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Transforming Long-Term Care Pain Management in North America: The Policy-Clinical Interface | Request PDF rruggia

Authors:

  • Thomas Hadjistavropoulos, University of Regina
  • Gregory Marchildon, University of Toronto
  • Perry G Fine, University of Utah
  • Keela Herr, University of Iowa
  • Howard A. Palley, University of Maryland, Baltimore
  • Sharon Kaasalainen, McMaster University
  • Francois Beland, Université de Montréal
     

Abstract.

The undertreatment of pain in older adults who reside in long-term care (LTC) facilities has been well documented, leading to clinical guideline development and professional educational programs designed to foster better pain assessment and management in this population. Despite these efforts, little improvement has occurred, and we postulate that focused attention to public policy and cost implications of systemic change is required to create positive pain-related outcomes. Our goal was to outline feasible and cost-effective clinical and public policy recommendations designed to address the undermanagement of pain in LTC facilities. We arranged a 2-day consensus meeting of prominent United States and Canadian pain and public policy experts. An initial document describing the problem of pain undermanagement in LTC was developed and circulated prior to the meeting. Participants were also asked to respond to a list of relevant questions before arriving. Following formal presentations of a variety of proposals and extensive discussion among clinicians and policy experts, a set of recommendations was developed. We outline key elements of a transformational model of pain management in LTC for the United States and Canada. Consistent with previously formulated clinical guidelines but with attention to readily implementable public policy change in both countries, this transformational model of LTC has important implications for LTC managers and policy makers as well as major quality of life implications for LTC residents.

Long-term care United States, canada
Sistema Nacional de Cuidados rruggia

El Sistema Nacional de Cuidados promueve la implementación de políticas públicas destinadas a atender las necesidades de personas mayores de 65 años en situación de dependencia, niños de 0 a 3 años y personas con discapacidad severa. Además, busca mejorar la vida de las personas dependientes a través de prestaciones de cuidados integrales; visualizar como responsabilidad de toda la sociedad el cuidado de las personas que no tienen autonomía; conciliar la vida laboral con la reproducción familiar; regular los servicios públicos y privados existentes; descentralizar los servicios adaptados a las necesidades de cada lugar mediante acuerdos con las intendencias y los municipios; valorizar y capacitar a los cuidadores, tanto a los que perciben una remuneración por su tarea como los que no. El sistema está integrado por los ministerios de Desarrollo Social, Educación y Cultura, Trabajo y Seguridad Social, Salud Pública, y Economía y Finanzas. También participa en su puesta en práctica la Oficina de Planeamiento y Presupuesto, la Administración Nacional de Educación Pública, el Banco de Previsión Social y el Instituto del Niño y el Adolescente del Uruguay. A su vez está conformado por la Junta Nacional de Cuidados, la Secretaría Nacional de Cuidados y el Comité Consultivo.

Long-term care uruguay
Cuidados en América Latina y el Caribe en tiempos de COVID-19: hacia sistemas integrales para fortalecer la respuesta y la recuperación rruggia

La construcción de sistemas integrales de cuidados es un factor fundamental para el logro del empoderamiento de las mujeres y la igualdad de género, y un elemento clave para la recuperación socioeconómica al convertirse en un generador directo e indirecto de empleo y un facilitador de que otros sectores de la economía funcionen adecuadamente. Por ello, ONU MUJERES y CEPAL llaman a los gobiernos de la región a colocar los cuidados en el centro de sus respuestas al COVID-19, creando paquetes de incentivos y recuperación, promoviendo sistemas integrales que aseguren el acceso al cuidado de las personas que lo requieren y garantizando los derechos a las personas que los brindan. Los sistemas integrales de cuidados pueden convertirse en un verdadero motor de una recuperación socioeconómica que no deje a nadie atrás. Este documento fundamenta la relevancia que tienen los cuidados para las sociedades, caracteriza la situación actual de los cuidados en América Latina y el Caribe y describe los impactos generados por la crisis del COVID-19, así como las medidas de contingencia que se vienen implementado en varios de los países de la región para hacer frente a la crisis, y concluye con una serie de recomendaciones de políticas para abordar la crisis de los cuidados como parte de la salida de la crisis del COVID-19.

Long-term care latin america
How Can Basic Income and Health Care Prevent the Next Crisis? pmassetti

globalcitizen.org (10.09.2021) As countries seek to contain COVID-19, a return to the way things were is not an option, according to Olivier De Schutter, the UN Special Rapporteur on Extreme Poverty and Human Rights. Instead, countries must guarantee basic living conditions. “We see that when social protection remains weak, the poorest pay the price,” De Schutter said. “Due to the COVID-19 pandemic and economic slowdown, an estimated 115 million additional people may have fallen into extreme poverty in 2020, and 35 million more may follow this year. “This could have been avoided with strong social protection mechanisms, which shows that if governments maintain low levels of social support, societies are not ready to cushion shocks,” he added. “They actually run into a stone wall.”  De Schutter recently spoke to Global Citizen about the global effort to achieve a “social protection floor,” what people get wrong about welfare, and how eliminating poverty helps all of us. 

covid19 Extension of coverage
We are just now discovering how devastating COVID-19 has been for the very poor pmassetti
COVID-19's four lessons for improving Africa's social protection systems pmassetti

Africa at LSE (01.09.2021) Across Africa, states have adapted or expanded social protection measures in response to the COVID-19 pandemic. These interventions provide valuable policy lessons and political opportunities to reimagine the social contract on the continent.

covid19 Extension of coverage Africa
World Social Protection Report 2020-22: More than 4 billion people still lack any social protection, ILO report finds pmassetti

ILO 2021. The COVID-19 pandemic has revealed and exacerbated the social protection gap between countries with high and low income levels.

covid19
[Report] WHO compendium of innovative health technologies for low-resource settings 2021. COVID-19 and other health priorities pmassetti

who.int (31.08.20121) Health technologies are essential for a functioning health system. The  response  to  the  global  COVID-19  pandemic  crisis  has  exacerbated  the  need  for  rapid  evidence based  assessments  of  innovative  health  technologies  to  ensure  safe  and  appropriate  use.  Thus,  the objectives of the 2021 compendium are to: 1.Select  innovative  technologies  that  can  have  an  immediate  or  future  impact  on  the  COVID-19 preparedness  and  response,  have  the  potential  to  improve  health  outcomes  and  quality  of life,  and/or  offer  a  solution  to  an  unmet  medical/health  technology  need  by  evaluating  their appropriateness, quality, and safety.  2.  Shed  light  on  advantages  and  challenges  associated  with  the  adoption  of  innovative  health technologies in low-resource settings. 3. Acknowledge some success stories  and,  at  the  same time,  raise  awareness  of  the  pressing  need  for appropriate and affordable solutions and encourage more innovative efforts in the field. 4. Encourage greater interaction among Ministries of Health, procurement offices, donors, technology  developers,  manufacturers,  clinicians,  academics  and  the  general  public  to  ensure greater  investment  in  appropriate  health  technology  and  a  move  toward  universal  access  to essential health technologies. 5.  Support informed procurement decisions by NGOs, governments, and other stakeholders.

covid19 Africa
Towards a more gender-equitable COVID-19 response pmassetti

Modern Diplomacy (31.08.01 ) As the effects of the COVID-19 pandemic continue to ripple across the world, they leave in their wake an upheaval touching all areas of public life. While all have been effected, no segment of the population has been impacted more, and in more varied ways, than women. The pandemic has shown scant regard for women’s socio-economic or marital status, for motherhood, occupation ethnicity or region of origin. Instead, it has brought into stark relief the fragility of global progress toward gender equality, illuminating the deep and ongoing imbalances in our political, social and economic systems and threatening what advances have been accomplished over the past few decades.

covid19 Gender equality
COVID-19 G2P Cash-Transfer Payments : Case Study : Philippines pmassetti

worldbank.org (01.05.2021) The COVID-19 (coronavirus) pandemic is having devastating impacts on the economy and people of the Philippines, and since the onset of pandemic, the Government of the Philippines (GoP) has responded with strong social protection measures. The Social Amelioration Program (SAP) enacted under the Bayanihan To Heal as One Act in March 2020 and managed by the Department of Social Welfare and Development (DSWD), aims to provide cash assistance to 18 million households (over 75 percent of total households) in the country. The first tranche of SAP (SAP 1), however, experienced significant delivery challenges. This experience led to several changes in the operation of the second tranche of SAP (SAP 2). This case study aims to document the lessons learned from the implementation of the SAP 2, specifically focusing on the digital G2P (government to persons) payment delivery.

covid19 E-services, Cash transfers philippines, the
US: Most Rental Assistant Funds Not Yet Distributed, Figures Show pmassetti

 The New York Times (25.08.2021) Just $1.7 billion in funds intended to prevent eviction were disbursed in July as the White House braces for a Supreme Court decision that could strike down its eviction moratorium.

covid19 Housing United States
Digital bodies and digitalised welfare: North-South linkages in the politics of food assistance and social welfare pmassetti

ideas.repec.org (2021) This paper examines North–South linkages in the politics of contemporary food assistance and social welfare, and in particular the normalisation of poverty and humanitarian crisis caused by increased digitalisation, privatisation and individualisation of aid or welfare. Migrants and displaced populations are considered as extreme cases and we examine how these policies and practices are leading to the growth of a global precariat who are constantly on the edge of survival (or death). We use Sudan, India and the UK as case-study countries which have seen persistently high levels of acute malnutrition or rising levels of hunger (as in the case of the UK), as well as the introduction of new digital welfare systems. Digital practices often aim to improve access to food and form a key part of humanitarian and welfare assistance, thereby creating digital welfare states

Information and communication technology, Digital inclusion sudan, india, united kingdom
India And Unemployment: Covid-19 And Its Impact On The Indian Workforce pmassetti

Forbes India (20.08.2021) Structural weaknesses in the jobs market, amplified by Covid-19, continue to quietly impact many, particularly women and younger workers. Creating sustainable, quality employment opportunities need urgent policy attention and reforms

covid19 Unemployment india
The Increase in Social Protection Programs During COVID-19 pmassetti

BORGEN (14.08.2021) In an attempt to protect from economic disaster in the wake of the COVID-19 pandemic, governments enacted an unprecedented number of social protection programs. According to the World Bank, Social protection “traditionally consists of labor markets, pensions, social funds and ‘safety nets’.” Although developing countries introduced 1,300+ social protection and jobs programs related to COVID-19, the International Labor Organization (ILO) “estimates 255 million full-time equivalent” job losses in 2020.

covid19 Shocks & extreme events
Polish government announces new child benefits for families to "create the future of our nation" pmassetti

notesfrompoland.com (17.08.2021) The Polish government has unveiled plans for a new child benefit scheme. It hopes that the policy will provide an “incentive to have more children”, who will “create the future of our nation”. Under the “Family Welfare Capital” scheme approved by the cabinet today, the state will from the start of next year pay families 12,000 zloty (€2,630) for each child after their firstborn between the age of 12 and 36 months. The benefit will be available to all families, regardless of income. The child’s parents can decide whether the total is paid out in monthly instalments of 1,000 zloty over one year or 500 zloty over two years, reports Wprost. Those who already have a child within the eligible age range when the scheme is introduced can receive payments until the child reaches 36 months.

Family benefits poland
Bangladesh: Redesigning social safety net programmes to mitigate Covid-19 impacts pmassetti

thefinancialexpress.com.bd (10.08.2021) The Government of Bangladesh has allocated 17.83 per cent of the total budget for fiscal 2021-22 for Social Safety Net Programmes (SSNPs). The coverage is diverse; it includes programmes related to poverty eradication, education, health, infrastructure, disaster management, housing for the poor, amongst many. However, if we take out pensions and honorarium for the non-poor, educational stipends, agricultural subsidies and so on, the actual social safety net allocation comes down to 50 per cent.

covid19 Social policies & programmes bangladesh
Redesigning Canada’s social safety net for the post-pandemic economy pmassetti

policyoptions.irpp.org (10.08.2021) COVID revealed the shortcomings of Employment Insurance and income-support programs. As the economy rebuilds, now’s the time to examine the system.

covid19 Unemployment canada
Volvo Cars Family Bond gives all employees 24 weeks paid parental leave - Volvo Cars Global Media Newsroom rruggia

Volvo Cars is opting in its 40,000+ employees around the globe, in all plants and offices, into a new all-gender, paid parental leave policy as of April 1, 2021. The ‘Family Bond’ policy will give all employees with at least one year’s service a total of 24 weeks of leave at 80 per cent of their base pay by default. The policy applies to either parent and the leave can be taken anytime within the three first years of parenthood.

Parental leave sweden
India: Migrant workers cry neglected by the Government. How has the Covid-19 pandemic crisis highlighted the need for social security? pmassetti

 Inventiva (20.07.2021) India’s pandemic crisis has had its heart-rending consequences on millions of people across informal sectors.

covid19 Migration india
Spain inches ahead with pension reform pmassetti

Pension Policy International (19.07.2021) Spain will pay workers to postpone retirement as part of a pensions reform strategy that analysts warn does not go far enough to cut a huge deficit in the system.

Pensions spain
To tackle COVID-19 outbreaks, ASEAN MPs call for more inclusive policies for migrant workers pmassetti

ASEAN Parliamentarians for Human Rights - JAKARTA – As COVID-19 cases surge in Thailand and Malaysia, as well as elsewhere in the region, Southeast Asian lawmakers urge these governments to take more inclusive measures to protect everyone without discrimination, regardless of their migration status, ASEAN Parliamentarians for Human Rights (APHR) said today. “While we are all affected by the pandemic, governments are excluding migrant workers from their social and public health policies in their response, leaving them behind and struggling to survive. We will never recover from this health crisis if we do not provide care for everyone, including all migrants. Government policies must ensure that they have equal access to immediate aid, testing, treatment, and vaccinations, without fear,”

covid19 Migration Asia
Pandemic has eroded past efforts to fix unemployment, inequality, say BRICS Ministers pmassetti

The Economic Times (15.07.2021) The labour ministers of five BRICS nations -Brazil, Russia, India, China and South Africa on Thursday, said the COVID-19 pandemic has negatively impacted the efforts made in the past to address unemployment, decent work deficits and inequality. “Discussion on four priority areas of cooperation took place namely, promoting social security agreements amongst BRICS nations; formalisation of labour markets; participation of women in the labour force; and gig and platform workers’ role in the labour market,” it said in a statement.

brics, covid19 Unemployment india
Report: Employment and Social Developments in Europe review shows diverse impact of COVID-19 crisis pmassetti

European Commission (06.07.2021) This review provides an up-to-date economic analysis of the steps the European Union (EU) is taking towards a strong social Europe, particularly in the aftermath of the COVID-19 (coronavirus) crisis. This ESDE report shows that the social impact of the COVID-19 crisis has been uneven and diverse. Regional inequalities that already existed before the pandemic may have widened, according to the review. The 2021 ESDE highlights that in order not to jeopardise the success of the EU’s response to the pandemic crisis, a strong social dimension needs to accompany our economic recovery. Centred around evidence-based analysis, the review delves into how to achieve stronger social rights across the EU as we recover from the COVID-19 pandemic.

covid19 european union
India: Delhi govt launches social security scheme for Covid-19 affected families pmassetti

Times of India (06.07.2021) Delhi chief minister Arvind Kejriwal on Tuesday launched a scheme and an online portal to provide financial assistance to families who lost their loved ones to Covid-19 and asked officials not to find faults in their claim applications. Under the 'Mukhyamantri Covid-19 Pariwar Aarthik Sahayata Yojana', Rs 50,000 ex-gratia will be given to every family that lost a member to Covid-19 and an additional Rs 2,500 per month will be given if the deceased was the sole breadwinner. 

 

covid19 Family benefits, Cash transfers india
Germany finally launches basic pension scheme pmassetti

Pension Policy International (09.07.2021) Germany’s basic pension scheme kicks off this July Shortly before the federal election in September, Germany’s coalition government is finally delivering on its promise to top-up insubstantial pension benefits to ensure a basic standard of living for all retirees who have contributed to the social security system. Under the new system, anyone who has contributed towards a German pension for at least 33 years will qualify for a basic pension. This includes not just time spent working, but also time taken out to raise a family or care for a relative. Mini-jobs subject to pension insurance as well as military service or political imprisonment in the German Democratic Republic (GDR) are also taken into account, but periods of receiving unemployment benefits are not. The idea is to give an income supplement to those who have contributed towards a pension for a long period of time but – due to having a lower salary or fewer working hours – have not built up a sufficient pension entitlement to ensure a basic subsistence level. Federal Labour Minister Hubertus Heil expects 1,3 million people will be eligible for the basic pension – 70 percent of them women.

Pensions germany