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  • Better nursing home care will require more workers

    Better nursing home care will require more workers


    Jordan Rau

    Kaiser Health News

    The Biden administration has identified core impediments to better nursing home care in its proposed overhaul of the industry, but turning aspirations into reality will require a complex task: mandating adequate staffing levels for all homes without bankrupting those that can’t afford far higher labor costs.

    President Joe Biden’s proposals for the nation’s 15,000 skilled nursing facilities — released in advance of his State of the Union address last week — would lead to the most substantial increase in federal nursing home regulation since Congress reformed the industry in 1987. The centerpiece of the effort is establishing minimum staffing levels for facilities. To date, the Centers for Medicare & Medicaid Services requires “adequate” staffing but specifically mandates only a skeleton crew of round-the-clock nursing coverage and one registered nurse who works at least eight hours each day.

    CMS has rebuffed requests to mandate higher staffing levels in the past, saying each facility should “make thoughtful, informed staffing plans.” But multiple examinations — including a thorough CMS study in 2001 — have concluded staffing levels are frequently inadequate, particularly on nights and weekends. Studies have found that homes with higher staffing levels have fewer patient injuries. The 2001 study set a standard that many nursing homes currently don’t meet, saying optimal care required roughly one staffer for every seven short-stay patients — like those recovering from a hospital stay — and one staffer for every six long-stay residents.

    Biden is ordering CMS to conduct a similar study and incorporate it into a formal proposal within a year.

    “We would not be surprised to see that number [of staffers] be higher in a new study because we know the care needs for residents and acuity levels have actually increased over the last 20 years,” said Lori Smetanka, executive director of the National Consumer Voice for Quality Long-Term Care, which advocates for older people who get services in nursing homes, assisted living facilities, and at home.

    Requiring adequate staffing levels won’t solve the problem many homes face in finding and retaining nurses and aides, a systemic issue made worse by the pandemic. And it’s likely that many facilities — particularly those with the largest share of Medicaid residents — would struggle to afford substantial increases in their workforces.

    “Regulations and enforcement, even with the best intentions, just can’t change that math,” Katie Smith Sloan, president and CEO of LeadingAge, an association of nonprofit aging service providers, said in a statement. Mark Parkinson, president and CEO of the American Health Care Association, the largest nursing-home lobbying group, said in a statement that “we cannot meet additional staffing requirements when we can’t find people to fill the open positions nor when we don’t have the resources to compete against other employers.”

    Much of Biden’s plan promises to dig deeper into the finances of homes and make that information publicly available. “It’s just been so complicated,” said David Grabowski, a professor of health care policy at Harvard Medical School. “They’re going to finally determine who owns this building, what the arrangements are there, how the dollars really flow. That’s essential. We should have done this years ago.”

    The proposal would also task the government with examining the role of private equity and real estate investment trusts in buying and selling facilities. Some studies have concluded that ownership by those types of investors leads to smaller budgets and worse care. And Biden is calling for tracking the quality and finances of nursing home chains, in addition to facility by facility as is the current practice.

    “We’ve been urging that for 15 or 20 years,” said Charlene Harrington, a professor emeritus at the University of California-San Francisco School of Nursing. Harrington, who has long pushed for staffing increases and better financial disclosure, said, “Everything’s going to hang on the implementation, but I’m so happy they’re going to focus on the transparency issues.”

    The administration said it wanted Congress to give it the authority to ban from the Medicare and Medicaid programs facilities owned by people or corporations with terrible track records of running facilities. And Biden is asking Congress to give CMS almost $500 million more for inspections, a 25 percent increase, and hike the maximum fine for an individual violation from $21,000 to $1 million. That particularly targets habitually poor-performing facilities, which are subjected to more intense oversight through the Special Focus Facility program. A 2017 KHN investigation found that more than half of homes in the program harmed patients or put them in serious jeopardy after CMS declared them improved.

    Most of the changes will not require congressional approval. And the administration said it would “explore” increasing the use of fines deployed each day a home is in violation, an approach that the Trump administration had limited.

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    by Kaiser Health News, North Carolina Health News
    March 7, 2022

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  • Are Health Care Apps in Your Future? | Health News

    Are Health Care Apps in Your Future? | Health News

    (HealthDay)

    FRIDAY, March 4, 2022 (HealthDay Information) — Are you running a serious wellness issue, be it weight problems or diabetes or coronary heart disease or bronchial asthma?

    You will find probably an app for that.

    Health apps are getting much more and far more complex, presenting smartphone consumers enable in dealing with long-term ailments, mentioned Dr. David Bates, chief of inner medicine at Brigham and Women’s Hospital in Boston, and an internationally renowned pro in patient basic safety and health care know-how.

    “It may differ fairly a ton by application, but some of the apps have been shown to final result in benefits,” Bates stated in the course of a HealthDay Now interview. “Some of the excess weight loss apps actually do assist individuals reduce bodyweight. Similarly, some of the diabetic issues apps can enable you manage your [blood] sugar far more effectively.”

    Sad to say, it can be challenging to determine out which application is most effective, supplied the baffling assortment accessible to the regular person.

    “There are truly numerous hundred thousand on the marketplace, which is just bewildering as a patient,” Bates stated. That indicates many folks with persistent health problems are not taking benefit of these new tools, according to a current HealthDay/Harris Poll survey.

    About 61{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} of people residing with a chronic issue explained they use some sort of wellness application, but only 14{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} claimed they are making use of an application exclusively geared in direction of handling or tracking their precise wellbeing problem, the study identified.

    A single-third of people with a persistent sickness stated they really don’t bother with an app for the reason that they will not come to feel the want to consistently monitor their well being, the poll outcomes showed. And a quarter of individuals with serious problems stated they are worried about the privacy and safety of professional medical details they share with the application. About 17{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} stated they just are unable to pay for well being apps, and 14{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} claimed they locate them also sophisticated.

    Bates’ very own investigate into wellbeing app use uncovered similar developments.

    “There is moderately prevalent use among the a wide variety of age groups, but they’re notably well known among the persons who are younger and tech savvy,” Bates instructed HealthDay Now. Here’s the whole job interview underneath:

    Bates pointed to one the latest research amid people today with either language barriers or very little schooling. It located that “most people required to be ready to use the apps, but quite a few people today struggled with accomplishing even very simple jobs, like as a diabetic coming into your blood sugar [numbers],” he mentioned.

    “The privateness issues are a real problem, and the applications are not executing as good a position as they might in conditions of preserving our privateness,” Bates mentioned. “Which is a little something we have to have to continue to target on. Substantially of this variety of knowledge is not that private, but some of it is.”

    Folks in the marketplace for a wellness application ought to know that on-line ratings in the app retailers “are not always a seriously very good predictor of how fantastic the app is likely to be for you,” Bates said.

    Bates and his colleagues have suggested that an independent 3rd bash start out score wellness apps, so people today will be ready to uncover top quality items that go well with their wants.

    “We have to have to do a little something to restrict the quantity of decision, for the reason that when you have that quite a few choices folks frequently just won’t be able to choose. It really is also hard,” Bates claimed.

    Limiting the quantity to some degree would be really useful, he proposed. “For illustration, in England they have about 60 applications that are endorsed nationally and promoted. There is certainly a good deal of competitors to get into that team, but that helps make it a lot less complicated to choose which types may well be pertinent for you,” he discussed.

    With the advent of telemedicine, apps are getting to be even additional crucial, Bates included.

    People usually have to get their possess essential indications and observe their personal wellbeing details, so they can report their conclusions to their health practitioner throughout a telemedicine visit.

    “Ordinarily, you will find a lot more responsibility positioned on the individual to deal with things them selves, and an app can help you a whole lot,” Bates claimed. “It can aid you observe some of the numerous matters you should be viewing,” like your daily blood sugar levels or your weekly work out periods.

    Sooner or later, Bates believes that wellbeing gurus will start off “essentially prescribing applications. You’ll go to your health care provider and they’ll suggest that you use an app. Points will be established up so that the facts can appear back again to them, and they can see how you’re accomplishing. If you are doing effectively, they will congratulate you, and if you’re struggling a little bit they can support you out.”

    But for now, he warns that there are drawbacks to some applications out there. In individual, Bates is concerned that applications are not terrific at notifying people today of life-threatening conditions.

    “For several applications you can say your blood sugar is 10, which is existence-threateningly lower, and the application will not essentially tell you that you need to have to do anything urgently,” he mentioned. “I might like to see the apps do a better task all-around warning you if there is a major situation.”

    Supply: David Bates, MD, chief, inside medication, Brigham and Women’s Clinic, Boston

    Copyright © 2022 HealthDay. All rights reserved.

  • Should NC worry about omicron BA.2?

    Should NC worry about omicron BA.2?


    By Laura Lee, for Carolina Public Press

    In many North Carolina towns and cities, mask mandates are ending, and vaccination requirements are loosening, but questions remain about the next COVID-19 subvariant, omicron BA.2. 

    The subvariant makes up roughly 8{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} of cases nationwide, according to data from the national Centers for Disease Control and Prevention for the week ending Feb. 26. 

    “Just the fact that there is a new variant circulating doesn’t necessarily mean anything in terms of people’s risk or in terms of our trajectory with the pandemic,” said Dr. Zack Moore, North Carolina’s state epidemiologist. 

    Instead, scientists look at whether a subvariant is more transmissible, causes more severe disease and evades vaccines, as well as how it responds to different treatment options, Moore said. 

    Variants are simply viruses that share the same mutations, indicating that they come from the same place at the same time, Moore explained. 

    The original omicron variant was more transmissible than prior variants such as alpha and delta. The earlier variant of omicron caused a huge rise in cases in early 2022.

    “Early evidence suggests that the omicron variant is two to three times as contagious as the delta variant, making it four to six times as contagious as the original COVID-19 virus,” according to the N.C. Department of Health and Human Services. 

    As the earlier omicron variant took hold in the United States, cases spiked dramatically. North Carolina started the year with roughly 8,000 daily cases. Less than two weeks later, the daily case rate exceeded 45,000.

    Case numbers declined as dramatically as they grew, with fewer than 1,000 daily cases reported on the last day of February. Researchers are closely monitoring the new variant and its potential for another spike. 

    In the Southern region, which includes Alabama, Florida, Georgia, Kentucky, North Carolina, Mississippi, South Carolina and Tennessee, the latest CDC data showed the latest subvariant, omicron BA.2, accounting for about 4.5{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} of total cases, a slight increase from the prior week, when BA.2 made up roughly 2{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} of total cases.

    A study from Japan showed potential for more serious disease in lab experiments, similar to the delta variant, but Moore said data out of South Africa did not show any difference in indicators of severity in BA.1 and BA.2 patients in the real world. 

    “That, to me, is more meaningful than what is found in a laboratory study,” he said.

    The latest mutation of omicron has been called a “stealth” variant, but the name is not related to contagiousness, but rather to how it is detected in testing and sequencing. 

    BA.2 is slightly more contagious than the earlier variant, said Dr. Jonathan Quick, adjunct professor at Duke Global Health Institute, but it isn’t necessarily cause for alarm. 

    For each variant to be more contagious than the next is logical because of the way viruses operate, he said. 

    The virus is “predictably unpredictable,” Quick said. “The predictable part is the more contagious one will crowd out the less contagious one,” he said. “It’s just survival of the fittest. And the fittest doesn’t mean the most deadly. It means the most contagious.”

    Protecting against BA.2 and other variants

    The convergence of a new, more contagious variant and policy changes away from protective measures could cause the decline in overall cases to plateau. 

    Vaccines remain the best protection against all variants of the coronavirus, Moore said. At present, a booster is recommended for all recipients of earlier regimens, and immunocompromised individuals are encouraged to get a fourth dose of vaccine. 

    “A booster shot restores protection, making illness after infection about 74{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} less likely,” according to a Kaiser Health News report. 

    While the majority of North Carolinians received an initial regimen of two-dose mRNA shots or a single Johnson & Johnson shot, only 30{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} of the total population received a booster, according to NCDHHS.

    “The booster makes a big difference in omicron, whichever version,” Quick said. “In fact, less than 20{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} of Americans who are over the age of 5 are actually fully vaccine protected, which means that there are more people who are susceptible to infection.” 

    Scientists continue evaluating the durability of the current vaccines in the real world, but even if antibody immunity wanes, cellular immunity or T-cell immunity may hold up longer, Quick said. 

    While it seems likely that people may need additional shots “fairly frequently” as the virus mutates, new vaccine technology may develop to make the shots more durable, Quick said. 

    For those who contract COVID-19, medical developments such as antiviral drugs and monoclonal antibodies may also lessen the effects of the disease. 

    Research is continuing about what drugs might be useful against omicron, specifically the BA.2 variant. Some treatments that worked against earlier variants are not as effective against omicron, according to a Nature report.

    The U.S. Food and Drug Administration revised its guidance about two monoclonal antibody treatments in late January, noting that they are not effective against omicron variants. The agency said other drugs may be used for omicron patients. 

    For the emerging BA.2 variant, therapeutics have shown mixed results. An infusion of the monoclonal antibody sotrovimab may not be as effective against BA.2 as it is against earlier variants, though some studies showed it still had neutralizing effects, according to a Reuters report. 

    In mid-February, the FDA authorized use of a new monoclonal antibody, bebtelovimab, stating that it shows activity against the earlier omicron variant and BA.2. This antibody is designed to be used before hospitalization to prevent more severe disease. North Carolina has received nearly 5,770 doses of bebtelovimab since authorization, according to data from the U.S. Department of Health and Human Services.

    Some clinicians also prescribe Paxlovid, a five-day course of antiviral pills, authorized by the FDA for COVID-19, which must be taken early in illness to be effective. 

    “A big priority needs to be on the further development of therapeutics, particularly outpatient medicines that can be given early in an infection and can keep people at home,” Quick said.

    Those suffering from the disease may find some relief in knowing that prior infection may also offer some future protection from new variants. While some reports of reinfection with BA.2 after the initial variant have surfaced, “initial data from population-level reinfection studies suggest that infection with BA.1 provides strong protection against reinfection with BA.2, at least for the limited period for which data are available,” the World Health Organization said. 

    Scientists in the state continue to track new variants and their possible spread. A new network of researchers, called CORonavirus VAriant SEQencing or, CORVASEQ, was formed to test and track samples from all 100 counties. 

    As new variants are identified, people should continue to be diligent in their actions in response to the virus, Quick advised. He likened waves to a hurricane warning, cautioning that people should pay attention to public health officials and change behaviors before the situation gets out of hand. 

    “One of my biggest concerns is knowing that it is a possibility that people just think it’s over and then we fail to take action,” he said.

    Editor’s note: This story was updated to reflect booster numbers for North Carolina.

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    by Carolina Public Press, North Carolina Health News
    March 5, 2022

    1

  • Dementia Patients Divided Over Alzheimer’s Drug Aduhelm | Healthiest Communities Health News

    Dementia Patients Divided Over Alzheimer’s Drug Aduhelm | Healthiest Communities Health News

    If you listen to the nation’s largest Alzheimer’s ailment advocacy organizations, you may well imagine all people dwelling with Alzheimer’s would like unfettered access to Aduhelm, a controversial new remedy.

    Views about Aduhelm (also recognized as aducanumab) in the dementia group are various, ranging from “we want the federal government to cover this drug” to “we’re concerned about this medicine and feel it should really be analyzed more.”

    The Alzheimer’s Association and UsAgainstAlzheimer’s, the most influential advocacy organizations in the discipline, are in the previous camp.

    Equally are pushing for Medicare to include Aduhelm’s $28,000 yearly expense and fiercely oppose the Centers for Medicare & Medicaid Services’ January proposal to limit coverage only to men and women enrolled in clinical trials. Approximately 10,000 feedback have been gained on that proposal, and a closing choice is expected in April.

    “With respect, we have no a lot more time for debate or delay,” the Alzheimer’s Association national Early-Stage Advisory Group wrote in a Feb. 10 comment. “Every passing working day without having entry to possible remedies subjects us to a upcoming of irreversible decrease.” For its portion, UsAgainstAlzheimer’s termed CMS’ proposal “anti-individual.”

    Nevertheless the scientific evidence behind Aduhelm is inconclusive, its efficacy in avoiding the development of Alzheimer’s continues to be unproved, and there are considerations about its protection. The Food and drug administration granted accelerated acceptance to the treatment past June but requested the drugmaker, Biogen, to perform a new medical demo to validate its profit. And the agency’s choice arrived regardless of a 10- recommendation from carrying out so from its scientific advisory committee. (1 committee member abstained, citing uncertainty.)

    Other corporations symbolizing people today living with dementia are a lot more cautious, contacting for additional investigation about Aduhelm’s success and likely facet consequences. Safety information showed additional than 40{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} of people who took the treatment had swelling or bleeding in the mind — complications that need to be carefully monitored.

    The Dementia Motion Alliance, which supports individuals living with dementia, is between them. In a statement forwarded to me by CEO Karen Really like, the group reported, “DAA strongly supports CMS’s selection to limit accessibility to aducanumab to individuals enrolled in qualifying scientific trials in purchase to improved review aducanumab’s efficacy and adverse effects.”

    Meanwhile, Dementia Alliance International — the world’s largest firm run by and for folks with dementia, with far more than 5,000 customers — has not taken a placement on Aduhelm. “We felt that coming out with a statement on 1 aspect or a different would break up our group,” mentioned Diana Blackwelder, its treasurer, who life in Washington, D.C.

    Blackwelder, 60, who was diagnosed with early-onset Alzheimer’s in 2017, explained to me, “To say that thousands and thousands of people today stricken with a condition are all up in arms from CMS’s proposal is just erroneous. We’re all individuals, not a collective.”

    “I realize the need for hope,” she reported, expressing a own impression, “but individuals dwelling with dementia require to be guarded as nicely. This drug has really really serious, frequent facet results. My problem is that no matter what CMS decides, they at least set in some guardrails so that persons getting this drug get good workups and monitoring.”

    The discussion over Medicare’s final decision on Aduhelm is essential, due to the fact most persons with Alzheimer’s are older or very seriously disabled and protected by the governing administration health application.

    To understand extra, I talked to quite a few men and women dwelling with dementia. Here’s some of what they told me:

    Jay Reinstein, 60, is married and life in Raleigh, North Carolina. He was diagnosed with early-onset Alzheimer’s disease a few many years in the past and

    Jay Reinstein(Elizabeth Reinstein)

    formerly served on the countrywide board of administrators of the Alzheimer’s Association.

    “I realize [Aduhelm] is controversial, but to me it is a possibility I’m inclined to choose for the reason that there’s practically nothing else out there,” Reinstein claimed, noting that men and women he’s fulfilled by help teams have progressed in their condition really promptly. “Even if it is a 10{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} prospect of slowing [Alzheimer’s] down by six months, I am however ready to just take it. Even though I am progressing slowly but surely, I want a lot more time.”

    Early on, she was prescribed Aricept (donepezil), a person of a handful of medications that address Alzheimer’s indicators. “I grew to become fully perplexed and disoriented, I couldn’t feel, I could not focus,” she told me. Following halting the medication, people signs or symptoms went away.

    “I am not for CMS approving this drug, and I wouldn’t take it,” Scherrer said. At discussion groups on Aduhelm hosted by the Dementia Action Alliance (Scherrer is on the board), only two of 50 contributors needed the drug to be manufactured greatly offered. The purpose, she mentioned: “They don’t think there are adequate rewards to counteract the achievable harms.”

    Chopp is a member of a freshly fashioned team of five men and women with dementia who satisfy frequently, “support 1 one more,” and want to “tell the tale of Alzheimer’s from our standpoint,” she explained.

    Two men and women in the team have taken Aduhelm, and the two report that it has enhanced their effectively-becoming. “I believe in science, and I am incredibly respectful of the massive range of scientists who feel that [Aduhelm] ought to not have been approved,” she instructed me. “But I’m equally compassionate toward those people who are determined and who really feel this [drug] could possibly help them.”

    Chopp opposes CMS’ choice simply because “Aduhelm has been Fda-authorized and I believe it should be funded for these who opt for to get it.”

    Joanna Resolve, 53, of Colorado Springs was diagnosed with early-onset Alzheimer’s sickness in Oct 2016. She, far too, made critical complications
    soon after using Aricept and yet another dementia medication, Namenda (memantine).

    Joanna Correct(Joanna Deal with)

    “I would appreciate it if tomorrow any individual stated, ‘Here’s something that can heal you,’ but I do not feel we’re at that point with Aduhelm,” Fix instructed me. “We have not been hunting at this [drug] prolonged ample. It feels like this is just throwing a thing at the ailment because there’s very little else to do.”

    “Please, remember to take it from anyone dwelling with this disease: There is additional to everyday living than having a magic capsule,” Correct ongoing. “All I treatment about is my good quality of lifetime. My marriage. Educating and serving to other men and women dwelling with dementia. And what I can continue to do working day to day.”

    Phil Gutis, 60, of Solebury, Pennsylvania, has participated in scientific trials and taken Aduhelm for 5½ years after staying identified with early-onset Alzheimer’s in 2016.

    He’s convinced the treatment has assisted him. “I don’t know how to describe it other than to say my head feels so much clearer now,” he informed me. “I really feel a great deal extra capable of performing issues now. It is not like I’ve gained my reminiscences again, but I definitely have not deteriorated.”

    Gutis thinks CMS’ proposed limits on Aduhelm are misguided. “When the Food and drug administration accredited it, there was this feeling of exhilaration — oh, we’re getting somewhere. With the CMS conclusion, I sense we are setting the discipline back again once again. It’s this consistent emotion that progress is currently being designed and then — whack.”

    Christine Thelker, 62, is a widow who lives alone in Vernon, British Columbia. She was diagnosed with vascular dementia seven decades in the past and is a
    board member for Dementia Advocacy Canada, which supports limitations on Aduhelm’s availability.

    Christine Thelker(Christine Thelker)

    “Most of us who are living with dementia comprehend a cure is not likely: There are way too lots of distinctive forms of dementia, and it is just too sophisticated,” Thelker explained to me. “To believe we’re just likely to acquire a pill and be greater is not practical. Don’t give us phony hope.”

    What people with Alzheimer’s and other sorts of dementia need to have, as a substitute, is “various sorts of rehabilitation and assistance that can boost our high quality of existence and enable us keep a feeling of hope and reason,” Thelker claimed.

    Jim Taylor of New York City and Sherman, Connecticut, is a caregiver for his wife, Geri Taylor, 78, who has moderate Alzheimer’s. She joined a clinical trial for Aduhelm in 2015 and has been on the drug since, with the exception of about 12 months when Biogen quickly stopped the medical demo. “In that interval, her small-time period memory and communications skills significantly declined,” Jim Taylor explained.

    “We’re confident the treatment is a great issue, even though we know it’s not useful for everybody,” Taylor ongoing. “It seriously boosts [Geri’s] spirits to feel she’s element of research and performing everything she can.

    “If it is useful for some and it can be monitored so that any side consequences are caught in a timely way, then I believe [Aduhelm] should be out there. That conclusion really should be left up to the human being with the ailment and their care companion.”

    This story was developed by KHN (Kaiser Well being Information) a national newsroom that creates in-depth journalism about health troubles and a main working program at KFF (Kaiser Family Foundation). It has been printed with permission.

  • After Ralston makes rare pitch, House panel OKs mental health bill

    After Ralston makes rare pitch, House panel OKs mental health bill

    “I think it is the most vital [topic] we will acquire up this calendar year.”

    With that remark, Ga Household Speaker David Ralston, in a exceptional appearance at a legislative committee listening to, established out the stakes Wednesday for passage of the mental health and fitness parity monthly bill that he has sponsored.

    Ralston

    “The No. 1 state for small business in this country can’t and will not be among the worst for mental health care and obtain and high-quality,’’ stated Ralston, a Blue Ridge Republican.

    Later, the House Overall health and Human Products and services Committee, meeting for the 3rd time on the proposal, handed Residence Bill 1013 unanimously.

    Two co-sponsors, Reps. Todd Jones (R-Cumming) and Mary Margaret Oliver (D-Decatur), mentioned they have been “sticking strongly’’ with the parity language and definitions in the invoice, together with the medical investing specifications for Medicaid managed care firms.

    GHN and Kaiser Health Information noted that Ga is just one of only a couple of states that don’t need a least stage of healthcare paying out and high quality improvements for Medicaid insurers.

    The demanded amount of these shelling out set by the bill is at minimum 85 per cent — or 85 cents of just about every greenback that Medicaid insurers receive from the method.

    Rep. Mark Newton (R-Augusta), a committee member and medical professional, claimed he hopes the state’s Section of Local community Wellbeing, which oversees Medicaid, will be encouraged to request an even bigger health care paying threshold in its contracting system with insurers.

    The bill’s parity language demands that health and fitness designs ought to cover mental wellness and compound use remedy at the same stages as physical situations. The monthly bill also says that the definitions of “medical necessity” will arrive from conventional medical protocols, and not be identified by insurers.

    The new variation of the monthly bill sets up a multi-action approach for involuntary determination of anyone who’s undergoing a mental well being disaster.

    Stock image

    Under present state law, mentally sick folks will have to demonstrate an “imminent” threat of harm to them selves or other individuals right before they can be committed for treatment.

    The monthly bill would create quite a few conditions for such determination. The measures would contain deciding that a man or woman presents a “substantial risk” of hurt to by themselves or other people and generates a sensible expectation that a crisis or major psychiatric deterioration will happen with no that treatment.

    Other criteria involve an evaluation that there’s a sensible prospect that healthcare facility therapy would aid that human being that other, significantly less restrictive alternate options are not suitable and that the person has declined voluntary remedy or lacks the capacity to make this sort of a decision.

    Another modify in the monthly bill also aims to relieve some of the burden that legislation enforcement agencies encounter in obtaining to transport a individual from an ER or other facility again to a group location.

    Other normal provisions include things like:

    ** Creating a buyer criticism process on parity violations, and oversight by the point out insurance policy commissioner

    ** Providing cancellable education loans to college students education in the psychological health and fitness and substance abuse fields

    ** Developing “co-response” teams with law enforcement officers and mental well being gurus around the point out

    Oliver

    Rep. Shelly Hutchinson (D-Snellville), who’s a accredited scientific social worker, praised the monthly bill but expressed problem to Ralston that it would insert to the pressure on “a damaged system’’ of mental well being care.

    Ralston responded, “I make no apologies for it staying a massive bill,” adding that it would not further injury the method.

    Immediately after the hearing, Oliver instructed reporters that the laws aims to bolster crisis behavioral wellness solutions. “That’s exactly where we’re hurting,’’ she explained.

    The invoice is expected to get to the House floor upcoming 7 days.

  • Pandemic exacerbated looming nursing shortage, burnout

    Pandemic exacerbated looming nursing shortage, burnout


    By Rose Hoban

    “Family and friends say I look exhausted all of the time.”

    “Some days I absolutely dread going to work.”

    “I started having to take an (antidepressant) in order to function without breaking down every day.”

    These were just some of the dozens of responses to an anonymous survey in which the North Carolina Nurses Association queried registered nurses across the state on how they were doing two years into the pandemic. The survey, conducted last month, found that nurses continue to be affected by the effects of the pandemic. Many of the 229 nurses who responded to the questionnaire described themselves as experiencing burnout.

    Those results really trouble Erin Fraher, a researcher on North Carolina’s health care workforce at the Sheps Center for Health Services Research at UNC Chapel Hill. Fraher has been watching trends in the nursing workforce in the state for the better part of three decades and last month, she told lawmakers that she’s “never been so worried about a workforce in my life based on the data.”

    Fraher went on to tell lawmakers that before the COVID-19 pandemic, her data were telling her that the state faced a probable shortage of about 12,500 nurses in the coming decade. But since the pandemic has stretched nurses to their limit, leading many to consider and take early retirement, the state could have something closer to 21,00 too few nurses by 2033. 

    Even as nurses were willing to cut loose anonymously, many are still reticent about speaking ill of their institutions for fear of retaliation by employers, said nurses reached by NC Health News. But surveys and data show that the health care workforce is likely to lose some of the most experienced staffers. 

    The reasons are many. They include:

    • The stress that comes from working in a pandemic for two years with overextended personnel;
    • Financial woes besetting some health care systems and providers;
    • The ire at disparities in pay; and
    • More recently, animosity from the public. 

    “The level of exhaustion is so real,” said Lisa Harrison, health director for Granville and Vance counties. 

    “No more meditation or pizza parties… We need real concrete help.” – anonymous response

    At the beginning of the pandemic, restaurants provided free meals to nurses and other health care workers, hospitals put up billboards praising their staffers, and members of the public offered applause every night. But as COVID-19 cases rose and fell, and the public became tired of mask mandates and infection-control measures, health care personnel grew wearier while also taking more of the brunt of the public’s frustration.

    Some hospitals have done a better job than others at mitigating the burnout that’s come with the two years of surging workloads. Those hospitals that have taken the time and expense to prevent burnout likely saved money, according to Jane Muir, a nurse researcher from the University of Virginia. For her doctoral research, she did an economic analysis of the costs of burnout to hospitals.

    Hospitals looking to prevent such fatigue among their staff nurses spend on average $11,592 per nurse per year to prevent the exhaustion, Muir found. Those costs include measures such as spending more on full-time staff to share the load, creating programs to improve patient safety and the quality so nurses feel like they’re providing better care, providing opportunities for professional development for nurses and increased vacation time. 

    But doing nothing actually costs hospitals more, Muir’s analysis found. She calculated that when hospitals simply stayed with the status quo, they ended up spending about $16,736 per nurse per year on their nurses. That’s because they had higher turnover rates and incurred costs to recruit new nurses, get them up to speed and hire expensive fill-in nurses to pick up the slack.

    “A lot of pretty raw feelings” 

    People in all professions have left their jobs as the pandemic has spooled out, and nurses have been a part of the so-called “great resignation.”

    Frustrated RNs may not have quit the profession completely, Fraher told lawmakers, but many have left their staff jobs for travel assignments that became more lucrative as the pandemic extended from weeks to months to years. “Travelers” have long provided temporary fill-in for busy hospital units. They work for temporary staffing agencies who recruit and place them. Often travelers make a lot more than the staff nurses they work alongside, something that was a frustration even before the pandemic.

    “It used to be when someone decided they wanted to do travel nursing, it was to take a job across the country somewhere, not across the street to the competitor,” said Dennis Taylor, the immediate past president of the North Carolina Nurses Association.

    As a traveling nurse, Taylor explained, “you could go make sometimes triple or quadruple your hourly rate, and then turn around and either come back to your original organization because they need people, or decide to stay on at that new organization.”

    During the pandemic, those frustrations have at times boiled over, Taylor said. 

    “I think that has led to a lot of pretty raw feelings among folks who had been working at institutions for 10, 12, 15, 20 years,” he said. 

    Those kinds of rewards, Taylor said, pushed some nurses who were close to retirement to jump ship. 

    “I think that, unfortunately, the signal that it sent to them was that we don’t value your tenure, your experience or your loyalty to the organization,” he said.

    “I gladly left my job due to dissatisfaction and frustration with a broken healthcare system” – anonymous response

    Those are the kinds of retirees that really have Fraher worried, she told lawmakers. They are the more experienced nurses bailing out of bedside care.

    Four years ago, Fraher’s center published data showing that the average age of nurses in the state was 45 for metro-area nurses and 46 in rural parts of the state. Now, that average has crept upward as the entire workforce has aged. Many of those older nurses can find different jobs with less stress. 

    Before the pandemic, Fraher projected the state would need about 125,726 nurses by 2033, but would only have 113,277 available, leaving a deficit of 12,500. If nurses within five years of retirement age decide to jump ship early, that would almost double the deficit to 21,032.

    Fraher told lawmakers that pre-COVID, NC was forecasted to face an estimated shortage of 12,500 RNs by 2033. If burnout or other factors cause nurses to exit the workforce five years earlier, that shortage nearly doubles, she said. Image courtesy: Erin Fraher/ Sheps Center for Health Services Research, NurseCast

    Taylor was one of those people. After years of critical care nursing and leading the state nursing association during the pandemic, he also decided to leave his position, for now. 

    This week, Hugh Tilson, head of the North Carolina Area Health Education Centers, told lawmakers that his organization had surveyed employers to find that they were already having trouble recruiting and retaining staff to fill vacancies, especially for nurses. 

    In November, AHEC found that many facilities reported “exceptionally long” vacancies for open positions. When it came to RN positions, responses from 19 types of facilities – from nursing homes to hospitals – reported long periods where they couldn’t fill vacant jobs, including 31 of 35 hospitals surveyed. RN retention was also an issue. 

    “The important thing about our study is that it confirmed that these problems existed in the past, and COVID made it worse,” Tilson said. He said there needs to be coordination at the state level to consistently monitor, track and report to the legislature where the needs are in the health care workforce, otherwise, “we’ll be in the same place 10 years from now as we are now.”

    Tilson also noted that health care institutions can’t “solve the nursing problem in isolation, but only if they work with the larger health care ecosystem and with other professions within health care. 

    Public health workforce also stressed

    In the public eye, the image of nurses in the pandemic has been that of someone covered head to toe in protective gear, hovering at the bedside of an ICU patient. But Lisa Harrison, the public health director in Vance and Granville counties, pointed out that her public health nurses have been just as much on the front lines, maybe more so, as they’ve been outside the bubble of a hospital and confronting an often angry public.

    “Communicable disease nurses in local health departments, so many people forget the roles and responsibilities they bear in the case investigation and the contact tracing,” Harrison said last week. “The abuse they’ve received in these last two years doing their jobs has been profound and their exhaustion is also profound.”

    Many public health nurses across the state have been “holding the line because they feel this just overwhelming dedication to community and public,” Harrison added. “The public heart thing is ‘I’m not going to leave here in the middle of a crisis, but as soon as the crisis abates, phew, I need a vacation badly and it needs to be a two-year vacation.” 

    Those public health nurses often are confronted with anger from people who were pro-mask, anti-mask, pro-vaccine, anti-social distancing, Harrison added, saying you name the position, they’ve heard criticism about it. 

    “Seeing the abuse they’ve received in these last two years doing their jobs has been profound and their exhaustion is also profound,” she said.

    Harrison predicted that many public health nurses might look for an exit ramp soon, some temporarily, some permanently. 

    “We’re gonna lose a lot.”

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    by Rose Hoban, North Carolina Health News
    March 2, 2022

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