'Secure' Health Care

There is a good opinion piece in today's paper concerning the inappropriateness of using security guards as long-term attendants for patients suffering from various forms of dementia.

There is no question that many with Alzheimer's and various other issues are simply confused and wandering the halls of health care institutions. Others become violent.

And it's not like we can them "accountable" for that in some meaningful way - consider how much their world has changed, how confusing and scary that must be and then add in ever-changing caregivers, some always better than others. Consider that someday that could well be you and I.

Even without the issue of violence, the 'wanderers' can pose a huge problem. Both for their own safety (if they happen to wander off the ward) and to the mental health of other patients. We saw that happening during Mom's long hospital ordeal last year.

When Mom was hospitalized and confined to bed by her physical illness, an older gentleman in the room across the hall was a wanderer. He would come and stand in the doorway to Mom's room and talk to her. The problem was that both and he and Mom were subject to dementia. So while what he said probably wasn't making a whole lot of sense, it made even less sense to Mom's fogged mind.

When we returned from a weekend away, I found Mom terrified, refusing to eat or sleep. Between 'the man in the doorway', the nurses in and out of the room and the absence of her main support person (me), those two days became too much for her. It had all meshed into some confused horrifying story in her mind which made her sure that "they" were out to hurt her and her family.

Ironically, it turned out that 'the man in the doorway' was the father of a close friend, who I never even realized was in the hospital. Once we discovered that and told Mom about it, she was fine. Because, as she put it, she "knew the family".

But we also saw hospital rooms with security guards at the door day and night. It definitely made you wonder what was up.

First of all, it can't be an efficient use of resources.

Then there is the question of how much training these officers have. Does it prepare them to safely engage the "60-year-old stroke victim who throws furniture; the psychotic senior who violently strikes everyone, including their own family; or the frail grandmother who screams day and night"?

There's a situation ripe with potential for abuse. Although, in fairness, that's not just an issue for security guards.

And, as noted in the article, the "deterrent factor" offered by a uniformed presence might only serve to make thing worse, especially if paranoia is part of the patient’s illness. The omnipresent security guard, outside the door, only adds to the patient’s isolation, stigmatizes them and their family, and erodes what little dignity the disease has left them.

I can say it no better than the words of John D. Allen (a security professional for more than 20 years; four of those spent supervising the security teams assigned to three Nova Scotia hospitals):

A security officer should never be the primary care plan. It is a clear indication you are not coping.

. . .

Whether their condition is organic, caused by trauma or dementia, brain-injured Nova Scotians deserve the same level of dignity and care we all enjoy, and the need for properly trained health care professionals to deal with their special needs has been clear for some time.

Mahatma Gandhi said, "You can judge a society by how it treats its weakest members" - but the issue, as with everything in health care, is funding.

As we age and face the insidious prospect of our minds turning on us, specially trained orderlies and attendants will become a necessity if we hope to live in a dignified, caring environment.

Shhh...

I assume most of my many readers, being as discerning and intelligent as they are, realize that email is not private. But it may be even less private than you think.

Is anyone familiar with a service called Hushmail? They bill themselves as offering private, secure, free e-mail accounts.

Hush uses industry standard algorithms as specified by the Open PGP standard (RFC 2440) to ensure the security, privacy and authenticity of your email. With Hushmail, users need only create and remember their own passphrases, and the secure Hushmail server does the rest. Encryption and decryption are transparent to the user, making Hushmail the most user-friendly secure mail solution available. Through the Hush Encryption Engine™, the Hush key servers take care of public/Private key exchange in a completely seamless fashion. When a user wishes to encrypt/decrypt data or verify/sign a signature, a connection is automatically made to a Hush Key Server to retrieve the necessary Public/Private Key. It's that simple! Only Hush's solution provides such a high level of security combined with total ease of use. The descriptions below will give you an overview of how the Hush system secures email.

But maybe not so much.

A court document in a drug smuggling case has shown that the private email service Hushmail has been cooperating with police in handing over user emails. Hushmail claims to offer unreadable email as it uses PGP encryption technology and a company specific key management system that it says will ensure only the sender and recipient can read the emails. However it seems the Canadian company has been divulging keys to the American authorities.

Do you remember that sage advice about being careful as to what you say? Something about eating your words or something like that...

The news will be embarrassing to the company, which has made much of its ability to ensure that emails are not read by the authorise, including the FBI's Carnivore email monitoring software."Hushmail's security cannot be broken or weakened by this government sponsored snooping software," the company states.

Uh huh. A morale for the company (what do you think the chances are that they will be sued ... or of them being able to rely on the protection afforded by US legislation?) and to all those who traverse the internet.

Shhh ... if you don't want anyone to 'hear' you, it might just be better to not to 'say' it all.


H/T to Business Lawyer Blog

Canadian v. U.S. Security ... Or Home At Last

Would you be surprised to learn that a United States Government Accountability Report released yesterday cited major failures by the US Customs and Border Protection at their 'Ports of Entry", with the result that "several thousand" individuals who were inadmissible under the immigration law, were nevertheless permitted to enter the country?

This despite “significant progress in certain areas" and the fact that in 2006, officers turned away 200,000 travelers ineligible to enter the country, with "574 noncitizens and 63 criminal aliens" said to be refused daily.

The Report cited instances of officers’ waving vehicles and pedestrians into the country without stopping them or even looking up from a computer screen. Officers did not interview passengers in back seats or board recreational vehicles to see who was inside.

Seven of the ports were so short-staffed that managers had to cancel training sessions to keep operations running, the report said. Some officers balked at searching for drugs because they had not been properly trained.

Officers exhausted from double shifts called in sick to avoid overtime duty, the report said, and poor morale had driven officers out of the agency.

Two of the Congressional investigators who tested the inspection system at one land port of entry were simply asked by an officer at a desk if they were American citizens. They said “yes” and were passed through.

It doesn't surpise me much. Simply because whether pre or post-911, entering the United States has always been 'easy as pie' for us. I remember as a kid taking multiple car trips to and through the States. And when we drove to Florida two years ago, although I had my husband sign formal certificates stating that I had his permission to take our children out of the country without him, no one even questioned the issue. At least, not until we crossed the border back into Canada. Only then did Canadian officials ask about the status of the kids. Waved through by the US officials, yes, we were.

Even more interesting was my trip to California in 2003. I flew from Halifax to Boston and the only questioning I really faced was the exact address of where I would be staying in California. Which (long story) I didn't have readily available to me. The Customs officer sent me to phone an American friend to confirm an address. But when I went to a stewardess for directions to a phone, we chatted for a few minutes and when she found out that I had with me the address of another American friend (even though I told her that not only was I not staying there but I wouldn't even be actually going anywhere near there), she insisted that I should just use that.

Coming back home, however, was another story. There were a few Americans who got off the red eye flight with me in Halifax. One guy even had a gun case with him. When I first got off the plane, I went to the restroom and when I came out, the other people from the flight were gone. So I was a little surprised when I picked up my suitcases and was told to go wait 'down there".

My luggage was eventually thoroughly searched by a rather uptight, cranky Canadian Customs Agent who had lots of questions to ask. Why was I in the US? she wanted to know. Well, once upon a time a person could get away with a 'business' or 'pleasure' response. So I replied "Pleasure". Nope. What exactly was I doing there? Visiting friends. Were these friends American? Mostly, but one couple was from the UK. How long had I known these friends? About 6 years. Did I meet them online? Why, yes I had. Were they all female?

Now by this time my poor sleep-deprived brain was starting to wake up. But only starting to. I told her that one person was male and must have given her a bit of a perplexed look. Because she immediately told me that there was no need to be embarassed, it happened all the time. I told her I wasn't embarassed, just confused by her questions.

And then 'Ding, Ding' .. the bells went off and the lights came on. Boy, had she went down the wrong road! I started laughing and told her that no, I had a daughter with seizures on a special diet and had met a group of moms online whose children had the same condition. And finally after six years of corresponding, some of us manged to get together.

Talk about an attitude change... she immediately asked if my family was waiting for me (Yes, they were). Well I am sure that my socks, underwear and the $10 T-shirts I had bought for the kids appreicated being finally left alone. She quickly repacked my suitcase, told me to have a nice day and sent me on my way.

Yup, always has been harder to get through Canadian Customs, I find. And to think that I live here. And actually pay their salaries. Its probably a good thing I was half asleep and stunned through most of that latter incident or I most likely would have told her that I would be happy to answer her questions ... if she could show me by what authority I had to. THAT no doubt would have resulted in extending that four day trip by another five or six hours.

Ah well, better safe than sorry as they say.


H/T to James Patterson Law Office