Continence is a key moment of care that can tell us about the wider care of people living with dementia within acute hospital wards. The spotlight is currently on the quality of hospital care of older people across the UK, yet concerns persist about their poor treatment, neglect, abuse, and discrimination within this setting. Thus, within hospitals, the care of people living with dementia is both a welfare issue and a human rights issue. The challenge of continence care for people living with dementia can be seen as the ‘canary in the coal mine’ for the unravelling of dignity within the acute setting. This paper draws on an ethnographic study within five hospitals in England and Wales, selected to represent a range of hospital types, geographies and socio‐economic catchments. Observational fieldwork was carried out over 154 days in acute hospitals known to admit large numbers of people living with dementia. This paper starts to fill the gap between theory and data by providing an in‐depth ethnographic analysis examining the ways in which treatment as a person is negotiated, achieved or threatened. We examine how the twin assaults on agency of a diagnosis of dementia and of incontinence threaten personhood. The acute threats to this patient group may then act to magnify perils to treatment as a person. Our findings suggest that personal dignity and the social construction of moral personhood are both threatened and maintained in such a setting. We show how empirical ethnographic data can lend weight to, and add detail to, theoretical accounts of moral personhood and dignity.
The Canary in the Coal Mine: Continence Care for People with Dementia in Acute Hospital Wards as a Crisis of DehumanizationMay 5, 2018
Preliminary figures show faster growth in the amounts governments are budgeting for healthcare over the past three years, according to a new report from the C.D. Howe Institute. In “Healthcare Costs in Canada: Stopping Bad News Getting Worse,” author William B.P. Robson warns that the preliminary figures likely understate the acceleration, since later figures typically reveal that provinces and territories have overshot their budget targets.
A study by the Fraser Institute titled The Effect of Wait Times on Mortality in Canada estimated that “increases in wait times for medically necessary care in Canada between 1993 and 2009 may have resulted in between 25,456 and 63,090 (with a middle value of 44,273) additional deaths among females.” Adjusting for the difference in populations (the US has about 9 times as many people), that middle value inflates to an estimated 400,000 additional deaths among females over a 16 year period. This translates to an estimated 25,000 additional female deaths each year if the American system were to suffer from increased mortality similar to that experienced in Canada due to increases in wait times.
The Declaration of Independence states that all people are endowed with certain unalienable rights, and that among these is the pursuit of happiness. But is happiness available equally to everyone in America today? How about elsewhere in the world? Carol Graham draws on cutting-edge research linking income inequality with well-being to show how the widening prosperity gap has led to rising inequality in people’s beliefs, hopes, and aspirations.
For the United States and other developed countries, the high costs of being poor are most evident not in material deprivation but rather in stress, insecurity, and lack of hope. The result is an optimism gap between rich and poor that, if left unchecked, could lead to an increasingly divided society. Graham reveals how people who do not believe in their own futures are unlikely to invest in them, and how the consequences can range from job instability and poor education to greater mortality rates, failed marriages, and higher rates of incarceration. She describes how the optimism gap is reflected in the very words people use—the wealthy use words that reflect knowledge acquisition and healthy behaviors, while the words of the poor reflect desperation, short-term outlooks, and patchwork solutions. She also explains why the least optimistic people in America are poor whites, not poor blacks or Hispanics.
Happiness for All? highlights the importance of well-being measures in identifying and monitoring trends in life satisfaction and optimism—and misery and despair—and demonstrates how hope and happiness can lead to improved economic outcomes.
All of which is to show that your probability of dying from a range of common conditions is much higher in the UK than here. Perhaps that’s why (with no hint of irony) The Guardian’s write-up of a Commonwealth Fund Report suggesting the UK’s health system was “the best in the world” said “the only serious black mark against the NHS was its poor record on keeping people alive.”
We highlight recent data on stillbirths, discount life expectancy at birth (LEB) for stillbirths, and suggest discounted LEB be used as an element in measuring well-being. Information on stillbirths in all countries has been available since 2006; and that on neonatal and infant mortality since 1990. Using data from The Lancet and World Bank, we redefine stillbirth rate consistently with neonatal and infant mortality, and show its incidence is quite close to neonatal mortality’s; and for high and upper middle income countries, it is higher. Overtime, the reduction in the two rates for low income countries is smaller than for high income from their already very low rates. Recent stillbirth data for all countries has been ignored by economists and social scientists. We suggest stillbirths be estimated annually by the same Inter-Agency Group that estimates neonatal and infant mortality. Almost as many live births do not survive beyond the first day as the intra-partum stillbirths. On grounds that stillbirths lie on a continuum between premature births and neonatal mortality where only the latter are included in the LEB, we suggest a parallel measure, discounted LEB, be developed. Discounting LEB for stillbirths will make it a better measure of health, reduce the neglect of the malaise of stillbirths, show how far the poor countries truly have to travel to capture the perceived low-hanging fruit of catching-up with high income countries’ life expectancy level, and lead to a better beyond GDP measure of well-being.
Social Assistance and Minimum Income Levels and Replacement Rates Dataset by Jinxian Wang, Olaf van Vliet :: SSRNFebruary 9, 2017
The Social Assistance and Minimum Income Levels and Replacement Rates Dataset provides two new indicators for comparisons of social assistance and minimum income benefits across countries and over time, namely real net minimum income benefit levels and net minimum income benefit replacement rates. The dataset contains information for 33 countries for the period 1990–2009. For information on social assistance and minimum income benefits, the dataset draws upon information from Nelson’s (2013) dataset. The minimum income replacement rates are comparable to unemployment replacement rates.