling, a Swiss doctor then presented on a person centered framework of interaction for both doctor and patient, addressing trusting relationships, active listening, patient reflection and the consultation as an interactive process, with both doctor and person as patient as experts at “eye level”.
The conference also addressed the importance of digital and data solutions, from pharmaceutical companies reinventing themselves to software developers (RemindMeCare/ReMeLIfe,Simon Hooper) engaging fully with the social and emotional space of the person living in the care home. We had an especially interesting talk from Dr Bharat Tewarie who presented on how artificial intelligence and big data could be used to inform decision makers of human needs, wishes and priorities in health care.
A special thanks to the European Society for Person Centered Healthcare, in particular Professor Andrew Miles and Sir Jonathan Ashbridge for organising and running this highly focused, incredibly detailed and informed set of presentations and discussions.
Active Living with Walking Poles (Urban Poling)
It is not uncommon to see someone strolling past with a cane, having to rely on it for balance and stability. But don’t be surprised if you see someone zip past you on the street, propelled by specialized walking poles. This is exactly what participating in a fitness activity called Urban Poling (aka Nordic walking) looks like. Just think of cross-country skiing (minus the skis) in an urban setting!
ACTIVATOR poles are a specialized kind of walking pole designed by a Canadian occupational therapist specifically for rehabilitation and active living. It continues to gain popularity among people looking to prevent falls by staying active. One of these individuals is Bob Lewis, who describes himself as follows:
I am 61, overweight and have Type 2 diabetes and [have] twisted my ankle a few times. Now, with the ACTIVATOR poles, I have no problems with balance, sore feet, or going downhill. I enjoy walking because I don’t have my fears of injury.”
Interestingly, perhaps the most valuable aspect of the poles is that they have a look and feel that represents active living in a way that traditional assistive devices, like canes, do not. Fourteen years since the development of the Activator Poles, many have embraced it as just that – a tool to promote active living. Letty Kurucz agrees with this perception of walking poles. She recalls that when her orthopaedic surgeon recommended a cane for her painful knee joint, she felt depressed and discouraged, perceiving herself as disabled at the age 42 and unable to be actively manage her weight. She felt helpless until she saw someone urban poling. At that moment, she recalls that one word came to mind: “Ability.”
You might be wondering about the benefits of walking with these specialized poles? That’s what Urban Poling Inc. founder and occupational therapist Mandy Shintani wondered after a neighbour from Sweden attributed the health of Scandinavians to their culture of walking and in particular, Nordic walking. Mandy was surprised to find independent research studies showing numerous benefits of pole walking in key factors related to preventing falls (as of December 2019, there are 280+ listed on PubMed!). For example: improving core strength, stability, posture, balance and also confidence for walking. Walking with poles offers these benefits because it engages approximately 90% of a walker’s muscles. Walkers actively swing their arms and shoulders while pressing down on the ledge of the poles’ handles with each step. Doing so contracts the core ab muscles giving the walker a full-body workout.
Conditions like osteoporosis, Parkinson’s, ABI and MS typically produce a stooped posture and a shuffling gait pattern, which are two factors that increase the risk of falls. ACTIVATOR poles support good posture by providing bilateral support while encouraging the walker to stay upright and lift their feet.
Unfortunately, wintertime presents more challenges for walking due to rough and slippery roadside conditions. As a result, many older adults sometimes report feeling trapped in their homes. While walking on ice is not recommended, there are a few strategies for walking more safely in the winter. For example, taking off the rubber tip from the ACTIVATOR poles and using the carbide steel tip underneath, and also walking with supportive footwear and good treads.
With safety in mind, Mandy developed the ACTIVATOR poles with several features to improve balance and weight-bearing capacity. To learn about the research on the patented ACTIVATOR Poles and the walking technique designed for improving balance, go to www.urbanpoling.com
Whether you love walking and are looking for a way to make the most out of your walks or seeking a solution for fall prevention for your clients, one thing is for sure: adding a set of specialized poles to your walk might just be the answer!
For more information contact:
Dolly Mehta, BSc, MSc, MMgt, Health Promotion and Sales Manager, Urban Poling Inc.
T: 416.319.1900 | T: 1.877.499.7999 | F: 604.990-7715 urbanpoling.com
Or
Health Promotion, Urban Poling Inc., 416-319-1900 www.urbanpoling.com
