She found Forbes face down in the street in August 2023, two weeks before he had planned to move away from the empty storefronts, boarded-up houses, and poverty that make this one of the most troubled places in the nation.

Naketra Guy thought about how her son overcame losing his father at age 4 and was the glue of the family. She called him “humble” and “respectful,” a leader in the community and on the football field, where he shined.

Yet he could not outrun the grim statistics of his hometown. Bogalusa posts some of the worst health outcomes and poverty in Louisiana, a state that routinely ranks among the worst nationally in both. And Bogalusa has endured another indicator of poor public health: high levels of gun violence.

Since the beginning of the covid-19 pandemic, gun violence has shattered any sense of peace or progress here. Louisiana suffers the nation’s second-highest firearm death rate — and Bogalusa, a predominantly Black community with 10,000 residents, has seen dozens of shootings and a violent crime rate approaching twice the national average.

A nearby team refused to play football at Bogalusa High School in fall 2022, citing safety concerns.

Bogalusa’s mayor, Tyrin Truong, was elected in 2022 at age 23 on his promises to fix entrenched challenges: few youth programs and good jobs, and perpetual crime and blight.

“I ran for mayor because I got sick of seeing our city painted as mini-New Orleans,” he said, “due to the high levels of youth gun violence.”

In January, the Louisiana State Police arrested Truong, accusing him of soliciting a prostitute and participating in a drug trafficking ring that allegedly used illicit proceeds to buy firearms. He has said he is innocent. “I still haven’t been formally arraigned,” he told KFF Health News in late July, “and I haven’t been charged with anything.”

Every year tens of thousands of Americans — one every few minutes — are killed by gun violence on the scale of a public health epidemic.

Many thousands more are left to recover from severe injuries, crushing medical debt, and the mental health toll of losing loved ones.

Most headlines focus on America’s urban centers, but the numbers also reflect the growth of gun violence in places like Bogalusa, a pinprick of a town 75 miles north of New Orleans. In 2020, the gun violence death rate for rural communities was 40% higher than in large metropolitan areas, according to Johns Hopkins University.

Firearms are the No. 1 killer of children in the U.S., and no group suffers more than young Black people. More Black boys and men ages 15 to 24 in 2023 were killed in gun homicides than from the next 15 leading causes of deaths combined. Though overall U.S. homicides dropped sharply after the pandemic ended, adolescent gun deaths climbed even higher in the years after, according to research by Jonathan Jay, an associate professor in the School of Public Health at Boston University.

“It has all the markers of an epidemic. It is a major driver of death and disability,” Jay said. “Gun violence does not get the attention it deserves. It is underrecognized because it disproportionately impacts Black and brown people.”

Rather than bolstering efforts to save lives, federal, state, and local government officials have undermined them. KFF Health News undertook an examination of gun violence since the pandemic, a period when firearm death rates surged. Reporters reviewed government reports and academic research and interviewed dozens of health policy experts, activists, and victims or their relatives. They reviewed corporate earnings reports from gun manufacturers and data on the industry’s donations to politicians.

In polling published in 2023 by KFF, more than half of Americans said they or a family member had been impacted by gun violence such as by seeing a shooting or being threatened, injured, or killed with a gun.

American politicians and regulators have put in place laws and practices that have helped enrich firearm and ammunition manufacturers — which tout $91 billion in economic impact — even as gun violence has terrorized neighborhoods already damaged by white flight, systemic disinvestment, and other forms of racial discrimination.

President Donald Trump championed gun rights on the campaign trail and has received millions from the National Rifle Association, to whose members he promised, “No one will lay a finger on your firearms.” His administration has rolled back efforts under President Joe Biden to address the rise in gun violence.

Emboldened in his second term, Trump is pushing to allow more guns in schools, weaken federal oversight of the gun industry, override state and local gun laws, permit sales without background checks, and cut funding for violence intervention.

Trump ordered the attorney general to review all Biden administration actions that “purport to promote safety but may have impinged on the Second Amendment rights of law-abiding citizens.”

The Biden administration said “a historic spike in homicides” during the pandemic took its greatest toll on racially segregated and high-poverty neighborhoods.

Black youths in four major cities were 100 times as likely as white ones to experience a firearm assault, research showed. Gun suicides reached an all-time high, and for the first time the firearm suicide rate among older Black teens surpassed that of older white teens.

In Bogalusa, the pandemic gun violence spread fear. Among the victims killed were a 15-year-old attending a birthday party and a 24-year-old nationally known musician. Thirteen people were injured at a memorial for a man who himself had been shot. Residents said neighbors stopped sitting in their yards because of stray bullets.

Researchers say communities like Bogalusa endure a collective trauma that shatters their sense of safety. Two years after Forbes’ death, his mother says that when she leaves home her surviving children worry that she, too, might get shot.

Repercussions from the surge will last years, researchers said: Exposure to shootings increases risk for post-traumatic stress disorder, anxiety, suicide, depression, substance abuse, and poor school performance for survivors and those who live near them.

“We saw gun violence exposure go up for every group of children except white children, in the cities we studied,” Jay said. “Limits on government funding into gun violence research may stop us from ever knowing exactly why.”

Politics of Pain

The year before Forbes died in Bogalusa, Biden signed into law the Bipartisan Safer Communities Act, considered the most sweeping firearm legislation in decades.

In a matter of months, Trump has systematically dismantled key provisions.

Efforts to regulate guns have long proven ineffective against the power of political and business interests that fill the streets with weapons. In 2020, the number of guns manufactured annually in the U.S. hit 11.3 million, more than double a decade earlier, according to the federal government. In 2022, the United States had nearly 78,000 licensed gun dealers, more than its combined number of McDonald’s, Burger King, Wendy’s, and Subway locations, according to Everytown for Gun Safety, an advocacy group.

The Biden administration announced in 2021 it would attempt to reduce gun violence by adopting a “zero tolerance” policy toward firearm dealers who committed violations such as failing to run a required background check or selling to someone prohibited from buying a gun.

The federal Bureau of Alcohol, Tobacco, Firearms and Explosives, or ATF, which licenses gun dealers, has the authority to enforce laws meant to prevent illegal gun sales. In issuing an executive order, the Trump administration declared that, under Biden, the agency targeted “mom-and-pop shop small businesses who made innocent paperwork errors.”

From October 2010 to February 2022, the agency conducted more than 111,000 inspections, recommending revocation of a dealer’s license only 589 times, about 0.5% of cases, an inspector general’s report said. Even when it cited serious violations, the ATF rarely shut dealers down.

ATF leaders told the inspector general’s office that recommendations for license revocations increased after Biden’s zero-tolerance policy was implemented. In April, the Trump administration repealed it.

Surgeon General Vivek Murthy last year declared firearm violence a public health crisis. Within weeks of Trump’s inauguration, his administration removed the advisory. Of the 15 leading U.S. causes of death, firearm injuries received less research funding from the National Institutes of Health for each person who died than all but poisoning and falls, according to an analysis in 2024 by Brady, an anti-gun violence organization. Trump is trying to cut that funding, too.

Trump’s Department of Justice abruptly cut 373 grants in April for projects worth about $820 million, with a large share from gun violence intervention.

“We are going to lose a generation of community violence prevention folks,” said Volkan Topalli, a gun violence researcher at Georgia State University. “People are going to die, I’m sorry to say, but that is the bleak truth of this.”

Asked about its policies, the White House did not address questions about public health considerations around gun violence.

“Illegal violence of any sort is a crime issue, and President Trump has been clear since Day One that he is committed to Making America Safe Again by empowering law enforcement to uphold law and order,” White House spokesperson Kush Desai said.

Trump administration officials “want safer streets and less violence,” Topalli said. “They are hurting their cause.”

Garen Wintemute, an emergency medicine professor who directs the violence prevention program at the University of California-Davis, was among the first in the nation to consider guns and violence as a public health issue. He said race plays a significant role in perceptions about gun violence.

“People look at the demographic risk for firearm homicide and depending on the demographics of the people in the audience, I can see the transformation in their faces,” Wintemute said. “It’s like they’re saying, ‘Not my people, not my problem.’”

Eroding Gun Restrictions

Trump’s incursions against public health efforts to contain gun violence are backed by lobbying power.

Firearm industry advocacy groups made millions of dollars in political donations in recent years, mostly to conservative causes and Republican candidates. That includes $1.4 million to Trump, according to OpenSecrets, which tracks campaign finance data.

The assassination of civil rights icon the Rev. Martin Luther King Jr. helped lead to the passage of the federal Gun Control Act of 1968, which imposed stricter licensing rules and outlawed the sale of firearms and ammunition to felons.

While it remains the law of the land, over time, federal and state government actions have significantly weakened its protections.

Most states now allow people to carry concealed weapons without a permit or background check, even though research suggests the practice can increase the risk of firearm homicides.

In Louisiana, Democratic former Gov. John Bel Edwards, in office from 2016 to 2024, vetoed a bill that would have allowed people to carry concealed firearms without a permit.

Elected in 2023, Republican Gov. Jeff Landry signed a law to allow any person over age 18 to conceal-carry without a permit.

The Trump administration has created a task force to implement his executive order to end most gun regulations and which would allow more people with criminal convictions, including for domestic abuse, to own guns.

Figures vary, but some researchers estimate as many as 500 million guns circulate in the U.S. Sales reached record highs during the pandemic and publicly traded firearm and ammunition companies saw profits jump.

Donald Trump Jr. this summer joined the board of GrabAGun, an online gun retailer that went public in July under the stock ticker PEW. In a Securities and Exchange Commission filing, the company, which markets guns to people ages 18 to 44, cited “gun violence prevention and legislative advocacy organizations that oppose sales of firearms and ammunition” as threats to its sales growth.

Dave Workman, a gun rights advocate with the Second Amendment Foundation, said firearms are not to blame for the surge in pandemic shootings.

“Bad guys are going to do what bad guys are going to do regardless of the law,” Workman said. “Taking away gun rights is not going to reduce crime.”

David Yamane, a Wake Forest University sociology professor and national authority on guns, said the U.S. firearm debate is complex and the industry is often “painted with too broad a brush.”

Most guns will never be used to kill anyone, he said. Americans tend to buy more guns during times of unrest, Yamane added: “It’s part of the American tradition. Guns are seen as a legitimate tool for defending yourself.”

‘A Low Level of Hope’

Once called “the Magic City,” Bogalusa has become a grim symbol of deindustrialization.

Bogalusa emerged as Black people formed their own communities in the time of Jim Crow racial segregation at the turn of the 20th century.

Racism concentrated Black people in neighborhoods that became epicenters of poor health, reflected in high rates of cancer, asthma, chronic stress, preterm births, pregnancy-related complications — and, over recent decades, firearm violence.

Thousands flocked to Bogalusa after the Great Southern Lumber Company built one of the world’s biggest sawmills, establishing Bogalusa as a company town. Racial tensions soon followed.

Members of the local Deacons for Defense and Justice gained national attention in the 1960s for protecting civil rights organizers from the Ku Klux Klan, a hate group that burned houses and churches, terrorizing and killing Black people.

As the mill changed hands over the decades, Bogalusa’s fortunes slid. In the mid-20th century, the population surpassed 20,000, but it is now about half that.

International Paper, a Fortune 500 company based in Tennessee, runs the mill as a containerboard factory, employing about 650 people. In 2021, the state announced incentives for the company that included a $500,000 tax break, saying the move would help bring “prosperity.”

Businesses remain boarded up along the main drag. Houses still bear damage from Hurricane Katrina, and many streets are eerily quiet.

Nearly 1 in 3 people in Bogalusa live in poverty — 2½ times the national average.

Bogalusa’s violent gun crime rate reached 646.1 per 100,000 people in 2022, higher than Louisiana’s and 1.7 times the national one, according to the nonprofit Equal Justice USA, citing FBI Uniform Crime Reporting data.

In many rural towns across the South, “there is a level of desperation that is more apparent” than in other parts of the U.S., said Luke Shaefer, a University of Michigan professor of social justice and public policy.

“They don’t have the same infrastructure to have robust social services. People are like, ‘What are my life chances?’” Shaefer said. “People feel like there is nothing that can be done. There is a low level of hope.”

Missed Opportunities

Mayor Truong lamented the violence in Bogalusa after Forbes was killed, writing on Facebook, “When are we as a community going to come together and decide enough is enough?”

The federal government had offered one path forward.

The Biden administration provided billions of dollars to local governments through the American Rescue Plan Act during the pandemic. Biden urged them to deploy money to community violence intervention programs, shown to reduce homicides by as much as 60%.

A handful of cities seized the opportunity, but most did not. Bogalusa has received $4.25 million in ARPA funds since 2021. None appears to have gone toward violence prevention.

The Louisiana legislative auditor, Michael Waguespack, found that Bogalusa used nearly $500,000 for employee bonuses, which his report said may have violated state law. In some cases, the report says, payments were not tied to work performed.

Bogalusa officials did not respond to a public records request from KFF Health News seeking detailed information about its ARPA money.

Former Mayor Wendy O’Quin-Perrette, who served from 2015 through early 2023, told Waguespack in a June 2024 letter that the city used ARPA money to improve streets and pay the bonuses. “We would not have done it without being sure it was allowed,” she said.

O’Quin-Perrette did not respond to requests for comment.

In a 2023 letter to Waguespack, O’Quin-Perrette’s successor, Truong, wrote that Bogalusa officials didn’t know how the federal money was spent. When he took office, Truong alleged, officials discovered “tens of thousands of dollars of checks and cash” stashed “in various drawers and on desks” in city offices.

Truong defended his stewardship of ARPA funds, saying that about $1 million remained when he assumed office but that the money was needed for more urgent sewer infrastructure repairs. “I wish we could have invested more, invested any money in gun violence prevention efforts,” he said.

In an interview, Truong said the city has been “intentional” about bringing down gun violence, including through a summer jobs program. He pointed to statistics that show homicides decreased from nine in 2022 to two in 2024. “If you keep them busy, they won’t have time to do anything else,” he said.

Asked about his January arrest, Truong said he has political enemies.

“I’m the only Democrat in a very red part of the state, and, you know, I’ve made a lot of changes at City Hall, and that ticks people off,” Truong told KFF Health News. He said that he ended long-standing city contracts with local businesspeople. “When you’re shaking up power structures, you become a target.”

Josie Alexander, a Louisiana-based senior strategist for Equal Justice USA, said city officials missed an opportunity when they didn’t use ARPA funds for gun violence prevention. “The sad thing is people here can now see that money was coming in,” she said. “But it just wasn’t used the way it needed to be.”

‘Too Much Trouble Here’

Truong said the city is still reeling from the pandemic spike in violent crime. He said he was at Bogalusa High School’s homecoming football game in 2022 when one teen shot another. Shots rang out, Truong said, and he grabbed his 3-month-old son and “laid in the bleachers.”

“It’s not a foreign topic to hardly anybody in town, whether you’ve heard the gunshots in the distance, whether you have attended a funeral of somebody who passed due to gun violence,” he said. Many still grapple with trauma.

In December 2022, Khlilia Daniels said, she hosted a birthday party for her teenage niece, praying no one would bring a gun.

The hosts checked guests for weapons, she said.

Yet gunfire erupted, Daniels said. Three teens were shot, including 15-year-old Ronié Taylor, who died, according to police.

“When someone you know is killed, you never forget,” said Daniels, 32, who held Taylor until emergency responders arrived.

Tajdryn Forbes was planning his future when he was killed, likely because of a dispute that started on social media over lyrics in a rap song, Guy said.

In a Facebook post in January, Bogalusa police said they had arrested someone in connection with Forbes’ killing. Authorities had previously announced the arrest of a teen in connection with the homicide.

Forbes had been a high school football standout, like his late father, Charles Forbes Jr., who played semipro. When Forbes scored a touchdown, he would look to the sky to honor his dad.

The school praised Forbes for his senior baseball season in a social media post: “This young man makes a difference on our campus and on the field with his strong character.”

When hopes for a college football scholarship did not pan out, Forbes worked as a deckhand for a marine transportation company. He saved money, looking forward to moving to Slidell, a suburb of New Orleans.

“He would always say, ‘There’s too much trouble here’” in Bogalusa, Guy recalled.

The post Guns, Race, and Profit: The Pain of America’s Other Epidemic appeared first on Medika Life.

Last fall, before being named the senior U.S. health official, Robert F. Kennedy Jr. said the Trump administration would liberate Americans from the FDA’s “aggressive suppression” of vitamins, dietary supplements, and other substances — ending the federal agency’s “war on public health,” as he put it.

In fact, the FDA can’t even require that supplements be effective before they are sold. When Congress, at the agency’s urging, last considered legislation to require makers of vitamins, herbal remedies, and other pills and potions to show proof of their safety and worth before marketing the products, it got more negative mail, phone calls, and telegrams than at any time since the Vietnam War, by some accounts. The backlash resulted in a 1994 law that enabled the dietary supplement industry to put its products on the market without testing and to tout unproven benefits, as long as the touting doesn’t include claims to treat or cure a disease. Annual industry revenues have grown from $4 billion to $70 billion since.

With Kennedy now in the driver’s seat, the industry will likely expect more: It aims to make bolder health claims for its products and even get the government, private insurers, and flexible spending accounts to pay for supplements, essentially putting them on an equal footing with FDA-approved pharmaceuticals.

On Feb. 13, the day Kennedy was sworn in as secretary of Health and Human Services, President Donald Trump issued a “Make America Healthy Again” agenda targeting alleged corruption in health regulatory agencies and instructing them to “ensure the availability of expanded treatment options and the flexibility for health insurance coverage to provide benefits that support beneficial lifestyle changes and disease prevention.”

Kennedy has said exercise, dietary supplements, and nutrition, rather than pharmaceutical products, are key to good health. Supplement makers want consumers to be able to use programs like health savings accounts, Medicare, and even benefits from the Supplemental Nutrition Assistance Program, or SNAP, to pay for such items as vitamins, fish oil, protein powders, and probiotics.

“Essentially they’re seeking a government subsidy,” said Pieter Cohen, a Harvard University physician who studies supplements.

As the Senate Finance Committee questioned Kennedy during his Jan. 29 confirmation hearing, supporters in the Alliance for Natural Health lunched on quinoa salad in the U.S. Capitol Visitor Center and crowed that the moment had finally arrived for their health freedom movement, which has combined libertarian capitalism and mistrust of the medical establishment to champion unregulated compounds since the 19th century.

“The greatest opportunity of our lifetimes is before us,” said Jonathan Emord, the group’s general counsel, who has brought many successful lawsuits against the FDA’s restrictions on unproven health claims. “RFK has dedicated his whole life to opposing the undue influence” of the pharmaceutical industry and “assuring that our interests triumph,” Emord said.

In speeches and in a pamphlet called “The MAHA Mandate,” Emord and alliance founder Robert Verkerk said Kennedy would free companies to make greater claims for their products’ alleged benefits. Emord said his group was preparing to sue the FDA to prevent it from restricting non-pharmaceutical production of substances like biopeptides — complex molecules related to drugs like Ozempic.

HHS spokesperson Andrew Nixon did not respond to a request for comment on the agency’s plans vis-à-vis dietary supplements.

While the basic law governing the FDA establishes that a substance alleged to have treatment or curative effects is by definition a “drug,” and therefore comes under the agency’s requirements for high standards of scientific evidence, the new administration could reallocate money away from enforcement, said Mitch Zeller, former head of the FDA’s Center for Tobacco Products.

As a Senate aide early in his career, Zeller investigated a tainted L-tryptophan supplement that killed at least 30 people and sickened thousands in the U.S. in 1989. The scandal led the FDA to seek heavier regulation of supplements, but a powerful backlash resulted in the relatively weak supplements law of 1994.

Even that law’s enforcement could be undercut with a stroke of the pen that would keep FDA inspectors out of the field, Zeller said.

Sweeping changes couldn’t come too soon for Nathan Jones, founder and CEO of Xlear, a company that makes products containing xylitol, an artificial sweetener. The Federal Trade Commission sued Xlear in 2021 for making what it called false claims that its nasal spray could prevent and treat covid.

Jones points to a handful of studies evaluating whether xylitol prevents cavities and infections, saying the FDA would require overly expensive studies to get xylitol approved as a drug. Meanwhile, he said, dentists have been bought out by “Big Toothpaste.”

One can hardly find any products “without fluoride for oral health,” he said. “Crest and Colgate don’t want it to happen,” he said.

Kennedy’s desire to rid water supplies of fluoride because of its alleged impact on children’s IQ is welcome news, he said, and not only because it could highlight the value of his products. Jones stresses, as do many health freedom advocates, that clean air and water and unadulterated food do more to prevent and cure disease than vaccines and drugs. For example, he and other advocates claim, wrongly, that the United States eliminated the crippling disease polio through better sanitation, not vaccination.

The Alliance for Natural Health hopes that in lieu of strict FDA standards, Kennedy will enable companies to make expanded marketing claims based on evidence from non-FDA sources, Verkerk said, such as the National Institutes of Health’s nutritional information site, which describes the pros and cons of different supplements.

Kennedy has also called for relaxing the strictures on psychedelic drugs, which interest some veterans as potential remedies for such conditions as post-traumatic stress disorder. VETS, a San Diego-based organization, has paid for 1,000 veterans to get treatment with the powerful hallucinogen ibogaine at clinics in Mexico and other countries, said the group’s co-founder Amber Capone.

She got involved after her husband, a retired Navy SEAL, pulled out of a suicidal spiral after spending a week at an ibogaine clinic near Tijuana, Mexico, in 2017. She wants NIH, the Defense Department, and the Department of Veterans Affairs to fund research on the illegal substance — which can cause cardiac complications and is listed as a Schedule I drug, on par with heroin and LSD — so it can be made legally available when appropriate.

Coincidentally, the push for less onerous standards on supplements and psychedelics would come while Kennedy is demanding “gold-standard science” to review preservatives and other food additives that he has said could play a role in the country’s high rate of chronic diseases.

“Put aside the fact that there’s precious little evidence to support” that idea, said Stuart Pape, a former FDA food center attorney. “There’s been no indication they want the same rigor for supplements and nutraceuticals.”

Although most of these products don’t have major safety concerns, “we have no idea which products work, so in the best case people are throwing away a ton of money,” Zeller said. “The worst-case scenario is they are relying on unproven products to treat underlying conditions, and time is going by when they could have been using more effective FDA-authorized products for diseases.”

Supplement makers aren’t entirely unified. Groups such as the Consumer Healthcare Products Association and the Council for Responsible Nutrition have advocated for the FDA to crack down on products that are unsafe or falsely represented. The Alliance for Natural Health and the Natural Products Association, meanwhile, largely want the government to get out of the way.

“The time has come to embrace a radical shift — from reactive disease management to proactive health cultivation, from top-down public health diktats to personalized, individual-centric care,” Emord and Verkerk state in their “MAHA Mandate.”

The post With RFK Jr. in Charge, Supplement Makers See Chance To Cash In appeared first on Medika Life.

FALLON, Nev. — Linda Noneo turned up the heat in her van to ward off the early-morning chill that persists in northern Nevada’s high desert even in late June. As the first rays of daylight broke over a Christian cross on the top of a hill near the Fallon Paiute-Shoshone colony, she drove toward her first stop to pick up fellow tribal members waiting for transportation to their medical appointments.

Noneo is one of four community health representatives for the Fallon Paiute-Shoshone, which the tribe said includes about 1,160 enrolled members. The role primarily involves driving tribal members to their health appointments, whether in Fallon, a city of just under 10,000, or Reno, more than 60 miles west. Noneo said she and her colleagues have also taken patients as far away as Sacramento, California, and Salt Lake City, round trips of nearly 400 and 1,000 miles, respectively.

Public health experts contend the role Noneo and others like her fill is an integral part of ensuring people receive the care they need, especially for chronic illnesses, by helping close gaps in areas with medical provider shortages. Besides transporting patients to their appointments, community health representatives provide health education, patient advocacy, and more. Noneo said she and her colleagues spend a lot of time helping young mothers and elders, checking on the latter, taking them to get groceries, or delivering their medication.

Yet, most state Medicaid programs don’t recognize or pay for services offered by health workers, such as Noneo, who work on tribal lands. That’s despite their work being essentially the same as that of “community health workers” in nontribal communities, a classification many state Medicaid programs cover.

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In Nevada, that disparity recently changed when the state began allowing workers on tribal lands to qualify for Medicaid reimbursement as community health workers. Tribal leaders say the Medicaid payments supplement existing personnel funding by covering the individual services the workers provide. That in turn should allow tribes to train and hire more community health representatives, which could expand health and support services for tribal members.

Only two other states, South Dakota and Arizona, treat community health representatives serving Native American populations as eligible for the same Medicaid reimbursement as their similarly named counterparts in nontribal areas, according to Michelle Archuleta, a community health representative program consultant for the federal Indian Health Service. However, she said, the tribes the CHRs work for have not begun billing the states’ Medicaid programs.

The Community Health Representative program, established by Congress in 1968, is among the nation’s oldest community health workforces. It’s jointly funded by each tribe and the IHS, an agency within the Department of Health and Human Services responsible for providing health care to members of federally recognized tribes. As of 2019, more than 1,600 of these tribal linchpins worked in the United States, according to the IHS.

Last year, the Centers for Medicare & Medicaid Services approved Nevada’s plan to make community health workers who complete training and certification requirements eligible for Medicaid reimbursement when they assist with chronic disease management and prevention.

And in December, leaders with the Nevada Community Health Worker Association helped tribes make sure their community health representatives would receive the necessary training for certification. The association would “fully support” tribal clinics submitting their community health representative training for recognition in the state and it would not require a change to state law, said Jay Kolbet-Clausell, program director for the group. For now, community health representatives are receiving double training to be able to file for Medicaid reimbursement.

Training and certification requirements for community health workers vary widely by state and employer, as workers are often hired by hospitals, local organizations, health departments, or federally qualified health centers. But a movement has been emerging across the country to bring more uniformity to those requirements and formalize the roles, said Sweta Haldar, a policy analyst with the Racial Equity and Health Policy program at KFF.

As part of this process, states are expanding coverage for community health workers under Medicaid. According to a brief Haldar co-authored, 28 of 47 states, and Washington, D.C., reported having policies that allow Medicaid reimbursement for services provided by community health workers. Arkansas, Georgia, and Hawaii did not respond to KFF’s survey.

“There’s a really robust evidence base that is growing every day that community health worker interventions can be effective in reducing health disparities, particularly in communities of color,” Haldar said.

Studies have also shown that community health worker programs are effective in improving health outcomes for people with chronic conditions and that they reduce health care costs.

Soon after Nevada implemented its program, about 50 community health representatives completed the requirements. Another cohort of 20 finished the curriculum later, said Kolbet-Clausell. The goal is for those who have completed the recent training to help their peers through it, they said.

Even before the tribal workers were included in the community health workforce, one of its greatest strengths was its diversity, Kolbet-Clausell said. In Nevada, the 2022 student group was made up of greater shares of people who are American Indian or Alaska Native, Hawaiian or Pacific Islander, Black, Hispanic, or from rural areas than the state’s general population. They said it’s likely one of the most diverse health programs in the state.

Community health representatives such as Noneo are typically tribal or community members themselves, which, public health experts say, allows them to connect more easily with the patients they serve and better connect them to health care.

For example, the first person she picked up that June morning was her cousin, who had a 6 a.m. dialysis appointment.

Kolbet-Clausell said they’re optimistic about the growing workforce and the support it’s getting from state leaders.

“Five, six years ago, there was a lot more resistance,” they said, because lawmakers saw the efforts to expand the community health workforce as simply spending more money. “But this actually just benefits rural communities as much as it benefits underserved urban communities. It serves everyone.”

Back in Fallon, Noneo reflected on her 27 years as a community health representative for her tribe as she prepares to retire in September. She has been there with her fellow tribal members through important and hard times in their lives — like driving an expectant mother to Reno to deliver a baby, taking people to receive treatment for mental health crises and addiction, and bringing patients to their dialysis treatments on her week off around Christmas so they wouldn’t miss their appointments.

The most challenging part of the job, she said, is experiencing the loss of someone she has regularly seen and provided years of services for.

“We all have compassion,” she said. “In this kind of job, you have to have that.”

After decades of shuttling patients, Noneo has the work down to a steady and familiar rhythm. Four hours after dropping off her cousin for dialysis, Noneo picked her up at the clinic as she dropped off the next dialysis patient. On a clipboard, she logged the hours and mileage for each appointment.

The post Tribal Health Workers Aren’t Paid Like Their Peers. See Why Nevada Changed That appeared first on Medika Life.

Because so many Black people die young — with many years of life ahead of them — their higher mortality rate from 1999 to 2020 resulted in a cumulative loss of more than 80 million years of life compared with the white population, the study showed.

Although the nation made progress in closing the gap between white and Black mortality rates from 1999 to 2011, that advance stalled from 2011 to 2019. In 2020, the enormous number of deaths from covid-19 — which hit Black Americans particularly hard — erased two decades of progress.

Authors of the study describe it as a call to action to improve the health of Black Americans, whose early deaths are fueled by higher rates of heart disease, cancer, and infant mortality.

“The study is hugely important for about 1.63 million reasons,” said Herman Taylor, an author of the study and director of the cardiovascular research institute at the Morehouse School of Medicine.

“Real lives are being lost. Real families are missing parents and grandparents,” Taylor said. “Babies and their mothers are dying. We have been screaming this message for decades.”

High mortality rates among Black people have less to do with genetics than with the country’s long history of discrimination, which has undermined educational, housing, and job opportunities for generations of Black people, said Clyde Yancy, an author of the study and chief of cardiology at Northwestern University’s Feinberg School of Medicine.

Black neighborhoods that were redlined in the 1930s — designated too “high risk” for mortgages and other investments — remain poorer and sicker today, Yancy said. Formerly redlined ZIP codes also had higher rates of covid infection and death. “It’s very clear that we have an uneven distribution of health,” Yancy said. “We’re talking about the freedom to be healthy.”

A companion study estimates that racial and ethnic inequities cost the U.S. at least $421 billion in 2018, based on medical expenses, lost productivity, and premature death.

In 2021, non-Hispanic white Americans had a life expectancy at birth of 76 years, while non-Hispanic Black Americans could expect to live only to 71. Much of that disparity is explained by the fact that non-Hispanic Black newborns are 2½ times as likely to die before their 1st birthdays as non-Hispanic whites. Non-Hispanic Black mothers are more than 3 times as likely as non-Hispanic white mothers to die from a pregnancy-related complication. (Hispanic people can be of any race or combination of races.)

Racial disparities in health are so entrenched that even education and wealth don’t fully erase them, said Tonia Branche, a neonatal-perinatal medicine fellow at Lurie Children’s Hospital of Chicago who was not involved in the JAMA study.

Black women with a college degree are more likely to die from pregnancy complications than white women without a high school diploma. Although researchers can’t fully explain this disparity, Branche said it’s possible that stress, including from systemic racism, takes a greater toll on the health of Black mothers than previously recognized.

Death creates ripples of grief throughout communities. Research has found that every death leaves an average of nine people in mourning.

Black people shoulder a great burden of grief, which can undermine their mental and physical health, said Khaliah Johnson, chief of pediatric palliative care at Children’s Healthcare of Atlanta. Given the high mortality rates throughout the life span, Black people are more likely than white people to be grieving the death of a close family member at any point in their lives.

“We as Black people all have some legacy of unjust, unwarranted loss and death that compounds with each new loss,” said Johnson, who was not involved with the new study. “It affects not only how we move through the world, but how we live in relationship with others and how we endure future losses.”

Johnson’s parents lost two sons — one who died a few days after birth and another who died as a toddler. In an essay published last year, Johnson recalled, “My parents asked themselves on numerous occasions, ‘Would the outcomes for our sons have been different, might they have received different care and lived, had they not been Black?’”

Johnson said she hopes the new study gives people greater understanding of all that’s lost when Black people die prematurely. “When we lose these lives young, when we lose that potential, that has an impact on all of society,” she said.

And in the Black community, “our pain is real and deep and profound, and it deserves attention and validation,” Johnson said. “It often feels like people just pass it over, telling you to stop complaining. But the expectation can’t be that we just endure these things and bounce back.”

Teleah Scott-Moore said she struggles with the death of her 16-year-old son, Timothy, an athlete who hoped to attend Boston College and study sports medicine. He died of sudden cardiac arrest in 2011, a rare condition that kills about 100 young athletes a year. Research shows that an underlying heart condition that can lead to sudden cardiac death, hypertrophic cardiomyopathy, often goes unrecognized in Black patients.

Scott-Moore still wonders if she should have recognized warning signs. She also has blamed herself for failing to protect her two younger sons, who found Timothy’s body after he collapsed.

At times, Scott-Moore said, she wanted to give up.

Instead, she said, the family created a foundation to promote education and health screenings to prevent such deaths. She hears from families all over the world, and supporting them has helped heal her pain.

“My grief comes back in waves, it comes back when I least expect it,” said Scott-Moore, of Baltimore County, Maryland. “Life goes on, but it’s a pain that never goes away.”

The post Study Reveals Staggering Toll of Being Black in America: 1.6M Excess Deaths Over 22 Years appeared first on Medika Life.

[This story also ran on The Daily Yonder.]

That effort pleased researchers and advocates for improving rural health because the dozen or so examinations of rural health data provided important details about the 46 million Americans who live away from the nation’s population centers. It began to fill a gap in the information used by those who study and address the issues that affect people in rural communities.

But those reports, the Morbidity and Mortality Weekly Report rural health series, began and ended in 2017. And though the CDC has addressed rural health in other weekly reports and data briefs, the agency hasn’t examined it in such depth since.

That’s one reason rural health advocates successfully pushed for the CDC to extend its rural health focus by creating an Office of Rural Health at the agency. The office is operational as of March 2023, and advocates hope the agency will commit to rural health research and provide analyses that lead to good public health policies for rural communities.

“What we’re seeing is rural continually getting left behind,” said Alan Morgan, CEO of the National Rural Health Association, which urged Congress to fund the office. “They’re communities at risk, communities that may not be employing public health safety measures, and we are flying blind,” he said.

“What’s needed is an ongoing look at rural communities, their populations, to better direct both state and federal efforts to address health disparities,” he said.

The omnibus appropriations bill signed by President Joe Biden in December 2022 gave the CDC $5 million for the 2023 fiscal year to create the Office of Rural Health inside the agency, which has a $9.3 billion budget this year. Congress directed the CDC to sharpen its focus on public health in rural areas with the new office, after covid-19 had an outsize impact on rural America.

Though the CDC is a data-driven public health agency, it’s unlikely the new office will solve preexisting rural data challenges. But CDC officials have said in-depth rural health initiatives that require collaborations across the CDC — like the Morbidity and Mortality Weekly Report rural health series — could become more common practice at the agency.

“Instead of comparing rural and non-rural, it was looking within rural,” said Diane Hall, acting director of the office, about the 2017 reports. “That MMWR sort of laid out some things that we can be thinking about doing more of so that within rural variation, [there’s] better understanding of how race and ethnicity play out in rural communities.”

In addition to ethnic disparities, the series examined illicit drug use, causes of death, and suicide trends, among other things. Those topics are already part of what the CDC tracks, but typically the agency compares rural data for those topics with urban data rather than creating a stand-alone analysis.

Hall said having an Office of Rural Health will also help the CDC continue collaborating with the Federal Office of Rural Health Policy, part of the Health Resources and Services Administration. That office has existed since 1987 and has been the primary federal office dedicated to rural health care. But its focus is on increasing access to health care rather than monitoring public health.

At the CDC’s Office of Rural Health, “we’re more likely to be focusing on prevention,” Hall said.

What the office is unlikely to do, she said, is create new surveys and collect data that the CDC does not already track. It would be a “pretty costly” undertaking, she said. “I think what would be more impactful is to work with the people that are already doing that and help them better understand that rural context.”

Rural data analysis poses challenges because of the smaller size of rural population centers compared with the larger populations of urban areas. For instance, small communities might not have adequate response rates to surveys, which can limit the conclusions researchers can make about the data.

Michael Meit, co-director of the Center for Rural Health Research at East Tennessee State University, said the 2017 series helped to mitigate the “small numbers” challenge, wherein samples aren’t large enough to be properly analyzed because rural areas have smaller populations.

Each of the series’ reports outlined data limitations such as small numbers and their effect on the analysis, which shows the CDC was “already pushing forward and trying to bring voice to these issues,” Meit said. “I think that by itself is huge.”

Hall, the acting director, said there isn’t a simple solution to challenges like small sample sizes but that the “CDC’s Office of Rural Health can work to highlight creative solutions being developed, such as our PLACES project.” PLACES, or Population Level Analysis and Community Estimates, is a collaboration among the CDC, Robert Wood Johnson Foundation, and CDC Foundation that releases data for smaller cities and rural areas. (KFF Health News receives funding support from the Robert Wood Johnson Foundation.)

Another challenge with rural health data is that small numbers can make it possible to identify who in a particular community is included in data. But the CDC has restrictions in place to prevent that from happening.

Sometimes, though, the agency does allow researchers to access files containing details like “race or ethnicity for small and highly visible groups” and “extreme values of income and age.”

Keith Mueller, director of the Rural Policy Research Institute, hopes the Office of Rural Health will make it easier for researchers to access that more detailed data.

“There would be somebody at the agency who can get at the data, who can help us answer the research question,” he said. “Collaborative work between people in the field and people in the agency who have the direct access to the data is far more readily available or likely to happen with this new office.”

Since the office is based in the CDC’s new Public Health Infrastructure Center, which launched in February, Hall said it’s well positioned to partner with researchers. The center manages the agency’s partnership grants, which are awarded to organizations that plan to improve public health services.

Hall said the office’s most immediate priorities, though, are to grow the staff beyond its current three members and to develop the CDC’s strategic plan for rural health.

The post The CDC Lacks a Rural Focus. Researchers Hope a Newly Funded Office Will Help appeared first on Medika Life.

If you or someone you know may be experiencing a mental health crisis, contact the 988 Suicide & Crisis Lifeline by dialing “988,” or the Crisis Text Line by texting “HOME” to 741741.

In the weeks after Stanford University soccer goalie Katie Meyer, 22, died by suicide last March, her grieving teammates were inseparable even when not training.

Coaches adjusted practices to give the athletes time and space to make sense of losing their friend and team captain. They offered to cancel the spring season, but the players declined, said Melissa Charloe, who started as a Stanford assistant women’s soccer coach the day Meyer died.

“It’s hard because there’s no playbook on how to do this,” Charloe said.

No playbook exists because, until recently, it was relatively uncommon for student-athletes to die by suicide. But at least five NCAA athletes, including Meyer, ended their lives in a two-month period last year. And a 2021 NCAA poll released in May found that student-athletes say they are experiencing more mental health concerns, anxiety, and depression than they reported in surveys conducted before the covid-19 pandemic took hold in 2020.

Suicide is the second-leading cause of death on college campuses. And despite the overall rise in mental health concerns there, universities have been caught off guard when student-athletes have died by suicide. Traditionally, sports psychologists focused on mental health as it related to performance on the field. Their goal was to help athletes improve physically — jump higher, run faster — not navigate mental health crises, largely because of a misperception that college athletes were less susceptible to mental health concerns.

What little research exists about student athletes and mental health is inconsistent and inconclusive. But many experts thought athletes were insulated from risk factors such as depression and social isolation, in part because physical activity is good for mental health and athletes have a steady stream of people around them, including coaches, trainers, and teammates, said Kim Gorman, director of counseling and psychological services at Western Carolina University.

“They’re kind of used to pain — it’s not so foreign to them,” added organizational psychologist Matt Mishkind, deputy director of the Helen and Arthur E. Johnson Depression Center at the University of Colorado’s Anschutz Medical Campus.

Still, athletes face pressures that their peers in the general student population don’t, such as balancing sports, schoolwork, fears of career-ending injuries, and mistakes that can lead to ridicule that gets amplified on social media. With suicide rates in the general population on the rise and the effects of the pandemic continuing to threaten well-being, high-profile suicides highlight how to deal with the unthinkable — and how to try to prevent it from happening again.

In the wake of such suicides, schools are reevaluating the kind of mental health support they provide. Creating a safe space to talk about grief with someone who understands suicide is a critical first step, said psychologist Doreen Marshall, a vice president at the American Foundation for Suicide Prevention.

“Many professionals are good with grief, but suicide grief can be a little different,” she said, as it often involves guilt and questions about why someone would end their life.

Gina Meyer, Katie’s mother, and her husband, Steve, have developed an initiative, Katie’s Save, to ensure that all students have a trusted advocate to turn to in times of trouble. “We know that the bravest thing you can do is ask for help,” she said.

The Meyers filed a wrongful death lawsuit against Stanford in November alleging that their daughter ended her life after receiving an email from the university about disciplinary action against her. Stanford University spokesperson Dee Mostofi did not answer questions about the case, but Stanford posted a statement on its website saying the Meyers’ suit contains misleading information and the school disagrees with their allegations that it is responsible for Katie’s death.

“Like other colleges and universities across the country, Stanford has seen a sharp increase in demand for mental health counseling and other well-being resources over the last two years,” Mostofi said. “Mental health remains not only an ongoing challenge but our most urgent priority.”

After Meyer died, Stanford provided mental health counselors and a sports psychologist to her teammates, but the players said they lobbied the university to pay for Zoom sessions with a specialist, Kimberly O’Brien, a clinical social worker in the Sports Medicine Division’s Female Athlete Program at Boston Children’s Hospital.

O’Brien has professional and personal experience dealing with sports and suicide: She was an ice hockey player at Harvard in 1998 when one of the athletes in her university house died. “I wasn’t even extremely close to her, but it affected me profoundly,” she said. “There were no resources to deal with it.”

That’s changing. Colleges are trying to hire more mental health therapists to meet increasing and varied needs. Some, including Stanford and Washington State University, are working with The Jed Foundation, which provides suicide prevention programming for high school and college students. And crisis support doesn’t happen just in the student health center: Colleges are establishing campus-wide “postvention” programs to prevent suicide contagion.

Before cross-country runner Sarah Shulze, 21, died by suicide at the University of Wisconsin-Madison in April 2022, the athletics department was expanding its professional mental health support from two staffers to six to help the school’s approximately 800 student-athletes, said David Lacocque, the department’s director of mental health and sport psychology. The department, known until eight months ago as “clinical & sport psychology,” changed its name in part because student-athletes were asking for mental health support.

In addition to scheduled appointments, the sports liaisons attend practices, team meetings, training sessions, and competitions to help normalize mental health concerns.

“Gone are the days when we sit in our office and wait for people to knock on the door and talk to us,” Lacocque said.

Student-athletes can also seek free help from the university’s mental health professionals or providers in the community under contract with the University of Wisconsin athletics department. And some women’s cross-country athletes at the school now keep an eye on their teammates when coaches aren’t around, letting the team’s liaison know if they’re concerned about someone’s mental health.

“We don’t want anyone slipping between the cracks,” said teammate Maddie Mooney. “It’s a hard time for everybody, and everybody grieves at different paces and processes things differently.”

Teammate Victoria Heiligenthal, who shared a house with Shulze, said she avoided talking to campus counselors for months after her close friend died. “I only wanted to be alone or be with my friends who really understood the situation,” she said.

Heiligenthal couldn’t bear to stay in the home where she and Shulze had lived, so the university put her and Mooney up in a hotel for a week, and then she stayed awhile at Mooney’s apartment. Once back in her own place, teammates, coaches, training staff, and psychologists checked in on her and Mooney.

But the real game changer for the two was connecting last spring with Stanford soccer players Sierra Enge and Naomi Girma (who now plays professionally). Enge reached out after seeing something Mooney posted on Instagram. Since then, the four have met via Zoom. They have also talked with O’Brien and will join her on a mental health panel at a conference in Boston in June to talk about their experiences of losing a teammate to suicide.

“It was powerful hearing the parallels,” Heiligenthal said. “It made you realize Maddie and I weren’t alone; there were others who were experiencing similar things to us.”

At the University of Wisconsin-Madison and Stanford, athletes honored their late teammates last fall by raising mental health awareness. At a major meet in October, the Wisconsin runners painted green ribbons on the course, put ribbons in race packets, and contributed to a video. At Stanford’s game against UCLA in November, spectators wore green ribbons to highlight the importance of addressing mental health issues.

Stanford won the game, handing UCLA its first loss of the season. The victory was bittersweet. A year earlier, Meyer had spearheaded the team’s first mental health awareness game.

The post When College Athletes Kill Themselves, Healing the Team Becomes the Next Goal appeared first on Medika Life.

Just off the historic U.S. Route 66 in eastern New Mexico, a 10-bed hospital has for decades provided emergency care for a steady flow of people injured in car crashes and ranching accidents.

It also has served as a close-to-home option for the occasional overnight patient, usually older residents with pneumonia or heart trouble. It’s the only hospital for the more than 4,500 people living on a swath of 3,000 square miles of high plains and lakes east of Albuquerque.

“We want to be the facility that saves lives,” said Christina Campos, administrator of Guadalupe County Hospital in Santa Rosa. Its leaders have no desire to grow or be a big, profitable business, she said.

But even with a tax levy to help support the medical outpost, the facility lost more than $1 million in the past six months, Campos said: “For years, we’ve been anticipating kind of our own demise, praying that a program would come along and make us sustainable.”

Guadalupe is one of the nation’s first to start the process of converting into a Rural Emergency Hospital. The designation was created as part of the first new federal payment program launched by the Centers for Medicare & Medicaid Services for rural providers in 25 years. And though it is not expected to be a permanent solution to pressures facing rural America, policymakers and hospital operators alike hope it will slow the financial hemorrhage that continues to shutter those communities’ hospitals.

More than 140 rural hospitals have closed nationwide since 2010, and health policy watchers aren’t sure how many of the more than 1,700 rural facilities eligible for the new designation will apply. CMS officials said late last month that seven have already filed applications. Dr. Lee Fleisher, director of the Center for Clinical Standards and Quality at CMS, said how long it will take to review the applications will vary. The agency declined to provide the names or locations of hospitals seeking the designation.

Facilities that convert will get a 5% increase in Medicare payments as well as an average annual facility fee payment of about $3.2 million in exchange for giving up their expensive inpatient beds and focusing solely on emergency and outpatient care. Rural hospitals with no more than 50 beds that closed after the law passed on Dec. 27, 2020, are eligible to apply for the new payment model if they reopen.

The new program “strikes me as the first time we are saying, you know, maybe we can just take the beds away,” said Dr. Paula Chatterjee, an assistant professor at the University of Pennsylvania’s Perelman School of Medicine. Outpatient and emergency visits already make up about 66% of Medicare payments for rural hospitals that are eligible to convert, according to Chatterjee’s recent research.

Still, she found that many would likely need to scale up some outpatient services, such as telehealth and substance use care. Even then the payment model might not be able to shift the “foundational pressures” of declining, aging, and sicker populations that are making it hard to deliver care in rural America, she said.

“This feels like rearranging deck chairs on the Titanic,” Chatterjee said.

More than 50 hospitals and other organizations have expressed interest in the rural emergency designation, said Janice Walters, chief operating officer of programs for the Rural Health Redesign Center, which has a federal grant to provide technical assistance to facilities interested in converting.

Most hospitals “are still trying to figure out, ‘Is the math going to work?’” Walters said.

Those showing immediate interest are very small, with three or fewer patients staying overnight any given day, and, generally, they long ago gave up maternity care to save on expenses. The federal law will need to be amended to help larger rural hospitals with more overnight stays, said Brock Slabach, chief operations officer for the National Rural Health Association.

“It’s enough for now,” Slabach said. “But is it going to be enough for the long term? I don’t think so.” Top priorities for the group include adding the ability for hospitals to participate in a federal drug discount program and allowing for longer patient stays.

At Stillwater Medical in Oklahoma, Chief Administrative Officer Steven Taylor said the switch already makes sense for two of the system’s smaller hospitals that “have struggled financially.” The small regional health system’s outpost in Perry, which rarely has more than two inpatients a day, has already filed an application, and its facility in Blackwell will likely do so soon, he said.

Keeping emergency services “is the most important thing” for the small communities, he said. The new model requires a 24-hour emergency department and a clinician on call. It also caps the average length of patient stays at 24 hours — which Taylor said is not a problem. One patient may need to be watched for 12 hours for chest pain while another, with pneumonia, may need to stay for 36 hours, but that will average out to less than 24 hours for the year, he said.

Plus, he said, anybody who needs more intense care can be transferred to their regional hospital in Stillwater. Oklahoma, like other states, is working to update state laws for licensing or regulations to ensure hospitals can be credentialed with the rural emergency designation quickly.

John Henderson, president and chief executive of the Texas Organization of Rural & Community Hospitals, agreed with other speakers at the National Rural Health Association’s February policy conference in Washington, D.C. The new rule “could be a relief valve” for very small rural hospitals, he said. A two-bed facility in Crosbyton confirmed for Henderson earlier that day that it was the first in Texas to be approved for the new payment mechanism.

Henderson said he knew of several more of the state’s 158 rural hospitals that are applying or have already applied, and others are considering it: “These are the folks that are just hanging on.”

Dr. Denise Brown, CEO of virtual care provider Fident, spoke up from the front row during Henderson’s presentation. Her company uses telehealth so doctors and other clinicians can work virtually with multiple hospitals in different states. Brown said she was concerned that hospitals that convert won’t have enough ambulances available to transport or a place to send sicker patients, especially if they aren’t part of a larger health system.

Heads began to nod throughout the crowded room. Many rural hospitals needed every bed they had during the worst of the covid-19 pandemic, and to give up those beds now seems counterintuitive.

Those same rural hospitals often find that larger facilities refuse to take their patients who need specialized care, Brown said.

“How do I know that I can guarantee somebody a bed?” Brown said, adding that she prefers rural hospitals keep patients longer. How would she explain to concerned family members that their loved one was “two or three hours from home”?

The post Struggle to Survive, the First Rural Hospitals Line Up for New Federal Lifeline appeared first on Medika Life.

The interim sheriff of Macon County, Illinois, posed the question in 2018 as he and Andricks discussed the community’s needs. When she responded that she’d have to do some research, she was told not to take too long because the offer wouldn’t be there forever.

“I thought: ‘Oh, my God, he’s serious,’” Andricks said.

That sheriff was Howard Buffett, the philanthropist son of billionaire investor Warren Buffett. The younger Buffett ended up giving Crossing about $30 million from his charitable foundation to build an addiction treatment center in Decatur, a city with a population of just over 69,000 in the heart of Macon County.

There was a caveat, though. The donation to Crossing was a one-time gift to pay only for the buildings. It was up to Andricks and her team to find money to run the programs. And that has proven difficult.

The covid-19 pandemic upended everything mere months after the facilities opened in October 2019. An audited financial statement said the inpatient recovery center had lost $2.5 million by June 2021, and management worried about its ability to continue operating. Even so, the center remained open while other addiction treatment facilities around the country shuttered.

Now communities nationwide are preparing for an unprecedented windfall of their own for addiction treatment from a nearly $26 billion national opioid settlement and a more than $300 million expansion of a federal pilot program for mental health. The experience at Crossing offers them a model but also a warning: It will take more than a single shot of money to build a treatment program that can last.

https://www.marketplace.org/2023/01/19/a-30-million-gift-to-build-an-addiction-treatment-center-then-staffers-had-to-run-it//popout

Drug addiction wasn’t on Howard Buffett’s radar, he told KHN, until he joined the Macon County sheriff’s office as an auxiliary deputy in 2012. While the county has had some treatment resources, like a behavioral health center, it has one of the state’s higher death rates from opioid overdoses.

Buffett moved to the area in 1992 to work for food-processing giant Archer Daniels Midland. He runs a farm nearby and his Decatur-based foundation donates hundreds of millions of dollars for initiatives ranging from helping people kidnapped by Joseph Kony’s Lord’s Resistance Army in central Africa to revitalizing the cacao industry in El Salvador.

Soon after Buffett was appointed interim sheriff in 2017, he toured Crossing to learn more about local social services. The health center offers primary care, including mental health, for all ages and sees roughly 17,500 patients a year. Most Crossing patients are on Medicaid, the public health insurance for people with low incomes.

“He was impressed with what we were able to provide patients,” Andricks recalled. “I don’t think he expected the scope and size of what we do.”

Addiction treatment, though, is notoriously difficult. Evidence supports treating addiction like a chronic illness, meaning even after difficult short-term behavior changes, it requires a lifetime of management. Research suggests relapse rates can be more than 85% in the first year of recovery. So any new treatment program is likely to face headwinds.

Buffett didn’t set Crossing up for failure. In fact, he has helped fund other aspects of the organization’s work. Part of the idea behind paying for the addiction treatment buildings but not the operations, Buffett said, is to keep his foundation “creative.” If it spends all its money on the same programming every year, that means less is available to fund other work around the globe. Buffett said it’s also about sustainability.

“If Tanya can show ‘with this investment I made this work,’” Buffett said, “then other people should be making that investment.”

Crossing’s inpatient recovery center holds eight beds for medication-assisted detox, 48 beds for rehabilitation, and a cafeteria where meals are cooked with input from dietitians working with patients. An outpatient treatment center also has classrooms for continuing education, a gym with a small bowling alley, and a movie theater. Buffett insisted on the last two amenities. (“People have to feel good about getting better,” he said.)

A separate building holds 64 beds of transitional housing, and just across the street are 20 rent-controlled apartments. Buffett spent an additional $25 million on buildings at that campus for other organizations focused on housing, workforce development, and education, among other things.

“There’s a lot to like in this program,” said Dr. Bradley Stein, director of Rand Corp.’s Opioid Policy and Tools Information Center.

As positives, Stein pointed specifically to the spectrum of care offered to patients as they progress in their recovery, the use of medication-assisted treatment to help stave off physical cravings for opioids, the connection to the health center, and even the involvement of law enforcement.

Laura Cogan, a 36-year-old mother who has struggled with addiction since she was 14, is one of the patients working their way through the system.

Cogan said she was the first patient in the doors when the recovery center opened. Less than 24 hours later, she was also the first patient to walk out.

The biggest challenge with Cogan’s previous attempts at recovery, she said, was never being sure about her next steps: What was she supposed to do after getting out of detox and residential treatment?

Crossing’s approach was designed to address that by providing transitional housing, easy access to outpatient services, and educational programming.

On her third attempt, Cogan got a round of applause after completing the first three days in detox. After six days, she joined residential treatment. After a month, she moved over to transitional housing, began outpatient treatment, and started offering peer support at Crossing. She tutored other patients, taught a writing class, and helped them get on computers and fill out job applications.

Then the pandemic hit.

Like other health centers around the nation, Crossing turned its attention to providing covid testing and vaccines. Meanwhile, just about every aspect of addiction treatment became more expensive. Crossing halved the number of residential treatment beds so each room would have only one patient and converted the rooms into negative pressure chambers to reduce the risk of covid transmission.

Staffing grew harder amid a nationwide nursing shortage. The number of patients in residential treatment dropped, Andricks said, because few people wanted to live inside a facility and wear masks. It was common to have as few as 10 beds occupied on a given day. The women’s unit was temporarily closed due to lack of demand and staffing constraints.

Cogan said several other transitional housing residents left once the $1,200 pandemic stimulus checks arrived, with some resuming treatment when that money dried up. But Cogan continued. Eventually she moved into Crossing’s rent-controlled apartments, where she has been one of just a few tenants.

Without the federal Paycheck Protection Program’s $1,375,200 forgivable loan in 2020, Andricks said, the outpatient treatment program might have had to close altogether.

But momentum at the recovery center started to change last spring as covid cases tapered off, Andricks said. Hiring became easier. More patients arrived. In October, the center received a grant to use the apartments for women with a history of substance misuse who are pregnant or who have given birth within the prior year. They’ve placed six women, in addition to Cogan, there already. The inpatient recovery center now averages about 27 occupied beds a day, within striking distance of the 30 that Andricks said the inpatient center needs to survive.

Rand’s Stein suggested another measurement of a treatment program’s success: whether people in the community get into treatment when they need it. National “secret shopper” reports have found significant barriers to service, such as long wait times.

Crossing’s program quadrupled the number of residential treatment beds in Macon County, according to Andricks. In the three years since the inpatient recovery center opened, it has had over 1,300 admissions. While most patients haven’t stayed in recovery, staffers have seen a pattern of success with those like Cogan who stay on campus and become involved with recovery offerings — although Andricks estimated that’s fewer than 10% of the patients.

Cogan said she hopes Crossing doesn’t get discouraged. People are going to mess up, she said, but she’s living proof of the impact the recovery center can have.

“I’m one of the lucky ones and I don’t know why,” Cogan said, sitting on a couch in the apartment on Crossing’s campus that she shares with her 12-year-old son since regaining custody of him. “I just know that today I am. And I hope that more people get the opportunity.”

The post A $30 Million Gift to Build an Addiction Treatment Center. Then Staffers Had to Run It. appeared first on Medika Life.

The 25-year-old blogger and college student has autism and several chronic illnesses, and with the support of her grandparents and friends, who help her access a complex network of social services, she lives relatively independently in Johnson City, Tennessee.

“If something happens to them, I’m not certain what would happen to me, especially because I have difficulty with navigating things that require more red tape,” she said.

Johnson said she hasn’t made plans that would ensure she receives the same level of support in the future. She especially worries about being taken advantage of or being physically harmed if her family and friends can’t help her — experiences she’s had in the past.

“I like being able to know what to expect, and thinking about the future is a bit terrifying to me,” she said.

Johnson’s situation isn’t unique.

Experts say many people with intellectual and developmental disabilities do not have long-term plans for when family members lose the ability to help them access government services or care for them directly.

Families, researchers, government officials, and advocates worry that the lack of planning — combined with a social safety net that’s full of holes — has set the stage for a crisis in which people with disabilities can no longer live independently in their communities. If that happens, they could end up stuck in nursing homes or state-run institutions.

“There’s just potential for a tremendous human toll on individuals if we don’t solve this problem,” said Peter Berns, CEO of the Arc of the United States, a national disability-rights organization.

About one-quarter of adults in the U.S. live with a disability, according to the Centers for Disease Control and Prevention. Nearly three-quarters of Americans with disabilities live with a family caregiver, and about one-quarter of those caregivers are 60 or older, according to the Center on Developmental Disabilities at the University of Kansas.

But only about half of families that care for a loved one with disabilities have made plans for the future, and an even smaller portion have revisited those plans to ensure they’re up to date, said Meghan Burke, an associate professor of special education at the University of Illinois in Urbana-Champaign.

“Engaging in it once is good, right? But you can’t only engage in it once,” she said. “It’s a living document, because things change, people change, circumstances change.”

Burke’s research has found several barriers to planning for the future: financial constraints, reluctance to have hard conversations, trouble understanding government services. Creating plans for people with disabilities also is a complex process, with many questions for families to answer: What are their relatives’ health needs? What activities do they enjoy? What are their wishes? Where will they live?

Burke has firsthand experience answering those questions. Her younger brother has Down syndrome, and she expects to become his primary caregiver in the future — a situation she said is common and spreads the work of caregiving.

“This is an impending intergenerational crisis,” she said. “It’s a crisis for the aging parents, and it’s a crisis for their adult offspring with and without disabilities.”

Nicole Jorwic, chief of advocacy and campaigns for Caring Across Generations, a national caregiver advocacy organization, said the network of state and federal programs for people with disabilities can be “extremely complicated” and is full of holes. She has witnessed those gaps as she has helped her brother, who has autism, access services.

“It’s really difficult for families to plan when there isn’t a system that they can rely on,” she said.

Medicaid pays for people to receive services in home and community settings through programs that vary state to state. But Jorwic said there are long waitlists. Data collected and analyzed by KFF shows that queue is made up of hundreds of thousands of people across the country. Even when people qualify, Jorwic added, hiring someone to help can be difficult because of persistent staff shortages.

Jorwic said more federal money could shorten those waitlists and boost Medicaid reimbursements to health care providers, which could help with workforce recruitment. She blamed chronic underinvestment in Medicaid disability services for the lack of available slots and a dearth of workers to help people with disabilities.

“It’s going to be expensive, but this is four decades of funding that should have been done,” she said.

Congress recently put about $12.7 billion toward enhancing state Medicaid programs for home- and community-based services for people with disabilities, but that money will be available only through March 2025. The Build Back Better Act, which died in Congress, would have added $150 billion, and funding was left out of the Inflation Reduction Act, which became law this summer, to the disappointment of advocates.

Jeneva Stone’s family in Bethesda, Maryland, has been “flummoxed” by the long-term planning process for her 25-year-old son, Rob. He needs complex care because he has dystonia 16, a rare muscle condition that makes moving nearly impossible for him.

“No one will just sit down and tell me what is going to happen to my son,” she said. “You know, what are his options, really?”

Stone said her family has done some planning, including setting up a special needs trust to help manage Rob’s assets and an ABLE account, a type of savings account for people with disabilities. They’re also working to give Rob’s brother medical and financial power of attorney and to create a supported decision-making arrangement for Rob to make sure he has the final say in his care.

“We’re trying to put that scaffolding in place, primarily to protect Rob’s ability to make his own decisions,” she said.

Alison Barkoff is acting administrator for the Administration for Community Living, part of the U.S. Department of Health and Human Services. Her agency recently released what she called a “first ever” national plan, with hundreds of actions the public and private sectors can take to support family caregivers.

“If we don’t really think and plan, I’m concerned that we could have people ending up in institutions and other types of segregated settings that could and should be able to be supported in the community,” said Barkoff, who noted that those outcomes could violate the civil rights of people with disabilities.

She said her agency is working to address the shortages in the direct care workforce and in the supply of affordable, accessible housing for people with disabilities, as well as the lack of disability-focused training among medical professionals.

But ending up in a nursing home or other institution might not be the worst outcome for some people, said Berns, who pointed out that people with disabilities are overrepresented in jails and prisons.

Berns’ organization, the Arc of the United States, offers a planning guide and has compiled a directory of local advocates, lawyers, and support organizations to help families. Berns said that making sure people with disabilities have access to services — and the means to pay for them — is only one part of a good plan.

“It’s about social connections,” Berns said. “It’s about employment. It’s about where you live. It’s about your health care and making decisions in your life.”

Philip Woody feels as though he has prepared pretty well for his son’s future. Evan, 23, lives with his parents in Dunwoody, Georgia, and needs round-the-clock support after a fall as an infant resulted in a significant brain injury. His parents provide much of his care.

Woody said his family has been saving for years to provide for his son’s future, and Evan recently got off a Medicaid waitlist and is getting support to attend a day program for adults with disabilities. He also has an older sister in Tennessee who wants to be involved in his care.

But two big questions are plaguing Woody: Where will Evan live when he can no longer live at home? And will that setting be one where he can thrive?

“As a parent, you will take care of your child as well as you can for as long as you can,” Woody said. “But then nobody after you pass away will love them or care for them the way that you did.”

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COLUMBIA FALLS, Mont. — On a recent rainy afternoon in this small town just outside Glacier National Park, Lisa Beaty and Kim Hilton were preparing to sell most of their belongings before moving out of their three-bedroom, two-bathroom rental home.

Hilton, who was recovering from a broken leg, watched from his recliner as friends and family sorted through old hunting gear, jewelry, furniture, and clothes. “The only thing that’s not for sale is the house — everything else has to go,” Hilton, 68, said as he checked his blood sugar.

Hilton has Type 2 diabetes, heart disease, and other health issues that have left him disabled and unable to work for years. For income, he relies on federal disability benefits. Because of a shoulder injury and fibromyalgia, 64-year-old Beaty — Hilton’s partner of seven years — does, too. Combined, their income is roughly $1,500 a month.

That’s no longer enough, though. Investors bought their house this year and raised the rent from $1,000, including utilities, to $1,800, plus the cost of utilities.

“They’re not evicting me — on a fixed income, I can’t do it,” Beaty said as she sorted through her belongings.

They have nowhere else to go. And they were not just losing their home: The stress of the ordeal caused them to end their relationship. Beaty planned to move into her daughter’s one-bedroom apartment.

Despite his poor health and still relying on leg braces to prevent another broken leg, Hilton, who is on Medicare, planned to live out of his truck while he waited for a spot to open up at one of the few assisted living facilities in Flathead County, which is mostly rural. The wait could last days, or months.

Beaty and Hilton are part of a recent surge of homelessness among people older than 60. The housing affordability crisis, driven in part by the covid-19 pandemic, and high inflation are chipping away at their fixed incomes. Although data is limited, advocates for seniors and people who are homeless say greater numbers of adults are showing up at shelters across the country.

The problem is particularly acute in Montana, where the snow has started to fly as the long Rocky Mountain winter sets in.

Rents in Montana have skyrocketed since the pandemic started. Since 2019, Lewis and Clark County, for example, has seen rental costs jump 37%, one of the largest spikes in the U.S., according to data from the research firm CoStar Group published by The Washington Post. Nationally, rents rose 11% on average in 2021.

The fast-paced growth in Montana and elsewhere in the Mountain West has been driven in part by an influx of highly paid remote workers, drawn to wide-open spaces and abundant recreation opportunities in communities that were plagued by housing shortages even before the pandemic. Kalispell, the largest city in Flathead County, is the fastest-growing city among those in the U.S. with fewer than 50,000 people, according to Census Bureau data.

Inflation and rising rents are leaving many older Americans on the brink of ruin. The poverty rate for people 65 and older rose from 8.9% in 2020 to 10.3% in 2021, according to Ramsey Alwin, president and CEO of the National Council on Aging.

Alwin said people who rely on traditional retirement income, such as Social Security, are having trouble affording the basic necessities. “You’ll find that individuals are often coming up short by about $1,000 a month in order to meet their true needs,” she said.

As a result, many older people must make hard choices about whether to pay for daily needs such as food and medication or rent. Others simply can’t stretch their money and must leave their homes. An upcoming 8.7% cost-of-living increase in Social Security benefits will help offset the effects of inflation, which was 8.2% for the 12 months that ended in September. But Alwin said that won’t be enough to stem the tide of seniors who are losing housing because of rising rental prices.

Montana is home to one of the oldest populations in the country. According to a recent survey of older adults in the state, about 44% struggled with housing during the previous year, and only 10% considered housing affordable.

Emergency homeless shelters in Montana, and across the country, are reporting that more seniors have been showing up at their doors over the past year, many of whom could no longer make rent or couldn’t find a new place to live after their homes were sold out from under them, said Steve Berg, vice president for programs and policy at the National Alliance to End Homelessness.

Berg said it’s impossible to say how many seniors are winding up homeless for the first time because national homeless counts don’t break down the number of people 25 and older into smaller age groups and other data isn’t granular enough to differentiate people losing housing for the first time from older people who are chronically homeless.

Community organizers working directly with homeless people have a deep understanding of how the trend is playing out in their areas.

At the Poverello Center in Missoula, Montana, people in their 60s have become the second-largest age group served by the shelter, said Programs Director Lisa Sirois. She said that she has seen people in their 80s and 90s with no place to go and that the shelter has had to turn away some of them because it wasn’t designed for their needs.

People in wheelchairs have difficulty navigating the narrow hallways, she said, and the shelter’s elevator often breaks down, forcing people to use the stairs to access its dorms. The dorms are lined with bunk beds, which also present challenges.

“Any senior clients or folks with disabilities usually can’t do a top bunk,” Sirois said.

Brian Guyer, housing department director for the Human Resource Development Council Bozeman, said that when his shelter can’t serve a senior, it also must ask the person to leave. A memory that still haunts him, he said, is of an older man who froze to death three days after being denied a spot in the Bozeman shelter because he was incontinent and had mobility problems. “He actually was found outside of a Lowe’s store here in Bozeman,” Guyer said.

And with the older homeless population growing, his staff, already overworked and underpaid, cannot take care of them all, he said.

To prevent the worst outcomes, state and national groups are proposing a slew of changes.

The Montana Coalition to Solve Homelessness, a new organization that plans to lobby on behalf of shelter providers during the legislative session that starts in January, wants the state to modify its Medicaid program to make shelters eligible for funding. They would use the money to provide Medicaid services that could assist seniors living in a shelter or pay for case management services to help seniors navigate benefit programs that offer food assistance and subsidized housing or find assisted living and nursing home facilities.

But the number of available spots in those facilities is shrinking. Nationally, nursing home closures have displaced thousands of residents. In Montana, eight nursing homes either have closed this year or are slated to close by the end of December, according to Montana health officials. Rose Hughes, executive director of the Montana Health Care Association, said other facilities are having difficulty keeping their doors open because Medicaid reimbursement rates are often lower than their operating costs.

Other advocacy organizations want to focus on economic stabilization initiatives that would help older people stay in their homes. One idea is to change how Social Security payments are calculated by pegging them to the Elder Index, an online calculator that estimates living expenses by location. But that would require congressional approval.

“Your current housing is your best chance for keeping housing for this population,” said Mark Hinderlie, CEO of Hearth, which focuses on homelessness among seniors nationally.

Then there is increasing the housing supply, which most people agree is a long-term solution. In Montana, Republican Gov. Greg Gianforte is proposing policies that would create incentives to encourage the building of more market-rate apartments. But critics say developers are unlikely to create enough subsidized housing on their own.

For Hilton, any sort of open housing unit can’t come soon enough. As he leaned against his truck in the driveway of his now former home, he hugged Beaty as she sobbed into his shoulder before they parted ways.

He drove away in search of a place to camp out, waiting for a call from a local assisted living facility with an opening. He hoped that call would come before winter temperatures settled in.

This story is printed with permission from Kaiser Health News and in a partnership that includes Montana Public Radio, NPR, and KHN.

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