‘A crisis in nursing is upon us,’ nursing survey shows, even after the pandemic | CNN



CNN
 — 

As an emergency room nurse, Terry Foster has cared for people on their worst days. He loves his work, and as president of the Emergency Nurses Association, a group that represents about 50,000 nurses, he’s met countless others who share a similar commitment to helping others. But he’s concerned about the future of his profession.

“I’ve worked in the emergency department 45 years, and you’re not going to hear people say that again. I don’t think you’re going to see that kind of tenure anymore,” he said.

Something changed with the Covid-19 pandemic, Foster said. That change is among the many captured in the 2023 Survey of Registered Nurses from AMN Healthcare, a nurse staffing company.

The biannual survey of 18,000 nurses, published Monday, points to what AMN Chief Clinical Officer Dr. Cole Edmonson called a “perfect storm” of problems for the profession that could leave the US health care industry without the nurses it needs.

The survey, which was conducted in January, shows a group of professionals who care very much about their work, but it also shows a significant decline in work satisfaction and a significant increase in stress levels. Many are thinking about leaving the profession.

“A crisis in nursing is upon us,” Edmonson says in the survey.

Nurses typically like their profession, surveys have found over the years. For more than a decade, their career satisfaction was around 80% to 85%. Yet when they were asked in the new poll whether they were extremely satisfied or somewhat satisfied with their choice of nursing as a career, the number dropped a full 10 percentage points from the most recent AMN survey, done in 2021.

If 71% of nurses say they are satisfied with their work in 2023, that’s still a lot of people, but the drop is concerning, said Christin Stanford, vice president of client solutions for AMN Healthcare.

“I don’t think any of us were prepared to see just how drastic the drop was in career job satisfaction, mental health and well-being, and what the overall feeling of the nurse profession today was,” she said.

Another troubling sign, she said, is that younger nurses seem less satisfied with their careers than older professionals.

Research has shown that nurses who are satisfied with their work typically stay on the job. But only 63% of millennials and 62% of Gen Zers said they were satisfied with their career choice, as opposed to 78% of baby boomers.

“The overall data is very concerning. But if you segment out and look at a few different splices or populations within the survey data, it is even more distressing,” Stanford said.

The survey found that many nurses are thinking about leaving their jobs.

Hospitals could face the most instability. Only 15% of hospital nurses say they will continue in the same job in one year, the survey found.

Nearly a third of all the nurses surveyed said they are likely to leave the profession, up 7 points from the 2021 survey.

Only 40% said they will stay in the same job in one year, a 5 percentage-point drop since 2021. The rest said they will look for work as a travel nurse, move to part-time or per diem work, take a job outside of nursing or patient care, or return to school.

Foster, who works as an emergency room nurse in Northern Kentucky and was not involved in the AMN survey, in part faults typical burnout. About 100,000 registered nurses in the US left the workplace due to the stresses of the Covid-19 pandemic, according to the results of a survey published this month by the National Council of State Boards of Nursing.

Foster says patients and their families have also changed in recent years.

“There’s just a new level of incivility from the public,” he said.

The same violence seen in social media videos of people attacking flight attendants or fast food workers is happening more and more in health care settings, he said. Health care workers are five times more likely to experience workplace violence than employees in all other industries, government surveys have found.

“We’re just trying to take care of people, and they’re lashing out at us,” Foster said. “It’s patients who don’t want to wait, or they act out or are very dramatic or violent. And sometimes our patients are fine, but their families will lash out at us and threaten us.”

This new survey showed that 4 out of 5 nurses said they experienced “a great deal” or “a lot of stress” in their work, an increase of 16 points since 2021.

More nurses said they worried that their job was taking a toll on their health, and they often felt emotionally drained.

Nearly 40% of nurses surveyed said they felt burnt out. Nearly a third said they felt misunderstood or underappreciated, and about the same number felt that they were not getting what they needed out of their job.

Another part of the problem is a lack of adequate staffing.

Only a third of those surveyed said they had the ideal time they needed with patients, a 10-point decrease from 2021. The percentage of nurses who were satisfied with the quality of care that they were able to provide fell 11 points, from 75% in 2021 to 64% in 2023.

Stanford said that in just a couple of years, the profession will be 1 million nurses short, partially because of a demographic change.

Baby boomers are reaching the age of retirement, and there will be more demand for nurses because boomers are also reaching the age when they need more medical care.

Another problem is education. While the number of candidates who passed the nursing licensure exam has steadily grown over the years, according to the union National Nurses United, there are still many more people who want to become nurses than there are classes. Schools just don’t have enough people to teach, Stanford said.

There may also be a lack of interest in doing the work in today’s environment.

There are about a million registered nurses with active licenses who are not employed as nurses, according to a National Nurses United analysis of Bureau of Labor Statistics data from 2021.

Coming out of the pandemic, far too many hospitals cut corners on staffing and allowed a higher nurse-to-patient ratio, said Kristine Kittelson, an RN in Austin and a National Nurses United member. Essentially, that’s placed nurses in a moral dilemma, she said, where they can’t completely help their patients even if they want to.

“We are being put in these challenging work environments that really forced us to feel like we, as nurses, aren’t providing the best care that we can,” said Kittelson. who also was not involved in the new survey. “We’re just not being given the resources that we need and the staffing that we need.”

More flexibility in schedules could help, Stanford said. Do nurses have enough flexibility to take time off and take care of themselves?

Nearly every nurse who participated in the new survey said they wanted increased staff support, a reduction in the number of patients per nurse, an increase in salary, a safer working environment and more opportunities to share their input with decision-making.

“This is a great profession, and it’s very rewarding, but I think that the pandemic has really shown how undervalued we are,” Kittelson said. “We should just be able to put in a position to give patients what they deserve and not feel stressed.”

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Up to 60% of stroke survivors may develop cognitive decline within a year | CNN



CNN
 — 

Up to 60% of all stroke survivors develop memory and thinking problems within a year, and one-third go on to develop dementia within five years, according to a new American Stroke Association scientific statement.

“The numbers are staggering, right?” said Dr. Andrew Freeman, director of cardiovascular prevention and wellness at National Jewish Health in Denver.

“This is a call to action to up our game and focus on prevention,” said Freeman, who was not part of the scientific committee who prepared the statement.

An estimated 9.4 million American adults — about 3.6% of the US adult population — report having had a stroke, according to 2023 statistics from the American Heart Association.

“Cognitive impairment is an often under-reported and under-diagnosed but yet very common condition stroke survivors frequently deal with,” said Dr. Nada El Husseini, an associate professor of neurology at Duke University Medical Center in Durham, North Carolina, in a statement.

About 40% of the survivors of stroke have mild cognitive impairment that does not meet the diagnostic criteria for dementia. Mild or not, the mental difficulties can seriously affect quality of life, said El Husseini, who chaired the writing committee for the statement.

“Cognitive impairment after stroke ranges from mild impairment to dementia and may affect many aspects of life, such as remembering, thinking, planning, language and attention, as well as a person’s ability to work, drive or live independently,” El Husseini said.

Cognitive impairment is most common within the first two weeks after a stroke, the statement said. Mental decline may go hand in hand with other conditions associated with a stroke such as behavioral and personality changes, depression, physical disability and disruption in sleep, all of which can contribute to a lower quality of life.

The American Stroke Association’s statement did offer some good news: About 20% of people who experience mild cognitive impairment after a stroke fully recover their cognitive function, typically within the first six months.

People are at higher risk for strokes if they have atrial fibrillation, an irregular heartbeat that sufferers often describe as a quiver, flutter or flip-flop of the heart in the chest. Those with uncontrolled high cholesterol or high blood pressure are also at high risk, as are people who smoke or use drugs or alcohol. Being diabetic or obese can be risk factors, too.

Ischemic strokes, caused by a clot in the blood vessels that feed blood to the brain, account for 87% of all strokes, according to the statement. Brain bleeds caused by a rupture of a weak vessel in the brain, called hemorrhagic strokes, are much less common, accounting for some 13% of all strokes.

The following are signs of a stroke, according to the National Institute of Neurological Disorders and Stroke:

  • Sudden numbness or weakness in the face, arm or leg, especially on one side of the body.
  • Sudden confusion, trouble speaking or difficulty understanding speech.
  • Sudden trouble seeing in one or both eyes.
  • Sudden trouble walking, dizziness, loss of balance or lack of coordination.
  • Sudden severe headache with no known cause.

Other, less commons symptoms include dizziness, disorientation, nausea, memory loss or vomiting.

Any of the warning signs may last only a few moments and then disappear, which could mean the person is having a minor stroke or a transient ischemic attack, or TIA. Any symptom should not be ignored, experts say, as it can signal a more serious stroke to come.

“One might call a TIA a ‘lucky stroke’ because it’s less serious, but it really is a sentinel event,” Freeman said.

It’s never too late for prevention, but serious effort is needed after even mild stroke to “extinguish the fire if you will, with aggressive change and aggressive medication therapy when appropriate,” Freeman added.

“It should push people to make very drastic lifestyle changes: Eat better, exercise more, go on the appropriate statins or aspirins or whatever their doctor suggests are appropriate so that their risk is as low as possible,” he said.

Damage to the brain occurs when some cells stop getting oxygen and die, while other brain cells may die due to bleeding in the brain. As a result, permanent brain damage can occur within minutes to hours, according to the institute. “Some brain cells die quickly but many linger in a compromised or weakened state for several hours,” it said.

Immediate medical attention is key to lessening the impact of a stroke. Learning the symptoms of a stroke using the acronym FAST can help identify the signs quickly, according to the US Centers for Disease Control and Prevention.

  • F — Face: Ask the person to smile. Does one side of the face droop?
  • A — Arms: Ask the person to raise both arms. Does one arm drift downward?
  • S — Speech: Ask the person to repeat a simple phrase. Is the speech slurred or strange?
  • T — Time: If you see any of these signs, call 911 right away.

Be sure to capture the time when any symptom first appears, the CDC advises, to help medical personnel determine the best course of treatment.

Additional strokes only worsen potential cognitive decline, the scientific statement said, so prevention is key. Stroke risk factors, such as hypertension, high cholesterol and type 2 diabetes, should be treated, as should atrial fibrillation.

Keeping high blood pressure under control has been linked to a reduction in risk for additional strokes as well as mild cognitive impairment, the statement said.

“Stroke survivors should be systematically evaluated for cognitive impairment so that treatment may begin as soon as possible after signs appear,” El Husseini said.

“Perhaps the most pressing need, however, is the development of effective and culturally relevant treatments for post-stroke cognitive impairment,” she said. “We hope to see big enough clinical trials that assess various techniques, medications and lifestyle changes in diverse groups of patients that may help improve cognitive function.”

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Doctors watching for more cases after mysterious cluster of brain infections strikes kids in southern Nevada | CNN



CNN
 — 

Disease detectives with the US Centers for Disease Control and Prevention are investigating a cluster of rare and serious brain abscesses in kids in and around Las Vegas, Nevada, and doctors from other parts of the country say they may be seeing a rise in cases, too.

In 2022, the number of brain abscesses in kids tripled in Nevada, rising from an average of four to five a year to 18.

“In my 20 years’ experience, I’ve never seen anything like it,” said Dr. Taryn Bragg, an associate professor at the University of Utah who treated the cases.

Pediatric neurosurgeons like Bragg are rare. She is the only one for the entire state of Nevada, and because she treated all the cases, she was the first to notice the pattern and to alert local public health officials.

“After March of 2022, there was just a huge increase,” in brain abscesses, Bragg said. “I was seeing large numbers of cases and that’s unusual.”

“And the similarities in terms of the presentation of cases was striking,” Bragg said.

In almost every case, kids would get a common childhood complaint, such as an earache or a sinus infection, with a headache and fever, but within about a week, Bragg says, it would become clear that something more serious was going on.

After a presentation on the Nevada cases the Epidemic Intelligence Service Conference on Thursday, doctors from other parts of the country said they are seeing similar increases in brain abscesses in kids.

“We’re just impressed by the number of these that we’re seeing right now,” said Dr. Sunil Sood, a pediatric infectious disease specialist at Northwell Health, a health system in New York. He estimates they are seeing at least twice as many as usual, though they haven’t done a formal count. He urged the CDC to continue investigating and work to get the word out.

Brain abscesses are not, by themselves, reportable conditions, meaning doctors aren’t required to alert public health departments when they have these cases.

They typically only come to the attention of public health officials when doctors notice increases and reach out.

Brain abscesses are pus-filled pockets of infection that spread to the brain. They can cause seizures, visual disturbances, or changes in vision, speech, coordination or balance. The earliest symptoms are headaches and a fever that comes and goes. Abscesses often require several surgeries to treat, and kids may spend weeks or even months in the hospital recovering after they have one.

In the Clark County cluster, roughly three-quarters of the cases were in boys, and most were around age 12.

Dr. Jessica Penney is the CDC Epidemic Intelligence Service officer, or “disease detective,” assigned to Southern Nevada Health District, the health department that investigated the cases. She presented her investigation of the Clark County cluster at the CDC’s annual Epidemic Intelligence Service conference on Thursday.

Penney says as they tried to figure out what was driving the increase, they looked at a slew of factors – travel, a history of Covid-19 infection, underlying health, any common activities or exposures – and they didn’t find anything that linked the cases.

Then, she says they decided to look back in time, looking for brain abscess cases in children under 18 all the way back to 2015.

“I felt like that helped us get a better sense of what might be contributing to it,” Penney said in an interview with CNN.

From 2015 to 2020, Penney says the number of cases of brain abscesses in Clark County was pretty stable at around four a year. In 2020, the number of brain abscesses in kids dipped, probably because of measures like social distancing, school closures, and masking – things that shut down the spread of all kinds of respiratory infections, not just Covid-19. In 2021, as restrictions began to lift, the number of these events returned back to normal levels, and then in 2022, a big spike.

“So the thoughts are, you know, maybe in that period where kids didn’t have these exposures, you’re not building the immunity that you would typically get previously, you know with these viral infections,” Penney said. “And so maybe on the other end when we you had these exposures without that immunity from the years prior, we saw a higher number of infections.”

This is a theory called the immunity debt. Doctors have recently seen unusual increases in a number of serious childhood infections, such as invasive group A strep. Some think that during the years of the pandemic, because children weren’t exposed to the number of viruses and bacteria they might normally encounter, it left their immune systems less able to fight off infections.

Sood said he’s not sold on the theory that there’s some kind of immunity debt at work. Instead, he thinks Covid-19 temporarily displaced other infections for a while, essentially crowding others out. Now, as Covid-19 cases have fallen, he thinks other childhood infections are roaring back – he points to unprecedented surge in RSV cases last fall and winter as an example.

Sood says brain abscesses normally follow a very small percentage of sinus infections and inner ear infections in kids. Because they are seeing more of those infections now, the number of brain abscesses has increased proportionally, too.

If immunity debt or a higher burden of infections were to blame, it stands to reason that brain abscesses might have increased in other places, too.

Last year, the CDC worked with the Children’s Hospital Association to find and count brain abscesses in kids, to see if there was any sort of national spike. Data collected through May 2022 did not detect any kind of widespread increase, according to a study published in the Morbidity and Mortality Weekly Report last fall.

But Bragg thinks the data cutoff for the study may have been too early. She says spring 2022 was when she saw cases in her area really take off. She says the CDC is continuing to collect information on brain abscesses and evaluate local and national trends.

About a third of the brain abscesses in the Clark County cluster were caused by a type of bacteria called Streptococcus intermedius that normally hangs out harmlessly in the nose and mouth, where our immune system keeps it in check. But when it gets into places it shouldn’t be, like the blood or brain, it can cause problems.

That can happen after dental work, for example, or when someone has an underlying health condition that weakens their immunity, like diabetes.

That wasn’t the case with the kids in the Clark County cluster, however.

“These are healthy children. With no prior significant medical history that would make them more prone…there wasn’t any known immunosuppression or anything like that,” Bragg says.

Like the cases in Clark County, Sood says most of the kids they are seeing are older, in grade school and middle school. He says until kids reach this age, their sinus cavities are underdeveloped, and haven’t yet grown to their full size. This may make them particularly vulnerable to infection. He thinks these small spaces may become filled with pus and burst. When that happens over the eyebrow, or behind the ear, where the barrier between the brain and sinuses is thinner, the infection can travel to the brain.

Sood says the signs of a sinus infection in kids can be subtle and parents don’t always know what to watch for. If a child gets a cold or stuffy nose and then the next day wakes up with a red and swollen eye, or an eye that’s swollen shut, it’s a good idea to seek medical attention. They may also complain of a headache and point to the spot above their eyebrow as the location of the pain.

Bragg says so far, in 2023, she’s treated two more kids with brain abscesses, but the pace of new cases seems to be slowing down – at least she hopes that’s the case.

Some of the children she treated needed multiple brain and head and neck surgeries to clear their infections.

Sood says in his hospital, doctors have a patient who has been there for two to three months and had five surgeries, although he says she was an extreme case.

Penney says the CDC continues to watch the situation closely.

“We’re going to continue to monitor throughout the year working very closely with our community partners to see you know what, what happens down in Southern Nevada,” she said.

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Reset your body and mind with 10 ‘spring-cleaning’ tips | CNN

Editor’s Note: Dana Santas, known as the “Mobility Maker,” is a certified strength and conditioning specialist and mind-body coach in professional sports, and is the author of “Practical Solutions for Back Pain Relief.



CNN
 — 

With the weather warming up, you might feel inspired to clean out your closets, wash your windows and give your house a deep scrub and reorganization. Not only is a clean environment good for your physical health, but research has shown that the good feelings you get from having a clean, uncluttered home reduce stress levels and ward off depression.

Imagine how great you would feel if you took that same spring-cleaning approach to your body — your living, breathing home.

Of course, you should already be subscribing to annual checkups with your primary care physician and eye doctor, and you may even see your dentist biannually. But what about taking a closer look at how you fuel and move your body — and making healthy changes to clean up those areas?

As a mind-body coach in professional sports, I work with coaches, medical staff and expert consultants every year during baseball spring training to help players prepare their bodies for the season. In addition to conducting annual physicals, we do nutritional and movement assessments to create appropriate action plans.

You may not be a professional athlete, but your body is still the vehicle used to navigate your life, and the quality of its ability to move and how well you feel in it affects the overall quality of your life.

That’s why I enlisted the help of two nutrition and human movement experts to provide 10 “spring-cleaning” tips to avoid injury, move pain-free, reduce inflammation, maintain a healthy weight and generally feel better in your body.

Important note: It’s recommended to consult your doctor before starting any new exercise programs or dietary changes.

You might expect a cleanse to be tip No. 1, but think twice before you dive into one of the many popular advertised cleanses. A lot of them can “do more harm than good,” according to registered dietitian Angie Asche, owner of Eleat Sports Nutrition and author of “Fuel Your Body: How to Cook and Eat for Peak Performance.” Asche said cleanses can be dehydrating and contain herbal supplements with potentially negative side effects and contraindications with certain medications. What’s more, some of these regimens don’t deliver on their promise, according to the National Institutes of Health. “Most are missing key nutrients that are necessary for your body to naturally detoxify,” she explained.

Fiber, found in plant foods, is the key to safe and efficient cleansing, according to Asche. She advises eating five to nine fruits and vegetables daily for bowel regularity and weight management. “Not only do plant foods like nuts, seeds, legumes, whole grains, fruit and vegetables contain antioxidants,” Asche said, “but the more variety of plants we have in our diets, the better for the diversity of our gut biome.”

With your focus on eating more real, whole foods rich in fiber, Asche also recommends limiting ultraprocessed packaged foods such as cookies, candy, crackers, baked goods and fried foods. These foods are full of saturated fat, sodium, sugar and preservatives while being devoid of nutritional value.

How much water you drink affects all the functions of your body — including your mental performance; a body water loss of just 1% to 2% can impair cognitive function. To promote good health and weight management, Asche advises drinking at least half your body weight in ounces daily but said the amount can vary depending on a person’s activity level.

Asche said that most fluids, including tea, coffee and carbonated water, can count toward your water intake, but she points out that alcohol does not — and should be limited. “In large amounts, alcohol can overwhelm the gut, promoting intestinal inflammation and increasing harmful bacteria … (which) can lead to a wide range of health problems,” she said.

Screens that look at your ability to do functional movements, such as squatting and lunging, are a great way to proactively prevent injury, according to physical therapist Gray Cook, a cofounder of Functional Movement Systems.

“Signs of weakness, tightness and balance problems can be early indicators of arthritis and posture issues as well as increased injury risk for athletes and fall risk for the elderly,” Cook said.

You can get the assistance of a physical therapist or qualified trainer to perform a movement assessment, but a recent study showed that self-movement assessment (using an app codeveloped by Cook) is valid and reliable for identifying musculoskeletal risk factors.

Whether working with professional athletes or doing my own workouts, I ensure that I cover all primary functional movements in all planes of motion in every training session. Executing that kind of total-body workout sounds more complicated than it is. It’s simply about practicing and strengthening your ability to perform your body’s basic movement functions: squatting, hinging, pushing, pulling, rotating and stabilizing your core.

And, just like the multidirectional movement of everyday life, it helps to exercise in all three planes of motion: sagittal (forward/backward), frontal (side to side) and transverse (rotating). You can easily practice these movements with a body-weight workout or yoga flow.

It's important to practice and strengthen your ability to perform the body's basic movement functions.

The key to exercise’s effectiveness is consistency. With as little as 11 minutes of exercise per day, you can enjoy numerous health benefits — including increasing your life span. Walking outside is a great way to get in those 11 minutes daily, and because of the alternating and reciprocal nature of gait, it offers the opportunity to tune into your body and self-assess by noticing if there are any imbalances.

Breathing plays a vital role in how you think, feel and move. In addition to reducing your heart rate, blood pressure and stress response, learning how to breathe better will improve your diaphragm function and rib mobility, which can improve posture and reduce back pain. Practice taking breathing breaks a few minutes throughout your day.

Sleep is essential for overall health. Adults need at least seven hours of sleep nightly, according to the US Centers for Disease Control and Prevention. If you’re not getting that minimum amount of shut-eye, it’s time to clean up your sleep routine and start prioritizing rest.

Just like the physical and mental benefits of traditional spring-cleaning within your home, these 10 tips will refresh and revitalize your body and mind in noticeably positive ways.

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US cigarette smoking rate falls to historic low, but e-cigarette use keeps climbing | CNN



CNN
 — 

The percentage of adults who smoked cigarettes in the United States fell to a historic low last year, the US Centers for Disease Control and Prevention found. However, e-cigarettes are becoming even more popular.

About 11% of adults told the CDC last year that they were current cigarette smokers, according to the latest preliminary data from the National Health Interview Survey, a biannual survey that provides general information about health-related topics. The survey includes responses from 27,000 people age 18 and older. In 2020 and 2021, about 12.5% of adults said they smoked cigarettes.

This is a significant drop from when surveys like these started. Surveys of Americans in the 1940s found that about half of all adults said they smoked cigarettes. Rates began to decline in the 1960s, and more recently, in 2016, 15.5% of adults said they smoked cigarettes.

Recent studies have shown some groups are still at higher risk. While the latest CDC survey doesn’t capture this level of detail, cigarette smoking rates among some communities – including Native Americans, Alaska Natives and members of the LGBTQ community remain “alarmingly high” according to the 2023 State of Tobacco Control report from the American Lung Association.

The general drop in cigarette smoking among adults should have a positive impact on public health.

Cigarette smoking is still the leading cause of preventable death and disability in the US. So many people have died from smoking, the CDC finds, that more than 10 times as many US citizens have died prematurely from cigarette smoking than have died in all the wars fought by the US.

Smokers are 90% of the lung cancer cases in the United States, but smoking can also cause someone to have a stroke, coronary heart disease, and COPD, as well as other cancers including bladder, colon, kidney, liver, stomach and other cancers. People who live with smokers also are at a greater risk of death, because of secondhand smoke.

This latest survey does not capture why fewer people smoked cigarettes, but the number has been on the decline since the 1960s, after the US surgeon general released the first report on smoking and health that concluded that smoking causes serious health problems.

Experts credit a variety of efforts for the decline in cigarette smoking – anti-smoking campaigns, programs that educate children about the danger of smoking, laws that severely restrict where people could smoke and where cigarette companies could advertise, as well as better access to smoking cessation programs and higher taxes that make cigarettes expensive.

However, Congress hasn’t raised federal tobacco taxes in 14 years. The federal cigarette tax remains $1.01 per pack, and taxes vary for other tobacco products. No state increased its cigarette taxes in 2022.

The pandemic may also have had an influence. Smokers were much more vulnerable to the severe consequences of Covid-19 and that gave some people the extra motivation they needed to quit – and may have given doctors the extra motivation they needed to help them too, according to Dr. Panagis Galiatsatos, a volunteer medical spokesperson with the American Lung Association. At some level, the pandemic also made the medical establishment easier to access.

“The pandemic, I think, really allowed physicians time they never probably had in the past to conduct these telemedicine visits that were appropriate just for smoking cessation strategies, helping them help patients quit and stay quit,” said Galiatsatos, who is a pulmonary and critical care medicine physician and is director of the Tobacco Treatment Clinic with Johns Hopkins Medicine.

Galiatsatos points to the US Surgeon General report released during the Trump administration, just prior to the start of the pandemic. The report detailed that of the patients they have now that smoke, the few that are left are going to be the most resistant to quitting. Then-Surgeon General Jerome Adams’ report encouraged more doctors to help their patients quit. The report found that 40% of smokers are not routinely told by their doctors to stop.

Still, the culture has changed. Smoking is much less socially acceptable in some cultures in the US.

E-cigarette use, though, seems to be more socially acceptable, especially among younger people studies show, and that may explain why those numbers are up.

The current survey found that e-cigarette use rose to nearly 6% last year, that’s up from about 4.9% the year before.

Some argue that e-cigarettes are a good substitute for regular cigarettes, and in some countries they are even promoted as a smoking cessation devices, but the CDC says that “e-cigarettes are not safe for youth, young adults, and pregnant women, as well as adults who do not currently use tobacco products.”

A BMJ study published in February found that people who used e-cigarettes to quit smoking found them to be less helpful than more traditional smoking cessation aids.

The US Food and Drug Administration says there is not enough evidence to support claims that these products are effective tools to help people quit smoking. None are approved for this purpose. The FDA says there are no safe tobacco products, including e-cigarettes, vapes, and other electronic nicotine delivery systems.

“I always hold no stigma or judgment when anyone wants to smoke a traditional cigarette or use electronic cigarettes, but as a lung doctor, I will always promote only air to come into the lungs,” said Galiatsatos. “From my standpoint, I think we should still have a public health mindset around e-cigarette usage because for some individuals, they’re going to have health consequences from this product.”

He said people may choose to vape instead of smoke cigarettes, but clinicians should be prepared to help this population if they do want to quit.

E-cigarettes can, though, produce a number of chemicals that are not good for human health, including acrolein, acetaldehyde, and formaldehyde. Studies show these chemicals are known as aldehydes and can cause lung and heart disease, according to the American Lung Association.

Among teens, nicotine exposure can harm the developing brain, according to the US surgeon general.

E-cigarettes are much more popular than cigarettes among teens, so the adult e-cigarette user numbers will likely continue to grow.

About 14% of high school students said they used e-cigarettes, and 2% of high school students smoked cigarettes last year, according to separate CDC data.

The rate of kids that use e-cigarettesis high, the American Academy of Pediatrics says.

Specifically, in 2022, nearly 5% of middle school and about 17% of high school students reported some form of current tobacco use, according to CDC data from an earlier survey. In 2021, about 11% of middle schoolers and 34% of high schoolers said they had ever tried tobacco.

These “try rates” are important because most adult smokers started at young ages, according to the CDC.

The AAP continues to encourage pediatricians to screen for tobacco use as part of a child’s regular checkup. A talk about tobacco should start no later than age 11 or 12, the report says.

For adult smokers, the CDC encourages encourages people to call 1-800-QUIT-NOW where people can get free confidential coaching. The government also offers free online resources and even text programs that can help people quit.

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Your pollen allergies are overwhelming? This might be why | CNN

Editor’s Note: Sign up for CNN’s Life, But Greener newsletter. Our limited newsletter series guides you on how to minimize your personal role in the climate crisis — and reduce your eco-anxiety.



CNN
 — 

Pollen has exploded to eye-watering levels this spring in some parts of the country after warm weather pushed plants out of their winter slumber much earlier than normal.

In Atlanta, the pollen count sky rocketed to “extremely high” in early March and stayed high through much of April, according to the Atlanta Allergy and Asthma physicians practice. Farther north in Washington, DC, allergy sufferers have been dreading the lime-green film of pollen covering that covers windshields and porches and piles up on streets and sidewalks.

But these aren’t isolated trends. As the planet warms, researchers say allergy season is starting earlier and lasting longer. And a study from the journal Nature published last year found that pollen count is projected to increase by 200% by the end of the century if planet-warming pollution continues to rise.

Climate Central, a nonprofit focused on climate news and research, recently analyzed how warmer temperatures have affected allergy season in 203 US cities since 1970.

It found that on average, the growing season – the period between the last freeze in spring to the first freeze of fall – is lasting 16 days longer in the Southeast, 15 days longer in the Northeast and 14 days longer in the South.

In the West, growing season is 27 days longer on average, Climate Central reported. Reno, Nevada, for example, has seen a shocking increase of 99 days.

And a longer growing season means a longer allergy season.

“Because of climate change, we’re now seeing an earlier and longer growing season for plants, which of course make pollen, which is the enemy of many Americans that suffer from pollen allergies – and mold allergies as well,” Lauren Casey, a meteorologist with Climate Central, told CNN. “Pollen can also trigger an asthma attack, which of course is much more serious for people that suffer from asthma.”

When plants reproduce, typically during the spring, many release tiny pollen grains that are carried by wind. The pollen grains are small enough to be inhaled, and some people’s immune systems react very poorly to the miniscule particles.

More than 24 million people in the US have pollen-induced respiratory allergies like hay fever, according to the Centers for Disease Control and Prevention. The center’s data shows that more than one in four adults suffered from seasonal allergies in 2021.

Growing season has lengthened by 34 days in Atlanta, according to a Climate Central analysis.

Growing season has lengthened by 20 days in Washington, DC, according to a Climate Central analysis.

A longer and earlier start to pollen season could trigger a public health emergency, researchers say. As temperatures get warmer in the South and drought plagues the Southwest, pollen from plants like ragweed or poaceae – a plant that typically grows in grasslands or salt-marshes – is projected to be higher across those regions than in the North.

Wind-driven pollen, which plays an important role in plant fertilization, is closely tied to temperature and precipitation changes. So, as spring seasons get warmer earlier due to climate change, plants could pollinate much earlier and for a longer period of time than they currently do.

Plant pollen isn’t the only trigger of seasonal allergies. Mold, a type of fungi that reproduces with tiny airborne spores, can also be allergenic for some people and can exacerbate seasonal allergies, according to the report.

While outdoor mold is not as well-studied as pollen, according to the report, one thing is clear: Warmer and wetter weather – conditions that many locations are seeing more of amid the climate crisis – is favorable for mold development.

“With climate change, we’re seeing increases in warming in all seasons, but particularly the fastest warming season for most locations across the US is the winter season,” Casey said. “So now we’re dealing with mold at a time of year that we typically wouldn’t.”

Casey also pointed out that the climate crisis is making extreme precipitation more likely, which provides that crucial dampness for mold to grow. The report highlights the link between allergens and thunderstorms, which researchers say spread pollen and mold spores through the air more efficiently.

“The problem with pollen grains is that when they get wet, they rupture, and they break into tinier bits called sub-pollen particles,” Casey said. “Those tinier bits are more easily dispersed by the wind when they dry out, and they have an easier time getting into your nasal passages.”

Oak trees are pumping out pollen in the Southeast, contributing to extremely high levels early in the season.

Dr. Mitchell Grayson, chair of the Asthma and Allergy Foundation of America’s Medical Scientific Council and chief of the division of allergy and immunology at Nationwide Children’s Hospital, said he has seen pollen allergies arrive earlier than usual.

“In general, we may be seeing people a little earlier in the spring with symptoms – so mid-February from what might have been early March in the past – but there is significant year-to-year variability in this,” he told CNN. “I haven’t seen worse symptoms, but I’m in a hospital that provides specialist care, and we do see people with all ranges of severity.”

The treatment of allergies won’t change even as the season gets longer, Grayson said. But it’s important to be aware of what you’re allergic to and know where these triggers are in the environment.

Experts recommend:

  • Staying indoors, especially early in the morning or late in the afternoon, when most plants release pollen.
  • Wear masks outdoors when possible to mitigate the effects, Amiji said.
  • Keeping windows closed in your home and car to minimize your exposure to pollen particles.
  • Changing air filters more frequently for your A/C and heating systems in your home and car, according to the manufacturer’s instructions.
  • Preparing early by stocking up on anti-allergy medications. If you use a steroid nasal spray, Grayson said it’s important to start using it one to two weeks before your allergy season and to continue through the full season.

Casey, the meteorologist, also noted that allergy season could be a financial burden on low-income families, especially those whose members have asthma, due to the “billions of dollars spent a year on the medical costs of asthma and allergies.”

She said awareness is key, especially as the world pumps more carbon pollution into the atmosphere, which could worsen allergy seasons.

“You know your own body and are aware of what a typical year is going to look like for you, especially if you’re an allergy sufferer,” she said. “But that whole paradigm is changing with this increase in the growing season, so having awareness that you may be suffering now and going forward in times of the year when you typically wouldn’t, so be prepared for that in your daily life.”



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These women ran an underground abortion network in the 1960s. Here’s what they fear might happen today | CNN



CNN
 — 

The voice on the phone in 1966 was gruff and abrupt: “Do you want the Chevy, the Cadillac or the Rolls Royce?”

A Chevy abortion would cost about $200, cash in hand, the voice explained. A Cadillac was around $500, and the Rolls Royce was $1,000.

“You can’t afford more than the Chevy? Fine,” the voice growled. “Go to this address at this time. Don’t be late and don’t forget the cash.” The voice disappeared.

Dorie Barron told CNN she recalls staring blankly at the phone in her hand, startled by the sudden empty tone. Then it hit her: She had just arranged an illegal abortion with the Chicago Mafia.

The motel Barron was sent to was in an unfamiliar part of Chicago, a scary “middle of nowhere,” she said. She was told to go to a specific room, sit on the bed and wait. Suddenly three men and a woman came in the door.

“I was petrified. They spoke all of three sentences to me the entire time: ‘Where’s the money?’ ‘Lie back and do as I tell you.’ And finally ‘Get in the bathroom,’” when the abortion was over, Barron said. “Then all of a sudden they were gone.”

Bleeding profusely, Barron managed to find a cab to take her home. When the bleeding didn’t stop, her bed-ridden mother made her go to the hospital.

At 24, Barron was taking care of her ailing mother and her 2-year-old daughter when she discovered she was pregnant. Her boyfriend, who had no job and lived with his parents, “freaked,” said Barron, who appears in a recent HBO documentary. The boyfriend suggested she get an abortion. She had never considered that option.

“But what was I to do? My mom was taking care of my daughter from her bed while I worked — they would read and play games until I got home,” Barron said.”How was either of us going to cope with a baby?

“Looking back, I realize I was taking my life in my hands,” said Barron, now an 81-year-old grandmother. “To this day it gives me chills. If I had died, what in God’s green earth would have happened to my mom and daughter?”

Women in the 1960s endured restrictions relatively unknown to women today. The so-called “fairer sex” could not serve on juries and often could not get an Ivy League education. Women earned about half as much as a man doing the same job and were seldom promoted.

Women could not get a credit card unless they were married — and then only if their husband co-signed. The same applied to birth control — only the married need apply. More experienced women shared a workaround with the uninitiated: “Go to Woolworth, buy a cheap wedding-type ring and wear it to your doctor’s appointment. And don’t forget to smile.”

Marital rape wasn’t legally considered rape. And, of course, women had no legal right to terminate a pregnancy until four states — Alaska, Hawaii, New York and Washington — legalized abortion in 1970, three years before Roe v. Wade became the law of the land.

Illinois had no such protection, said Heather Booth, a lifelong feminist activist and political strategist: “Three people discussing having an abortion in Chicago in 1965 was a conspiracy to commit felony murder.”

Despite that danger, a courageous band of young women — most in their 20’s, some in college, some married with children — banded together in Chicago to create an underground abortion network. The group was officially created in 1969 as the “Abortion Counseling Service of Women’s Liberation.”

But after running ads in an underground newspaper: “Pregnant? Don’t want to be? Call Jane,” each member of the group answered the phone as “Jane.”

Despite their youth, members of Jane managed to run an illegal abortion service dedicated to each woman's needs.
From left: Martha Scott, Jeanne Galatzer-Levy, Abby Pariser, Sheila Smith and Madeline Schwenk.

“We were co-conspirators with the women who called us,” said 75-year-old Laura Kaplan, who published a book about the service in 1997 entitled “The Story of Jane: The Legendary Underground Feminist Abortion Service.”

“We’ll protect you; we hope you’ll protect us,” Kaplan said. “We’ll take care of you; we hope you’ll take care of us.”

What started as referrals to legitimate abortion providers changed to personalized service when some members of Jane learned to safely do the abortions themselves. Between the late 1960s and 1973, the year that the Supreme Court decided Roe v. Wade, Jane had arranged or performed over 11,000 abortions.

“Our culture is always searching for heroes,” said Kaplan. “But you don’t have to be a hero to do extraordinary things. Jane was just ordinary people working together — and look what we could accomplish, which is amazing, right?”

Even after several members were caught and arrested, the group continued to provide abortions for women too poor to travel to states where abortion had been legalized.

“I prayed a lot. I didn’t want to go to jail,” said 80-year-old Marie Learner, who allowed the Janes to perform abortions at her apartment.

“Some of us had little children. Some were the sole breadwinners in their home,” Learner said. “It was fearlessness in the face of overwhelming odds.”

Marie Learner opened her home to women undergoing abortions. Her neighbors knew, she said, but did not tell police.

The story of Jane has been immortalized in Kaplan’s book, numerous print articles, a 2022 movie, “Call Jane,” starring Elizabeth Banks and Sigourney Weaver, and a documentary on HBO (which, like CNN, is owned by Warner Bros. Discovery).

Today the historical tale of Jane has taken on a new significance. After the 2022 Supreme Court reversal of Roe v. Wade and the mid-term takeover of the US House of Representatives by Republicans, emboldened conservative lawmakers and judges have acted on their anti-abortion beliefs.

Currently more than a dozen states have banned or imposed severe restrictions on abortion. Georgia has banned abortions after six weeks, even though women are typically unaware they are pregnant at that stage. In mid-April, Florida Governor Ron DeSantis signed a bill that would ban most abortions after six weeks. It won’t go into effect until the state Supreme Court overturns its previous precedent on abortion. Several other states are considering similar legislation. In other states, judicial battles are underway to protect abortion access.

“It’s a horrific situation right now. People will be harmed, some may even die,” said Booth, who helped birth the Jane movement while in college.

“Women without family support, without the information they need, may be isolated and either harm themselves looking to end an unwanted pregnancy or will be harmed because they went to an unscrupulous and illegal provider,” said Booth, now 77.

A key difference between the 60s and today is medication abortion, which 54% of people in the United States used to end a pregnancy in 2022. Available via prescription and through the mail, use of the drugs is two-fold: A person takes a first pill, mifepristone, to block the hormone needed for a pregnancy to continue.  A day or two later, the patient takes a second drug, misoprostol, which causes the uterus to contract, creating the cramping and bleeding of labor.

In early April a Texas judge, US District Judge Matthew Kacsmaryk – a Trump appointee who has been vocal about his anti-abortion stance — suspended the US Food and Drug Administration’s approval of mifepristone despite 23 years of data showing the drug is safe to use, safer even than penicillin or Viagra.

On Friday, the Supreme Court froze the ruling and a subsequent decision by the Fifth US Circuit Court of Appeals at the request of the Justice Department and the drug manufacturer. The action allows access to mifepristone in states where it’s legal until appeals play out over the months to come.

However, 15 states currently restrict access to medication abortion, even by mail.

The actions of anti-abortion activists, who have been accused of “judge shopping” to get the decisions they want, is “an unprecedented attack on democracy meant to undermine the will of the vast majority of Americans who want this pill — mifepristone — to remain legal and available,” Heather Booth told CNN.

“This is a further weaponization of the courts to brazenly advance the end goal of banning abortion entirely,” she added.

If women in her day could have had access to medications that could be used safely in their homes, they would not have been forced to risk their lives, said Dorie Barron, thinking back to her own terrifying abortion in a sketchy Chicago motel.

“I’m depressed as hell, watching stupid, indifferent men control and destroy women’s lives all over again,” she said. “I really fear getting an abortion could soon be like 1965.”

Chicago college student Heather Booth had just finished a summer working with civil rights activists in Mississippi when she was asked to help with a different kind of injustice.

Heather Booth, 18, with civil rights heroine Fannie Lou Hamer during

A girl in another dorm was considering suicide because she was pregnant. Booth, who excelled at both organization and chutzpah, found a local doctor and negotiated an abortion for the girl. Word spread quickly.

“There were about 100 women a week calling for help, much more than one person could handle,” Booth said. “I recruited about 12 other people and began training them how to do the counseling.”

Counseling was a key part of the new service. This was a time when people “barely spoke about sex, how women’s bodies functioned or even how people got pregnant,” Booth said. To help each woman understand what was going to happen to them, Booth quizzed the abortion provider about every aspect of the procedure.

“What do you do in advance? Will it be painful? How painful? Can you walk afterwards? Do you need someone to be with you to take you home?” The questions continued: “What amount of bleeding is expected, and can a woman handle it on their own? If there’s a problem is there an urgent number they can call?”

Armed with details few if any physicians provided, the counselors at Jane could fully inform each caller about the abortion experience. The group even published a flyer describing the procedure, long before the groundbreaking 1970 book “Our Bodies, Ourselves” began to educate women about their sexuality and health.

“I don’t particularly like doctors because I always feel dissatisfied with the experience,” said Marie Learner, who spoke to many of the women who underwent an abortion at her home.

“But after their abortion at Jane, women told me, ‘Wow, that was the best experience I’ve ever had with people helping me with a medical issue.’”

Eileen Smith, now 73, was one of those women. “Jane made you feel like you were part of this bigger picture, like we were all in this together,” she said. “They helped me do this illegal thing and then they’re calling to make sure I’m OK? Wow!

“For me, it helped battle the feeling that I was a bad person, that ‘What’s wrong with me? Why did I get pregnant? I should know better’ voice in my head,” said Smith. “It was priceless.”

Like many young women in the 60s, Heather Booth often protested for civil and women's rights.

Many of the women who joined Jane had never experienced an abortion. Some viewed the work as political, a part of the burgeoning feminist movement. Others considered the service as simply humanitarian health care. All saw the work as an opportunity to respect each woman’s choice.

“I was a stay-at-home mom with four kids,” said Martha Scott, who is now in her 80s. “We knew the woman needed to feel as though she was in control of what was happening to her. We were making it happen for her, but it was not about us. It was about her.”

Some volunteers, like Dorie Barron, experienced the Jane difference firsthand when she found herself pregnant a few years after her abortion at the hands of the Mafia.

“It was a 100% total reversal — I had never experienced such kindness,” Barron said. Not only did a Jane hold each woman’s hand and explain every step of the process, “they gave each of us a giant supply of maternity sanitary pads, and a nice big handful of antibiotics,” she said. “And for the next week, I got a phone call every other day to see how I was.”

Barron soon began volunteering for Jane by providing pregnancy testing for women in the back of a church in Chicago’s Hyde Park.

“It wasn’t just abortion,” Barron explained. “We also said, ‘You could consider adoption,’ and gave adoption referrals. And if the woman wanted to continue with her pregnancy, we said, ‘Fine, please by all that is holy make sure you get prenatal care, take your vitamins, and eat as best you can.’ It was women helping women with whatever they needed.”

Most of the women who contacted Jane were unable to support themselves, in unhealthy relationships, or already had children at home, so the service was a way of “helping them get back on track,” said Smith, who, like Barron, had begun working for Jane after her abortion.

“We were telling them ‘This isn’t the end of the world. You can continue to leave your boyfriend or your husband or continue to just take care of those kids you have.’ We were there to help them get through this,” said Smith, who later became a homecare nurse.

From left: Eileen Smith, Diane Stevens and Benita Greenfield were three of the dozens of women who volunteered for Jane.

Diane Stevens says she came to work for Jane after experiencing an abortion in 1968 at the age of 19. She was living in California at the time, which provided “therapeutic abortions” if approved in advance by physicians.

“I’d had a birth control failure, and I was coached by Planned Parenthood on how to do this,” said Stevens, now 74. “I had to see two psychiatrists and one doctor and tell them I was not able to go through with the pregnancy because it would a danger to both my physical and mental health.

“I was admitted to the psychiatric ward, although I didn’t really know that — I thought I was just in a hospital bed. But oh no, ‘I was mentally ill,’ so that’s where they put me,” said Stevens, who later went to nursing school with Smith. “Then they wheeled me off for the abortion. I had general anesthesia, was there for two days, and then I was discharged. Isn’t that crazy?”

Sakinah Ahad Shannon, now 75, was one of the few Black women who volunteered as a counselor at Jane. She joined after accompanying a friend who was charged a mere $50 for her abortion. At that time, Jane’s fee was between $1 and $100, based on what the woman could afford to pay, Shannon said.

“When I walked in, I said, ‘Oh my God, here we go again. It’s a room of White women, archangels who are going to save the world,’” said Shannon, a social worker and member of the Congress of Racial Equality, an interracial group of non-violent activists who pioneered “Freedom Rides” and helped organize the March on Washington in 1963.

What she heard and saw at her friend’s counseling session was so impressive it “changed my life,” Shannon said. She and her family later opened and operated three Chicago abortion clinics for over 25 years, all using the Jane philosophy of communication and respect.

“It was a profoundly amazing experience for me,” she said. “I call the Janes my sisters. The color line didn’t matter. We were all taking the same risk.”

Sakinah Ahad Shannon and her daughters went on to open and run three abortion clinics in Chicago.

It wasn’t long before the women discovered a “doctor” performing abortions for Jane had been lying about his credentials. There was no medical degree — in the HBO documentary, he admitted he had honed his skills by assisting an abortion provider.

The group imploded. A number of members quit in horror and dismay. For the women who stayed, it was an epiphany, said Martha Scott. Like her, several of the Janes had been assisting this fake doctor for years, learning the procedures step by step.

“You’d learn how to insert a speculum, then how to swap out the vagina with an antiseptic, then how to give numbing shots around the cervix and then how to dilate the cervix. You learned and mastered each step before you moved on to the next,” said Laura Kaplan, who chronicled the procedure in her book.

By now, several of the Janes were quite experienced and willing to do the work. Why not perform the abortions themselves?

“Clearly, this was an intense responsibility,” said Judith Acana, a 27-year-old high school teacher who joined Jane in 1970. She started her training by helping “long terms,” women who were four or five months along in the pregnancy.

“Remember, abortion was illegal (in Illinois) so it could take weeks for a woman to find help,” said Arcana, now 80. “Frequently women who wanted an abortion at 8 or 10 weeks wound up being 16 or 18 weeks or more by the time they found Jane.”

The miscarriage could happen quickly, but it rarely did, she said. It usually took anywhere from one to two days.

“Women who had no one to help them would come back when contractions started,” Arcana said. “One of my strongest memories is of a teenage girl who had an appointment to have her miscarriage on my living room floor.”

The group also paid two Janes to live in an apartment and be on call 24/7 to assist women who had no one to help them miscarry at home, said Arcana, a lifelong educator, author and poet. “But many women took care of it on their own, in very amazing and impressive and powerful ways,” she said.

Judith Arcana learned how to do abortions herself and wrote about the Jane experience in poems, stories, essays and books.

Any woman who had concerns or questions while miscarrying alone could always call Jane for advice any time of the day or night.

“People would call in a panic: ‘The bleeding won’t stop,’” Smith recalled. “I would tell them, ‘Get some ice, put it on your stomach, elevate your legs, relax.’ And they would say ‘Oh my gosh, thank you!’ because they were so scared.”

For women who were in their first trimester, Jane offered traditional D&C abortions — the same dilation and curettage used by hospitals then and today, said Scott, who performed many of the abortions for Jane. Later the group used vacuum aspiration, which was over in a mere five to 10 minutes.

“Vacuum aspiration was much easier to do, and I think it’s less difficult for the woman,” Scott said. “Abortion is exactly like any other medical procedure. It’s the decision that’s an issue — the doing is very straightforward. This was something a competent, trained person could do.”

It was May 3, 1972. Judith Arcana was the driver that day, responsible for relocating women waiting at what was called “the front” to a separate apartment or house where the abortions were done, known as “the place.”

On this day, a Wednesday, the “place” was a South Shore high-rise apartment. Arcana was escorting a woman who had completed her abortion when they were stopped by police at the elevator.

“They asked us, ‘Which apartment did you come out of?’ And the poor woman burst into tears and blurted out the apartment number,” Arcana said. “They took me downstairs, put cuffs on me and hooked me to a steel hook inside of the police van.”

Inside the apartment on the 11th floor, Martha Scott said she was setting up the bedroom for the next abortion when she heard a knock at the door, followed by screaming: “You can’t come in!”

“I shut the bedroom door and locked it,” Scott said, then hid the instruments and sat on the bed to wait. It wasn’t long until a cop kicked the door in and made her join the other women in the living room.

“We tell this joke about how the cops came in, saw all these women and said, ‘Where’s the abortionist?’ You know, assuming that it would be a man,” Scott said.

By day’s end, seven members of Jane were behind bars: Martha Scott, Diane Stevens, Judy Arcana, Jeanne Galatzer-Levy, Abby Pariser, Sheila Smith and Madeleine Schwenk. Suddenly what had been an underground effort for years was front page headlines.

“Had we not gotten arrested, I think no one would ever have known about Jane other than the women we served,” Scott said.

Top: Sheila Smith and Martha Scott.
Bottom: Diane Stevens and Judith Arcana.

An emergency meeting of Jane was called. The turnout was massive — even women who had not been active in months showed up, anxious to know the extent of the police probe, according to the women with whom CNN spoke.

Despite widespread fear and worry, the group immediately began making alternate plans for women scheduled for abortions at Jane in the next few days to weeks. The group even paid for transportation to other cities where abortion had already been legalized, they said.

News reports over the next few days gave further details of the bust: There was no widespread investigation by the police. It was a single incident, triggered by a call from a sister-in-law who was upset with her relative’s decision to have an abortion, they said.

“It wasn’t long after I was arrested that I came back and worked for quite a few months,” said Scott, one of the few fully trained to do abortions.

“I like to think I was a good soldier,” Scott said. “I like to think what did made a difference not only to a whole bunch of people, but also to ourselves. It gave us a sense of empowerment that comes when you do something that is hard to do and also right.”

As paranoia eased, women began to come back to work at Jane, determined to carry on.

“After the bust, we had a meeting and were told ‘Everybody needs to start assisting and learn how to do abortions.’ I was like, ‘Whoa, whoa, whoa!’” said Eileen Smith, who had not been arrested. “But you felt like you really didn’t have much of a choice. We had to keep the service running.”

Laura Kaplan volunteered for the Janes, later immortalizing the group in her book,

The preliminary hearing for the arrested seven was in August. Several of the women in the apartment waiting for abortions the day of the arrest suddenly developed amnesia and refused to testify. According to Kaplan’s book, one of the women later said, “The cops tried to push me around, but f**k them. I wasn’t going to tell on you.”

It didn’t matter. Each Jane was charged with 11 counts of abortion and conspiracy to commit abortion, with a possible sentence of up to 110 years in prison.

As they waited for trial, the lawyer for the seven, Jo-Anne Wolfson, adopted delaying tactics, Kaplan said. A case representing a Texas woman, cited as “Jane Roe” to protect her privacy, was being considered by the US Supreme Court. If the Court ruled in Roe’s favor, the case against the Jane’s might be thrown out.

That’s exactly what happened. On March 9, 1973, three months after the Supreme Court had legalized abortion in the US, the case against the seven women was dropped and their arrest records were expunged.

Later that spring, a majority of Janes, burned out by the intensity of the work over the last few years, voted to close shop. An end of Jane party was held on May 20. According to Kaplan’s book, the invitation read:

“You are cordially invited to attend The First, Last and Only Curette Caper; the Grand Finale of the Abortion Counseling Service. RSVP: Call Jane.”

Today, most of the surviving members of Jane are in their 70s and 80s, shocked but somehow not surprised by the actions of abortion opponents.

“This is a country of ill-educated politicos who know nothing about women’s bodies, nor do they care,” said Dorie Barron. “It will take generations to even begin to undo the devastating harm to women’s rights.”

In the meantime, women should research all available options, keep that information confidential, seek support from groups working for abortion rights, and “share your education with as many women as you can,” Barron added.

As more and more reproductive freedoms have been rolled back over the past year, many of the Janes are angry and fearful for the future.

Abortion rights demonstrators walk across the Brooklyn Bridge in New York nearly two weeks after the leak of a draft Supreme Court opinion that would overturn Roe v. Wade.

“This is about the most intimate decision of our lives — when, whether and with whom we have a child. Everyone should have the ability to make decisions about our own lives, bodies, and futures without political interference,” said Heather Booth, who has spent her life after leaving Jane fighting for civil and women’s rights.

“We need to organize, raise our voices and our votes, and overturn this attack on our freedom and our lives. I have seen that when we take action and organize we can change the world.”

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End of data sharing could make Covid-19 harder to control, experts and high-risk patients warn | CNN



KFF Health News
 — 

Joel Wakefield isn’t just an armchair epidemiologist. His interest in tracking the spread of covid is personal.

The 58-year-old lawyer who lives in Phoenix has an immunodeficiency disease that increases his risk of severe outcomes from covid-19 and other infections. He has spent lots of time since 2020 checking state, federal, and private sector covid trackers for data to inform his daily decisions.

“I’m assessing ‘When am I going to see my grandkids? When am I going to let my own kids come into my house?’ ” he said.

Many Americans have moved on from the pandemic, but for the millions who are immunocompromised or otherwise more vulnerable to covid, reliable data remains important in assessing safety.

“I don’t have that luxury to completely shrug it off,” Wakefield said.

The federal government’s public health emergency that’s been in effect since January 2020 expires May 11. The emergency declaration allowed for sweeping changes in the U.S. health care system, like requiring state and local health departments, hospitals, and commercial labs to regularly share data with federal officials.

But some shared data requirements will come to an end and the federal government will lose access to key metrics as a skeptical Congress seems unlikely to grant agencies additional powers. And private projects, like those from The New York Times and Johns Hopkins University, which made covid data understandable and useful for everyday people, stopped collecting data in March.

Public health legal scholars, data experts, former and current federal officials, and patients at high risk of severe covid outcomes worry the scaling back of data access could make it harder to control covid.

There have been improvements in recent years, such as major investments in public health infrastructure and updated data reporting requirements in some states. But concerns remain that the overall shambolic state of U.S. public health data infrastructure could hobble the response to any future threats.

“We’re all less safe when there’s not the national amassing of this information in a timely and coherent way,” said Anne Schuchat, former principal deputy director of the Centers for Disease Control and Prevention.

A lack of data in the early days of the pandemic left federal officials, like Schuchat, with an unclear picture of the rapidly spreading coronavirus. And even as the public health emergency opened the door for data-sharing, the CDC labored for months to expand its authority.

Eventually, more than a year into the pandemic, the CDC gained access to data from private health care settings, such as hospitals and nursing homes, commercial labs, and state and local health departments.

CDC officials have been working to retain its authority over some information, such as vaccination records, said Director Rochelle Walensky.

Walensky told the U.S. House in February that expanding the CDC’s ability to collect public health data is critical to its ability to respond to threats.

“The public expects that we will jump on things before they become public health emergencies,” she later told KFF Health News. “We can’t do that if we don’t have access to data.”

The agency is negotiating information-sharing agreements with dozens of state and local governments, Walensky said, as well as partnering with the Centers for Medicare & Medicaid Services. It is also lobbying for the legal power to access data from both public and private parts of the health care system. The hospital data reporting requirement was decoupled from the health emergency and is set to expire next year.

But it’s an uphill battle.

“Some of those data points we may not have anymore,” Walensky said, noting how access to covid test results from labs will disappear. That data became a less precise indicator as people turned to at-home testing.

Moving forward, Walensky said, the CDC’s covid tracking will resemble its seasonal flu surveillance, which uses information from sample sites to establish broad trends. It’ll offer a less granular view of how covid is spreading, which experts worry could make it harder to notice troubling new viral variants early.

Overall, federal courts — including the U.S. Supreme Court — have not been supportive of expanded public health powers in recent years. Some issued rulings to block mask mandates, pause mandatory covid vaccination requirements, and end the nationwide eviction moratorium.

Such power limits leave the CDC with its “utterly dysfunctional, antiquated” data collection system, said Lawrence Gostin, director of the O’Neill Institute for National and Global Health Law at Georgetown University. It’s like a “mosaic,” he said, in which states and territories collect data their own way and decide how much to share with federal officials.

Although covid numbers are trending down, the CDC still counts thousands of new infections and hundreds of new deaths each week. More than 1,000 Americans are also hospitalized with covid complications daily.

“When we stop looking, it makes it all more invisible,” Gostin said. “Covid knowledge and awareness is going to melt into the background.”

State and local public health officials are generally willing to share data with federal agencies, but they often run into legal hurdles that prevent them from doing so, said Marcus Plescia, chief medical officer of the Association of State and Territorial Health Officials.

It will take a lot of work to loosen state restrictions on public health data. And the political will may be lacking, considering many jurisdictions have rolled back public health powers in recent years. Until rules change, the CDC’s power to help states is limited, Plescia said.

“Their hands are tied a little bit in how much they can do,” he said.

Public health officials rely on data to target interventions and track how well they’re working. A lack of information can create blind spots that exacerbate poor outcomes for high-risk populations, said Denise Chrysler, a senior adviser for the Network for Public Health Law.

“If you don’t have the data, you can’t locate who you’re failing to serve. They’re going to fall between the cracks,” she said.

The lack of covid data broken down by race and ethnicity in the early days of the pandemic obscured the outsize impact covid had on marginalized groups, such as Black and Hispanic people, Chrysler said. Some states, like New Jersey and Arizona, issued rules to mandate the collection of race and ethnicity data for covid, but they were temporary and tied to state emergency declarations, she said.

Inconsistent local data precipitated the end of privately run projects that supplemented government resources.

The available data researchers could pull from “was just terrible,” said Beth Blauer, associate vice provost for public sector innovation at Johns Hopkins, who helped launch its dashboard. The decision to end the program was practical.

“We were relying on publicly available data sources, and the quality had rapidly eroded in the last year,” she said.

The fast collapse of the data network also raises questions about state and local agencies’ long-term investments in tracking covid and other threats.

“I wish that we had a set of data that would help us guide personal decision-making,” Blauer said. “Because I’m still fearful of a pandemic that we don’t really know a ton about.”

To Schuchat, formerly of the CDC, there’s a lot of ground to regain after years of underinvestment in public health, long before the covid pandemic — and high stakes in ensuring good data systems.

The CDC’s detection of a vaping-related lung illness in 2019 was recognized after case reports from a hospital in Wisconsin, she said. And she attributed the nation’s slow reaction to the opioid crisis on poor access to emergency room data showing a troubling trend in overdoses.

“We’re much better when we detect things before there’s an emergency,” Schuchat said. “We can prevent major emergencies from happening.”

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Covid-sniffing dogs can help detect infections in K-12 schools, new study suggests | CNN



CNN
 — 

Elementary students lined up behind a white curtain in the middle of a grand gymnasium at their school in northern California. They stood still as a dog handler walked a yellow Labrador along the other side of the curtain.

Hidden from the children’s view, the 2-year-old female pup sniffed each child’s shoes from beneath that curtain barrier. After each sniff, the dog looked back up at the handler. Then the handler brought the dog to the next tiny pair of feet beneath the curtain, and the dog curiously brought her snout close to those toes, then a young girl’s lavender tennis shoes and then another child’s white high-tops.

The dog was smelling for what are called volatile organic compounds that are known to be associated with Covid-19 infections.

While watching the Covid-sniffing dog in action, Dr. Carol Glaser saw her vision come to life.

Months prior, Glaser and her team were implementing the school’s Covid-19 testing program, using antigen nasal swab tests. Around that same time, Glaser heard about reports of dogs being used to screen for Covid-19 infections in sports venues, airports and other public settings.

That’s when Glaser had her “aha” moment – incorporating canines into Covid-19 testing programs at schools, nursing homes or other public facilities could help save time, personnel, possibly even costs, and “would be a lot more fun,” she said.

“I thought if we had dogs in schools to screen the students it would be so much faster and less burdensome for schools,” said Glaser, assistant deputy director in Central Laboratory Services and medical officer for infectious disease laboratories at the California Department of Public Health.

“Remember when an antigen test is done at school, as opposed to home, there’s a whole bunch of rules and regulations that run under that. It’s not as simple as just handing those things out at school and having the kids do them,” said Glaser, who oversaw antigen testing programs at some California public schools.

For now, Glaser and her colleagues described in a new study the lessons they learned from the Covid-19 dog screening pilot program that they launched in some California K-12 public schools.

In their research, published Monday in the journal JAMA Pediatrics, they wrote that the goal was to use dogs for screening and only use antigen tests on people whom the dogs screened as positive – ultimately reducing the volume of antigen tests performed by about 85%.

They wrote that their study supports the “use of dogs for efficient and noninvasive” Covid-19 screening and “could be used for other pathogens.”

The dogs used in the pilot program – two yellow Labradors named Rizzo and Scarlett – trained for a couple of months in a laboratory, sniffing donated socks that were worn by people who either had Covid-19 or didn’t. The dogs alerted their handlers when they detected socks that had traces of the disease – and received a reward of either Cheerios or liver treats.

“The one thing we do know for sure is when you’re collecting a sample off of a human being, you want to go where the most scent is produced. That is the head, the pits, the groin and the feet. Given those options, I went with feet,” said Carol Edwards, an author of the study and executive director of the nonprofit Early Alert Canines, which trains medical alert service dogs, including Rizzo and Scarlett.

“We collected some socks from people willing to donate socks, and we taught the dogs, by smelling the socks, which ones were the Covid socks and they picked it up very quickly,” Edwards said. “Then we moved into the schools and started sniffing the kids at the ankles.”

Last year, from April to May, the dogs visited 27 schools across California to screen for Covid-19 in the real world. They completed more than 3,500 screenings.

Rizzo acted as an energized worker, performing tasks with eagerness, Edwards said, while Scarlett tended to have more of a mellow and easygoing personality.

The screening process involves people – who voluntarily opted in to participate – standing 6 feet apart while the dogs, led by handlers, sniff each person’s ankles and feet. The dogs are trained to sit as a way of alerting their handlers that they detect a potential Covid-19 infection.

To protect each person’s privacy, sometimes the people face away from the dogs and toward a wall or behind a curtain, so that they can’t see the dogs or when a dog sits. If the dog sits in between two people, the handler will verbally ask the dog, “Show me?” And the dog will move its snout to point toward the correct person.

“Our dogs can come in, they can screen 100 kids in a half hour, and then only the ones the dog alerts on have to actually do a test,” Edwards said. “There’s no invasive nasal swab unless the dog happens to indicate on you.”

The researchers found that the dogs accurately alerted their handlers to 85 infections and ruled out 3,411 infections, resulting in an overall accuracy of 90%.

However, the dogs inaccurately alerted their handlers to infections in 383 instances and missed 18 infections, which means the dogs demonstrated 83% sensitivity and 90% specificity when it came to detecting Covid-19 infections in the study.

“Once we stepped into the schools, we saw a drop in their specificity and sensitivity due to the change,” Edwards said, referring to the distractions that children in a school setting can bring. However, Edward said, accuracy improved as the dogs spent more times in schools.

In comparison, Covid-19 BinaxNOW antigen tests have been shown in one real-world study to demonstrate 93.3% sensitivity and 99.9% specificity. That study was conducted in San Francisco and published in 2021 in The Journal of Infectious Diseases.

“We never said the dogs will replace the antigen. This was a time for us to learn how they compared,” Glaser said. “We will always plan on doing some amount of backup testing, but the idea would be that the actual antigen testing would be a fraction of what it would currently be because of the dogs.”

“To run these antigen testing programs at school, it’s taking a lot of school personnel resources, test cards as well as biohazard waste. So, I have no doubt in the long-run once it can be perfected, dogs will be cheaper, but I don’t have a great cost comparison,” she said.

This isn’t the first time that dogs’ abilities to detect traces of Covid-19 infections in real-time have been studied in the scientific literature.

“What we have learned in this work is that the dogs in general are capable of discriminating samples from individuals testing,” said Dr. Cindy Otto, professor and director of the Penn Vet Working Dog Center at the University of Pennsylvania, who was not involved in the new study.

Regarding the new research, Otto said, “On the surface their results are encouraging and with the appropriate selection of dogs, rigorous training and impeccable quality control, there is the potential for dogs to be incorporated in threat monitoring.”

Now that Glaser and her colleagues have published research about their Covid-19 dog screening pilot program, she is eager to implement the approach in nursing home settings.

“Honestly, schools aren’t that interested in testing anymore. The outbreaks just aren’t what they used to be, but what we have done is we’ve transitioned to nursing homes, because there is a tremendous need in nursing homes,” Glaser said, adding that many residents may prefer to undergo screening with a dog than with uncomfortable nasal swabs. “What would you rather have: A swab in your nose or something that just maybe tickles your ankle at most for testing?”

Covid-sniffing dogs Scarlett and Rizzo at a skilled nursing home in California.

In skilled nursing homes, the dogs visit each resident’s room to sniff their feet, calmly smelling for Covid-19 volatile organic compounds as the resident lies in bed or sits in a chair.

“Thinking about where dogs would be deployed, I do really think nursing homes and residential care facilities and even schools – if they were ever to have a big outbreak – would be the natural next fit for this,” Glaser said.

“We think we’ll probably end up primarily using them in nursing homes,” she said. “But we’re still doing a little bit of both – there was a school that asked us to come back last week.”

The pilot program within California public schools also has left Edwards with hope for future opportunities in which canines can help detect disease in humans.

“I really do think it’s the tip of the iceberg. This is the door swinging wide open, and now we need to collaborate with those in the science world and figure out where we can take this,” Edwards said.

“There’s been a lot of chatter, even in the very beginning of this project, talking about what other diseases they could do. We’ve talked about TB, we’ve talked about flu A and B, possibly for this next flu season, seeing if we can get the dogs to alert on that,” she said, as volatile organic compounds are also produced by people with influenza. “It’s just a matter of being able to figure out how to collect samples, how to train the dogs, and then to be safe and effective around those diseases too.”

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The cost of senior care is rising while caregivers are ‘drowning’ without help | CNN



CNN
 — 

For most of her life, Tammy La Barbera has been taking care of someone other than herself. First, it was her two children. Then, it was her brother and father, who both died after being diagnosed with cancer. Now, Tammy is taking care of her 90-year-old mother, Ada, who was diagnosed with dementia five years ago.

In recent months, Ada’s condition deteriorated so quickly that Tammy resigned from her job as an event manager to become a full-time caregiver.

“I don’t have help here, and I know it’s going to get worse,” she said.

Tammy, 53, struggles to provide her mother with the care she needs and would like to place her in a memory care facility equipped to handle the mood swings and outbursts that her mother has due to her condition. But Tammy says she doesn’t expect to ever have enough money to pay for that care.

Recently, she said, she looked into an assisted living facility near her home in Murrieta, California. She says placing her mother at the facility – or others like it – would cost between $7,000 and $10,000 a month out-of-pocket.

Across the country, millions of caregivers like Tammy are looking after a loved one – a relative or a friend. About 53 million US adults are caregivers, according to a 2020 report from AARP.

Sixty-three percent of US caregivers who look after adults said the person they were looking after needed care because of “long-term physical conditions,” the report says.

Since her mother’s diagnosis, Tammy’s life has been turned upside-down.

Ada cannot bathe herself or cook for herself. Most days, she doesn’t even remember who her daughter is.

“All her daily duties are done by me,” Tammy said, caring for her mother all day is like being a prisoner in her own home.

Sooner or later, she said, she will have to move her mother to a long-term care facility and do whatever she can to pay for it.

“I know that I’m reaching a crossroads with my mom’s care, and I’m trying to do this as long as I can,” Tammy said. “But I know the way things are going, and if she’s progressing pretty rapidly, I’m not going to have a choice.”

Ada La Barbera was a teacher for 20 years, so she gets a pension check each month. Tammy puts that money, along with her mother’s monthly Social Security checks, toward bills.

It’s just over $3,300 a month, and along with Tammy’s dwindling savings, it’s barely enough to keep them afloat, Tammy says. She can barely afford her rent.

It’s because of her financial struggles that Tammy has been putting off long-term care for her mother.

Where Tammy and Ada live in California, a home health aide would cost about $137 for one hour of care, according to an online calculator from AARP.

“When you’re on a fixed income, you can’t afford that,” Tammy said. “So I don’t have the luxury to do that.”

A long-term care facility is even more expensive. On average, it costs $10,830 a month to stay at a nursing home and $5,806 per month for an assisted living facility, according to the nonprofit National Investment Center for Senior Housing and Care.

Then there is memory care, where Tammy says her mother belongs.

Memory care facilities are the fastest-growing sector of the senior housing market, according to the National Investment Center. On average, memory care costs just over $7,500 a month, center COO Chuck Harry says.

These facilities offer more hands-on care for people with dementia. They can include special features like locked units that prevent wandering patients from leaving the facility unattended and enclosed outdoor spaces where patients can move about safely.

A nurse comes to see Ada at home every other week. During that 40-minute visit, Ada’s vitals are checked, and her medications are adjusted. Those visits are covered by Medicare, Tammy says.

Medicare is a medical health insurance program that is for people 65 years or older. But Medicare does not cover the cost of a long-term care facility.

And although Ada and Tammy are on a fixed income, Ada doesn’t qualify for other federal safety net programs like Medicaid because Tammy says they are not considered low-income.

For middle-income families, Medicaid goes into effect only after a family has gone through the process of “spending down” their assets until they qualify for the program.

“That is usually the path of anyone going into a nursing home for the long term: spending your own money – which is all out of pocket – and then reaching a Medicaid level of eligibility,” said Susan Reinhard, senior vice president and director of the AARP Public Policy Institute, noting that each state has its own Medicaid program and process.

Until a family qualifies for Medicaid, the program will only cover the medical costs of a stay at a long-term facility, not room and board.

Caroline Pearson, the lead author of a landmark 2019 demographic study called “The Forgotten Middle,” says most middle-income Americans find themselves in a position where they are too “wealthy” to receive Medicaid coverage for long-term care services but too “poor” to afford the out-of-pocket costs of that care.

So why does putting a loved one in a nursing home or an assisted living facility cost so much? Providing long-term care services is expensive, Pearson says, adding that the senior housing industry requires a large workforce of nurses and staff to support it. That is also expensive.

Additionally, as seniors sell their homes and move into these facilities, long-term care facilitators are essentially providing housing, she said. And housing is not cheap.

The senior housing industry also caters to a high-income population, according to Pearson, who is now executive director of the Peterson Center on Healthcare.

“The fit and finish at the buildings … [residents] expect to be really high-end. The amount of amenities and services that are part of that senior housing property … they expect to be high-end,” she said. “The market has seen good returns and then replicated that model.”

And the demand for high-quality, long-term care is only expected to go up as the baby boomer generation continues to age, according to Pearson.

“Most people don’t begin to need long-term care services until between 75 and 85. And so as the baby boomers hit those ages, that is where we’re going to see that demand really explode,” she said.

According to the US Census Bureau, baby boomers – people born from 1946 to 1964 – will all be over the age of 65 by 2030. The oldest members of that generation will be 84 at that point.

In 2019, there were about 8 million middle-income seniors – people 75 and older – living in the United States, Pearson says in her study.

She projects that there will be 14.4 million middle-income seniors in the US by 2029, with 60% expected to have mobility limitations and 20% expected to have “high health care and functional needs.”

“We are going to [have] double the number of middle-income seniors when the baby boomers age,” Pearson said. “Fewer of those baby boomers are going to have spouses or children who live nearby to provide unpaid caregiving support.”

Most family caregivers are spouses or middle-age daughters, the study notes.

At the end of the day, Pearson says, many Americans don’t think about aging until it’s staring them in the face.

“People [think] that they will live healthy and independently until they die, and sadly, that’s just statistically very unlikely for most people,” she said.

Tammy, with her parents and brother, says her family thought they were prepared for the future.

Tammy says her family thought they were prepared for the future.

In 1965, Ada married Tammy’s father, Peter “Jazz” La Barbera, an accountant.

“My dad was a very, very good saver, and he did have a little bit of savings,” Tammy said. “He was set just for the future, not for anything unexpected.”

In 1970, Tammy was born in Queens. She and her older brother, Peter Jr., grew up an hour outside New York City.

“We had a small house, and we lived in that house our whole lives, and … we were the perfect family,” Tammy said.

She eventually moved to California, where she had two kids. Her parents followed, along with her brother and his wife.

Tammy says the physical and mental toll of caring for her husband and son kickstarted Ada's health problems.

But soon after the move, Peter Jr. was diagnosed with cancer, and he died a year later. Two years after that, Tammy’s father received a cancer diagnosis and died within seven weeks.

Tammy believes that the physical and financial toll of taking care of her son and husband kickstarted her mother’s health problems. Shortly after her husband died, Ada had a minor stroke and was diagnosed with dementia.

“It’s almost like her grief was so overwhelming. Especially losing her son. I don’t think her brain had the capacity to deal with anything else anymore,” Tammy said.

The stress associated with taking care of a loved one full-time, or even part-time, can have negative consequences, research has shown.

Some of the physical symptoms associated with taking care of someone with dementia include higher levels of depression and anxiety, worse self-reported physical health, compromised immune function and increased risk of early death, the US Centers for Disease Control and Prevention reports.

Over half (53%) of caregivers indicate that a decline in their health compromises their ability to provide care, according to the CDC.

“I have sacrificed 10 years of my life being a caretaker, and I don’t have a life,” Tammy said. “It’s an honor to take care of my mother. But doing this every single day … it’s a lot.”

Tammy is preparing for her own future by taking part in genetic testing that will tell her whether she is more likely to develop dementia like her mother.

“I would like to prepare as much as I can, whether it’s medication or adjusting my life,” she said. “I just don’t want to put my kids through this.”

She would also like to see changes to the system.

Pearson says the solution to the cost issue is not simple and will probably be resolved only through a combination of incremental Medicaid expansion, changes to the senior housing industry and federal subsidies.

AARP’s Reinhard says tax credits for family caregivers could help people like Tammy get a break. Employers could also help by supporting workers who need to stop working to care for a family member or friend.

In September, the US Department of Health and Human Services, through its Administration for Community Living, announced a national strategy aimed at supporting family caregivers, highlighting nearly 350 actions the federal government will take.

The strategy also includes 150 actions that it says local governments, communities and private businesses can adopt to help build a more supportive system.

“Supporting family caregivers is an urgent public health issue, exacerbated by the long-term effects of the COVID-19 pandemic,” HHS Secretary Xavier Becerra said in a news release. “This national strategy recognizes the critical role family caregivers play in a loved one’s life.”

Gal Wettstein, a senior research economist for the Center for Retirement Research at Boston College, says it would be beneficial for middle-income Americans to speak to a financial adviser as early as possible and transfer assets to a family member if they think they might need to enter a long-term care facility in the near future.

This way, if their only option is to spend down their assets to become eligible for Medicaid, they hit that eligibility sooner.

Long-term care insurance is another option, but experts say it’s rarely sold anymore because it is typically more expensive than other kinds of insurance.

Pearson says Americans can plan ahead by investing in long-term care insurance in their 40s for it to benefit them when they will most likely need it, in their 80s.

Wettstein also recommends long-term care insurance.

“[Long-term care insurance] plans are getting harder and harder to sign, but they do still exist. Some insurers will still sell them,” he said.

Ultimately, covering the cost of senior care comes down to families and how much they save for the future, until changes are made by senior housing providers and policy makers.

“We are so far away from having any sort of swift and universal solution,” Pearson said.

For now, Ada is on a waitlist for a spot at a skilled-nursing home about an hour from where they live. If she moves there, her cost of living might be partially covered through a Medicaid program.

Tammy was told that Ada is one of more than 2,000 people waiting for a spot.

“We’re drowning. We’re care workers, and we’re drowning,” Tammy said. “We don’t have help.”

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