Clinical Corner : Wellness

Is Health Care a Right or a Privilege? Part 1 - Pro

Carol Kleinman — Mon, 20 Jul 2009 19:03:00 GMT

Once upon a time before the Military-Industrial-Government Complex, Americans were mostly rural and relied on direct sources of food, water, fuel, and shelter. Personal involvement in and responsibility for those needs has decreased with the transformation from direct personal sourcing modes to control of sourcing by corporate operations.

That transformation happens without anything one can reasonably consider as adequate citizen or government oversight. All too often, lack of transparency is intentional with the result that American citizens have woefully inadequate awareness of the long-term cost/benefit picture. With the advent of "globalization" this sorry state of affairs is now being propagated abroad by corporate entities in the form of WTO, NAFTA, World Bank, etc.

While some aspects of quality of life improve for some populations, it is undeniable that tragic consequences have befallen segments of populations with little or no opportunity for them to correct the wrongs of the larger society and improve their lot. Medical statistics have shown that degraded diet, water, and air quality are responsible for billions of dollars in AVOIDABLE health care costs. That degradation has happened largely without citizen involvement in the decisions that brought it about.

So one must ask, if YOU had cancer-right now-would you consider medical treatment a privilege?

Considering the above, one must conclude that

Health care is a human right
Preventive care must include broad revision and oversight of all commercial activity that has human health implications
Federal level controls must be implemented to protect citizen health and quality of life, at least until citizens are equipped to take on that responsibility

Pet Therapy Part IX: Key Components for Successful Use of Animals in AAA, AAT and RA Programs

Carol Kleinman — Wed, 17 Jun 2009 14:16:00 GMT

The following recommendations are from the American Veterinary Medical Association:

Interdisciplinary cooperation. Successful AAA, AAT and RA programs are inherently interdisciplinary and present a wonderful opportunity for veterinarians, physicians, nursing staff, activity directors, therapists, and volunteers to work together toward a common goal.

Planning. Establish realistic goals and expectations. Anticipation of possible problems and development of solutions prior to their occurrence can avoid conflicts that cause program failure.

Supervision. Staff and administrative supervision of AAT, AAT and RA programs are required to protect the welfare of human and animal participants. All personnel need to be made aware that the program is in place and that it is considered to play an integral role in patient care. If an animal becomes a permanent resident of a facility, one individual should be assigned primary responsibility for its care and management, including arrangements for weekend and holiday care.

Animal selection. Animals should be selected on the basis of type, breed, size, age, sex and, particularly, natural behavior appropriate for the intended use. Only animals with known medical and behavioral histories should be used, and medical and behavioral assessments should be performed prior to placing animals in a program. Animals should have been, and should be, trained by use of positive reinforcement. Animals must be chosen with the target population in mind. A boisterous, overactive dog may be friendly, but inappropriate for a nursing home in which many patients are using walkers. A visiting calf or lamb may be more effective with patients who have rural backgrounds than would a caged rodent.

Animal health, human health and environmental concerns. A wellness program should be instituted for animals participating in AAA, AAT, and RA programs to prevent or minimize human exposure to common zoonotic diseases such as rabies, psittacosis, salmonellosis, toxoplasmosis, campylobacteriosis, and giardiasis. Need for specific screening tests should be cooperatively determined by the program's attending veterinarian(s) and physician(s). Animals should also be appropriately immunized and licensed. With respect to immunization for rabies, the current Compendium of Animal Rabies Prevention and Control (prepared by the National Association of State Public Health Veterinarians and published annually in the Journal of the American Veterinary Medical Association) and/or state guidelines should be followed. If the animal is to reside at a facility, provisions must be made for its feeding, watering, housing, grooming, and exercise. Associated noise and waste disposal problems must also be solved.

Human animal interactions and welfare. During interactive sessions, the welfare of residents, animals, volunteers, staff, and visitors must be considered. Introductions of animals and human participants must be arranged and supervised, because some individuals may not enjoy interacting with animals or may have physical or emotional problems that contraindicate such interactions. Animals should be an integral part of a treatment program and not a reward for appropriate behavior on the part of the human participant. Animals should be monitored closely for clinical signs of stress and should have ample opportunity and space for solitude. Any problems or incidents that occur must be reported to appropriate supervisory staff.

Pet Therapy Part VIII: American Veterinary Medical Association Guidelines

Carol Kleinman — Wed, 10 Jun 2009 19:05:00 GMT

The following is the American Veterinary Medical Association's statement of policy, retrieved from: http://www.avma.org/issues/policy/animal_assisted_guidelines.asp

When the AVMA officially recognized, in 1982, that the human animal bond was important to client and community health, it acknowledged that the human animal bond has existed for thousands of years and that this relationship has major importance for veterinary medicine. As veterinary medicine serves society, it fulfills human and animal needs. Animal assisted activities, animal-assisted therapy, and resident animal programs are included and endorsed by human healthcare providers as cost effective interventions for specific patient populations in various acute and rehabilitative care facilities. Veterinarians, as individuals and professionals, are uniquely qualified to provide community service via such programs and to aid in scientific evaluation and documentation of the health benefits of the human animal bond. Animal assisted activities, animal-assisted therapy, and resident animal programs should be governed by basic standards, be regularly monitored, and be staffed by appropriately trained personnel. The health and welfare of the humans and animals involved must be ensured. Veterinarians' involvement in these programs from their inception is critical because they serve as advocates for the health and welfare of animals participating in these programs.

Animal assisted activities (AAA) provide opportunities for motivation, education, or recreation to enhance quality of life. Animal assisted activities are delivered in a variety of environments by specially trained professionals, paraprofessionals, or volunteers in association with animals that meet specific criteria.

Animal assisted therapy (AAT) is a goal directed intervention in which an animal meeting specific criteria is an integral part of the treatment process. Animal assisted therapy is delivered and/or directed by health or human service providers working within the scope of their profession. Animal assisted therapy is designed to promote improvement in human physical, social, emotional, or cognitive function. Animal assisted therapy is provided in a variety of settings, and may be group or individual in nature. The process is documented and evaluated.

Resident animals (RA) live in a facility full time, are owned by the facility, and are cared for by staff, volunteers, and residents. Some RA may be formally included in facility activity and therapy schedules after proper screening and training. Others may participate in spontaneous or planned interactions with facility residents and staff.

Human animal support services (HASS) enhance and encourage responsible and humane interrelationships of people, animals, and nature.

The Experience of Aging, Part VII - The Eden Alternative

Carol Kleinman — Wed, 07 Jan 2009 15:54:00 GMT

Long-term care has been considered many not to have evolved as quickly or as profoundly as other points along the health care continuum. However, many models have been and are continuing to be developed that provide a radically new way of viewing the care of older residents who often must live out their days in a care facility. One example is the Eden Alternative.

The Eden Alternative is an organization based on the core belief that aging should be a continued stage of development and growth, rather than a period of decline.

Founded in 1991 by Dr. William Thomas, a Harvard-educated physician and board-certified geriatrician, the Eden Alternative is being used in the U.S., Canada, Europe, and Australia. The staff and management of the facilities using this model work toward culture change through a dedication to improving the quality of life for those in their care.

The Eden Alternative shows how companionship, the opportunity to give meaningful care to other living things, and the variety and spontaneity that mark an enlivened environment can succeed where pills and therapies often fail. Places that have adopted the Eden Alternative typically are filled with plants, animals and are regularly visited by children.

Studies have shown that the Eden Alternative has been a tool for improving quality of life and quality of care for those living in long term care facilities. In those that have adopted Eden as an organizational-wide philosophy, there is often improved staff satisfaction and retention and significant decreases in the overuse of medications and restraints. Most importantly, Elders, supported by their caregivers, are better able to direct their own lives and feel a greater sense of control over their environment.

For more information, go to the Eden Alternative's Web site.

The Experience of Aging, Part II - The Myths of Aging

Carol Kleinman — Tue, 11 Nov 2008 18:26:00 GMT

Stereotypes abound about the aging process and the experience of older adults. I thought I would share some of them and provide the counterpoint of reality.

Myth 1: To be old means to be ill.

Rates of chronic illness and disability actually do increase with chronological age. However, even with functional deficits many older adults are still able to live independently in their own homes until they reach a very advanced age. Those that do not, still maintain a high degree of independence in care facilities. Despite limitations on activity, older people adapt in many ways, for example, by relying on a cane or walker or by using a hearing aid.

Myth 2: Older people have diminished cognitive abilities and cannot learn.

It has been said that older adults lose millions of brain cells each day. However, neurobiology has shown that the human brain actually retains a high degree of functionality and the ability to learn new things even into advanced age. This means older people can make changes that will improve their lives. There is significant data showing how changes in health behavior have delayed disability and diminished the need for long-term care. We must continually provide cognitive stimulation and new information that will assist older adults in making informed decisions in later life.

Myth 3: Successful aging is based on heredity.

The Human Genome Project and other advances in genetics have clarified the role of genetics as an influence on aging and health and it is becoming clearer that genetic factors actually play a smaller role in old age than they do earlier in life. In fact, it is not genetics but social and behavioral factors within our control that play the largest role shaping health and well-being. As aging adults learn this, they are able to focus on health promotion behaviors that will improve quality and duration of health and life.

Myth 4: It is too late for the elderly person to make changes.

We now understand that adopting healthy lifestyle behaviors can provide a positive return even into old age. Quitting smoking allows human lung function to approach normal after only a few years, even for those who quit smoking in middle age or later. Implementing an exercise regime has been shown to increase muscle mass and bone density well into old age and improved eating habits have been shown to reverse or ameliorate certain medical conditions.

Myth 5: The elderly do not have much to offer society.

More and more older people are attracted by what is called "productive aging," whether by extending years of paid employment or by engaging in productive roles in their families and communities. If older people are allowed to believe they have little to contribute, they may overlook ways in which their expertise and life experience can be useful to others. As education levels rise, physical health remains more robust into the senior years, and guaranteed pension income becomes more uncertain, it is likely that many more older people will continue to work well beyond what been normal retirement age.