Tuesday, February 27, 2007

Sick elderly left starving in public hospitals

As many as four in every 10 elderly patients in Queensland hospitals could be slowly starving in their beds. Health staff are failing to notice the signs of malnutrition and are too busy to check whether patients are eating properly, The Courier-Mail can reveal. Malnutrition can delay recovery times and in severe cases quicken a patient's death.

Merrilyn Banks, director of nutrition at the Royal Brisbane and Women's Hospital, said: "We think malnutrition only happens in Third World countries, but it is a problem in aged care and hospitals here. "We have found that 30 to 40 per cent of elderly patients are affected. There's generally not enough awareness of the issue because we are used to treating disease and are just not looking for under-nutrition."

Malnutrition can cause the condition of a patient admitted to hospital with a minor illness to rapidly deteriorate. "When people get ill they have trouble with their appetite and it becomes more difficult for them to eat," Ms Banks said. "Malnutrition can actually increase the rate of infection and may slow rehabilitation." She said medical staff were not necessarily to blame for patients failing to eat. "In a lot of cases malnutrition is just not obvious," she said. "Everybody in the health system is very busy."

Anthony Power, a Brisbane private practice nutritionist, said he saw up to 10 elderly patients each week suffering from malnutrition after being discharged from hospital. In one case, a woman in her 60s had lost almost 20kg after she developed a post-operative infection. "It can happen very quickly. They may be recovering from an illness and don't have the energy to eat and then develop vitamin and mineral deficiencies which further impair their digestion. "The system needs to do more to tackle this."

Ms Banks has received funding from the hospital's Research Foundation to assess how much the problem is costing Queensland Health through longer hospital stays and the treatment of associated complications. One solution might be the appointment of dedicated care assistants to ensure elderly people eat properly while on the wards.

Val French, president of Queensland pressure group Older People Speak Out, said: "Older people are the least likely to ever complain." Gay Hawksworth, secretary of the Queensland Nurses Union, added: "There is a shortage of nurses . . . but nurses are well aware of the need to make sure patients are eating and drinking." [The notoriously low attractiveness of public hospital food surely does not help. And the recent move to make it "healthy" has almost certainly reduced its attractiveness even further. People are not rabbits and elderly people in particular are most unlikely to change lifetime dietary habits]


Preschool for all? No thanks

Both in Australia and California there is a strong political push in that direction. Well-researched comment below from an Australian homeschooler

Politicians are calling for compulsory preschool and there is a lot of rhetoric around about ensuring all children have the benefits of a preschool education so they are not left behind when they begin school. But is compulsory preschool something we really want? Education Minister, Julie Bishop's argument in favour of compulsory preschool is: "many studies and research and analysis show that investment in high quality, large scale, early childhood programs find that early learning experiences, including pre-literacy and numeracy skills make the transition to school easier for children, and it increases the chances of school success."

University studies are often quoted to support the perceived academic benefits of preschool. What is not often mentioned is that, while these studies demonstrate preschool in a favourable light when compared with an impoverished home environment, preschool does not compare favourably with the average home environment.

Even Professor Edward Zigler, credited as "the father of Headstart" a widespread American preschool program admits "there is a large body of evidence that there is little to be gained by exposing middle class children to early education . (and) evidence that indicates early schooling is inappropriate for many four-year-olds, and that it may be harmful to their development".

If preschool were truly beneficial in terms of giving children a head start, those places with some form of compulsory preschool should do demonstrably better academically. The evidence does not bear this out. For example, the two states of America which have compulsory preschool, Georgia and Oklahoma, have the lowest results for fourth grade reading tests in the country.

In 2000, the Program for International Study Assessment (PISA) compared the academic scores of children from 32 industrialised nations in reading literacy, maths and science. The results showed that in countries where schooling starts at a young age they do not consistently outperform those who start later. Finland, which has a compulsory schooling age of seven, held the top ranking in all test subjects of the Third International Mathematics and Science (TIMS) results in 1999. Singapore, which also scored highly in the PISA and TIMS assessments, has no publicly funded early education programs.

By contrast, Sweden, which has one of the most comprehensive early child-care programs in Europe, was one of the lowest scoring nations. Hungary and Czechoslovakia, cut their day-care programs significantly in the 1990s after studies determined that institutional care damages preschool-aged children.

Perhaps most tellingly of all, the longitudinal studies often quoted to argue an academic advantage provided by preschool for lower socio-economic groups, actually also show that this "advantage" disappears by grade three.

But what about the much-touted social benefits of preschool programs? Here again, there is research to refute this. A 2005 Stanford University study reported: "We find that attendance in preschool centers, even for short periods of time each week, hinder the rate at which young children develop social skills and display the motivation to engage in classroom tasks, as reported by their [prep] teachers."

In 1986, Tizzard and Hughes compared the language environments at home and in preschools in the UK. Their method involved tape-recording the conversations of four-year-old girls at preschool in the morning and again at home with their mothers in the afternoon. They reported:

We became increasingly aware of how rich this [home] environment was for all the children (working-class and middle-class). The conversations between the children and their mothers ranged freely over a variety of topics. The idea that children's interests were restricted to play and TV was clearly untenable.

At home the children discussed topics like work, the family, birth, growing up, and death; they talked with their mothers about things they had done together in the past, and their plans for the future; they puzzled over such diverse topics as the shape of roofs and chairs, the nature of Father Christmas, and whether the Queen wears curlers in bed.

Many of these conversations took place during recognisably educational contexts - such as during play or while reading books - but many did not. A large number of the more fruitful conversations simply cropped up as the children and their mothers went about their afternoon's business at home - having lunch, planning shopping expeditions, feeding the baby and so on.

When we came to analyse the conversations between these same children and their [preschool] teachers, we could not avoid being disappointed. The children were certainly happy at school, for much of the time absorbed in play. However, their conversations with their teachers made a sharp contrast to those with their mothers.

The richness, depth and variety which characterised the home conversations were sadly missing. So too was the sense of intellectual struggle, and of the real attempts to communicate being made by both sides.

The questioning, puzzling child which we were so taken with at home was gone: in her place was a child who, when talking to staff, seemed subdued, and whose conversations with adults were mainly restricted to answering questions rather than asking them, or taking part in minimal exchanges about the whereabouts of other children and play materials.

In all this research, it is difficult to sort out to what extent there is a difference between compulsory preschool programs and optional preschool but it seems that there is enough evidence both to question the push towards compulsory preschool and to throw doubt on the theory that preschool is beneficial for all. Children at home with their families are not disadvantaged. Indeed they are very likely better off. So if your child does not wish to go to kindergarten, or you do not wish to send them, rest assured that you are not depriving them.

Relationships are the most important part of life. For small children especially, the time spent in the secure home environment is invaluable. Contrary to popular opinion, forcing children to separate from their parents before they are ready to is not necessary.

Preschool should remain optional so that parents are in control of the amount of time their children spend there. For some families this will be full time, for others, no time at all, but as a society we should stop pressuring families into thinking that a decision not to preschool their child is somehow irresponsible and will disadvantage the child. The evidence just does not support this view.

Throughout history small children have always been nurtured by their parents. Parents talk, read and sing to their preschoolers; they answer questions; they play games; they provide stimulating experiences and the security of cuddles and they accompany their children out into the world as mentor guides who interpret and explain new sights and experiences. Some families wish to supplement this rich rewarding education with a preschool experience. By all means make preschool freely available to all who wish to use it but why make it compulsory?


Taxes thwart homebuyers

More than 150,000 housing lots are available for development in the nation's three biggest cities, refuting the Howard Government's claims of a land shortage. The figures, compiled by The Australian, show there are 155,500 lots across Sydney, Brisbane and Melbourne zoned for residential development - between three and eight years' supply - despite John Howard's claims last week that a shortage of land was contributing to the housing crisis and driving up rents.

In Sydney, where housing affordability is the lowest in the nation and continuing to deteriorate, developers have thousands of housing blocks ready to sell, and are sitting on tens of thousands more. "Every time I see John Howard blaming land supply I see red because it's just not true - there are literally thousands of lots available," said Peter Icklow, chief executive of one of Sydney's biggest developers, Monarch. Mr Icklow said rather than land shortages, it had been increases in property taxes - levied by all levels of government since the beginning of the property boom - that had led to the affordability crises.

He said there was plenty of land available for sale and for development, but there were no buyers at current prices and developers could not drop prices any further without losing money. "I've got about 3000 lots of land and I can't develop any of them until they take some of these taxes off or we get a 20 per cent lift in prices," he said. "And we're not doing this to be greedy, we just need to make a return. The bank won't lend me money if we can't show a return."

Residential Development Council executive director Ross Elliott said governments at all levels had used the property boom as an easy cash cow, but now that the boom had receded the effect of the new taxes had come into stark focus. He said inflated taxes were stifling any recovery in the property market and in turn driving the rental shortage.

Starting with the Howard Government's introduction of GST on all new homes, and culminating with the NSW Government's infrastructure levy on new homes introduced last year, property taxes had ballooned since 2000. Taxes associated with a typical house-and-land package have grown by an average of $77,000 nationally in the past six years, with the problem most pronounced in Sydney's northwest, where government costs have ballooned by $115,000 in that time, according to research by consultants Urbis JHD. The group said taxes and red tape cost more than the land.


NSW conservatives to attack land tax problem

Land tax will be axed for about 39,000 small property investors and a further 90,000 will save $800 a year under a state Coalition government. At the launch of his election campaign yesterday, the Opposition Leader, Peter Debnam, promised to slash $100 million a year from land tax by raising the tax-free threshold on investment property. The tax would kick in once properties had a land valuation of $415,000 rather than the current $368,000.

Vowing to "fix NSW", Mr Debnam said the land tax cut would boost property investment and improve the affordability and supply of rental accommodation. "If the entire land tax cut is passed on to tenants, rents could drop by up to $17 a week," he said. It is pitched squarely at voters disgruntled by the Iemma Government's changes to property taxes, including the short-lived vendor tax, and the even shorter period when land tax was levied on all investment properties, regardless of land value.

"Twelve years in Opposition is a long time and, unlike Morris Iemma, I remember the last 12 years, not just the last 18 months," Mr Debnam said. He said Mr Iemma had been an integral part of the Labor Government, including the decisions on property taxes. Unlike Mr Iemma, who has sought to put the spotlight on his leadership, Mr Debnam yesterday said it would take a team to fix NSW's problems. Flanked by the Prime Minister, John Howard, and the former premier Nick Greiner, he said he planned to rescue the NSW economy, tackle the water crisis and restore trust in government in NSW.

Mr Howard, who has previously described the task facing Mr Debnam as "Everest-like", said he believed the Opposition Leader was "going very well". "The people of this state really want a change," he said.

Mr Debnam said the land tax relief would be funded by previously announced cuts to recruitment and spending in the public service and a reduction in the number of Government departments from 33 to nine. Under the land tax regime, the value of an investor's properties is totalled, so a cut in the threshold has more impact for people with small holdings. "This is a positive move and will help mum and dad investors," said the Housing Industry Association's executive director, Graham Wolfe. But he said investors should be allowed to claim the threshold separately for each of their properties.

The executive director of the NSW Property Council, Ken Morrison, said business investors would still be above the threshold. "We would like to see a cut in the rate of land tax, which would benefit more people, and duties abolished for new dwellings." But Michelle Burrell, from the Council of Social Service of NSW, said the cuts would divert funds from essential services such as health and education.


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