WHEN OUR LOCAL CANDIDATES CAMPAIGN FOR HEALTH TECHNOLOGY----WHEN THEY TELL US OBAMA IS ADDRESSING HEALTH FRAUD AND SAVING MEDICARE AND MEDICAID----IF WE KNOW OBAMA IS A FAR-RIGHT 1% WALL STREET GLOBAL CORPORATE NEO-LIBERAL----AS IS O'MALLEY/BROWN ----AS IS PUGH/DIXON/EMBRY/WARNOCK/MOSBY/STOKES----WE KNOW THEY ARE PRETENDING TO HELP WE THE PEOPLE.
This is what MOVING FORWARD means to a PUGH as Mayor of Baltimore and a Larry Hogan as a Bush neo-conservative as Governor of Maryland.
When we see a World Health Organization under far-right 1% Wall Street leaders instead of the social progressives all last century we know all that HEALTH CARE FOR ALL funding that did used to build local health in developing nation communities is going to global corporate profits ----they are now simply using those funds to train more global labor pool workers who leave their communities because WHO is not building health institutions for them to work in their own nations. As this article states----there is plenty of funding available both from donor nations and in developing nations to build a HEALTH CARE FOR ALL structure---WHO as global 1% Wall Street does not want to. These global labor workers are of course sent to International Economic Zones around the world and work for almost nothing. Those making it to the US will do the same if Trans Pacific Trade Pact is installed---taking US citizens with them----US citizens as global sweat shop labor----white collar or factory.
The Global Tug-of-War for Health Care Workers
December 1, 2004
By Kimberly Hamilton, Jennifer YauIn the not too distant past, discussions involving "health" and "migration" would likely have focused on the physical and mental condition of immigrants, or, perhaps, the incidence of communicable diseases in a refugee camp. Today, however, the connection between health and migration can just as readily be illustrated by a hospital in AIDS-stricken Malawi, which has only 30 nurses, 26 of whom have plans to leave the country.
The international mobility of health workers is nothing new. In recent years, however, migration of health workers — from highly skilled physicians to those in lesser skilled positions, from the developing world to wealthier destinations — has increased. Moreover, the countries with the most alarming outflows include those sub-Saharan African nations suffering acutely from the HIV/AIDS epidemic and dwindling numbers of health workers.
Controversy surrounds the proper role of policy interventions in the global labor market of health care professionals. Emigration of health care workers weakens already failing health systems in the developing world. Yet this movement may more accurately be described as a symptom or an aggravating factor, and not the root cause of health care system failures in the developing world.
At the same time, the graying of the industrialized world has placed pressures on industrialized countries to find a solution for scarce or poorly distributed health care labor to support their aging populations.
Both scenarios shed light on this new global tug-of-war for health care workers. It is still unclear what the new rules of engagement will be to retain and train health care workers where they are most needed and to mitigate the grave imbalance between the rich and the poor with regard to health care. In light of these factors, experts are weighing a series of policy options that have important implications for the migration of the world's health care workers.
Ethical considerations that pit the right of individuals to move against a greater public good are at stake as well. Policymakers find themselves struggling with two complex sets of issues: how can health care workers with needed skills maintain their freedom of movement and the opportunity to respond to more favorable employment offers outside their country or region of origin without damaging the fundamental right of others in a population to a basic standard of health care?
WE CAN BUILD REAL PUBLIC HEALTH CARE IN DEVELOPING NATIONS SO THESE HEALTH WORKERS CAN STAY.
The Care Drain: A Global Phenomenon with Local Implications
While the flight of health care workers from sub-Saharan Africa to the United Kingdom, Australia, and North America captures the spotlight in current discussions on "health care brain drain," mapping out medical migration as a global phenomenon highlights the interconnections of flows across regions.
Notable source regions for health care-related migration are Africa, the Caribbean, South Asia, and Southeast Asia. According to the Organization for Economic Cooperation and Development (OECD), the primary destinations are the Anglophone countries of Canada, the U.S., the UK, Australia, and New Zealand. Across these countries, an average of 23 to 24 percent of physicians are trained abroad. Other recipients of significant numbers of medical migrants include Western Europe and the oil-exporting Gulf States.
Nurses, in particular, are leaving their home countries in greater numbers. The number of nurses in the UK from non-EU countries grew from approximately 2,000 in 1994-1995 to more than 15,000 in 2001-2002.
In the U.S., the percentage of nurses trained abroad increased from six percent in 1998 to 14 percent in 2002. Even the Philippines, a traditional sending country, sent more than three times the number of nurses abroad in 2001 than in 1996, primarily to the UK, Ireland, and Saudi Arabia. Such trends persist despite severe or emerging shortages in home countries. In fact, long-time source countries like India and the Philippines face health worker shortages themselves in rural and underserved areas.
Some developing countries, too, are becoming both destinations and sources of skilled workers. While an estimated 5,000 doctors have moved from South Africa to the U.S., UK, Canada, and Australia, South Africa has become a destination for health professionals in its own right, as indicated in a 2002 study by the Southern Africa Migration Project (SAMP). Neighboring Botswana shares a similar position in the Southern Africa region.
Among industrialized countries, too, there is an ever-shifting pattern of movement. The United Kingdom has replaced its health professionals who have gone to North America with entrants from Germany. Germany, in turn, hosts a significant and growing number of physicians from the Czech Republic. In anticipation of a mass exodus after EU expansion in May 2004, Czech health systems identified recruitment from neighboring Slovakia as a coping strategy. The downstream effects of such recruitment strategies have a profound effect on source countries.
Impact of Health Care Migration on Source Countries
Outflows of health care workers are not necessarily a sign of health system malfunction. In fact, in some countries, such flows have been part of an overall strategic labor export plan. The Philippines, India, and Cuba have intentionally invested in the training of health workers for export. In return, some migrants contribute to their home countries with remittances and enhanced skills when they return.
However, for some countries, even limited migration can have a big impact. Indeed, a study by the Joint Learning Initiative at Harvard University notes that "while the absolute numbers may not be large, the outflows can be 'fatal' for disadvantaged people in source countries."
Health care migration from countries that are involuntary or reluctant sources tends to have more wide-spread negative reverberations. This is especially true in the case of sub-Saharan African countries, whose health systems are already compromised by an HIV/AIDS epidemic that claimed 77 percent of the disease's deaths worldwide in 2003.
Approximately 37 of 47 sub-Saharan African countries do not have 20 doctors per 100,000 people, as recommended by the World Health Organization (WHO) minimum standards (see Table 1). In contrast, the average among OECD countries was approximately 222 physicians per 100,000 people in 2000. Malawi filled only 28 percent of vacant nursing positions in 2003. South Africa had up to 4,000 doctor vacancies and 32,000 nurse vacancies in 2003.
Health care savings accounts are the same as myRA----it ends our public Medicare and Medicaid and Social Security and throws all that money taken from paychecks into the same criminal stock market ending with pols telling us SORRY----NO MONEY IN THESE TRUSTS. This same HEALTH SAVINGS ACCOUNT policy is now being installed under the guise of World Health Organization HEALTH CARE FOR ALL----with the same result----people will never see them.
FEDERAL MEDICARE AND MEDICAID WORKED WONDERFULLY IN STATES THAT ALLOWED THE FUNDS TO BE USED AS LEGALLY REQUIRED. WE SIMPLY NEED TO REBUILD OVERSIGHT AND ACCOUNTABILITY AND KEEP THESE FUNDS FROM THE HANDS OF CORPORATIONS AND WALL STREET.
Who passed policy for these health care savings accounts as they dismantled our public health structures? CLINTON/BUSH/OBAMA ----Congressional Clinton neo-liberals and Republicans.
CREATING A HEALTH INSURANCE SCHEME WHERE OVER 90% OF AMERICANS WILL BE TIED TO PREVENTATIVE CARE ONLY AND PUSHED INTO CATASTROPHIC INSURANCE WITH PAYROLL DEDUCTIONS PRETENDING TO BE HEALTH SAVINGS ACCOUNTS.
HMMMMM---I thought that was was payroll taxes for Medicare and Medicaid was to do only we paid for developed world hospital access health care.
The Benefits of a Health Savings Account
Category: Health Savings Account Originally Posted: December 11, 2014 by HealthCare.com Staff Last modified: May 7, 2015
Health insurance can be expensive and confusing. For many people, a health savings account (HSA) combined with high deductible insurance is a great option that is cheaper, offers tax advantages and puts the power of choice back in their hands.
Health savings accounts have been called “A powerful financial tool to cover medical expenses and save for the future.” by Kiplinger Financial. They are often referred to as “Health IRAs” because they operate in much the same way. Money is put into a tax deductible account each month either by the consumer or their employer. It can be spent on many healthcare expenses like medical bills, prescription drugs and other qualified expenses.
Funds that accumulate in a health savings account remain tax deferred until age 65, when they can be withdrawn with no penalty if not spent on medical expenses.
There are contribution limits to this powerful and flexible tool. In 2014 the tax deferred limits are $3,300 for an individual and $6,550 for a family. For individuals over 55 years of age, the government allows an additional $1,000 in contributions each year. In order to qualify as the required insurance under the Affordable Care Act a health savings account also has to be accompanied by a high deductible policy with an annual deductible not less than $1,250 for an individual or $2,500 for a family.
Health savings accounts are especially attractive for small businesses who want to offer insurance to their employees but feel they cannot afford a traditional plan. High deductible insurance is usually hundreds of dollars per month cheaper than a comprehensive policy. Employers can provide all or part of the difference as their contribution to an employee’s HSA, fitting the cost of providing health care to their own budget. In addition, relatives can make gift contributions to a health savings account. It’s then up to the consumer to find the healthcare of their choice.
One important change which came with Obamacare was to eliminate prescription drugs from qualifying health savings account expenses. All other health expenses still qualify, such as doctor’s visits, prescription glasses, and other medical devices. If expenses for an illness exceed the limits of the accompanying high deductible policy, that kicks in to cover the rest.
There are many benefits to a health savings account beyond your health care. Money not spent from an HSA in one calendar year is rolled over to the next year with no penalty, providing a source of pre-tax investment. Many financial advisers now offer interest bearing HSA plans which operate like an IRA. Plans which include an HSA are offered by most major health insurance provider as well.
For all of the advantages of a health savings account, there are some potential pitfalls. For example, the cost and quality of health care now falls on the consumer, and that information can be hard to find. Persons with chronic health problems, which require regular care, may also find that a high deductible health plan with an HSA isn’t right for them. The Mayo Clinic has a good guide to how to decide if they are right for you based on your own situation.
With all the advantages, health savings accounts are growing rapidly. While only 8% of all Americans have one, or about 15.5 million people, they are growing at a rate of 15% per year. The popularity of an HSA comes from both the flexibility to make your own health choices as well as the financial and tax advantages, according to the same survey by America’s Health Insurance Plans, a trade association of insurance providers.
Health savings accounts are a great alternative to the traditional, higher cost, whole-health insurance model for people who want to manage their own health care. The ability to put savings from good health practices away in a tax-deferred account while saving money over a comprehensive plan is a great benefit. The required high deductible plan also means that you are covered in the case of a catastrophic event.
If it works for you, a health saving account can be a win-win all around for cost effectively taking control of your own health care. It is a choice that every consumer should read up on to decide if it is the right choice for their own personal health situation.
Obama's several years was about creating the most public policy geared to fleecing the poor making Clinton and Bush look like beginners. Now we have PRE-PAID CARDS for phone----for social services----for energy---and as we see here----health care. This is just another fraud but the point is this: With 1% Wall Street through corporations like FICO building platforms for remotely stopping consumer access to these cards----with economic crashes designed to make these pre-paid accounts disappear---we are now seeing what took car buying----home buying----now taking our access to health care. IT IS PREDATORY AND EXTREME PROFIT-DRIVEN AND GLOBAL HEALTH SYSTEMS COULD CARE LESS ABOUT PUBLIC HEALTH OUTCOMES.
These kinds of formats---pre-paid cards for ordinary activity is tied to this surveillance structure where every move a citizen makes is recorded in a database. The remote power to stop access----to make funds disappear----to constantly tie citizens with fees, fines, improper charges with no ability to get justice from all that----
THIS IS ONE WORLD GLOBAL CORPORATE RULE---INTERNATIONAL ECONOMIC ZONE POLICY--MOVING FORWARD SAY WALL STREET GLOBAL POLS.
Rather than simply having public health clinics and public hospitals in our communities that anyone walked to and accessed because they PAY TAXES.
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This is towards what all that health industry data collection leads----remember we talked about a MAO-style RE-EDUCATION ----REHABILITATION forced labor camp structure being built in lieu of public health---mental health/addictions et al. 1% Wall Street intends to create EVIDENCE-BASED PREDICTIVE BEHAVIOR----looking not only at whether a citizen is predisposed to violence or crime---but towards any 'WEAKNESS' in living life. This is MAYOR BLOOMBERG'S stop drinking big sodas ON STEROIDS.
Think about all the ways data combines on an individual to frame a person's health profile. Our DNA is the big one----how we spend our money----what foods we buy----how we spend our spare time---all of this is BEHAVIORAL ANALYSIS. When we go to SAFEWAY---or any big box food store having those discount cards we scan to save a few dollars-----that makes all of our grocery purchases available in a database. This is why these cards are used. For decades this technology was used for marketing brands----big boxes would use this data to predict what kinds of products they needed on the shelves.
What this data will do now is fall into mega-data super-computers as part of our PROFILE----and it will be used by global health systems led by global health insurance corporations to decide IF----or HOW MUCH our health insurance plans should cost. It will tell them not to insure an individual at all pushing them into CATASTROPHIC HEALTH PLANS ----
THEY SAY---YOU HAVE NO CHOICE BUT TO LIVE JUST AS WE TELL YOU! WE ARE ONLY LOOKING OUT FOR PEOPLE.
The Behavioral Risk Factor Surveillance System
The Behavioral Risk Factor Surveillance System (BRFSS) is the nation's premier system of health-related telephone surveys that collect state data about U.S. residents regarding their health-related risk behaviors, chronic health conditions, and use of preventive services. Established in 1984 with 15 states, BRFSS now collects data in all 50 states as well as the District of Columbia and three U.S. territories. BRFSS completes more than 400,000 adult interviews each year, making it the largest continuously conducted health survey system in the world.
By collecting behavioral health risk data at the state and local level, BRFSS has become a powerful tool for targeting and building health promotion activities. As a result, BRFSS users have increasingly demanded more data and asked for more questions on the survey. Currently, there is a wide sponsorship of the BRFSS survey, including most divisions in the CDC National Center for Chronic Disease Prevention and Health Promotion; other CDC centers; and federal agencies, such as the Health Resources and Services Administration, Administration on Aging, Department of Veterans Affairs, and Substance Abuse and Mental Health Services Administration.
In addition, countries eager to develop similar surveillance systems have requested technical assistance from BRFSS staff.
These countries include:
- South Korea
- Nations in the Caribbean, and
CLINTON/BUSH/OBAMA will pretend this is all about the usual Centers for Disease Control monitoring for communicable disease vectors which as always been the policies for CDC----and that is fine. What the goal of global predatory for-profit health care systems will be ----how to profit from all this data. First, they sell that data to global research facilities---they sell that data to corporations hiring employees----they use that data for FOR-PROFIT PATENTING of medical devices/PHARMA----without any health value for 90% of global citizens.
None of this works well for any citizen----regardless of race or class. It is the very picture of FAR-RIGHT AUTHORITARIAN and it will be used for goals that will harm citizens. Whether killing opportunity for employment----for advancement in career----for status in mandated health care insurance----
TO BE SURE WE FOLLOW HEALTH ORDERS THEY HAVE THEIR REMOTE CONTROLLED MICRO-CHIPS THAT WILL BE INSTALLED IN EACH PATIENT.
Yes, it will go that far and it will happen very quickly because the goal of CORPORATE SUSTAINABILITY is to maximize profits and keep HUMAN CAPITAL productive as cheaply as possible.
THESE ARE THE POLICIES BEING INSTALLED IN JOHNS HOPKINS----UNIVERSITY OF MARYLAND MEDICAL SYSTEMS---AND PRIVATE HEALTH SYSTEMS IN YOUR NECK OF THE WOODS.
There are many medical examinations required in industry to satisfy Legal Requirements, enforced by the Health and Safety Executive, or to comply with COSSH requirements, or down to basics, sorting out sickness absence.
The more common surveillances are :
- Hearing Surveillance
- Hand Arm Vibratio
- Lung Surveillance
- Skin Surveillance
- VDU Assessment
- Night Worker Assessment (DTT)
- Fork Lift Truck Assessment
- Urine Analysis for drug and diabetes testing
- Pre-employment screening
A good attitude towards occupational health will benefit your business by:
- Lower employee absence through sickness
- Reduce insurance premiums
- Reduce health related claims
- Reduce operating costs
- Increase productivity
- Improve employee relations
- Improve company image
The UK is about a decade ahead of where 1% Wall Street here in the US are MOVING FORWARD---so looking at research from UK helps us know ahead of time where predatory health care is going.
In Baltimore, then Mayor O'Malley created what is called DATA-STAT. This was the beginning of the SMART CITIES structure and it was touted as helping communities grow more healthy. Today, the citizens of Baltimore have absolutely no voice in what happens in their communities whether health oriented policy or any else-----because of this DATA-STAT. This is what the mega-computer sent to Johns Hopkins by Obama and Congress is meant to do----all this data will have no transparency to you or me----it is sold------used by global NGOs-----to decide what global NGOs in our communities need as policy. It will also connect to those SMART METER/HEALTH SURVEILLANCE structures to tell WE THE PEOPLE how to live.
These structures are being built in all International Economic Zones and now including US cities deemed International Economic Zones. It matters that our elections are rigged and captures---all pols today are those 5% to the 1% SHOW ME THE MONEY AND I WILL DO ANYTHING I'M TOLD citizens. We must look beyond what policy does today to see what things look like a decade or two from now---I might not be alive but I have family that will.
This article looks at our global health system and the surveillance being built especially in remote-site care---they make it sound progressive but most people will be elderly and alone and it will not end well. Think as we glance through how these policies will be installed in all industries---we already see where our public schools being made corporate schools are placing observation video cameras on teachers and classrooms. Those being RALLIED in support of these policies thinking people need to be held accountable should think again------think about what all this looks like when International Economic Zone and Trans Pacific Trade Pact makes these surveillance policies more and more authoritarian and repressive.
As our underserved communities are left to be simply violent and full of crime because they are not being rebuilt-----the need is for more surveillance cameras. As we breakdown all our public and community health structures moving to robotics and telemedicine we are seeing patient abuse soar so the answer is more surveillance.
Electronic surveillance in health and
social care settings: a brief review
Review of literature on the use of video and associated technology
The Social Care Institute for Excellence (SCIE) was
established by Government in 2001 to improve
social care services for adults and children in the
We achieve this by identifying good practice and
helping to embed it in everyday social care
SCIE works to:
based good practice
involve people who use services, carers,
practitioners, providers and policy makers
advancing and promoting good practice in
enhance the skills and professionalism of social
care workers through our tailored, targeted and
'On the other hand, there have been serious concerns raised about the implications of surveillance for individual privacy, choice and consent
In the United States (US) there has been a relevant, high-profile debate about the use of video surveillance in the rooms of care home residents (termed “granny cams”) as a'mechanism for preventing abuse. Bharuchaet al. (2006) note that advocates of this technology identify it as a necessary response to widespread abuse of vulnerable people.
The literature sampled suggests the legal and funding implications of this technology (within the US context) has been particularly prominent in this debate
Ethics, privacy and consent
The ethical implications of surveillance are complex and under
-researched. The issue of ethics was one of the most prominent themes in the literature sampled. Niemeijer et al
note that ‘is it still not clear what the ethical and practical
implications of [surveillance] interventions would be in a formal residential care setting’ (p1130) and that the limited existing research in this area provide ‘a perfunctory summary of the views rather than an in-depth analysis’ (p1138). There is
also a noted gap in terms of evidence on views of people using services (Niemeijer et al., 2010).
Privacy is inextricably linked to the notion of consent. In terms of legislation affecting the UK, Article 8 (1) of the Human Rights Act 1998 gives individuals the right to respect for a private and family life. This is a qualified right in that it can be limited if there is a legitimate aim (Liberty, online).
There are ethical issues, therefore, stemming from whether
or not a person knows about, and gives their permission to be
the subject of surveillance. The issue of consent to the use of
surveillance in health and care settings relates not only to that of the person using the service, but also to families, carers, visitors and staff. There are questions about ‘moral acceptability’ of technological interventions, that is to say, the extent to which any benefits derived from their use are
justifiable when there is a conflict with personal freedoms and/or a potential impact on the service user- carer relationship
(Niemeijer et al, 2010, p1138).
There is a range of relevant government policy and some concern that it is not coherent-In relation to overt surveillance (CCTV) in NHS settings, Desai (2009) highlighted that government has not had a ‘specific, coherent...policy or strategy’ (p46). She also notes that the Information Commissioner’s Office (2008) stipulated it should be used
only after ‘alternative ways of improving security’ have been
explored (p46), and that it should result in ‘minimum interference with privacy and rights’ (p46, also referencing Mental Health Act Commission 2005).
In terms of covert surveillance, the Home Office recently (2014) issued a draft Code of Practice which also summarised a range of UK legislation surrounding its use by public authorities
Review of literature on the use of video and associated technology
Environments that comprise both communal and private spaces are particularly complex in terms of surveillance and ethics-
This review found evidence of complexities related to consent-
and levels of privacy to which one is
entitled- in communal spaces (e.g. lounges, corridors) compared to private spaces (e.g. bedrooms and flats).
The definition of what constitutes ‘public’ and ‘private’ space may be disputed or unclear (Adelman, 2002) even when care is being provided in an individual’s home (Mortenson
et al., 2013) and this can have an impact on whether consent is deemed to be required (Desai,2009).
There may also be tension between balancing the rights of patients who do not wish to be subject to monitoring (CCTV, in this case) with those who have given consent (Desai,2009).
One could reasonably extend this to professionals, carers and visitors. Minuk (2006, 224) argues strongly that use of video cameras in residents’ bedrooms as a preventative measure, i.e. before any evidence of abuse, are “excessively intrusive”
on the grounds that they are an invasion of privacy even though workers will be providing care in that space.
The issue of professionals’ right to privacy is complex
for example, Kohl notes that ‘some commentators make a distinction between professional and non-professional staff in assessing their rights to privacy’ (2002, p2098, citing Galloro
supranote 114, at 24). There is also a debate about implied c
onsent, i.e.if staff have been informed about the use of surveillance technologies and carry on working for the employer, this equates to them giving their consent to be subject to surveillance (Bharucha et al., 2006 citing Rothstein
, 2000). Impact of surveillance
Overall,research on impact, including preventative capability,is limited. For example, Desai (2009) noted little evidence on effectiveness of CCTV on managing aggressive patient behaviour in NHS settings and concluded that its impact in this
respect ‘ is as yet unknown’ (p51). Similarly, Niemeijer et al.’s
2010systematic review of surveillance technologies in residential care for people with dementia or intellectual disabilities noted that ‘the effects of this technology...have scarcely been studied’ (p1138). Woolrych et al. highlight the lack of before-and-after comparative analysis (2013) and, indeed, gold standard measures of effectiveness of an
intervention require suitably robust study design (Eccles et al.,
Understanding perspective is important
Niejeimer et al., highlight ‘three
perspectives: that of the institution, the resident; and the care relation’ (2010,p1131). They go on to suggest that institutions are likely to be concerned with whether something works, as well as the impact on risk and on staffing. Critical for
Review of literature on the use of video and associated technology residents, they note, are the complex relationships between surveillance and personal freedoms, while carers are likely to be concerned with ‘duty of care versus autonomy of the resident’ as well as how technology features within an overall care package (2010, p1131).
Benefits and harms
Limited research has indicated there may be potential benefits
in terms of patient care. Desai (2009) highlighted some evaluation evidence that use of infra-red CCTV ‘helps to reduce the number of unwelcome intrusions into patients’
bedrooms by other patients on the ward’ (p47, citing Dix,2002).
She also noted that use of infra-red CCTV allowed less intrusive night-time observations (Desai, 2009, citing Warr et al.,2005). Woolrych et al.
conclude that ‘video surveillance has the
potential to generate observational data on the movements and behaviours of various actors within the care facility’; complementing traditional observation techniques through the provision of ‘continuous, real-time data’ (Mortenson et al.,
2013 p2, citing Sixsmith, 2013; also, Bharucha et al. , 2006).
Surveillance data can support professionals as they review incidents.
Reviewing video footage can help to build a picture of what led to a negative event, such as an accident, occurring (Mortenson et al., 2013).
The potential for video footage to provide ‘hard evidence’ that can be used either by families or in a court of law is reported to be one of the potential benefits cited by proponents of
this technology (Cottle, 2004) but a number of authors assert
that this should be as part of a holistic approach, rather than something used in isolation (see:Considerations).
Use of surveillance technology offers some potential efficiencies in terms of staffing.
Whereas previously, surveillance could be burdensome in terms of human resources, improved technologies mean that it can now complement traditional staff models, offering potential efficiencies (Mortenson et al, 2013). Mortenson et al.,
provide the example of how Ambient Assistive Living (AAL) technologies such as fall detectors or other sensor-
based products ‘[offer] the possibility for large numbers of
individuals to be monitored automatically and continually...by a relatively small number of people’ (2013, p6) although this was within the context of enabling people to live at home independently for longer (rather than in institutions).
Awareness of surveillance could have positive and negative
impacts on staff behaviour. Desai (2009) suggests that staff may change their behaviour out of fear that their actions could be perceived in a negative way when viewed on CCTV. She
highlights a study in which they are ‘reluctant to engage in therapeutic touch’ (Desai, 2009, p49 citing Chambers and Gilliard,2005).
Providing a range of legal references, Cottle sets out some of the concerns from staff about how their actions may be perceived negatively on video, as well as noting, on the other hand, that Review of literature on the use of video and associated technology proponents of this type of surveillance include some care home administrators who think its use will help ‘to raise previously concealed issues’ (Cottle, 2004, p126).
On the other hand, in the same study, staff felt better able to restrain patients appropriately, on the basis that CCTV ‘would provide evidence of their proper conduct’ (Desai, 2009, p49 citing Chambers and Gilliard,2005).
There may be the potential for misuse of CCTV by staff.
Desai also noted the potential for abuse of overt surveillance by staff, for example (p48, citing Warr et al 2005) ‘targeting of certain patients’ bedrooms’ to judge whether their behaviour
when alone was consistent with that observed in communal settings and highlighted how the guidance available at that time (specifically, Data Protection Act 1998 and
CCTV Code of Practice 2008) ‘are insufficient’ for addressing the risk of staff breaching agreements made with service users about how CCTV will be used (p48).
Awareness of, or uncertainty about whether surveillance is in use can potentially have a negative impact on people using services. Evidence from research on telecare indicates that awareness of surveillance can have an impact on
the behaviour of people using services, specifically, leading them to act in a way they would not do otherwise, out of fear that their normal behavior would trigger ‘alarms, warnings and contact from care-givers’ (Mortensonet al.’s 2013 p10, citing
Percival and Hanson, 2006). They also highlight research which shows that when people are aware surveillance is in use, they ‘anticipate having a sense of ‘being
watched’ even without the presence of video-cameras’ (Mortenson et al.’s, 2013, citing: Percival and Hanson,
2006; Savage 2010; and, Sixsmith and Sixsmith, 2000).
From wider literature, Desai notes that ‘not knowing whether one is being watched or not results in the ‘self-monitoring’ of behaviour’ (p50, 2009, citing Marx, 2002, p10).
Implementing surveillance technology can have unintended consequences. Woolrych et al. emphasise the importance of recognising that technology can be ‘socially transformative in nature’ (2013, p8). It can change the way people behave in unexpected ways. Mortensonet al. also urge the reader to recognise that ‘[u]ltimately, surveillance is about power, or the way individuals and groups within society interact and influence one another.’ (2013, p8). They note this can be
positive or negative and, within the context relevant here ‘...attention should be focused on how the new technology will affect power relations in informal and formal caring relationships...’ (2013, p15).
It is likely to be important to provide support and guidance to en
able staff to engage with surveillance technologies appropriately. Staff may not always be comfortable with using surveillance to monitor patient behaviour, or clear about how
to respond when patients behave in a way that caused concern. As a result, additional surveillance-
specific staff training may be warranted (Desai,2009).
A Review of literature on the use of video and associated technology number of authors note the importance of having clear legislation, policies and procedures for use of surveillance in place specific to the care environment, recognising it as both a place where people live and a workplace (Adelman, 2002;Cottle, 2004;Kohl, 2002)
Professional judgement is critically important when using video to reflect on incidents. Desai conclude that CCTV per se does not prevent violent incidents, even when monitoring is undertaken in ‘real time’ (p49) because it does not replace
professional judgement about when to intervene and how (Desai, 2009, citing Koskela 2000) and can distort reality (Desai, 2009) or create ‘trial by video’ approach to incident review (Woolrych et al.,2013 p7 citing Schnelletet al., 2004).
Evaluation of CCTV use in psychiatric wards illustrated that it can affect the culture, becoming
the first port-of-call in the event of an incident (Desai, 2009, citing Chambers and Gilliard, 2005). Woolrych et al. highlighted impact on safety culture as a potential benefit of video surveillance, but cautioned against over-reliance on this technology given the complexity of the care environment and the ‘narrow frame of reference’ it provides (2013, p7, citing Nowak and Hubbard, 2009). This was supported by Desai
who argues that CCTV evidence of abuse ‘should not be presented as a full account
of an incident’ (2009, p48)
Overall, this review found no definitive evidence
about: when and when not to use surveillance; and effectiveness or impacts (positive and negative) of different
methods with different populations, under different circumstances. Evidence was limited and patchy. There was also a notable gap in terms of service user and carer views on the topic although there was reference to the value of person-centered care, and a theme indicating it is important that surveillance is not used in isolation, and does not replace human intervention.
The study on CCTV in psychiatric units, for example, emphasised it should complement human observation and face-to-face therapeutic activities (Desai,2009, citing Koskela, 2000;Lyon,2001;and,Mental Health Act Commission, 2005).
This is a brief review aimed at illustrating some of the key issues related to the topic. It therefore includes, necessarily, only a very small sample of the literature. It should be
noted that the types of surveillance technologies
included in the literature seem very diverse (for example,
a CCTV camera on a hospital ward aimed at preventing
aggressive behaviour, and sensors in a person’s own
home, with remote monitoring triggering a response if they have an accident). While the review comprises literature from peer-reviewed academic journals as well as relevant guidance from established, credible organisations, it has not undergone critical appraisal to assess quality. It should also be noted that the literature comes from the US as well as the UK and there are
Review of literature on the use of video and associated technology considerable differences, for example, in terms of policy, practice, funding and culture that mean results may not be directly comparable or transferable. There is a noted paucity of studies designed to address questions of intervention effectiveness. Finally, as the legal aspect is prominent in the US “Granny-cam” debate, some of the literature included comes from legal journals rather than from the health or social sciences
Polls are showing Americans want to age in place. This is what all the national media and corporate health systems are telling us. At the same time we are seeing another economic crash----percentage of people owning homes falling to record lows and rents rising higher and higher. Rent control housing is disappearing and we all know 1% Wall Street is not building AFFORDABLE HOUSING----the goal of International Economic Zones is having global corporate campus housing-----for the 1% and their 2% that will be extremely wealthy----for the 99% it will be dormatory/warehousing. Affordable Care Act was written to encourage citizens having complex health issues to sign wavers on measures to resuscitate----the costs of health care to a family is placing patients in a position of feeling guilty about growing health costs----a lower-tiered GUTTED OF FUNDING MEDICAID FOR ALL will build warehouse hospices returning to the days of sanitoriums where citizens go to die.
I share the worst case scenario because we need to think where this might lead in a repressive 1% Wall Street SOCIAL DARWIN society as is pragmatic nilism----the idea that all that computer and medical equipment with medical staff on routine visits to check on chronically ill citizens IS NOT TO BE BELIEVED.
IT WILL NOT HAPPEN FOR 99% OF GLOBAL CITIZENS.
One can see extreme wealth receiving these kinds of health care and yes, they will have that money to make sure the computers, equipment, staff are at hand. The surveillance structures for group hospice will be far different.
The key to aging-in-place? Mobile and telehealth tools
From the mHealthNews archive
By Kirby Cunningham
February 05, 2015By 2050, there will be an increase of 4.6 million people 85 years or older who suffer from memory impairment, bringing the total to 6.2 million people. This significant increase means there will be added pressure to provide care to this population - despite the fact that the industry won't see any uptick in providers.
Advancements in technology - particularly in the telehealth and remote monitoring realm - hold many advantages that can help serve more seniors who suffer from memory loss. One emerging trend, for example, is the use of wearable devices that can track seniors’ vital signs and location and alert caregivers or family members when they have fallen or exited an exterior door.
The interdisciplinary care team that will monitor seniors (either at their homes or on a care facility campus) must have access to real-time data captured from diverse patient-facing devices and applications. This data should be coupled with predictive analytics and decision support applications that can alert providers to potential adverse events in time to intervene. Ensuring interoperability between the caregivers’ and the patients’ technology will also be essential as remote monitoring care model becomes more common.
More seniors aging in place
Nearly 90 percent of people older than age 65 want to stay in their home for as long as possible, and 80 percent believe their current residence is where they will always live, according to results from a 2012 survey of AARP members. Even with memory impairments, many seniors will want to remain in their home and will be able to thanks to existing and emerging remote monitoring technology and other telehealth services.
For early stages of memory loss, programs in which caregivers phone seniors to check on health status and offer medication reminders have been shown to be effective. For later memory-loss stages, sensor technology that can inform caregivers about a senior's sleeping position or location could be deployed, as could devices that prevent an occupant from leaving home unless his or her safety is at risk.
In another trend, care organizations are interacting with early-stage memory loss seniors in their home or living-in-care communities through video-streaming services, such as Skype or FaceTime. Seniors who are able to use health-monitoring devices, such as blood pressure cuffs, support the off-site clinician by reading measurements from the devices during the video encounter. In the near future, small patches placed on the arm that can capture and transmit measurements such as blood glucose levels, blood pressure and heart rate will bolster these video visits. Senior care organizations and payers are investing in technology-enabled care like this because it can be delivered more cost effectively than a physician’s office visit and is safer and more convenient for the memory-impaired population and their families.