Memory Monday | Spartan wrestlers suffer home loss to Falcons
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Families are not happy with states requiring Covid tests for nursing home visits
Officials in California, New York, and Rhode Island say new covid testing requirements are necessary to protect residents — an enormously vulnerable population — from exposure to the highly contagious omicron variant. But many family members say they can’t secure tests amid enormous demand and scarce supplies, leaving them unable to see loved ones. And being shut out of facilities feels unbearable, like a nightmare recurring without end.
Severe staff shortages are complicating the effort to ensure safety while keeping facilities open; these shortages also jeopardize care at long-term care facilities — a concern of many family members.
Andrea DuBrow’s 75-year-old mother, who has severe Alzheimer’s disease, has lived for almost four years in a nursing home in Danville, California. When DuBrow wasn’t able to see her for months earlier in the pandemic, she said, her mother forgot who she was.
"This latest restriction is essentially another lockdown," DuBrow said at a meeting last week about California’s new regulations. "The time that my mom has left when she can recognize in some small locked-away part of her that it is me, her daughter, cleaning her, feeding her, holding her hand, singing her favorite songs — that time is being stolen from us."
"This is a huge inconvenience, but what’s most upsetting is that no one seems to have any kind of long-term plan for families and residents," said Ozzie Rohm, whose 94-year-old father lives in a San Francisco nursing home.
Why are family members subject to testing requirements that aren’t applied to staffers, Rohm wondered. If family members are vaccinated and boosted, wear good masks, stay in a resident’s room, and practice rigorous hand hygiene, do they pose more of a risk than staffers who follow these procedures?
California was the first state to announce new policies for visitors to nursing homes and other long-term care facilities on Dec. 31. Those took effect on Jan. 7 and remain in place for at least 30 days. To see a resident, a person must show evidence of a negative covid rapid test taken within 24 hours or a PCR test taken within 48 hours. Also, covid vaccinations are required.
In a statement announcing the new policy, the California Department of Public Health cited "the greater transmissibility" of the omicron variant and the need to "protect the particularly vulnerable populations in long-term care settings." Throughout the pandemic, nursing home residents have suffered disproportionately high rates of illness and death.
New York followed California with a Jan. 7 announcement that nursing home visitors would need to show proof of a negative rapid test taken no more than a day before. And on Jan. 10, Rhode Island announced a new rule requiring proof of vaccination or a negative covid test.
Patient advocates are worried other states might adopt similar measures. "We are concerned that Omicron will be used as an excuse to shut down visitation again," said Sam Brooks, program and policy manager for the National Consumer Voice for Quality Long-Term Care, an advocacy group for people living in these facilities.
"We do not want to go back to the past two years of lockdowns in nursing homes and resident isolation and neglect," he continued.
That’s also a priority for the federal Centers for Medicare & Medicaid Services, which has emphasized since Nov. 12 residents’ right to receive visitors without restriction as long as safety protocols are followed. Nursing homes could encourage but not require visitors to take tests in advance or provide proof of covid vaccination, guidance from CMS explained. Safety protocols included wearing masks, rigorous hand hygiene, and maintaining adequate physical distance from other residents.
With the rise of omicron, however, facilities pushed back. On Dec. 17, an organization representing nursing home medical directors and two national long-term care associations sent a letter to CMS’ administrator asking for more flexibility to "protect resident safety" and "place temporary visitation restrictions in nursing homes." On Jan. 6, CMS affirmed residents’ right to visitation but said states could "take additional measures to make visitation safer."
Asked for comment about the states’ recent actions, the federal agency said in a statement to KHN that "a state may require nursing homes to test visitors as long as the facility provides the rapid antigen tests, and there are enough testing supplies. … However, if there are not enough rapid testing supplies, the visits must be allowed to occur without a test (while still adhering to other practices, such as masking and physical distancing)."
Some relief from test shortages may be at hand under the Biden administration’s new plan to distribute four free tests per household. But for family members who visit nursing home residents several times a week, that supply won’t go very far.
Since the start of the year, tension over the balance between safety and residents’ rights to visitation has intensified. In the week ended Jan. 9, 57,243 nursing home staffers reported covid infections, almost 10 times as many as three weeks before. During the same period, resident infections rose to 32,061, almost eight times as many as three weeks earlier.
But outbreaks are occurring against a different backdrop today. More than 87% of nursing home residents have been fully vaccinated, according to CMS, and 63% have also received boosters, reducing the risk that covid poses. Also, nursing homes have gained experience handling outbreaks. And the toll of nursing home lockdowns — loneliness, despair, neglect, and physical deterioration — is now far better understood.
"We have all seen the negative effects of restricting visitation on residents’ health and well-being," said Joseph Gaugler, a professor who studies long-term care at the University of Minnesota’s School of Public Health. "For nursing homes to go back into a bunker mentality and shut everything down, that’s not a solution."
Amid egregious staffing shortages, "we need people in these buildings who can take care of residents, and often those are visitors who are basically functioning as unpaid certified nursing assistants: grooming and toileting residents, turning and repositioning them, feeding them, stretching, and exercising them," said Tony Chicotel, a staff attorney at California Advocates for Nursing Home Reform.
Nearly 420,000 staffers have left nursing homes since February 2020, according to the U.S. Bureau of Labor Statistics, worsening existing shortages.
When DuBrow learned of California’s new testing requirement for visitors, she arranged to get a PCR test at a testing site on Jan. 6, expecting results within 48 hours. Instead, she waited 104 hours before getting a response. (Her test was negative.) Eager to visit her mother, DuBrow called every CVS, Walgreens, and Target in a 25-mile radius of her home asking for a test but came up empty.
In a statement, the California Department of Public Health said the state had established 6,288 covid testing sites and sent millions of at-home tests to counties and local jurisdictions.
In New York, Democratic Gov. Kathy Hochul has pledged to deliver nearly 1 million covid tests to nursing homes, where visitors can take them on the spot, but that presents its own problems. "We don’t want to test visitors who are lining up at the door. We don’t have the clinical staff to do that, and we need to focus all our staff on the care of residents," said Stephen Hanse, president and CEO of the New York State Health Facilities Association, an industry organization.
With current staff shortages, trying to ensure that visitors are wearing masks, physical distancing, and adhering to infection control practices is "taxing on the staff," said Janine Finck-Boyle, vice president of regulatory affairs at Leading Age, which represents not-for-profit long-term care providers.
"Really, the challenges are enormous," said Gaugler, of the University of Minnesota, "and I wish there were easy answers."
Subscribe to KHN's free Morning Briefing.
5 Easy Ways to Enhance Digestive Health
- Allowing 4-6 hours between meals
- Avoiding eating between meals
- Avoiding foods with cold, wet and heavy qualities
- Drinking ginger tea or hot water to stimulate the Agni
- Starting a meal with pungent (hot), sour and salty flavors
- Consuming a small amount of bitter taste before a meal to increase the production of hydrochloric acid in the stomach
Online platform helps indies and gig workers take control of key aspects of their venture
The demonstrated success of working remotely means that independent workers will be key to the future of work, even as many people return to in-person office settings.
To thrive both professionally and personally, independent workers need support and tools to promote their skills and manage their business.
An online platform known as Indy provides these features and more. Indy offers a complete productivity suite that helps independent workers take the management of their businesses to the next level, with tools and guidance for creating contracts, generating invoices, and everything in between. Additionally, their blog, The Independent Worker, is focused on addressing topics of interest to freelancers, ranging from business development to managing burnout.
"We proudly empower today's 'Indies' - including solopreneurs, freelancers, consultants, contractors, microbusinesses and side hustlers - to streamline the most time-consuming parts of operating their businesses. We help them work smarter, get paid faster, and thrive," says Sebastian Gyr, CEO and co-founder of Indy.
The Indy app offers freelancers a suite of tools designed to help them own three key aspects of their business: :
- Marketing. Indy provides templates for proposals, project briefs, and profiles to help you organize your pitches, and showcase your unique skills.
- Organization. Time tracker and task management tools help you keep everything organized, and Indy also offers a chat feature that freelancers can use for quick communication with clients.
- Business management. Templates for legally-binding contracts and non-disclosure agreements take a lot of the effort and stress out of contract creation, so you can get right to work and invoicing tools will let you quickly and easily send highly professional invoices to the client directly to be paid either electronically or the old-fashioned way - via a check in the mail.
Indy takes pride in empowering an inclusive and diverse community of freelancers, including the LGBTQ community, Black Americans, BIPOC, and workers with disabilities, who are often underserved in the workplace despite the recent rise in equity initiatives. Leaning into these tenets, Indy recently launched a new, digital series called 'Miss Independent' featuring a Black drag queen who offers short videos commenting on freelancing and the freelancing life.
"We're spotlighting what's currently missing for today's virtual workforce and are boldly embracing the opportunity to drive conversations and narratives around equitable pay, diversity, and inclusion, by enabling the success of all workers, especially those from underserved communities," according to the company.
"We celebrate the uniqueness of those human beings that we serve by providing the products, services, space, and the megaphone for them to be their authentic selves, shine, and thrive."
Visit weareindy.com for more information and to create an account for free.
Guest Commentary: Can you imagine what it would be like if American truckers went strike?
Grocery store shelves are not like they used to be. Before the pandemic there was plenty of whatever we typically wanted. It’s not like that today.
Car dealerships have changed. Before the pandemic most dealers had plenty of new and used cars to sell. We were accustomed to browsing several lots as we shopped and compared models and prices. It’s not like that today.
When you needed your car fixed, parts were readily available or just an overnight order away. Today, you might wait three or four months for a part.
I recently looked into adding an additional heating unit to my house and was told, "Order it now and you might have it by summer."
A friend of mine ordered a small boat last August with the hopes he will have it by May or June this year, maybe.
The pandemic has changed our lives in more ways than sickness and death. The new normal is having to wait longer on what used to be so available.
If you think America’s products, food and merchandise are difficult to get now, then can you imagine if our American truckers all went on strike?
Canadian truckers have recently blocked the flow of goods into the United States. The protest follows rallies over opposition to COVID-19 mandates in cities across Canada. In a show of solidarity with a demonstration in Ottawa that has gone on for more than a week by the so-called Freedom Truck Convoy. The protests have paralyzed the Canadian capital’s business district and led the mayor to call for 2,000 extra police officers to quell the nightly demonstrations.
Several people involved in the protest Tuesday in Canada said the demonstrations had expanded from its original purpose, opposing mandates for cross-border truck drivers, and were there in opposition to all vaccine mandates, in addition to supporting truck drivers, the Windsor Star reported.
"Any delay or disruption in the supply chain creates problems, not just for agriculture but the state economy," said Chuck Lippstreu, president of the Michigan Agri-Business Association, which represents businesses that support farmers, early in the closure.
The Canadian Vehicle Manufacturers’ Association, which represents the Detroit Three automakers, called for an end to the protest, citing its effect on the country’s economy. (NNY.360.com)
If the American truckers stopped driving today, the grocery stores would dry up and the movement of most everything you would want or need would not be available.
Truckers work hard. They have long hours. They sacrifice a lot by being gone so many hours, days and weeks. They deserve whatever they are paid and I’m sure in many cases are deserving of more. However, to our truckers, I have this request, please help us keep this country moving. We have enough problems in this country. A shut-down of any kind by America’s truckers would create severe hardship on the people everywhere in America.
We respect you. We appreciate you. We need you to keep this country moving. Furthermore, God bless you for what you do.
Dr. Glenn Mollette is a syndicated American columnist and author of Grandpa's Store, American Issues, and ten other books. He is read in all 50 states. The views expressed are those of the author and are not necessarily representative of any other group or organization.
This article is the sole opinions of the author and does not necessarily reflect the views of The Sentinel. We welcome comments and views from our readers. Submit your letters to the editor or commentary on a current event 24/7 to editor@oursentinel.com.
Radon is common in most homes and easy to fix
Breaking ~ Illinois to go maskless on Feb. 28
- Schools.
- Day cares.
- Health care facilities.
- Congregate care facilities.
- Public transportation, including buses, trains and airplanes.
- Federal buildings in areas of high of substantial risk of transmission.
- Long-term care facilities when in communal areas.
- In businesses that privately require mask use.
- When in municipalities, like cities or counties, that have mask mandates.
- Local business and places of employment
Wayback Wednesday | Rockets topple Comets to advance to 3A title game
Photo: PhotoNews Media
Photo: PhotoNews Media
| Date | Opponent | W/L | Own | Opp |
| *8/24 | Macon (Meridian) | W | 59 | 6 |
| *8/31 | Maroa (M.-Forsyth) | W | 7 | 6 |
| *9/7 | Moweaqua (Central A & M) | L | 41 | 47 |
| *9/14 | Argenta (A.-Oreana) | W | 29 | 26 |
| *9/21 | Sullivan [S.-Okaw Valley Coop] | W | 49 | 20 |
| *9/28 | Decatur (St. Teresa) | W | 49 | 21 |
| *10/5 | Monticello | W | 18 | 14 |
| *10/12 | Clinton | W | 47 | 28 |
| *10/19 | Shelbyville | W | 50 | 12 |
| *10/27 | Pana (H.S.) | W | 46 | 8 |
| *11/3 | Pleasant Plains | W | 22 | 7 |
| *11/10 | Williamsville | W | 10 | 7 |
| *11/17 | Greenville | W | 56 | 21 |
| *11/23 | Aurora Christian | L | 12 | 42 |
To view more photos from this game, please follow this link to place a request to see additional photos in the PhotoNews Media Archives.
Prep Sports Notebook: SJO, Rockets add another win to their record.
Unity bounces back
With 16 points to her credit, Taylor Henry dropped points in all four quarters of the Rockets home game against Monticello on Monday. The senior was also credited with six rebounds as Unity picked up the conference win, 37-34.
Raegen Stringer delivered three assists and racked up four steals as the team's second-leading scorer with eight points.
Producing just a single free throw, Katey Moore led the Rockets' rebounding effort with seven boards to break a three-game skid.
Mboyo-Meta leads Tigers' scoring effort
Gabrielle Mboyo-Meta scored 11 points in Urbana's 64-29 loss at home to Champaign Central. The junior was a perfect 4-for-4 from the free-throw line. Destiny Barber had 8 points and Jasmine McCollough scored seven in the Big 12 Conference loss rounding out the top three scorers for the Tigers.Spartans notch 20th win
SJO boys win road game
The St. Joseph-Ogden boys basketball team still have their magic touch. The Spartans toppling Bloomington Central Catholic on the road 73-61 to earn their 19th victory of the season.Study suggests young marijuana smokers may be at greater risk of recurrent stroke
Cannabis use disorder is defined as dependent use of cannabis despite having a psychological, physical and social functioning impairment. According to the American Heart Association, stroke rates are increasing in adults between ages 18 and 45, and each year young adults account for up to 15% of strokes in the United States.
"Since marijuana use is more common among younger people and is now legal in several U.S. states, we felt it was crucial to study the various risks it may impose," said Akhil Jain, M.D., lead author of the study and a resident physician at Mercy Fitzgerald Hospital in Darby, Pennsylvania. "First-time stroke risk among cannabis users is already established, so it intrigued us to investigate whether continued marijuana dependence also predisposes younger people to develop further strokes."
The researchers examined health information from the National Inpatient Sample, a large, publicly available database that compiles data on more than 7 million hospital stays annually across the U.S. For this study, the sample included 161,390 adults between 18-44 years of age who had been hospitalized for any reason between October 2015 and 2017, and whose health records indicated a previous stroke (either clot-caused or bleeding stroke) or TIA.
Using hospital diagnosis codes, researchers identified patients within the sample who met the criteria for cannabis use disorder, excluding those with charts indicating their cannabis dependence was in remission. This divided the sample into 4,690 patients who had been diagnosed with cannabis use disorder and 156,700 who had not. The median age for both groups was 37 years.
The study found that when compared with patients without cannabis use disorder, patients with the condition were:
- More likely to be male (55.2% vs. 40.9%), Black adults (44.6% vs. 37.2%), or to smoke tobacco (73.9% vs. 39.6%).
- More likely to be diagnosed with chronic obstructive pulmonary disease (21.5% vs. 19.0%), depression (20.4% vs. 16.1%) or psychosis (11.2% vs. 7.5%).
- Significantly more likely to abuse alcohol (16.5% vs. 3.6%).
- Less likely to have high blood pressure (53.1% vs. 55.6%), diabetes (16.3% vs. 22.7%), high cholesterol (21.6% vs. 24.1%) or obesity (12.0% vs. 19.6%).
Compared to current hospitalizations, the analysis found:
- Among adults with cannabis use disorder, 6.9% were hospitalized for a recurrent stroke, compared to only 5.4% hospitalized without the disorder.
- After adjusting for demographic factors and relevant pre-existing medical conditions (age at admission, sex, race, payer status, median household income, type of admission, hospital bed-size, region, location/teaching status and other medical conditions including traditional cardiovascular risk factors), patients with cannabis use disorder were 48% more likely to have been hospitalized for recurrent stroke than those without the disorder.
- Cannabis use disorder was most prominent among males, young Black or white adults and those who lived in low-income neighborhoods or in the northeast and southern regions of the U.S.
"Young marijuana users who have a history of stroke or TIA remain at significantly higher risk of future stroke. Therefore, it is essential to increase awareness among younger adults of the adverse impact of chronic, habitual use of marijuana, especially if they have established cardiovascular disease risk factors or previous stroke episodes," Jain said.
Possible mechanisms that have emerged from other research on cannabis use disorder include impairment of blood vessel function, changes in blood supply, an increased tendency towards blood-clotting, impaired energy production in brain cells, and an imbalance between molecules that harm healthy tissue and the antioxidant defenses that neutralize them.
Results from this study may not be generalizable to older adults (ages greater than 44), who are more likely to have a greater number of chronic health conditions and cardiovascular risk factors. The study is also limited in that all data was collected at a single point in time, rather than following participants over time. In addition, while the hospital coding identified cannabis use disorder, the data did not include information on the exact amount and duration of cannabis use or medications used.
"Our study is hypothesis-generating research for future prospective and randomized controlled studies. More research work is required to look deeply into this concerning clinical question. Most importantly, the impact of various doses, duration, forms of cannabis abuse, and the use of medicinal cannabis on the occurrence of recurrent strokes are critical questions that need to be answered," Jain said.
According to an August 2020 scientific statement from the American Heart Association, preliminary studies have found that cannabis use may negatively impact the heart and blood vessels. Although cannabis may be helpful for conditions such as spasticity associated with multiple sclerosis, among others, cannabis does not appear to have any well-documented benefits for the prevention or treatment of cardiovascular diseases.
Co-authors of the study include: Rupak Desai, M.B.B.S.; Terry Ricardo Went, M.B.B.S.; Waleed Sultan, M.B.B.Ch.; Dwayne Wiltshire, M.B.B.S.; Geethu Jnaneswaran, M.B.B.S.; Athul Raj Raju, M.B.B.S.; Roshna Asifali; Aamer Mohammad, M.B.B.S.; and Bisharah Rizvi, M.D.
SJO FFA to host auction fundraiser this Saturday
Recipe: Irresistible Red Wine Braised Beef Short Rib Ragu
Red Wine Braised Beef Short Rib Ragu
Prep time: 25 minutes / Cook time: 3 hoursInstructions:
Heat oven to 350 F. In 5-quart Dutch oven, heat olive oil over medium heat. Season short ribs with salt and ground black pepper, to taste. Place one layer of short ribs in pot. Set remaining ribs aside. Cook ribs 3-4 minutes per side until browned. Transfer to plate and set aside. Repeat with remaining short ribs. Add celery, carrots and onion to pot used to brown ribs. Stir and cook until vegetables are browned, about 15 minutes. Add garlic and stir 1-2 minutes. Add tomato paste. Cook 2-3 minutes. Carefully pour red wine into pot. Stir and scrape any browned bits from bottom of pot. Cook 3-4 minutes until wine is almost completely absorbed into vegetables. Add rosemary, sage, thyme and bay leaves to pot. Add sauce, bone broth and browned ribs. Cover pot and place in oven 2 1/2-3 hours, or until ribs are fall-apart tender. Remove pot from oven. Transfer ribs to plate or cutting board. Remove and discard herb stems and bay leaves. Remove bones from ribs then shred meat into bite-sized pieces using two forks or tongs. Return shredded ribs to pot with ragu. Stir to combine. Set aside. Bring large stockpot of water to boil. Boil pappardelle pasta until al dente. Add drained pasta to pot with beef ragu and toss until combined. Garnish with freshly grated Parmesan cheese. Find more romantic dishes perfect for sharing at Bertolli.com.Memory Monday | SJO baseball team falls to Chargers
Photo: PhotoNews Media/Clark Brooks
Photo: PhotoNews Media/Clark Brooks
Photo: PhotoNews Media/Clark Brooks
Photo: PhotoNews Media/Clark Brooks
Photo: PhotoNews Media/Clark Brooks
Northern Ireland agency could be a model for US juvenile-justice system
Photo Gallery | St. Joseph-Ogden girls defeat Unity at home to win IPC title
New Federal aid could help lead pipeline removal in Illinois
Illinois has more lead pipelines than any other state in the nation, but a new plan from the Biden-Harris administration could boost the state's lead-line removal efforts.
Guest Commentary: Masked or not, at least say 'Howdy'
"Howdy," was a common everyday word where I grew up. Raised on old Stidham, now known as Milo road in rural Appalachia, I spent a lot of time at my Grandpa and Grandma Hinkle’s store. People came and went buying gasoline, sandwich meat, snacks or groceries for the week. There were cane bottom chairs in the store. Often people would sit and chat for a while.
Regardless of how many times during the week I walked down the road to that store, the opening salutation was typically, "howdy."
People were in and out of the Hinkle store doing business. A family member was often coming or going because my grandparents had raised ten children and there were many grandchildren who frequented the Hinkle business. Often, family members were buying a soda pop or just stopping in to say “howdy.”
We grew up on Milo speaking to most everyone who came and went. When a car drove by, we usually waved even though we didn’t always know them. At family or church gatherings we typically talked to everyone for a minute or two and shook hands or hugged a few people.
The only time I can remember our family being speechless was when fifteen or twenty of us were sitting on the porch and a man from New York City pulled up in an older car.
My grandpa had received an advertisement in the mail about a great used car he could buy for $500. He ordered the car to surprise my grandma and we were all really surprised when this man pulled in front of the store in an old beat up looking car. He had driven the car from New York City, which was a long drive on those roads back then.
After being drop jaw stunned silent for a few minutes, everyone loosened up and eventually started talking to the man who was just doing a job but now had to get back to New York. By this time, some of us were chuckling just a little. A couple of the family members took the guy over to Kermit, West Virginia to catch a Greyhound bus to begin his long journey back home.
A part of American culture has been hand shaking and embracing those we know. A part of most American religious gatherings has been shaking hands. One church I attended insisted on everybody hugging each other.
Covid-19 has impacted our world with death, sickness and business failures. The distancing for many of us continues to be tough. We wear our masks and seldom know who else is in the grocery store.
We’re fearful of going to the funeral home to honor and respect the deceased. Shaking hands or embracing anyone anywhere is typically totally unwelcome. Many holiday parties of large gatherings were fewer over the past holidays. People don’t want to be sick and so the distancing continues.
We do have the telephone, social media and email which helps us at least stay connected.
However, please keep in mind, when you do recognize someone at the grocery or any public place you may not feel comfortable embracing or shaking hands, but you can still convey a greeting and kindness by at least saying, "howdy."
Dr. Glenn Mollette is a syndicated American columnist and author of Grandpa's Store, American Issues, and ten other books. He is read in all 50 states. The views expressed are those of the author and are not necessarily representative of any other group or organization.
This article is the sole opinions of the author and does not necessarily reflect the views of The Sentinel. We welcome comments and views from our readers. Submit your letters to the editor or commentary on a current event 24/7 to editor@oursentinel.com.
Unity girls fall at SJO
Illini Prairie Conference Standings
As of 2/5/221. St. Joseph-Ogden 9-0
2. Prairie Central 7-1
3. Unity 6-3
4. Olympia 5-3
4 Bloomington Central Catholic 5-3
6. Illinois Valley Central 5-5
7. Monticello 3-5
7. St. Thomas More 3-5
9. Paxton-Buckley-Loda 2-7
10. Pontiac 1-7
11. Rantoul 0-7
Make it with love, set the table for romance with this Creamy Italian Garlic Chicken dish
Creamy Italian Garlic Chicken Pasta
Prep time: 10 minutes / Cook time: 20 minutesIngredients
2 tablespoons olive oil2 large chicken breasts
1 teaspoon Italian seasoning
salt, to taste
pepper, to taste
4 cloves garlic, minced
1/4 cup onions, chopped
1/4 cup sun-dried tomatoes, cut into strips
2 tablespoons capers, drained
6 fresh basil leaves, sliced
1 jar Bertolli d'Italia Creamy Rosa Sauce
1/2 cup heavy cream
water
1/2 box Casarecce or preferred pasta
parsley, for garnish
Parmesan cheese, for garnish