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Tag: Health care costs

  • State Medicaid offices target dead people’s homes to recoup their health care costs

    State Medicaid offices target dead people’s homes to recoup their health care costs

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    WASHINGTON — As Salvatore LoGrande fought cancer and all the pain that came with it, his daughters promised to keep him in the white, pitched roof house he worked so hard to buy all those decades ago.

    So, Sandy LoGrande thought it was a mistake when, a year after her father’s death, Massachusetts billed her $177,000 for her father’s Medicaid expenses and threatened to sue for his home if she didn’t pay up quickly.

    “The home was everything,” to her father said LoGrande, 57.

    But the bill and accompanying threat weren’t a mistake.

    Rather, it was part of a routine process the federal government requires of every state: to recover money from the assets of dead people who, in their final years, relied on Medicaid, the taxpayer-funded health insurance for the poorest Americans.

    A person’s home is typically exempt from qualifying for Medicaid. But it is subject to the estate recovery process for those who were over 55 and used Medicaid to pay for long-term care such as nursing home stays or in-home health care.

    This month, a Democratic lawmaker proposed scuttling the “cruel” program altogether. Critics argue the program collects too little — roughly 1% — of the more than $150 billion Medicaid spends yearly on long-term care. They also say many states fail to warn people who sign up for Medicaid that big bills and claims to their property might await their families once they die.

    LoGrande says that’s how she ended up in a two-year legal battle with Massachusetts after her father died. Several years before he died in 2016, she had turned to a local nonprofit for advice on caring for her elderly father. The group suggested she sign him up for Medicaid. She even remembers asking about the house, but was assured the state would only seek the house if it sent her father to a nursing home.

    “He never would have signed on with anything that would put his home in jeopardy,” she said.

    For years, her father got an annual renewal notice from the state’s Medicaid office. She says it wasn’t until after his death, when the state’s demand for $177,000 arrived, that she saw the first bill for his care, which included a brief stint in the hospital for pain from cancer, medications and hospice.

    “That’s what ripped my guts out,” LoGrande said. “It was dishonest.”

    The state settled with the LoGrandes in 2019 and released its claim on the house.

    State policies around this recovery process vary widely, according to a 2021 report from the Medicaid and CHIP Payment and Access Commission, which makes policy recommendations to Congress.

    Some states will put a lien — a legal right — on a home while others don’t. Meanwhile, some Medicaid offices try to recoup all medical costs from patients, like doctor visits or prescriptions, while others just pursue the costs for long-term care. Alaska and Arizona pursued just dozens of properties in recent years while other states go after thousands of homes, totaling hundreds of millions of dollars.

    New York and Ohio topped the country for such collections, recovering more than $100 million combined in a single year, a Dayton Daily News investigation found.

    An investigation into the Kansas program, released Tuesday by the Health and Human Services inspector general, found that program was cost effective — yielding $37 million while only spending $5 million to recover the money, But the state didn’t always collect the money from estates that were eligible.

    Last month, a foundation for one of the industry’s biggest health insurance giants called on Massachusetts to overhaul its process, which includes collecting reimbursement for most Medicaid costs, beyond the federal government’s minimum requirement to recover long-term care expenses. The Blue Cross Blue Shield Foundation of Massachusetts recommended the state Legislature pass a law that would prohibit those additional collections.

    Estate recovery “has the potential to perpetuate wealth disparities and intergenerational poverty,” said Katherine Howitt, a Medicaid policy director with the foundation.

    In Tennessee, which recovered more than $38.2 million from more than 8,100 estates last year, Imani Mfalme found herself in a similar predicament after her mother’s death in 2021.

    As her mother’s early-onset Alzheimer’s worsened, Mfalme continued to care for her. But in 2015, when Mfalme was diagnosed with breast cancer and needed a double mastectomy, she started looking at other options. She hosted a meeting in her mother’s home with the local Medicaid office. The representative told her to drain her mother’s bank accounts – money Mfalme poured into assisted living facility payments for her mom – so her mother would qualify for the program.

    She recalls being somewhat offended during the meeting after the representative asked her three times: “This is your mother’s home?” The representative, Mfalme said, made no mention that she could be forced to sell the house to settle her mother’s bill with Medicaid once she died.

    Now, Tennessee’s Medicaid office says she owes $225,000 and the state is seeking a court order that would require Mfalme to sell the house to pay up.

    Mfalme, now 42, said she wants to pay what she can, but the house is a particular pain point. Her mother, a Black woman, purchased her dream home in Knoxville after she won a landmark discrimination lawsuit against her former employer, Boeing, for paying her less than her male coworkers.

    “She fought hard for equal pay and equal rights. Just to see that ripped away just because she was sick and I was sick, it’s just absolutely devastating,” Mfalme said of her mother.

    TennCare, Tennessee’s Medicaid office, said in an email to The Associated Press that it would not comment on specific cases.

    The Medicaid and CHIP Payment and Access Commission’s report recommended that Congress reverse the 1993 law that required states to recover money from estates, instead making it optional.

    Earlier this month, Democratic Rep. Jan Schakowsky of Illinois reintroduced legislation that would end the federal government’s mandate. Schakowsky believes the rule is a losing proposition for families, who give up their homes, and taxpayers, who don’t see big returns from the recovery efforts.

    “It is one of the most cruel, ineffective programs that we see,” Schakowsky told the AP. “This is a program that doesn’t work for anybody.”

    In a gridlocked Congress, where some Republicans are clamoring to trim Medicaid entitlements, the bill is unlikely to garner the bipartisan support needed to become law.

    There’s at least one person who acknowledges the rule isn’t working: the man who engineered it.

    Many people don’t know about the decades-old mandate, which was intended to encourage people to save for long-term care — or risk losing the equity from their home, explained Stephen Moses, who now works for the conservative Paragon Health Institute.

    “The plan here was to ensure that people who need long-term care can get it but that you plan ahead to be able to pay privately so you don’t end up on the public health care program,” Moses said.

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  • State Medicaid offices target dead people’s homes to recoup their health care costs

    State Medicaid offices target dead people’s homes to recoup their health care costs

    [ad_1]

    WASHINGTON — As Salvatore LoGrande fought cancer and all the pain that came with it, his daughters promised to keep him in the white, pitched roof house he worked so hard to buy all those decades ago.

    So, Sandy LoGrande thought it was a mistake when, a year after her father’s death, Massachusetts billed her $177,000 for her father’s Medicaid expenses and threatened to sue for his home if she didn’t pay up quickly.

    “The home was everything,” to her father said LoGrande, 57.

    But the bill and accompanying threat weren’t a mistake.

    Rather, it was part of a routine process the federal government requires of every state: to recover money from the assets of dead people who, in their final years, relied on Medicaid, the taxpayer-funded health insurance for the poorest Americans.

    A person’s home is typically exempt from qualifying for Medicaid. But it is subject to the estate recovery process for those who were over 55 and used Medicaid to pay for long-term care such as nursing home stays or in-home health care.

    This month, a Democratic lawmaker proposed scuttling the “cruel” program altogether. Critics argue the program collects too little — roughly 1% — of the more than $150 billion Medicaid spends yearly on long-term care. They also say many states fail to warn people who sign up for Medicaid that big bills and claims to their property might await their families once they die.

    LoGrande says that’s how she ended up in a two-year legal battle with Massachusetts after her father died. Several years before he died in 2016, she had turned to a local nonprofit for advice on caring for her elderly father. The group suggested she sign him up for Medicaid. She even remembers asking about the house, but was assured the state would only seek the house if it sent her father to a nursing home.

    “He never would have signed on with anything that would put his home in jeopardy,” she said.

    For years, her father got an annual renewal notice from the state’s Medicaid office. She says it wasn’t until after his death, when the state’s demand for $177,000 arrived, that she saw the first bill for his care, which included a brief stint in the hospital for pain from cancer, medications and hospice.

    “That’s what ripped my guts out,” LoGrande said. “It was dishonest.”

    The state settled with the LoGrandes in 2019 and released its claim on the house.

    State policies around this recovery process vary widely, according to a 2021 report from the Medicaid and CHIP Payment and Access Commission, which makes policy recommendations to Congress.

    Some states will put a lien — a legal right — on a home while others don’t. Meanwhile, some Medicaid offices try to recoup all medical costs from patients, like doctor visits or prescriptions, while others just pursue the costs for long-term care. Alaska and Arizona pursued just dozens of properties in recent years while other states go after thousands of homes, totaling hundreds of millions of dollars.

    New York and Ohio topped the country for such collections, recovering more than $100 million combined in a single year, a Dayton Daily News investigation found.

    An investigation into the Kansas program, released Tuesday by the Health and Human Services inspector general, found that program was cost effective — yielding $37 million while only spending $5 million to recover the money, But the state didn’t always collect the money from estates that were eligible.

    Last month, a foundation for one of the industry’s biggest health insurance giants called on Massachusetts to overhaul its process, which includes collecting reimbursement for most Medicaid costs, beyond the federal government’s minimum requirement to recover long-term care expenses. The Blue Cross Blue Shield Foundation of Massachusetts recommended the state Legislature pass a law that would prohibit those additional collections.

    Estate recovery “has the potential to perpetuate wealth disparities and intergenerational poverty,” said Katherine Howitt, a Medicaid policy director with the foundation.

    In Tennessee, which recovered more than $38.2 million from more than 8,100 estates last year, Imani Mfalme found herself in a similar predicament after her mother’s death in 2021.

    As her mother’s early-onset Alzheimer’s worsened, Mfalme continued to care for her. But in 2015, when Mfalme was diagnosed with breast cancer and needed a double mastectomy, she started looking at other options. She hosted a meeting in her mother’s home with the local Medicaid office. The representative told her to drain her mother’s bank accounts – money Mfalme poured into assisted living facility payments for her mom – so her mother would qualify for the program.

    She recalls being somewhat offended during the meeting after the representative asked her three times: “This is your mother’s home?” The representative, Mfalme said, made no mention that she could be forced to sell the house to settle her mother’s bill with Medicaid once she died.

    Now, Tennessee’s Medicaid office says she owes $225,000 and the state is seeking a court order that would require Mfalme to sell the house to pay up.

    Mfalme, now 42, said she wants to pay what she can, but the house is a particular pain point. Her mother, a Black woman, purchased her dream home in Knoxville after she won a landmark discrimination lawsuit against her former employer, Boeing, for paying her less than her male coworkers.

    “She fought hard for equal pay and equal rights. Just to see that ripped away just because she was sick and I was sick, it’s just absolutely devastating,” Mfalme said of her mother.

    TennCare, Tennessee’s Medicaid office, said in an email to The Associated Press that it would not comment on specific cases.

    The Medicaid and CHIP Payment and Access Commission’s report recommended that Congress reverse the 1993 law that required states to recover money from estates, instead making it optional.

    Earlier this month, Democratic Rep. Jan Schakowsky of Illinois reintroduced legislation that would end the federal government’s mandate. Schakowsky believes the rule is a losing proposition for families, who give up their homes, and taxpayers, who don’t see big returns from the recovery efforts.

    “It is one of the most cruel, ineffective programs that we see,” Schakowsky told the AP. “This is a program that doesn’t work for anybody.”

    In a gridlocked Congress, where some Republicans are clamoring to trim Medicaid entitlements, the bill is unlikely to garner the bipartisan support needed to become law.

    There’s at least one person who acknowledges the rule isn’t working: the man who engineered it.

    Many people don’t know about the decades-old mandate, which was intended to encourage people to save for long-term care — or risk losing the equity from their home, explained Stephen Moses, who now works for the conservative Paragon Health Institute.

    “The plan here was to ensure that people who need long-term care can get it but that you plan ahead to be able to pay privately so you don’t end up on the public health care program,” Moses said.

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  • Insurer delays and denials hamper patients seeking at-home breathing machines

    Insurer delays and denials hamper patients seeking at-home breathing machines

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    Lou Gehrig’s disease took away Grace Armant’s ability to speak, but the 84-year-old still has plenty to say about her insurance.

    UnitedHealthcare has rejected several requests from her doctors for coverage of a machine Armant needs to breathe as she deals with the fatal illness.

    “They are no good,” Armant said, typing slowly into a device that speaks for her. “I can’t do without the machine.”

    Doctors around the country say UnitedHealthcare and other insurers have made it harder to get coverage for certain home ventilators that patients like Armant need as their lungs fail. They say patients often must struggle first with less effective — and cheaper — devices before some insurers will pay. In other cases, insurers balk at paying for a second machine needed when patients transfer from their bed to a wheelchair.

    Temple University doctoral student Jaggar DeMarco waited more than three years to get his.

    “Breathing is not a luxury,” he said. “It’s really the bare minimum, and that’s what we’re asking for.”

    Some physicians believe insurers are making it harder on patients because more of the devices are being prescribed. Spending by the federal government’s Medicare program on the ventilators jumped from about $3 million to nearly $269 million between 2009 and 2017, according to the U.S. Department of Health and Human Services Office of Inspector General.

    Insurers say they do cover the machines, but that coverage can depend on several factors.

    These “noninvasive” ventilators help patients breathe around the clock by forcing air into the lungs, often through a mask. They are called noninvasive because they don’t require trachea surgery to open the airway, like ones used in hospitals.

    The machines have battery backups so they can keep working when the power goes out. They also are more powerful than other devices meant to be used mainly at night for conditions like sleep apnea. At around $1,200 a month, they can be three times as expensive as those devices.

    These ventilators can help prolong the life of someone with Lou Gehrig’s disease, also known as amyotrophic lateral sclerosis, doctors say.

    But insurance rejections have picked up for those patients and people dealing with advanced cases of chronic obstructive pulmonary disease, said Chuck Coolidge, chief strategy officer for VieMed, which provides respiratory equipment for patients in 46 states.

    That includes both initial approvals and reauthorizations, he said.

    “In early 2023, it was almost like a switch flipped,” he said.

    UnitedHealthcare spokeswoman Heather Soule said her company covers the machines and re-evaluates requests if it gets new information. Coverage can depend on the patient’s condition, terms of their health plan or guidelines from the federal government’s Medicare program.

    Those guidelines give insurers room to reject many ventilator requests, even those for seriously ill patients, said Dr. John Hansen-Flaschen, a pulmonary medicine expert with the University of Pennsylvania.

    Government-funded Medicare Advantage plans run by UnitedHealthcare now deny nearly all initial requests for the ventilators, said Dr. Cathy Lomen-Hoerth, a neurologist with the University of California San Francisco.

    In West Virginia, Dale Harper says it took several months and a personal plea before UnitedHealthcare would cover a ventilator for his 25-year-old son, Jacob, who has a rare and aggressive form of ALS.

    After appeals from Jacob’s doctor failed, Harper called a number on his insurance card and asked for a supervisor.

    “I said, ‘I can feed him, I can help him go to the bathroom, I can move him from one place to the other,’” the Winfield, West Virginia, resident recalled. “The only thing I cannot do is breathe for him … and he can’t breathe.”

    Harper said ventilator coverage was approved within an hour of that call early last year.

    Doctors caring for Armant, who lives outside New Orleans, say they usually get decent ventilator coverage.

    “No one thought there would be a problem,” said Deidre Devier, an LSU Health experimental psychologist who specializes in cognitive disorders.

    They first sought coverage in May, 2022, and Devier said Armant has only had it for around three months near the end of that year. She said a medical device company has been providing Armant’s ventilator for free while her case was appealed. But those appeals have ended.

    Armant’s daughter said she’s considering starting hospice care, which would allow for ventilator coverage but prevent her mom from seeing her regular doctors. She’s also looking online for a refurbished machine.

    “She doesn’t have $20,000″ to buy the machine, Terrellyn Armant said.

    Representatives of both patients with UnitedHealthcare coverage gave the insurer written permission to discuss their cases, but Soule declined to comment on the record.

    Coverage complications aren’t limited to UnitedHealthcare. DeMarco, the Temple student, said Aetna denied a request for a second breathing machine, and then several appeals. Eventually, his father’s employer essentially overruled the insurer and allowed coverage.

    Doctors recommend a second ventilator for people who use wheelchairs during the day. That avoids mistakes in adjusting the machine’s settings when moving someone from their bed.

    “I’m constantly angry that my life and what I can do with (it) is sometimes determined by insurance companies and bureaucracy,” said the 30-year-old DeMarco, who has chronic respiratory failure.

    An Aetna representative said the company could not comment on individual cases. But he added that Aetna does cover second ventilators in certain circumstances. Aetna’s policy bulletin says they are medically necessary for people who need an additional ventilator for their wheelchair during the day.

    Ventilator coverage problems started picking up after technology improvements made the devices easier to use, according to Dr. Lisa Wolfe, a professor at Northwestern’s Feinberg School of Medicine. That led to a rise in use for patients with conditions that are not immediately life-threatening.

    She said she thinks insurers are reacting to that expanded use.

    ALS patients without ventilator access have limited options. They can use a device that’s covered but doesn’t work as well. They may get ventilator coverage by entering hospice care or having a tracheostomy.

    They also might wind up bouncing in and out of hospitals, said Hansen-Flaschen, the Penn physician.

    “Or they die prematurely, and it’s a wretched death because they can’t breathe,” he said.

    ___

    The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.

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  • In water-stressed Singapore, a search for new solutions to keep the taps flowing

    In water-stressed Singapore, a search for new solutions to keep the taps flowing

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    SINGAPORE — A crack of thunder booms as dozens of screens in a locked office flash between live video of cars splashing through wet roads, drains sapping the streets dry, and reservoirs collecting the precious rainwater across the tropical island of Singapore. A team of government employees intently monitors the water, which will be collected and purified for use by the country’s six million residents.

    “We make use of real-time data to manage the storm water,” Harry Seah, deputy chief executive of operations at PUB, Singapore’s National Water Agency, says with a smile while standing in front of the screens. “All of this water will go to the marina and reservoirs.”

    The room is part of Singapore’s cutting-edge water management system that combines technology, diplomacy and community involvement to help one of the most water-stressed nations in the world secure its water future. The country’s innovations have attracted the attention of other water-scarce nations seeking solutions.

    A small city-state island located in Southeast Asia, Singapore is one of the most densely populated countries on the planet. In recent decades the island has also transformed into a modern international business hub, with a rapidly developing economy. The boom has caused the country’s water consumption to increase by over twelve times since the nation’s independence from Malaysia in 1965, and the economy is only expected to keep growing.

    With no natural water resources, the country has relied on importing water from neighboring Malaysia via a series of deals allowing inexpensive purchase of water drawn from the country’s Johor River. But the deal is set to expire in 2061, with uncertainty over its renewal.

    For years Malaysian politicians have targeted the water deal, sparking political tensions with Singapore. The Malaysian government has claimed the price at which Singapore purchases water — set decades ago — is too low and should be renegotiated, while the Singaporean government argues its treatment and resale of of the water to Malaysia is done at a generous price.

    And climate change, which brings increased intense weather, rising seas and a rise in average temperatures, is expected to exacerbate water insecurity, according to research done by the Singaporean government.

    “For us, water is not an inexhaustible gift of nature. It is a strategic and scarce resource,” Singapore Prime Minister Lee Hsien Loong said at the opening of a water treatment facility in 2021. “We are always pushing the limits of our water resources. And producing each additional drop of water gets harder and harder, and more and more expensive.”

    Seeking solutions to its water stresses, the Singaporean government has spent decades developing a master plan focusing on what they call their four “national taps”: water catchment, recycling, desalination and imports.

    Across the island, seventeen reservoirs catch and store rainwater, which is treated through a series of chemical coagulation, rapid gravity filtration and disinfection.

    Five desalination plants, which produce drinking water by pushing seawater through membranes to remove dissolved salts and minerals, operate across the island, creating millions of gallons of clean water every day.

    A massive sewage recycling program purifies wastewater through microfiltration, reverse osmosis and ultraviolet irradiation, adding to drinking supply reservoirs. Dubbed “NEWater”, the treated wastewater now provides Singapore 40% of its water, with the government hoping to increase capacity to 55% of demand in years to come. To help build people’s confidence in the safety, Singapore’s national water agency collaborated with a local craft brewery to create a line of beer made from treated sewage.

    Innovation has been possible partially because of the involvement of private businesses, Seah said.

    “Sometimes private sectors may have a different way of doing things, and you can learn from them. Industry involvement in us is very important,” Seah said.

    Getting community participation and buy in has been an effective method to improved awareness and conservation as well, Seah said.

    In 2006 the government launched the Active, Beautiful, Clean Waters Program, which transformed the country’s water systems into more public areas. Through the program, residents can kayak, hike and picnic on the reservoirs, giving a greater sense of ownership and value to the country’s water supplies. Several water facilities now have public green spaces on the roofs where the public can picnic amid big lush green lawns.

    In schools, children are taught about best practices for water use and conservation. Schools hold mock water rationing exercises where water taps are shut off and students collect water in pails.

    The international community has tapped into Singapore’s water innovation as well. The country has become a global hub for water technology, as home to nearly 200 water companies and over 20 research centers and hosts a biennial International Water Week.

    Water technology developed and used in Singapore, such as portable water filters, water testing technology and flood management tools, have been exported to over 30 countries, including Indonesia, Malaysia and Nepal.

    But not all of the solutions used in Singapore will relevant to other countries, especially those with less-developed infrastructure concedes Seah.

    Despite the leaps that Singapore has made in its journey for water security, Seah warns that continued progress is essential for the island.

    “After more than two decades we are still constantly analyzing the water,” he said. “We can never be complacent.”

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  • A city famous for its beaches is helping residents age in place. What to know if you want to stay in your home

    A city famous for its beaches is helping residents age in place. What to know if you want to stay in your home

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    Laguna Beach, California

    Luciano Lejtman | Moment | Getty Images

    When most people think of Laguna Beach, California, they think of its scenic coves and beaches.

    But the small coastal city — with a population of around 22,600 — is also pioneering a new model for elder care.

    About 77% of adults ages 50 and up hope to stay in their homes long term, according to AARP. In Laguna Beach, the rate is even higher, with about 90% of residents, according to Rickie Redman, director of the city’s aging-in-place services, dubbed Lifelong Laguna.

    The program, which provides services through a hometown nonprofit, was piloted in 2017. Lifelong Laguna is based on the Village movement, where aging in place is encouraged with community support.

    The Laguna Beach program aims to fulfill a specific need for a city where approximately 28% of residents are age 65 and over, while local assisted living and memory care services are scarce.

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    Many of the older residents have lived in the city since they were in their 20s and 30s, and now find themselves in their 70s and 80s, according to Redman. Many of them trace back to the city’s artistic roots, she said.

    “They make this city unique,” Redman said. “They’re the placeholders for the Laguna that we now know.”

    Notably, there is no cost for the city’s older adults to participate in most of the services.

    The program, which currently has around 200 participants, relies on grants and local fundraising, according to Redman. Its services address a wide range of needs, including a home repair program the city operates in collaboration with Habitat for Humanity, nutrition counseling and end-of-life planning.

    Other cities have also adopted community support models for residents who age in place through the Village movement. That includes tens of thousands of older adults in 26 states and Washington, D.C., according to Manuel Acevedo, founder and CEO of Helpful Village, which provides technology support to seniors and participating communities.

    Retirees confront high costs to stay at home

    The high costs of aging in place are one of the biggest obstacles that prevents older adults from fulfilling their desire to stay put, experts say.

    About 10,000 baby boomers are expected to turn age 65 every day until 2030. An estimated 70% of those individuals will need long-term care services at some point, according to Genworth Financial.

    In 2021, the highest year-over-year increase in cost was in home-care services, Genworth’s research found. The median annual cost for in-home care was $61,776 for a home health aide to provide hands-on personal care and $59,488 for homemaker services to help with household tasks.

    Those costs have been influenced by supply and demand, according to Genworth.

    As more people age and require care, the Covid pandemic led to an insufficient supply of professionals to meet care needs, as well as a high turnover rate.

    Preferences for aging in place are also showing up in the real estate market.

    Baby boomers currently represent the biggest portion of home buyers, according to Jessica Lautz, deputy chief economist and vice president of research at the National Association of Realtors. More than half of boomers are saying that the property they are purchasing now is where they plan on living for the rest of their lives, a sentiment that has increased since the Covid pandemic.

    “There definitely is a mindset change, where people are saying, ‘I do want to stay put, I don’t necessarily want to move into a nursing home or into assisted care,’” Lautz said.

    ‘Forever grateful’ for community

    Sylvia Bradshaw, an 84-year-old Laguna Beach resident who moved to the city in 1983, describes it as “paradise.”

    She has lived there since that time, apart from a stint when she and her husband relocated to Ireland. Still, the couple held on to their home, the city’s third-oldest house, which was built in 1897.

    “My husband had ideas about selling our home,” Bradshaw said. “But I would never sell it, because I said ‘Once it’s gone, it’s gone forever.’”

    Bradshaw’s husband was a teacher in the city’s high school and later became a lawyer. More recently, he had health struggles that made it difficult for the couple to keep up with yard work, Bradshaw said.

    As members of the Laguna aging-in-place community, they had access to help.

    Redman helped arrange for a team of workers to come to clean up the yard, which included removing 17 bags of scraps and trimming a roughly 30-year-old fig tree.

    “Now people can see that there’s a house there; they just couldn’t see it [before],” said Bradshaw, who said she is “forever grateful” for the gesture.

    The support of the community also was especially helpful in sorting through the hospice care issues prior to her husband’s recent death.

    “Anything that I’ve needed, I’ve gotten help,” Bradshaw said.

    That has included help sorting through insurance choices, legal advice, transportation assistance and classes and social events, said John Bradshaw, Sylvia’s son.

    Having the elder community support his parents is a “big comfort,” John said, particularly as he no longer lives in Laguna Beach.

    “It is just such a wonderful relief,” John said. “It’s like having a second family, this team of people really supporting my parents, and others like them, to be able to stay and enjoy this part of the country.”

    What to do if you want to age in place

    If you want to age in place, it helps to start planning early to make sure it’s feasible, said Carolyn McClanahan, a physician and certified financial planner who is the founder of Life Planning Partners in Jacksonville, Florida.

    “We actually start bringing it up with clients in their 50s and 60s: Where do you want to live out the end of your life?” McClanahan said. “Of course, most people do say, ‘I want to live in my home.’”

    It’s important to be realistic about those plans.

    Ask yourself whether the decision to age in place is just “rationalized inertia,” or giving yourself an out when it comes to confronting other important aging decisions, said Tom West, senior partner at Signature Estate and Investment Advisors in Tysons Corner, Virginia.

    If you do decide staying in your home is the best option, be prepared to make changes to your home, he said. That may include wider doorways to accommodate wheelchairs or walkers, as well as grab bars to help prevent falls.

    Like the aging-in-place models established in Laguna Beach and elsewhere, it helps to have community support. McClanahan recommends developing strong relationships with your neighbors where you agree to look out for each other.

    It also helps to set certain boundaries for when staying at home no longer makes sense.

    For example, it may cost $240,000 a year to stay home if you need 24-hour care, McClanahan said.

    “Even if you’re super rich, a lot of families hate seeing that much money go out the window, when you would pay half the cost to actually go into a facility,” McClanahan said.

    Further, be sure to outline your wishes in all potential circumstances. While you may want your children to promise not to put you in a nursing home, it may come to a point where it is more cost effective and safer to go to a care unit, McClanahan said.  

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  • New York governor vetoes change to wrongful death statute, nixing damages for emotional suffering

    New York governor vetoes change to wrongful death statute, nixing damages for emotional suffering

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    ALBANY, N.Y. — New York Gov. Kathy Hochul has again vetoed legislation that would have changed the state’s wrongful death statute by letting families recover damages for emotional suffering from the death of a loved one.

    Hochul declined Friday to sign the Grieving Families Act for the second time this year. In a veto memo, the Democrat said she favors changing the statute but the bill lawmakers sent her had the “potential for significant unintended consequences.”

    Among Hochul’s concerns, she said, were the possibility of increased insurance premiums for consumers and a risk to the financial well-being of public hospitals and other health care facilities.

    New York is one of just a few states that account only for economic loss in wrongful death lawsuits. Almost all states allow family members to be compensated for emotional loss.

    The head of the New York State Trial Lawyers Association, David Scher, called Hochul’s veto “a grave miscarriage of justice.”

    The governor’s decision “puts the safety of New Yorkers in jeopardy and upholds a perverse standard of morality in current New York law,” Scher said in a statement.

    The state’s existing wrongful death statute calculates how much families are compensated based on pecuniary loss, or the potential earning power of the deceased person. That means the family of a top-earning lawyer, for example, can recover more damages than the family of a minimum-wage worker.

    Hochul wrote that valuing life based on potential earnings “is unfair and often reinforces historic inequities and discriminatory practices,” but said she chose to veto the bill because lawmakers failed to adequately address concerns she raised when she nixed a previous version last January.

    “Every human life is valuable and should be recognized as such in our laws and in our judicial system,” Hochul wrote. “I proposed compromises that would have supported grieving families and allowed them to recover additional meaningful compensation, while at the same time providing certainty for consumers and businesses.”

    The long-sought bill stalled for about two decades before reaching Hochul’s desk for the first time after passing last year. She vetoed that version on the grounds that it would drive up already-high insurance premiums and harm hospitals recovering from the pandemic.

    “We tried to address her concerns squarely,” said Sen. Brad Hoylman-Sigal, who sponsored both vetoed bills. “It’s absolutely outrageous that lives in New York are valued differently under our wrongful death statute.”

    The latest version was passed by lawmakers in June with strong bipartisan support. Hochul said she went through “much deliberation” before deciding to veto it. In her memo, she said she remains open to updating the wrongful death statute.

    The legislation would have enabled families who file lawsuits over a loved one’s wrongful death to be compensated for funeral expenses, for some medical expenses related to the death and for grief or anguish incurred as a result, in addition to pecuniary losses.

    ___

    Maysoon Khan is a corps member for the Associated Press/Report for America Statehouse News Initiative. Report for America is a nonprofit national service program that places journalists in local newsrooms to report on undercovered issues. Follow Maysoon Khan on X, formerly known as Twitter.

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  • Delaware hospital system will pay $47 million to settle whistleblower allegations of billing fraud

    Delaware hospital system will pay $47 million to settle whistleblower allegations of billing fraud

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    DOVER, Del. — Delaware’s largest hospital system will pay more than $47 million to settle whistleblower allegations by its former compliance officer that it provided kickbacks to outside doctors in return for patient referrals, resulting in fraudulent Medicaid billing.

    The settlement announced Friday comes nearly seven years after Ronald Sherman filed his whistleblower lawsuit, which remained under seal for more than a year, against Christiana Care Health System.

    The lawsuit alleged that Christiana Care employees, including nurse practitioners, hospitalists and physician assistants, treated patients referred by non-CHSS physicians at no cost or below fair market value.

    Those outside physicians then billed insurers, primarily Medicaid, for care that was actually provided by Christiana employees.

    In exchange for the unearned billings, the physicians continued to funnel patients to Christiana Care rather than to other hospitals, according to the lawsuit.

    The alleged fraud occurred between April 2011 and September 2013 involving Christiana’s neonatology department, and between April 2011 and April 2017 invoving the cardiovascular surgery, urology, neurosurgery and ear, nose and throat departments.

    State and federal authorities said the scheme violated anti-kickback laws and state and federal false claims statutes.

    Attorneys for Sherman said the case is believed to be the largest False Claims Act settlement in Delaware history and similar lawsuits could be brought against other hospitals nationwide.

    “Any other hospital in the country which operates under that model that led to this settlement should consider changing its practices immediately,” Dan Miller, lead counsel for Sherman, said in a statement.

    Miller suggested that the scheme was partly a reaction to new industry rules in 2003 limiting the number of hours that hospitals could require medical residents to work.

    “To fill the gap left behind by residents, many hospitals hired mid-level providers such as nurse practitioners and physician assistants,” he said. “At Christiana Care, we alleged that services performed by mid-level providers were billed for by private attending physicians who were in a position to make future referrals to the hospital. Put differently, we alleged that Christiana Care paid kickbacks to the private physicians in the form of free employees.”

    Under the settlement, Christiana Care will pay about $32 million to the federal government and roughly $11 million to the state of Delaware, with half of each amount being restitution. Sherman will receive slightly more than $12 million, with roughly $9 million coming from the federal government and $3 million from the state. Christiana Care will also pay $4.6 million to Sherman’s attorneys.

    A statement issued by Shane Hoffman, a spokesman for Christiana Care, noted that the settlement involves no admission of liability.

    “We are pleased to settle this matter as we focus forward on meeting the evolving health needs of the diverse communities we serve,” it said.

    In 2010, Christiana Care paid $3.3 million to settle a similar whistleblower suit alleging Medicare and Medicaid fraud involving neurology doctors. As part of that settlement, Christiana entered into a “corporate integrity agreement” with the inspector general’s office of the U.S. Department of Health and Human Services.

    That agreement, among other things, required Christiana to maintain programs to detect and encourage internal reporting of potential violations of laws prohibiting kickbacks and patient referrals in return for financial consideration. Christiana also was required to report probable violations and overpayments to the government.

    The lawsuit alleges that Sherman was stonewalled and marginalized by Christiana officials including Dr. Janice Nevin, the president and CEO, after expressing concerns about questionable billing practices that the hospital continued to engage in despite the earlier settlement. He was fired by Nevin in 2014.

    “Mr. Sherman had an obligation to investigate compliance concerns. The mere fact that he was doing so appeared (to) cause a ‘problem’ for Dr. Nevin, which she was unable to explain during her deposition,” former federal prosecutor Virginia Evans said in an export report commissioned by Sherman’s attorneys.

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  • Custom made by Tulane students, mobility chairs help special needs toddlers get moving

    Custom made by Tulane students, mobility chairs help special needs toddlers get moving

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    NEW ORLEANS — At 19 months old, Elijah Jack, born with no femur bone in one leg and a short femur in the other, is unable to walk on his own like most toddlers his age. Another 19-month-old, Freya Baudoin, born prematurely at 28 weeks and delayed in her mobility, has finally taken her first step.

    Special needs children like these often take longer than most to become independently mobile, which can be a hardship for parents and others who care for them. Elijah is often carried because of his limb difference and clubfeet, meaning that instead of being straight, his feet are twisted inward and his toes point downward.

    As a result, getting around on his own is a challenge.

    That was until this past Spring. Elijah was one of the first recipients of a specially designed rolling chair built by a team of biomedical engineering students at Tulane University. Today, Elijah has mastered getting around on wheels – turning, stopping and steering all on his own.

    “He loves his chair,” said Crystal Jack, Elijah’s mom. “So, I get a lot of things done because I know in his chair, he’s safe. He know how to go around the house with it and everything, so I get a lot of things done now.”

    Before the chair, Jack said her son was able to scoot on the floor to get where he needed to go but the chair offers a whole new level of independence.

    “Like I said we come a long way, but I’m blessed to have him,” Jack said, smiling warmly as he moved back and forth around the living room of her mother’s home in Ventress, Louisiana.

    The Tulane students partnered with the nonprofit MakeGood in 2022 to design and produce the chairs to help toddlers (roughly ages 1-4) build independence and strength, and for some, prepare for a real wheelchair. While it remains difficult to access precise numbers for total wheelchair use among children, there were about 2.8 million wheelchair users in the U.S. in 2002, of whom 121,000 were under 15 years of age, according to the US Census.

    MakeGood is the New Orleans area coordinator for TOM Global, an Israeli nonprofit that combines modern design and digital manufacturing to fulfill neglected needs of people with disabilities and limitations. TOM stands for Tikkun Olam, which is Hebrew for “repairing the world.”

    The students partnered with the nonprofits as part of a service-learning project — a graduation requirement at Tulane. But many say they had no idea when the project started the depth of impact their chairs would make in the lives of children in the community.

    Dylan Lucia, a graduate student at Tulane from the San Diego, California area, said he chose the field of biomedical engineering to help people and this project has manifested that.

    “Seeing that direct kind of patient feedback and seeing how much these (chairs) were improving their lives and helping them become a more independent person, even as a small toddler … like, it was really, really endearing to see something like that and to see the positive change,” Lucia said.

    The chairs are particularly helpful for families whose children will eventually need wheelchairs. Noam Platt, director of MakeGood, said insurance companies typically don’t cover the cost of a wheelchair for a child unless there is sufficient evidence that the child can use it effectively.

    “These devices are used to create that evidence that their quality of life will be improved so they can get maybe a more durable assistive technology,” Platt said.

    Freya’s chair was one of five made throughout several weekends early this fall at Tulane’s Scot Ackerman MakerSpace, an enormous workshop with laser cutters, 3D printers and drilling and sewing equipment.

    Students applied padding and safety straps to the chairs, and some required modifications to accommodate the needs of the children receiving them. For instance, Freya’s chair needed a wider strap to help secure her torso, and another patient needed a space behind the chair big enough to hold his breathing vent. Freya’s chair also had a bar added to the back, so that she could push it like a stroller. She took her first steps in early December after working with her physical therapist and her chair.

    There’s no word on how long Freya will have to use the chair but her mother said it has been more than a blessing.

    “At first, we thought the muscle tone in her ankles wasn’t strong enough for her to walk at all, but the neurologists recently told us everything is looking good and she should be walking on her own or with limited assistance soon,” said her mom, Heather Hampton, of Metairie, Louisiana.

    Hampton said Freya’s able to push the chair like a stroller on her own. She wishes they could’ve gotten it sooner but understands the adjustments that needed to be made.

    “We’re just happy that she’ll ultimately be able to get around and walk independently,” Hampton said.

    Platt said the mobility chairs’ original design and plans came from TOM Global but the parts were purchased in the U.S. or made and then assembled by hand at Tulane. The wood panels used for the chair’s frame were laser cut and then sanded by students to buff out any splinters and rough edges. Padded seats were stuffed into fabric cushions sewn by students. Wheels were purchased online and then screwed into place.

    Elijah has had his chair since the end of March. It was made in the first batch of about 10 chairs delivered to pediatric patients for use in occupational and physical therapy sessions.

    “His chair shows him that, like, ‘I could be up like other children.’ You know, he don’t let his (being) disabled get in the way,” said Jack who added Elijah will likely need some type of mobility assistance for the rest of his life.

    Bumpers were added to the bottom front of the most recent batch of chairs after parents from the first round said their furniture – and feet – were taking hits as their children became better and faster at using their chairs.

    Platt said there have been two rounds, so far, of chair building and 15 chairs have been given away. But, he said they’re aiming for at least 10 to 15 more by Spring 2024.

    “We coordinate with our clinical partners to find kids that would be a good fit for these devices,” he said. “We work with the clinical team to make sure each chair fits the individuals and make customizations if necessary.”

    Platt said the chairs cost less than $200 each to make, and even though these chairs were donated to patients at no cost, the price is still much lower than most pediatric wheelchairs on the market and electric-powered wheelchairs can run into the thousands.

    The student-made chairs also look and feel more like toys than hospital equipment, Platt said. They’re made to be light and easy to maneuver.

    Platt said he’d ultimately like to see the chairs be made in high schools and colleges across the country.

    “For the students that I work with, I tell them this is just the beginning,” Platt said. “I’m trying to open their eyes to kind of a lifelong passion that they’ll have to solving these problems because once you see the problems, you see the scope of the problems and you can’t really ignore them.”

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  • Ahead of Dutch elections, food banks highlight the cost-of-living crisis, a major campaign theme

    Ahead of Dutch elections, food banks highlight the cost-of-living crisis, a major campaign theme

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    VOORBURG, Netherlands — Cans of fish, jars of pasta sauce and bags of beans are stacked in blue crates. Meat, dairy and bread are kept cold in a huge freezer and a walk-in refrigerator in this affluent Dutch town. The supplies are on hand to feed the new poor in one of the richest nations in the world.

    Needy families are lining up for free handouts at food banks across the Netherlands, underscoring how poverty is taking root even in lower middle-class families and why tackling it has become a major theme in next Wednesday’s parliamentary election.

    If it gets any worse, “then it really becomes a scandal for society,” said Rob Kuipers, a 70-year-old retired senior civil servant who is the chairman of the local food bank in Leidschendam-Voorburg, within easy cycling distance of the parliament in The Hague.

    The cost-of-living crisis, a chronic shortage of social and affordable housing and limits on access to affordable healthcare have combined to become known by the catch-all title “security of existence” in election campaigning and it’s a topic all parties are addressing in their election programs.

    “We, for a long time, had people living in poverty but this was always, relatively speaking, a smaller group and a quite marginal group and now this has spread to the lower middle class. And that, I think, is the reason why we are talking so much about it now,” said Maurice Crul, a professor of sociology at the Vrije Universiteit Amsterdam.

    “This was always a topic that the progressive or the left-wing parties put on the agenda,” he added. “But now you see that also populist right wing parties and the middle party is putting this on the agenda big time, too.”

    That centrist “middle party” is personified by Pieter Omtzigt, a former Christian Democrat who set up the New Social Contract over the summer. It is already polling so high that he will play a key role in coalition talks once the votes have been counted.

    After years campaigning on behalf of marginalized members of society and uncovering government scandals, tackling poverty is one of his two main campaign themes.

    “There is a long list of things we need to do to challenge that cost-of-living crisis,” he told reporters at a campaign event. “We will make the primary necessities of life affordable,” his party’s manifesto says, with measures including reforming taxation and welfare rules to give people more disposable income.

    The center-right People’s Party for Freedom and Democracy, or VVD, of outgoing Prime Minister Mark Rutte — traditionally seen as a party for the wealthy and a supporter of the free-market economy — is also pledging to help.

    “To make sure people who work full-time can make ends meet, we will raise the minimum wage,” the party’s manifesto pledges. “To tackle childhood poverty, we will give targeted support to families with children.”

    Underscoring how the issue cuts across traditional party lines, a center-left two-party bloc led by former European Union climate chief Frans Timmermans proposes some of the same solutions. It advocates raising the Dutch minimum wage to 16 euros ($17.40) per hour. For employees aged over 21 years, the current minimum is 12.79 euros for a 36-hour work week.

    For some workers and for others living on welfare benefits, that is not enough.

    The national umbrella organization for 176 Dutch food banks says that they serve a total of 38,000 households — 100,000 people — each week and that 1.2 million people live below the poverty line. The number is down slightly from a year ago when inflation was soaring in the Netherlands and across the world.

    Just 18 months ago, the food bank in Leidschendam-Voorburg, a municipality of some 78,000 people that recently ranked fifth in a survey of the most “livable” towns in the the Netherlands, had 140 clients. That shot up to 250 as a cost-of-living crisis swept across the world and did not spare the wealthy Netherlands. Those 250 households amount to up to 700 people, Kuipers said.

    The true number of people on the breadline may be much higher. The Leidschendam-Voorburg food bank Kuipers oversees estimates that the true number of people eligible for food aid could be two to three times higher.

    Now he is waiting to see how the election plays out and the new constellation of parties joining forces to run the country.

    Party programs “are full of beautiful words and relatively few precise actions,” he said.

    He’s watching to see “how those beautiful words will be translated into concrete actions” after the election.

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  • Ohio will vote on marijuana legalization. Advocates say there’s a lot at stake

    Ohio will vote on marijuana legalization. Advocates say there’s a lot at stake

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    COLUMBUS, Ohio — Voters in Ohio will decide next week whether to legalize recreational marijuana, but people on both sides of the issue say more hangs in the balance than simply decriminalizing the drug.

    Supporters of legalization say Ohio can reclaim tax revenue being lost to states such as Michigan, where marijuana is legal, and take power from illegal drug markets through government regulation. But opponents warn of increased workforce and traffic accidents by people under the influence, and argue much of the revenue will land in the pocket of the marijuana industry, not taxpayers.

    Issue 2 on the Nov. 7 ballot would allow adults 21 and over to buy and possess up to 2.5 ounces (71 grams) of cannabis and 15 grams (about a half-ounce) of extract, and to grow up to six plants per individual through a government program. A 10% tax would be imposed on any purchases, with those proceeds going toward administrative costs and addiction treatment in the state and to municipalities that host dispensaries.

    It would also create a social equity program to give a financial boost to people who want to start a business selling or growing cannabis and who meet certain criteria. They or a family member would need to have had a past run-in with the law for marijuana, and be part of a disadvantaged group based on race, gender, disability or economic considerations.

    The program would fall under the Division of Cannabis Control in the state Department of Commerce, an office that will fashion the rules around licensing, testing and product standards, among other regulations.

    If it passes, Ohio would become the 24th state to legalize recreational marijuana for adult use, a move that supporters say socially and financially makes sense for the state.

    “We’re taking money away from drug dealers and Michigan dispensary owners and putting it back into the pockets of our local governments,” said Tom Haren, spokesperson for the pro-legalization campaign Regulate Marijuana Like Alcohol.

    The measure also gives those with marijuana-related arrests and convictions, as well as their loved ones, a chance to benefit from the industry once possession of cannabis is no longer illegal. Haren said a marijuana charge can make life much harder for people and has a “downstream effect” on their families.

    Issue 2, should it pass, would also create greater access for those who may not be able to afford medical marijuana through their insurance or get a doctor to sign off on it. This includes veterans, according to Haren, who usually get their insurance through the federal government — which has not cleared marijuana for medical or recreational use.

    But even if it gets the needed votes Tuesday, the future of marijuana use will not be entirely set.

    As a citizen-initiated statute, the measure went first to the Republican-dominated Legislature. Lawmakers had four months to pass it, under state law. But with many — if not all — GOP legislators heartily against it, the measure did not move.

    After the election, if it passes, state law calls for the measure to return again to the Legislature, where lawmakers can tweak it to their liking. They can also vote to repeal it entirely, as GOP Senate President Matt Huffman has indicated could happen.

    Opponents of Issue 2, including Ohio prosecutors and the Ohio Chamber of Commerce, are in line with Huffman.

    “There’s legalization, which generally people have a live-and-let-live attitude about. And then there’s Issue 2,” said Scott Milburn, spokesperson for Protect Ohio Workers and Families, the main campaign against the issue.

    The measure, opponents say, gives around one third of the revenue in that 10% tax revenue back to the marijuana industry — making it more of a benefit to marijuana corporations and small businesses than to taxpayers.

    And according to Ohio Treasurer Robert Sprague, the portion allotted for costs such as addiction treatment and administration under the 10% tax isn’t enough, and the tax would at least need to be doubled to pay for what the measure says it would.

    The Ohio Prosecuting Attorneys Association has also cautioned that legalization could lead to greater traffic and workforce accidents, as well as increased substance abuse among state residents.

    Last year, a study by the by the National Highway Traffic Safety Administratio n found that 54% of injured or killed drivers had drugs or alcohol in their systems, with tetrahydrocannabinol (THC), an active ingredient in marijuana, the most prevalent.

    The study looked at over 7,000 cases from seven different hospitals around the country from 2019 to 2021, but the authors of the study cautioned that it’s not indicative of drivers nationwide, especially when tracking data on marijuana use and traffic accidents is still so new.

    ___

    Samantha Hendrickson is a corps member for the Associated Press/Report for America Statehouse News Initiative. Report for America is a nonprofit national service program that places journalists in local newsrooms to report on undercovered issues.

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  • Ohio will vote on marijuana legalization. Advocates say there’s a lot at stake

    Ohio will vote on marijuana legalization. Advocates say there’s a lot at stake

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    COLUMBUS, Ohio — Voters in Ohio will decide next week whether to legalize recreational marijuana, but people on both sides of the issue say more hangs in the balance than simply decriminalizing the drug.

    Supporters of legalization say Ohio can reclaim tax revenue being lost to states such as Michigan, where marijuana is legal, and take power from illegal drug markets through government regulation. But opponents warn of increased workforce and traffic accidents by people under the influence, and argue much of the revenue will land in the pocket of the marijuana industry, not taxpayers.

    Issue 2 on the Nov. 7 ballot would allow adults 21 and over to buy and possess up to 2.5 ounces (71 grams) of cannabis and 15 grams (about a half-ounce) of extract, and to grow up to six plants per individual through a government program. A 10% tax would be imposed on any purchases, with those proceeds going toward administrative costs and addiction treatment in the state and to municipalities that host dispensaries.

    It would also create a social equity program to give a financial boost to people who want to start a business selling or growing cannabis and who meet certain criteria. They or a family member would need to have had a past run-in with the law for marijuana, and be part of a disadvantaged group based on race, gender, disability or economic considerations.

    The program would fall under the Division of Cannabis Control in the state Department of Commerce, an office that will fashion the rules around licensing, testing and product standards, among other regulations.

    If it passes, Ohio would become the 24th state to legalize recreational marijuana for adult use, a move that supporters say socially and financially makes sense for the state.

    “We’re taking money away from drug dealers and Michigan dispensary owners and putting it back into the pockets of our local governments,” said Tom Haren, spokesperson for the pro-legalization campaign Regulate Marijuana Like Alcohol.

    The measure also gives those with marijuana-related arrests and convictions, as well as their loved ones, a chance to benefit from the industry once possession of cannabis is no longer illegal. Haren said a marijuana charge can make life much harder for people and has a “downstream effect” on their families.

    Issue 2, should it pass, would also create greater access for those who may not be able to afford medical marijuana through their insurance or get a doctor to sign off on it. This includes veterans, according to Haren, who usually get their insurance through the federal government — which has not cleared marijuana for medical or recreational use.

    But even if it gets the needed votes Tuesday, the future of marijuana use will not be entirely set.

    As a citizen-initiated statute, the measure went first to the Republican-dominated Legislature. Lawmakers had four months to pass it, under state law. But with many — if not all — GOP legislators heartily against it, the measure did not move.

    After the election, if it passes, state law calls for the measure to return again to the Legislature, where lawmakers can tweak it to their liking. They can also vote to repeal it entirely, as GOP Senate President Matt Huffman has indicated could happen.

    Opponents of Issue 2, including Ohio prosecutors and the Ohio Chamber of Commerce, are in line with Huffman.

    “There’s legalization, which generally people have a live-and-let-live attitude about. And then there’s Issue 2,” said Scott Milburn, spokesperson for Protect Ohio Workers and Families, the main campaign against the issue.

    The measure, opponents say, gives around one third of the revenue in that 10% tax revenue back to the marijuana industry — making it more of a benefit to marijuana corporations and small businesses than to taxpayers.

    And according to Ohio Treasurer Robert Sprague, the portion allotted for costs such as addiction treatment and administration under the 10% tax isn’t enough, and the tax would at least need to be doubled to pay for what the measure says it would.

    The Ohio Prosecuting Attorneys Association has also cautioned that legalization could lead to greater traffic and workforce accidents, as well as increased substance abuse among state residents.

    Last year, a study by the by the National Highway Traffic Safety Administratio n found that 54% of injured or killed drivers had drugs or alcohol in their systems, with tetrahydrocannabinol (THC), an active ingredient in marijuana, the most prevalent.

    The study looked at over 7,000 cases from seven different hospitals around the country from 2019 to 2021, but the authors of the study cautioned that it’s not indicative of drivers nationwide, especially when tracking data on marijuana use and traffic accidents is still so new.

    ___

    Samantha Hendrickson is a corps member for the Associated Press/Report for America Statehouse News Initiative. Report for America is a nonprofit national service program that places journalists in local newsrooms to report on undercovered issues.

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  • Volunteer medical students are trying to fill the health care gap for migrants in Chicago

    Volunteer medical students are trying to fill the health care gap for migrants in Chicago

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    CHICAGO — Using sidewalks as exam rooms and heavy red duffle bags as medical supply closets, volunteer medics spend their Saturdays caring for the growing number of migrants arriving in Chicago without a place to live.

    Mostly students in training, they go to police stations where migrants are first housed, prescribing antibiotics, distributing prenatal vitamins and assessing for serious health issues. These student doctors, nurses and physician assistants are the front line of health care for asylum-seekers in the nation’s third-largest city, filling a gap in Chicago’s haphazard response.

    “My team is a team that shouldn’t have to exist, but it does out of necessity,” said Sara Izquierdo, a University of Illinois Chicago medical student who helped found the group. “Because if we’re not doing this, I’m not sure anyone will.”

    More than 19,600 migrants have come to Chicago over the last year since Texas Gov. Greg Abbott began sending buses to so-called sanctuary cities. The migrants wait at police stations and airports, sometimes for months, until there’s space at a longer-term shelter, like park district buildings.

    Once in shelter, they can access a county clinic exclusively for migrants. But the currently 3,300 people in limbo at police stations and airports must rely on a mishmash of volunteers and social service groups that provide food, clothes and medicine.

    Izquierdo noted the medical care gap months ago, consulted experienced doctors and designed a street-medicine model tailored to migrants’ medical needs. Her group makes weekly visits to police stations, operating on a shoestring budget of $30,000, mostly used for medication.

    On a recent Saturday, she was among dozens of medics at a South Side station where migrants sleep in the lobby, on sidewalks and an outdoor basketball court. Officers didn’t allow the volunteers in the station so when one patient requested privacy, their doctor used his car.

    Abrahan Balizario saw a doctor for the first time in five months.

    The 28-year-old had a headache, toothache and chest pain. He recently arrived from Peru, where he worked as a driver and at a laundromat but couldn’t survive. He wasn’t used to the brisk Chicago weather and believed sleeping outdoors exacerbated his symptoms.

    “It is very cold,” he said. “We’re almost freezing.”

    The volunteers booked him a dental appointment and gave him a bus pass.

    Many migrants who land in Chicago and other U.S. cities come from Venezuela where a social, political and economic crisis has pushed millions into poverty. More than 7 million have left, often risking a dangerous route by foot to the U.S. border.

    The migrants’ health problems tend to be related to their journey or living in crowded conditions. Back and leg injuries from walking are common. Infections spread easily. Hygiene is an issue. There are few indoor bathrooms and outdoor portable toilets lack handwashing stations. Not many people carry their medical records.

    Most also have trauma, either from their homeland or from the journey itself.

    “You can understand the language, but it doesn’t mean you understand the situation,” said Miriam Guzman, one of organizers and a fourth-year medical student at UIC.

    The doctors refer patients to organizations that help with mental health but there are limitations. The fluid nature of the shelter system makes it difficult to follow-up; people are often moved without warning.

    Chicago’s goal is to provide permanent homes, which could help alleviate health issues. But the city has struggled to manage the growing population as buses and planes arrive daily at all hours. Mayor Brandon Johnson, who took office in May, calls it an inherited issue and proposed winterized tents.

    His administration has acknowledged the heavy reliance on volunteers.

    “We weren’t ready for this,” said Rey Wences Najera, first deputy of immigrant, migrant and refugee rights. “We are building this plane as we are flying it and the plane is on fire.”

    The volunteer doctors also are limited in what they can do: Their duffle bags have medications for children, bandages and even ear plugs after some migrants wanted to block out sirens. But they cannot offer X-rays or address chronic issues.

    “You’re not going to tell a person who has gone through this journey to stop smoking,” said Ruben Santos, a Rush University medical student. “You change your way of trying to connect to that person to make sure that you can help them with their most pressing needs while not doing some of the traditional things that you would do in the office or a big academic hospital.”

    The volunteers explain to each patient that the service is free but that they’re students. Experienced doctors, who are part of the effort, approve treatment plans and prescribe medications.

    Getting people those medications is another challenge. One station visit prompted 15 prescriptions. Working from laptops on the floor — near dozens of sleeping families — the doctors mapped out which medics would pick up medications the following day and how they’d find the recipients.

    Sometimes the volunteers must call for emergency help.

    Thirty-year-old Moises Hidalgo said he had trouble breathing. Doctors heard a concerning “crackling” sound, suspected pneumonia and called an ambulance.

    Hidalgo, who came from Peru after having left his native Venezuela more than a decade ago, once worked as a chef. He’s been walking around Chicago looking for jobs, but has been turned away without a work permit.

    “I’ve been trying to find work, at least so that I can pay to sleep somewhere, because if this isn’t solved, I can’t keep waiting,” he said.

    To stay warm while sleeping outside, he wore four layers of clothing; his loose pants cinched with a shoelace.

    The medics hope Chicago can formalize their approach. And they say they’ll continue to keep at it — for some, it’s personal.

    Dr. Muftawu-Deen Iddrisu, who works Advocate Illinois Masonic Medical Center, said he wanted to give back. Originally from Ghana, he attended medical school in Cuba.

    “I come from a very humble background,” he said. “I know how it feels. I know once sometime back someone did the same for me.”

    ___

    Associated Press video journalist Melissa Perez Winder contributed to this report.

    ___

    The Associated Press Health and Science Department receives support from the Robert Wood Johnson Foundation. The AP is solely responsible for all content.

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  • COVID-19 treatments to enter the market with a hefty price tag

    COVID-19 treatments to enter the market with a hefty price tag

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    The COVID-19 treatments millions of have taken for free from the federal government will enter the private market next week with a hefty price tag

    ByAMANDA SEITZ Associated Press

    October 27, 2023, 3:00 PM

    FILE – Doses of the anti-viral drug Paxlovid are displayed in New York, Aug. 1, 2022. The COVID-19 treatments millions of have taken for free from the federal government will enter the private market next week with a hefty price tag. Pharmaceutical giant Pfizer is setting the price for a five-day treatment of Paxlovid at $1,390, but Americans can still access the pills at no cost, for now. Millions of free, taxpayer-funded courses of the pills will remain at pharmacies, hospitals and doctor’s offices across the country, U.S. Health and Human Services officials said Friday, Oct. 27, 2023. (AP Photo/Stephanie Nano, File)

    The Associated Press

    WASHINGTON — The COVID-19 treatments millions of Americans have taken for free from the federal government will enter the private market next week with a hefty price tag.

    Pharmaceutical giant Pfizer is setting the price for a five-day treatment of Paxlovid at $1,390, but Americans can still access the pills at no cost — for now. The less commonly used COVID-19 treatment Lagevrio, manufactured by Merck, also will hit the market next week.

    Millions of free, taxpayer-funded courses of the pills will remain at pharmacies, hospitals and doctor’s offices across the country, U.S. Health and Human Services officials said Friday. People on private insurance may start to notice copays for the treatments once their pharmacy or doctor’s office runs out of the COVID-19 treatments they received from the government.

    The U.S. government initially inked a deal with Pfizer to pay more than $5 billion for 10 million courses of Paxlovid in 2021.

    Under a new agreement, reached last month between Pfizer and the federal government, people on Medicaid, Medicare or those who are without medical insurance will not pay any out-of-pocket costs for the treatment through the end of next year. Pfizer will also offer copay assistance for the treatment through 2028. The Department of Veterans Affairs, the Department of Defense and Indian Health Service will still be able to access Paxlovid the government has on hand. The government will also get 1 million treatment courses to keep in its stockpile.

    Suppliers to pharmacies, doctor’s offices and hospitals can begin ordering the treatments from the drug companies starting next week.

    “Pfizer is committed to a smooth commercial transition and is working collaboratively with the U.S. government and health care stakeholders to ensure broad and equitable access to this important medicine for all eligible patients,” the company said in an emailed statement to The Associated Press.

    Paxlovid has been used to treat COVID-19 since 2021, but the Food and Drug Administration granted full approval earlier this year for it to be used on adults with coronavirus who face high risks of hospitalization or death. That group typically includes older adults and those with medical conditions like diabetes, asthma and obesity.

    Full-year revenue for Paxlovid and Pfizer’s COVID-19 vaccine, Comirnaty, is expected to be approximately $12.5 billion.

    Merck has not confirmed a list price yet for its Lagevrio treatment but said in a statement to AP that it will also offer the treatment free to patients “who, without assistance, could not otherwise afford the product.”

    —

    Associated Press reporter Tom Murphy in Indianapolis contributed to this report.

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  • A Swiss populist party rebounds and the Greens sink in the election. That’s a big change from 2019

    A Swiss populist party rebounds and the Greens sink in the election. That’s a big change from 2019

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    GENEVA — Switzerland’s anti-immigration Swiss People’s Party rebounded from searing losses four years ago to become the largest parliamentary faction after the election, official results showed, as two environmentally-minded parties lost ground despite record glacier melt in the Alpine country.

    Pre-election polls suggested that Swiss voters had three main concerns: Rising fees for the obligatory, free market-based health insurance system; climate change, which has eroded Switzerland’s many glaciers; and worries about migrants and immigration.

    The final tally late Sunday showed the people’s party, known as SVP by its German-language acronym, gained nine seats compared to the last vote in 2019, and climbed to 62 seats overall in parliament’s 200-member lower house. The Socialists, in second, added two seats to reach 41 in that chamber, known as the National Council.

    It marked the latest sign of a rightward turn in Europe, after victories or electoral gains by conservative parties in places like Greece, Sweden and Italy over the last year, even if voters in Poland rejected their national conservative government last week.

    A new political alliance calling itself The Center, born of the 2021 fusion of the center-right Christian Democrat and Bourgeois Democrat parties, made its parliamentary election debut and took third place — with 29 seats, eclipsing the free-market Liberal party, which lost a seat and now will have 27.

    Environmentally minded factions were the biggest losers: The Greens shed five seats and will now have 23, while the more centrist Liberal-Greens lost six, and now will have 10.

    Political analyst Pascal Sciarini of the University of Geneva said Monday that the result was largely a “swing of the pendulum” and that support for the Greens was diluted in part because many voters felt they had already taken a big step toward protecting the environment by overwhelmingly approving a climate bill in June that will curb Switzerland’s greenhouse gas emissions.

    “At first glance, it’s a bit surprising because the climate crisis is even more present than it was four years ago — when climate worries were the dominant issue among the population,” he said.

    He suggested that the bounce back for the SVP was a sign that rising insurance premiums and concerns about growing migration into Switzerland captured many voters’ minds this time.

    “It’s perhaps that there was a sort of competition among concerns — and that made the job harder for the Greens to make climate concerns the dominant theme in the media,” Sciarini said.

    Overall, the vote isn’t likely to have significant impact on Swiss foreign policy, he said. The country’s executive branch operates like a permanent government of national unity, where no single faction has total sway — what’s known among the Swiss as their “magic formula” of democracy to ensure balance and moderation, and ensure that personalities don’t dominate politics.

    Even with their electoral victory, the SVP only holds just over 30% of seats in the lower house. The composition of the legislature, which is elected every four years, ultimately shapes the composition of the executive branch, which is called the Federal Council and includes President Alain Berset, who plans to leave government at the end of the year.

    But the legislative vote result won’t significantly alter the composition of the Federal Council, where the SVP already has two seats — as do the Socialists, the free-market Liberals, while the Center has one.

    The Center party, by outscoring the Liberals, may make a bid to swipe one of their two seats, and the Socialists will have to choose a successor for Berset; Those are the only likely changes to the Federal Council.

    The Swiss president is essentially “first among equals” in the seven-member council, where each of the members hold portfolios as government ministers and take turns each year holding the top job — which is essentially a ceremonial one to represent Switzerland abroad. Berset will be succeeded next year by centrist Viola Amherd.

    In Switzerland, voters also participate directly in government decision making. Voters regularly go to the polls — usually four times a year — to vote on any number of policy decisions. Those referendum results require parliament to respond.

    More broadly, Switzerland has found itself straddling two core elements to its psyche: Western democratic principles like those in the European Union — which Switzerland has refused to join — and its much vaunted “neutrality” in world affairs.

    A long-running and intractable standoff over more than 100 bilateral Swiss-EU agreements on issues like police cooperation, trade, tax and farm policy, has soured relations between Brussels and Bern — key trading partners.

    The Swiss did line up with the EU in imposing sanctions against Russia over its war in Ukraine. The Federal Council is considering whether to join the EU and the United States in labeling Hamas a terror organization. Switzerland has joined the United Nations in labeling al-Qaida and Islamic State group as terrorists.

    Switzerland, with only about 8.5 million people, ranks 20th in world economic output, according to the International Monetary Fund, and it’s the global hub of wealth management: where the world’s rich park much of their money, to benefit from low taxes and a discreet environment.

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  • California Gov. Newsom signs law to slowly raise health care workers’ minimum wage to $25 per hour

    California Gov. Newsom signs law to slowly raise health care workers’ minimum wage to $25 per hour

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    California Gov. Gavin Newsom has signed a law to raise the minimum wage for health care workers

    ByADAM BEAM Associated Press

    October 13, 2023, 11:11 PM

    EMBARGOED HOLD FOR RELEASE – FILE – California Gov. Gavin Newsom speaks during an interview with Politico in Sacramento, Calif., Sept. 12, 2023. On Friday, Oct. 13, 2023, Newsom announced he signed a law that will increase the minimum wage for health care workers in the state. (AP Photo/Rich Pedroncelli, File)

    The Associated Press

    SACRAMENTO, Calif. — California will raise the minimum wage for health care workers to $25 per hour over the next decade under a new law Democratic Gov. Gavin Newsom signed Friday.

    The new law is the second minimum wage increase Newsom has signed. Last month, he signed a law raising the minimum wage for fast food workers to $20 per hour.

    Both wage increases are the result of years of lobbying by labor unions, which have significant sway in the state’s Democratic-dominated Legislature.

    “Californians saw the courage and commitment of healthcare workers during the pandemic, and now that same fearlessness and commitment to patients is responsible for a historic investment in the workers who make our healthcare system strong and accessible to all,” said Tia Orr, executive director of the Service Employees International Union California.

    The wage increase for health care workers reflects a carefully crafted compromise in the final days of the legislative session between the health care industry and labor unions to avoid some expensive ballot initiative campaigns.

    Several city councils in California had already passed local laws to raise the minimum wage for health care workers. The health care industry then qualified referendums asking voters to block those increases. Labor unions responded by qualifying a ballot initiative in Los Angeles that would limit the maximum salaries for hospital executives.

    The law Newsom signed Friday would preempt those local minimum wage increases.

    It was somewhat unexpected for Newsom to sign the law. His administration had expressed concerns about the bill previously because of how it would impact the state’s struggling budget.

    California’s Medicaid program is a major source of revenue for many hospitals. The Newsom administration had warned the wage increase would have caused the state to increase its Medicaid payments to hospitals by billions of dollars.

    Labor unions say raising the wages of health care workers will allow some to leave the state’s Medicaid program, plus other government support programs that pay for food and other expenses.

    A study by the University of California-Berkely Labor Center found almost half of low-wage health care workers and their families use these publicly funded programs. Researchers predicted those savings would offset the costs to the state.

    The $25 minimum wage had been a point of negotiations between Kaiser Permanente and labor unions representing about 75,000 workers. Those workers went on strike for three days last week. Both sides announced a tentative deal Friday.

    The strike came in a year when there have been work stoppages within multiple industries, including transportation, entertainment and hospitality. The health care industry has been confronted with burnout from heavy workloads, a problem greatly exacerbated by the COVID-19 pandemic.

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  • California Gov. Newsom signs law to slowly raise health care workers’ minimum wage to $25 per hour

    California Gov. Newsom signs law to slowly raise health care workers’ minimum wage to $25 per hour

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    California Gov. Gavin Newsom has signed a law to raise the minimum wage for health care workers

    ByADAM BEAM Associated Press

    October 13, 2023, 11:11 PM

    EMBARGOED HOLD FOR RELEASE – FILE – California Gov. Gavin Newsom speaks during an interview with Politico in Sacramento, Calif., Sept. 12, 2023. On Friday, Oct. 13, 2023, Newsom announced he signed a law that will increase the minimum wage for health care workers in the state. (AP Photo/Rich Pedroncelli, File)

    The Associated Press

    SACRAMENTO, Calif. — California will raise the minimum wage for health care workers to $25 per hour over the next decade under a new law Democratic Gov. Gavin Newsom signed Friday.

    The new law is the second minimum wage increase Newsom has signed. Last month, he signed a law raising the minimum wage for fast food workers to $20 per hour.

    Both wage increases are the result of years of lobbying by labor unions, which have significant sway in the state’s Democratic-dominated Legislature.

    “Californians saw the courage and commitment of healthcare workers during the pandemic, and now that same fearlessness and commitment to patients is responsible for a historic investment in the workers who make our healthcare system strong and accessible to all,” said Tia Orr, executive director of the Service Employees International Union California.

    The wage increase for health care workers reflects a carefully crafted compromise in the final days of the legislative session between the health care industry and labor unions to avoid some expensive ballot initiative campaigns.

    Several city councils in California had already passed local laws to raise the minimum wage for health care workers. The health care industry then qualified referendums asking voters to block those increases. Labor unions responded by qualifying a ballot initiative in Los Angeles that would limit the maximum salaries for hospital executives.

    The law Newsom signed Friday would preempt those local minimum wage increases.

    It was somewhat unexpected for Newsom to sign the law. His administration had expressed concerns about the bill previously because of how it would impact the state’s struggling budget.

    California’s Medicaid program is a major source of revenue for many hospitals. The Newsom administration had warned the wage increase would have caused the state to increase its Medicaid payments to hospitals by billions of dollars.

    Labor unions say raising the wages of health care workers will allow some to leave the state’s Medicaid program, plus other government support programs that pay for food and other expenses.

    A study by the University of California-Berkely Labor Center found almost half of low-wage health care workers and their families use these publicly funded programs. Researchers predicted those savings would offset the costs to the state.

    The $25 minimum wage had been a point of negotiations between Kaiser Permanente and labor unions representing about 75,000 workers. Those workers went on strike for three days last week. Both sides announced a tentative deal Friday.

    The strike came in a year when there have been work stoppages within multiple industries, including transportation, entertainment and hospitality. The health care industry has been confronted with burnout from heavy workloads, a problem greatly exacerbated by the COVID-19 pandemic.

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  • Toddlers with developmental delays are missing out on help they need. It can hurt them long term

    Toddlers with developmental delays are missing out on help they need. It can hurt them long term

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    CHICAGO — Alexander watches Paw Patrol with fervor, bowls his baby brother over with hugs and does everything with gusto.

    What the 3-year-old West Chicago toddler can’t do yet is speak more than a few words. His balance is wobbly and he isn’t able to tell his preschool teachers when he’s hurt or scared.

    Alexander qualified for five therapies through Early Intervention, a federal program dedicated to treating developmental delays in babies and toddlers and helping them develop the tools they need to thrive. But his mother, Hilda Garcia, said securing that help felt “like another job.”

    Even after repeatedly calling, researching for hours and pushing herself to the limit with work and childcare, Garcia had to wait more than a year for an in-person appointment with an Early Intervention provider.

    The federally mandated program is plagued by chronic staffing shortages, leaving thousands of desperate parents frustrated: they know their children need support, they’re aware of proven therapies that can help, and yet some have to wait months or even years for the care they need. Many age out of the program before accessing any services at all.

    “When we miss those opportunities to help them at those younger ages, sometimes we are limiting their potential into adulthood,” according to speech-language pathologist Sarah Ziemba, an Early Intervention provider in Peoria, Illinois.

    Early Intervention was created in 1986 to address developmental delays in children like Alexander as soon as possible. About one in six children in the U.S. has at least one developmental disability or other developmental delay, according to the U.S. Centers for Disease Control and Prevention.

    Since all U.S. states and territories accept federal funding for Early Intervention, they are obligated under the Individuals with Disabilities Education Act to provide services to all who qualify. But almost all states reported Early Intervention provider shortages in 2022, and federal officials say they are still struggling to find staff to meet the needs of children with disabilities.

    Service delays in Illinois, where Alexander lives, nearly doubled in 2022, according to Chicago-based early childhood advocacy organization Start Early.

    Waitlists — technically not allowed since all eligible kids are entitled to Early Intervention — have increased dramatically and thousands of providers have left the field, according to the Illinois Department of Human Services.

    When children turn 3, responsibility for providing special education services shifts from Early Intervention programs to school districts. But those systems are also understaffed and overbooked, Ziemba said.

    Families with private insurance can pay for therapy outside the program, but those without the means are often left behind, so “in a way, Early Intervention is contributing to some social inequity,” she said.

    Research supports her assessment. A report published this year by the National Institute for Early Education Research found that Asian, Hispanic and Black children are less likely to receive Early Intervention and Early Childhood Special Education services than white non-Hispanic children.

    “For Black children, the disparities in access to services are especially large and cannot plausibly be explained by differences in need,” the report says.

    Income also plays a role, said lead researcher Allison Friedman-Krauss.

    “Poorer states are serving a lower percentage of children, so really suggesting that there is a problem there,” Friedman-Krauss said.

    But states need more providers, and there is no way to attract more without better wages, Ziemba said, adding that most Illinois Early Intervention providers get no health benefits or paid time off, and could effectively double their salaries by working in hospitals, schools or nursing homes.

    “I really feel like we’re kind of seeing the implosion of the whole program,” she said.

    Providers and service coordinators, who connect families with Early Intervention services, are woefully underpaid, according to Darcy Armbruster, a Chicago-area physical therapist who has worked in Early Intervention for 11 years.

    Armbruster said she loves the relationships she builds with families, but passion and job fulfillment don’t pay the bills.

    “Every month, I have to sit down and reevaluate where I am and if I can keep going and doing this,” she said.

    “Providers are just really, really tired of the lack of improving reimbursement, that they don’t see this problem changing,” she said.

    Illinois Gov. J.B. Pritzker signed a budget in June giving Early Intervention providers a 10% raise. That will help, Ziemba said, but it won’t make up for the impact of inflation and years of stagnant wages. The state also announced a retention program designed to reward tenured Early Intervention providers, interpreters and service coordinators with payments of up to $1,300 to stay in the field.

    The impact therapy can have is palpable. Lindsey Faulkner, a mother of four living in Peoria, got in-person speech therapy sessions for her 2-year-old daughter, Aria, within a month of her referral. She raves about the difference she has seen in her child after a year working with therapist Megan Sanders.

    “She was an entirely different kid a year ago,” Faulkner said.

    Although Aria was able to start speech therapy promptly, she has been on the waitlist for developmental therapy for more than a year.

    Faulkner was “floored” when she learned about the wait times.

    “You need to get answers for your child,” she said. “But here, now you have to sit and wait.”

    ___

    Savage is a corps member for the Associated Press/Report for America Statehouse News Initiative. Report for America is a nonprofit national service program that places journalists in local newsrooms to report on undercovered issues.

    ___

    The Associated Press receives support from the Overdeck Family Foundation for reporting focused on early learning. The AP is solely responsible for all content.

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  • Woman who fled the Maui wildfire on foot has died after weeks in a hospital burn unit

    Woman who fled the Maui wildfire on foot has died after weeks in a hospital burn unit

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    HONOLULU — A woman who escaped Hawaii’s Lahaina wildfire by running through a flaming field has died after spending more than seven weeks in a hospital burn unit.

    Laurie Allen died Friday at Straub Medical Center in Honolulu, according to a gofundme page set up for her and her husband, Perry Allen.

    “Laurie slipped away peacefully. Her heart was tired, and she was ready,” her sister-in-law, Penny Allen Hood, wrote on the website.

    Allen’s husband, two brothers, a sister and other relatives were at her side.

    Allen was among at least 98 people killed by the fire Aug. 8 that devastated historic Lahaina on the west coast of Maui. The fire was the deadliest in the U.S. in more than a century and destroyed 2,200 buildings, most of them homes.

    The fire began when strong winds appeared to cause a Hawaiian Electric power line to fall and ignite dry brush and grass. After being declared contained, the fire flared up and raced through the town.

    Perry Allen, an artist, lost a lifetime of work when their home burned, according to Hood. He was working 15 miles (24 kilometers) away when the fire hit.

    Laurie Allen, a physical therapist’s administrative assistant who worked from home, was home when the fire erupted. She fled with others in a vehicle, but a fallen, flaming tree blocked their way.

    Allen got out of the car and fled 100 yards (91 meters) across a field of burning grass. A policeman and fireman met her, and she was taken to an emergency shelter.

    At the hospital, Allen endured infections and a series of operations, including skin grafts, and was brought into and out of consciousness. She had difficulty communicating but at one point raised hopes by being able to wiggle her toes when asked.

    Her prognosis worsened in recent days, however, and Hood posted Thursday that “the battle to repair and rebuild Laurie’s earthly body” would soon be over. Allen was taken off life support Friday.

    “This ordeal touched numerous lives. For me, it was realizing how many shared concerns for Laurie — people from her childhood, her family, work colleagues, church friends, and clients at the PT Clinic she worked at,” Hood wrote Friday. “This is a reminder that we never know how much our smile or even a simple greeting can leave an impression on others.”

    Some Lahaina residents whose homes burned began returning to the devastated town last week. Authorities urged them not to sift through the ashes for belongings out of concern they could stir up dust containing asbestos, lead, arsenic or other toxins.

    Returnees were given water, shade, washing stations, portable toilets, medical and mental health care, and transportation help. Nonprofit groups also were offering personal protective equipment, including masks and coveralls.

    Nearly 8,000 displaced residents are living in hotels and other accommodations around Maui. Economists have warned that, without zoning and other changes, housing costs in already expensive Lahaina could be prohibitively costly for many after rebuilding.

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  • Scottish officials approve UK’s first drug consumption room intended for safer use of illegal drugs

    Scottish officials approve UK’s first drug consumption room intended for safer use of illegal drugs

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    LONDON — Scottish authorities on Wednesday approved a 2.3 million-pound ($2.8 million) pound drug consumption room, the first government-backed place in the U.K. where users can take illegal drugs such as cocaine and heroin under the supervision of medical staff.

    Local officials in the Scottish city of Glasgow on Wednesday approved the facility, which had long been delayed by political disagreements. Authorities hope the pilot project will help tackle drug misuse problems in Scotland, which has the highest drug death figures in Western Europe and saw almost three times the rate of drug poisoning deaths compared to the U.K. average in 2021.

    The facility, which will start recruiting staff next year, was first proposed in 2016 following an HIV outbreak in Glasgow among people who injected drugs in public places. It’s backed by the Scottish government, although some lawmakers have raised concerns about the impact on local residents and businesses.

    Proponents, including Scotland’s drug and alcohol policy minister Elena Whitham, say evidence from more than 100 similar facilities worldwide, including in Germany and the Netherlands, show they work to save lives and reduce overall costs to health services.

    The center will be staffed by trained health care professionals and offer a hygienic environment where people can consume drugs they obtained elsewhere.

    Officials say people can’t share drugs with others in the facility, and that health and social workers at the center will offer advice and support on recovery and welfare. They added that the center doesn’t encourage drug use but promotes harm reduction and reduces overdoses.

    In a report, Glasgow officials, including health professionals, said there was “overwhelming international evidence” that such facilities reduce the negative impact of drug use in public spaces, in particular the risk of infection and risks to the public from discarded needles.

    It said that following the 2016 HIV outbreak, an assessment found there were “approximately 400 to 500 people injecting drugs in public places in Glasgow city centre on a regular basis.”

    Official figures for last year showed that 1,051 people died in Scotland because of drug misuse, a decrease compared to recent years but still far higher than the rest of the U.K. and most places in Europe. The city of Glasgow had the worst problem, with 44 such deaths per 100,000 people.

    Whitham said Scotland’s government has committed 2.35 million pounds a year from 2024 to fund the pilot facility.

    Scotland’s devolved government makes it own policy decisions on matters such as health and education. The U.K.-wide government in London has previously said it does not support such facilities in England and Wales, citing concerns that they condone or encourage drug use.

    The Scottish government, which often taken more liberal positions on social issues than the Conservative administration in London, has proposed decriminalizing possession of all drugs for personal use. But that suggestion was blocked by the U.K. government in London, which said it had no plans to soften drug laws.

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  • Gates Foundation commits $200 million to pay for medical supplies and contraception

    Gates Foundation commits $200 million to pay for medical supplies and contraception

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    NEW YORK — The Bill & Melinda Gates Foundation pledged $200 million to help save the lives of mothers and children during child birth, as the largest American philanthropic donor throws its weight behind the issue during the nonprofit’s annual Goalkeepers conference on the sidelines of the U.N. General Assembly.

    Melinda French Gates, who says the issue is personal to her, smiled broadly as she introduced herself not just as the co-founder and co-chair of the foundation but as “Nona,” or grandmother, gesturing to her oldest daughter, Jennifer, who was seated in the audience in New York on Wednesday.

    The foundation pledged $100 million each to health products manufacturer Unitaid, and UNFPA, the U.N. agency for reproductive health, to fund access to health care and contraceptive supplies and information in low- and middle-income countries. The Gates Foundation has been a major supporter of Unitaid, donating $50 million in each 2012 and 2017, according to the foundation’s grant database.

    Founded in 2017, the Goalkeepers initiative is how the foundation tracks progress toward the Sustainable Development Goals, which U.N. member countries agreed in 2015 to meet by 2030. The goals set lofty targets to reduce poverty, improve health and education and protect the environment, though progress toward achieving them has fallen significantly off track, especially following the pandemic and the war in Ukraine.

    In an effort to reach an audience outside of government officials, experts and policy circles, the foundation hosted an award ceremony in New York Tuesday evening and recruited social media influencers to cover it, said Blessing Omakwu, who leads the Goalkeepers initiative.

    “My goal is they go back and take these things that we said in a very policy way and make it accessible to their followings and say, ‘Look, this matters. You should care about maternal health,’” she said.

    French Gates recognized former President Jimmy Carter and former First Lady Rosalynn Carter with a lifetime achievement award, pointing in part Carter’s long commitment to the elimination of guinea worm disease. Singer Bono also received a special award for his work advocating over many years for access to health care in developing countries and for the role he played in launching the U.S. President’s Emergency Plan for AIDS Relief, or PEPFAR.

    The program to combat HIV/AIDS was created by President George W. Bush and the U.S. Congress two decades ago and is credited with saving 25 million lives. The fate of the program, set to expire at the end of September, is uncertain because of a demand from Republican lawmakers to bar nongovernmental organizations that used any funding from providing or promoting abortion services.

    Bill Gates was absent from the award ceremony Tuesday because he had been invited to attend an event with President Joe Biden, French Gates said on stage. The two announced their divorce in 2021 but committed to continuing to work together at the foundation.

    Speaking of the future of PEPFAR on Wednesday, Bill Gates said the idea the program would not continue is quite scary, given that it continues to provide life saving medications for millions of people around the world.

    “It’s a shame that, at least temporarily, this is caught up in sort of a, ‘Does the U.S. reach out to the world and help the world?’ — some of those controversies. I think we will overcome that because the U.S. has a lot to be proud on this one,” Gates said.

    Gates also made the case for a suite of interventions to prevent the deaths of children in the year after they are born, which he said was one of the first priorities of the foundation. He spoke with emotion about a visit he made to a South African clinic, where doctors asked the mother of a child who had died that day if she would allow them to try to determine more specifically the cause of the baby’s death as a part of a larger study. Cumulatively, the results of that study, which the foundation funded, has advanced knowledge about the causes of infant mortality.

    The foundation also recognized the leaders of projects they said exemplified the aims of the development goals, including Eden Tadesse from Ethiopia, who designed a platform to provide job opportunities to refugees, and Aidan Reilly, Ben Collier, and James Kanoff, who started a project that delivers vegetables and produce that otherwise would be thrown out to food banks in the U.S.

    Award winner Ashu Martha Agbornyenty, a midwife from Cameroon, called the foundation’s recognition of her work a victory for those who study to become midwives and for the health of women in her country.

    “Everyone around me was like, ‘There’s nothing for midwifery. Midwifery is just a layman’s profession. There’s no future for midwifery.’ But me being here in New York today, it’s victory,” she said standing on a red carpet.

    The Gates Foundation was not alone in announcing new commitments to support progress toward the development goals. On Tuesday, the IKEA Foundation pledged $20 million to help workers and communities who may lose jobs in the transition to renewal energy sources in Vietnam, South Africa and Indonesia. The Rockefeller Foundation announced last week that it will focus 75% of its resources over five years on what it calls climate solutions in energy, health, agriculture and finance, committing $1 billion in granted funds. And the Clinton Global Initiative announced that gender equity would now be a pillar of its work.

    Last year, the Gates Foundation put the spotlight on hunger and promoted its support for crops engineered to adapt to climate change and resist agricultural pests, which have been criticized by farming groups and researchers who say that conflicts with worldwide efforts to protect the environment.

    ___

    Associated Press coverage of philanthropy and nonprofits receives support through the AP’s collaboration with The Conversation US, with funding from Lilly Endowment Inc. The AP is solely responsible for this content. For all of AP’s philanthropy coverage, visit https://apnews.com/hub/philanthropy.

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