Category Archives: Social & Family Issues

Nearly half of Americans over 65 need help with daily tasks

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Clinic elderly doctor nurse office couchBy Millie Dawson
Health Behavior News Service

Nearly half of Americans age 65 and older, totaling about 18 million people, require help with routine daily activities like bathing, handling medications or meals.

A new study in Milbank Quarterly reveals a growing need for improved services and support for older Americans, their spouses, their children and other “informal caregivers.”

While 51 percent of older Americans in the study reported no difficulty with routine tasks, “29 percent reported receiving help with taking care of themselves or getting around in the previous month,” said co-author Vicki A. Freedman, Ph.D., a research professor with the Institute for Social Research at the University of Michigan.

“Another 20 percent reported that they had difficulty carrying out these activities on their own,” she said.

KEY POINTS

  • Nearly half of Americans age 65 and older require help with routine daily activities such as bathing, meals or taking medications.
  • Substantial numbers of older adults living outside of nursing homes experience adverse consequences from unmet care needs.
  • There is a growing need for improved community-based services and support for older Americans and their caregivers.

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For those who were once obese, stigma often remains

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Carlos Romero and girlfriend Kate Rowe sit down for a meal that they cooked together at Romero's apartment in Seattle (Photo by Mike Kane/NPR).

Carlos Romero and girlfriend Kate Rowe sit down for a meal that they cooked together at Romero’s apartment in Seattle (Photo by Mike Kane/NPR).

This KHN story also ran on NPR

SEATTLE — Carlos Romero’s apartment is marked with remnants from his former life: a giant television from his days playing World of Warcraft and a pair of jeans the width of an easy chair. The remnants of that time—when he weighed 437 pounds—mark his body too: loose, hanging skin and stretch marks.

“I lift weights and work out and work hard, but there’s lasting damage,” said Romero.

Yet for all the troubles he had dating when he was obese—all those unanswered requests on dating web sites—shedding weight left him uneasy about how much to reveal.

Carlos Romero 1 176

Romero once weighed 437 pounds. (Photo by Sarah Varney/KHN).

“If you were to say to someone on the first date, ‘I lost 220 pounds,’ you’re indicating that you had a very serious issue at one point and that you may still have that issue,” he said. “So it’s not something I put on a dating profile because I don’t want people to judge me for it.”

Indeed, the stigma of obesity is so strong that it can remain even after the weight is lost. Holly Fee, a sociologist at Bowling Green State University, has conducted some of the only research on dating attitudes toward the formerly obese. In 2012, Fee published her findings in the journal Sociological Inquiry.

She found that potential suitors said they would hesitate to form a romantic relationship with someone who used to be heavy. “The big dragging factor in why they had this hesitation in forming this romantic relationship was that they believed these formerly obese individuals would regain their weight,” Fee said. Continue reading

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Low-cost, long-acting contraceptives cut teen pregnancy, abortion rates

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A diagram showing a hormonal IUD in the uterusBy Lisa Gillespie
KHN / OCTOBER 1ST, 2014

Teenage girls who are given access to long-acting contraceptives such as IUDs or hormonal implants at no cost are less likely to become pregnant, according to a study in the New England Journal of Medicine released Wednesday.

The findings come just two days after the American Academy of Pediatrics recommended that health providers should consider IUDs and implants first when discussing contraception choices with teen girls.

Young women with access to these methods at no cost were almost five times less likely to get pregnant, five times less likely to give birth and four times less likely to have an abortion.

Although there are not as many teenage pregnancies as there once were — rates have been cut by more than half since 1991 — they still pose serious public health issues because of the costs associated with child birth and public assistance for young mothers.

These pregnancies can also stunt education and income opportunities for teenage moms.

Each year, 750,000 teenage girls become pregnant, and 80 percent of those pregnancies are unintended. Continue reading

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Minnesota, not Florida, not Hawaii, is healthiest state for seniors

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Minnesota_population_map_croppedBy Elizabeth Stawicki,
Minnesota Public Radio

“Minnesota Nice” might be the key to good health for seniors.

America’s Health Rankings Senior Report rated Minnesota the healthiest state in the nation for adults aged 65 and over — beating out Hawaii. And that retiree and snowbird haven, Florida? It came in 28th.

What could put Minnesota, which just weathered arguably the harshest winter in the country, ahead of those sunny climes? Volunteering is one factor. Continue reading

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Training police to handle those with mental illnesses

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mental health cops 300

Officer Lance Newkirchen on his way to visit the family of a man who, two days earlier, considered suicide (Photo by Jeff Cohen/WNPR).

By Jeff Cohen, WNPR

How do you tell the difference between someone who needs to be taken to jail and someone who needs to be taken to the hospital?

That’s a big concern in Connecticut, where the intersection of law enforcement and mental health has been a huge issue since the Sandy Hook Elementary School shootings in Newtown in 2012.

Lance Newkirchen is a regular patrol officer in the nearby town of Fairfield. But he’s also an officer who is specifically trained to respond to mental health calls.

On a recent weekday, he headed in his patrol car on a follow-up call.

“We’re going to go meet with a father whose 21-year-old son, two days earlier, at three o’clock in the morning, through his depressive disorder, was having suicidal thoughts,” Newkirchen explains. Continue reading

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Medicaid expansion to cover many former prisoners

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ACA health reform logoBy Guy Gugliotta
This KHN story was produced in collaboration with wapo

ADRIAN, Mich.—When Medicaid expands next year under the federal health law to include all adults living close to the poverty line, one group of eligible beneficiaries will be several million men and women who have spent time in state and federal prisons and jails.

The Department of Justice estimates former inmates and detainees will comprise about 35 percent of the people who will qualify for Medicaid coverage in the states expanding their programs to anyone earning less than 138 percent of the federal poverty level, or about $15,000 for an individual in 2013.

The Congressional Budget Office estimated earlier this year  that 9 million people will get that new coverage next year.

In addition, the expansion could help states cover the medical costs of some current inmates who need hospitalization or other expensive specialized care outside of prison.

Michigan, which has long been recognized as an innovator in inmate health care, is expanding its Medicaid program.  Officials here say that funding could help cover the needs of some seriously ill inmates as well as provide new coverage for released offenders, which could be a valuable tool in curbing recidivism.

“A significant number have never prepared their own meals. They don’t know how to shop, or how to budget,” said Tammy Meek, prisoner re-entry coordinator for the Gus Harrison Correctional Facility in this small city in southern Michigan. “Some can’t even write their name in cursive. Health care is critical in protecting the public and giving the client [former inmate] the tools he needs to succeed.”

GOP Lawmakers’ Concerns

But the Medicaid coverage for former offenders has stoked the interest of some powerful GOP members of Congress, including one from Michigan, House Energy and Commerce Committee Chairman Fred Upton.

He and Health Subcommittee Chairman Joe Pitts of Pennsylvania last month asked the Government Accountability Office to review the effect of the health law’s Medicaid provisions on former offenders.

“We  must better understand the true costs of expanding the program to any new population and weigh such costs with the competing interests of our nation’s most vulnerable law-abiding citizens,” they wrote.

A Republican committee source said Upton and Pitts simply wanted “updated data” from GAO on “how Medicaid interacts with the criminal justice system” because they were “committed to understanding how every Medicaid dollar” will be spent under the new health law.

A Democratic committee source, however, dismissed the Upton initiative as “a complete red herring” prompted by Republicans’ search “for another way to come up with something that will ding the Affordable Care Act.”

The congressmen’s request notes that some researchers have suggested that large numbers of people added to the Medicaid rolls in an expansion could be prisoners. But ordinary, in-prison health care is not covered by Medicaid.

The Medicaid law, passed in 1965, denies federal matching funds for convicted prisoners—about 1.5 million adults nationwide—and for 750,000 unconvicted detainees held for trial or petty crimes and misdemeanors in county and city jails on any given day.

Each state, county or city must pay for the medical needs of all detainees from its general funds. The Affordable Care Act does not change this law.

However, since 1997, the federal government has allowed matching Medicaid funds to pay for specialized hospital care for 24 hours or more outside the prison system for inmates who were enrolled in or eligible for Medicaid before their incarcerations.

Since most states narrowly draw the eligibility rules for adults, this funding generally covered people such as the frail elderly, patients suffering from serious disabilities and chronic diseases and pregnant women.

Michigan received $8 million in matching funds for that program during the year ending Sept. 30, state Department of Corrections spokesman Russ Marlan said. Next year, when about half the states have agreed to expand their Medicaid programs, the number of these patients should rise dramatically as will the federal matching funds.

Marlan said Michigan could receive $20 million in Medicaid funding from the federal government in 2014 to help pay for such specialized treatment of prisoners, “but it’s probably too early to know for sure.”

Potentially far more important for the state’s bottom line, Medicaid expansion will also cover low-income inmates leaving prison.

“Having access to health care and mental health care contributes to their success in staying out of prison,” noted Heidi E. Washington, warden at the Charles E. Egeler correction facility in Jackson, Mich.

Lowering Recidivism

Helping former inmates adjust to the outside world has been shown in many studies to curb recidivism. Michigan, which has used state funds for reentry programs that include health care for nearly a decade, has seen its prison population drop in the past five years from 51,554 to 43,636.

For released offenders with special needs—mostly mental disorders—recidivism rates plummeted from 50 percent in 1998 to 22.5 percent in 2012. Michigan spends $35,000 each year for every imprisoned inmate.

But curbing recidivism doesn’t just hinge on having funding from programs like Medicaid, noted Ira Burnim, legal director of the Bazelon Center for Mental Health Law. “These folks have to have services, and when they have access to housing and local support, they do very, very well.”

Michigan in 2005 hired a private company, Professional Consulting Services, to coordinate individual release plans for special needs inmates, serving as an intermediary between the Department of Corrections, state Medicaid officials and outside housing and service providers.

Chief Operating Officer Betsy Hardwick said PCS handles about 1,200 cases at any one time, preparing individual support plans and monitoring inmates for their first nine months on the outside.

Hardwick said that 28 percent of the special needs inmates had Medicaid on release, but by the end of their first year in the community, “anecdotally we think between 60 percent and 70 percent are being approved.”

The effort appears to be a critical confidence builder for Martin Baker, 61, a repeat offender for breaking and entering who earlier this month was getting ready for parole at Adrian’s Gus Harrison prison and had been notified that he will have Medicaid upon release.

“I’ve got a bad liver from hepatitis C, and I couldn’t afford any medications on my own,” said Baker, a small but fit gray-haired man who also suffers from bipolar disorder and battled drug issues in the past. “My primary goal is to get my medical situation stabilized and get into a solid recovery program.”

Without insurance, he said, “you feel sick, and it causes you to get depressed and not care, so you say, ‘okay, I’m going out and get a pack of heroin.’ I don’t want that to happen.

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

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Firearm retailers join with King County to promote safe gun storage

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GunFrom Public Health – Seattle & King County: 

New research into youth firearm deaths in King County has prompted a partnership with ten national and local retailers to promote the secure storage of guns as a means of preventing deadly shootings.

“Gun violence is a public safety crisis. It is also a public health crisis, and I directed our staff to develop innovative strategies to reduce gun violence using a data-driven public health approach,” said King County Executive Dow Constantine. “The evidence is clear: Safe storage can save lives.”

The “Safe Storage Saves Lives” campaign, developed by Public Health – Seattle & King County, also includes 20 participating law enforcement agencies.

The new data is contained in a report released today by Public Health – Seattle & King County, The Impact of Firearms on King County’s Children: 1999 – 2012, which documents the current risk of suicides and accidental shootings in King County and urges local leaders to promote safe storage:

  • More than 30,000 King County homes have a loaded and unlocked firearm.
  • More than 5,000 of King County’s children live in homes where firearms are loaded and unlocked.
  • The risk of a youth suicide in King County is nine times higher in homes where firearms are kept unlocked, compared to homes where firearms are locked.

“Protecting our communities from gun violence is one of our top priorities. Making it easier for people to safely store a gun helps us reach that goal,” said Seattle Mayor Mike McGinn.

How the partnership will reach out to gun owners

The “Safe Storage Saves Lives” campaign features the LOK-IT-UP website and key partners who will expand the use of safes and lockboxes:

  • Retailers will offer 10 to 15 percent discounts on select firearm-storage devices when they mention LOK-IT-UP or Public Health from November 25, 2013 through the end of 2014. Retailers will also distribute information about how to store a firearm safely.
  • Law enforcement agencies will promote locking devices to anyone seeking a Concealed Pistol License or visiting their customer service desks. Officers and deputies will also promote safe storage at community events.

“We are thrilled to have firearm retailers involved in the safety message, and we hope this partnership helps change the norms around storing firearms,” said Dr. David Fleming, Director and Health Officer for Public Health – Seattle & King County.

Participating retailers include national chains such as Sports Authority and Costco, along with prominent local stores.

“We are glad to partner with King County to offer reduced-price safe-storage devices to make it easier for gun owners to make their homes and communities safer – and protect their investment, too,” said Mike Coombs, co-owner of Outdoor Emporium, Sportco and FARWEST Sports.

A secure lockbox can prevent thefts as well as suicides. Last year, more than $4.5 million worth of firearms were reported stolen in Washington state, according to the Washington State Association of Sheriffs and Police Chiefs.

“It’s time for lockboxes and gun safes to become as normal as wearing a seatbelt – which would reduce firearm thefts and prevent school-based threats. That improves community safety,” said King County Sheriff John Urquhart.

Law enforcement officers all too often are the first-responders who witness tragedy when firearms are left loaded and unlocked – and a curious or impulsive child is nearby.

“I have never forgotten when I responded to a 9-1-1 call and found a boy had unintentionally shot and killed his best friend with a rifle they were playing with and thought was unloaded,” said Bothell Police Chief Carol Cummings. “What was so tragic to me was that this death could have been averted by safely storing the firearm.”

Developing innovative strategies using a data-driven public health approach

In his State of the County address earlier this year, Executive Constantine directed Public Health – Seattle & King County to develop innovative strategies to reduce gun violence using a data-driven “public health approach,” a process that’s proven effective with other safety and prevention challenges, such as automobile and boating safety. Key facts from the report include:

  • Between 1999 and 2012, 68 children in King County under the age of 18 died from gun violence, and 25 of those were suicides.
  • Another 125 children were injured by firearms and had to be hospitalized.
  • In King County, nearly one-quarter of all households have at least one firearm, and among those with firearms, an estimated 17% (31,200 households) stored them loaded and unlocked.
  • During the 2011–2012 school year, 52 King County students were suspended or expelled for possessing a firearm on public school grounds.

The report also finds that further progress on reducing firearm violence is hampered by scattered and incomplete data on gun violence, especially pertaining to children.  Basing new policies and programs on data and evidence will depend on creating new systems for sharing data across agencies.

In the meantime, the report says safe storage is an important first step toward eliminating firearm deaths among King County’s youth. Research has shown that parents can become complacent as their children get older and don’t realize it could be their child or a friend who accesses their firearms.

“We want gun retailers to talk as much about safe-storage as a car dealer talks about the air-bags and safety features in a new car,” said Dr. Fleming.

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CorrectionalHealthcare_thumb

Aging inmates push up prison healthcare costs

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By Christine Vestal
Stateline Staff Writer

State spending on prisoner health care increased in 42 states between 2001 and 2008, with a median growth of 52 percent, according to a new report from The Pew Charitable Trusts. The primary driver of the cost spike is bigger and older prison populations.

“Health care is consuming a growing share of state budgets, and corrections departments are not immune to this trend,” said Maria Schiff, director of the State Health Care Spending Project, an initiative of Pew and the John D. and Catherine T. MacArthur Foundation.

Pew analyzed inflation-adjusted correctional health care expenditures collected by the U.S. Department of Justice from 44 states that participated. Overall, these states spent $6.5 billion on inmate health care in 2008, up from $4.2 billion in 2001. Average per-inmate spending also grew in 35 of the states during the same period at a median rate of 32 percent.

CorrectionalHealthcare_Fig_4

Of the states in the study, prisoner health care costs in Illinois and Texas decreased. Those not included in the study are Georgia, Kansas, Kentucky, New Mexico, Vermont, Wyoming and Washington, D.C.

Although sentencing changes have resulted in a recent decline in the prison population, the number of people held in state prisons ballooned over the last 30 years. During the study period, it grew by about 200,000, a 15 percent increase.

During the same period, the number of state and federal inmates age 55 and older grew from 40,200 to 77,800, a 94 percent increase. Since 2008, the number of elderly inmates has continued to grow to 121,800 in 2011. The aging of the prison population is the result of a large number of inmates living out longer sentences and an uptick in the number of older people who are sent to prison.

Like the the population on the outside, elderly prisoners are more likely to have chronic medical and mental conditions that require expensive treatments. The health care costs for inmates age 55 and older with a chronic illness is on average two to three times that of the cost for other inmates, according to the study.

 CorrectionalHealthcare_Fig_3

Cutting Costs

States have developed a number of strategies to mitigate the rising cost of caring for prisoners, including increased use of telemedicine and the outsourcing of medical services to state universities and other providers, according to the report.

In addition, a small number of states have made limited use of Medicaid to help finance rising prison health care costs. The potential benefits of Medicaid financing will increase substantially in 2014 when the Affordable Care Act takes effect, but only in states that expand their programs.

Currently, most state Medicaid programs cover very few childless adults, who make up the bulk of the prison population. In most cases, only pregnant women and disabled inmates are eligible for Medicaid.

By expanding Medicaid to all adults with incomes up to 138 percent of the federal poverty line ($11,490 for an individual), virtually everyone who is incarcerated will qualify for the federal-state program. The federal government will pay 100 percent of costs for newly eligible adults from 2014 through 2016 and gradually decrease its share to 90 percent by 2020.

For inmates, Medicaid pays only for health care services provided outside of prison walls. But those charges – for inmates admitted for 24 hours or more to a hospital, nursing home or psychiatric center – are often substantial.

In Ohio, where Republican Gov. John Kasich recently circumvented the GOP-led legislature to approve the expansion, the state estimates it will save $273 million in prison health care costs in the first eight years. Michigan expects to save about $250 million on inmate health expenses in the first 10 years, and California expects to save nearly $70 million each year.

Stateline logo

Stateline is a nonpartisan, nonprofit news service of the Pew Center on the States that provides daily reporting and analysis on trends in state policy.

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Think all caregivers are unhappy? They’re really not

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A younger man holds an elderly man's handBy Nancy Shute, NPR News

This story comes from our partner ‘s Shots blog.

The stereotype of caring for a family member is that it’s so stressful it harms the caregiver’s health. But that’s not necessarily so.

Studies are conflicted, finding that caregiving can harm or help the caregiver. Here’s one on the plus side: A study finds that people who care for a family member live longer than similar people who aren’t caregiving.

The scientists didn’t ask the caregivers why they might be healthier and presumably happier than similar people who weren’t caring for someone. But the 3,503 people who participated represented a broad swath of the American public and may be a better representation of the caregiving experience overall.

Just 17 percent of the people surveyed said they had high levels of caregiving strain, and the majority put in fewer than 14 hours of care a week.

“The burden of caregiving certainly can be overwhelming and negative to health,” says David Roth, director of the Center on Aging and Health at Johns Hopkins University and lead author of the study, which was published in the American Journal of Epidemiology. “But those are not necessarily the typical experience.”

The study data was originally gathered for a big multiyear study on stroke risk, but the people being cared for in this study had a broad range of health problems. The caregivers themselves were age 64 on average, more likely to be female and either white or African-American.

Family caregivers were 18 percent less likely to die than non-caregivers over six years, the researchers found.

Something must have made life better for the caregivers. But what? To help find out, we called up Leah Eskinazi, director of operations for the Family Caregiver Alliance in San Francisco.

“There are people who find caregiving very rewarding,” Eskinazi told Shots. “They feel really good that they can give back to Mom, for example, because Mom was really there for them when they were growing up. Maybe they weren’t the best kid, but as they’ve aged they can have a more balanced healthier relationship and heal some of those wounds.”

Context is everything, Eskinazi says. Caring for someone with dementia can be more stressful and depressing because the person is facing a long inevitable decline. “You’re caring for someone who can’t voice their preferences,” she says. “You’re making decisions for another person and for yourself, and that can last for a long time. It’s tough.”

But only about 10 percent of family caregivers are tending someone with dementia, other studies have found.

Caring for someone after a stroke, by contrast, can be very positive. “There’s a lot of energy going into helping that person recover,” Eskinazi says.

And in many cases the person being cared for is in a position to be grateful. “To have someone stick by you, or a group of people stick by you, that’s pretty cool,” Eskinazi says. “It gives you an opportunity to say thank you.”

Spouses typically expect to be taking care of their mate in old age, but adult children don’t always prepare for that possibility — or try not to think about it.

People tend to avoid the Family Caregiver Alliance’s booth at health fairs, Eskinazi admits. “People don’t really want to think about it. It’s time, it’s emotion and it takes energy.”

But this latest study points out that caregiving isn’t all a big minus for the caregiver — something to prepare for, perhaps, but a normal, often rewarding part of life.

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

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Jerral Hancock and Stacie Tscherny Portrait

Finally home, injured vets face new lives as VA faces costs

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By Jessica Wilde, News21

This report is part of a project on post-9/11 veterans in America produced by the Carnegie-Knight News21 program.

Jerral Hancock wakes up every night in Lancaster, Calif., around 1 a.m. dreaming he is trapped in a burning tank. He opens his eyes, but he can’t move, he can’t get out of bed and he can’t get a drink of water.

Stacie Tscherny dropped everything to take care of her son, U.S. Army veteran Jerral Hancock, when he came home from Iraq without an arm. She helps take care of his two children now as well. (Photo by Jessica Wilde/News21)

Hancock, 27, joined the Army in 2004 and went to Iraq, where he drove a tank. On Memorial Day 2007 — one month after the birth of his second child — Hancock drove over an IED. Just 21, he lost his arm and the use of both legs, and now suffers from post-traumatic stress disorder.

The Department of Veterans Affairs pays him $10,000 every month for his disability, his caretakers, health care, medications and equipment for his new life.

Jerral Hancock and Stacie Tscherny Portrait

Stacie Tscherny dropped everything to take care of her son, U.S. Army veteran Jerral Hancock, when he came home from Iraq without an arm. She helps take care of his two children now as well. (Photo by Jessica Wilde/News21)

No government agency has calculated fully the lifetime cost of health care for the large number of post-9/11 veterans of the wars in Iraq and Afghanistan with life-lasting wounds.

But it is certain to be high, with the veterans’ higher survival rates, longer tours of duty and multiple injuries, plus the anticipated cost to the VA of reducing the wait times for medical appointments and reaching veterans in rural areas.

“Medical costs peak decades later,” said Linda Bilmes, a professor in the Kennedy School of Government at Harvard University and coauthor of “The Three Trillion Dollar War: The True Cost of the Iraq Conflict.”

As veterans age, their injuries worsen over time, she said. The same long-term costs seen in previous wars are likely to be repeated to a much larger extent.

Post-9/11 veterans in 2012 cost the VA $2.8 billion of its $50.9 billion health budget for all of its annual costs, records show. And that number is expected to increase by $510 million in 2013, according to the VA budget.

Like Hancock, many veterans returning from Iraq and Afghanistan have survived multiple combat injuries because of military medicine’s highly advanced care. Doctors at Brooke Army Medical Center in San Antonio repaired Hancock’s body with skin grafts and sent him to spinal-cord doctors for the shrapnel that ultimately left him paralyzed. He still has his right arm, but he can only move the thumb on his right hand.

Injuries like Hancock’s likely will lead to other medical issues, ranging from heart disease to diabetes, for example, as post-9/11 veterans age.

“So we have the same phenomenon but to a much greater extent,” Bilmes said. “And that drives a lot of the long-term costs of the war, which we’re not looking at the moment, but which will hit in 30, 40, 50 years from now.”

Veterans like Hancock with polytraumatic injuries will require decades of costly rehabilitation, according to a 2012 Military Medicine report that analyzed the medical costs of war through 2035. More than half of Iraq and Afghanistan veterans are between the ages of 18 and 32, according to 2011 American Community Survey data. They are expected to live 50 more years, the Institute of Medicine reports.

About 25 percent of post-9/11 veterans suffer from post-traumatic stress disorder, and 7 percent have traumatic brain injury (TBI), according to Congressional Budget Office analyses of VA data. The average cost to treat them is about four to six times greater than those without these injuries, CBO reported. And polytrauma patients cost an additional 10 times more than that.

Post-9/11 veterans use the VA more than other veterans and their numbers are growing at the fastest rate. Fifty-six percent of Iraq and Afghanistan veterans use the VA now, and their numbers are expected to grow by 9.6 percent this year and another 7.2 percent next year, according to a VA report from March 2013.

Jerral Hancock Drinking Water

Hancock drove over an IED in Iraq in 2007. Hancock’s stepfather, Dirrick Benjamin, helps him take his medication. He and Hancock’s mother take care of him full time, helping him with everyday tasks like getting dressed and drinking water. (Photo by Jessica Wilde/News21)

 

In response to multiple injuries suffered by Iraq and Afghanistan veterans, the VA established its polytrauma care system in 2005, creating centers around the country where veterans are treated for multiple injuries, ranging from TBI and PTSD to amputations, hearing loss, visual impairments, spinal-cord injuries, fractures and burns.

Post-9/11 veterans make up around 90 percent of polytrauma patients, said Susan Lucht, program manager of the polytrauma center at the Southern Arizona VA Health Care System in Tucson.

Each polytrauma patient costs the VA on average $136,000 a year, according to a CBO report, using VA data from 2004 through 2009. And many of their medical issues will never go away.

One TBI patient at the Tucson center, Erik Castillo, has received speech, physical, occupational, psychological and recreational therapies for all of the paralysis, cognition and memory issues associated with injuries he received in a bomb blast in Baghdad.

But Castillo’s treatment is exactly what medical professionals and economists say could potentially be cost-saving as well as life-saving.

If the VA treats primary injuries early on and creates a community and family support system, it might be able to lower costs later, said Dr. James Geiling, Dr. Joseph Rosen and Ryan Edwards, an economist, in their 2012 Military Medicine report.

“And those are the costs that we’re trying to reduce by giving the care that we do,” said Dr. G. Alex Hishaw, a staff neurologist at the Tucson center.

Castillo has been living with TBI for nine years, and he still goes to the VA three times a week for therapy. “I’ll utilize the VA for the rest of my life,” he said.

The shrapnel that entered Castillo’s brain from a bomb in Baghdad in 2004 burned a portion of his frontal lobe, which had to be removed. Doctors told his parents that he wouldn’t survive and that if he did, he would need care for the rest of his life.

Slowly, Castillo started to re-create himself. He learned to talk again, to eat again, to move his left arm and leg. Now, he is going to college.

“We want them to graduate,” Lucht said. “But they always know that this is their foundation. This space is here. And their needs will change as they age.”

As Hancock and other post-9/11 veterans age, they will need increased medical care and will become more expensive for the VA. The injuries they have now will likely lead to more complicated and expensive medical issues. TBI, for example, may lead to greater risk of Alzheimer’s disease, psychological, physical and functional problems, and alcohol-abuse disorders.

Doctors and economists argue that today’s conversation should not only be about the primary wounds of war, but about the medical issues that are often associated with them. PTSD, for example, is often associated with smoking, substance abuse, depression, anxiety, heart disease, obesity and diabetes. Amputations are associated with obesity, cardiovascular disease, osteoarthritis, back pain and phantom limb pain.

“We should help an amputee to reduce his cholesterol and maintain his weight at age 30 to 40, rather than treating his coronary artery disease or diabetes at age 50,” Geiling, Rosen and Edwards wrote.

“Society is not yet considering the medical costs of caring for today’s veterans in 2035 — a time when they will be middle-aged, with health issues like those now seen in aging Vietnam veterans, exacerbated by comorbidities of post-traumatic stress disorder, traumatic brain injury and polytrauma,” they wrote.

Polytrauma centers have expanded across the country. But that doesn’t mean that all veterans live close enough to access them. In many parts of country, health care is hampered by distance because veterans who use the VA live far away from their closest VA hospital.

For Army Spc. Terence “Bo” Jones, it is more important that he live near his family.

U.S. Army Spc. Terence “Bo” Jones stepped on an IED in Afghanistan in 2012, and lost both of his legs. Now an outpatient at the VA polytrauma center in San Antonio, Texas, Jones is learning to walk on prostheses and drive an adapted car with only his hands. (Photo by Jessica Wilde/News21)

Jones lost both of his legs to an improvised explosive device blast in Afghanistan in 2012. Like Hancock, Jones woke up at Brooke Army Medical Center with his family by his side.

He was 21 when he stepped on the IED. It shot him 10 feet into the air and he landed in a nearby well. He doesn’t remember it, but his friends told him he was conscious and trying to climb out.

Now an outpatient at the VA polytrauma center in San Antonio, Jones is learning to walk on prosthetic legs, provided to him by the VA. The VA also provides adaptive driving equipment for his car, and he is taking driver education to learn how to drive with only his hands. One day, he hopes to get a service dog, and the VA will pay for veterinary care and equipment for the dog to help its owner.

“We can get them anything that they need,” Lucht said.

The VA provides other assistive accommodations for injured veterans — from grab bars and walk-in showers to wheelchairs and specialized seating. And a lot of veterans wear out their prosthetic limbs because they’re active, Lucht said.

When Jones finishes rehab, he plans to move home to Idaho, go to college and open his own shop doing custom cars and motorcycles. But in Idaho, Jones won’t be near a polytrauma center anymore.

One of the most rural veteran populations in the country is served by the Reno, Nev., VA hospital, said Darin Farr, the hospital’s public affairs officer. “We’re actually considered frontier,” he said.

The hospital’s patients come from as far away as 280 miles. More than 29,000 veterans are enrolled in the Reno hospital, staffed by 1,200 employees, only 40 to 50 percent of whom actually provide medical care.

Many VA hospitals fall behind in entering data from private health records or following up with patients, especially mental health patients for whom follow-up care is particularly important, according to VA Office of Inspector General reports.

The VA doesn’t always provide timely mental health evaluations for first-time patients, and existing patients often wait more than the recommended 14 days for their appointments, the OIG reported last year.

Veterans have complained for many years about long wait times to schedule appointments. “Long wait times and inadequate scheduling processes at VA medical centers have been long-standing problems that persist today,” the U.S. Government Accountability Office reported in February. Inconsistent scheduling policies, staffing, phone access and an outdated scheduling system make the problem worse.

Meanwhile, both the GAO and OIG have reported that VA’s data on wait times for medical appointments is unreliable, and some schedulers entered incorrect dates or changed them to meet performance standards.

Farr says the Reno hospital faces unique challenges that might contribute to wait times. The hospital competes with other hospitals for employees who might pay more than the government does.

“We don’t have a lot of space,” he added. The hospital schedules more than 373,000 outpatient visits and 4,200 inpatient visits every year. But it only has 64 hospital beds — 14 psychiatric, 12 ICU and only 38 for general use.

When Terence Jones finishes rehab at the polytrauma center in San Antonio, he hopes adaptive equipment will help him return to a normal life. Jerral Hancock, on the other hand, knows that he never will.

Hancock misses the adrenaline rush of life before his injury. He longs for a wheelchair that will go faster than 5 mph. He described the time he fell out of his hospital bed as exhilarating. He busted his cheek open, but he loved it.

With the $100,000 the Defense Department gave Hancock for his injuries when he was discharged, he bought two mobile homes outside Los Angeles, one for him and his two children, ages 9 and 6, and one for his mother and stepfather, who take care of him full time. Hancock supports all of them with his monthly disability check from the VA.

The VA bought him a wheelchair and put a lift into his front porch. They widened the doors in his mobile home so his wheelchair could fit in and out. They will pay for his medications and all of his medical care for the rest of his life.

When Hancock arrived at his new mobile home, he couldn’t fit his wheelchair in the front door. So he kept one wheelchair inside, and his stepdad carried him through the door and down the steps to a second wheelchair that he paid for himself. It took eight months for the VA to pay him $1,000 for the second wheelchair, and four months to put a lift into his front porch.

“I was stuck in the house for six months over this fight,” Hancock said. “I had a wheelchair upstairs and I had a wheelchair downstairs. And my caretaker carried me up and down the stairs from wheelchair to wheelchair. It was ridiculous.”

The VA also bought Hancock an $85,000 arm that he could attach to his shoulder to use. But he can’t seem to get it to work.

The VA gave Hancock $11,000 toward a car, but his mother said that doesn’t come close to the cost of a handicap-equipped vehicle. Instead, he bought a seven-passenger bus with a lift for his wheelchair.

Even with all of the money that the VA spends on Hancock’s medical and family care, he still lives in a mobile home, and his bedroom has little extra space with a hospital bed and a wheelchair in it. He can’t fit into his kids’ bedrooms. He can’t drink a glass of water on his own. And his air conditioning hardly works, even though he can’t be in the heat for too long because his burns prevent him from sweating.

Hancock’s children also have had to adjust.

“My son watched me walk off — he was going on 3 — and I jumped on a bus with a couple hundred pounds of gear,” he said. “The next time he saw me, I lost 100 pounds … I looked like a skeleton and I had tubes coming out everywhere … My daughter, this is all she knows.”

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

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Life and Death in Assisted Living, Part 1 — “The Emerald City”

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“The Emerald City”

By A.C. THOMPSON, ProPublica and JONATHAN JONES in collaboration with 

A special to ProPublica

joan_boiceJoan Boice needed help. Lots of it. Her physician had tallied the damage: Alzheimer’s disease, high blood pressure, osteoporosis, pain from a compression fracture of the spine. For Joan, an 81-year-old former schoolteacher, simply getting from her couch to the bathroom required the aid of a walker or wheelchair.

The Alzheimer’s, of course, was the worst. The disease had gradually left Joan unable to dress, eat or bathe without assistance. It had destroyed much of the complex cerebral circuitry necessary for forming words. It was stealing her voice.

Joan’s family was forced to do the kind of hard reckoning that so many American families must do these days. It was clear that Joan could no longer live at home. Her husband, Myron, simply didn’t have the stamina to provide the constant care and supervision she needed. And moving in with any of their three children wasn’t an option.

These were the circumstances that eventually led the Boice family to Emeritus at Emerald Hills, a sprawling, three-story assisted living facility off Highway 49 in Auburn, Calif. The handsome 110-bed complex was painted in shades of deep green and cream, reflecting its location on the western fringe of the craggy, coniferous Sierra Nevada mountain range. It was owned by the Emeritus Corp., a Seattle-based chain that was on its way to becoming the nation’s largest assisted living company, with some 500 facilities stretching across 45 states.

Emeritus at Emerald Hills promised state-of-the art care for Joan’s advancing dementia. Specially trained members of the staff would create an individual plan for Joan based on her life history. They would monitor her health, engage her in an array of physically and mentally stimulating activities, and pass out her 11 prescription medications, which included morphine (for pain) and the anti-psychotic drug Seroquel (given in hopes of curbing some of the symptoms of her Alzheimer’s). She would live in the “memory care” unit, a space designed specifically to keep people with Alzheimer’s and other forms of dementia safe.

At Emerald Hills, the setting was more like an apartment complex than a traditional nursing home. It didn’t feel cold or clinical or sterile. Myron could move in as well, renting his own apartment on the other side of the building; after more than 50 years of marriage, the couple could remain together.

Sure, the place was expensive — the couple would be paying $7,125 per month — but it seemed ideal.

During a tour, a salesperson gave Myron and his two sons, Eric and Mark, a brochure. “Just because she’s confused at times,” the brochure reassured them, “doesn’t mean she has to lose her independence.”

Here are a few things the brochure didn’t mention:

Just months earlier, Emeritus supervisors had audited the operations of the memory care unit where Joan would be living. It had been found wanting in almost every important regard. In truth, those “specially trained” staffers hadn’t actually been trained to care for people with Alzheimer’s and other forms of dementia, a violation of California law.

The facility relied on a single nurse to track the health of its scores of residents, and the few licensed medical professionals who worked there tended not to last long. During the three years prior to Joan’s arrival, Emerald Hills had cycled through three nurses and was now employing its fourth. At least one of those nurses was alarmed by what she saw, telling top Emeritus executives — in writing — that Emerald Hills suffered from “a huge shortage of staff” and was mired in “total dysfunction.”

During some stretches, the facility went months without a full-time nurse on the payroll.

The paucity of workers led to neglect, according to a nurse who oversaw the facility before resigning in disgust. Calls for help went unanswered. Residents suffering from incontinence were left soaking in their own urine. One woman, addled by dementia, was allowed to urinate in the same spot in the hallway of the memory care wing over and over and over.

The brochure also made no mention of the company’s problems at its other facilities. State inspectors for years had cited Emeritus facilities across California, faulting them forfailing to employ enough staff members oradequately train them, as well as for other basic shortcomings.

Watch Life and Death in Assisted Living Preview on PBS. See more from FRONTLINE.

Emeritus officials have described any shortcomings as isolated, and insist that any problems that arise are promptly addressed. They cite the company’s growing popularity as evidence of consumer satisfaction. They say that 90 percent of people who take up residence in assisted living facilities across the country report being pleased with the experience.

Certainly, the Boice family, unaware of the true troubles at Emerald Hills, was set to be reassured.

“We were all impressed,” recalled Eric Boice, Joan’s son. “The first impression we had was very positive.”

And so on Sept. 12, 2008, Joan Boice moved into Room 101 at Emerald Hills. She would be sharing the room with another elderly woman. After a succession of tough years, it was a day of great optimism.

Measuring the dimensions of his mother’s new apartment, Eric Boice sought to recreate the feel of her bedroom back home. He arranged the furniture just as it had been. He hung her favorite pictures in the same spots on the wall. On her dresser, he set out her mirror and jewelry box and hairbrush.

Joan, 5-foot-2 and shrinking, had short snow-and-steel hair and wintry gray-blue eyes. Eric looked into those eyes that day at Emerald Hills. He thinks he might have seen a flicker of fear. Or maybe it was just confusion, his mom still uncertain where, exactly, she was.

A Reform Movement Winds Up on Wall Street

The Emeritus Corp., the assisted living corporation now entrusted with Joan’s life, sat atop an exploding industry.

Two decades earlier, Keren Brown Wilson had opened the nation’s first licensed assisted living facility in Canby, Ore., a small town outside of Portland. Wilson was inspired by tragedy: A massive stroke had paralyzed her mother at the age of 55, forcing her into a nursing home, where she was miserable, spending the bulk of her days confined to a hospital bed.

Wilson aimed to create an alternative to nursing homes. She envisioned comfortable, apartment building-style facilities that would allow sick and fragile seniors to maintain as much personal autonomy as possible.

“I wanted a place where people could lock the door,” Wilson explained. “I wanted a place where they could bring their belongings. I wanted a place where they could go to bed when they wanted to. I wanted a place where they could eat what they wanted.”

These “assisted living” facilities would offer housing, meals and care to people who could no longer live on their own but didn’t need intensive, around-the-clock medical attention. The people living in these places would be called “residents” — not patients.

Joan1cIt took Wilson nine years to persuade Oregon legislators to rewrite the state’s laws, a crucial step toward establishing this new type of facility. After that, states across the country began adopting the “Oregon model.”

But what began as a reform movement quickly morphed into a lucrative industry. One of the early entrants was Emeritus, which got into the assisted living business in 1993, opening a single facility in Renton, Wash. The company’s leader, Daniel Baty, had his eyes on something much grander: He was, he declared, aiming to create a nationwide chain of assisted living facilities.

Two years later, Baty took the corporation public, selling shares of Emeritus on the American Stock Exchange, and piling up the cash necessary to vastly enlarge the company’s footprint. Many of Emeritus’s competitors followed the same path.

The company’s rapid growth was, at least in part, a reflection of two significant developments. Americans were living longer, with the number of those in the 65-plus age bracket ballooning further every year. And this growing population of older Americans was willing to spend serious money, often willing to drain their bank accounts completely to preserve some semblance of independence and dignity — in short, something of their former lives.

As the assisted living business flourished, the federal government, which oversees nursing homes, left the regulation of the new industry to the states, which were often unprepared for this torrent of expansion and development. Many states didn’t develop comprehensive regulations for assisted living, choosing instead to simply tweak existing laws governing boarding homes.

In this suddenly booming, but haphazardly regulated industry, no company expanded more aggressively than Emeritus. By 2006, it was operating more than 200 facilities in 35 states. The corporation’s strategy included buying up smaller chains, many of them distressed and financially troubled, with plans to turn them around.

Wall Street liked the model. Market analysts touted the virtues of the company and its stock price floated skyward. One of the corporation’s appeals was that its revenues flowed largely from private bank accounts; unlike hospitals or nursing homes, Emeritus wasn’t reliant on payments from the government insurance programs Medicare or Medicaid, whose reimbursement rates can be capped. As the company noted in its 2006 annual report, nearly 90 percent of its revenues came from “private pay residents.”

In filings with the Securities and Exchange Commission and in conference calls with investors, Emeritus highlighted many things: occupancy rates; increasing revenue; a constant stream of complex real estate deals and acquisitions; the favorable demographic trends of an aging America.

“The target market for our services is generally persons 75 years and older who represent the fastest growing segments of the U.S. population,” Emeritus stated in a 2007 report filed with the SEC.

Today, the assisted living industry rivals the scale of the nursing home business, housing nearly three-quarters of a million people in more than 31,000 assisted living facilities, according to the U.S. Department of Health and Human Services.

Keren Brown Wilson, the early and earnest pioneer of assisted living, is happy that ailing seniors across the country now have the chance to spend their final years in assisted living facilities, rather than nursing homes. But in her view, the rise of assisted living corporations — with their pursuit of investment capital and their need to please shareholders — swept in “a whole new wave of people” more focused on “deals and mergers and acquisitions” than caring for the elderly.

She speaks from experience. After her modest start, Wilson went on to lead a company called Assisted Living Concepts, and took it onto the stock market. Wilson left the company in 2001, and it has encountered a raft of regulatory and financial problems over the last decade.

“I still have a lot of fervor,” said Wilson, who now runs a nonprofit foundation and teaches at Portland State University. “I believe passionately in what assisted living can do. And I’ve seen what it can do. But for some of the people, it’s just another job, or another business. It’s not a passion.”

“A Phenomenal Deal”

Joan1aJoan Boice, born Joan Elizabeth Wayne, grew up in Monmouth, Ill. It was a tiny farm belt community, not far from the Iowa border. Her father, a fixture in the local agriculture trade, owned a trio of riverfront grain elevators on the Mississippi and a fleet of barges. As a teenager, she spent her summers trudging through the fields, de-tasseling corn.

In 1952, accompanied by a friend, Joan packed up a car and followed the highway as far west as it would go. Then in her early 20s, she was propelled by little more than the notion that a different life awaited her in California. In a black-and-white snapshot taken shortly after she arrived, Joan is smiling, a luxuriant sweep of dark hair framing her pale face, gray waves curling in the background. It was the first time she’d seen the Pacific.

Joan had been a teacher for two years in Illinois, and she quickly found a job at an elementary school in Hayward, a suburb of San Francisco. In certain regards, her outlook presaged the progressive social movements that were to remake the country during the next two decades. She viewed education as a “great equalizing force” that could help to remake a society far too stratified by class, race and gender.

“She was just free-spirited and confident,” Eric, her son, said.

Joan met Myron Boice through a singles group at a Presbyterian church in Berkeley. On their wedding day, Joan flouted convention by showing up in a blue dress. The Boice children came along fairly quickly: Nancee, then Mark, then Eric.

Myron Boice was a dreamer. A chronic entrepreneur. He sold tools from a van. He made plans to open restaurants. He had one idea after another. Some worked; others didn’t.

Joan’s passion for education never dissipated. Even in her late 60s, she continued to work as a substitute teacher in public schools. After retirement, she began volunteering with a childhood literacy program.

But age eventually tightened its grip, and hints of a mental decline began surfacing around 2005. Eric grew worried when she couldn’t figure out how to turn on her computer twice in the span of a few months. Then she forgot to include a key ingredient while baking a batch of Christmas cookies. The cookies were inedible.

The elderly couple was still living in the San Francisco suburbs, when, in late 2006, a doctor diagnosed Joan with Alzheimer’s. As her mind deteriorated, Myron struggled to meet her needs. The situation was worsened by the fact that none of the children lived nearby. Mark was in Ohio. Nancee was about an hour away in Santa Cruz. And Eric and his wife, Kathleen, were roughly two hours away in the foothills of the Sierra.

“We offered my parents to come and live with us,” Eric recalled. But Myron said no. He and Joan wouldn’t move in with any of the kids. The family patriarch refused to become a burden.

A physician encouraged Joan and Myron to consider assisted living. It made sense. And so Myron sold their home in 2007 and the couple moved into a facility called The Palms, near Sacramento. The move put them approximately 40 minutes away from Eric and Kathleen.

“They were very attentive to every single thing she needed,” Kathleen Boice said of the staff at The Palms. “They actually re-taught her to eat with a fork and a knife.”

Joan1eBy 2008, however, Myron wanted a change. He wanted to be closer to his son and daughter-in-law and grandkids. He wanted different meals, a new environment. Myron began hunting for a new place to live, a search that led to Emeritus at Emerald Hills in Auburn.

Emeritus opened the Emerald Hills complex in 1998. It was, in many ways, a classic Emeritus facility, situated in a middle-class locale that was neither impoverished nor especially affluent. It was a sizable property, capable of housing more than 100 people.

In part because of its appetite for expansion, Emeritus was in the early stages of what proved to be a period of enormous stress. In 2007, the company had made its biggest acquisition to date, buying Summerville Senior Living Inc., a California-based chain with 81 facilities scattered across 13 states.

The purchase — which expanded Emeritus’s size by roughly one-third — helped the company make another major leap, bouncing from the low-profile American Stock Exchange into the big leagues of commerce, the New York Stock Exchange. News of the Summerville deal propelled the company’s stock to a new high. Emeritus was poised to become the nation’s No. 1 assisted living chain.

But the timing for this bold move turned out to be wretched. The real estate market was freezing up, and it would soon collapse, plunging the nation into an epochal recession. For Emeritus, the economic slowdown and then the housing crash posed direct challenges. Its services didn’t come cheap, so many people needed to sell their homes before they could afford to move into the company’s facilities. With the real estate market calcified, Emeritus’s customer pool shrank.

“Our stock price plummeted,” recalled Granger Cobb, Emeritus’s chief executive officer, who joined the company as part of the Summerville deal. The company’s occupancy rates had been trending skywards. Now they went flat.

At Emerald Hills, the economic slowdown that summer was making life tough for Melissa Gratiot, the lead sales agent.

“It was way harder to move residents in,” she remembered.

But there was some good news. She was close to a significant sale, this one to a couple. Gratiot worked the pitch. She talked with the family. She emailed. She gave them a tour of the facility’s memory care unit, called The Emerald City. She told the family she’d received approval from higher ups to offer the family “a phenomenal deal.”

Gratiot closed the sale. On Aug. 29, 2008, Myron and Eric signed the contract, and the family opened its wallet: A $2,500 initial move-in fee; $2,772 for Joan’s first two weeks in Room 101; another $1,660 for Myron.

There had been one oversight, though. No one at Emeritus with any medical training had ever even met Joan, much less determined whether Emerald Hills could safely care for her.

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Washington 16th

Minnesota ranked best state for seniors – Washington, 16th

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By Judith Graham

Hoping to jump-start a discussion about the well-being of America’s rapidly-growing aging population, the United Health Foundation on Wednesday published the first comprehensive state-by-state analysis of senior health across the nation.

Minnesota won the top spot on the list of healthiest states for seniors to live, followed by Vermont, New Hampshire, Massachusetts and Iowa.

Bringing up the rear, Mississippi was found to be the unhealthiest state for older adults, with Oklahoma, Louisiana, West Virginia and Arkansas following, in that order.

Screen Shot 2013-05-29 at 06.25.18

The report is meant to become a benchmark against which to evaluate future efforts to improve the health of the nation’s fastest growing demographic group – adults 65 and older.  Currently, 40.3 million people fall in this category;  that number is set to soar to 88.5 million by 2050.

“I think it will be a useful tool for states to examine their preparedness and progress in providing needed services to our growing older population,” said James Firman, president of the National Council on Aging.

Several findings are sobering, although not altogether new.  Notably, only 38.4  percent of older adults  rated their health as “very good or excellent” in 2011. One in every five seniors said they did not get sufficient social and emotional support, putting them at risk of isolation and loneliness, conditions known to have an adverse impact on older adults’ health.

Meanwhile, obesity is on the rise in older adults and now affects 25.3 percent of seniors, while physical inactivity is common, with 30.3 percent of seniors in fair or better health saying they failed to get any kind of exercise in the past month.

About one of every seven older adults face the threat of hunger; almost one in eight in nursing homes could live in the community if better community supports were available.

“We hope this report will be a call to action for people and that people will use the data to identify challenges in their states and, even more important, mobilize the full range of local resources and assets to address these challenges,” said Dr. Reed Tuckson, senior advisor to United Health Foundation.

“Government cannot do this alone; that is impossible,” he continued. “We need businesses, the philanthropic sector, community-based organizations, families and individuals to all work together.”

Recognizing that solutions will differ in various states, the report steers clear of recommending specific actions but invites readers to share information about innovative programs that will be posted on America’s Health Rankings web site.

The lack of concrete suggestions left Dr. William Dale, chief of geriatrics and palliative medicine at University of Chicago Medicine, at a bit of a loss.

“If this study generates conversation, that would be great, but I didn’t feel like I knew what to do with it – what policies work and what changes should be made,” he said.

Complicating the picture is the fact that budget cuts for programs serving seniors are a stark reality in Illinois as well as other states.

Overall rankings in the report are based on a composite score of 34 measures of senior health, with data drawn from more than a dozen government agencies and organizations such as the Dartmouth Atlas Project and the Commonwealth Fund.

The measures reflect a broad view of health as encompassing individual behaviors (for instance, smoking and chronic alcohol consumption), the environments in which older adults live (e.g., the extent of poverty and funding for community supports), public policies (e.g., the availability of geriatricians and the extent of drug coverage for seniors), and clinical care and the delivery of health care services (e.g., the number of preventable hospitalizations and hospital readmissions for seniors).

“I believe that if we want to get serious about improving the welfare of older people, we have to get serious about measuring their health,” said Dr. Kenneth Covinsky, a geriatrician and professor of medicine at the University of California, San Francisco.  That said, the “big limitation is you can only report what’s being measured.”

Covinsky said he would have liked more information about older adults’ functional status – the extent to which they can accomplish activities of daily living like bathing, dressing, paying bills or cooking a meal – and the extent to which their needs are addressed once disability sets in.  Also, more robust measures of psychological health would have been welcome, he said.

Enormous variation between states at the top and bottom of various rankings is a key but hardly surprising finding. For instance, community support for poor seniors in Alaska was $8,033 per person, while Nevada spent $283. A measure of the acute shortage of geriatricians – the percent of needed geriatricians who are not available – was only 16.3 percent in Hawaii but 87.3 percent in Montana.

Seniors aren’t generally expected to die in the first decade after they reach the age of 65. Rates of premature death for this group per 100,000 population were 2,558 in Mississippi, compared to 1,425 in Hawaii.

In Illinois, seniors reported three poor mental health days per month, double the 1.5 days reported by older adults in Iowa, South Dakota and Hawaii.

One lesson from the report is the importance of systems of care that address the needs of seniors with chronic illness. Nearly 80 percent of the 65-plus population has been diagnosed with at least one such illness; half the population has received a diagnosis of two or more chronic conditions.

“The top states all have strong networks of community organizations that encourage and promote healthy behaviors and, increasingly, link these networks to the clinical care side,” said Firman of the National Council on Aging.

This article was produced by Kaiser Health News with support from The SCAN Foundation.

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

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Teens and Sexual Assault: Developmentally Delayed Teens

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Seattle Children's Whale LogoBy
This article first appeared on Seattle Children’s Teenology 101 blog.

Developmentally delayed teens are at a much higher risk of sexual assault than their non-delayed peers; the numbers are both depressing and well-validated.Despite the high rates of sexual assault in the teenage population, developmentally delayed teens are at even greater risk. The reason is simple: they are seen as an easy target, and there are predators out there looking to take advantage of them.

“Developmental delay” is a vague term (and is starting to become replaced by the phrase “intellectually disability”), encompassing Down Syndrome, autism, and other conditions that may be genetic or acquired. The range of developmental delay spans from teens who cannot communicate in any fashion with their caregivers, to articulate teens who plan to graduate high school and seek higher education or employment. Obviously, discussion and education for a delayed teen is not a one-size-fits-all task.

For the most delayed teens, unfortunately, there is no way to give them information to help protect themselves. It’s vital that anyone who looks after a delayed teen has had a thorough background check, either through a facility or when you hire them directly. Teens who go to public schools are cared for by employees with in-depth, although not infallible, surveys of their background. If your teen attends a private school or day care facility, sit down with the director and ask about how they ensure the safety of their clientele. Your teen should be spending most of their day in a group activity with one or more staff present. Having trust in whoever works with your teen can help relieve your mind, but it’s also important to keep a keen eye out for something that feels wrong.

If your teen can communicate, you may be able to provide helpful knowledge and skills. Of course, you have to modify this advice to fit your teen’s level of cognition and understanding. A good rule of thumb is:  if your teen asks questions, answer them. If your teen seems to be getting confused or frustrated, simplify.

Any teen who can grasp the concept should receive an education on sexuality appropriate to their level. Sit down with a book like Where Do I Come From? and discuss the basics of bodies and sexuality. They should learn about male and female organs, what sex, pregnancy, and childbirth involve, all about privacy and personal space, and that it’s normal to feel sexual feelings.

Most developmentally delayed teens will have strong sexual urges, like their non-delayed peers, and society in general is uncomfortable with this. People tend to think of delayed teens and adults as either “innocent”, with no sexuality whatsoever, or fear their sexual urges as “uncontrollable.” Like non-delayed teens, in the vast majority of cases, neither is true. Even if it makes you feel uncomfortable, the best way to discuss sexual matters with developmentally delayed teens is to approach their sexuality in a calm and informed manner.

Delayed teens should know that nobody is allowed to touch them sexually without their consent, and they are never allowed to touch anyone sexually without the other person’s consent. Tell them that if somebody tries, you want them to say a resounding no (delayed teens are often taught to obey those with authority, so stress that it’s okay to say no in this situation) and tell a trusted adult immediately. If no trusted adults are around, they should run and/ or call 911 if possible. Encouraged them to tell someone, even if it’s a secret, or they’re worried they’ll get into trouble. Be clear that your teen will never get in trouble for telling someone about their concerns.

Some parents are tempted to describe all sexual contact as “bad” for their teen. Understandably, they are nervous about their teen getting into a sexual situation. However, being touched in a sexual way can feel good, and if a teen doesn’t know that about this, they may not stop a situation because it doesn’t feel like the terrible thing they’ve been told about. Giving your teen a realistic view of sex can help them make healthy decisions, now and in the future.

Of course, some developmentally delayed teens will want to consent to sexual contact with someone. The question of whether a developmentally delayed teen can consent to sexual activity is very tricky, and obviously a lot depends on the level of delay. Encourage your teen to come to you with questions about sex, and tell you if they are thinking of starting a sexual relationship with someone. It won’t be an easy discussion if this happens, but it will be a valuable one.

A few resources: This book is written for parents of Down Syndrome children, but has good information for anyone. This short article is a good introduction. This longer piece is written for educators, but might be useful for parents as well, and the multiple links at the end are to great organizations that deal with this kind of issue. If you have access to Seattle Children’s Hospital, many providers in Adolescent Medicine have skill and experience working with developmentally delayed teens and their families around issues of sexuality.

What questions, success stories, or good advice do you have?

About Jen Brown, RN, BSN

Jen Brown, RN, BSN Teens never cease to amaze me with their strength, creativity, and new perspectives! Throughout my career, I’ve enjoyed helping teens and their parents tackle health concerns and navigate social issues. Nursing is my second career; my first degree was in biology from Carleton College, and a few years later I went to the University of Virginia for their Second Degree Nursing Program. Recently I began a graduate program at the University of Washington.

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Teens and Sexual Assault, Part 8: The Media’s Response to the Steubenville Convictions

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Photo by Brainloc

Photo by Brainloc

By
This article first appeared on Seattle Children’s Teenology 101 blog.

I thought Part 7 was my last post in the series, but the media response to the sentencing of the two rapists in the Steubenville case has been so outrageous that I’m going to tack on a postscript here.

One of the first news reports to come out after the conviction was from CNN, and it spent much more time sympathizing with the rapists than the victim- in fact, the victim was not mentioned. You can watch the video here.

A concerned Poppy Harlow states, ”It was incredibly emotional, incredibly difficult even for an outsider like me, to watch what happened, as these two young men, that had such promising futures, star football players, very good students, literally watched as they believed their life fell apart…”

She then goes on to describe said emotion in the courtroom, and the offenders’ sadness. Later on, another reporter asked a legal correspondent, “What’s the lasting effect of two young men being found guilty in juvenile court of rape, essentially?”

There is so much wrong there: the concern over the rapists, the “essentially” tacked on to “rape”, the complete and utter absence of any thoughts of the victim. Just as people were beginning to criticize CNN, it turned out that the problem was not just with them.

NBC kept talking about the rapists’ “promising football careers.” I’m not sure why that’s relevant.

ABC News ran a piece on Ma’lik Richmond that talked extensively about his athletic prowess and difficult childhood. And yet, many athletes with difficult childhoods have refrained from raping someone.

Good Morning America mentions that “A juvenile judge will decide the fates of Trent Mays and Ma’lik Richmond, who face incarceration in a detention center until their 21st birthdays and the almost-certain demise of their dreams of playing football.” Perhaps if you dream of playing football, it’s best not to commit a sex crime.

The Associated Press opens a story with “Two members of Steubenville’s celebrated high school football team were found guilty Sunday of raping a drunken 16-year-old girl.” They are celebrated high school football players, the victim is left with the epithet “drunken.”

What none of these major media outlets seem to be addressing is that (ideally) if you rape someone, you pay the consequences for it. None of them are lamenting the long-term effects on a young women of being raped by two young men (and having pictures of it sent to peers). None of them are pointing out that this situation wouldn’t have happened if the two offenders had made the choice not to rape someone. Their promising football careers would be continuing untouched, they might have gone to great universities, and enjoyed all the opportunities and rewards given to people who have chosen not to commit rape.

What are our teens supposed to think when the mainstream media’s treatment of rapists is not full of revulsion, fear, or condemnation, but seems almost… affectionate? At the least, they feel very bad for them.

And they fail to mention concern over the fate of the rape victim. In fact, if she’s mentioned at all, it’s to point out that she was intoxicated. As Henry Rollins (yes, thatHenry Rollins) said in a piece in Raw Story, “It is ironic and sad that the person who is going to do a life sentence is her.”

I spoke earlier in this series about how important it is to talk to your teen about issues regarding sexual consent. It’s also important for you to talk to your teen about rape culture, how they can make sure they’re not a part of it, and what they can do to change it.

About Jen Brown, RN, BSN

Jen Brown, RN, BSN Teens never cease to amaze me with their strength, creativity, and new perspectives! Throughout my career, I’ve enjoyed helping teens and their parents tackle health concerns and navigate social issues. Nursing is my second career; my first degree was in biology from Carleton College, and a few years later I went to the University of Virginia for their Second Degree Nursing Program. Recently I began a graduate program at the University of Washington.

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Picture of a table after a party with wine and beer bottles

Teens and Sexual Assault, Part 2: Drinking and Drugs

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By  This article first appeared on Seattle Children’s Teenology 101 blog.

Picture of a table after a party with wine and beer bottlesIn this post, and posts to come, I’m going to talk about safety measures that teens can take to try and lower their risk of sexual assault. However, that comes with two important caveats.

The first is that, unfortunately, there is nothing a teen can do to keep themselves 100% safe from sexual assault.

The second is that if a sexual assault occurs, the blame is 100% on the perpetrator. It does not matter how the victim was acting, or what risks they took, or whether or not they showed good judgment in the situations leading up to the assault; a person who sexually assaults another person is the only one who bears responsibility for that assault.

The tips I am giving in the next few posts are ways to possibly lower risk, but someone who chooses to ignore all of them should never be blamed if they are attacked.

Sometimes I wonder if we spend time teaching our teens to take safety measures and then forget to teach our teens to not sexually assault people.

Like I mentioned in my last post, take the time to discuss with your teen, no matter what their gender, what is and is not acceptable.

Again, I’m not implying your teen is the type of person to victimize someone, but they might be able to speak up to help someone else.

If one teen had chosen to call the police when they saw what was happening during the Steubenville incident, the victim’s assaults- or at least some of them- might never have happened.

Let’s discuss ways to talk to your teen about increasing their safety, and possibly decreasing their risk of being seen as an “easy target” (again, there are unfortunately no guarantees.) And we’ll start by talking about drinking and drugs.

When someone is intoxicated or under the influence of drugs, their judgment and decision-making capacity is lowered and sometimes nonexistent.

This means that they may not be able to assess risk like somebody sober. They may decide to spend time with someone who, were they sober, their gut instinct would warn them away from.

They may be unable to see the danger of a situation that would normally set off alarm bells. If the effects of alcohol or drugs are visible, someone who is seeking a vulnerable person may be drawn to them. Or, if their impulse control is lowered, they may act aggressively towards somebody else.

If your teen decides to drink- hopefully once they are over 21, but the majority of teens do experiment with alcohol before then- they can avoid drinking to the point of severe impairment, especially when in large groups (keeping in mind, however, that most sexual assaults involve someone known to the victim).

When I was in college, we usually had a friend who agreed to be the “lookout” for an evening of parties, someone to avoid intoxication and make sure that nobody was taken advantage of, and that everyone got back to their dorm room safely. Groups of friends can rotate this responsibility among them.

This is obviously not a sure thing- the designated lookout can be drunk him or herself, they can assume one of their charges is having a good time when really they are quite incapacitated… etc.

But it’s never a bad idea for teens to look out for each other in party or group settings, and speak up if they are concerned that someone is being taken advantage of.

Sometimes teens can become incapacitated without having the chance to consider whether or not they want to drink or take drugs. Another important thing for teens to consider is the possibility that someone might slip a drug into their drink to render them less able to respond to or remember incidents.

When possible, teens should get their own drinks, or at least watch them being poured from a previously unopened container, and never leave their drink unattended. You and your teen can find out more about “date-rape drugs”, and ways to avoid them, here.

There are, of course, many other risks to drinking and drugs, many of which are discussed in the “Drug Use Among Teens” post by Dr. Evans.

But encourage your teen to think about drinking and drugs in terms of sexual assault as well. This may help them increase their own safety, or be able to help a friend when they need it most.

About Jen Brown, RN, BSN

Jen Brown, RN, BSN Teens never cease to amaze me with their strength, creativity, and new perspectives! Throughout my career, I’ve enjoyed helping teens and their parents tackle health concerns and navigate social issues. Nursing is my second career; my first degree was in biology from Carleton College, and a few years later I went to the University of Virginia for their Second Degree Nursing Program. Recently I began a graduate program at the University of Washington.

 

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