Category Archives: Social & Family Issues

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.

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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.

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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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Teens and Sexual Assault, Part 1: The Steubenville Incident

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Seattle Children's Whale LogoBy

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

The small town of Steubenville, Ohio, has suddenly become reluctantly but internationally famous, and events there have made headlines around the world.

The story of a teen girl, dragged unconscious from party to party, her repeated assaults known of and even witnessed by peers, is a nightmare.

It chills any parent’s heart, for multiple reasons: the young woman’s vulnerability, the callous nature of the assault, the youth and former promise of the young men who committed it, and the small town politics that many allege obstructed the initial investigation (the mother of one of the accused is the town’s prosecuting attorney).

I want to go over how to talk to your teens about sexual assault and consent. I touch on this in item number three of “10 Tips For Talking to Your Teen About Sex“, but it deserves further discussion.

It’s vital that you have a frank discussion with your teen about sexual assault, and the media coverage of the Steubenville incident gives parents a perfect opportunity to bring it up.

Your teen needs to know the importance of taking “no” for an answer.

First of all, nobody wants to think their child is capable of sexually assaulting someone else. I’m not trying to imply that your child is a budding sexual predator who would perform the acts the young men are accused of in the Steubenville case.

However, bringing up the topic of sexual assault and sexual consent can help your teen with situations that some teens don’t know how to handle, or where others have made the wrong decision.

You can also hear what your teen thinks, both about Steubenville and sexual assault among teenagers.

Rape and sexual assault are terms that apply to a wide variety of circumstances, not just a man forcing sex on a resisting woman. A woman can sexually assault a man, and same-sex sexual assault occurs all too frequently.

Some victims are temporarily incapacitated by drugs or alcohol (or permanently incapacitated by disabilities, which is beyond my scope here), and under these conditions, cannot consent.

Having sex with a partner who is much younger than the other partner is also a form of sexual assault, and can be prosecuted as such.

Your teen needs to know the importance of taking “no” for an answer- you can’t really be too firm on this point- but that also that consent goes deeper than that.

If someone is intoxicated or their thinking is altered by drugs, they do not have the capacity to choose whether or not they want to have sex.

The one extreme of this is the victim of the Steubenville incident, who either was intoxicated to the point of unconsciousness, or was drugged by her aggressors; reports are unclear.

However, people can be awake and still too intoxicated to consent. Someone who is obviously under the influence is not someone that anyone should be physically intimate with.

Encourage your teen to seek consent from their partner, as opposed to just assuming it. Sometimes when a person perceives that a situation is getting out of control, they may “freeze” instead of fighting back.

This happened to someone I knew in college; in the boy’s mind, she was going along and didn’t say “no,” and in the girl’s mind she had frozen on perceiving danger, and he had continued anyway.

Instead of waiting for “no,” talk to your teen about the important of a “yes.” A simple “Is this okay?” shows not only respect for their partner, but helps a teen know that they are with someone who is truly willing, and is enjoying the experience as much as they are.

Make sure your teen knows that sexual activity with someone younger than them, even if that person gives a resounding “yes,” may be illegal. If they have detailed questions, direct them here to see the specifics.

Have you tried to talk to your teen about this? How did it go? Did they say anything that surprised (or impressed) you? Are teens watching the Steubenville incident unfold, and what do they think about 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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Ombudsman Carolyn Mosebar, left, chats with Bob Jones during a visit in January at the Palmers' home in Walla Walla, Wash., where Jones receives long-term care. Mosebar helped get Jones out of a nursing home and move into the Palmers’ family care home (Kai-Huei Yau/AP Images for KHN).

Independence of advocates for long-term care residents challenged

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Ombudsman Carolyn Mosebar, left, chats with Bob Jones during a visit in January at the Palmers' home in Walla Walla, Wash., where Jones receives long-term care. Mosebar helped get Jones out of a nursing home and move into the Palmers’ family care home (Kai-Huei Yau/AP Images for KHN).

Mosebar helped get Jones out of a nursing home and move into the Palmers’ family care home (Kai-Huei Yau/AP Images for KHN).

By Jenni Bergal

This story was produced in collaboration with 

The 2.3 million elderly or disabled people living in nursing homes or assisted living centers might not know it, but they’ve got an advocate – someone who’s supposed to be looking out for their health, safety and rights.

Ombudsman Carolyn Mosebar, left, chats with Bob Jones during a visit in January at the Palmers’ home in Walla Walla, Wash., where Jones receives long-term care.

In 2011, state long-term care ombudsmen — assisted by hundreds of local ombudsmen programs and thousands of volunteers – responded to 204,000 complaints nationwide.

They ranged from roommate conflicts to lack of privacy to allegations of abuse or neglect.

State ombudsmen also are expected to testify before the legislature, talk to the media and take a public stance on long-term care issues, without interference by government officials.

But that’s not always the case. While ombudsmen in some states maintain their autonomy, in other states conflicts have erupted and government officials have been accused of trying to muzzle ombudsmen, especially when they publicly disagree with state policies or battle industry officials.

Among the controversies in recent years:

  • In Florida, the state ombudsman – for years considered a thorn in the long-term care industry’s side – was ousted in 2011 under orders from newly-elected Gov. Rick Scott. This prompted a state Senate hearing and a federal Administration on Aging investigation, which found that the action “raised troubling concerns” and that Florida had violated the spirit of the Older Americans Act, which created the ombudsman program.
  • In Iowa, the state Department on Aging’s director resigned in 2010 amid allegations that the administration had tried to thwart the state’s ombudsman.
  • In California, local ombudsmen campaigned for three years to strengthen the state ombudsman’s independence, arguing that he wasn’t able to take positions on long-term care issues that clashed with the governor or state officials. In 2012, the legislature enacted a bill that beefs up the ombudsman’s independence.

“Ombudsman independence has been a longstanding hot-button issue in a number of areas, both at the state and local level,” says Lori Smetanka, director of the National Long-Term Care Ombudsman Resource Center in Washington, D.C., which provides support and training to ombudsmen. She and her staff regularly hear from ombudsmen who say their ability to speak out is being challenged or limited.

“Sometimes it’s an issue of personalities,” she says. “Sometimes, it’s state policies that get in the way. Oftentimes, it means that there is no one speaking out for nursing home residents or that their voice is not being carried to that higher level.”

Bob Jones cuddles with Sugar on Saturday, January 12, 2013 at the Palmers' home in Walla Walla, Wash., where he receives long-term care. Jones enjoys the companionship of a pet, which he didn't have at the nursing home. (Kai-Huei Yau / AP Images for Kaiser Family Foundation)

Jones enjoys the companionship of a pet, which he didn’t have at the nursing home (Kai-Huei Yau/AP Images for KHN).

The $87 million-a-year ombudsman program dates to 1972 and today operates in every state, the District of Columbia, Puerto Rico and Guam, along with 576 local ombudsmen programs, serving all long-term care residents. The program, funded mostly by the federal government and states, has 1,185 paid staffers and 9,065 trained volunteers nationwide.

Ombudsmen can’t impose sanctions or levy fines, but the law requires them to investigate complaints and advocate for improvements to the long-term-care system. They usually refer serious violations to state licensing officials.

Ombudsmen are also required to report whether they have visited long-term care facilities at least quarterly to find out how residents are doing. In 2011, ombudsmen visited 70 percent of all nursing homes and about 33 percent of all board and care and assisted living centers at least once every three months.

Among the most frequent complaints they investigate: improper discharge or eviction, lack of respect from staff, poor quality food and medication problems.

Other examples: In Maryland an ombudsman assisted a 68-year-old nursing home resident with Parkinson’s disease in getting her wheelchair repaired after it had been broken for months.

In Oregon, an ombudsman helped a 95-year-old veteran who lived in a nursing home get a refund after he was scammed by a telemarketer.

In Michigan, an ombudsman helped a 49-year-old woman with multiple sclerosis transition out of a nursing home to her own apartment after a legal battle to remove her guardian.

LocalHealthGuide Note: To learn more about the Long-Term Care Ombudsman Program in King County and to find information about other ombudsmen programs in the state visit: www.ltcop.org

“So many of the people who live in nursing homes don’t have family members,” says Mitzi McFatrich, executive director of Kansas Advocates for Better Care. “They are truly vulnerable. If you’re being overcharged, if you’re not properly cared for, if you’re being given antipsychotic medications to keep you in line, without the ombudsman program, those residents don’t have any place to turn.”

For Bob Jones, having an ombudsman was “a great relief.”

The 84-year-old former chef badly wanted to leave his Walla Walla, Wash., nursing home. Jones, a stroke victim who suffers from mild dementia and pulmonary disease, had become withdrawn and had lost 47 pounds.

That’s when volunteer ombudsman Carolyn Mosebar came into his life. The 78-year-old retired nurse helped Jones move out of the nursing home in October and into a family care home owned by a couple he knew.

“Carolyn was an advocate and she was a darn good one. She got my confidence back. By being there, she gave me hope,” says Jones, who also worked as a stuntman in Hollywood and used to go fishing with Roy Rogers.

While local ombudsmen across the country have the freedom to help individuals such as Jones, it’s a more slippery slope when it comes to state ombudsmen advocating publicly on long-term care issues.

Mosebar and Jones sit in Jones’ bedroom. The assist poles pictured were not available in his nursing home room (Kai-Huei Yau/AP Images for KHN).

Part of the controversy revolves around how the states have structured their ombudsmen programs. Most are part of state government. Others are located in nonprofit or legal assistance organizations.

And in seven states, including Washington, Maine and Colorado, the ombudsman program is located within a nonprofit or legal assistance organization. In five states, including Kansas, New Jersey and Oregon, the governor appoints the ombudsman.

Some experts say it’s a bad idea for the program to be within state government.

“I think the ombudsman programs outside of state government have more independence and are less subject to political pressure,” says Eric Carlson, an attorney at the National Senior Citizens Law Center in Los Angeles.

A 2007 survey by the National Association of State Long-Term Care Ombudsman Programs found that more than a third of state ombudsmen said they needed prior approval before testifying about long-term care issues and that one in five said they were not allowed to initiate contact with legislators.

Some ombudsmen argue that there are advantages to being located within a state agency, such as having access to decision-makers and clerical and IT support. Many say that the state’s culture is more important than the program’s location.

“For some states, it has been an awkward fit. We’re actively working with a number of them so they don’t have the situation in which ombudsmen would be muzzled,” says Becky Kurtz, director of the federal Office of Long-Term Care Ombudsman Programs, which administers the program.

Kurtz and other experts believe that shackling an ombudsman can directly affect long-term care residents. For example, if a state is considering reducing the number of staffers required in nursing homes or cutting a Medicaid benefit, the ombudsman must have the freedom to come to the table and represent residents’ interests, they say.

Even state units on aging agree that the ombudsman program needs to remain an independent voice.

“Sometimes, state officials don’t understand that the ombudsman’s role is unlike any other state employee and that federal law requires autonomy,” says Deborah Merrill, senior policy director for National Association of States United for Aging and Disabilities. “Over the course of time, some states have struggled with it. Florida is the most obvious.”

Brian Lee was Florida’s state ombudsman for almost eight years until he was forced to resign.

“The nursing home industry and the adult care industry hated me. I was very outspoken,” says Lee, who is now executive director of Families for Better Care, a Tallahassee-based advocacy group.

In January 2011, everything came to a head when Lee asked Florida’s nursing homes to provide his office with detailed corporate ownership information, citing a provision in the new Affordable Care Act. Less than two weeks later, the governor’s office told state officials that it was time for Lee to go.

Florida officials maintained that Lee’s departure was part of the normal turnover that occurs with a change of administration. They said the governor’s office wanted the ombudsman program to “go in a new direction,” according to an investigative report by the federal Administration on Aging.

Four days after Lee was ousted, the state retracted the request for nursing home corporate ownership information.

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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How the NRA undermined law to require mental health checks for gun buys

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NRA National_Rifle_Association logoHow the NRA Undermined Congress’ Last Push for Gun Control

by Joaquin Sapien
ProPublica

Last week, President Obama unveiled sweeping proposals on gun control, including a ban on military-style assault weapons, a reduction of ammunition magazine capacity and stiffer background checks on gun buyers.

National Rifle Association President David Keene quickly accused the Obama administration of being opportunistic. The president is “using our children to pursue an ideological anti-gun agenda,” he said.

The NRA has already begun to  lobby on Capitol Hill to counter the administration’s effort.

To get a sense of what the NRA might do, it’s helpful to look at how it scored a victory during the last major federal initiative to tighten gun control.

After a Virginia Tech student killed 32 students and faculty in April 2007, the Bush administration proposed legislation that would require all states to share the names of residents involuntarily committed to mental health facilities. The information would be provided to a Federal Bureau of Investigation database.

The idea, in part, was to help gun dealers get important information about whether potential customers were mentally ill.

In order to get the support of the NRA, Congress agreed to two concessions that had long been on the agenda of gun rights advocates — concessions that later proved to hamstring the database.

The NRA wanted the government to change the way it deemed someone “mentally defective,” excluding people, for example, who were no longer under any psychiatric supervision or monitoring.

The group also pushed for a way for the mentally ill to regain gun rights if they could prove in court that they’d been rehabilitated.

The NRA found allies on both sides of the aisle to champion the concessions.

GunRep. John Dingell, D-Mich., reportedly pushed the provisions, ultimately with the support of the bill’s lead sponsor, Rep. Carolyn McCarthy, D-N.Y. (McCarthy’s husband was killed and her son wounded in a 1993 shooting on the Long Island Railroad.)

The NRA agreed to the support the bill, in exchange for provisions pushing states to create gun rights restoration programs.

Here’s how it worked. It would cost money for states to share their data: A state agency would have to monitor the courts, collect the names of people who had been institutionalized, and then send that information to the FBI on a regular basis.

So, to help pay for data-sharing Congress created $375 million in annual federal grants and incentives. But to be eligible for the federal money, the states would have to set-up a gun restoration program approved by the Justice Department. No gun rights restoration program, no money to help pay for sharing data.

A spokesman for Dingell’s office did not respond to calls for comment on this story. A McCarthy spokesman, Shams Tarek, said the congresswoman is now working on new legislation to “provide more incentives and stiffen penalties for states to put names in the database.”

“We definitely think there’s a lot of room for improvement,” said Tarek.

The NRA supported Dingell and McCarthy’s version of the bill, but the group won further concessions when the legislation reached the Senate.

Sen. Tom Coburn, R-Okla., who once joked he’d like to bring a gun with him to the Senate floor, blocked the legislation, citing concerns about  privacy and spending.

He negotiated language that, among other things, would allow a person’s application for gun restoration rights to be granted automatically if an agency didn’t respond within 365 days of the application and allowed people to have their attorney’s fees reimbursed if they were forced to go to court to restore their rights.

The final bill was sent to President Bush for his signature in January 2008.

The NRA praised Coburn and released a statement calling the law a victory for gun owners: “After months of careful negotiation, pro-gun legislation was passed through Congress today.” (The NRA didn’t respond to calls for comment.)

In an email, a Coburn spokesman told ProPublica that the senator “does not operate as an agent of the NRA when considering legislation regarding gun rights” and pointed to a recent statement on the president’s gun proposals. (In the statement, Coburn said he supports improving the mental health database, but said overall, “we first must ensure our constitutional rights and individual liberties.”)

Since the bill’s passage, two analyses have shown that the NICS database has significant gaps, partly because of the way the NRA managed to tweak the legislation. Many states aren’t sharing all of their mental health records.

A July 2012 report by the Government Accountability Office, the investigative arm of Congress, found that while the overall number of records increased exponentially since the law passed, the rise is largely due to cooperation from just 12 states.

The non-profit group Mayors Against Illegal Guns also released a report in 2011 showing that many states have failed to fulfill their obligations to report data on the mentally ill to the federal government.

While Virginia and a few others have disclosed tens of thousands of records, 23 others and the District of Columbia reported fewer than 100 records. Seventeen states reported fewer than 10 records and four submitted no data at all.

“Millions of records identifying seriously mentally ill people and drug abusers as prohibited purchasers are missing from the federal background check database because of lax reporting by state agencies,” the report said.

According to the report, the reasons for such uneven compliance vary by state. Some states don’t turn over data because their privacy laws prevent them from doing so. Some states have a different interpretation on what kind of data needs to be provided, or what, exactly, constitutes “mentally ill” or “involuntarily committed.”

Still others simply can’t afford the expense of gleaning the data from the courts, providing it to the relevant state agency and then passing it on to the federal government.

The NRA-backed language creates problems for these states.

As a New York Times investigation found, many states haven’t qualified for federal funding to share their data because they haven’t established gun rights restoration programs.

In 2012, only 12 states received federal grants, according to the Bureau of Justice Statistics.

A Coburn spokesman pointed out that some states have had trouble setting up restoration programs because gun control advocates in those states have protested them.

While mental health data has remained sparse, some states have made it easier for the mentally ill to restore their gun rights. As the Times noted, in Virginia some people have regained rights to guns by simply writing a letter to the state. Other Virginians got their rights back just weeks or months after being hospitalized for psychiatric care.

It’s difficult to know just how many people in Virginia have had their gun rights restored because no agency is responsible for keeping track.

Despite the limitations of the mental health database, some gun control advocates still see it as better than nothing.

“The fact that so many states have been able to get so many records into the database does demonstrate a willingness on the part of certain groups to work on this issue and that’s a good sign. The others really need to step up,” said Lindsay Nichols a staff attorney at the San Francisco-based Law Center to Prevent Gun Violence.

The group, then known as the Legal Community Against Violence, was one of several gun control organizations that opposed the legislation when it was first signed into law.

Nichols is optimistic that the NRA won’t succeed in commandeering the gun control debate the way the group did after Virginia Tech.

“I think there’s new awareness among the public and legislators that we need to take this issue seriously and it’s not an issue where the public is going to accept political wrangling.”

Want to know more? Follow ProPublica on Facebook and Twitter, and get ProPublica headlines delivered by e-mail every day.

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Mental health provisions of Obama’s gun plan focuses on children, teens, and young adults

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By Sarah Varney
KHN Staff Writer

This story was produced in collaboration with NPR

If the National Rifle Association’s plan to curb violence is, in part, arming school employees with guns, President Barack Obama wants to arm them with something quite different: mental health training.

The president’s plan centered largely on training teachers and others who work with children, teens and young adults to recognize mental illness as it’s developing.

“I think this is really putting the focus on children’s mental health as a child issue,” says Dr. Paramjit Joshi, the president-elect of the American Academy of Child & Adolescent Psychiatry. She notes that “about 50 percent of lifetime mental illness starts before the age of 14.”

President Barack Obama signs executive orders initiating 23 separate executive actions after announcing new measures to help prevent gun violence, in the South Court Auditorium of Eisenhower Executive Office Building in Washington, D.C., Jan. 16, 2013. (Official White House Photo by Chuck Kennedy)

President Barack Obama signs executive orders initiating 23 separate executive actions after announcing new measures to help prevent gun violence, in the South Court Auditorium of Eisenhower Executive Office Building in Washington, D.C., Jan. 16, 2013. (Official White House Photo by Chuck Kennedy)

Dr. Joshi says 3 out of 4 people with mental illness develop their condition – including bipolar disorder, depression and schizophrenia — by young adulthood when the intricate structures of the brain are taking shape. But fewer than half receive treatment.

The president has called for a new initiative – which would need congressional approval — that would provide mental health first aid training for teachers and set up a robust referral system for children with mental health and behavioral problems.

President Barack Obama signs a series of executive orders about the administration’s new gun law proposals
Mike Fitzpatrick, executive director of the National Alliance on Mental Illness, says that training is critical: “People say: ‘Oh, we saw the signs,’ but no one knows what the next steps are. And that includes families and caregivers and teachers and resource officers. So to go into the communities and offer training on what to look for, how to spot the signs of mental illness and where do you go to get assistance: This, in many ways, would be a game changer.”

Obama’s proposal also points out that a startling number of children have direct experience with gun violence: 22 percent of 14 to 17 year olds in the U.S. have witnessed a shooting in their lifetime, and the plan calls on Congress to direct some $25 million to help traumatized students.

“People say: ‘Oh, we saw the signs,’ but no one knows what the next steps are . . . “

A separate initiative would aim support at older teens and young adults — ages 16 to 25 — in need of help who can get lost in the tumble of college or a first job.

But mental health experts say that while it’s critical to recognize the first signs of mental illness, it’s just as important that children and their families have health insurance that guarantees them coverage for treatment.

That problem was supposed to be addressed, in part, in 2008 when then-President George W. Bush signed the Mental Health Parity and Addiction Equity Act.

GunIt requires employers with more than 50 workers to offer mental health coverage that is on par with medical benefits.

But writing the regulations has proved difficult: There has been disagreement, for example, over a lifetime cap on the number of therapy visits for people with depression.

In the meantime, advocates say that people with mental illness have languished under temporary rules that have barred patients from a full range of mental health services.

That’s set to change now. One of the executive actions the president signed yesterday included a vow to issue final rules sometime next month.

Chuck Ingoglia of the National Council for Community Behavioral Healthcare says the rules will apply to nearly every type of insurance, from state Medicaid programs to employer coverage to individual health plans sold under the Affordable Care Act.

Among the so-called “essential benefits” will be mental health care.  “We’re hoping a final rule on parity will make it very clear about the scope of services that are offered. … The whole intent of the parity law was that if you need mental health and addiction services, that it should be available to you.”

Those rules won’t require congressional approval, but much of the president’s plan to improve mental health services – and his other gun-related proposals – will hinge on support from House Republicans, who vociferously oppose the administration’s health policies, especially implementing and funding the 2010 federal health law.

Still, the NRA and a number of Republicans have said they support addressing the nation’s fractured mental health system, and advocates for the mentally ill say they anticipate far less political resistance.

The total package of mental health proposals in the president’s plan total some $155 million in federal spending. And the modest scale, those advocates say, might just be something everyone can agree on.

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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Federal grant to fund new North Seattle community health center

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Neighborcare is one of five community health centers in Washington State to receive a federal New Access Point grant under the Affordable Care Act.

The grant will provide $650,000 per year to support the operation of a new clinic focused on the area of North Seattle from Lake Union to the King County northern border, including the residents of 22 public housing communities.

The proposal includes providing more than 30,000 patient visits in the two years of the grant project period.

In May 2012, Neighborcare was also the recipient of two federal capital grants to remodel its 45th Street Medical & Dental Clinic in Wallingford to improve disabled access, and to build a replacement facility for its undersized Greenwood Medical Clinic.

North Seattle has the greatest percentage of low-income people not yet served by a community health center in the city of Seattle: 22% of the total population (68,600 individuals) is low-income, living at or below 200% of the Federal Poverty Level, and 70% (48,220) of those individuals are not served by a community health center.

Neighborcare clinics provide a wide range of primary health care services for men, women and children, including:

  • Preventive medical and dental care
  • Obstetrics and newborn care, including midwifery services
  • Gynecology and reproductive health care
  • Pediatrics and well-child care
  • Immunizations
  • Geriatrics
  • Adolescent medicine
  • Home health care referrals
  • HIV/AIDS screening and treatment
  • Outreach and case management
  • Pharmacy and laboratory services
  • Nutrition counseling and health education
  • Substance abuse counseling
  • Individual, marital, family counseling
  • Social work services, including referrals for housing and financial assistance

To learn more:

Local resources:

Community Clinics

Community Resources:

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