Merry Christmas

Wishing everyone a very happy and healthy holiday season.

from everyone at 

Shylo Nursing and Home Healthcare

Vancouver's Premier Home Health Agency since 1980

Vancouver Senior Health Blog is honoured to have been nominated for a 'Best in Show: Blog Award' in this year's WEGO Health Activist Awards!  If you have enjoyed our Blog and feel we share helpful and relevant health information, you could endorse our nomination HERE

Home Care = Improved Health Outcomes, Less Cost & Increased Patient Satisfaction

Home Is Best™ – the philosophy states that home, not hospital or residential care, is the best place to recover from an illness or injury, manage long-term conditions and live out our final days.  Although Home is Best was pioneered by Fraser Health, similar philosophies are being adopted across Canada.

Ensuring that clients can access the right care, at the right time, in the right place, with the right provider, is critical to achieving the best client outcomes and improved quality of life.  Targeted populations included adults with chronic or complex health conditions, and the frail elderly.  Through the integration of primary care, and home & community care, seniors, who have been telling health care providers they want to stay in their homes as long as possible, are provided with the services and tools to realize their goals. 

This approach to care in the home has resulted in reductions in the time it takes a client to access community services; shorter lengths of stay in hospital; and reduced emergency room visits. Furthermore, health care clinicians are more satisfied and more effective as this new approach encourages professionals to practice to their full-scope to meet the needs of clients.  A model tested in one community in Fraser Health in 2007/08 showed a 33% decrease in ER visits, a 61% decrease in hospitalizations, and increased client satisfaction.

The goal is to improve the outcomes of clients who have long-term health conditions that impact their functional well-being. In so doing, emergency room visits and hospital admissions are avoided; and hospital stays, for those requiring the expertise of the acute care team, shortened. Ultimately people will be able to live at home longer, with improved quality of life.

To date, the early results are very promising. Practitioners and clients are reporting more productive, meaningful relationships and interactions. They report feeling more secure in the care that is provided.

• Improved population health by improving the health outcomes of each individual.     
• Improved patient/provider experience through the realization of effective access and navigation of the community-based health care system.
• System sustainability as evidenced by reduced per capita costs for target populations; reduced emergency room visits and decreased hospital length of stay.

Home is familiar and is the best place for most individuals to age in place, manage or recover from illness, or receive palliative care.  Any decisions regarding a change in living circumstances can be made from the normalcy of the home setting and during a period of wellness and stable health.

As Home Care is being implemented as the preferred method of care delivery for clients with chronic health challenges in Europe and North America, the results speak for themselves:

• Improved clinical outcomes
• Improved physical and emotional well being
• Improved client satisfaction
• Increased client autonomy
• Increased mobility 
• Faster client recovery and healing
• Fewer visits to the Emergency Department
• Fewer re-admissions to Acute Care
• Decreased length of stay in hospital
• More flexibility in care delivery options 
• Decreased infections
• Decreased incontinence
• Decreased delirium
• Decreased functional decline 
• Decreased health care needs
• Decreased client fears & anxiety
• Decreased stress on the extended family 
• Decreased caregiver burnout
• Decreased congestion in Acute Care
• Decreased cost

Home is the best place to manage chronic health conditions!

FOOTNOTES:

http://www.cdnhomecare.ca

http://www.fraserhealth.ca

http://www.bcbudget.gov.bc.ca/2011/sp/pdf/ministry/hlth.pdf

Ministry of Health. Health Service Plan 2010/11 – 2012 /13. British Columbia

Foley, Linda. (2010) Developing an Integrated Primary & Community Care System. Presentation at 2010 CHCA Home Care Summit. Quebec City

Evaluation of Physician Care Partnership. Fraser Health

http://www.youtube.com/watch?v=jVVEN0Rpx64

MENTAL ILLNESS — Part III

We are pleased to publish the third and final section of our 2012 Blog on Mental Illness.  We appreciate all the positive feedback we received and hope that this has been a helpful resource for our readers. 

Self Injury:

Self-harm is a way of expressing and dealing with deep distress and emotional pain. As counter-intuitive as it may sound to those on the outside, hurting yourself makes you feel better. In fact, you may feel like you have no choice. Injuring yourself is the only way you know how to cope with feelings like sadness, self-loathing, emptiness, guilt, and rage. 

The problem is that the relief that comes from self-harming doesn’t last very long. It’s like slapping on a Band-Aid when what you really need are stitches. It may temporarily stop the bleeding, but it doesn’t fix the underlying injury. And it also creates its own problems.  

If you’re like most people who self-injure, you try to keep what you’re doing secret. Maybe you feel ashamed or maybe you just think that no one would understand. But hiding who you are and what you feel is a heavy burden. Ultimately, the secrecy and guilt affects your relationships with your friends and family members and the way you feel about yourself. It can make you feel even more lonely, worthless, and trapped.

Self-injury can indicate a number of different things. Someone who is hurting themselves may be at risk of suicide. Others engage in a pattern of self-injury over weeks, months or years and are not necessarily suicidal.

Suicide:

Suicide is rarely a spur of the moment decision. In the days and hours before people kill themselves, there are usually clues and warning signs. The strongest and most disturbing signs are verbal – "I can’t go o" "Nothing matters any more" or even "I’m thinking of ending it all."   Such remarks should always be taken seriously.

Other common warning signs include:

·       Becoming depressed or withdrawn

·       Behaving recklessly

·       Getting affairs in order and giving away valued possessions

·       Showing a marked change in behavior, attitudes or appearance

·       Abusing drugs or alcohol

·       Suffering a major loss or life change

The following list gives more examples, all of which can be signs that somebody is contemplating suicide. Of course, in most cases these situations do not lead to suicide. But, generally, the more signs a person displays, the higher the risk of suicide.

Experts in the field suggest that a suicidal person is feeling so much pain that they can see no other option. They feel that they are a burden to others, and in desperation see death as a way to escape their overwhelming pain and anguish. The suicidal state of mind has been described as constricted, filled with a sense of self-hatred, rejection, and hopelessness.

It is best to treat talk and threats about suicide seriously. Research indicates that up to 80% of suicidal people signal their intentions to others, in the hope that the signal will be recognized as a cry for help. These signals often include making a joke or threat about suicide, or making a reference to being dead. If we do take them seriously and ask them if they mean what they are saying, the worst that can happen is we will learn that they really were joking. Not asking could result in a far worse outcome.

Research suggests that 70 to 90 per cent of people who have made a lethal attempt, or died by suicide, were suffering from one or more unmanaged mental health issues – such as protracted depression or anxiety, bi-polarity, psychosis, and/or substance abuse. While the presence of an unmanaged mental health issue is strongly associated with suicide, it is important to note that most people assessed with a mental illness are not at risk of suicide, and that few suicides are wholly the result of a mental illness.

If you suspect someone may be at risk of suicide, it is important to ask them directly about suicidal thoughts. Do not avoid using the word ‘suicide’. It is important to ask the question without dread, and without expressing a negative judgment. The question must be direct and to the point. For example, you could ask “Are you having thoughts of suicide?” or “Are you thinking about killing yourself?”  If you appear confident in the face of the suicide crisis, this can be reassuring for the suicidal person.

Although some people think that talking about suicide can put the idea in the person’s mind, this is not true. Another myth is that someone who talks about suicide isn’t really serious. Remember that talking about suicide may be a way for the person to indicate just how badly they are feeling.

Violence:

People with psychotic symptoms, particularly paranoia, have been found to be at higher risk of physical aggression toward others. Physical violence in hospital has been reported in approximately 20% of samples studied. Typically, a small number of patients (e.g. 5%) are found to be responsible for just over half of all violent incidents and more than half of the serious injuries.

A number of studies have examined the relationship of specific diagnoses to violence within populations of psychiatric inpatients. The major issue addressed by this avenue of research is what kinds of mental illnesses predict violence and criminality among mentally ill populations, not whether mental illness, per se, predicts criminality and violence. 

Perhaps the most consistent and striking finding is the association of substance abuse disorders (alcohol and/or drug) with violence and criminality, and the lack of or small association between other disorders (e.g. schizophrenia, affective disorders, or anxiety disorders) with violence.

Mental Illness in Canada

20% of Canadians will personally experience a mental illness during their lifetime.  The economic cost of mental illnesses in Canada was estimated to be at least $7.331 billion in 1993.

During their lifetime about 1 in 10 people in Canada will experience an episode of major depressive disorder (the diagnosis given to those suffering from depression). Unfortunately many people, unaware of how common depression is, avoid seeking treatment because they worry what others will think of them. They feel like they’re the only ones. Depression is in fact a widespread medical condition.

Schizophrenia affects 1% of the Canadian population; 52% of hospitalizations for schizophrenia in general hospitals are among adults 25-44 years of age.

Anxiety disorders affect 12% of the population, causing mild to severe impairment. The highest rates of hospitalization for anxiety disorders in general hospitals are among those aged 65 years and over.

It is estimated that about 6% to 9% of the population has a personality disorder.  Anti-social personality disorder is frequently found among prisoners (up to 50%).  Suicide accounts for 24% of all deaths among 15-24 year-olds and 16% among 25-44 year-olds. In 1998, 3,699 Canadians died as a result of suicide.

If anyone has questions or concerns not addressed in this blog, or you just need someone to talk to, the Association of BC Mental Health Information & Crisis Line is open 24/7 at 310-6789 (no area code required).

This concludes our three part blog on Mental Illness; we put a lot of research into its writing so we could share an up-to-date and thorough review of current Mental Health issues without being weighed down with too much medical terminology.

If there are any topics of interest our readers would like us to address in the near future, please do not hesitate to send your ideas and requests to Margot@ShyloNursing.caMargot@ShyloNursing.ca

Excerpts:

http://www.anxietycanada.ca

http://www.ncbi.nlm.nih.gov/pubmedhealth

http://www.phac-aspc.gc.ca/publicat/miic-mmac/sum-eng.php

http://www.cmha.ca/mental-health/understanding-mental-illness

http://www.bcss.org/category/resources/about-mental-illness/psychosis
http://www.mooddisorderscanada.ca/page/elephant-in-the-room-campaign