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Making good on promises: Long-term care workers’ mental health is a shared long-term responsibility

Long-term care workers experienced mental health challenges and moral distress during the pandemic. Research shows why workplace standards and support…



As COVID-19 fades from public consciousness, workers in long-term care (LTC) are at risk of falling out of sight and out of mind.

Beyond the death tally headlines that propelled them into the spotlight during the first waves of COVID-19, LTC workers had to manage unprecedented pandemic demands — and encountered correspondingly extreme mental health challenges.

Demands on LTC workers during COVID-19 resulted in extreme mental health challenges. SOURCE, Author provided

These skilled workers spend their days and nights at the side of residents who are navigating some of life’s most profound experiences, including incapacitation, illness and death.

The unglamorous nature of this sector invokes topics many would prefer not to think about, but it is vital we keep shining a light on LTC workers’ needs to ensure that lessons from the pandemic are acted upon.

Recommendations for support

Collaborating with LTC workers throughout Canada, our Calgary-based team of researchers, which includes those with first-hand LTC experience, aims to do just that. Through Canadian Institutes of Health Research funding, we produced a two-minute video animation to communicate the mental health needs of the LTC workforce, and are developing a mental health app tailored to LTC workers, funded by the Alberta Ministry of Labour and Immigration.

We also published recommendations for how organizations across Canada can support LTC workers, in a new report commissioned by Healthcare Excellence Canada (HEC).

Animated video ‘We needed help, but we were supposed to be the help,’ about the mental health needs of long-term care workers.

Our research to better understand and support LTC workers entailed in-depth interviews with 75 LTC workers at LTC organizations in Alberta, British Columbia and Ontario.

We asked about their mental health experiences in relation to their work, and we heard stories of strength and resilience along with stories of distress and fear. Our two-minute animation, We needed help, but we were supposed to be the help, encapsulates these responses.

Work can provoke moral distress

We further focused our research by conducting an online moral distress survey to which 484 LTC workers responded.

Moral distress occurs when staff know what needs to be done, but feel powerless to do it. We learned about a range of morally distressing aspects of LTC work during the pandemic, such as being unable to respond to residents’ needs for attention, and being powerless to follow the wishes of their family members.

Graphic of a person in scrubs and a face mask in a long-term care setting, with text
LTC workers shared ideas for mitigating moral distress at work, and these focused on improved communication, collaboration and support. SOURCE, Author provided

These morally distressing experiences left workers feeling helpless and isolated, and we identified an immediate need for personal, tangible support on site.

Reducing moral distress through workplace community

Importantly, workers shared ideas for mitigating moral distress at work, and these focused on improved communication, collaboration and support. We are now creating a user-centred mental health app that is being developed alongside LTC workers through participation in research focus groups.

Mental health apps can be a quick and effective way for improving user well-being, and are an increasingly accessible, cost-effective workplace tool for employers. Our LTC app will include features for improving communication, such as real-time links with colleagues and managers about their mental health. We also plan to include peer support capability, plus peer and manager problem-solving features.

One of our goals is to shift away from standard employee mental health approaches, which focus on individual actions outside of the workplace, such as meditation, eating and sleep habits. Instead, we want to emphasize that mental health in LTC is a shared responsibility.

Screen shots of a smartphone app
Example screenshots of some early features of our LTC app when accessed via phone. SOURCE, Author provided

By targeting the need for workplace communication, collaboration and support, our app will encourage proactive workplaces to initiate actions that have wider and shared responsibility for completion.

What more can LTC workplaces do?

During 2021 and 2022, the Health Standards Organization (HSO), a non-profit organization based in Ottawa, carried out a public review into LTC with the aim of creating new standards through consultation with residents, families, staff and stakeholders.

When the final standard was published in January 2023, our team was gratified to see worker moral distress noted as a key consideration for enabling healthy, competent and resilient staff working under healthy conditions. We want our research to strengthen this push to effect real change, and not only because this will improve the mental health of workers in LTC, but also for the downstream positive effect it will have on LTC residents.

With this aim, our research lab, the Creating and Renewing Equity through Research Lab, published our own report, commissioned by HEC, in May 2023.

Infographic titled 'Paths to strengthen long-term care worker resilience'
An infographic sets out recommended, actionable workplace practices suggested in a 2023 report on long-term care work. SOURCE, Author provided

Paths to Strengthen Long-term Care Worker Resilience reports the LTC worker ideas and feedback we collected, and sets out recommended, actionable workplace practices. These recommended paths are summarized in the infographic above. Going forward, it is critical that the HSO standard is implemented at all LTC workplaces across Canada, and that these workplaces have the provincial and federal support they need.

The COVID-19 pandemic may appear to be behind us, but for many workers in LTC, the pressure has not fully abated and concerns about future crises remain. As the director of care at one LTC home in Alberta told us: “We’re yes people. We’re helpers, and we don’t put ourselves first. We don’t. Until sometimes it’s too late.”

Bonnie Lashewicz receives funding from Canadian Institutes for Health Research, Healthcare Excellence Canada, and the Alberta Ministry of Labour and Immigration.

Pauline McDonagh Hull does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

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I Say We’re Setting Up For A Major Bottom

It’s almost impossible to call market tops and market bottoms using basic technical analysis tools like price and volume. Don’t get me wrong, that combination…



It's almost impossible to call market tops and market bottoms using basic technical analysis tools like price and volume. Don't get me wrong, that combination is my favorite during trend-following periods. But trying to spot bearish reversals is difficult when price action keeps riding higher and higher. The same is true in trying to spot bullish reversals when prices keep moving lower and lower. Maybe that seems unconventional to hard-core technicians, but I believe it's the reality. Too many folks say "when this line crosses that line, then this will happen". To me, that's following technical analysis and wearing blinders. Just my two cents.

I use technical price action to confirm what other signals are suggesting. We get plenty of signals on a regular basis - some short-term in nature, others long-term - if we're only willing to listen. While I've been bullish since June 2022, I do recognize short-term warning signals that tell us that risks of remaining long have increased substantially. In mid-July, I turned very cautious short-term and discussed those signals in a "Your Daily 5" episode that aired on July 19th. Let me pull up an S&P 500 chart, so you can see where U.S. equities stood when I fired this warning shot:

There were several reasons for the stock market bulls to hit quicksand. Tesla (TSLA), a Wall Street darling and a favorite stock of mine, suggested a possible 20% drop. That call aired the day of TSLA's top and TSLA fell closer to 30% in less than one month. These signals work and help us to manage risk! As I always say, they do NOT guarantee future price action, but they make us aware of increasing risk and that's how you invest more successfully. Since that July top, I've encouraged our EB members to tread very cautiously, whatever that means to each individual member. To some, it's being in cash. To others, it might simply mean to avoid leverage on the long side. But this cautious period is coming to an end.

If you want to see what was discussed on July 19th and why I felt the stock market was in short-term trouble, check out the Your Daily 5 recording on YouTube!

I absolutely LOVE when my signals take the opposite view of the masses. And now that everyone believes we're resuming the prior bear market, my signals are saying HOGWASH. Could we continue to proceed lower? Sure. There are never any guarantees with the stock market. But I see signs that suggest shorting is a VERY HIGH RISK strategy, with those risks growing every day. I'm discussing one major reason why in our FREE EB Digest newsletter that will be published early Monday morning, before the stock market opens. If you're not already an EB Digest subscriber, it's 100% free with no credit card required. Simply CLICK HERE and enter your name and email address. I'll discuss Reason #1 to turn bullish tomorrow morning. And I'll also focus on other reasons to be thinking bullish thoughts when I publish the EB Digest on Wednesday and Friday. Don't wait until it's too late. Check them out NOW!

Happy trading!


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Highlights from My Week’s Reading

Natalię Dowzicky, “How Florida Beat California to High-Speed Rail,” Reason, September 20, 2023.
Not only is Brightline the first privately…



Natalię Dowzicky, “How Florida Beat California to High-Speed Rail,” Reason, September 20, 2023.


Not only is Brightline the first privately funded intercity rail line in the U.S., but it’s also the fastest train in the country outside of the northeast corridor. Topping out at 125 mph in Florida, it will travel from Miami to Orlando in about three hours. For comparison, the Amtrak in the area takes about six and a half hours to complete that same trip.

Mike Reininger, CEO of Brightline, told Reason that passenger rail makes commercial sense under specific conditions, such as the case in Florida, where it connects two populous, tourist-friendly cities that are about 250 miles apart. At that distance, Reininger says, “It is too far to drive and too short to fly. You can approximate the time of flying significantly, improve the time of driving, and you can offer it at a price point that makes it an economic proposition.”

Not surprisingly, though, Brightline has become a subsidy sucker.

Romina Boccia, “Social Security Benefits are Growing Too Fast,” Cato at Liberty, September 21, 2023.


When a Social Security‐​eligible worker’s benefits are first calculated, this worker’s past wages are indexed to bring them to the same level as today’s earnings. This is called wage indexing and is based on the growth in average wages in the economy. When the Social Security Administration (SSA) first indexes a worker’s lifetime covered earnings, it does so using the SSA’s Average Wage Index (AWI). The AWI includes all wages that are subject to federal income tax, including wages in excess of the taxable Social Security maximum payroll tax threshold.

Wage indexing gives retirees a benefit amount that reflects the increase in the standard of living over their working careers—even if they didn’t earn commensurate wages. It’s like giving workers retroactive credit for improvements in the economy, including for wage improvements among the highest income earners.

Definitely worth reading carefully.

Christopher Wilcox, “Truck This: Why I’m Leaving the Long-Haul Industry,” American Institute for Economic Research, September 21, 2023.


More recently, environmental regulations requiring manufacturers to reduce emissions gave us the diesel particulate filter (DPF), an exhaust treatment system that replaces a standard muffler. While there is no current federal mandate requiring a DPF, the filters are required by the 2008 California Statewide Truck and Bus Rule, which has incentivized many nationwide fleets to adopt them. The problem with DPFs is the filter system clogs. A lot.

When DPFs go down, trucks roll to a stop. Truckers report having to have a DPF serviced as often as every 5,000 miles, which means lots of lost productivity and stranded cargo. I’ve had four breakdowns over the past two years, and three were due to my DPF. A tow truck driver I spoke to on one of those occasions told me half of his business comes from malfunctioning DPFs. Repairs are a specialized affair, and replacements can cost up to $2,000. When my truck isn’t moving, I’m not earning. And these regulators have required that my truck stand still far too often.

Of course California is in the forefront of regulation.

Fiona Harrigan, “Biden Administration Announces New Measures to Get Migrants to Work,” Reason, September 21 2023.


Yesterday, the Biden administration announced new actions to help get recent immigrants to work, including offering almost half a million Venezuelans a status that will let them live and work in the U.S. legally for the next 18 months. The new measures come at a critical time, as labor shortages persist and cities struggle to provide for newcomers.

Certain Venezuelan migrants are eligible for temporary protected status (TPS), a designation offered to migrants who can’t safely return to their home countries due to armed conflict, environmental disaster, or another temporary safety hazard. Venezuela was first designated for TPS in 2021 due to a severe political and economic crisis perpetuated by Nicolás Maduro’s regime. Under that designation, Venezuelans who came to the U.S. before March 2021 qualified for protection; now, the status will apply to Venezuelans who arrived before the end of July this year. There are currently 16 countries designated for TPS.

If I understand the program correctly, it sounds good: let them work instead of forcing taxpayers to subsidize their living expenses. It’s win-win-win for immigrants, employers and consumers, and taxpayers.

James Herndon, “Keep the Washington Consensus,” Law & Liberty, September 21, 2023.


Despite those deliberate omissions, synergies still allowed the Consensus to exceed the sum of its parts. Opening up foreign direct investment eased privatization. Privatization enabled balanced budgets. Balanced budgets limited inflation, which encouraged foreign direct investment. The common denominators were respect and restraint: leaders had to trust that firms and citizens knew better than the bureaucrats how best to allocate their own labor and resources. That’s why the Consensus’ first beneficiary was always likely to be the poor. After all, funding for primary education and basic healthcare does far more to reduce poverty than subsidies for diesel fuel and national airlines.

In short, Williamson promoted policies that enabled sustainable growth in developing countries with respect for their autonomy and an emphasis on raising prospects for the least fortunate. The Left never forgave him.

It’s the nicest treatment of the Washington Consensus that I’ve read. Lots of good nuggets.



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Miss Universe denies link with recently unveiled coin project

The Miss Universe Organization said that there is no Miss Universe cryptocurrency or blockchain offering involved with the Miss Universe or Miss Universe…



The Miss Universe Organization said that there is no Miss Universe cryptocurrency or blockchain offering involved with the Miss Universe or Miss Universe Philippines.

The Miss Universe Organization has denied any association with the Miss Universe Coin project announced at the Philippine Blockchain Week (PBW) event held earlier this month. PBW said that they are in contact with all involved parties and will post an update soon.

Earlier this month, a project called Miss Universe Coin was announced at PBW. Donald Lim, the founder of the organization managing the PBW, said during the event that the PBW will “launch the Miss Universe Coin.” However, weeks after the announcement, the official organization behind Miss Universe has denied any association with the coin project and called it a fraud. 

Official announcement published on the Miss Universe Facebook page. Source: Facebook

On Sept. 22, the Miss Universe official Facebook page announced that the Miss Universe Organization and JKN Global Group, the company behind the pageant, are not associated with the coin project that was unveiled at the PBW event. According to the organization, it will be pursuing “all legal options with regards to this infringement.” 

“There is currently no Miss Universe cryptocurrency or blockchain offering, and these products are in no way involved with the voting or selection process for Miss Universe or the Miss Universe Philippines pageants,” they wrote.

Related: JPEX hikes withdrawal fee to almost $1K after Hong Kong watchdog warning

In a statement sent to Cointelegraph, a representative from the Miss Universe Organization claimed that the Miss Universe Coin is a "fraud," and they expect it to be further announced in other events across the globe. “We suspect that people may be planning to mention this at upcoming blockchain conferences in Dubai and Singapore. If you see it there, please do not cover, it's a fraud,” they said.

In a statement on X (formerly Twitter), PBW said that they are currently in contact with all of the parties involved and will announce an update as soon as possible. Cointelegraph reached out to the Philippine Blockchain Week but did not get an immediate response.

Magazine: Chinese billionaire’s $1B fraud charges, Kwon’s $11M bet, Zhu Su and Islam: Asia Express

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