Tuesday, July 30, 2013

Canvassers For Health Coverage Find Few Takers In Boca Raton

More From Shots - Health News HealthDoctors Increasingly Ignore Evidence In Treating Back PainHealth CareCanvassers For Health Coverage Find Few Takers In Boca RatonHealthPanel Urges Lung Cancer Screening For Millions Of AmericansHealthBoys With Autism Or ADHD More Prone To Overuse Video Games

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Canvassers For Health Coverage Find Few Takers In Boca Raton

More From Shots - Health News HealthDoctors Increasingly Ignore Evidence In Treating Back PainHealth CareCanvassers For Health Coverage Find Few Takers In Boca RatonHealthPanel Urges Lung Cancer Screening For Millions Of AmericansHealthBoys With Autism Or ADHD More Prone To Overuse Video Games

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Thursday, July 25, 2013

Move Over Nursing Homes — There's Something Different

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At the Baltimore Green House, every resident has a private room that's close to the common areas, shown here.

Courtesy of Catholic Charities

At the Baltimore Green House, every resident has a private room that's close to the common areas, shown here.

Courtesy of Catholic Charities

One thing just about everyone dreads as they age is the possibility of ending up in a nursing home. We all think we know what that's like: sharing a room with strangers, sitting slumped in a wheelchair all day, rigid schedules, bad smells. And for more than 1 million Americans, this is home. But there's an effort to change all that, and it's known as The Green House Project.

In the past 10 years, more than 140 of these alternative, nonprofit nursing homes have been built in 24 states.

There are four residences in Baltimore, on the grounds of the old Memorial Stadium, where the Orioles used to play baseball. A little league field remains, and you can see it from the front porches of the Green House homes here.

But at midday, no one's on the porch because it's lunchtime. In an open kitchen that looks like it belongs in a big suburban home, Tumarka Wilson prepares the meal: chicken Parmesan, broccoli and parsley egg noodles. But Wilson isn't the cook here. She's a nursing assistant, and like all Green House nursing assistants, she's trained to do a bit of everything.

Wilson likes her job's variety and says it wasn't like that at the nursing home where she used to work. "We cook for them, we do daily activities with them. We spend a lot of quality time with our elders," she says.

One of the reasons Wilson and the other nursing assistants can spend quality time with the "elders," as they're called here, is that there are no more than 12 residents living in any one Green House home. Every resident has a private room and bath that's close to a common area, which includes the kitchen, the living room and a communal dining table that has more than enough seating for residents and staff to eat together.

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As 88-year-old Lawson Suber sits at the table waiting for lunch to be served, he explains that he came to the Green House after a fainting episode; his children insisted that he could no longer live on his own. But he's surprised to hear this place referred to as a "nursing home." "I guess it's somewhat like a nursing home. I guess it is," he says.

Dr. Bill Thomas, who came up with the idea for the homes in the 1990s, says the Green House is based on "a really radical idea: Let's abolish the nursing home."

Thomas, a geriatrician from upstate New York, had patients then who lived in nursing homes, and he realized "that the medicines I was prescribing were not treating the true source of suffering, which was loneliness."

He also realized that traditional nursing homes were going to have to be replaced soon anyway. "Most of them were built in the 1960s and '70s, and, you know, their time is done. So I got to asking the question: What comes next?"

What came next were the first Green House homes, which opened in Tupelo, Miss., in 2004. Now, with 148 Green House homes nationwide, there's enough research to get an idea of how they're working.

And they're doing pretty well.

Enlarge image i

There are no strict schedules at Green House homes, so resident Charles Tyler, 72, is free to stay in his recliner in the living room during mealtimes.

Ina Jaffe/NPR

There are no strict schedules at Green House homes, so resident Charles Tyler, 72, is free to stay in his recliner in the living room during mealtimes.

Ina Jaffe/NPR

Studies show that residents are happier and stay healthier longer. David Farrell, director of the Green House Project nationwide, explains that those private rooms aren't a luxury � they're safer than a traditional nursing home, where two or even three people might share a room and also share a bathroom with the two or three people in the room next door.

"So now you're talking about six people sharing the toilet and the washbasin, which of course just further increases the spread of infection for all the elders living there," Farrell says.

Research also shows that Green House residents maintain their independence longer than residents of traditional nursing homes, where hallways are long and schedules are tight. "So people really are kind of relegated to a wheelchair in order to efficiently move them around," Farrell says, "and they quickly lose their ability to walk."

There are no strict schedules at Green House homes, so while many of the residents gather at the table for lunch, Charles Tyler stays in his recliner in the living room, blanket up to his chin. The 72-year-old is not in the mood for lunch right now, but he's not worried about missing a meal. "Anytime I get ready, just press the button, and they'll bring me a raisin-bread sandwich. That's my favorite," Tyler says.

Personal service, private rooms � it all sounds expensive, but Green House home costs are about the median for nursing homes nationally. In fact, in Baltimore, the Green House homes serve mostly low-income people on Medicaid � so all Tyler has to do is focus on keeping up his strength.

"No pressure on you," Tyler says. "All you have to do is ask them what needs to be done and what is my part in it, and try. That's all."

There are now about 150 more Green House homes in development, where residents will be able to enjoy the privacy of their own rooms or the company of the communal table. It'll be their choice.

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Full-Time Vs. Part-Time Workers: Restaurants Weigh Obamacare

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The California Tortilla chain is one company still deciding how to react to the new health care requirements for business, set to take effect next year.

John Ydstie/NPR

The California Tortilla chain is one company still deciding how to react to the new health care requirements for business, set to take effect next year.

John Ydstie/NPR

Many businesses that don't offer health insurance to all their employees breathed a sigh of relief earlier this month when they learned they'd have an extra year to comply with the new health care law or face stiff penalties.

President Obama delayed the requirement for businesses with 50 or more employees after complaints that the plan was too complicated to implement by the original deadline, January 2014. Now, the restaurant industry, which employs a lot of part-time employees, is weighing strategies for how to respond.

At a California Tortilla restaurant in downtown Washington, D.C., managers say they're still figuring out what strategy to use to comply with the new law's mandate to provide health insurance for all workers who put in at least 30 hours a week: whether they should trim hours, hire more part-timers or leave things unchanged.

But management at another fast-food chain has made a decision. White Castle decided it will not fire full-time employees or cut benefits as a result of the new health care law, says Vice President Jamie Richardson. These full-time employees, who make up roughly half of White Castle's 9,600-member workforce, are already covered by the company's health care plan.

"If you're full-time at White Castle, you're going to stay full-time at White Castle," Richardson says. But as White Castle looks into the future after the new law takes effect, Richardson says the company is considering hiring only part-time workers.

The reason is simply cost, he says.

"If we were to keep our health insurance program exactly like it is with no changes, every forecast we've looked at has indicated our costs will go up 24 percent," he says.

The profit per employee in restaurants is only $750 per year, says Richardson, much lower than in most other industries. So, he says, adding health insurance as a benefit for all employees over 30 hours, as the health care law requires, isn't feasible.

But for another restaurant owner, the calculation is very different. Jeff Benjamin has four restaurants in the Philadelphia area and is planning three more. This past spring he invited a dozen restaurateurs from other cities to meet in Chicago to brainstorm strategies to respond to Obamacare's employer mandate. Adding more part-time workers, less than 30 hours a week, was one idea, but Benjamin says it didn't get traction.

"I really only think one or two of the folks in the room suggested it," he says. "All of them kind of agreed that there are too many fixed costs to having an employee to make it worthwhile to go the part-time route."

Having two part-timers instead of one full-time employee doubles the cost of things like training, scheduling and uniforms, Benjamin says.

"I'm a big fan of [the idea that] full-time employees give you full-time work," he says. "And sometimes as you lower people's hours they may not be as committed. So, I love to be able to give someone a full-time job."

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But Benjamin acknowledges that his staffing needs and profit margins are different from a fast-food chain like White Castle, and that's why they have different calculations about hiring part-timers. A number of big fast-food chains have said they'll use the strategy of increasing part-time workers, although one, Darden Restaurants, which owns Olive Garden and Red Lobster, has reversed course. Part of the reason was a public backlash to the decision that hurt their business.

A recent survey from the U.S. Chamber of Commerce found that half of the small businesses responding said they will reduce hours or add more part-timers in response to the law. But there are no hard data, so far, showing the industry moving to more part-time employees, says Scott DeFife, a spokesman for the National Restaurant Association.

"There's no big strategic part-time shift," he says. "In fact, data shows that in the past year average hours per employee is going up."

The National Restaurant Association hopes that Congress will use the one-year delay to make the law less burdensome to employers, DeFife says. But that would mean they'd provide fewer of their workers with health insurance.

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How A Family Copes With Schizophrenia And Suicide

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Wednesday, July 24, 2013

Obama Turns To Comedians To Promote Health Coverage

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Saturday, July 20, 2013

White House Muddles Obamacare Messaging — Again

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Friday, July 19, 2013

White House Muddles Obamacare Messaging — Again

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Wednesday, July 17, 2013

Pause in Honor of Medicare

At this time of year I usually start thinking about the passage of Medicare in July of 1965. How in the world did President Johnson decide to take on Congress to approve such a huge program for seniors? To sum it up, it was just the right thing to do. Why?

A personal story may help. In 1965 I was chief medical resident at Albany Hospital under Professor Richard Beebe. He allowed us to moonlight. I worked in Ravena in the practice of Drs. Mosher and LeFevre. Our elderly patients often had no money for their office visits or medicines. Sometimes they might leave a chicken on Mrs. Mosher’s back door. These folks were forced to rely on charity but had no real access to quality care. It just wasn’t right.

After Medicare was implemented in 1966, there were changes in medicine. Medicare Part A paid for hospital stays and also paid medical residents a better wage. Part B reimbursed outpatient care at 80 cents on the dollar and physicians flourished.

Later on, the disabled and those with kidney failure and ALS were covered as was Hospice care. Why? It was the right thing to do.

Some conservatives have always hated this government program for the elderly along with the program for the poor, Medicaid, that was enacted at the same time. They say that government should not be responsible for any health care. And even now they would privatize Medicare by turning it over to insurance companies through vouchers. You and I, through our Congress and our President, have so far beaten back these efforts. Why did we organize to fight for Medicare? Because it was the right thing to do.

And so, as July 30 approaches, it is proper that we pause to remember the signing of the Medicare Act, which took place at the Truman Library in Independence, Mo., on that day. Here is what Lyndon Johnson said: “No longer will older Americans be denied the healing miracle of modern medicine. No longer will illness crush and destroy the savings they have so carefully put away over a lifetime so that they might enjoy dignity in their later years.”

We honor Presidents Truman, Kennedy and Johnson and their staffs for their foresight and work that sustains our grandparents, parents, children, and generations yet unborn. Harry Truman proposed a national health plan in 1945. John Kennedy had health care on his agenda when he was assassinated in 1963. Lyndon Johnson carried their causes to fruition. And we will celebrate this historic achievement with a Medicare 48th birthday party at noon in West Capitol Park in Albany on Wednesday, July 31. Join us! It’s the right thing to do.

Then we will continue the struggle to improve and expand Medicare for all, as a right. We will do this to obey the ethics of all faiths that instruct us to “love your neighbor as yourself.” It’s the right thing to do.

Dr. Richard Propp lives in Albany and is chair of Capital District Alliance for Universal Healthcare, which he co-founded.

Tuesday, July 16, 2013

Doctors Heed Prescription For Computerized Records

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Friday, July 12, 2013

Messy Rollout Of Health Law Echoes Medicare Drug Expansion

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Tuesday, July 9, 2013

Youths At Risk Of Violence Say They Need Guns For Protection

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Wednesday, July 3, 2013

Savory And Sweet: A Taste For Infertility

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Federal Rule Extends Subsidies For College Students

More From Shots - Health News HealthOne Man's Quest To Make Medical Technology Affordable To AllHealthCuring Drug-Resistant Tuberculosis In Kids Takes CreativityHealthFederal Rule Extends Subsidies For College StudentsHealthSavory And Sweet: A Taste For Infertility

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Tuesday, July 2, 2013

You Ask, We Answer: Demystifying The Affordable Care Act

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