CHAMPAIGN - Every August, communities across the United States come together to celebrate National Breastfeeding Month, a time dedicated to promoting the benefits and importance of breastfeeding. This month-long observance aims to raise awareness, provide education, and encourage support for breastfeeding mothers and their families.
In conjunction with National Breastfeeding Month, the Champaign-Urbana Public Health District (CUPHD) announced its third annual breastfeeding supplies drive. Building upon their past success the drive will take place during the entire month of August.
Sarah Chai/PEXELS
The donated supplies will be given to parents enrolled in the WIC Breastfeeding Peer Counselor Program. This program offers support to expectant and postpartum parents, helping them learn about breastfeeding and overcome any obstacles they may encounter in achieving their individual breastfeeding goals.
The WIC program's mission is to safeguard the health of low-income pregnant women, new mothers, breastfeeding women, infants, and children up to age five who are at nutritional risk. It provides nutritious food to improve diets, offers education on healthy eating and breastfeeding, and connects participants to healthcare services.
National Breastfeeding Month was established in 2011 by the United States Breastfeeding Committee (USBC) to align with World Breastfeeding Week, which takes place during the first week of August. The initiative was created to bring greater attention to breastfeeding as a key component of public health and to advocate for policies that support breastfeeding mothers. The month-long celebration serves as a platform to highlight the critical role that breastfeeding plays in the health and well-being of both mothers and infants.
Breastfeeding provides numerous benefits for both mothers and their babies. For infants, breast milk is a complete source of nutrition that contains antibodies, enzymes, and hormones crucial for their development. It helps protect against infections, reduces the risk of chronic conditions, and promotes a healthy weight. For mothers, breastfeeding can lower the risk of certain cancers, aid in postpartum recovery, and strengthen the bond with their baby. Additionally, breastfeeding has economic benefits, reducing the need for formula and healthcare costs associated with treating illnesses.
Through the breastfeeding supplies drive, CUPHD hopes to support WIC families by providing them with the supplies they need to breastfeed longer to meet their breastfeeding goals and improve their infant's health.
Items needed include nursing pads, pillows, and covers; breast milk storage bags; electric and manual breast pumps; and breast pump accessories. All items must be received new and sealed in their original packaging.
Photo: Brytny.com/Unsplash
National Breastfeeding Month is a vital initiative that brings attention to the importance of breastfeeding for maternal and infant health. By participating in this celebration, individuals and organizations can help create a supportive environment that empowers mothers and promotes the well-being of future generations.
A curated Amazon wish list is available for virtual donations. Donated items will be sent directly to CUPHD to distribute to clients enrolled in the Breastfeeding Peer Counselor program. Donations from this list can be made year-round.
Products can also be donated in person at CUPHD, August 1-31, at the WIC intake window inside the CUPHD main lobby.
Ways to donate:
Online: Amazon wish list
The wish list will remain open year-round, 24/7.
In-person:
CUPHD Champaign WIC desk (201 West Kenyon Road, Champaign): Monday through Friday, 8:30 a.m.—noon, 1:00 p.m.—4:30 p.m.
CUPHD Rantoul WIC desk (520 East Wabash Avenue, #2, Rantoul): Tuesday, Wednesday, and Friday, 8:30 a.m.—noon, 1:00 p.m.—4:30 p.m.
Orchard Downs clinic (2040 South Orchard Street, Unit 2040-A, Urbana): Thursday, 8:30 a.m.—noon, 1:00 p.m.—4:30 p.m.
Urbana Farmers Market WIC booth
Saturday, August 24, 7:00 a.m.—noon
Come celebrate National Breastfeeding Month with breastfeeding-related games, giveaways, information about WIC and breastfeeding laws, and more!
While admitting that Medicare and Medicaid “help many,” the authors of Project 2025 nonetheless declare that the programs “operate as runaway entitlements that stifle medical innovation,
by Sonali KolhatkarConservatives have done the United States a huge favor by explaining in detail what they’ll try to do if Donald Trump is reelected.
Project 2025, a “presidential transition project” of the Heritage Foundation, helpfully lays out how a group of former Trump officials would like to transform the country into a right-wing dystopia where the rich thrive and the rest of us die aspiring to be rich.
Declaring in its Mandate for Leadership that “unaccountable federal spending is the secret lifeblood of the Great Awokening” (really!), the plan focuses heavily on reversing social progress on the rights of racial and sexual minorities.
It also promises to decimate the most popular benefits programs in the U.S.: Medicare and Medicaid.
In a section dedicated to the Department of Health and Human Services, Project 2025 declares that “HHS is home to Medicare and Medicaid, the principal drivers of our $31 trillion national debt.”
This is a popular conservative framing used to justify ending social programs. In fact, per person Medicare spending has plateaued for more than a decade and represents one of the greatest reductions to the federal debt.
While admitting that Medicare and Medicaid “help many,” the authors of Project 2025 nonetheless declare that the programs “operate as runaway entitlements that stifle medical innovation, encourage fraud, and impede cost containment, in addition to which their fiscal future is in peril.”
To solve these imaginary problems, they suggest making “Medicare Advantage the default enrollment option” rather than traditional Medicare.
But Medicare Advantage (MA) is not a government-run healthcare program. It’s merely a way to turn tax dollars into profits for private health insurers. The more that MA providers deny coverage, the more money their shareholders make. There is no incentive for them to cover the health care needs of seniors.
There is plenty of evidence that MA programs not only fleece taxpayers by submitting inflated reimbursement bills to the government but also routinely deny necessary medical coverage.
In other words, they’re drinking out of both sides of the government trough.
The Center for Economic and Policy Research pointed out in a March 2024 paper that the “insurance companies that run these MA plans spend significant sums of money to blanket seniors with marketing” while relying on “heavily restricted networks that damage one’s choice of provider along with dangerous delays and denials of necessary care.”
But Project 2025 claims, without evidence, that “the MA program has been registering consistently high marks for superior performance in delivering high-quality care.”
Medicaid, the government program that covers health care for the lowest-income Americans, including millions of children, is also a major target of the conservative authors.
They want to add work requirements to the benefit, adopting the familiar conservative trope of low-income Americans living off tax dollars because they’re too lazy to work. And like the MA programs, they want to allow private insurers to get in on the game.
Calling Medicaid a “cumbersome, complicated, and unaffordable burden on nearly every state,” Project 2025 complains about the program’s increased eligibility while at the same time claiming to care about how it impacts “those who are most in need.”
But a June 2024 report by the Center on Budget and Policy Priorities concludes that Medicaid’s expanded eligibility rules have helped insure millions of Americans who would otherwise be uninsured and saved money in state budgets.
Most encouragingly, “the people who gained coverage have grown healthier and more financially secure, while long-standing racial inequities in health outcomes, coverage, and access to care have shrunk.”
Project 2025 claims to have the underlying ideology to “incentivize personal responsibility,” as if its authors simply want Americans to begin acting like responsible grownups. But they mysteriously don’t apply this same standard to wealthy elites — perhaps because that’s precisely who they are.
Sonali Kolhatkar is the host of “Rising Up With Sonali,” a television and radio show on Free Speech TV and Pacifica stations. This commentary was produced by the Economy for All project at the Independent Media Institute and adapted for syndication by OtherWords.org.
You’re a doctor. You have fifteen minutes with your patient, who cries as she ticks off a laundry list of vague symptoms. Depression is very common, you think, and it could explain all of those symptoms. Do you diagnose the patient with depression, noting it in her medical record, or do you begin an expensive, time-consuming investigation?
Now, replay the scenario from the patient’s perspective. You’re Elke Martinez, a veterinary technician, and you’ve developed muscle and joint pain, headaches, fatigue, and gastrointestinal problems. You go to your primary care doctor, part of the Kaiser Permanente healthcare system, and he attributes your symptoms to depression and anxiety. You know that’s not right, since you’re already being treated for those issues, and the treatment works. What do you do?
What Martinez did was humor her doctor. She attended Kaiser’s group cognitive behavioral therapy classes. The classes didn’t improve any of her symptoms, but they did consume a lot of her time and energy. Meanwhile, she saw more doctors to try to figure out what was actually wrong, but every Kaiser-affiliated doctor asked her about the psychiatric diagnosis already in her chart. “You can see on their face that they’re already checked out,” she says. These experiences undermined not only her trust in her doctors, but also in herself: “You get told this enough and you start to believe it and doubt yourself.”
Your odds of having an experience similar to Martinez’s are shockingly high. A 2017 meta-analysis published in The Lancet showed that for every 100 patients seen in primary care, 15 of them will receive a misdiagnosis of depression.
The problem takes a particular toll on patients who are chronically ill. A 2014 survey by the Autoimmune Association found that 51 percent of patients with autoimmune disease report that they had been told that “their disease was imagined or they were overly concerned.” And a 2019 survey of 4,835 patients with postural orthostatic tachycardia syndrome found that before getting a correct diagnosis, 77 percent of them had a physician suggest their symptoms were psychological or psychiatric.
Incorrect psychiatric diagnoses in medical records can cause long-lasting havoc.
In our culture, aspersions against patients with poorly understood chronic illness still run deep. Just a few months ago in OpenMind, we covered longstanding efforts to label as head cases and confabulators individuals with fibromyalgia, myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), persistent symptoms of Lyme disease, and long covid. You can read it here.
Patients affected by rare disorders (those with fewer than 200,000 sufferers in the United States) also suffer enormously from this type of dismissal. According to the National Organization for Rare Diseases, if you initially receive a false psychiatric diagnosis, it takes you 2.5 to 14 times as long to get diagnosed compared to those who were never misdiagnosed, and between 1.25 and 7 times as long as those who received a false non-psychiatric diagnosis.
Even when a patient is in fact depressed or anxious, that might not be the correct explanation for their physical symptoms. The causation may go in the other direction: The patient might have a physical illness that’s causing their psychological distress. Lyme disease patients, for example, are often misdiagnosed
as having depression, bipolar disorder, and more. Yet as a
2021 study pointed out, these patients are often depressed precisely because they are ill. Systemic, whole-body or brain infection can cause impaired sleep, attention, memory, and performance, all of which contribute to depression. Targeting those psychological symptoms without effectively treating the underlying infection will never work.
Psychological diagnoses are often the easiest ones for doctors to make, and the hardest ones for patients to shake. Once a psychological diagnosis is entered into a patient’s medical records, it becomes the starting place for every subsequent doctor who reads it. Patients may not even know the diagnosis is there, since they often don’t see their records (although they have a right to — see Tools for Readers, below).
Martinez realized that the only way she was going to get a proper diagnosis of her physical symptoms was by leaving the Kaiser system, so that she could go to a new set of doctors who couldn’t see the psychiatric misdiagnosis in her chart. Thirteen years after her symptoms started, she finally got an explanation: She has Ehlers-Danlos Syndrome, a disorder of the connective tissue that can cause devastating symptoms throughout the body. By the time she received a proper diagnosis, she was disabled and had to give up the career she loved in veterinary work. And she was luckier than many. On average, with a psychiatric misdiagnosis, it typically takes patients 22 years to get diagnosed with Ehlers-Danlos syndrome.
Photo: SHVETS Production/PEXELS
Incorrect psychiatric diagnoses in medical records can cause long-lasting havoc. When one U.S.-based patient I interviewed, who requested anonymity, was erroneously diagnosed with Munchausen’s syndrome — meaning that she was accused of fabricating her illness — she became unable to get medication for her severe pain for several months, while her therapist worked to persuade the psychologist who diagnosed her to remove it from her chart. In the meantime, she resorted to taking large doses of Ibuprofen, which resulted in a stomach ulcer.
Another patient that I interviewed, also in the U.S., told me that her exhaustion led to a diagnosis of depression while she was a medical resident, even though her low energy was sufficiently explained by her autoimmune disease. When she received her medical license, it came with conditions. Due to her diagnosis of mental illness, she was required to receive a high level of supervision, making it impossible for her to practice.
Yet another patient I spoke with lost the ability to digest food, weighing in at 85 pounds at 5’7”, but the local hospital wouldn’t admit her to the emergency room because her medical records diagnosed her problem as psychiatric. Since she lives in a remote area and is too ill to travel, she hasn’t been able to access medical care at all; last I heard, she had not gotten to the bottom of her digestive woes.
Even today, doctors routinely use the term “medically unexplained symptom” to imply a psychological origin for a patient’s physiological reports.
The problem of misdiagnosing physiological illness as psychological is particularly pernicious because it evokes the loaded and sexist aura of the old, discarded term "hysteria." Sigmund Freud claimed, without evidence, that unconscious traumatic memories can be converted into symbolically relevant physical symptoms. In so doing, he gave doctors permission to think of literally any symptom as having a psychological origin, even in the absence of psychological symptoms. This led to the term “conversion disorder,” which has multiplied into endless euphemisms designed to cover over its sexist origins, including somatization disorder, functional disorder, and bodily distress disorder. Specialists sometimes argue over fine distinctions between the terms, but fundamentally, they all imply that looking for physical causes for your symptoms will be fruitless and that you should instead address them psycho-behaviorally.
Even today, doctors routinely use the term “medically unexplained symptom” to imply a psychological origin for a patient’s physiological reports. In UpToDate, a highly respected online guide for evidence-based treatment, a search for “medically unexplained symptoms” reroutes to an entry on somatization in psychiatry. Both the language and the culture of modern medicine systematically nudge some doctors toward the assumption that ambiguous symptoms are psychosomatic; it is a culture we need to change. “As a matter of peculiar professional fact, there is no term that names diagnostic uncertainty without also naming psychological diagnosis,” bioethicist Diane O’Leary and health psychologist Keith Geraghty state in the Oxford Handbook of Psychotherapy Ethics.
Writing in The American Journal of Bioethics, philosopher Abraham Schwab at Clarkson University notes that psychological diagnoses may be incorrect either because the doctor doesn’t have the knowledge to come to the proper biomedical diagnosis or because the patient has a biological condition that is not yet understood by medical science. “As a result,” he says, “psychogenic diagnoses should carry with them low levels of confidence.”
In practice, though, a psychological diagnosis tends to override other interpretations, making it difficult for doctors to discover a medical explanation for the patient’s symptoms. That’s partly by design: Investigating undiagnosed medical conditions is expensive, and it often doesn’t lead to treatment that relieves the patient's symptoms. The widely used MacLeod’s Clinical Investigation Handbook cautions that “if [patients with medically unexplained symptoms] are not managed effectively, fruitless investigations and harm from unnecessary drugs and procedures may result.” Furthermore, a patient’s very determination to find a medical explanation can be dismissed as “doctor-shopping” and viewed as an indication of somatization.
Mental health professionals have historically resisted making records available to their patients.
Patients with erroneous psychological records face enormous obstacles since their doctors are discouraged from seeking out the physiological cause of their suffering and further complaints may be met with further suspicion. But there are ways to push back against these challenges, and the place to start is by accessing medical records — and then pushing to get errors fixed.
Mental health professionals have historically resisted making records available to their patients. Common justifications are that patients suffering delusions will become hostile if told in records that their beliefs aren’t correct, or that clinicians will hold back in their note-taking because they’re worried about the reaction of the patient. But some other professionals have argued for encouraging patients to review records, writing in the Journal of the American Medical Association: “The clinician who actively solicits open and ongoing dialogue, including a patient’s opinion about a note’s accuracy, may enhance both clinical precision and the treatment relationship.”
Since 1996 the Health Insurance Portability and Accountability Act (HIPAA) has given patients a legal right to access their medical records. Starting in October of 2022, the 21st
Century Cures Act made it easier to do so. In particular, the Act requires that healthcare providers provide patients access to all the health information in their electronic medical records without delay and without charge. This rule does not include notes from psychotherapy sessions that are not contained within the regular medical record, but it does include any diagnoses made. If a patient believes anything in that record is wrong — such as an incorrect psychiatric diagnosis — they can request that it be changed. See the “Tools” section below for specific guidance on how to purgi falsehoods from your medical record.
Fully fixing the problem of incorrect psychiatric diagnoses, and the array of challenges that result from them, will take a major shift in mindset in the medical profession. It will require a much more nuanced understanding of the complexities of how our mental and physical states affect one another bidirectionally. It will require an acceptance that psychological treatment is an adjunct for physical treatment, rather than a way of getting rid of responsibility for a problematic patient. And it will require a transformation in our healthcare system so that doctors have the time they need to investigate complex patients.
Such changes are beyond what any individual patient can accomplish. But in the meantime, patients can at least ensure that their medical records aren’t making their quest for accurate diagnosis and effective treatment more difficult.
... my first and only experience with motherhood was marred by stress and trauma.
I had a baby in 2021 and quickly learned how parenting and child care expenses add up.
My husband and I had saved up for months to afford my unpaid maternity leave — I kept working even after my water broke because we needed every penny. It was a dream come true to have a career that I was proud of and finally be welcoming a child into our lives.
But I had no idea how hard it would really be.
Bringing a bundles of joy like this cute little one into the world shouldn't be a financial burden.
Photo: Kaushal Mishra/Unsplash
While I was on unpaid maternity leave that cost us our health benefits, my husband was let go from his job. Already reliant on WIC — the federal food aid program for women, infants, and children — we were forced to go to food pantries, apply for Medicaid, and referred to a diaper bank. We were in survival mode: exhausted, stressed out, and worried.
Despite a litany of postpartum complications that continue to plague me more than two years later, I ended up only taking seven weeks of leave before I returned to work out of desperation.
I wondered: Why doesn’t the U.S. have a paid parental leave policy?
Instead, my first and only experience with motherhood was marred by stress and trauma. Again and again, I had to choose between my health and a paycheck, which can feel like a punishment. I’d proudly served my country on a one-year assignment overseas working on foreign aid, and it didn’t matter.
We found child care at a loving, quality child care center, but the tuition kept increasing. Now the monthly cost is almost twice our mortgage. In fact, child care costs exceed college tuition where we live in North Carolina, as well as in at least 27 other states. My stomach gets in a knot every six months when I know the tuition will increase again.
I wondered: Why don’t we invest more in early care and education?
Meanwhile, the crises causing outsized harm to families throughout the pandemic compounded: a diaper shortage, a formula shortage, inflation, and wages that wouldn’t keep up. So many people are struggling to get back on their feet and desperately need balance and some peace of mind. The stress took its toll, and my husband and I separated in spring 2023.
I wondered: If only we’d had more support, would we have made it?
I have an advanced degree and work as a communications director at a nonprofit while also freelancing. After paying for necessities, we have nothing left, so I get food and supplies from neighbors and friends. I work so hard as a single mom to try to achieve the dreams I have for myself and my baby boy — the dreams that all mothers have. I don’t want my child to deal with the stress and constant refrain of “we don’t have the money for that,” like I did growing up.
Families desperately need, want, and deserve better. Welcoming a child should never be the reason a family plunges into poverty, especially in one of the wealthiest countries in the world. We shouldn’t be sacrificing health, quality early learning, or stability in exchange for a roof over our heads and food. Instead, we should be building strong foundations and generational wealth for our kids.
We need federally mandated paid parental and medical leave. We need additional dedicated funding for programs like WIC that support over 6 million families.
And we need to continue expanding the Child Tax Credit. In North Carolina alone, the monthly Child Tax Credits received in 2021 helped the families of 140,000 children lift themselves out of poverty. Nationally, the credit cut child poverty by over 40 percent before Congress let the pandemic expansion expire at the end of 2021.
Congress must put our tax dollars and policies toward strong support for families. Let’s ensure no parent experiences welcoming a child a child as a financial catastrophe and make this country a place where families prosper.
About the author: Lindsay K. Saunders is a North Carolina mother and dedicated advocate for RESULTS Educational Fund, a national anti-poverty organization. This op-ed was distributed by OtherWords.org.
Why can I speak about this issue? I worked as a pharmacy technician before working as a Registered Nurse (RN) and ultimately becoming a Nurse Practitioner (NP) in 2000. I have been employed in health care for 33 years, including over 20 of those years as a NP. At present, I work in a specialized emergency service, and am attending the University of Washington for a Doctor of Nursing Practice (DNP) degree. I am writing in hopes to affect change on this ubiquitous delivery of health care problem.
A personal story exemplifies this issue. My 90-year-old grandfather was discharged from an ER and resumed taking a long discontinued antihypertensive (blood pressure) medication from an old pill bottle. He took this in addition to his newly prescribed antihypertensive medication, both medications listed as active in his discharge instructions.
Fortunately, my grandfather was okay, and my mother caught this error and understandably had something to say about it. She drove back to the hospital to give them a piece of her mind, before recommending they come up with a better system. They agreed.
One recurring and nationwide theme are health care providers, and patients, becoming confused with the list of medications in their medical records in all phases of care, including at hospital admission and discharge. This medication list often includes medications that are listed as active and those they haven't taken at times since many years ago.
Sadly, this is not an exaggeration, and often leads to harmful medication errors which are a big problem during all phases of health care. Affected phases include outpatient ambulatory care clinics, during hospital admissions, during hospital stays and hospital discharge. Because of these gaps, medication errors are not surprisingly a leading cause of injury or death.
This is a serious issue that I believe can be solved with a concerted effort by an interdisciplinary team approach along with a streamlined electronic health record system. This is in addition to an emphasis on patient education throughout all stages of treatment which includes outpatient care, an urgent hospital visit or inpatient stay. Providers and ancillary services should always be involved in this process.
Better practice solutions:
1. For health care providers, at all phases of treatment, if it remains unclear if a patient is taking a medication, ask questions, and if medication reconciliation is not possible then list it as such. Increasing awareness of this problem in the advent of increasing use of Electronic Health Records (EHR) is key.
2. Incorporation of admission and discharge medication reconciliation as a continuous process by admitting and discharging RNs, the pharmacist and nurse practitioner and physicians.
As noted by J AM Med inform Association (2016) working towards a solution would include incorporating reconciliation modules that are interoperable with other Electronic Health Record components. This includes medication history, the computerized order set and discharge documentation. Some EHRs have some interoperability with external sources (hospitals, clinics, pharmacy) to import medication history and share updated medication list at discharge, although this is not fail safe and should not be relied on itself alone.
3. As health care consumers, don't be afraid to ask questions or clarification. Most health care providers want you to be involved in your own care. You reserve this right 100 percent and it is okay to ask questions and include your loved ones to advocate for you in your treatment plan.
In summary, medication confusion and errors are fear reaching. It is up to us as health care providers to be conscientious and provide essential emphasis on patient education and collaboration. Encouraging patients and their loved ones to actively participate in their care is vital. This includes asking questions and seeking clarification about medications along with interdisciplinary providers to help prevent confusion and potential medication errors. Involving patient's loved ones can contribute to healthy outcomes. Refining EHR is of the utmost importance.
I thank all health care providers for dedication to this important cause, and I wish success in your continued efforts to make a positive impact on health care practices while encouraging health consumers to be proactive in their care.
Angela Buxton, FNP-BC is a national Board-Certified (BC) Family Nurse Practitioner (FNP) since 2000 and who is originally from Massachusetts, obtaining her undergraduate and graduate degrees at UMASS, Amherst, and worked as both a Registered Nurse (RN) and FNP throughout her career. She is currently attending the University of Washington to expand her skills as a Doctor of Nursing Practice in Psychiatric Mental Health. She has now been working as a NP at Harborview Medical Center in Seattle, Washington for the last 20 years. She enjoys her role in assessing, diagnosing and developing client centered treatment plans, not limited to prescribing medications. Population includes those who are underserved and across the lifespan. She has membership in Snohomish County, WA Search and Rescue (SSAR), has participated in team endurance events with lessons learned that crossover into daily life. Other outside interests include photography, painting, skiing and hiking the Pacific Northwest.
As Medicare Advantage continues to gain popularity among seniors, three Southern California companies are pioneering new types of plans that target cultural and ethnic communities with special offerings and native-language practitioners.
Clever Care Health Plan, based in Huntington Beach, and Alignment Health, based in nearby Orange, both have plans aimed at Asian Americans, with extra benefits including coverage for Eastern medicines and treatments such as cupping and tui na massage. Alignment also has an offering targeting Latinos, while Long Beach-based SCAN Health Plan has a product aimed at the LGBTQ+ community. All of them have launched since 2020.
Asian Americans may want coverage for traditional Eastern treatments, while LGBTQ+ patients might be especially concerned with HIV prevention or management
While many Medicare Advantage providers target various communities with their advertising, this trio of companies appear to be among the first in the nation to create plans with provider networks and benefits designed for specific cultural cohorts. Medicare Advantage is typically cheaper than traditional Medicare but generally requires patients to use in-network providers.
“This fits me better,” said Clever Care member Tam Pham, 78, a Vietnamese American from Westminster, California. Speaking to KFF Health News via an interpreter, she said she appreciates the dental care and herbal supplement benefits included in her plan, and especially the access to a Vietnamese-speaking doctor.
“I can always get help when I call, without an interpreter,” she said.
Proponents of these new culturally targeted plans say they can offer not only trusted providers who understand their patients’ unique context and speak their language, but also special products and services designed for their needs. Asian Americans may want coverage for traditional Eastern treatments, while LGBTQ+ patients might be especially concerned with HIV prevention or management, for example.
Health policy researchers note that Medicare Advantage tends to be lucrative for insurers but can be a mixed bag for patients, who often have a limited choice of providers — and that targeted plans would not necessarily solve that problem. Some also worry that the approach could end up being a new vector for discrimination.
“It’s strange to think about commodifying and profiting off people’s racial and ethnic identities,” said Naomi Zewde, an assistant professor at the UCLA Fielding School of Public Health. “We should do so with care and proceed carefully, so as not to be exploitive.”
Still, there’s plenty of evidence that patients can benefit from care that is targeted to their race, ethnicity, or sexual orientation.
A November 2020 study of almost 118,000 patient surveys, published in JAMA Network Open, underscored the need for a connection between physician and patient, finding that patients with the same racial or ethnic background as their physicians are more likely to rate the latter highly. A 2022 survey of 11,500 people around the world by the pharmaceutical company Sanofi showed a legacy of distrust in health care systems among marginalized groups, such as ethnic minorities, LGBTQ+ people, and people with disabilities.
Clever Care, founded by Korean American health care executive Myong Lee, aimed from the start to create Medicare Advantage plans for underserved Asian communities, said Peter Winston, the senior vice president and general manager of community and provider development at the company. “When we started enrollments, we realized there is no one ‘Asian,’ but there is Korean, Chinese, Vietnamese, Filipino, and Japanese,” Winston added.
The company has separate customer service lines by language and gives members flexibility on how and where to spend their allowances for benefits like fitness programs.
Winston said the plan began with 500 members in January 2021 and is now up to 14,000 (still very small compared with mainstream plans). Herbal supplement benefit dollars vary by plan, but more than 200 products traditionally used by Asian clients are on offer, with coverage of up to several hundred dollars per quarter.
Sachin Jain, a physician and the CEO of SCAN Group, said its LGBTQ+ plan serves 600 members.
“This is a group of people who, for much of their lives, lived in the shadows,” Jain added. “There is an opportunity for us as a company to help affirm them, to provide them with a special set of benefits that address unmet needs.”
Alignment also has an offering aimed at Latinos, dubbed el Único, in parts of Arizona, Nevada, Texas, Florida, and California.
SCAN has run into bias issues itself, with some of its employees posting hate speech and one longtime provider refusing to participate in the plan, Jain recounted.
Alignment Health offers a plan targeting Asian Americans in six California counties, with benefits such as traditional wellness services, a grocery allowance for Asian stores, nonemergency medical transportation, and even pet care in the event a member has a hospital procedure or emergency and needs to be away from home.
Alignment also has an offering aimed at Latinos, dubbed el Único, in parts of Arizona, Nevada, Texas, Florida, and California. The California product, an HMO co-branded with Rite Aid, is available in six counties, while in Florida and Nevada, it’s a so-called special needs plan for Medicare beneficiaries who also qualify for Medicaid. All offer a Spanish-speaking provider network.
Todd Macaluso, the chief growth officer for Alignment, declined to share specific numbers but said California membership in Harmony — its plan tailored to Asian Americans — and el Único together has grown 80% year over year since 2021.
Alignment’s marketing efforts, which include visiting places where prospective members may shop or socialize, are about more than just signing up customers, Macaluso said.
“Being present there means we can see what works, what’s needed, and build it out. The Medicare-eligible population in Fresno looks very different from one in Ventura.”
“Just having materials in the same language is important, as is identifying the caller and routing them properly,” Macaluso added.
Blacks, Latinos, and Asians overall are significantly more likely than white beneficiaries to choose Medicare Advantage plans, according to recent research conducted for Better Medicare Alliance, a nonprofit funded by health insurers. (Latino people can be of any race or combination of races.) But it’s not clear to what extent that will translate into the growth of targeted networks: Big insurers’ Medicare Advantage marketing efforts often target specific racial or ethnic cohorts, but the plans don’t usually include any special features for those groups.
Utibe Essien, an assistant professor of medicine at UCLA, noted the historical underserving of the Black community, and that the shortage of Black physicians could make it hard to build a targeted offering for that population. Similarly, many parts of the country don’t have a high enough concentration of specific groups to support a dedicated network.
Still, all three companies are optimistic about expansion among groups that haven’t always been treated well by the health care system. “If you treat them with respect, and bring care to them the way they expect it, they will come,” Winston said.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
She was taking care of her father, now 86, who has been in and out of hospitals and rehabs after a worsening series of strokes in recent years.
Working from home for a rental property company, she could handle it. In fact, like most family caregivers during the early days of covid-19, she had to handle it. Community programs for the elderly had shut down.
Work-from-home made it much easier for caregivers to take care of their loved ones and improve the quality of life those they were responsible for during the COVID-19 pandemic.
In theory, the national debate about remote or hybrid work is one great big teachable moment about the demands on the 53 million Americans taking care of an elderly or disabled relative.
But the “return to office” debate has centered on commuting, convenience, and child care. That fourth C, caregiving, is seldom mentioned.
That’s a missed opportunity, caregivers and their advocates say.
Employers and co-workers understand the need to take time off to care for a baby. But there’s a lot less understanding about time to care for anyone else. “We need to destigmatize it and create a culture where it’s normalized, like birth or adoption,” said Karen Kavanaugh, chief of strategic initiatives at the Rosalynn Carter Institute for Caregivers. For all the talk of cradle to grave, she said, “mostly, it’s cradle.”
She’s also not alone. About one-fifth of U.S. workers are family caregivers, and nearly a third have quit a job because of their caregiving responsibilities, according to a report from the Rosalynn Carter Institute. Others cut back their hours. The Rand Corp. has estimated that caregivers lose half a trillion dollars in family income each year — an amount that’s almost certainly gone up since the report was released nearly a decade ago.
Workplace flexibility, however desirable, is no substitute for a national long-term care policy, a viable long-term care insurance market, or paid family leave, none of which are on Washington’s radar.
President Joe Biden gave family caregivers a shoutout in his State of the Union address in February and followed up in April with an executive order aimed at supporting caregivers and incorporating their needs in planning federal programs, including Medicare and Medicaid. Last year, his Department of Health and Human Services released a National Strategy to Support Family Caregivers outlining how federal agencies can help and offering road maps for the private sector.
Although Biden checked off priorities and potential innovations, he didn’t offer any money. That would have to come from Congress. And Congress right now is locked in a battle over cutting spending, not increasing it.
They cashed in his retirement fund to hire part-time caregivers.
So that leaves it up to families.
Remote work can’t fill all the caregiving gaps, particularly when the patient has advanced disease or dementia and needs intense round-the-clock care from a relative who is also trying to do a full-time job from the kitchen table.
But there are countless scenarios in which the option to work remotely is an enormous help.
When a disease flares up. When someone is recuperating from an injury, an operation, or a rough round of chemo. When a paid caregiver is off, or sick, or AWOL. When another family caregiver, the person who usually does the heavy lift literally or metaphorically, needs respite.
“Being able to respond to time-sensitive needs for my dad at the end of his life, and to be present with my stepmother, who was the 24/7 caregiver, was an incredible blessing,” said Gretchen Alkema, a well-known expert in aging policy who now runs a consulting firm and was able to work from her dad’s home as needed.
That flexibility is what Rose Garcia has come to appreciate, as a small-business owner and a caregiver for her husband.
Garcia’s husband and business partner, Alex Sajkovic, has Lou Gehrig’s disease. Because of his escalating needs and the damage the pandemic wrought on their San Francisco stone and porcelain design company, she downsized and redesigned the business. They cashed in his retirement fund to hire part-time caregivers. She goes to work in person sometimes, particularly to meet architects and clients, which she enjoys. The rest of the time she works from home.
As it happened, two of her employees also had caregiving obligations. Her experience, she said, made her open to doing things differently.
For one employee, a hybrid work schedule didn’t work out. She had many demands on her, plus her own serious illness, and couldn’t make her schedule mesh with Garcia’s. For the other staff member, who has a young child and an older mother, hybrid work let her keep the job.
If caregivers quit or go part time, they lose pay, benefits, Social Security, and retirement savings.
A third worker comes in full time, Garcia said. Since he’s often alone, his dogs come too.
In Lincoln, Nebraska, Sarah Rasby was running the yoga studio she co-owned, teaching classes, and taking care of her young children. Then, at 35, her twin sister, Erin Lewis, had a sudden cardiac event that triggered an irreversible and ultimately fatal brain injury. For three heartbreaking years, her sister’s needs were intense, even when she was in a rehab center or nursing home. Rasby, their mother, and other family members spent hour after hour at her side.
Rasby, who also took on all the legal and paperwork tasks for her twin, sold the studio.
“I’m still playing catch-up from all those years of not having income,” said Rasby, now working on a graduate degree in family caregiving.
Economic stress is not unusual. Caregivers are disproportionately women. If caregivers quit or go part time, they lose pay, benefits, Social Security, and retirement savings.
“It’s really important to keep someone attached to the labor market,” the Rosalynn Carter Institute’s Kavanaugh said. Caregivers “prefer to keep working. Their financial security is diminished when they don’t — and they may lose health insurance and other benefits.”
But given the high cost of home care, the sparse insurance coverage for it, and the persistent workforce shortages in home health and adult day programs, caregivers often feel they have no choice but to leave their jobs.
Temote and hybrid work is mostly for people whose jobs are largely computer-based. A restaurant server can’t refill a coffee cup via Zoom.
At the same time, though, more employers, facing a competitive labor market, are realizing that flexibility regarding remote or hybrid work helps attract and retain workers. Big consultant companies like BCG offer advice on “the working caregiver.”
Successful remote work during the pandemic has undercut bosses’ abilities to claim, “You can’t do your job like that,” observed Rita Choula, director of caregiving for the AARP Public Policy Institute. It’s been more common in recent years for employers to offer policies that help workers with child care. Choula wants to see them expanded “so that they represent a broad range of caregiving that occurs across life.”
Yet, even with covid’s reframing of in-person work, telecommuting is still not the norm. A March report from the Bureau of Labor Statistics found only 1 in 4 private businesses had some or all of their workforce remote last summer — a dropoff from 40% in 2021, the second pandemic summer. Only about 1 in 10 workplaces are fully remote.
And remote and hybrid work is mostly for people whose jobs are largely computer-based. A restaurant server can’t refill a coffee cup via Zoom. An assembly line worker can’t weld a car part from her father-in-law’s bedside.
But even in the service and manufacturing sectors, willing employers can explore creative solutions, like modified shift schedules or job shares, said Kavanaugh, who is running pilot programs with businesses in Michigan. Cross-training so workers can fill in for one another when one has to step into caregiving is another strategy.
She also needs to be in. “Every night, he says, ‘Thank you for all you do,’” she said of her father. “I tell him, ‘I do this because I love you.’”
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
URBANA - Have a plan.
It’s something you’ll hear OSF HealthCare Mission Partners Heather Ludwig and Stephanie Kitchens say over and over.
Ludwig, an international board certified lactation consultant, and Kitchens, a registered nurse, are helping new mothers navigate pumping breast milk at work as a federal law on pumping takes effect.
"If you feel like your employer is going to support you with pumping, you’re going to be extremely loyal to that job," Ludwig says.
Laws protecting moms
In general, Illinois, Michigan and federal laws allow moms to pump at work and in a private space better than a bathroom stall until the child is 1 year old. But on April 28, 2023, the Providing Urgent Maternal Protections for Nursing Mothers Act (the PUMP Act for short) goes into effect. The law expands the number of mothers who are protected and strengthens a mother’s ability to get relief in court if their employer is not following the law. It also says mothers can stay on the clock while pumping if they keep working, for example simply answering emails.
But moms still need to be their own best advocate, Ludwig says. It starts before you return to work. Three to four weeks prior, build up a supply of breast milk at home. Talk to your boss, coworkers and human resources representative about your needs. Be firm but fair in setting the expectations. Keep the conversation going during your months of pumping. Have allies like a lactation consultant in your corner.
"Think about where you’re going to pump and what supplies you need to bring," Ludwig says. Make sure your pump fits you and is working. Ideally, your workplace will provide a space where you can leave the equipment and come and go to pump for a few minutes. That won’t empty the tank, but it will "reset the clock" for a while before you feel the physical pressure of needing to pump again.
"Full and uncomfortable is one thing. But if you wait too long, you can end up with clogged ducts, mastitis and other nasty things," Ludwig says. "An emptied breast is a breast that’s going to continue to make milk and a mom that’s going to stay comfortable."
Kitchens’ experience
Having a dedicated pumping space is crucial for professions like nursing, law enforcement or restaurant workers. For example, a waitress can’t abandon her tables for a half hour and still expect a big tip.
Kitchens, too, couldn’t afford to be away from her cardiac patients for a long time. Her first child came into the world in March 2020, and she returned to work that June – all during the height of the pandemic.
"I was a little unsure about how pumping would work," she admits. "I was more into trying to please everybody and be the better nurse."
Now with the task of producing milk for her second child, born in April 2022, Kitchens has been taking some of Ludwig’s advice to heart and having a smoother experience.
"I’m very open with my patients now," Kitchens says with a smile. "I say ‘listen I’m a breastfeeding mother. I have to go relieve myself. When I’m done with that, I’ll come back and meet your needs.’ And they are totally fine with that."
For other high stress jobs, options exist too. Police officers could be temporarily assigned to office work so they are not in a squad car all day. Truck drivers can hook up a hands-free pump before they turn on the engine and let the machine do its work underneath their clothes. Yes, hands-free pumping and driving is legal, Ludwig says.
Navigating the day
Ludwig says moms can expect to pump several times during a typical eight-to-10-hour shift. Staying on schedule and staying stress-free about it all is important. "If you’re stressed out and your cortisol levels are high, it’s hard for your body to let your milk come out," Ludwig says. "So having a good location is going to help mom feel supported. She can take care of business quicker so she can get back to work."
Some mothers will bring their baby to work to feed at the breast. Having a good home support system is key for this option to work. Milk can be stored in any cold, sanitary place, like the break room refrigerator. "A lot of moms will just have a little lunch bag cooler with some freezer packs," Ludwig says.
Bottom line advice
Kitchens agrees with Ludwig that mothers returning to work need to be their own best advocate. Stand up for yourself, even, Kitchens says. Make it clear that a pump break and a lunch break are separate, for example.
To view it another way: "Would an adult ask to use the bathroom or would they just go?" Kitchens says slyly.
A new report finds thousands of low-income or uninsured people in Illinois face medical debt that is depleting their savings and, in some cases, affecting their health.
The report, from the Illinois Coalition for Immigrant and Refugee Rights, described situations where patients racked up big bills because they didn't know that hospitals or community agencies could offer financial assistance. House Bill 2719 was filed this week to require all Illinois hospitals to screen uninsured patients and inform them of their options for paying medical bills.
Luvia Quinones, senior director of health policy at the coalition, said many low-income and working-class people are unnecessarily losing sleep - and cash.
"Many of these individuals are actually eligible for something, whether it be some type of health coverage program or for hospital financial assistance," she said, "and unfortunately, many of them are not made aware of either of these services or programs."
The Illinois Department of Health Care and Family Services reported in 2021 that more than 900,000 people in the state were uninsured. It said one-third of them qualify for coverage under Medicaid or through the Insurance Marketplace, while others are eligible for hospital financial programs or charity care.
Most Democrats in the General Assembly support the bill, but Republicans have not publicly staked out a position. The measure is pending before the Health Care Availability and Accessibility Committee. Quinones said the bill's goal is ultimately to prevent excessive medical debt.
"By hospitals screening these individuals, you could prevent them both ending up in medical debt," she said, "and it could also help the hospitals to be able to get reimbursed for some of the services."
Legislation enacted in December will be phasing out that money over the next year and calls for states to resume cutting off from Medicaid people who no longer qualify.
States are preparing to remove millions of people from Medicaid as protections put in place early in the covid-19 pandemic expire.
The upheaval, which begins in April, will put millions of low-income Americans at risk of losing health coverage, threatening their access to care and potentially exposing them to large medical bills.
It will also put pressure on the finances of hospitals, doctors, and others relying on payments from Medicaid, a state-federal program that covers lower-income people and people with disabilities.
Almost three years ago, as covid sent the economy into free fall, the federal government agreed to send billions of dollars in extra Medicaid funding to states on the condition that they stop dropping people from their rolls.
But legislation enacted in December will be phasing out that money over the next year and calls for states to resume cutting off from Medicaid people who no longer qualify.
Now, states face steep challenges: making sure they don’t disenroll people who are still entitled to Medicaid and connecting the rest to other sources of coverage.
Even before the pandemic, states struggled to stay in contact with Medicaid recipients, who in some cases lack a stable address or internet service, do not speak English, or don’t prioritize health insurance over more pressing needs.
“We have no illusion that this will be beautiful or graceful, but we will be doing everything we can not to lose anyone in the process,” Dana Hittle, Oregon’s interim Medicaid director, said of the so-called Medicaid unwinding.
With the rate of uninsured Americans at an all-time low, 8%, the course reversal will be painful.
The Biden administration has predicted that 15 million people — 17% of enrollees — will lose coverage through Medicaid or CHIP, the closely related Children’s Health Insurance Program, as the programs return to normal operations. While many of the 15 million will fall off because they no longer qualify, nearly half will be dropped for procedural reasons, such as failing to respond to requests for updated personal information, a federal report said.
Certain states may be hit particularly hard: Nevada’s enrollment in Medicaid and CHIP has risen 47% since February 2020. Many signed up toward the start of the pandemic, when the state’s unemployment rate spiked to nearly 30%.
Ordinarily, people move in and out of Medicaid all the time. States, which have significant flexibility in how they run their Medicaid programs, typically experience significant “churn” as people’s incomes change and they gain or lose eligibility.
The unwinding will play out over more than a year.
We acknowledge that this is going to be a bumpy road
People who lose Medicaid coverage — in the more than 30 states covered by the federal marketplace — will have until July 31, 2024, to sign up for ACA coverage, CMS announced on Jan. 27. It’s unclear whether the state-based marketplaces will offer the same extended open-enrollment period.
Even states that are taking far-reaching action to make sure people don’t end up uninsured worry the transition will be rough.
In California alone, the state government forecasts that at least 2 million people out of 15 million in the program today will lose Medicaid coverage because of loss of eligibility or failure to reenroll.
“We acknowledge that this is going to be a bumpy road,” California Health and Human Services Secretary Mark Ghaly said. “We’re doing all we can to be prepared.”
In an all-hands-on-deck effort, states are enlisting Medicaid health plans, doctors, hospitals, state insurance marketplaces, and an assortment of nonprofit groups, including schools and churches, to reach out to people at risk of losing coverage.
States will also use social media, television, radio, and billboards, as well as websites and mobile phone apps, to connect with enrollees. That’s in addition to letters and emails.
Nevada has developed a mobile app to communicate with members, but only 15,000 of its 900,000 Medicaid enrollees have signed up so far.
“[T]he transient nature of Nevada’s population means that maintaining proper contact information has been difficult,” a state report said in November. At least 1 in 4 letters sent to enrollees were returned on account of a wrong address.
The law that allows states to begin disenrolling ineligible Medicaid recipients on April 1 bars states from disenrolling anyone because mail was returned as undeliverable until the state has made a “good faith effort” to contact the person at least one other way, such as by phone or email.
To further reduce disruption, the law requires states to cover children in Medicaid and CHIP for 12 months regardless of changes in circumstances, but that provision doesn’t take effect for almost a year.
States will give Medicaid recipients at least 60 days to respond to requests for information before dropping them, said Jack Rollins, director of federal policy at the National Association of Medicaid Directors.
States will use government databases such as those from the IRS and Social Security Administration to check enrollees’ income eligibility so they can renew some people’s coverage automatically without having to contact them. But some states aren’t taking full advantage of the databases.
States have until February to submit their unwinding plans to the federal Centers for Medicare & Medicaid Services, which will monitor the process.
We want to make it easier to say yes to coverage
But it is already clear that some states are doing much more than others to keep people insured.
Oregon plans to allow children to stay on Medicaid until age 6 and allow everyone else up to two years of eligibility regardless of changes in income and without having to reapply. No other state provides more than one year of guaranteed eligibility.
Oregon is also creating a subsidized health plan that would cover anyone who no longer qualifies for Medicaid but has an annual income below 200% of the federal poverty level, which amounts to about $29,000 for an individual, state officials said. The program will have benefits similar to Medicaid’s at little or no cost to enrollees.
Rhode Island will automatically move people who are no longer eligible for Medicaid — and with annual incomes below 200% of the poverty rate — into an Affordable Care Act plan and pay their first two months of premiums. State officials hope the shift will be seamless for many enrollees because they’ll be moving between health plans run by the same company.
California will move some people to a subsidized private plan on the state’s marketplace, Covered California. Enrollees will have to agree and pay a premium if they don’t qualify for a free plan. However, the premium could be as low as $10 a month, said Jessica Altman, executive director of Covered California. (Altman’s father, Drew Altman, is president and CEO of KFF. KHN is an editorially independent program of KFF.)
“We want to make it easier to say yes to coverage,” Altman said.
But experts worry about what will become of Florida Medicaid enrollees.
Florida doesn’t have its own ACA marketplace. As in most states, its residents use the federal exchange to shop for ACA plans. As a result, the handoff of people from Medicaid to marketplace may not be as efficient as it would be if it involved two state agencies that regularly work together, said Jodi Ray, director of Florida Covering Kids and Families, a nonprofit that helps people find coverage.
Another concern for advocates is that Florida makes less use of government databases than other states to check enrollees’ incomes. “We make everyone jump through hoops to get reenrolled instead of utilizing all the acceptable data,” Ray said.
Florida typically takes weeks to process Medicaid applications, while some states do it in a day, she said.
Florida’s unwinding plan illustrates the difficulty of reaching enrollees. The plan said that, since 2020, the state has identified 850,000 cases in which Medicaid recipients did not respond to requests for information.
Florida Medicaid officials did not return calls for comment.
While state officials struggle to manage the unwinding, health care providers are bracing for the fallout.
Dennis Sulser, chief executive of Billings, Montana-based Youth Dynamics, which provides mental health services to many children on Medicaid, expects some will lose coverage because they get lost in the process.
That could leave patients unable to pay and the nonprofit financially stretching to try to avoid children facing an interruption in treatment.
“If we had to discharge a child who is in our group home care, and they're only halfway through it and don't have all of the fundamentals of the care support needed, that could be tragic,” Sulser said.
KHN correspondents Daniel Chang in Hollywood, Florida; Angela Hart in Sacramento, California; Katheryn Houghton in Missoula, Montana; Bram Sable-Smith in St. Louis; and Sam Whitehead in Atlanta contributed to this report.
KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.
StatePoint Media -- According to a new survey, American nurses are overwhelmed by job demands, a long-brewing situation only exacerbated by the COVID-19 pandemic. While the majority of nurses continue to be dedicated to the care of patients, many are considering leaving the profession at a time when staff shortages are part of the problem. But there’s hope, according to industry experts, who say that understanding these challenges can lead to meaningful and necessary reforms.
The 2022 national survey, “The Future of Nursing: A Profession in Crisis,” of nurses and student nurses, was conducted by Cross Country, a market-leading tech-enabled workforce solutions platform and advisory firm, in partnership with Florida Atlantic University’s Christine E. Lynn College of Nursing.
Overall, the study revealed that nurses remain passionate about patient care, with 66% citing helping people through meaningful work as a main driver for staying in the field. Nevertheless, ongoing challenges have created undue burdens for nurses, with pay rates/compensation (86%), staff shortages (53%), stress (39%) and burnout (35%) cited as top career dissatisfiers.
This frustration has put the industry in crisis: 28% of nurses indicated their desire to leave the profession has increased dramatically since the pandemic, while those who said their desire to stay has dropped from 24% in 2021 to 4% in 2022. This translates to a real potential loss of talent in hospitals, physicians’ offices, long-term care facilities and other healthcare settings. Of those surveyed, 23% plan to look for a new career in 1-2 years and 13% plan to retire in 1-5 years.
“We had hoped that as the pandemic eased, nurses would have better balance, mental health and working conditions, but we are not there and as a result, nurses are leaving the profession in droves,” says John A. Martins, president and chief executive officer, Cross Country Healthcare. “The time to fix these mounting problems is now.”
To that end, Cross Country is deploying several strategies to transform the nursing profession. These include an ongoing examination of pay rates and retention practices; identifying new pathways for education, licensing, and talent development; focusing on flexibility and growth opportunities; and investments toward innovation to strengthen the nursing workforce.
The company continues to invest heavily in technology and digital transformation to support these strategies. Among these initiatives is a new website dedicated to nursing candidates. Found at crosscountry.com, the site aims to help health care professionals find and engage with potential job opportunities more effectively.
Identifying new pathways for nursing education is also a critical steppingstone towards reforming the profession and addressing healthcare provider shortages. That’s why the Christine E. Lynn College of Nursing offers accredited programs at all levels to prepare and train students, including various tracks for a BSN, Master of Science in Nursing (MSN), PhD and DNP focused on Caring Science. Also offered are a BSN-DNP program with a Psychiatric Mental Health Nurse Practitioner concentration and post-graduate dermatology and telehealth certificate courses, as well as other concentrations that intersect innovation and technology.
“Nursing is the greatest profession in the world. The experience you will get is priceless,” said one of the survey respondents. “Make sure you’re getting into nursing for the right reasons because I love coming to work and look forward to caring for patients every day. No two patients are alike, so every day in nursing is like a new experience and adventure. And you make the difference.”
To learn more about the challenges facing the nursing industry, visit crosscountry.com/the-future-of-nursing, where the complete study results, can be found.
Meggan Ingram was fully vaccinated when she tested positive for COVID-19 early this month. The 37-year-old’s fever had spiked to 103 and her breath was coming in ragged bursts when an ambulance rushed her to an emergency room in Pasco, Washington, on Aug. 10. For three hours she was given oxygen and intravenous steroids, but she was ultimately sent home without being admitted.
Seven people in her house have now tested positive. Five were fully vaccinated and two of the children are too young to get a vaccine.
As the pandemic enters a critical new phase, public health authorities continue to lack data on crucial questions, just as they did when COVID-19 first tore through the United States in the spring of 2020. Today there remains no full understanding on how the aggressively contagious delta variant spreads among the nearly 200 million partially or fully vaccinated Americans like Ingram, or on how many are getting sick.
The nation is flying blind yet again, critics say, because on May 1 of this year — as the new variant found a foothold in the U.S. — the Centers for Disease Control and Prevention mostly stopped tracking COVID-19 in vaccinated people, also known as breakthrough cases, unless the illness was severe enough to cause hospitalization or death.
Individual states now set their own criteria for collecting data on breakthrough cases, resulting in a muddled grasp of COVID-19’s impact, leaving experts in the dark as to the true number of infections among the vaccinated, whether or not vaccinated people can develop long-haul illness, and the risks to unvaccinated children as they return to school.
If you’re limiting yourself to a small subpopulation with only hospitalizations and deaths, you risk a biased viewpoint.
"It’s like saying we don’t count,” said Ingram after learning of the CDC’s policy change. COVID-19 roared through her household, yet it is unlikely any of those cases will show up in federal data because no one died or was admitted to a hospital.
The CDC told ProPublica in an email that it continues to study breakthrough cases, just in a different way. "This shift will help maximize the quality of the data collected on cases of greatest clinical and public health importance,” the email said.
In addition to the hospitalization and death information, the CDC is working with Emerging Infections Program sites in 10 states to study breakthrough cases, including some mild and asymptomatic ones, the agency’s email said.
Under pressure from some health experts, the CDC announced Wednesday that it will create a new outbreak analysis and forecast center, tapping experts in the private sector and public health to guide it to better predict how diseases spread and to act quickly during an outbreak.
Tracking only some data and not releasing it sooner or more fully, critics say, leaves a gaping hole in the nation’s understanding of the disease at a time when it most needs information.
"They are missing a large portion of the infected," said Dr. Randall Olsen, medical director of molecular diagnostics at Houston Methodist Hospital in Texas. "If you’re limiting yourself to a small subpopulation with only hospitalizations and deaths, you risk a biased viewpoint."
On Wednesday, the CDC released a trio of reports that found that while the vaccine remained effective at keeping vaccinated people out of the hospital, the overall protection appears to be waning over time, especially against the delta variant.
Among nursing home residents, one of the studies showed vaccine effectiveness dropped from 74.7% in the spring to just 53.1% by midsummer. Similarly, another report found that the overall effectiveness among vaccinated New York adults dropped from 91.7% to just under 80% between May and July.
The new findings prompted the Biden administration to announce on Wednesday that people who got a Moderna or Pfizer vaccine will be offered a booster shot eight months after their second dose. The program is scheduled to begin the week of Sept. 20 but needs approval from the Food and Drug Administration and a CDC advisory committee.
No vaccine is 100% percent effective against transmission, health officials warned.
This latest development is seen by some as another example of shifting public health messaging and backpedaling that has accompanied every phase of the pandemic for 19 months through two administrations. A little more than a month ago, the CDC and the FDA released a joint statement saying that those who have been fully vaccinated "do not need a booster shot at this time.”
The vaccine rollout late last year came with cautious optimism. No vaccine is 100% percent effective against transmission, health officials warned, but the three authorized vaccines proved exceedingly effective against the original COVID-19 strain. The CDC reported a breakthrough infection rate of 0.01% for the months between January and the end of April, although it acknowledged it could be an undercount.
As summer neared, the White House signaled it was time for the vaccinated to celebrate and resume their pre-pandemic lives.
Trouble, though, was looming. Outbreaks of a new, highly contagious variant swept India in the spring and soon began to appear in other nations. It was only a matter of time before it struck here, too.
"The world changed," said Dr. Eric Topol, director of the Scripps Research Translational Institute, "when delta invaded."
The current crush of U.S. cases — well over 100,000 per day — has hit the unvaccinated by far the hardest, leaving them at greater risk of serious illness or death. The delta variant is considered at least two or three times more infectious than the original strain of the coronavirus. For months much of the focus by health officials and the White House has been on convincing the resistant to get vaccinated, an effort that has so far produced mixed results.
Yet as spring turned to summer, scattered reports surfaced of clusters of vaccinated people testing positive for the coronavirus. In May, eight vaccinated members of the New York Yankees tested positive. In June, 11 employees of a Las Vegas hospital became infected, eight of whom were fully vaccinated. And then 469 people who visited the Provincetown, Massachusetts, area between July 3 and July 17 became infected even though 74% of them were fully vaccinated, according to the CDC’s Morbidity and Mortality Weekly Report.
While the vast majority of those cases were relatively mild, the Massachusetts outbreak contributed to the CDC reversing itself on July 27 and recommending that even vaccinated people wear masks indoors — 11 weeks after it had told them they could jettison the protection.
And as the new CDC data showed, vaccines continue to effectively shield vaccinated people against the worst outcomes. But those who get the virus are, in fact, often miserably sick and may chafe at the notion that their cases are not being fully counted.
"The vaccinated are not as protected as they think," said Topol, "They are still in jeopardy."
The CDC tracked all breakthrough cases until the end of April, then abruptly stopped without making a formal announcement. A reference to the policy switch appeared on the agency’s website in May about halfway down the homepage.
"I was shocked," said Dr. Leana Wen, a physician and visiting professor of health policy and management at George Washington University. "I have yet to hear a coherent explanation of why they stopped tracking this information.”
The CDC said in an emailed statement to ProPublica that it decided to focus on the most serious cases because officials believed more targeted data collection would better inform "response research, decisions, and policy."
Sen. Edward MMarkey, D-Mass., became alarmed after the Provincetown outbreak and wrote to CDC director Dr. Rochelle Walensky on July 22, questioning the decision to limit investigation of breakthrough cases. He asked what type of data was being compiled and how it would be shared publicly.
It is unclear how often breakthroughs occur or how widely cases are spreading among the vaccinated.
"The American public must be informed of the continued risk posed by COVID-19 and variants, and public health and medical officials, as well as health care providers, must have robust data and information to guide their decisions on public health measures," the letter said.
Markey asked the agency to respond by Aug. 12. So far the senator has received no reply, and the CDC did not answer ProPublica’s question about it.
When the CDC halted its tracking of all but the most severe cases, local and state health departments were left to make up their own rules.
There is now little consistency from state to state or even county to county on what information is gathered about breakthrough cases, how often it is publicly shared, or if it is shared at all.
"We’ve had a patchwork of information between states since the beginning of the pandemic,” said Jen Kates, senior vice president and director of global health and HIV policy at Kaiser Family Foundation.
She is co-author of a July 30 study that found breakthrough cases across the U.S. remained rare, especially those leading to hospitalization or death. However, the study acknowledged that information was limited because state reporting was spotty. Only half the states provide some data on COVID-19 illnesses in vaccinated people.
"There is no single, public repository for data by state or data on breakthrough infections, since the CDC stopped monitoring them,” the report said.
In Texas, where COVID-19 cases are skyrocketing, a state Health and Human Services Commission spokesperson told ProPublica in an email the state agency was "collecting COVID-19 vaccine breakthrough cases of heightened public health interest that result in hospitalization or fatality only."
Other breakthrough case information is not tracked by the state, so it is unclear how often breakthroughs occur or how widely cases are spreading among the vaccinated. And while Texas reports breakthrough deaths and hospitalizations to the CDC, the information is not included on the state’s public dashboard.
"We will be making some additions to what we are posting, and these data could be included in the future," the spokesperson said.
I thought, ‘COVID is over and I’m going to Disney World,’
South Carolina, on the other hand, makes public its breakthrough numbers on hospitalizations and deaths. Milder breakthrough cases may be included in the state’s overall COVID-19 numbers but they are not labeled as such, said Jane Kelly, an epidemiologist at the South Carolina Department of Health and Environmental Control.
"We agree with the CDC,” she said, "there’s no need to spend public health resources investigating every asymptomatic or mild infection.”
In Utah, state health officials take a different view. "From the beginning of the pandemic we have been committed to being transparent with our data reporting and … the decision to include breakthrough case data on our website is consistent with that approach," said Tom Hudachko, director of communications for the Utah Department of Health.
Some county-level officials said they track as many breakthrough cases as possible even if their state and the CDC does not.
For instance, in Clark County, Nevada, home of Las Vegas, the public health website reported that as of last week there were 225 hospitalized breakthrough cases but 4,377 vaccinated people overall who have tested positive for the coronavirus.
That means that less than 5% of reported breakthrough cases resulted in hospitalization. "The Southern Nevada Health District tracks the total number of fully vaccinated individuals who test positive for COVID-19 and it is a method to provide a fuller picture of what is occurring in our community,” said Stephanie Bethel, a spokesperson for the health district in an email.
Sara Schmidt, a 44-year-old elementary school teacher in Alton, Illinois, is another person who has likely fallen through the data hole.
"I thought, ‘COVID is over and I’m going to Disney World,’" she said. She planned a five-day trip for the end of July with her parents. Not only had she been fully vaccinated, receiving her second shot in March, she is also sure she had COVID-19 in the summer of 2020. Back then she had all the symptoms but had a hard time getting tested. When she finally did, the result came back negative, but her doctor told her to assume it was inaccurate.
"My guard was down," she said. She was less vigilant about wearing a mask in the Florida summer heat, assuming she was protected by the vaccination and her presumed earlier infection.
On the July 29 plane trip home, she felt mildly sick. Within days she was "absolutely miserable." Her coughing continued to worsen, and each time she coughed her head pounded. On Aug. 1 she tested positive. Her parents were negative.
Now, three weeks later, she is far from fully recovered and classes are about to begin at her school. There’s a school mask mandate, but her students are too young to be vaccinated. "I’m worried I will give it to them, or I will get it for a third time," she said.
But it is doubtful her case will be tracked because she was never hospitalized. That infuriates her, she said, because it downplays what is happening.
"Everyone has a right to know how many breakthrough cases there are," she said, "I was under the impression that if I did get a breakthrough case, it would just be sniffles. They make it sound like everything is under control and it’s not."
The St. Joseph-Ogden soccer team hosted Oakwood-Salt Fork in their home season opener on Monday. After a strong start, the Spartans fell after a strong second-half rally by the Comets, falling 5-1. Here are 33 photos from the game.
by Sentinel News Service
