Reform In Ontario’s Palliative Care

Palliative-Care-e1296105093850

On my flight back from London, U.K., I’ve read one of the best books in 2014 according to The New York Times – Being Mortal written by Harvard surgeon Atul Gawande. Dr. Gawande pointed out in his book that doctors are usually trained at medical school to save lives. He said that perhaps doctors should reflect more on how to give dying patients more choices and help them relieve their pain while withering away instead of unnecessarily prolonging their lives. Dr. Gawande also gave three real-life examples in his book – his grandfather’s long and unusually happy old age; his wife’s grandmother’s extremely long and unhappy old age; and his own father’s (another successful surgeon) struggle with age and illness.

Dr. Gawande also admitted in his book that “No one really ever has control.” As The New York Times book review said,”That’s quite a statement coming from a surgeon, for whom control is the sine qua non of all professional endeavor, and from an essayist who has proposed a host of ways to control the loose ends of medicine.”

To us boomers too, most of whom are control freaks (myself included), this is a stark reality. Whether we’re caretakers of aging and dying parents, or we are increasingly facing our own mortalities, we begin to realize that we eventually have to let go. Dr. Gawande acknowledged in his book that sometimes, the only sure way to gain control is first to relinquish it, whether to a bad disease, a dying patient or the constraints of a finite life span.

That’s why I was glad to read the new report from Health Quality Ontario which says that dying needs to be “demedicalized and demystified,” and patients and their families need more say and more choice on how their final days should play out. Like everywhere else in the world, Ontario’s palliative care is currently far from ideal. Ontario’s Auditor-General has, not too long ago, described the provision of end-of-life care as insufficient, inefficient and inequitable, and complained that there isn’t even good data showing what is currently being done.

In an interview with The Globe and Mail, Irfan Dhalia, the vice-president of evidence development and standards at Health Quality Ontario, said, “Our best guess is that only about 30 percent of patients get the kind of palliative care they should.” The report advocated that every patient nearing end-of-life should have access to quality palliative care in the location of their choice. According to The Globe, while access to palliative care is poor in our province, it is actually better than in much of the rest of Canada.

According to the Canadian Hospice Palliative Care Association, between 16 and 30 percent of patients have access to palliative care, and while the overwhelming majority of people want to die at home, about 70 percent actually die in the hospital. In addition to making quality palliative care widely available, the new 24-page report, End-of-Life Care in Ontario, makes several other key recommendations, including:

  • Patients and health-care providers must make clear care plans, including legal documents like advance care planning
  • All patients should have a choice about where they want to die, be it at home, in a hospice or in a palliative-care bed in hospital
  • End-of-life care should be an integral part of medical and nursing school education; family caregivers need better training and support
  • Clear directives are required about when cardiopulmonary resuscitation should be used on terminally ill patients

The Auditor-General’s 2014 Annual Report also said that using accepted standards of practice, Ontario – where there are roughly 90,000 deaths a year – should have about 1,080 beds in hospices and 270 palliative-care beds in hospitals. Currently, there are only 271 hospice beds in the province and there is no good information on how many palliative-care beds there are in hospitals.

It certainly looks like that palliative care in Ontario is moving from piecemeal patchwork to better planned reforms which is excellent news for baby boomers and seniors.

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British Hospitality Role Model

 

Photo credit: bestourism.com

Photo credit: bestourism.com

I’ve always felt that whenever I travel outside Canada, I get excellent service – whether it’s in the U.S.or Asia. Now, even London, UK, exemplifies great hospitality.

Four years ago, I stayed at The Langham London and wrote a blog post on its excellent service. Last month, I stayed for six days again in the same hotel and marvelled at its quality again. In fact, not only was the hotel able to maintain its property and rooms in top-notch shape, but the service actually further improved from that of four years ago!

Due to my dietary constraints, I have called the hotel prior to my departure to inform them of my special requests for meals in the Club Lounge. Not only were they able to give me gluten-free options during breakfast, but they also provided ample selections for afternoon tea and hot and cold hors d’oeuvres in the evening as well. The staff at the Club Lounge were all attentive and eager to please. My request for unsweetened almond milk for breakfast was fulfilled throughout my entire stay without fail. I also noticed that the food quality and selections at the Lounge were higher and more generous than the options from my visit four years ago.

Club Lounge attendant Annabel proactively checked all the benefits of the hotel’s loyalty program for me and express check-in and check-out were super efficient. One of the longest-serving doormen, Ian, who has been working for the hotel for 12 years, was super charming and addressed me by the last name. With such well-trained staff, how can a hotel guest not be happy and satisfied?

My only complaints, if any, were the overly-vibrant noise level of the hotel’s Artesian Bar almost every evening during my stay and the occasional fruit flies over lunch at The Palm Court Restaurant.

When it comes to hotel bars in London, my preference would be The Churchill Bar at The Hyatt Regency Churchill. The elegant and stylish bar was designed with a young Winston Churchill and his wife in mind, with references to the late Prime Minister’s life in photography and art, and in travel and animals. This is the bar where London Mayor Boris Johnson recently launched his new biography on Churchill by conducting media interviews here – a bar with interesting cocktails where you could either relax alone or talk to friends over drinks without the need to yell at one another.

London’s weather was bone-chill cold and damp in November, and I was eventually glad to return to Toronto even though it’s at least five degrees Celsius colder here. But I must say that I miss the excellent service at The Langham which should be an exemplary role model for our hospitality industry in Canada!

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Boomers Serve Boomers

 

Photo Credit: Hello Magazine

Photo Credit: Hello Magazine

As a blogger, I’ve been receiving many sales pitches of blogpost content ideas from companies and their marketng firms targeting at baby boomers. Recently, I came across two Canadian entrepreneurial ventures which I thought might be of interest to my readers and followers.

Earlier this month, Blaycation, a bucket-list travel adventure company was launched as an online travel planner for baby boomers and mature adventure seekers. Whether it’s walking with lions in Zimbabwe, kayaking in Vietnam’s Halong Bay, witnessing a Stanley Cup Final Game in L.A., or zip-lining across Victoria Falls, the firm wants to help its clients realize their personal travel dreams.

The company’s travel website www.blaycation.com features 20 personally-designed tours that include many exotic travel destinations and bucket-list adventures. The online service offers to boomers who have the time and the disposable income to realize their travel dreams while recognizing that the clock is ticking. The website features prepackaged tours, but also specializes in customized trips to suit their clients: from couples looking for a romantic getaway to families planning a vacation for multigenerational travel to corporations looking to reward top performers.

According to Blaycation’s founder and President, Mark Stiles, one of the company’s major differentiators is appealing to people’s dream vacations and bucket-list adventures and tying them both together in a personable product delivery. Stiles said that he wants to inspire people to see more, do more and to have rich authentic experiences through both his designed tours as well as their very own personal bucket-list items.

After reviewing and surfing the site for a while, I found the site very easy and fun to navigate. The bucket-list concept is also quite unique since there are a lot of adventure travel firms out there, but few focus on just fulfilling bucket-list travel dreams. When asked why there is no adventure travel just catering to single boomer travellers, Stiles responded that this audience might be a niche target that he’s planning for the future.

As the first travel group is just taking off this month, I will certainly talk to Stiles in six months’ time to see how his business is doing and whether boomers are responding positively to this concept.

Another interesting entrepreneurial service, targeting at baby boomers who are often caregivers of their elderly parents, is a monitoring system using  wireless sensor technologies to help boomers’ elderly parents maintain their independence while monitoring their activities and getting help for them when necessary. The company, Everpresent, positions itself as a service that provides peace of mind for families with independent elders. According to their website, www.myeverpresent.ca, the company senses activity in the home and watches for regular activity patterns and irregular events via their heuristics engine. Based on rules that customers decide, mobile text or email notifications are then sent to selected family members or friends. For example, it’s 3 a.m. and the garage door has been opened – please check on Mom. Or, it’s midnight, and high temperature is sensed in the kitchen – please check on Dad.

According to the company’s founder, Keith Seibold, Everpresent Services developed the cloud-based “heuristics engine” that collects sensed information over time and compares readings against rules of interest or concern and notifies family and/or friends. Since this system is all computer-driven, there is no individual person who will be watching any sensor and ensures that privacy is maintained. The system is automated and runs 24×7. When addressing my concern about the possibility of batteries running out, Seibold said that the sensoring device is operated on batteries that can last for years. Some last for up to four years without any battery replacement. The system continually monitors battery levels and reports back to Everpresent and to the customer if the battery level drops below a defined threshold. If it does, a message will be sent to the customer to replace it. Seibold said that the sensors are proven industrial-grade solutions that they’ve integrated with the company’s heuristics engine to determine when behaviours of concern or interest occur.

Seibold developed this system when he and his wife faced the challenge of taking care of Seibold’s father-in-law while enabling him to maintain his independence. Because this is not a security solution, it does not require the elder to wear any device. The sensor sits passively in the background sensing activity (or lack of) and using customized rules to notify one or more family members or friends if there’s something of concern. Depending on which of the three services customers subscribe to – basic, enhanced or customized – the monthly service cost can range from $39 a month for one sensor to $49 a month for three sensors. Customized services would incur a higher monthly cost. There is also a one-time installation cost, that includes the installation of the sensors, which might vary depending on how many sensors are desired.

Since this service is also relatively new, I would like to check on them in mid-2015 to gauge their customer response. If successful, this would be great news for the aging-in-place population!

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Retirement and Longevity

retirement_road (foxbusiness.com)

Everybody, by now, must be familiar with the fact that life expectancy continues to climb for older North Americans. According to the annual report on mortality rates by the U.S. National Center for Health Statistics, released earlier this month, people who reached age 65 could look ahead to an average additional 19.3 years on the planet, “an all-time high” according to The New York Times. Men would anticipate another 17.9 years, on average, and women another 20.5.

Should we boomers cheer for or be concerned about these statistics? It all depends on your perspective towards life itself. If you believe in quality, rather than, quantity, then this long lifespan might be bad news. But if you want to cling on to life itself, good or bad, sick or healthy, then this is definitely good news. But what about the impact of a long lifespan on your retirement?

A paper attributed to the aircraft-maker Boeing Aerospace shows that employees who retire at 55 live to, on average, 83. But those who retire at 65 only last, on average, another 18 months. A more recent actuarial study conducted on some of the larger U.S. pension funds, including Boeing, indicates that employees who retired at the age of 65, died within two years of retirement. According to business.com, the studies were based on the number of pension fund cheques sent to Boeing retirees. The Boeing experience was that employees retiring at age 65 received pension cheques for 18 months, on average, prior to death. A similar experience was discovered at Lockheed Martin, where on average, employees received pension cheques for just 17 months. Other companies such as Ford Motor Company and Bell Labs were similar to those of Boeing and Lockheed.

The implication is that the hard-working later retirees (at age 65) are more than likely putting too much stress on their ageing bodies and minds and due to stress, they develop a variety of health problems. The associated stress accounts for health problems that lead to them dying within two years of retirement.

Another statistic from Boeing is that those who retire earlier, around age 55, tend to enjoy their retirement, on average, for more than 25 years. The chances are that those able to retire earlier have less stress; have planned and managed their lives better, in terms of finances, health and career; and are able to retire comfortably.

Another observation is that these younger retirees are quite active after early retirement. They may be keeping busy with part-time work, hobbies and pursuing their passions in life. So they are far less stressed than their working counterparts from age 55 to 65. This study pretty much implied that for every year you work beyond the age of 55, on average one forfeits two years of lifespan.

Although none of these studies carried strong enough evidence to prove that the findings are true or scientifically sound, they are certainly food for thought for baby boomers who are thinking about their retirement. But when you get to that old, you might not be happy, particularly if your life is prolonged by medical interventions and drugs! Your caregivers might not be cheering either.

Whether you choose to retire early or not, make sure that you’ll be financially sound and debt-free when you retire. Find a hobby to pursue, exercise and stay active. The rest is in God’s hands!

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A Generation Split On Hong Kong Protests

Photo Credit: businessweek.com

Photo Credit: businessweek.com

Ever since the protests in Hong Kong began about three weeks ago, I have been arguing and fighting with many of my friends in both Hong Kong and Canada via e-mails, long distance telephone conversations and even over many meals. There are usually five camps of people among my friends: those who, like me, support democracy at all costs and, therefore, support the protesters; those who are pro-China because they see China as their motherland and any disturbances and challenges to the Chinese and Hong Kong authorities are seen to be disloyal; others who are just pro-business and do not want chaos and disorderly conduct to prevent them from continuing to make good money in Hong Kong; those who live and work in China with foreign passports whose main goal is to make a quick buck and then returning to their respective adopted countries to retire; and, finally, those who have chosen to retire in China and, therefore, adopt the attitude of the three wise monkeys: see no evil, hear no evil and speak no evil.

I have long predicted that such an outburst would be inevitable. Historically, Britain’s handover of Hong Kong back to China was the right thing to do. Hong Kong should belong to China and Britain has occupied and reigned the island during a time when China was weak and helpless. But, in reality, Hong Kong has thrived under British rule for over 150 years and its status as an international free trade centre and economic powerhouse over the years was indisputable. During that time, Hong Kong citizens (including myself) couldn’t care less about politics. In fact, we took pride in being politically frigid because all we cared about was how to climb up the corporate ladder and make more money.

I had applied for emigration to Canada even before the notorious June 4 Tiananmen Square protests took place in 1989. I’ve never had confidence in communist and autocratic governments because I believe we, who grew up in Hong Kong under British rule, have very much taken democracy and freedom of speech for granted. With the censorship of the press, the likelihood of me practising as a professional public relations practitioner without restraints would have been zero. I also did not not want to be any part of the government propaganda that I predicted would influence Hong Kong when China took over. I left the city where I was born and educated in 1990 and have never looked back or regretted my move.

When many of my friends said that Hong Kong is getting worse nowadays, I begged to differ that, on the contrary, the people of this Special Administrative Region of China are actually getting better in their political consciousness. Hong Kong people are actually speaking up for themselves and fighting for democracy and freedom of speech. Twenty years ago, such street protests in Hong Kong were simply impossible and would not have happened. I am particularly sympathetic with the student protesters who are really fighting for their future. With all the media analyses that have been appearing both online and offline, few have focused on the demographic split on what’s happening there. Students from both high schools and universities have a right to speak their minds because they are fighting for their future. Many of the protesters are also aware that they might not get what they want from China, but they do believe in the fundamental principles of democracy: speak up or you will be silenced forever!

I see many business-minded baby boomers in Hong Kong who focus on making money and maintaining Hong Kong’s status as an international business centre. I also see another group of boomer parents who took to the streets with their kids either because they were worried about their safety or they were just simply sympathetic to their cause. I do not buy China’s conspiracy theory that the United States and Britain have influenced the students and funded the protesters’ movement from behind the scenes. I also agree with the last British governor of Hong Kong, Chris Patten, who wrote in The Globe and Mail op-ed that “it is a slur on the integrity and principles of Hong Kong’s citizens to assert….that they are being manipulated by outside forces.” I have many friends who can’t even influence their own kids – it’s absolutely insulting to the bright, young students of Hong Kong to mention that they were capable of being influenced by the West.

At the moment when this blog is posted, the protesters and the Hong Kong government are still at a standstill. The authorities are trying to buy time and the protesters continue to ask for the Chief Executive C. Y. Leung to resign. This situation should not be compared to the Tiananmen protests because Hong Kong is not Beijing, and China is no longer the China of 1989. None of the protesters expect China to grant their request for universal suffrage, but if anybody believes that this demonstration will just go away because they will be fatigued, then they are really naive. Some dialogue is better than no coummunication at all and nobody wants to see any bloodshed, particularly among the students.

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