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Event: Making enquiries on providing great personal home care for the seniors in the community by Senior Homecare by Angels

Event: Making enquiries on providing great personal home care for the seniors in the community by Senior Homecare by Angels

Senior Homecare by Angels is Canada’s choice in home care. With Senior Homecare by Angels you will find peace of mind knowing you or your loved one is cared for with the right care and the right caregiver. We provide affordable and professional care, servicing seniors and adults.

The following services can be provided for a few hours a day up to 24/7 care.
Bathing & Dressing Assistance, Assistance with walking, Medication reminder, Errands & shopping, Light housekeeping, Meal preparation, Friendly companionship, Flexible hourly care, Respite care for families and 24-Hour care is also available.

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Cancer Care Events & Support Groups

Mindful Meditation

Third Wednesday of each month 12:10 – 12:50 p.m.

MercyOne Richard Deming Cancer Center

411 Laurel Street; Suite 3300, Des Moines, IA 50314

Conference Room

Free of charge

This is a drop-in group intended for cancer patients and survivors and their families. If you have questions, please email

Living with Cancer Support Group

Last Monday of each month 5:00 – 6:00 p.m.

MercyOne Richard Deming Cancer Center

411 Laurel Street, Suite 3300, Des Moines, IA 50314

Conference Room or join us virtually via Zoom

Free of charge

Registration is required. Please call our office at 515-643-8206 or email to register. Zoom link will be sent a few days prior.

Caregiver Connection and Support

Third Tuesday of each month 5:00 – 6:00 p.m.

MercyOne Richard Deming Cancer Center

411 Laurel Street; Suite 3300, Des Moines, IA 50314

Conference Room

Free of charge

Registration is required. Please contact Kathy Koenig at to register.

Being with Art Together

New audio program presented by the Des Moines Art Center

4700 Grand Avenue, Des Moines, IA

Hours: Tues–Wed 11 a.m. – 4 p.m. | Thur–Fri 11 a.m. –7 p.m. | Sat–Sun 10 a.m. – 4 p.m.

Please contact Mia Buch for more information and collaborative events with area cancer centers. 515-271-0349 or

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As volunteer numbers plummet, the big question is —are we too busy to care?

As volunteer numbers plummet, the big question is —are we too busy to care?

From the Dragon Boat Regatta in Broome to the Orange Mardi Gras festival on the other side of the country, community events are being cancelled and emergency services are struggling to cope as the number of volunteers plummets.

The trend has triggered soul-searching among community groups and charities — is it a temporary blip linked to the COVID pandemic, or have Australians become more selfish?

“What we’ve seen is a longer-term decline in volunteering rates, and that’s been amplified by the COVID pandemic,” Volunteering Australia CEO Mark Pearce says.

Paramedics gather around a person on the ground in a park with an ambulance parked nearby
Emergency service crews are staffed mainly by volunteers in many parts of regional Australia.(Supplied)

“There are also changes in how people want to volunteer and participate — there’s increasing demand for flexibility that doesn’t necessarily correlate with the structure of formal volunteering programs.”

The 2021 census data recorded a 19 per cent drop in volunteering since the last snapshot in 2016. The finding is backed up by more regular, in-depth social surveys done by the ABS.

A graph showing a reduction in numbers of a decade period
The number of Australians volunteering has reduced significantly in recent years.

The biggest decline has been recorded in the 15-24 year old age group, the same age group posting an increasing number of controversial ‘good deed’ stunts on social media. 

The depletion of the volunteer brigade is affecting sports clubs, emergency services and long-established organisations like Rotary and Lions, that help run events and raise funds for local charities.

Country towns suffering

The impact is most noticeable in regional areas, where event organisers and first-responders are more likely to be unpaid.

As a result, some events are being cancelled, such as the annual Dragon Boat Regatta in Broome. 

A wide shot of stalls, people and dragon boats lined up along turquoise waters of a bay.
The Dragon Boat Regatta sees dozens of teams race in Broome’s Roebuck Bay.(Supplied: Abby Murray Photography)

It has been a popular fixture in the town for almost 20 years, and raises tens of thousands of dollars for charity. But this year there weren’t enough people to organise or run it.

“The practical impact in regional and remote Australia is that social activities and the cohesion that takes place by community coming together is lost or significantly reduced,” Mr Pearce says.

“And that has implications for the livability of these communities in which people choose to spend their lives.”

The Dragon Boat Regatta is usually organised by the local Rotary chapter, which currently has only a handful of members.

It is hoping to find enough local people to help with the nine-month organising process to revive the regatta in 2023.

A group of drag queens blows kisses and laughs.
The Drags on Boats team debuted at the 2015 Dragon Boat Regatta, where most ended up in the water.(ABC News: Erin Parke)

Events struggling across the country

Meanwhile in Alice Springs, organisers are struggling to pull together enough volunteers to hold the beloved Henley-on-Todd Regatta, which raises money for local Rotary Club projects.

Every August, teams of people race on the dry Todd River in boats without bottoms in front of a crowd of about 4,000 people.

Secretary Ron Saint said getting the right number of volunteers had been “tenuous”.

“We would like to have 130 but we’ve got about a hundred. So we’re at that point where we’d like to have 12 people doing a certain role but we’ll have nine or eight,” he said.

Three men stand in a home-made cardboard boat ready to race down a dry riverbed.
Organisers are hoping more locals will get involved to ensure the future of the Henley-on-Todd river race.(ABC News: Alexandra Fisher)

“It’s not going to stop the event … but you’d want a few more [people] in case someone can’t make it.”

Mr Saint believed some people who might volunteer were now trying to make up for paid work lost during COVID lockdowns.

“People are time poor and as we try to get the economy kick started again it’s difficult to commit the discretionary time for volunteer work,” he said.

In March, a proposed inaugural Mardi Gras celebration in Orange, in central west New South Wales, was cancelled for the third year in a row when the small team of people organising the Rainbow City Festival event became “exhausted” from repeatedly having to postpone it. 

A scene from a mardi gras event.
The Rainbow City Festival will focus on providing more smaller-scale events in the future. (ABC News: Kevin Nguyen)

What’s causing the decline?

Australian Bureau of Statistics data shows that people aged 40 to 54 are most likely to volunteer.  

Women and men participate at a similar rate, with the greatest number of people volunteering with sporting clubs and religious groups.

People living in remote areas are most likely to volunteer, but the rates in regional and urban areas are almost identical. 

Social researcher Hugh Mackay has been monitoring Australian attitudes and lifestyle habits for six decades.

“This is a weird period we are in at the moment, that helps explain the decline of volunteering,” he says.

“We’ve been changing in ways that have made us more individualistic, much more concerned about ‘me and my rights and my entitlements and my identity’.

An elderly man leaning against a tree and smiling.
Ever the optimist, social researcher Hugh Mackay sees a silver lining in the COVID cloud.(Supplied)

“And that’s all working against our natural proclivities to be kind and compassionate and cooperative and help each other out.

“But it’s also worth noting that organisations that want volunteers have probably not been quite nimble enough, and not understanding all these societal shifts and the changing culture.”

Dr Mackay says the main change has been a withdrawal from community involvement.

This has been caused by an increase in the use of social media to stay “connected’; people living alone; and the trend for having fewer children, resulting in fewer opportunities to develop local friendships through schools and kids’ sporting clubs.

“We’ve also become too ‘busy’, and being ‘busy’ is a kind of hiding place, a barrier between us and others,” he says.

“It’s the enemy of social cohesion and the enemy of volunteering, because as long as we can convince ourselves we’re too busy to help other people, we can get away with it – we have made being busy a virtue.”

Are young people the problem?

Dr Mackay rejects the notion that young people are too selfish to volunteer, saying a more nuanced shift has occurred.

“Millennials have grown up with a deep sense of impermanence and have adopted a mantra of ‘let’s keep our options open’,” he says.

A large Chinese dragon performs for a crowd of people with palm trees in background
Every year dozens of volunteers are needed to be the ‘legs’ of Sammy the Dragon, as part of Broome’s Shinju Matsuri.(Supplied: Abby Murray Photography)

“Committing to anything long-term runs against the ethos of this generation, so they will be happy to help out, but reluctant to join up to anything that requires a weekly meeting or a long-term program.

“One of the favourite occupations of older people through history has been to bash younger people and complain about them.

“But it’s worth remembering that the rise of individualism is not a generational phenomenon, it’s happening right across the age ranges.”

All at sea as volunteers jump ship

Some organisations are adapting by asking people to help out with one-off events, or ramping up social media recruitment campaigns.

But sometimes the challenge is retaining the volunteer recruits who do sign up.

In the waters off Broome, it is a matter of life or death — every few weeks the volunteer Sea Rescue team is called out to save a sinking or stranded vessel.

A group of men in fluro shirts sit in a boat.
Volunteer skipper Gareth Owen briefs crew on a planned training exercise.(ABC News: Erin Parke)

Skipper Gareth Owen says cyclones, crocodiles and big tides make it a hazardous job.

 “It’s vital we’re able to crew the vessel, because the calls can come at any time,” he says.

“It’s always very close as to whether we have enough people.

“It’s a major problem, because we’re low on numbers and the commitment to training is quite high, so it can be  difficult to maintain people’s enthusiasm.”

Mr Owen, who originally signed up to learn marine skills with his young son, says he’s not surprised the latest census data shows a drop in volunteer numbers.

“I think we’ve seen over the past few years that some people have become a bit more self-centred and they don’t go out as much because of COVID,” he says.

“So I guess a lot of people have prioritised family, and that has put pressure on volunteers groups like us.”

Annie Stephenson has been volunteering with the group for two years, and coordinates recruitment.

A woman in a fluro short stands smiling in front of a boat.
Annie Stephenson says she benefited from volunteer organisations as a child, so is keen to contribute.(ABC News: Erin Parke )

Ms Stephenson says a recent advertising campaign attracted more than 20 people, but the numbers dropped away as they realised the commitment involved.

“It’s one thing to recruit people, but retaining them can be hard,” she says.

“Because there’s so much training involved, we’re looking for people who can commit for two years minimum, but people’s circumstances change, they’ll get a new job or have family commitments, which is totally understandable.

“The key thing for us is to have a big enough pool of qualified crew to share the load and fatigue management, and to make sure people don’t get burnt out.”

One of the new recruits is 18-year-old Byron Schaffer.

He says he doesn’t know many people his age who volunteer regularly.

Two men in fluro shirts on a boat at sunset
Byron Schaffer (left) is training as a Sea Rescue volunteer in Broome.(ABC News: Erin Parke)

“I think some teenagers see it as something that ‘adults’ do, people who are a bit more settled down,” he says.

“I really enjoy it, it’s something to do in your free time that makes you feel good.”

What does the future hold?

Volunteering Australia says there has been a small increase in participation rates this year, following the easing of COVID restrictions.

But they are still well short of the volunteer numbers of five years ago. 

Volunteer skipper Gareth Owen hopes recent natural disasters might prompt Australians to sign up and offer their time and expertise.

Volunteer Qld firefighter from the Rural Fire Brigade
Thousands of Australians volunteered during recent bushfires and floods.(Supplied: Queensland Department of Community Safety )

“With the floods and the firefighters you see so many awesome volunteers doing things, and I think people forget they are volunteers because they’re doing such an excellent job and they’re at it for so long,” he says.

“Sometimes people might think it’s part of the service we get for being Australian, and not realise we need to put our hand up and look out for each other by volunteering.”

Dr Mackay, now aged 83, remains optimistic.

“I think this rise of individualism marks a really weird, aberrant period in human history, and it’s not actually who we are,” he reflects.

“I think our true nature as communitarians, cooperators, and kind and compassionate people who look out for each other will re-emerge.”

“The pendulum is going to swing back, I am sure of it.”

Additional reporting Steven Schubert

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Shortages from syringes to dye for diagnostic exams: How world events are straining everyday health care supply

Shortages from syringes to dye for diagnostic exams: How world events are straining everyday health care supply

In May, clinicians and patients at the University of Arizona Health Network had to delay non-urgent CT scans that required contrast media, a type of dye injected into the body to make organs and blood vessels more visible. It’s used to aid in the diagnosis of a variety of conditions, including some serious ones, such as cancer and blood clots.

A strict COVID-19 lockdown in Shanghai, China, had shut down a plant that manufactures the contrast and the 30-hospital medical center, like many others, suddenly found itself in short supply of the important diagnostic agent.

“The shortage has hit us fairly acutely,” says Geoffrey Rubin, MD, chair of the Department of Medical Imaging at the University of Arizona College of Medicine – Tucson and clinical service chief of medical imaging at Banner University Medicine – Tucson.

In response, Rubin and his colleagues quickly rallied to create a tiered protocol that prioritized the most critical medical procedures. Some tests were done using alternative tools, such as CT scans without contrast or MRIs, if it made sense for the patient.

Also, because the health system sources its contrast media from two companies, only one of which was impacted by the Shanghai lockdown, their supply wasn’t completely cut off.

But this was not the case everywhere.

Contrast media is used in about 50 million exams per year in the United States, and about half of the market procures its contrast from GE Healthcare, which sources most of its product from Shanghai, says Matthew Davenport, MD, vice chair of the American College of Radiology (ACR) Commission on Quality and Safety and a professor of radiology and urology at Michigan Medicine in Ann Arbor.

“Health systems that used GE Healthcare as their preferred vendor for iodinated contrast media had an immediate crisis,” Davenport says.

According to a GE Healthcare spokesperson, the company is currently working on restabilizing its supply and continues to evaluate its global footprint to maximize resilience.

Contrast media is just one item on a growing list of medical supplies that are becoming harder to come by due to world events impacting the supply chain, from COVID-19 lockdowns in China and manufacturing errors in the United States to the rising cost of fuel and the war in Ukraine.

The Food and Drug Administration lists more than two dozen medical items currently in short supply, including personal protective equipment (PPE) such as surgical gloves and gowns, reagents for laboratory testing, and several dialysis-related products.

“[Health systems are experiencing] 8-10 times higher shortages than they were pre-pandemic,” says Kyle MacKinnon, senior director of operational excellence for Premier, a group purchasing company. “We are seeing more frequent short-term shortages than we ever have in the past.”

A history of shortages

Shortages of important medical supplies in the United States due to supply chain issues date back as far as World War II, when supply of a common malaria drug that was sourced in the Japanese-occupied East Indies was cut off. Since then, the United States has faced both consistent and acute shortages, according to a 2021 study by researchers from Baylor College of Medicine in Houston, Texas.

In 2017, Hurricane Maria wiped out a main supplier of saline solution in Puerto Rico, creating a grave shortage. At the beginning of the COVID-19 pandemic, health care workers resorted to reusing PPE and crafting gowns out of trash bags as deliveries of Chinese-made materials slowed to a trickle.

The country has also faced shortages of a variety of drugs, such as anesthetics, antibiotics, and chemotherapy agents, for decades. Often, the shortages are exacerbated by regional disasters that disrupt the supply chain.

Currently, in addition to the shortages caused by COVID-19 lockdowns and disruptions, the war in Ukraine has the potential to worsen shortages of helium, which is used in MRIs and CT scans, and neon, which is essential for making semiconductors used in MRIs, pacemakers, blood pressure monitors, and other common medical devices.

Since Russia is no longer exporting as much natural gas to some European countries, other countries have begun filling in that supply via pipeline, reducing the need to convert the gases to liquid form. Because liquification facilitates extraction of helium from natural gas, this shift has also halted some helium production processes. This is on top of several helium plants shutting down in recent months for safety reasons.

“What a convoluted way to have medical supplies disrupted by the Ukraine war,” says Wally Hopp, PhD, a professor at the University of Michigan Ross School of Business in Ann Arbor who chaired the National Academies of Sciences, Engineering, and Medicine task force to study medical supply chain resilience. “These supply chains are so complicated, so long, so interconnected, you can get crazy side effects like that.”

Also, Ukraine is a major global supplier of neon, which may exacerbate further shortages as the war stretches on.

“At this time, we haven’t seen direct shortages of semiconductors yet,” MacKinnon says, But “access to that is becoming a problem.”

Finding solutions

While the contrast media plant in Shanghai is now fully operational and hospitals across the country are gradually getting back to a regular supply of its product, it’s likely that supply chain disruptions for this and other medical supplies will continue to be affected by world events, says Tinglong Dai, PhD, a professor of operations management and business analytics at Johns Hopkins University Carey Business School.

This means that people in the medical industry, from medical students to administrators, should be prepared to both adjust to disruptions that occur and work to prevent them from happening.

“This crisis provided us with an opportunity to think through protocol when we have contrast restrictions and shortages,” Rubin says. “We had never experienced that before. Now we have a set of guidelines.”

For affected health systems, this required a variety of interventions, including lower dosing, performing CT scans without contrast and using alternative imaging strategies when appropriate, and triaging so that the most urgent exams were performed first. Although there is no longer an acute shortage, Davenport suspects that use of iodinated contrast media may go down if research shows lower-dose or unenhanced scanning is as effective as pre-shortage procedures.

“We have to be really attentive to what’s going on around the world, especially [when it comes] to health care.”

Tinglong Dai, PhD
Johns Hopkins University Carey Business School

During the shortage, Rubin held a meeting with his radiology residents to walk them through the crisis, from why it was happening to how the health system was responding to it. He believes that clinicians will have to learn to be more adaptable to whatever shortages and challenges their field faces.

“Oftentimes, there’s so much to learn in medicine [that] people in training — medical students — are focused on the domain of the specialty. The macro-level activities that allow health care to run are not really focused on,” Rubin says. “I think it is increasingly recognized [that] medical students, residents, and fellows [should] have their focus turned more toward these macro-level issues.”

Dai says that hospital administrators, and especially procurement officers, will also need to be more aware of geopolitical issues and how they might impact the supply chain.

“We have to be really attentive to what’s going on around the world,” he says. “Especially [when it comes] to health care.”

Fortifying the supply chains of the future

In response to a request from the U.S. Congress in the 2020 Coronavirus Aid, Relief, and Economic Security (CARES) Act, the National Academies of Sciences, Engineering, and Medicine convened a committee to assess the security of the nation’s medical product supply chain. In its report, released in March, the committee made several recommendations to improve supply chain resilience.

“Medical supply chains are really behind other industries in terms of building supply chain resilience,” says Hopp, who led the writing of the report.

He explains that Hurricane Katrina in 2005 resulted in unexpected supply chain shortages because companies didn’t realize that the materials they were buying were sourced from the Gulf Coast. This realization prompted many in supply chain logistics to better track where various materials needed for manufacturing their products were coming from, including risk assessment and diversification of where they sourced the materials in case of a regional disaster.

But this still isn’t common in the medical industry, at least in part because there is a lack of transparency in the production of pharmaceuticals and other medical supplies, Hopp says. Procurement officers at health systems often don’t know where the companies they contract with are sourcing and manufacturing their materials.

This becomes particularly problematic when health systems contract mainly with one company to get the best price and when they use a “just in time” inventory approach, meaning they only stock enough supply for a week or two to save money on storage costs, he adds.

“Transparency has to be step one,” Hopp says, explaining the committee’s foundational recommendation to create a public database that documents where materials are sourced and manufactured so that experts can better analyze risk and make further recommendations for fortifying the supply chain.

In addition to being aware of possible natural disasters, Dai emphasizes the importance of geopolitical awareness.

“A large proportion of medical supplies come from China. Most of the generic drugs are manufactured in India,” Dai says. “We are so dependent on countries that are geopolitically incompatible [with] us.”

He says that the United States can protect its future supply chains by focusing more on sourcing and manufacturing closer to home, not only in the United States, but in Canada and Latin America, or by strengthening our supply chain relationships with countries that are part of the North Atlantic Treaty Organization (NATO) while moving away from reliance on countries where there may be more political issues.

Hopp cautions against the idea of focusing solely on “on-shoring,” the manufacturing of goods on United States territory.

“It’s difficult to make every raw material, every intermediate step inside the U.S., [and] it’s expensive to do it in some cases,” he says.

Instead, there should be a variety of responses, including potentially stockpiling raw materials, mapping out supply chain routes to assess risk, and building contracts that incentivize companies to reduce the risk of complete disruption, Hopp says.

Many of these steps would require the federal government and manufacturers to act, but health care system administrators can also drive change by demanding better transparency and reliability from manufacturers as well as reconsidering their stockpiling strategies, according to Hopp.

Another key to securing the future of the U.S. medical supply chain, according to Dai, is ensuring that the country is on the forefront of developing innovative ideas that improve supply chains.

“If we lose the ability to innovate, that [would be] devastating,” he says. “The government can take an active role [by] investing in research and development, investing in universities and national labs, and providing support for new ideas.”

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CARE for Newcomers hosting interactive event June 24 celebrating World Refugee Day

CARE for Newcomers hosting interactive event June 24 celebrating World Refugee Day

Three rooms will be utilized in the museum for the event.

The first room, Llupi says, will share stories of refugees and their journeys of how they came to a place of safety.

The second room will consist of short presentations by the three collaborating members and a period for questions on what services are offered to refugees. CSS are the first to welcome and accommodate refugees, helping to find housing. CAIWA works with families, particularly women and children. CARE will be discussing their work with youth in schools and English courses.

The third room will be set like a theatre with what Llupi calls a “human library”. Eight refugees, rotating in groups of four, will gather to answer questions about their experience coming to Canada. Llupi says each story is unique, some coming as refugees from Colombia, others are high school students.

Llupi says that over the last three weeks, refugees coming to Red Deer include those from Afghanistan, Jordan, and Syria, with some moving to various different refugee camps before landing in Canada.

Despite the Russian-Ukrainian war, she says most Ukrainians coming to Canada are not registered as refugees but rather as “politically displaced persons”. This title, she says, does not provide them with the same help that refugees receive in Canada and has caused some confusion among organizations as to what they are allowed to provide them with.

Coming as an immigrant herself but not a refugee, Llupi hopes the event will provide a space for people to gain insight from those going through this journey first-hand and understanding their experience.

“I would like to break a little bit the barrier that you can ask questions if someone looks different or has an accent,” she said.

The organization also posted on their social media pages the films created by Reuben Tschetter, in association with CARE, from the 2016 live performances of “Journeys of Hope”, depicting the stories of multiple refugees.

On June 23 from 6 – 8 p.m., individuals can view a public showing of the films and meet those refugees in the Maple Room at CARE for Newcomers (202 – 5000 Gaetz Ave). Free refreshments will be available.

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KK’s death underscores the need for emergency care at public events CanIndia News

ISPR denies media report on events at PM House CanIndia News

The recent death of veteran singer Krishnakumar Kunnath (KK) after a concert in Kolkata has highlighted the need to learn the basic nuances of handling the health emergencies for all.

The post mortem report of singer indicated that KK had significant blockages in his heart vessels, which led to a heart attack. Even, he can be seen distressed and sweating during his live performance. The singer was taken to his hotel and then to a hospital where doctors declared him dead following a cardiac arrest.

The major point which is being widely discussed is — Had he survived if he had been promptly transported to a hospital?

“Timely CPR even by a lay person and immediate shifting to cardiac Centre might have different result”, says Dr (Prof) Tarun kumar, ABVIMS and RML hospital. He told IANS that if he had any symptoms, he should have been immediately taken to nearest medical Centre, instead of going to hotel. Time is both precious and precarious in such medical emergency, he said.

Emergency medical and critical care services can play a significant role in designing and implementing an effective approach towards public health. The top three reasons people visit an emergency are heart attack, a stroke, or an accident. In the case of a heart attack or accident, the patient must get to a hospital within 60 minutes. The time-to-treatment is most crucial in the case of heart attack. The medical guidelines say this should be 90 minutes or less to perform angioplasty in such cases.

The essential elements of an emergency medical system for cardiac patients are: ambulance operations, a call centre, and healthcare facilities.

“A heart attack is a medical emergency. It usually occurs when a blood clot blocks blood flow to the heart. It leads to myocardial injury and needs proper treatment to salvage the myocardium. In cardiac arrest, the heart abruptly stops beating. Without prompt intervention, it can result in the person’s death. Heart function stops abruptly and needs urgent intervention”, said Dr Kumar.

Availability of Cardiac defibrillator at public places is sometimes life saving, said Dr Kumar, highlighting the need of self awareness and proper training in such emergency cases. To handle the medical emergency, he emphasised on self awareness and regular cardiac check.

To prevent such incidents, Cardio-Pulmonary Resuscitation (CPR) may be helpful in certain situations if he or she has proper training. “Installation of Cardiac defibrillator at public places like bus stand, railway station, airport, stadium and General public awareness and training at mass level in CPR and usage of cardiac defibrillators can help us deal with any such health emergency”, Dr Kumar told IANS.

Deployment of ambulances at least equipped with necessary medicines and trained paramedics should be made mandatory at large gatherings or public events, he added further.

However, a 2020 AIIMS Delhi report on emergency and injury care at district hospitals in India says that even 88 per cent of hospitals had in-house ambulances, trained paramedics needed to assist ambulance services were present only in 3 per cent.

“Provision of specialized care during ambulance transport was largely poor: only 12 per cent hospitals had mobile Stroke/ STEMI (for heart attack) program. Most of the hospitals lacked Pre-hospital arrival notification system”, the study pointed out.

“Emergency care system in our country has seen uneven progress. Some states have done well, while others are still in the budding stages. Overall, it suffers from fragmentation of services from pre-hospital care to facility-based care in government as well as in the private sector. The system also suffers from lack of trained human resource, finances, legislation and regulations governing the system. Absence of standalone academic department since its inception is another factor which is ailing the system”, the study said about emergency services in the country.

Dr Abhishek Shankar, Associate Professor, Department of Radiation Oncology, AIIMS Patna, says that awareness about health for any minor issues in India is so poor that people land in trouble.

Dr Rohan Krishnan, President of Federation of All India Medical Association, emphasised on providing health education at plus two level irrespective of students’ stream. He said that students must be taught basic life saving skills at college level to deal with such emergency situation. Along with creating a mass level awareness on basic life saving skills, the general public also needs to imbibe ‘accepting attitude’ and abstain from ‘ignoring attitude’, as public visit hospital only when the condition becomes grave, said Dr Krishnan.

(Avinash Prabhakar can be reached at


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EDI office hosts positive change in health care panel during Pride 2022 events

pride flag

May 27, 2022 — 

The Office of Equity Diversity and Inclusion at the Rady Faculty of Health Sciences is hosting a community of practice event to discuss advocacy and positive solutions for 2SLGBTQIA+ people who have been marginalized and discriminated against when seeking health-care services. 

The virtual event Advocating for Positive Change in Health Care – channeling our own life experiences into helping others navigate the health care system will take place Monday, May 30 as part of several Pride 2022 events around the University of Manitoba.

“For many Manitobans, finding a good family doctor is challenging enough. Then on top of that, if you need one who understands what being gay, lesbian, trans or non-binary is, it can pose a bigger challenge,” says Shandi Strong, a transgender rights activist, author, public speaker and aspiring politician who will be the guest speaker at the event.

Shandi Strong

Shandi Strong

Strong says stigma and the fear of stigma can result in anxiety and stress that prevents people from seeking care when they should have. The lack of accessible mental health supports makes it difficult for those actively seeking counselling.  “Covid-19 has shone a light on the current lack of mental health supports in our province.  It’s a sad state of affairs when an emergency need for counselling has an eight-12 month wait list.” 

One of the key elements to improving health care for 2SLGBTQIA+ people is education, says Strong. “Not only on behalf of the caregivers, but the recipients too. Those who provide care need to be educated and trained to be accepting of 2SLGBTQIA+ folx. Recipients have to learn that they have the right to appropriate care, and options for where to look should they find it lacking.”

Strong looks forward to sharing her personal story as a way to give hope to people who may be facing the same challenging circumstances she did, so they can find the support and optimism to overcome them.

Strong says she will continue to strive to bring about change “so that in the future, we won’t have to worry about sexuality, gender, race, disabilities, or other such factors being deciding factors on how we treat each other as human beings.”

Ellie Caslake, a transgender women, artist and EDI project developer will host the community of practice event in conversation with Strong that will take place over Zoom, starting at 1:30 p.m.

Any questions or accommodations for the event please email funmi [dot] owoade [at] umanitoba [dot] ca.

Other University of Manitoba Pride 2022 Events:

Wednesday, June 1
Flag Raising

Fort Garry campus at the flagpoles outside of UMSU University Centre | 9:00 a.m.
The Pride flag will also be raised on Bannatyne campus in the Brodie Centre Atrium. 

Sunday, June 5
Pride Parade

Legislative Building | 11:00 a.m. | Register for the Pride Parade here.
Please meet by 10:15 a.m. on Memorial Blvd; parade to start at 11:00 a.m.

Stay up to date on events, share your photos and join the conversation on Twitter and Instagram using #umqueer.

If you require any accessibility accommodations, please contact umqueer [at] umanitoba [dot] ca.

All are welcome to these free events!

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Events in May celebrate Richmond child care providers

Events in May celebrate Richmond child care providers

Richmondites are invited to attend two events to celebrate Child Care Month.

The City of Richmond is kicking off Child Care Month with two planned events in May.

Child Care Month, which is celebrated every May in B.C., recognizes the work and dedication of early childhood educators and child care providers who support the well-being of children.

Child care was emphasized as an important essential service during the pandemic, according to Mayor Malcolm Brodie.

“The city is committed to working in partnership with child care stakeholders to ensure the needs of Richmond families and children are addressed,” said Brodie, adding that currently, there are over 7,700 licensed child care facilities in Richmond. 

The first event is a Child Care Symposium that is scheduled to take place virtually on Zoom on May 7 from 9 a.m. to 12:30 p.m. 

It will feature three presentations to help childcare providers and parents to learn about the importance of relationships as well as provide strategies to build those relationships with the children they care for.

A participation fee of $5 is required from people before they join the event. 

The second event, titled “Children’s Art Exhibition,” is hosted by the Richmond Public Library and features paintings and other original creations from local care programs at the Brighouse branch from May 2 to 22.

For more information about the Child Care Symposium and the Children’s Art Exhibition, click here or email

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Obama to make first public White House appearance since 2017 at health care event – National |

Obama to make first public White House appearance since 2017 at health care event - National |

Former President Barack Obama will be returning to the White House on Tuesday for his first public event there since he left office in 2017.

A White House official said Sunday that Obama will be joining President Joe Biden and Vice President Kamala Harris to “deliver remarks celebrating the success of the Affordable Care Act and Medicaid in extending affordable health insurance to millions of Americans.”

The event is part of Biden’s effort to turn his focus to pocketbook issues that directly affect American households. While job growth has been steady since he took office, inflation is at its worst level in a generation.

The White House said Biden “will take additional action to further strengthen the ACA and save families hundreds of dollars a month on their health care.”

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Health Secretary Xavier Becerra and other members of Biden’s Cabinet will attend Tuesday’s event.

Obama’s visit to the White House was first reported by NBC News.

© 2022 The Canadian Press

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Adverse events and risk management in residential aged care | RMHP

Angiotensinogen and Risk of Stroke Events in Patients with Type 2 Diab | DMSO


Regarding urbanization and industrialization, population aging is one of the most urgent problems globally, specifically for developing countries with limited resources for old-age care.1 China has the highest number of older adults; it is also one of the countries with the fastest aging population.2 The proportion of adults over 65 years has increased from 13.3% in 2010 to 18.7% in 2020.3 Residential aged care facilities (RACFs), a thriving way of old-age care, have become increasingly important in China, because of the “one-child” policy, increase in life expectancy, and weakening role of family care.4 Currently, less than 200,000 nurses provide nursing care for about 2.146 million older adults in 42,300 RACFs.5 Due to the decline of physical strength and physiological functions of older adults, their chances of suffering from chronic physical diseases, mental disorders, and disabilities have increased.6 Along with the shortage of nursing staff, insufficient professional skills, and other problems,7 older adults living in RACFs are at a high risk of suffering from care accidents and nursing adverse events (eg falls, burns, choking, aspiration, wandering away, and pressure sores),8 which negatively impact their physical and mental wellbeing and can cause disputes, economic and property losses, among others. The role of risk management in effectively reducing nursing adverse events and maintaining older adults’ safety has been widely documented.9,10 Given various risks faced by RACFs, managers urgently need to actively adopt risk management and early warning strategies to reduce the potential mistakes in care delivery for older adults.


Risk management is a complicated process of implementing and maintaining countermeasures to reduce risk impact to an acceptable level.11 In the past decade, governments, researchers, and RACFs have been devoted to exploring nursing risk indicators, establishing nursing risk early warning systems, and formulating nursing risk prevention strategies. For example, the UK and the US have applied a standardized assessment tool, namely the Minimum Data Set (MDS), to systematically assess and review nursing practices, identify nursing home residents at risk of deterioration, and protect residents’ integrity and autonomy.12,13 Australia developed nursing risk assessment indicators for older adults, which involve pressure sores, falls or fractures, use of physical restraints, and psychological and behavioral symptoms.14 Several risk analysis methods such as Failure Mode and Effects Analysis (FMEA),15 Fine–Kinney method,16 SHEL model (software, hardware, environment, and liveware),17 Swiss cheese model,18 are widely applied to identify potential human mistakes in practice. With the wide application of information technology (IT) in healthcare, risk management information systems (RMIS) are often applied for data collection, information analysis, and statistical reports to identify and monitor preventable incidents. In the UK, through the National Early Warning Score (NEWS) system19 as well as the National Reporting and Learning System, a supportive environment for actively reporting and sharing errors is created, and related experiences and lessons are widely disseminated.

Chinese scholars and healthcare professionals tried to conduct preliminary studies of risk management in RACFs. For example, Li et al20 used FMEA to analyze various internal risks regarding infectious diseases, injuries, falling, and accidents in RACFs. Zhou21 tried to establish risk prevention and management systems for RACFs including external, internal, and economic risks. Based on the prevention, preparedness, response, and recovery (PPRR) risk management model, Zhang22 established an emergency practical path for public health emergencies in RACFs. China’s government departments such as the China National Committee on Aging, Ministry of Civil Affairs, China Academy of Social Management have tried to improve RACFs care quality and have promulgated relevant policies and regulations. China’s Ministry of Civil Affairs created requirements for the room environment and older adults’ sanitation as well as safety measures in RACFs, such as barrier-free design and smooth and non-slip floors. The establishment of such facilities should pass the evaluation by local authorities regarding construction, fire protection, sanitation, and epidemic prevention. Additionally, the national mandatory standard-basic specification of service safety for senior care organizations requires each RACF to reduce risks of choking, pressure ulcer, scald, fall, and so on through standardized operation procures and risk management.23

Effective risk management activities usually include the following stages: identification, analysis, evaluation and treatment, and communication and consultation.24 Evaluation and feedback are essential to accumulate long-term evidence and guarantee the care outcomes and older adults’ safety regarding risk management and early warning in RACFs. However, existing studies fail to provide a clear picture of the prevalence status, risk management, and risk early warning of nursing adverse events in RACFs. Thus, this study aims to (1) investigate the prevalence of nursing adverse events, risk management, and risk early warning status and (2) explore the factors associated with risk management in RACFs in China.

Materials and Methods


This study used a cross-sectional design and employed an online questionnaire to investigate RACFs in Hunan Province.


A convenience sample (a type of non-probability sampling method where the sample is drawn from a group of people easy to contact and obtain their participation)25 of 272 RACFs were recruited in Hunan Province. RACFs’ managers were invited to respond to the survey. The inclusion criteria were 1) license for establishment and registration in the local civil affairs department; 2) operation duration of at least one year; 3) equipped with ten or more beds; 4) consent to participate in the study.

Survey Tools

The self-administered questionnaire used had four sections: prevalence of nursing adverse events, risk management, risk early warning, and general information survey scales.

Prevalence of Nursing Adverse Events

This section is used to inquire about the prevalence of nursing adverse events in RACFs in the past year (2019), including 14 fill-in-the-blank questions. Respondents were required to provide an accurate figure in each blank. The type of adverse events in this study included falls,26 falling out of beds (or chairs), fractures,27 food poisoning,28 burns or scalds,29 choking,30 aspiration or swallowing of foreign bodies,31 wandering away,32 accidental death, pressure sores,33 medication errors,34 adverse events caused by physical restraints,35 and accidental catheter removal (ie cannula, endotracheal tube, nasogastric tube, and urinary catheter).36

Risk Management Scale

The risk management scale was self-developed from our previous research37 to evaluate the status of RACFs. It includes 28 items and four management dimensions: environment (4 items), personnel (4 items), service (10 items), and safety (10 items). Each item is scored on a five-point Likert scale ranging from 1 (completely inappropriate) to 5 (completely appropriate). The scale is scored by summing the numerical ratings for each item and dividing the result by the total number of items. Possible scores ranged from 1 to 5. The higher the score, the better risk management. The overall Cronbach’s α coefficient of this scale was 0.974, and its split-half reliability (used to measure the internal consistency reliability of survey instruments and assessed by splitting the items of survey instrument in half, and then calculating the correlation of the scores for each half)38 was 0.951. Cronbach’s α coefficients for the environment personnel, service, and safety management dimensions were 0.842, 0.905, 0.924, and 0.943, respectively.

Risk Early Warning Scale

The risk early warning scale was self-designed from our previous study39 to evaluate the early warning status of RACFs. The scale comprises four dimensions with 26 items: nursing staff training (six items), a contingency plan for public security incidents (eight items), a contingency plan for age-related safety incidents (seven items), and emergency management (five items). Participants respond “Yes” or “No” to each item (1 = Yes; 0 = No). The total score ranges from 0 to 26, and a higher score signifies better risk early warning. In this study, the Cronbach’s α coefficient of the entire scale was 0.874 and the split-half reliability was 0.786. Cronbach’s α coefficients for the nursing staff training, a contingency plan for public security incidents, contingency plan for age-related safety incidents and emergency management dimensions were 0.720, 0.813, 0.724, and 0.682, respectively.

General Information

This section captured RACFs’ demographic characteristics, such as the ownership and location of the facility, whether it has the Practice Certificate of Social Welfare Facilities, operation duration (year), bed-size, number of residents, number of nursing staff, whether it requires nursing staff to work with certificates, and payment for nursing staff (RMB/month).

Data Collection

From February 1 and March 1, 2020, the primary researchers sent the recruitment invitation and informed consent form to the RACF managers in Hunan Province through email and obtained a copy of the written informed consent from 401 eligible RACFs. Then, we recruited sophomore nursing students as investigators, who were not allowed to return to School because of the isolation policy due to COVID-19. From March 5 to May 10, 2020, potential student investigators received curriculum and instructions on the questionnaire survey guidelines, quantitative research design, and data collection methods. The primary researcher distributed the questionnaire link to WeChat groups (the most popular social media application in China) and ensured all student investigators had the survey link. Finally, 114 students participated in the data collection of RACFs in their county administrative areas (one investigator per county-level administrative region). From May 13 to June 1, 2020, student investigators collected data from nearby RACFs and invited the managers to respond to the survey. In the field survey, the investigators did not conduct the questionnaire survey until they obtained the participants’ oral consent. While interviewing the RACF managers according to the survey scale, the investigators recorded the answers into the online questionnaire ( on their mobile phones.

Ethical Considerations

Before collecting data, the investigators explained the purpose, process, as well as potential benefits and risks to the RACF managers. The collected data did not contain the identifiable information of the RACFs or managers. This study conforms to the provisions and ethical principles of the 1995 Declaration of Helsinki (revised in Edinburgh in 2000). The Institutional Review Board of the Affiliated Hospital of Xiangnan University approved this study (registration number: KY–201508001).

Data Analysis

We excluded questionnaires with more than 20% data missing, which could not be supplemented by other means. The questionnaires were sorted by the principal researchers, and the data were analyzed using SPSS 25.0 statistical software. The Kolmogorov–Smirnov normality test was performed on continuous data. The normality tests showed that all continuous variables had a non-normal distribution. In this study, continuous variables were described by median (interquartile range, IQR), and categorical variables were described as frequency and percentage and presented in bar charts. The statistical analysis was conducted using the Mann–Whitney U-test and Kruskal–Wallis H-test, and Spearman correlation was used to analyze the association with the main independent variables. The significance level was set as 0.05.


General Characteristics of the Sample

In total, 328 questionnaires were collected; after excluding 56 questionnaires, 272 valid questionnaires were obtained. Figure 1 shows the distribution of the sample RACFs.

Figure 1 Distribution of the research residential aged care facilities in the Hunan Province.

Finally, this study analyzed 152 (55.88%) public and 120 (44.12%) private RACFs. Most were in rural areas (n = 150; 55.15%), obtained the Practice Certificate of Social Welfare Facilities (n = 234; 86.03%), and required nursing staff to work with certificates (n = 239; 87.87%). The operation duration of RACFs was 1 to 62 (11; IQR: 12) years. The number of beds in RACFs ranged from 10 to 10,000 (70; IQR: 97), among which 81 (29.78%) had 10 to 49 beds, 86 (31.62%) had 50 to 99 beds, 60 (22.06%) had 100 to 199 beds, and 45 (16.54%) had 200 or more beds. During the survey period, the number of older adult residents was between four and 7216 (40, IQR: 54), the number of nursing staff was between one and 4000 (7, IQR: 14), and the nursing hours per resident day (HPRD) ranged between 0.16 and 16.84 (1.48, IQR: 1.64; calculated according to nursing staff working 8h per day; Table 1, Figure 2).

Table 1 Demographic Characteristics of the Research RACFs (n=272)

Figure 2 General characteristics of the sample (median, n=272).

Prevalence of Nursing Adverse Events, Risk Management, and Risk Early Warning in RACFs

We found that an average of five (15) adverse events occurred in RACFs in 2019, with falls (2, IQR: 5) and pressure sores (0, IQR: 1.75) at the highest level, and accidental death (0, IQR: 0) and food poisoning (0, IQR: 0) at the lowest level (Figure 3).

Figure 3 The prevalence of nursing adverse events in 2019.

This study revealed that the facility’s risk management score was at an acceptable and relatively desirable level. The total average score of risk management in RACFs was 4.72 (0.98) out of 5. The score of environment management and personnel management dimensions was the highest at 4.75 (1), followed by safety management at 4.70 (1), while the score of service management dimension was the lowest at 4.60 (1; See Table 2).

Table 2 Risk Management in Residential Aged Care Facilities (n=272)

Regarding the nursing staff training of RACFs, as shown in Graph A of Figure 4, more than 90% had trained their nurses on nursing knowledge and rehabilitation skills, but only 72.79% on relevant ethical and legal considerations. In terms of contingency planning for public safety incidents, most RACFs had made contingency plans for fire (96.31%) and food poisoning (92.28%), but only 66.91% and 56.99% had formulated contingency plans for gas poisoning and drowning, respectively, as shown in Graph B of Figure 4. Regarding contingency planning for age-related safety incidents, Graph C of Figure 4 shows that 95.96% and 90.81% of RACFs had made contingency plans for falls and sudden changes of diseases, respectively. However, only 73.53% reported suicide contingency plans. More than 90% regularly organized nursing staff to conduct emergency drills (92.28%), had set up emergency teams (91.91%), established a safety emergency monitoring system (92.65%), and quickly coordinated and distributed emergency materials and equipment according to critical situations (94.12%). However, only 84.56% provided pre-hospital first aid for older adults, as shown in Graph D of Figure 4.

Figure 4 Risk early warning status in residential aged care facilities.

Associated Factors of Risk Management in RACFs

The Mann–Whitney U-test or the Kruskal–Wallis H-test showed that the following factors of RACFs favor risk management: in urban areas, obtaining the Practice Certificate of Social Welfare Facilities, with more than 50 beds, providing higher HRPD, requiring nursing staff to work with certificates, and paying higher salary (all p < 0.05; Table 3).

Table 3 Differences in Risk Management Scores with Participants’ Demographic Characteristics (Score, n = 272)

Relationships Between Risk Management Scores, Frequency of Nursing Adverse Events, and Risk Early Warning Scores

In this study, frequency of adverse events was weakly negatively correlated with the risk management scores (rs = −0.208, p < 0.01), as well as environment (rs =−0.151, p < 0.05), personnel (rs = −0.212, p < 0.01), service (rs = −0. 205, p < 0.01), and safety management (rs = −0.204, p < 0.01). Moreover, risk early warning scores was moderately positively correlated with the risk management scores (rs =0.516, p < 0.01), as well as environment (rs =0.434, p < 0.01), personnel (rs =0.461, p < 0.01), service (rs = 0.497, p < 0.01), safety management (rs =0.511, p < 0.01) scores, as shown in Table 4.

Table 4 Correlations Between Risk Management Scores, Frequency of Adverse Events, and Risk Early Warning Scores (Rs, N = 272)


We found RACFs experienced an average of five (15) adverse events in 2019, which is significantly higher than that in Italian nursing homes.40 This may be related to the differences in survey methods (field survey vs online survey), the healthcare environment, and the time period (one year vs six weeks). However, these numbers may be significantly lower than actual incidents. Generally, most RACFs try to underreport any adverse events, which might affect their quality ratings and reputation in the community.41,42 Kapoor43 reported that the prevalence of adverse events in patients transitioning from hospitals to long-term care facilities was 37.3%. According to a study by Health and Human Services Inspector General Office, about 22% of older adults experienced at least one adverse event during their stay in the nursing home, and the total cost leading to rehospitalization was about USD 208 million.44 The trend of adverse events is similar to those in other countries;43,45,46 for instance, falls, pressure sores, psychological adverse events, falling out of bed (or chair), choking, and aspiration or swallowing foreign bodies were common adverse events in RACF settings. These may have potentially negative impacts on residents’ health outcomes, quality of life, and mental health. Thus, RACFs and healthcare professionals need to make effective resident-safety interventions to reduce adverse events.

Although the facility’s risk management score is at an acceptable and relatively desirable level, it might be reasonable to increase it to a more optimal level, specifically in the safety management and service management domains. In RACFs, numerous quality and safety issues, such as minor mistakes, missing and rushed care, and disruptions in care, can negatively impact the physical and mental health of older people over time.47,48 A significant amount of previous research49,50 has shown that RACFs need to establish a safety culture and encourage active and unpunished error reporting of nursing adverse events to reduce potential harm. In China, the safety management and service quality provided by RACFs are highly variable due to weak quality regulation, insufficient inspections, and poor enforcement of rules.51 To ensure quality care in supporting independence, autonomy, dignity, and safety of the older adults, it is imperative to establish an effective long-term care regulatory framework and quality assurance system.

Regarding staff training in RACFs, only about 70% had trained nursing staff regarding relevant ethical and legal considerations. Legal knowledge is often neglected in the training and education of nursing staff.52 Typically, geriatric care training conducted by RACFs focuses on the daily-life care of older individuals and basic nursing knowledge, such as diet care, oral cleaning, pressure ulcer prevention, and use of crutches and wheelchairs. However, nursing staff in RACFs shoulder complex ethical responsibilities, take ethical care actions, and balance moral dilemmas and legal issues related to health and safety.53 Thus, it is important to emphasize nursing staff’s understanding of the legal and ethical framework for geriatric care to provide the better care.

Regarding contingency plans, this survey showed that 30% to 40% of the facilities did not have contingency plans for suicide, electric shock, gas poisoning, and drowning, although China’s Ministry of Civil Affairs issued the Administrative Measures for Residential Aged Care Facilities, which requires RACFs to formulate contingency plans for natural disasters, accidents, public health incidents, and social security incidents.54 Fisher et al55 stated that contingency planning is a continuous process, which demonstrates personnel responsibilities, response time, corresponding strategies as well as resource preparation before, during, and after the emergency. Moreover, evidence has shown that emergency preparedness and disaster response plan is important in the emergency system and guide timely and effective emergency rescue.56,57 Our findings demonstrate the need for administrative authorities (eg the Ministry of Civil Affairs and the Central Politics and Law Commission) to strengthen the monitoring of RACFs’ emergency system to effectively address emergencies and minimize losses.

Regarding emergency management, only 84.56% of RACFs utilized pre-hospital first aid for older adults. In China, to minimize daily operating costs, some small RACFs choose the sharing mode to cooperate with nearby community health service centers and hospitals to address residents’ healthcare treatment.58 However, due to the shortage of qualified employees and equipment, these facilities may experience potential hazards such as missing the prime time for first aid and causing serious life-threatening consequences. Hence, we recommend RACFs make an extensive and sustained effort to develop manpower (eg in-service training, simulation of incident scenes, and operational training)59 and equipment (eg alarm device, upgraded technologies, necessary emergency rescue equipment, and ambulances)60 to ensure residents’ safety and meet the needs of first aid and high-quality medical services.61

The findings revealed that urban RACFs scored significantly higher than those in rural areas. The common assumption is that those in rural areas with higher poverty rates, limited support staff, and lower availability of health promotion and disease projects62–65 experience more difficulty in creating a physical environment suitable for the older adults, recruiting and training nursing staff with sufficient competences, and establishing effective risk management programs. Moreover, RACFs that have obtained the Practice Certificate of Social Welfare Facilities are better at risk management. In China, they can successfully obtain it only when they meet the basic standards of civil affairs departments for living places, and outdoor activity venues, start-up funds, regulations and personnel, as well as the national fire safety, sanitation, and epidemic prevention standards. Such policy promotes managers to address the risk and safety issues in the application process of the certificate and further improves the scores in all dimensions. Similarly, in the US, the Centers for Medicare and Medicaid Services and health authorities in various states have issued a series of policies (eg Five-Star Quality Rating System) to supervise and inspect nursing homes, to ensure that care delivery meets the necessary legal, quality, and safety standards.66 We identified lower risk management scores in small-scale RACFs with 10 to 49 beds than those with more than 50 beds, consistent with the previous study by Liu,67 which found the vast majority of small RACFs are equipped with little emergency medical equipment and tend to recruit rural women with poor professional knowledge and limited emergency nursing skills as nursing aids. Notably, adequate and qualified nurses are important for risk management in RACFs along with nursing HPRD (staffing) and qualified care workers’ recruitment. Typically, nursing staff are crucial human resources in reducing pressure sores, falls, use of immobilization devices, and pain and furthering residents’ better outcomes.68,69 However, the results showed that the average nursing HPRD in RACFs in China was 1.48 (1.64), significantly lower than the international standard.68,70 According to payroll-based journal data, in 2019, nursing homes reported 3.89 nursing HPRD on average (0.68 registered nurse HPRD, 0.88 licensed vocational nurse/licensed practical nurse HPRD, and 2.33 certified nursing assistant HPRD, including all administrative nurses).71 It is well known that RACFs should recruit sufficient qualified nursing staff with appropriate competencies; however, in this study, although 85.45% of the facilities required nursing staff to work with certificates, many did not recruit on-site registered nurses. Given the low nursing HPRD and limited registered nurses in Chinese RACFs, further efforts are needed to attract nursing staff to geriatric care and retain them, thereby addressing the nursing shortage. Interestingly, the risk management score of RACFs is related to nursing staff’s salary. This can be explained as RACFs offering higher salaries for a greater likelihood of better financial resources and higher employee retention. Furthermore, it is well documented that nurses with relatively low incomes are more likely to report higher job burnout,72 lower prestige, less professional autonomy,73 and lower work creativity, which may lead to less empathic care delivery, and missing or rushed care. A national survey of 239,312 employees in China RACF settings also revealed that the labor (taking care of six to seven disabled or semi-disabled older adults on average every day) and payment (<3000 RMB) for nursing staff were significantly unbalanced, which leads to a continual decline in their efforts and attitudes toward nursing development and career retention.74 Recommendations include strengthening national route inspections and enforcement provisions, improving care workers’ performance, establishing a reward and punishment mechanism to help risk management of RACFs, specifically for those in a rural area with limited healthcare resources.

As expected, the lower frequency of adverse events was correlated with better risk management, consistent with the results of Lawati et al75 and Smith et al,76 which suggest that successful risk management programs could facilitate creating and maintaining safe systems of care, improving human performance, and reducing adverse events. However, the correlation was not as high as expected,77,78 with the figure of −0.208 indicating only a weak correlation between adverse event frequency and risk management. It is unclear whether this is related to confounding factors’ effect such as RACF characteristics and the validity of the measurement tool. More evidence is needed linking risk management to the incidence of adverse events. Additionally, RACFs’ risk early warning favors risk management, which is supported by previous studies.79,80 Catalyst11 believed that education and training, contingency plans, response, and mitigation are essential components for all healthcare risk management programs. Prevention beats remediation, with an emphasis on “early warning, risk reduction and managing uncertainties around older residents.”81 With the continuous development of artificial intelligence (AI), applying AI algorithms such as machine learning, and back propagation neural networks in constructing nursing risk early warning models can overcome the shortcomings of traditional integrated prediction methods and provide managers with decision-making information.82 RACFs could consider integrating innovative IT across risk early warning and management to address the quality and safety concerns of stakeholder groups.

The risk management and risk early warning of adverse events affect the interactions, attitudes, and practice of leaders, employees, and residents of RACFs, and can help leaders initiate quality improvement interventions. This study contributes to the existing literature on risk management and related factors. It also provides evidence for policymakers and RACF managers and staff to develop strategies to optimize care delivery in these settings.


This study has the following limitations. First, the cross-sectional design and potential selection bias limit the results’ generalizability. Future longitudinal study can include facilities from other provinces. Second, some facilities might choose to underreport adverse events and increase effective preventive measures to protect their reputation, although we required investigators to check the relevant documents and records of the organizations to minimize data biases. Third, the psychometric properties of the questionnaires and participants’ subjective ideas need to be further explored, although the entire scales have good reliability and validity with the Cronbach’s α coefficients between 0.874–0.974 and the split-half reliabilities between 0.786–0.951. Fourth, student investigators may lack an in-depth understanding of the questionnaire items, leading to missing important information and inability to guarantee the data accuracy. Moreover, given their low prestige, respondents could skip the question or choose the best answer provided, resulting in some biases on answers. Finally, this study failed to record some types of adverse events (eg suicide, hospital admissions) and did not consider some potential variables (eg star rating, occupancy ratio of disabled older adults, the proportion of residents aged over 80 years, and profit and loss status). Multi-center and cross-sector research is needed to evaluate other factors that may be related to risk management and early warning.


Adverse events in RACFs are the leading causes of morbidity and mortality among residents; facilities should conduct appropriate risk management and risk early warning. The results of our study showed that the staffing level of nursing staff in RACFs in Hunan, China was low, but the frequency of nursing adverse events (eg falls, pressure sore, psychological adverse events, falling out of bed [or chair] and choking) was high. Overall, the risk management level of the surveyed RACFs was at an acceptable and relatively desirable level. Regarding risk early warning, care workers’ ethical and legal training and some important contingency plans (eg suicide, electric shock, gas poisoning, and drowning) were often overlooked. Besides, large-scale urban RACFs that obtain the Practice Certificate of Social Welfare Facilities, are equipped with adequate and qualified care workers, pay a higher salary to their employees, and gain higher risk management scores. We observed that the lower the frequency of adverse events, the better the risk management, and the better the risk early warning, the higher is the risk management score. RACFs need to adopt multi-dimensional methods and strategies to address the high prevalence of nursing adverse events and advance risk management and risk early warning, to deliver safe and high-quality care for older adults. The results could inform an empirical study of risk management in RACF settings in China to develop a blueprint for the improvement of care outcomes in the context of global rapid aging.

Ethical Approval

The Ethics Review Committee of the Affiliated Hospital of Xiangnan University approved this study (reg. no. KY–201508001).


We would like to thank all the investigators and respondents who participated in this study for their contributions and the Affiliated Hospital of Xiangnan University for its approval and support. We are grateful to Hunan Social Science Achievement Evaluation Committee for their financial and material support.


This study was supported by the Hunan Social Science Achievement Evaluation Committee (grant no. XSP20YBC164), 2018 key scientific research projects of Hunan Provincial Department of Education [grant no. 18A459], the General Project of Hunan Provincial Department of Education [grant no. 21C0723], the General Project of Hunan Philosophy and Social Science Fund [grant no. 17Y3A361], Hunan Clinical Medical Technology Demonstration Base[grant no. 2021sk4046].


The authors report no conflicts of interest in this work.


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