PRESQUE ISLE, Maine — Outside the Mi’kmaq Nation’s health department sits a dome-shaped tent, built by hand from saplings and covered in black canvas. It’s one of several sweat lodges on the tribe’s land, but this one is dedicated to helping people recover from addiction. Up to 10 people enter the lodge at once. Fire-heated stones — called grandmothers and grandfathers, for the spirits they represent — are brought inside. Water is splashed on the stones, and the lodge fills with steam. It feels like a sauna, but hotter. The air is thicker, and it’s dark. People pray and sing songs. When they leave the lodge, it is said, they reemerge from the mother’s womb. Cleansed. Reborn. The experience can be “a vital tool” in healing, said Katie Espling, health director for the roughly 2,000-member tribe. She said patients in recovery have requested sweat lodges for years as a cultural element to complement the counseling and medications the tribe’s health department already provides. But insurance doesn’t cover sweat ceremonies, so, until now, the department couldn’t afford to provide them. In the past year, the Mi’kmaq Nation received more than $150,000 from settlements with companies that made or sold prescription painkillers and were accused of exacerbating the overdose crisis. A third of that money was spent on the sweat lodge. Health care companies are paying out more than $1.5 billion to hundreds of tribes over 15 years. This windfall is similar to settlements that many of the same companies are paying to state governments, which total about $50 billion. To some people, the lower payout for tribes corresponds to their smaller population. But some tribal citizens point out that the overdose crisis has had a disproportionate effect on their communities. Native Americans had the highest overdose death rates of any racial group each year from 2020 to 2022. And federal officials say those statistics were likely undercounted by about 34% because Native Americans’ race is often misclassified on death certificates. Still, many tribal leaders are grateful for the settlements and the unique way the money can be spent: Unlike the state payments, money sent to tribes can be used for traditional and cultural healing practices — anything from sweat lodges and smudging ceremonies to basketmaking and programs that teach tribal languages. “To have these dollars to do that, it’s really been a gift,” said Espling of the Mi'kmaq tribe. “This is going to absolutely be fundamental to our patients’ well-being” because connecting with their culture is “where they’ll really find the deepest healing.” Public health experts say the underlying cause of addiction in many tribal communities is intergenerational trauma, resulting from centuries of brutal treatment, including broken treaties, land theft, and a government-funded boarding school system that sought to erase the tribes’ languages and cultures. Along with a long-running lack of investment in the Indian Health Service, these factors have led to lower life expectancy and higher rates of addiction, suicide, and chronic diseases. Using settlement money to connect tribal citizens with their traditions and reinvigorate pride in their culture can be a powerful healing tool, said Andrea Medley, a researcher with the Johns Hopkins Center for Indigenous Health and a member of the Haida Nation. She helped create principles for how tribes can consider spending settlement money. Medley said that having respect for those traditional elements outlined explicitly in the settlements is “really groundbreaking.” ‘A Drop in the Bucket’ Of the 574 federally recognized tribes, more than 300 have received payments so far, totaling more than $371 million, according to Kevin Washburn, one of three court-appointed directors overseeing the tribal settlements. Although that sounds like a large sum, it pales in comparison with what the addiction crisis has cost tribes. There are also hundreds of tribes that are excluded from the payments because they aren’t federally recognized. “These abatement funds are like a drop in the bucket compared to what they’ve spent, compared to what they anticipate spending,” said Corey Hinton, a lawyer who represented several tribes in the opioid litigation and a citizen of the Passamaquoddy Tribe. “Abatement is a cheap term when we’re talking about a crisis that is still engulfing and devastating communities.” Even leaders of the Navajo Nation — the largest federally recognized tribe in the United States, which has received $63 million so far — said the settlements can’t match the magnitude of the crisis. “It’ll do a little dent, but it will only go so far,” said Kim Russell, executive director of the Navajo Department of Health. The Navajo Nation is trying to stretch the money by using it to improve its overall health system. Officials plan to use the payouts to hire more coding and billing employees for tribe-operated hospitals and clinics. Those workers would help ensure reimbursements keep flowing to the health systems and would help sustain and expand services, including addiction treatment and prevention, Russell said. Navajo leaders also want to hire more clinicians specializing in substance use treatment, as well as primary care doctors, nurses, and epidemiologists. “Building buildings is not what we want” from the opioid settlement funds, Russell said. “We’re nation-building.” High Stakes for Small Tribes Smaller nations like the Poarch Band of Creek Indians in southern Alabama are also strategizing to make settlement money go further. For the tribe of roughly 2,900 members, that has meant investing $500,000 — most of what it has received so far — into a statistical modeling platform that its creators say will simulate the opioid crisis, predict which programs will save the most lives, and help local officials decide the most effective use of future settlement cash. Some recovery advocates have questioned the model’s value, but the tribe’s vice chairman, Robert McGhee, said it would provide the data and evidence needed to choose among efforts competing for resources, such as recovery housing or peer support specialists. The tribe wants to do both, but realistically, it will have to prioritize. “If we can have this model and we put the necessary funds to it and have the support, it'll work for us,” McGhee said. “I just feel it in my gut.” The stakes are high. In smaller communities, each death affects the whole tribe, McGhee said. The loss of one leader marks decades of lost knowledge. The passing of a speaker means further erosion of the Native language. For Keesha Frye, who oversees the Poarch Band of Creek Indians’ tribal court and the sober living facility, using settlement money effectively is personal. “It means a lot to me to get this community well because this is where I live and this is where my family lives,” she said. Erik Lamoreau in Maine also brings personal ties to this work. More than a decade ago, he sold drugs on Mi’kmaq lands to support his own addiction. “I did harm in this community and it was really important for me to come back and try to right some of those wrongs,” Lamoreau said. Today, he works for the tribe as a peer recovery coordinator, a new role created with the opioid settlement funds. He uses his experience to connect with others and help them with recovery — whether that means giving someone a ride to court, working on their résumé, exercising together at the gym, or hosting a cribbage club, where people play the card game and socialize without alcohol or drugs. Beginning this month, Lamoreau’s work will also involve connecting clients who seek cultural elements of recovery to the new sweat lodge service — an effort he finds promising. “The more in tune you are with your culture — no matter what culture that is — it connects you to something bigger,” Lamoreau said. “And that’s really what we look at when we’re in recovery, when we talk about spiritual connection. It’s something bigger than you.” KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF. 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LAKE ELSINORE, Calif. — Yahushua Robinson was an energetic boy who jumped and danced his way through life. Then, a physical education teacher instructed the 12-year-old to run outside on a day when the temperature climbed to 107 degrees. “We lose loved ones all the time, but he was taken in a horrific way,” his mother, Janee Robinson, said from the family’s Inland Empire home, about 80 miles southeast of Los Angeles. “I would never want nobody to go through what I’m going through.” The day her son died, Robinson, who teaches phys ed, kept her elementary school students inside, and she had hoped her children’s teachers would do the same. The Riverside County Coroner’s Bureau ruled that Yahushua died on Aug. 29 of a heart defect, with heat and physical exertion as contributing factors. His death at Canyon Lake Middle School came on the second day of an excessive heat warning, when people were advised to avoid strenuous activities and limit their time outdoors. Yahushua’s family is supporting a bill in California that would require the state Department of Education to create guidelines that govern physical activity at public schools during extreme weather, including setting threshold temperatures for when it’s too hot or too cold for students to exercise or play sports outside. If the measure becomes law, the guidelines will have to be in place by Jan. 1, 2026. Many states have adopted protocols to protect student athletes from extreme heat during practices. But the California bill is broader and would require educators to consider all students throughout the school day and in any extreme weather, whether they’re doing jumping jacks in fourth period or playing tag during recess. It’s unclear if the bill will clear a critical committee vote scheduled for May 16. “Yahushua’s story, it’s very touching. It’s very moving. I think it could have been prevented had we had the right safeguards in place,” said state Sen. Melissa Hurtado (D-Bakersfield), one of the bill’s authors. “Climate change is impacting everyone, but it’s especially impacting vulnerable communities, especially our children.” Last year marked the planet’s warmest on record, and extreme weather is becoming more frequent and severe, according to the National Oceanic and Atmospheric Administration. Even though most heat deaths and illnesses are preventable, about 1,220 people in the United States are killed by extreme heat every year, according to the Centers for Disease Control and Prevention. Young children are especially susceptible to heat illness because their bodies have more trouble regulating temperature, and they rely on adults to protect them from overheating. A person can go from feeling dizzy or experiencing a headache to passing out, having a seizure, or going into a coma, said Chad Vercio, a physician and the division chief of general pediatrics at Loma Linda University Health. “It can be a really dangerous thing,” Vercio said of heat illness. “It is something that we should take seriously and figure out what we can do to avoid that.” It’s unclear how many children have died at school from heat exposure. Eric Robinson, 15, had been sitting in his sports medicine class learning about heatstroke when his sister arrived at his high school unexpectedly the day their brother died. “They said, ‘OK, go home, Eric. Go home early.’ I walked to the car and my sister’s crying. I couldn’t believe it,” he said. “I can’t believe that my little brother’s gone. That I won’t be able to see him again. And he’d always bugged me, and I would say, ‘Leave me alone.’” That morning, Eric had done Yahushua’s hair and loaned him his hat and chain necklace to wear to school. As temperatures climbed into the 90s that morning, a physical education teacher instructed Yahushua to run on the blacktop. His friends told the family that the sixth grader had repeatedly asked the teacher for water but was denied, his parents said. The school district has refused to release video footage to the family showing the moment Yahushua collapsed on the blacktop. He died later that day at the hospital. Melissa Valdez, a Lake Elsinore Unified School District spokesperson, did not respond to calls seeking comment. Schoolyards can reach dangerously high temperatures on hot days, with asphalt sizzling up to 145 degrees, according to findings by researchers at the UCLA Luskin Center for Innovation. Some school districts, such as San Diego Unified and Santa Ana Unified, have hot weather plans or guidelines that call for limiting physical activity and providing water to kids. But there are no statewide standards that K-12 schools must implement to protect students from heat illness. Under the bill, the California Department of Education must set temperature thresholds requiring schools to modify students’ physical activities during extreme weather, such as heat waves, wildfires, excessive rain, and flooding. Schools would also be required to come up with plans for alternative indoor activities, and staff must be trained to recognize and respond to weather-related distress. California has had heat rules on the books for outdoor workers since 2005, but it was a latecomer to protecting student athletes, according to the Korey Stringer Institute at the University of Connecticut, which is named after a Minnesota Vikings football player who died from heatstroke in 2001. By comparison, Florida, where Gov. Ron DeSantis, a Republican, this spring signed a law preventing cities and counties from creating their own heat protections for outdoor workers, has the best protections for student athletes, according to the institute. Douglas Casa, a professor of kinesiology and the chief executive officer of the institute, said state regulations can establish consistency about how to respond to heat distress and save lives. “The problem is that each high school doesn’t have a cardiologist and doesn’t have a thermal physiologist and doesn’t have a sickling expert,” Casa said of the medical specialties for heat illness. In 2022, California released an Extreme Action Heat Plan that recommended state agencies “explore implementation of indoor and outdoor heat exposure rules for schools,” but neither the administration of Gov. Gavin Newsom, a Democrat, nor lawmakers have adopted standards. Lawmakers last year failed to pass legislation that would have required schools to implement a heat plan and replace hot surfaces, such as cement and rubber, with lower-heat surfaces, such as grass and cool pavement. That bill, which drew opposition from school administrators, stalled in committee, in part over cost concerns. Naj Alikhan, a spokesperson for the Association of California School Administrators, said the new bill takes a different approach and would not require structural and physical changes to schools. The association has not taken a position on the measure, and no other organization has registered opposition. The Robinson family said children’s lives ought to outweigh any costs that might come with preparing schools to deal with the growing threat of extreme weather. Yahushua‘s death, they say, could save others. “I really miss him. I cry every day,” said Yahushua’s father, Eric Robinson. “There’s no one day that go by that I don’t cry about my boy.” This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF. USE OUR CONTENTThis story can be republished for free (details). from https://ift.tt/6WsFUMo Check out http://plush-draw15.tumblr.com/ Facility fees are charges tacked on for visiting a doctor’s office or even a telehealth visit. They’re becoming increasingly common and they can add hundreds of dollars to your bill. “An Arm and a Leg” host Dan Weissmann wants to know how often this happens, where, and how much it costs patients. If you’ve ever seen a charge for a facility fee on your medical bill — especially for a visit or service that didn’t take place in a hospital — “An Arm and a Leg” wants to hear from you.Click here to share your story. It may be featured on an upcoming episode. Dan Weissmann @danweissmann Host and producer of "An Arm and a Leg." Previously, Dan was a staff reporter for Marketplace and Chicago's WBEZ. His work also appears on All Things Considered, Marketplace, the BBC, 99 Percent Invisible, and Reveal, from the Center for Investigative Reporting.CreditsEmily Pisacreta Producer Adam Raymonda Audio wizard Ellen Weiss Editor“An Arm and a Leg” is a co-production of KFF Health News and Public Road Productions. To keep in touch with “An Arm and a Leg,” subscribe to the newsletter. You can also follow the show on Facebook and the social platform X. And if you’ve got stories to tell about the health care system, the producers would love to hear from you. To hear all KFF Health News podcasts, click here. And subscribe to “An Arm and a Leg” on Spotify, Apple Podcasts, Pocket Casts, or wherever you listen to podcasts. KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF. USE OUR CONTENTThis story can be republished for free (details). from https://ift.tt/P4msUZ1 Check out http://plush-draw15.tumblr.com/ Houston, Texas. – Los pacientes internados en el Hospital Metodista de Houston llevan adherido al pecho un dispositivo de monitoreo del tamaño de medio billete, desempeñando sin saberlo un papel en el uso cada vez más frecuente de la inteligencia artificial (IA) en la atención médica. Este delgado dispositivo, que funciona con baterías, se llama BioButton y registra los signos vitales de los pacientes, incluidas la temperatura, y las frecuencias cardíaca y respiratoria. Esos informes se envían —de manera inalámbrica— al personal de enfermería, que puede estar tanto en la sala de control del hospital, que funciona las 24 horas, como en sus propias casas. El software del dispositivo utiliza la IA para analizar la abrumadora cantidad de datos que registra, y también para detectar señales que indiquen que la salud del paciente está empeorando. Autoridades del hospital afirman que desde comenzaron a usarlo el año pasado, el BioButton ha mejorado la calidad de la atención y reducido la carga de trabajo de las enfermeras. “Como detectamos las cosas antes, a los pacientes les va mejor, ya que no tenemos que esperar a que el equipo de cabecera se dé cuenta si algo anda mal”, dijo Sarah Pletcher, vicepresidenta del sistema en Houston. “Sin embargo, algunas enfermeras temen que esta tecnología termine sustituyéndolas en lugar de respaldar su trabajo, lo que podría perjudicar a los enfermos. El Hospital Metodista de Houston, uno de los muchos hospitales estadounidenses que emplean el BioButton, es el primero en utilizar este dispositivo para monitorear a todos sus pacientes excepto los que están en cuidados intensivos”, explicó Pletcher. “Existe una publicidad engañosa y exagerada que afirma que estos dispositivos proporcionan cuidados a gran escala con menores costos laborales”, afirmó Michelle Mahon, enfermera titulada y directora adjunta de National Nurses United, el mayor sindicato del personal de enfermería del país. “Esta tendencia nos parece preocupante”, añadió. La implementación del BioButton es uno de los ejemplos más recientes del modo en que los hospitales utilizan la tecnología con el fin, por un lado, de optimizar la eficiencia y, por el otro, de hacer frente a la escasez de enfermeras, un problema que se ha agudizado con el tiempo. Sin embargo, esa transición ha generado otras preocupaciones, entre ellas el uso de IA para operar el dispositivo. Las encuestas muestran que el público desconfía de que los proveedores de salud dependan de la IA para atender a los pacientes. En diciembre de 2022, la Administración de Alimentos y Medicamentos (FDA) autorizó el uso del BioButton en pacientes adultos siempre que no estuvieran en terapia intensiva. Es una de las muchas herramientas de IA que ahora se usan en los hospitales para resolver un gran número de tareas, como por ejemplo interpretar los resultados de diagnósticos por imagen. En 2023, el presidente Joe Biden le encargó al Departamento de Salud y Servicios Humanos (HHS) la formulación de un plan para regular el uso hospitalario de la IA que incluyera la recopilación de informes de pacientes perjudicados por su uso. James Mault es el director general de BioIntelliSense, la empresa que desarrolló el BioButton. Desde su sede en Golden, Colorado, Mault afirma que este dispositivo supone un enorme avance si se lo compara con el trabajo tradicional de las enfermeras, que iban varias veces al día a las habitaciones para monitorear los signos vitales de los pacientes. “Con la IA hemos pasado de preguntarnos ‘¿por qué este paciente empeoró repentinamente?’ a decir ‘podemos prevenir la crisis antes de que se produzca e intervenir adecuadamente’”, afirma Mault. El BioButton se pega a la piel mediante un adhesivo, es resistente al agua y su batería tiene una vida útil de hasta 30 días. La empresa asegura que el pequeño dispositivo, que permite que los profesionales detecten rápidamente el deterioro de la salud a partir del registro de más de un millar de mediciones diarias por persona, se ha utilizado en más de 80,000 pacientes hospitalizados en todo el país durante el último año. Los hospitales le pagan a BioIntelliSense una cuota anual por los dispositivos y el software. Las autoridades del Hospital Metodista de Houston no quisieron revelar cuánto paga la institución por esta tecnología, aunque Pletcher dijo que la suma equivale a menos de una taza de café al día por paciente. Para un sistema hospitalario que atiende a miles de personas simultáneamente —el Metodista, en sus ocho hospitales del área de Houston, tiene 2,653 camas fuera de la UCI—, esa inversión podría traducirse en millones de dólares al año. Sin embargo, los directivos del hospital aseguraron que no hubo ningún cambio en la dotación del personal de enfermería por la implementación del BioButton ni tienen previsto que lo vaya a haber. Una mañana reciente unas, 15 enfermeras y técnicos en uniforme estaban sentados en el centro de control de monitoreo virtual del hospital frente a grandes monitores. Allí veían el estado de salud de cientos de pacientes. Una marca roja junto al nombre de uno de esos pacientes indicaba que el software de IA había detectado una tendencia fuera de lo normal. Los profesionales pudieron, entonces, hacer clic en el historial médico de ese paciente y comprobar cómo habían sido sus signos vitales a lo largo del tiempo así como otros antecedentes médicos. Estas “enfermeras virtuales”, por así decirlo, pudieron ponerse en contacto con las enfermeras de planta por teléfono o por correo electrónico, e incluso hacer una videollamada directamente a la habitación del paciente. Nutanben Gandhi, una técnica que esa mañana vigilaba a 446 pacientes en su monitor, dijo que cuando recibe una alerta consulta el historial médico de esa persona para ver si la anomalía puede explicarse fácilmente por su situación de salud o si es preciso que se ponga en contacto con las enfermeras de planta que la atienden en la sala. En muchas ocasiones, el llamado de atención puede ignorarse. Pero identificar signos de deterioro de la salud puede ser difícil, afirma Steve Klahn, director clínico de Medicina Virtual del Metodista de Houston. “Estamos buscando una aguja en un pajar”, explica. Donald Eustes, de 65 años, ingresó al hospital en marzo para someterse a un tratamiento contra el cáncer de próstata pero allí le detectaron un accidente cerebrovascular. Está contento de llevar el BioButton. “Nunca se sabe lo que nos puede pasar, y tener un conjunto de ojos extra observándonos es algo bueno”, reflexionó desde la cama del hospital. Después que le explicaron que el dispositivo utiliza IA, este hombre de Montgomery, Texas, dijo que no tiene ningún problema en que esta tecnología ayude a su equipo médico. “Parece un buen uso de la inteligencia artificial”, opinó. Tanto los pacientes como el personal de enfermería se benefician de un monitoreo a distancia como el que realiza el BioButton, aseguró Pletcher. También contó que el hospital ha colocado pequeñas cámaras y micrófonos en el interior de todas las habitaciones, lo que habilita a las enfermeras del centro de monitoreo a comunicarse con los pacientes y colaborar en ciertas tareas como las admisiones y las instrucciones de alta. “Los pacientes pueden incluir a sus familiares en las llamadas a distancia con el personal de enfermería o el equipo médico”, agregó. La tecnología virtual libera a los enfermeros de guardia de modo que puedan prestar una ayuda más directa, como colocar una vía intravenosa, explicó Pletcher. Con el BioButton, las enfermeras pueden espaciar el control de los signos vitales y realizarlo cada ocho horas en lugar de cada cuatro, como lo hacían habitualmente, explicó. Pletcher sostiene que el dispositivo reduce el estrés que genera en las enfermeras el monitoreo de los pacientes y permite que algunas trabajen con horarios más flexibles porque la atención virtual también puede hacerse desde sus propias casas. En última instancia, esto ayuda a retener al personal de enfermería, no lo ahuyenta, dijo. Sheeba Roy, jefa de enfermería del Metodista de Houston, dijo que, sin embargo, a algunos miembros del personal de enfermería los ponía nerviosos depender del dispositivo y no comprobar ellos mismos los signos vitales de los pacientes con tanta frecuencia. Pero las pruebas han demostrado que el dispositivo proporciona información precisa. “Cuando lo pusimos en marcha, al personal le encantó”, afirma Roy. Serena Bumpus, directora ejecutiva de la Asociación de Enfermeras de Texas, dijo que su preocupación ante cualquier innovación tecnológica es que pueda ser más gravosa para las enfermeras y quitarles tiempo con los pacientes. “Tenemos que estar muy atentos para asegurarnos de que no nos estamos apoyando en esta tecnología para sustituir la capacidad de las enfermeras de pensar críticamente, de evaluar a los pacientes y para que puedan corroborar que lo que este dispositivo está informando es lo correcto”, advirtió Bumpus. Este año, el Hospital Metodista de Houston tiene previsto enviar a los pacientes a su casa con el BioButton para que el hospital pueda efectuar un mejor seguimiento de su evolución en las semanas posteriores al alta, medir su calidad de sueño y comprobar la estabilidad con la que se mueven y caminan. “No vamos a necesitar menos enfermeras en la atención sanitaria, pero nuestros recursos son limitados y debemos utilizarlos de la forma más inteligente posible”, dijo Pletcher. “Si tenemos en cuenta la demanda proyectada y los recursos con los que realmente contamos, ya sabemos que no serán suficientes para satisfacerla, así que todo lo que podamos hacer para devolverles tiempo a las enfermeras es beneficioso”, concluyó. KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF. USE OUR CONTENTThis story can be republished for free (details). from https://ift.tt/nqa1JCS Check out http://plush-draw15.tumblr.com/ La esposa de Bill Thompson nunca lo había visto sonreír con confianza. Durante los primeros 20 años de su relación, una infección en la boca le había ido robando los dientes, uno a uno. “¡No tenía dientes para sonreír!”, dijo el hombre de 53 años de Independence, Missouri. Thompson dijo que durante años lidió con punzantes dolores de muelas y una hinchazón en la cara, también muy dolorosa, producto de abscesos, mientras trabajaba como cocinero en Burger King. Necesitaba desesperadamente ir al dentista, pero dijo que no podía permitirse tomar tiempo libre sin pago. Missouri es uno de los muchos estados que no requieren que los empleadores proporcionen licencia por enfermedad paga. Entonces, Thompson se tragaba un Tylenol y soportaba el dolor mientras trabajaba sobre la parrilla caliente. “O vamos a trabajar y tenemos un cheque de pago”, dijo Thompson. “O cuidamos de nosotros mismos. No podemos cuidar de nosotros mismos porque, bueno, estamos atrapados en este círculo vicioso”. En una nación que estuvo fuertemente dividida sobre los mandatos de salud del gobierno durante la pandemia de covid-19, el público se está sintiendo cómodo con la idea de reglas gubernamentales que proporcionen licencia por enfermedad remunerada. Antes de la pandemia, 10 estados y el Distrito de Columbia tenían leyes que requerían que los empleadores proporcionaran licencia por enfermedad paga. Desde entonces, Colorado, Nueva York, Nuevo México, Illinois y Minnesota han aprobado leyes que ofrecen algún tipo de tiempo libre por enfermedad remunerado. Oregon y California ampliaron las leyes de licencia paga que ya estaban vigentes. En Missouri, Alaska y Nebraska, defensores están presionando para llevar el tema a votación este otoño. Estados Unidos es uno de los nueve países que no garantizan licencia por enfermedad paga, según datos compilados por el World Policy Analysis Center. En respuesta a la pandemia, el Congreso aprobó la Emergency Paid Sick Leave y el Emergency Family and Medical Leave Act. Estas medidas temporales permitieron a los empleados tomar hasta dos semanas de licencia paga si la enfermedad estaba relacionada con covid y su atención. Pero las disposiciones expiraron en 2021. “Cuando golpeó la pandemia, finalmente vimos una voluntad política real para resolver el problema de no tener licencia por enfermedad paga federal”, dijo la economista Hilary Wething. Wething fue co-autora de un informe reciente del Economic Policy Institute sobre el estado de la licencia por enfermedad en el país. Descubrió que más de la mitad, el 61%, de los trabajadores peor pagos no pueden tomarse este tipo de licencia. “Me sorprendió mucho lo rápido que la pérdida de salario, debido a que estás enfermo, puede traducirse en recortes inmediatos y devastadores para el presupuesto familiar”, dijo. Wething señaló que la pérdida de salarios incluso por uno o dos días puede equivaler a un mes de gasolina que un trabajador necesitaría para llegar a su trabajo, o la elección entre pagar una factura de electricidad o comprar alimentos. Agregó que presentarse al trabajo enfermo representa un riesgo tanto para los compañeros como para los clientes. Los empleos mal remunerados que a menudo no tienen licencia por enfermedad paga, como cajeros, cosmetólogas, asistentes de salud en el hogar y trabajadores de comida rápida, implican muchas interacciones cara a cara. “Así que la licencia por enfermedad paga se trata tanto de proteger la salud pública de una comunidad como de proporcionar a los trabajadores la seguridad económica que necesitan desesperadamente cuando deben tomar tiempo libre del trabajo”, dijo. La National Federation Of Independent Business se ha opuesto a las reglas de licencia por enfermedad obligatoria a nivel estatal, argumentando que los lugares de trabajo deberían tener la flexibilidad para resolver el tema con sus empleados cuando se enferman. El grupo dijo que el costo de pagar a los trabajadores por tiempo libre, el papeleo adicional y la productividad perdida son una carga para los pequeños empleadores. Según un informe del National Bureau of Economic Research, una vez que estas disposiciones entran en vigencia, los empleados toman, en promedio, dos días más de enfermedad al año comparado con antes de que entrara en vigor la ley. Las reglas de tiempo libre pago de Illinois entraron en vigencia este año. Lauren Pattan es co-propietaria de Old Bakery Beer Co. allí. Antes de este año, la cervecería artesanal no ofrecía tiempo libre remunerado para sus empleados por hora. Pattan dijo que apoya la nueva ley de Illinois, pero tiene que ver cómo pagarla. “Realmente intentamos ser respetuosos con nuestros empleados y ser un buen lugar para trabajar, y al mismo tiempo nos preocupa no poder permitirnos ciertas cosas”, dijo. Eso podría significar que los clientes tengan que pagar más para cubrir el costo, agregó Pattan. En cuanto a Bill Thompson, escribió una columna de opinión para el periódico Kansas City Star sobre sus problemas dentales. “A pesar de trabajar casi 40 horas a la semana, muchos de mis compañeros no tienen hogar”, escribió. “Sin seguro, ninguno de nosotros puede pagar a un médico o un dentista”. Ese artículo generó atención local y, en 2018, un dentista de su comunidad donó su tiempo y trabajo para quitarle los dientes restantes a Thompson y reemplazarlos con dentaduras postizas. Esto permitió que su boca se recuperara de las infecciones con las que había estado lidiando durante años. Hoy, Thompson tiene una nueva sonrisa y un trabajo, con licencia por enfermedad paga, en el servicio de alimentos en un hotel. En su tiempo libre, ha estado recopilando firmas para presentar una iniciativa en la boleta electoral de noviembre que garantizaría al menos cinco días de licencia por enfermedad paga al año para los trabajadores de Missouri. Los organizadores de la petición dijeron que tienen suficientes firmas para llevarlo ante los votantes. KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF. USE OUR CONTENTThis story can be republished for free (details). from https://ift.tt/iXEoeQO Check out http://plush-draw15.tumblr.com/ Millions of people were surprised to find themselves booted from Medicaid over the past year after pandemic-era protections expired that had prevented states from terminating their coverage. Turns out, millions of them were also unaware they had been covered by the government program. Nearly 1 in 3 people enrolled in Medicaid in 2022 — or 26 million people — didn’t know it, according to a study by Harvard and New York University researchers published in Health Affairs this month. The report estimated that of those who didn’t know they were on Medicaid, about 3 million thought they were uninsured. They almost certainly had coverage, though, because the federal government from March 2020 to April 2023 prohibited states from dropping anyone from Medicaid rolls in exchange for billions of dollars in pandemic relief money. “What this means is people could have been accessing health-care services and probably did not because they thought they were uninsured,” said Jennifer Tolbert, deputy director of the KFF Program on Medicaid & Uninsured. “People not understanding that they have Medicaid is not a good thing.” This lack of awareness has implications for efforts to predict how much the nation’s uninsured rate has changed as a result of the Medicaid “unwinding” — the process that began last year in which states redetermine whether people enrolled in the program since the pandemic unfolded remain eligible. States have dropped about 22 million people from Medicaid in the past year, often for procedural reasons like failing to return paperwork. A KFF survey in April found about 1 in 4 adults who were disenrolled from Medicaid a year ago remained uninsured. One group enjoys some upside from Americans’ ignorance about their insurance coverage: the companies that administer Medicaid for most states, including UnitedHealthcare and Centene. States pay them a monthly fee for every person enrolled in their plans. But if people don’t know they’re insured, they’re less likely to seek health services — which means higher profits for the companies. “Insurers reaped windfalls from this reality,” said Brian Blase, president of the Paragon Health Institute and a former health policy adviser to President Donald Trump. “People who are enrolled but don’t know they are enrolled receive no benefit from the program.” In March 2022, the Centers for Medicare & Medicaid Services reported that about 88 million people had Medicaid coverage. But census survey data found about 62 million people self-reported Medicaid coverage — an undercount of 26.4 million, the study said. Several factors explain why enrollees may not realize they’re on Medicaid. They don’t pay monthly premiums, so the cost of the coverage can be invisible. Because it’s administered by private insurers, many Medicaid recipients may believe they have commercial coverage. And states often market their Medicaid programs with a consumer-friendly name, like Husky Health in Connecticut or SoonerCare in Oklahoma. “Medicaid having different names should not lead people to think they are uninsured,” said Benjamin Sommers, a health economist at Harvard who was one of the study’s authors. This article is not available for syndication due to republishing restrictions. If you have questions about the availability of this or other content for republication, please contact [email protected]. KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF. USE OUR CONTENTThis story can be republished for free (details). from https://ift.tt/xTlLJFR Check out http://plush-draw15.tumblr.com/ James Lemons, de 39 años, quiere que le extraigan la bala de su muslo para poder volver a trabajar. Sarai Holguín, de 71 años y originaria de México, ha aceptado la bala alojada cerca de su rodilla como su “compa”, es decir, una amiga cercana. A Mireya Nelson, de 15, la alcanzó una bala que atravesó su mandíbula y le rompió el hombro, donde quedaron fragmentos. Por ahora vivirá con ellos, mientras los médicos monitorean los niveles de plomo en su sangre por al menos dos años. A casi tres meses del tiroteo en el desfile del Super Bowl de los Kansas City Chiefs, que dejó al menos 24 personas heridas, recuperarse de esas heridas es algo profundamente personal e incluye una sorprendente área gris de la medicina: si las balas deberían o no extraerse. El protocolo médico no ofrece una respuesta clara. Una encuesta de 2016 entre cirujanos reveló que solo cerca del 15% de los encuestados trabajaban en instalaciones médicas que tenían normas sobre la extracción de balas. Los médicos en Estados Unidos a menudo dejan las balas enterradas profundamente en el cuerpo de una persona, al menos al principio, para no causar más trauma. Pero a medida que la violencia armada surge como una epidemia de salud pública, algunos investigadores se preguntan si esa práctica es la mejor. Algunos de los heridos, como James Lemons, quedan en una situación precaria. “Si hay una manera de sacarla y se saca de forma segura, sáquenla fuera de la persona”, dijo Lemons. “Hagan que esa persona se sienta más segura consigo misma. Y que no tengas que estar caminando con ese recuerdo dentro de tí”. Lemons, Holguín y Nelson están sobrellevando las cosas de manera muy diferente. El dolor se convirtió en un problema Tres días después de que los Chiefs ganaran el Super Bowl, Lemons condujo las 37 millas desde Harrisonville, Missouri, hasta el centro de Kansas City para celebrar la victoria. Lemons, quien trabaja en un depósito, llevaba a su hija de 5 años, Kensley, en sus hombros cuando sintió una bala entrar en la parte posterior de su muslo derecho. Los disparos se desataron en un área abarrotada de fans, dijeron más tarde los fiscales, después de una “confrontación verbal” entre dos grupos. Los detectives encontraron “múltiples cartuchos de bala calibre 9 mm y .40” en el lugar. Lemons dijo que entendió inmediatamente lo que estaba sucediendo. “Conozco mi ciudad. No estamos lanzando fuegos artificiales”, dijo. Mientras se tiraban al suelo, Lemons protegió el rostro de Kensley para que no golpeara sobre el cemento. Su primer pensamiento fue llevar a su familia —su esposa, Brandie; su hija de 17 años, Kallie; y su hijo de 10 años, Jaxson— a un lugar seguro. “Me dispararon. Pero no te preocupes”, recordó Lemons que le dijo a Brandie. “Tenemos que irnos”. Llevó a Kensley en sus hombros mientras la familia caminaba una milla hasta su auto. Al principio su pierna sangraba a través de sus pantalones, pero después paró, dijo. Ardía de dolor. Brandie insistió en llevarlo al hospital, pero el tráfico estaba estancado, así que encendió las luces de emergencia y condujo en la dirección opuesta. Lemons recordó que ella dijo: “’Te estoy llevando al hospital. Estoy cansada de que la gente se interponga en mi camino'”. “Nunca había visto a mi esposa así. La miré y pensé, ‘esto es algo sexy'”. Contó que le sonrió a su esposa y aplaudió, a lo que ella respondió: “¿Por qué estás sonriendo? Acaban de dispararte”. Se mantuvo en silenciosa admiración hasta que los detuvo un sheriff, que llamó a una ambulancia, recordó Lemons. Lo llevaron a la sala de emergencias de University Health, que ese día admitió a 12 pacientes del rally, incluidos ocho con heridas de bala. Las placas mostraron que la bala apenas había esquivado una arteria, dijo Lemons. Los médicos limpiaron la herida, pusieron su pierna en un aparato ortopédico y le dijeron que regresara en una semana. La bala todavía estaba en su pierna. “Me sentí un poco desconcertado, pero pensé, ‘Está bien, lo que sea, saldré de aquí'”, recordó Lemons. Cuando regresó, los médicos le quitaron el aparato ortopédico pero le explicaron que a menudo dejan balas y fragmentos en el cuerpo, a menos que se vuelvan demasiado dolorosos. “Entiendo, pero no me gusta eso”, dijo Lemons. “¿Por qué no la sacarías si pudieras?” Leslie Carto, vocera de University Health, dijo que el hospital no puede comentar sobre la atención de pacientes debido a las leyes federales de privacidad. Los cirujanos generalmente extraen las balas cuando las encuentran durante la cirugía o cuando están en lugares peligrosos, como en el canal espinal, o a punto de dañar un órgano, explicó Brendan Campbell, cirujano pediátrico del Connecticut Children’s. Campbell también preside el Comité de Prevención y Control de Lesiones del Comité de Trauma del Colegio Americano de Cirujanos, que trabaja en la prevención de lesiones por armas de fuego. LJ Punch, cirujano entrenado en trauma y fundador de la Bullet Related Injury Clinic en St. Louis, dijo que los orígenes de la atención del trauma también ayudan a explicar por qué las balas generalmente no se extraen. “La atención del trauma es medicina de guerra”, dijo Punch. “Está preparada para estar lista en cualquier momento, todos los días, para salvar una vida. No está equipada para cuidar la curación que se necesita después”. En la encuesta a los cirujanos, las razones más comunes dadas para extraer una bala fueron el dolor, una bala palpable alojada cerca de la piel o una infección. Mucho menos comunes fueron la intoxicación por plomo y las preocupaciones de salud mental como el trastorno de estrés postraumático y la ansiedad. Los cirujanos dijeron que lo que querían los pacientes también impactaba en sus decisiones. Lemons quería que le quitaran la bala. El dolor en su pierna se irradiaba desde su muslo, lo que le dificultaba moverse durante más de una hora o dos. Era imposible trabajar en el depósito. “Tengo que levantar 100 libras cada noche”, recordó Lemons que le dijo a sus médicos. “Tengo que levantar a mi hijo. No puedo trabajar así”. Ha perdido sus ingresos y su seguro de salud. Otro racha de mala suerte: el dueño de la casa que alquilaban decidió venderla poco después del desfile, y tuvieron que encontrar un nuevo lugar para vivir. La casa actual es más pequeña, pero era importante mantener a los niños en el mismo distrito escolar con sus amigos, dijo Lemons en una entrevista en el dormitorio rosa de Kensley, el lugar más tranquilo para hablar. Han pedido dinero prestado y recaudaron $6,500 en GoFundMe para ayudar con el depósito y las reparaciones del automóvil, pero el tiroteo del desfile ha dejado a la familia en un profundo pozo financiero. Sin seguro, Lemons temía no poder pagar para que le extrajeran la bala. Luego se enteró que su cirugía sería pagada por donaciones. Programó una cita en un hospital al norte de la ciudad, donde un cirujano tomó medidas en su radiografía y le explicó el procedimiento. “Necesito que estés involucrado tanto como yo voy a estar involucrado”, recordó que le dijeron, “porque —adivina qué— esta no es mi pierna”. La cirugía está programada para este mes. “Nos hicimos amigas” Sarai Holguín no es gran fanática de los Chiefs, pero aceptó ir al rally en Union Station para mostrarle a su amiga el mejor lugar para ver a los jugadores en el escenario. Era un día inusualmente cálido, y estaban paradas cerca de una entrada donde había muchos policías. Había papás con bebés en cochecitos, los niños jugaban al fútbol americano y Holguín se sentía segura. Un poco antes de las 2 pm, escuchó lo que pensó que eran fuegos artificiales. La gente comenzó a correr lejos del escenario. Se dio vuelta, tratando de encontrar a su amiga, pero se sintió mareada. No se dio cuenta que le habían disparado. Tres personas rápidamente la ayudaron a tirarse al suelo, y un extraño se quitó la camisa e hizo un torniquete en su pierna izquierda. Holguín, originaria de Puebla, México, ciudadana estadounidense desde 2018, nunca había visto tanto caos, tantos paramédicos trabajando bajo tanta presión. Fueron “héroes anónimos”, dijo. Los vio atendiendo a Lisa López-Galván, una conocida DJ de 43 años y dos hijos. López-Galván murió en el lugar, y fue la única víctima mortal. A Holguín la llevaron a University Health, a unos cinco minutos de Union Station. Allí, la operaron, pero dejaron la bala en su pierna. Holguín se despertó en medio de más caos. Había perdido su bolso y su teléfono celular, así que no pudo llamar a César, su esposo. La internaron en el hospital bajo un alias, una práctica común en los centros médicos para comenzar a atender al paciente de inmediato. Su esposo e hija no la encontraron hasta cerca de las 10 pm, unas ocho horas después de que le dispararan. “Ha sido un gran trauma para mí”, dijo Holguín a través de un intérprete. “Estaba herida y en el hospital sin haber hecho nada malo. [El rally] era un momento para jugar, relajarse, estar juntos”. Holguín estuvo una semana internada, e inmediatamente tuvo dos cirugías ambulatorias más para eliminar el tejido muerto alrededor de la herida. Usó un dispositivo especial durante varias semanas y tuvo citas médicas cada dos días. Campbell, el cirujano de trauma, dijo que esos dispositivos, llamados “de cierre asistido por vacío” son comunes cuando las balas dañan tejidos que no se pueden reconstruir fácilmente en la cirugía. (Ayudan a acelerar el proceso de cierre de la herida) “No son solo las lesiones físicas”, dijo Campbell. “Muchas veces son las lesiones emocionales, psicológicas, que muchos de estos pacientes también experimentan”. La bala sigue cerca de la rodilla de Holguín. “La tendré por el resto de mi vida”, dijo, agregando que ella y la bala se han convertido en “compas”, amigas cercanas. “Nos hicimos amigas para que ella no me haga ningún otro daño”, dijo Holguín sonriendo. Punch, de la Bullet Related Injury Clinic en St. Louis, dijo que algunas personas como Holguín pueden tener la fortaleza mental para vivir con una bala en el cuerpo. “Si puedes crear una historia sobre lo que significa que esa bala esté en tu cuerpo, eso te da poder; te empodera”, dijo Punch. La vida de Holguín cambió en un instante: está usando un andador para moverse. Su pie, dijo, actúa “como si hubiera tenido un derrame cerebral”, se queda colgando y es difícil mover los dedos de los pies. La consecuencia más frustrante es que no puede viajar para ver a su padre de 102 años, que está en México. Lo ve en video a través de su teléfono, pero eso no ofrece mucho consuelo, dijo, y pensar en él la hace llorar. En el hospital le dijeron que sus facturas médicas serían cubiertas, pero luego muchas de ellas llegaron por correo. Intentó obtener ayuda para las víctimas del estado de Missouri, pero le costo entender todos los formularios que tenía porque estaban en inglés. Solo alquilar el dispositivo de cierre asistido por vacío costaba $800 al mes. Finalmente escuchó que el Consulado de México en Kansas City podía ayudar, y el cónsul la remitió a la Oficina del Fiscal del condado de Jackson, donde se registró como víctima oficial. Ahora todas sus facturas están siendo pagadas, dijo. Holguín no buscará tratamiento de salud mental, ya que cree que uno debe aprender a vivir con una situación determinada o se convertirá en una carga. “He procesado este nuevo capítulo en mi vida”, dijo Holguín. “Nunca me he rendido y seguiré adelante con la ayuda de Dios”. “Vi sangre en mis manos” Mireya Nelson llegó tarde al desfile. Su madre, Erika, le dijo que se fuera temprano, por el tráfico y el millón de personas que se esperaba en el centro de Kansas City, pero ella y sus amigos adolescentes ignoraron el consejo. Los Nelson viven en Belton, Missouri, aproximadamente a media hora al sur de la ciudad. Mireya quería sostener el trofeo del Super Bowl. Cuando ella y sus tres amigos llegaron, el desfile que había pasado por el centro ya había terminado y había comenzado el rally en Union Station. Estaban atrapados entre la multitud y se aburrieron rápido, dijo Mireya. Mireya y una de sus amigas intentaron llamar al conductor de su grupo para irse, pero no tenían señal en el celular, por la gran multitud. En medio del caos de personas y ruido, Mireya de repente se desplomó. “Vi sangre en mis manos. Así que supe que me habían disparado. Sí, y simplemente me arrastré hacia un árbol”, dijo Mireya. “En realidad, al principio no sabía dónde me habían disparado. Solo ví sangre en mis manos”. La bala rozó la barbilla de Mireya, atravesó su mandíbula, le rompió el hombro y salió por su brazo. Quedaron fragmentos de bala en su hombro. Los médicos decidieron dejarlos porque la joven ya había sufrido mucho daño. Por ahora, la madre de Mireya apoya esa decisión, señalando que eran solo “fragmentos”. “Creo que si no la van a dañar el resto de su vida”, dijo Erika, “no quiero que siga volviendo al hospital y teniendo cirugías. Eso es más trauma para ella y más tiempo de recuperación, más terapia física y cosas así”. Punch dijo que los fragmentos de bala, especialmente los que son solo superficiales, a menudo se abren paso como astillas, aunque a los pacientes no siempre se les dice eso. Además, agregó, las lesiones causadas por las balas se extienden más allá de aquellos con tejido dañado a las personas a su alrededor, como Erika. Pidió un enfoque holístico para recuperarse de todo el trauma. “Cuando las personas permanecen en su trauma, ese trauma puede cambiarlas para toda la vida”, dijo Punch. Mireya será sometida a pruebas de niveles de plomo en su sangre durante al menos los próximos dos años. Ahora sus niveles están bien, dijeron los médicos a la familia, pero si empeoran, necesitará cirugía para remover los fragmentos, dijo su madre. Campbell, el cirujano pediátrico, dijo que el plomo es particularmente preocupante para los niños pequeños, cuyos cerebros en desarrollo los hacen especialmente vulnerables a sus efectos perjudiciales. Incluso una pequeña cantidad de plomo —3.5 microgramos por decilitro— es suficiente para informar a las autoridades de salud estatales, según los Centros para el Control y Prevención de Enfermedades (CDC). Mireya habla sobre adolescentes lindos, pero todavía usa pijamas de Cookie Monster. Parece confundida por los tiroteos, por toda la atención en casa, en la escuela, de los periodistas. Cuando le preguntaron cómo se siente sobre los fragmentos en su brazo, dijo: “Realmente no me importan”. Después de su estadía en el hospital, Mireya tomó antibióticos durante 10 días porque los médicos temían que hubieran bacterias en la herida. Ha tenido terapia física, pero es doloroso hacer los ejercicios. Tiene una cicatriz en la barbilla. “Una muesca”, dijo, que es “irregular”. “Dijeron que tuvo suerte porque si no hubiera girado la cabeza de cierta manera, podría haber muerto”, dijo Erika. Mireya enfrenta una evaluación psiquiátrica y sesiones de terapia, aunque no le gusta hablar de sus sentimientos. Hasta ahora, el seguro de Erika está pagando las facturas médicas, aunque espera obtener algo de ayuda del fondo #KCStrong de United Way, que recaudó casi $1.9 millones, o de una organización de fe llamada Unite KC. Erika no quiere limosnas. Tiene un trabajo en atención médica y acaba de tener un ascenso. La bala ha cambiado la vida de la familia de muchas maneras. Ahora forma parte de sus charlas. Hablan sobre cómo desearían saber qué tipo de munición era, o cómo se veía. “Como si quisiera quedarme con la bala que atravesó mi brazo”, dijo Mireya. “Quiero saber qué tipo de bala era”. Eso provocó un suspiro de su mamá, quien dijo que su hija había visto demasiados episodios de “Forensic Files”. Erika se culpa por la herida, porque no pudo proteger a su hija en el desfile. “Me duele mucho porque me siento mal, porque ella me suplicó que dejara el trabajo y no fui allí porque cuando tienes un puesto nuevo, no puedes simplemente irte del trabajo”, dijo Erika. “Porque yo hubiera recibido la bala. Porque haría cualquier cosa. Es lo que hace una mamá”. KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF. USE OUR CONTENTThis story can be republished for free (details). from https://ift.tt/fzSYZBr Check out http://plush-draw15.tumblr.com/ Jacqueline Saa has a genetic condition that leaves her unable to stand and walk on her own or hold a job. Every weekday for four years, Saa, 43, has relied on a home health aide to help her cook, bathe and dress, go to the doctor, pick up medications, and accomplish other daily tasks. Share Your Story With UsHave you or someone you know with disabilities unexpectedly lost Medicaid benefits since April 2023? Tell us about it here. contact usShe received coverage through Florida’s Medicaid program until it abruptly stopped at the end of March, she said. “Every day the anxiety builds,” said Saa, who lost her home health aide for 11 days, starting April 1, despite being eligible. The state has since restored Saa’s home health aide service, but during the gap she leaned on her mother and her 23- and 15-year-old daughters, while struggling to regain her Medicaid benefits. “It’s just so much to worry about,” she said. “This is a health care system that’s supposed to help.” Medicaid’s home and community-based services are designed to help people like Saa, who have disabilities and need help with everyday activities, stay out of a nursing facility. But people are losing benefits with little or no notice, getting bad advice when they call for information, and facing major disruptions in care while they wait for the issue to get sorted out, according to attorneys and advocates who are hearing from patients. In Colorado, Texas, and Washington, D.C., the National Health Law Program, a nonprofit that advocates for low-income and underserved people, has filed civil rights complaints with two federal agencies alleging discrimination against people with disabilities. The group has not filed a lawsuit in Florida, though its attorneys say they’ve heard of many of the same problems there. Attorneys nationwide say the special needs of disabled people were not prioritized as states began to review eligibility for Medicaid enrollees after a pandemic-era mandate for coverage expired in March 2023. “Instead of monitoring and ensuring that people with disabilities could make their way through the process, they sort of treated them like everyone else with Medicaid,” said Elizabeth Edwards, a senior attorney for the National Health Law Program. Federal law puts an “obligation on states to make sure people with disabilities don’t get missed.” At least 21 million people nationwide have been disenrolled from Medicaid since states began eligibility redeterminations in spring 2023, according to a KFF analysis. The unwinding, as it’s known, is an immense undertaking, Edwards said, and some states did not take extra steps to set up a special telephone line for those with disabilities, for example, so people could renew their coverage or contact a case manager. As states prepared for the unwinding, the Centers for Medicare & Medicaid Services, the federal agency that regulates Medicaid, advised states that they must give people with disabilities the help they need to benefit from the program, including specialized communications for people who are deaf or blind. The Florida Department of Children and Families, which verifies eligibility for the state’s Medicaid program, has a specialized team that processes applications for home health services, said Mallory McManus, the department’s communications director. People with disabilities disenrolled from Medicaid services were “properly noticed and either did not respond timely or no longer met financial eligibility requirements,” McManus said, noting that people “would have been contacted by us up to 13 times via phone, mail, email, and text before processing their disenrollment.” Allison Pellegrin of Ormond Beach, Florida, who lives with her sister Rhea Whitaker, who is blind and cognitively disabled, said that never happened for her family. “They just cut off the benefits without a call, without a letter or anything stating that the benefits would be terminating,” Pellegrin said. Her sister’s home health aide, whom she had used every day for nearly eight years, stopped service for 12 days. “If I’m getting everything else in the mail,” she said, “it seems weird that after 13 times I wouldn’t have received one of them.” Pellegrin, 58, a sales manager who gets health insurance through her employer, took time off from work to care for Whitaker, 56, who was disabled by a severe brain injury in 2006. Medicaid reviews have been complicated, in part, by the fact that eligibility works differently for home health services than for general coverage, based on federal regulations that give states more flexibility to determine financial eligibility. Income limits for home health services are higher, for instance, and assets are counted differently. In Texas, a parent in a household of three would be limited to earning no more than $344 a month to qualify for Medicaid. And most adults with a disability can qualify without a dependent child and be eligible for Medicaid home health services with an income of up to $2,800 a month. The state was not taking that into consideration, said Terry Anstee, a supervising attorney for community integration at Disability Rights Texas, a nonprofit advocacy group. Even a brief lapse in Medicaid home health services can fracture relationships that took years to build. “It may be very difficult for that person who lost that attendant to find another attendant,” Anstee said, because of workforce shortages for attendants and nurses and high demand. Nearly all states have a waiting list for home health services. About 700,000 people were on waiting lists in 2023, most of them with intellectual and developmental disabilities, according to KFF data. Daniel Tsai, a deputy administrator at CMS, said the agency is committed to ensuring that people with disabilities receiving home health services “can renew their Medicaid coverage with as little red tape as possible.” CMS finalized a rule this year for states to monitor Medicaid home health services. For example, CMS will now track how long it takes for people who need home health care to receive the services and will require states to track how long people are on waitlists. Staff turnover and vacancies at local Medicaid agencies have contributed to backlogs, according to complaints filed with two federal agencies focused on civil rights. The District of Columbia’s Medicaid agency requires that case managers help people with disabilities complete renewals. However, a complaint says, case managers are the only ones who can help enrollees complete eligibility reviews and, sometimes, they don’t do their jobs. Advocates for Medicaid enrollees have also complained to the Federal Trade Commission about faulty eligibility systems developed by Deloitte, a global consulting firm that contracts with about two dozen states to design, implement, or operate automated benefits systems. KFF Health News found that multiple audits of Colorado’s eligibility system, managed by Deloitte, uncovered errors in notices sent to enrollees. A 2023 review by the Colorado Office of the State Auditor found that 90% of sampled notices contained problems, some of which violate the state’s Medicaid rules. The audit blamed “flaws in system design” for populating notices with incorrect dates. Deloitte declined to comment on specific state issues. In March, Colorado officials paused disenrollment for people on Medicaid who received home health services, which includes people with disabilities, after a “system update” led to wrongful terminations in February. Another common problem is people being told to reapply, which immediately cuts off their benefits, instead of appealing the cancellation, which would ensure their coverage while the claim is investigated, said attorney Miriam Harmatz, founder of the Florida Health Justice Project. “What they’re being advised to do is not appropriate. The best way to protect their legal rights,” Harmatz said, “is to file an appeal.” But some disabled people are worried about having to repay the cost of their care. Saa, who lives in Davie, Florida, received a letter shortly before her benefits were cut that said she “may be responsible to repay any benefits” if she lost her appeal. The state should presume such people are still eligible and preserve their coverage, Harmatz said, because income and assets for most beneficiaries are not going to increase significantly and their conditions are not likely to improve. The Florida Department of Children and Families would not say how many people with disabilities had lost Medicaid home health services. But in Miami-Dade, Florida’s most populous county, the Alliance for Aging, a nonprofit that helps older and disabled people apply for Medicaid, saw requests for help jump from 58 in March to 146 in April, said Lisa Mele, the organization’s director of its Aging and Disability Resources Center. “So many people are calling us,” she said. States are not tracking the numbers, so “the impact is not clear,” Edwards said. “It’s a really complicated struggle.” Saa filed an appeal March 29 after learning from her social worker that her benefits would expire at the end of the month. She went to the agency but couldn’t stand in a line that was 100 people deep. Calls to the state’s Medicaid eligibility review agency were fruitless, she said. “When they finally connected me to a customer service representative, she was literally just reading the same explanation letter that I’ve read,” Saa said. “I did everything in my power.” Saa canceled her home health aide. She lives on limited Social Security disability income and said she could not afford to pay for the care. On April 10, she received a letter from the state saying her Medicaid had been reinstated, but she later learned that her plan did not cover home health care. The following day, Saa said, advocates put her in touch with a point person at Florida’s Medicaid agency who restored her benefits. A home health aide showed up April 12. Saa said she’s thankful but feels anxious about the future. “The toughest part of that period is knowing that that can happen at any time,” she said, “and not because of anything I did wrong.” Have you or someone you know with disabilities unexpectedly lost Medicaid benefits since April 2023? Tell KFF Health News about it here. KFF Health News correspondents Samantha Liss and Rachana Pradhan contributed to this report. KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF. USE OUR CONTENTThis story can be republished for free (details). from https://ift.tt/NwKQjpo Check out http://plush-draw15.tumblr.com/ In early 2020, with reports of covid-19 outbreaks making dire headlines, Trever Schapers worried about her father’s safety in a nursing home in Queens. She had delighted in watching her dad, John Schapers, blow out the candles on his 90th birthday cake that February at the West Lawrence Care Center in the New York City borough. Then the home went into lockdown. Soon her father was dead. The former union painter spiked a fever and was transferred to a hospital, where he tested positive for covid, his daughter said, and after two weeks on a ventilator, he died in May 2020. But when Trever Schapers sued the nursing home for negligence and wrongful death in 2022, a judge dismissed the case, citing a New York state law hastily passed early in the pandemic. It granted immunity to medical providers for “harm or damages” from an “act or omission” in treating or arranging care for covid. She is appealing the decision. “I feel that families are being ignored by judges and courts not recognizing that something needs to be done and changed,” said Schapers, 48, who works in the medical field. “There needs to be accountability.” The nursing home did not return calls seeking comment. In a court filing, the home argued that Schapers offered no evidence that the home was “grossly negligent” in treating her father. More than four years after covid first raged through many U.S. nursing homes, hundreds of lawsuits blaming patient deaths on negligent care have been tossed out or languished in the courts amid contentious legal battles. Even some nursing homes that were shut down by health officials for violating safety standards have claimed immunity against such suits, court records show. And some families that allege homes kept them in the dark about the health of their loved ones, even denying there were cases of covid in the building, have had their cases dismissed. Schapers alleged in a complaint to state health officials that the nursing home failed to advise her that it had admitted covid-positive patients from a nearby hospital in March 2020. In early April, she received a call telling her the facility had some covid-positive residents. “The call I received was very alarming, and they refused to answer any of my questions,” she said. About two weeks later, a social worker called to say that her father had a fever, but the staff did not test him to confirm covid, according to Schapers’ complaint. The industry says federal health officials and lawmakers in most states granted medical providers broad protection from lawsuits for good faith actions during the health emergency. Rachel Reeves, a senior vice president with the American Health Care Association, an industry trade group, called covid “an unprecedented public health crisis brought on by a vicious virus that uniquely targeted our population.” In scores of lawsuits, however, family members allege that nursing homes failed to secure enough protective gear or tests for staffers or residents, haphazardly mixed covid-positive patients with other residents, failed to follow strict infection control protocols, and brazenly misled frightened families about the severity of covid outbreaks among patients and staff. “They trusted these facilities to take care of loved ones, and that trust was betrayed,” said Florida attorney Lindsey Gale, who has represented several families suing over covid-related deaths. “The grieving process people had to go through was horrible,” Gale said. A Deadly Toll KFF Health News found that more than 1,100 covid-related lawsuits, most alleging wrongful death or other negligent care, were filed against nursing homes from March 2020 through March of this year. While there’s no full accounting of the outcomes, court filings show that judges have dismissed some suits outright, citing state or federal immunity provisions, while other cases have been settled under confidential terms. And many cases have stalled due to lengthy and costly arguments and appeals to hash out limits, if any, of immunity protection. In their defense, nursing homes initially cited the federal Public Readiness and Emergency Preparedness Act, which Congress passed in December 2005. The law grants liability protection from claims for deaths or injuries tied to vaccines or “medical countermeasures” taken to prevent or treat a disease during national emergencies. The PREP Act steps in once the secretary of Health and Human Services declares a “public health emergency,” which happened with covid on March 17, 2020. The emergency order expired on May 11, 2023. The law carved out an exception for “willful misconduct,” but proving it occurred can be daunting for families — even when nursing homes have long histories of violating safety standards, including infection controls. Governors of at least 38 states issued covid executive orders, or their legislatures passed laws, granting medical providers at least some degree of immunity, according to one consumer group’s tally. Just how much legal protection was intended is at the crux of the skirmishes. Nursing homes answered many negligence lawsuits by getting them removed from state courts into the federal judicial system and asking for dismissal under the PREP Act. For the most part, that didn’t work because federal judges declined to hear the cases. Some judges ruled that the PREP Act was not intended to shield medical providers from negligence caused by inaction, such as failing to protect patients from the coronavirus. These rulings and appeals sent cases back to state courts, often after long delays that left families in legal limbo. “These delays have been devastating,” said Jeffrey Guzman, a New York City attorney who represents Schapers and other families. He said the industry has fought “tooth and nail” trying to “fight these people getting their day in court.” Empire State Epicenter New York, where covid hit early and hard, is ground zero for court battles over nursing home immunity. Relatives of residents have filed more than 750 negligence or wrongful death cases in New York counties since the start of the pandemic, according to court data KFF Health News compiled using the judicial reporting service Courthouse News Service. No other area comes close. Chicago’s Cook County, a jurisdiction where private lawyers for years have aggressively sued nursing homes alleging poor infection control, recorded 121 covid-related cases. Plaintiffs in hundreds of New York cases argue that nursing homes knew early in 2020 that covid would pose a deadly threat but largely failed to gird for its impact. Many suits cite inspection reports detailing chronic violations of infection control standards in the years preceding the pandemic, court records show. Responses to this strategy vary. “Different judges take different views,” said Joseph Ciaccio, a New York lawyer who has filed hundreds of such cases. “It’s been very mixed.” Lawyers for nursing homes counter that most lawsuits rely on vague allegations of wrongdoing and “boilerplate” claims that, even if true, don’t demonstrate the kind of gross negligence that would override an immunity claim. New York lawmakers added another wrinkle by repealing the immunity statute in April 2021 after Attorney General Letitia James noted the law could give nursing homes a free pass to make “financially motivated decisions” to cut costs and put patients at risk. So far, appeals courts have ruled lawmakers didn’t specify that the repeal should be made retroactive, thus stymying many negligence cases. “So these cases are all wasting the courts’ time and preventing cases that aren’t barred by immunity statutes from being resolved sooner and clogging up the court system that was already backlogged from COVID,” said attorney Anna Borea, who represents nursing homes. Troubled Homes Deflect Suits Some nursing homes that paid hefty fines or were ordered by health officials to shut down at least temporarily because of their inadequate response to covid have claimed immunity against suits, court records show. Among them is Andover Subacute and Rehabilitation nursing home in New Jersey, which made national headlines when authorities found 17 bodies stacked in a makeshift morgue in April 2020. Federal health officials fined the facility $220,235 after issuing a critical 36-page report on covid violations and other deficiencies, and the state halted admissions in February 2022. Yet the home has won court pauses in at least three negligence lawsuits as it appeals lower court rulings denying immunity under the federal PREP Act, court records show. The operators of the home could not be reached for comment. In court filings, they denied any wrongdoing. In Oregon, health officials suspended operations at Healthcare at Foster Creek, calling the Portland nursing home “a serious danger to the public health and safety.” The May 2020 order cited the home’s “consistent inability to adhere to basic infection control standards.” Bonnie Richardson, a Portland lawyer, sued the facility on behalf of the family of Judith Jones, 75, who had dementia and died in April 2020. Jones’ was among dozens of covid-related deaths at that home. “It was a very hard-fought battle,” said Richardson, who has since settled the case under confidential terms. Although the nursing home claimed immunity, her clients “wanted to know what happened and to understand why.” The owners of the nursing home provided no comment. No Covid Here Many families believe nursing homes misled them about covid’s relentless spread. They often had to settle for window visits to connect with their loved ones. Relatives of five patients who died in 2020 at the Sapphire Center for Rehabilitation and Nursing in the Flushing neighborhood in Queens filed lawsuits accusing the home’s operators of keeping them in the dark. When they phoned to check on elderly parents, they either couldn’t get through or were told there was “no COVID-19 in the building,” according to one court affidavit. One woman grew alarmed after visiting in February 2020 and seeing nurses wearing masks “below their noses or under their chin,” according to a court affidavit. The woman was shocked when the home relayed that her mother had died in April 2020 from unknown causes, perhaps “from depression and not eating,” according to her affidavit. A short time later, news media reported that dozens of Sapphire Center residents had died from the virus — her 85-year-old mother among them, she argued in a lawsuit. The nursing home denied liability and won dismissal of all five lawsuits after citing the New York immunity law. Several families are appealing. The nursing home’s administrator declined to comment. Broadening Immunity Nursing home operators also have cited immunity to foil negligence lawsuits based on falls or other allegations of substandard care, such as bedsores, with little obvious connection to the pandemic, court records show. The family of Marilyn Kearney, an 89-year-old with a “history of dementia and falls,” sued the Watrous Nursing Center in Madison, Connecticut, for negligence. Days after she was admitted in June 2020, she fell in her room, fracturing her right hip and requiring surgery, according to court filings. She died at a local hospital on Sept. 16, 2020, from sepsis attributed to dehydration and malnutrition, according to the suit. Her family argued that the 45-bed nursing home failed to assess her risk of falling and develop a plan to prevent that. But Watrous fired back by citing an April 2020 declaration by Connecticut Gov. Ned Lamont, a Democrat, granting health care professionals or facilities immunity from “any injury or death alleged to have been sustained because of the individual’s or health care facility’s acts or omissions undertaken in good faith while providing health care services in support of the state’s COVID-19 response.” Watrous denied liability and, in a motion to dismiss the case, cited Lamont’s executive order and affidavits that argued the home did its best in the throes of a “public health crisis, the likes of which had never been seen before.” The operators of the nursing home, which closed in July 2021 because of covid, did not respond to a request for comment. The case is pending. Attorney Wendi Kowarik, who represents Kearney’s family, said courts are wrestling with how much protection to afford nursing homes. “We’re just beginning to get some guidelines,” she said. One pending Connecticut case alleges that an 88-year-old man died in October 2020 after experiencing multiple falls, sustaining bedsores, and dropping more than 30 pounds in the two months he lived at a nursing home, court records state. The nursing home denied liability and contends it is entitled to immunity. So do the owners of a Connecticut facility that cared for a 75-year-old woman with obesity who required a lift to get out of bed. She fell on April 26, 2020, smashing several teeth and fracturing bones. She later died from her injuries, according to the suit, which is pending. “I think it is really repugnant that providers are arguing that they should not be held accountable for falls, pressure sores, and other outcomes of gross neglect,” said Richard Mollot, executive director of the Long Term Care Community Coalition, which advocates for patients. “The government did not declare open season on nursing home residents when it implemented COVID policies,” he said. Protecting the Vulnerable Since early 2020, U.S. nursing homes have reported more than 172,000 residents’ deaths, according to Centers for Medicare & Medicaid Services data. That’s about 1 in 7 of all recorded U.S. covid deaths. As it battles covid lawsuits, the nursing home industry says it is “struggling to recover due to ongoing labor shortages, inflation, and chronic government underfunding,” according to Reeves, the trade association executive. She said the American Health Care Association has advocated for “reasonable, limited liability protections that defend staff and providers for their good faith efforts” during the pandemic. “Caregivers were doing everything they could,” Reeves said, “often with limited resources and ever-changing information, in an effort to protect and care for residents.” But patients’ advocates remain wary of policies that might bar the courthouse door against grieving families. “I don’t think we want to continue to enact laws that reward nursing homes for bad care,” said Sam Brooks, of the Coalition for the Protection of Residents of Long-Term Care Facilities, a patient advocacy group. “We need to keep that in mind if, God forbid, we have another pandemic,” Brooks said. Bill Hammond, a senior fellow at the Empire Center for Public Policy, a nonpartisan New York think tank, said policymakers should focus on better strategies to protect patients from infectious outbreaks, rather than leaving it up to the courts to sort out liability years later. “There is no serious effort to have that conversation,” Hammond said. “I think that’s crazy.” KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF. USE OUR CONTENTThis story can be republished for free (details). from https://ift.tt/9OpE7TI Check out http://plush-draw15.tumblr.com/ Ash Panakam is about to graduate from Harvard Medical School. She’s from Georgia and always assumed she would return to the South for her residency. But the Supreme Court’s 2022 decision overturning the nationwide right to abortion changed everything. “Ultimately I shifted my selection pretty drastically,” she said. “I was struggling to find a residency program in the South where I could still get the training I consider fundamental to the skill set needed to be an OB/GYN.” Instead of going home to Georgia, she’s headed to Pittsburgh to start her medical residency this summer. Panakam has plenty of company. For the second year running, fewer graduating U.S. medical students applied for residency training in states with abortion bans or restrictions than in the previous year, according to data from the Association of American Medical Colleges. (Overall applications were down slightly, because students are being urged to apply to fewer programs, but the decrease was markedly larger in states where abortion is illegal or significantly restricted.) It’s not just obstetrician-gynecologists; the decline crosses specialties, including those that don’t serve primarily pregnant patients. That could threaten the future of the overall medical workforce in states with bans, because doctors tend to locate permanently where they do residencies. “The geographic misalignment between where the needs are and where people are choosing to go is really problematic,” said Debra Stulberg, who chairs the Department of Family Medicine at the University of Chicago. “We don’t need people further concentrating in urban areas where there’s already good access.” The concerns of graduating medical students extend beyond their ability to practice medicine; they’re also worried about their own health, or that of their partners. “People don’t feel safe potentially having their own pregnancies living in those states,” Stulberg said. Some students say it’s a hard decision. “I feel some guilt and sadness leaving a situation where I feel like I could be of some help,” said new medical school graduate Hannah Light-Olson, who will leave Nashville for OB/GYN training at the University of California at San Francisco this summer. “I feel deeply indebted to the program that trained me, and to the patients of Tennessee.” It’s not that residency programs are going unfilled. There are still more graduating students from medical schools both in the United States and abroad than there are residency slots. But Beverly Gray, an associate professor of obstetrics and gynecology at Duke University School of Medicine, worries that abortion restrictions impact “whether we have the best and brightest coming to North Carolina.” Residents in states where abortion is banned will still get training in abortion techniques, which are also used for miscarriages and other conditions. But to train on the procedures they’ll have to leave the state. And some students worry the training won’t be sufficient. “I would rather have not become an OB/GYN than not be trained as a good one,” said Laura Potter, who is moving from medical school at the University of California at Davis to residency at Mass General Brigham in Boston. But there are students choosing to train in states with abortion restrictions to make sure patients there get the care they need. And others hope to relocate to those parts of the country after their training — including Panakam. “Long term, I still hope to practice in the South,” she said. “But at this point in my professional journey, it’s a little too early for me to restrict my training in any meaningful way.” This article is not available for syndication due to republishing restrictions. If you have questions about the availability of this or other content for republication, please contact [email protected]. KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF. USE OUR CONTENTThis story can be republished for free (details). from https://ift.tt/IDHxdsy Check out http://plush-draw15.tumblr.com/ |