Bancroft opens Health and Wellness Center at Lakeside
NJ.com, September 23, 2016—By: Community Bulletin
MULLICAL HILL — On Sept. 22, Bancroft, the largest organization in New Jersey providing education, support and services to children and adults with autism, intellectual and developmental disabilities, opened its state-of-the-art Health and Wellness Center at Lakeside. The facility is located on the Bancroft site where adults reside, enabling them to receive essential medical treatment right on campus and was made possible thanks to a $197,548 grant from the Salem Health and Wellness Foundation and the Community Foundation of New Jersey.
Adults with autism and other intellectual and developmental disabilities face immense challenges when they need medical intervention. A simple physical at the doctor’s office can incite fear, anxiety and aggressive behaviors. The Health & Wellness Center at Lakeside opens a world of opportunity and enables individuals to not only visit their physicians, but also to practice visiting the office as part of their desensitization therapy before medical treatment is necessary.
“The Health and Wellness Center at Lakeside represents the next wave of essential services Bancroft is able to provide thanks to our valued community partners,” said Toni Pergolin, Bancroft President and CEO. “As we continue to grow and expand throughout the region to meet an increased demand for autism services, we are grateful to be able to continue to enhance medical and residential options for families as well.”
“The Salem Health and Wellness Foundation has been delighted to partner with Bancroft to bring medical treatment and desensitization services directly to individuals who need them, improving access to care and quality of life for these adults,” said Brenda Goins, executive director of the foundation.
The program included a ribbon cutting ceremony and tours of the new facility, which is comprised of a comfortable waiting area and several treatment rooms. Speakers at the event included Assemblyman Adam Taliaferro, Bancroft CEO Toni Pergolin and Bancroft Medical Director Dr. Kurt Miceli as well as Brenda Goins with the Salem Health and Wellness Foundation.
Bancroft is a leading nonprofit provider of specialized services for individuals with autism, other intellectual or developmental disabilities and those in need of neurological rehabilitation. For nearly 133 years, Bancroft has been pioneering new ways of helping people with disabilities lead independent and fulfilling lives. Headquartered in Cherry Hill, Bancroft boasts 30 programs in 16 locations serving 1,700 people annually throughout New Jersey, Pennsylvania and Delaware, including more than 200 community-based group homes and supervised apartments. For more information, visit bancroft.org.
This item submitted by Kathryn Conda for Bancroft.
The Doctor Is In. In Your House, That Is.
NY Times, September 23, 2016—By: John F. Wasik
REMEMBER when doctors made house calls?
While only a relative handful of doctors still offer them, there is growing evidence that comprehensive home medical care could be a viable alternative to the attendant woes and soaring expenses of institutional health services, particularly for those in late retirement.
It will take some important legislative changes before focused; less intrusive care in a dignified, comfortable setting can become more widely available. The polarizing politics surrounding the Affordable Care Act makes any reform to the health care system particularly challenging. Still, given the overall popularity of Medicare — Hillary Clinton and Donald Trump both say they support it — getting a new home medical care benefit through Congress looks more promising.
At the heart of the home care renaissance is a combination of high-tech, portable medical equipment and the age-old practice of doctors coming into the home to personally examine and treat their patients.
“We can do X-rays, EKGs, medical records and other applications in the home,” said Dr. Thomas Cornwell, who has made more than 32,000 house calls in his Chicago-based practice and wants to see Medicare support more home-based medical care.
“I had a 92-year-old patient with a very high temperature,” Dr. Cornwell said, citing an example. “I brought in a portable X-ray and diagnosed pneumonia; she didn’t have to go to the hospital, and lived four more years.”
Dr. Cornwell is spearheading a national effort to revive physician house calls even as he pushes for doctors to be more fully compensated by Medicare for doing them. He is also training doctors to offer home-based care through the House Call Project, which is sponsored by the Home Centered Care Institute. He is chief executive of the nonprofit institute.
Home medical care may well be the key missing link in the “aging in place” model aimed at helping millions more older adults avoid spending the last years of their lives in nursing homes and other institutions.
Over the past decades, however, home care has been dwarfed by the significant shift of treatment to offices, clinics and hospitals. More than 50,000 practitioners work exclusively in hospitals, compared to about 5,000 doctors who make home-based visits to Medicare patients.
But a modest counterrevolution toward home care, devoted to a lower-cost, patient-centered approach, is underway. House calls to Medicare patients rose from 1.5 million in 1995 to more than 2.6 million in 2014, according to the Centers for Medicare and Medicaid Services.
Generally, the most expensive patients to treat have myriad health problems like diabetes and congestive heart failure. The top 5 percent of care-intensive patients account for 50 percent of total medical expenses, according to government data, with a median cost of more than $43,000 per person.
Dr. Cornwell and others argue that many of these gravely ill Americans can be better cared for — at less overall expense — at home.
“People want to be at home,” said Dr. Joanne G. Schwartzberg, a scholar-in-residence at the Accreditation Council for the Graduate Medical Education, who is working with Dr. Cornwell to advance home-based care. “Research has shown that these patients have better health outcomes at much lower costs. Now the challenge is to train more physicians in providing this complex but rewarding form of medical care.”
For now, people looking for home medical services need to do their own research. A nearby hospital may already offer a program. Referrals are also obtainable through visiting nurse associations or the American Academy of Home Care Medicine.
There are signs that the triad of care using doctors, nurses and the latest technology could help patients with multiple conditions.
Linda V. DeCherrie, who runs one of the largest academic house call programs in the country out of the Icahn School of Medicine at Mount Sinai Hospital in Manhattan, received a $9.6 million Medicare innovation award to study the expansion of home care “to include hospital level care at home and what it means for patients.”
Dr. DeCherrie, who supervises two programs at Mount Sinai that treat more than 1,500 patients, says comprehensive home-based health care “has the potential to provide solutions for many problems,” suggesting that seeing patients in their natural environment may offer improved care.
“It can be quite an ordeal to see a doctor in a hospital if you are a frail older adult,” Dr. DeCherrie said. “Patients are much happier not to have to go through that. In a home, you can get a better picture of what’s going on.”
The next step for broad-based home medical care is a legislative push to expand Medicare’s reach into the home and to revamp the prevailing fee-for-service model that rewards quantity of treatment over quality and cost savings.
Unless the traditional economic model is changed, experts say, few doctors would be interested in providing home-based care. It’s often a money loser for physicians under the current system.
Dr. Cornwell said he would like to see a new payment model that would allow Medicare to share any savings — relative to hospitalization — with doctors who make house calls.
“It would have profound national impact,” Dr. Cornwell said. “It would save billions in health care costs. For the horribly sick, hospitals are the worst place.”
The Independence at Home Act (S. 3130), a bill supported by a bipartisan group of senators, would expand a Medicare home care demonstration program “so that it can benefit more Medicare beneficiaries with severe chronic illness and disability through coordinated, home-based primary care,” according to an endorsement letter backed by organizations including AARP and the Retirement Research Foundation.
The first phase of the home medical care program demonstrated medical cost savings of $35 million — ranging from $1,000 to $3,000 per patient. Another independent study conducted by the Department of Veterans Affairs showed a 24 percent reduction in total costs and 62 percent fewer hospital stays, translating to some $9,000 in savings per veteran using home-based care.
Although the home medical care bill is unlikely to see action in Congress this year, Dr. Cornwell hopes it may be revived next year. But many policies, fiscal and political hurdles need to be crossed before home care can really take off.
How will doctors be monitored in the home? How will Medicare gauge the effectiveness of home-based treatments? Will Medicare reimbursement be enough to cover the costs of physicians, nurses and equipment? What about long-term care financing in addition to primary care that could provide better funding for custodial care outside of nursing homes?
Those questions, among others, are being considered by a diverse group of lawmakers, health care professionals and Medicare officials. Whether long-term care costs, which often include nonmedical caregiver or semiskilled home care, should also receive more support through government programs is another challenging issue.
“Many people who need help with basic tasks of daily life want to and can remain at home, rather than being forced to live in institutions in order to get care,” said Judith Feder, a professor of public policy at Georgetown.
The image of a doctor making house calls may recall a quaint Norman Rockwellesque painting, but home medical care could be part of a better future, too.
Millions in U.S. Climb Out of Poverty, at Long Last
NY Times, September 25, 2016—By: Patricia Cohen
Not that long ago, Alex Caicedo was stuck working a series of odd jobs and watching his 1984 Chevy Nova cough its last breaths. He could make $21 an hour at the Johnny Rockets food stand at FedEx Field when the Washington Redskins were playing, but the work was spotty.
Today, Mr. Caicedo is an assistant manager at a pizzeria in Gaithersburg, Md., with an annual salary of $40,000 and health benefits. And he is getting ready to move his wife and children out of his mother-in-law’s house and into their own place. Doubling up has been a lifesaver, Mr. Caicedo said, “but nobody just wants to move in with their in-laws.”
The Caicedos are among the 3.5 million Americans who were able to raise their chins above the poverty line last year, according to census data released this month. More than seven years after the recession ended, employers are finally being compelled to reach deeper into the pools of untapped labor, creating more jobs, especially among retailers, restaurants and hotels, and paying higher wages to attract workers and meet new minimum wage requirements.
“It all came together at the same time,” said Diane Swonk, an independent business economist in Chicago. “Lots of employment and wages gains, particularly in the lowest-paying end of the jobs spectrum, combined with minimum-wage increases that started to hit some very large population areas.”
Poverty declined among every group. But African-Americans and Hispanics — who account for more than 45 percent of those below the poverty line of $24,300 for a family of four in most states — experienced the largest improvement.
Government programs — like Social Security, the earned-income tax credit and food stamps — have kept tens of millions from sinking into poverty year after year. But a main driver behind the impressive 1.2 percentage point decline in the poverty rate, the largest annual drop since 1999, was that the economy finally hit a tipping point after years of steady, if lukewarm, improvement.
For the first time since the recession began, the poverty rate fell substantially in 2015. The number of people living under the poverty line declined by about 3.5 million, with every major demographic group benefiting from a stronger economy and an expanding job market. For all the improvement, though, poverty remains deeply entrenched, particularly among African-Americans and Hispanics, and is more prevalent in the South and Southwest.
Overall, 2.9 million more jobs were created from 2014 to 2015, helping millions of unemployed people cross over into the ranks of regular wage earners. Many part-time workers increased the number of hours on the job. Wages, adjusted for inflation, climbed.
“Another hidden benefit was lower prices at the pump,” Ms. Swonk said. “People who couldn’t afford the commute before could now afford to accept a minimum-wage job.”
There are different roads out of poverty, said Sheldon Danziger, president of the Russell Sage Foundation, a social science research institution, but today, one of the most promising is to “go somewhere where they raised the minimum wage.”
About 43 million Americans, more than 14 million of them children, are still officially classified as poor, and countless others up and down the income ladder remain worried about their families’ financial security. But the Census Bureau’s report found that 2015 was the first year since 2008, when the economic downturn began, that the poverty rate fell significantly and incomes for most American households rose.
“If you look under the hood of the census report,” Michael Strain, director of economic policy studies at the conservative research organization American Enterprise Institute, said, “you see more people are working, so fewer people are going to be in poverty.”
After a long period of rising inequality, Elise Gould, an economist at the left-leaning Economic Policy Institute in Washington, added, the benefits of the improving economy finally began to seep downward. Wage increases were “even stronger at the bottom than in the middle,” she said.
For those on the lower rungs of the income ladder, a step upward can be profound. For some, it means the difference between sleeping on a friend’s couch and having a home. For others, it is the change from getting shoes at Goodwill to buying a new pair at Target, or between not having the money to buy your daughter an ice cream cone to getting her a bicycle for her birthday.
The poverty rate fell in 23 states, with Vermont leading the way. The rest stayed flat; none got worse. And other evidence suggests the improvement has continued, if not as strongly, this year.
Mr. Caicedo, 32, initially found his job on Craigslist last summer, starting at $12 an hour. Recently, he was promoted to his salaried position and now drives a 2015 Nissan Pathfinder. His wife was able to leave her job at a clothing store and take care of their four children.
Michael Lastoria, who started the chain called & Pizza where Mr. Caicedo works, said: “We try to pay as close to a fair or living wage as possible,” roughly $2 an hour above the minimum with a steady full-time schedule and benefits. “We want people to have careers, not just jobs,” he said.
The availability of full-time jobs at a livable wage may be essential to move out of poverty but is not necessarily enough. Many poor people, saddled with a deficient education, inadequate health care and few marketable skills, find small setbacks can quickly set off a downward spiral. The lack of resources can prevent them from even reaching the starting gate: no computer to search job sites, no way to compensate for the bad impression a missing tooth can leave.
Many of those who made it had outsize determination, but also benefited from a government or nonprofit program that provided training, financial counseling, job hunting skills, safe havens and other services.
Cheyvonné Grayson, 29, grew up in South-Central Los Angeles, where he, at the age of 14, saw a friend gunned down. Since graduating from high school, Mr. Grayson has worked mostly as a day laborer. In 2014, he was paying $300 a month to sleep on someone’s couch and showing up at 6 a.m., morning after morning, at nonunion construction sites in the hopes of getting work.
Often the supervisors and workers spoke only Spanish, and it was hard to understand the orders and measurements. He remembered one foreman looking him up and down, skeptical that he could do the job.
“I had to prove this man wrong,” Mr. Grayson said.
At every site, he said he tried to pick up skills, carefully observing other workers, asking questions and later reinforcing the lessons by watching YouTube videos. Even so, the work was inconsistent and paid poorly, he said.
What made the difference, he said, was getting into the carpenters’ union — a feat he could not have achieved without the help of the Los Angeles Black Worker Center. “That was the door opener,” Mr. Grayson said.
He had to borrow a few hundred dollars for fees and tools, but his first apprenticeship as a carpenter started at $16.16 an hour. He quickly moved up to $20.20 an hour and is paid for his further training. He is now hanging doors for new dormitories at the University of Southern California.
For the first time in his life, he opened a bank account.
Seventeen hundred miles east, Christine Magee, a mother of four, joined an intensive self-sufficiency program administered by the Chicago Housing Authority and the Heartland Alliance after she fell into bankruptcy from racking up $22,000 in debt on a credit card. As a recipient of a federal housing voucher, Ms. Magee was eligible to enroll.
She set three goals after joining the program in 2014: buy a house, raise her dismal credit rating and get a better job that would provide for her retirement someday.
“She was really motivated,” said her counselor, Barbara Martinez. “Not everyone is.”
Ms. Magee’s husband has found only sporadic work. But she has moved from a health-technician job that paid $23,000 a year and left her family on Medicaid to one at a veterans hospital that pays more than $35,000 and provides health and educational benefits. The extra earnings automatically went into an escrow account.
A couple of weeks ago, she graduated from the program with more than $8,000 in savings — which she plans to use for a down payment on a home — and a bank letter confirming she qualifies for a mortgage.
“I knew,” Ms. Magee said, “there was something more out there.” (Back to Top)
It’s Easy for Obamacare Critics to Overlook the Merits of Medicaid Expansion
NY Times, September 26, 2016—By: Aaron E. Carroll (Back to Top)
Three years into Obamacare and it seems as if much of the news is bad: private insurers exiting the exchanges, networks being narrowed, premiums rising and competition dwindling out of existence.
But it’s important to remember that many, if not most, of the newly covered Americans became insured through an expansion of Medicaid. Here, too, you hear a lot of bad news: that Medicaid offers poor quality and little choice of providers, that it is expensive for the states to administer and that its growing cost will eventually bankrupt states. As of today, 19 states have still refused to participate in the expansion.
Such declarations consider only one side of the equation, though. In most ways, Medicaid offers an excellent return on investment.
A rigorous analysis of the health benefits of being insured shows that Medicaid works on a number of levels. Critics of the program will point to studies that show that having Medicaid is associated with poor outcomes, even worse than those for the uninsured. Such studies are often flawed, however, in that those on Medicaid are often poorer and sicker than those who are uninsured.
Some good randomized trials do exist. The Oregon Health Insurance Experiment is one of the most recent and best known. Many news articles have been written on the short-term findings of that study, which have been interpreted in many ways, both good and bad. But even that study couldn’t answer many of the long-term, holistic questions about its effects on health.
To see the longer-term benefits across a wider population, we need to turn to other types of studies. They exist as well, usually taking advantage of changes in policy. Medicaid coverage of children and births expanded rapidly from the late 1970s through the early 1990s. When expectant mothers got early prenatal coverage, babies were less likely to be obese when they grew up. They had fewer hospitalizations, especially preventable hospitalizations, for any number of chronic disorders.
Another study from last fall went further. By exploiting new Medicaid eligibility policies, researchers were able to closely compare people with and without benefits. They found that African-Americans who had more years of Medicaid eligibility as children had fewer hospitalizations and emergency department room visits as adults. More years of coverage achieved better results, even with respect to mortality.
Benefits from Medicaid extend beyond health. A 2016 National Bureau of Economic Research working paper examined the effect of the Medicaid expansion on financial outcomes of beneficiaries. Using credit report data, researchers showed that the expansion was associated with a reduction of collection balances of as much as $1,000 for those receiving Medicaid.
The financial benefits extend to society. A study from early 2015 looked at how expanding coverage to children in the 1980s and 1990s affected long-term finances. The analysis showed that children whose eligibility increased were more likely to go to college, earn higher wages and pay more taxes by the time they were 28 years old.
In fact, after accounting for other factors, the researchers estimated that the government would recoup 56 cents on each dollar spent on childhood Medicaid by the time beneficiaries reached age 60. Other studies confirm that Medicaid in childhood makes children more likely to finish high school and college.
At a national level, the expansion of Medicaid continues to yield benefits. Its coverage was increased, and its quality raised. Some states that have expanded Medicaid are even expecting net savings for the next few years. In states where Medicaid was expanded, hospitals had fewer uninsured visits.
Focusing on only the positives can be as misleading as focusing on only the negatives. Policy decisions, including those involving health, need to be considered in terms of trade-offs. It is true that providing Medicaid can cost the federal government, and even states, a lot of money, which can’t then be spent on other worthy pursuits. It is true that Medicaid reimburses physicians and hospitals less generously, and that it often leaves beneficiaries with fewer choices than private insurance might.
But when we look at the balance sheet for Medicaid — health benefits, financial security, societal improvements through education — it’s not hard to argue that money allocated to Medicaid is well spent.
Authorities: Officers use new training to rescue suicidal man from GWB
The Record, September 23, 2016–By Abbott Koloff
Two Port Authority police officers who completed crisis intervention training in Bergen County last week helped talk a 23-year-old man out of jumping from the George Washington Bridge on Friday, authorities said.
Officer Juan Guzman and Lt. Mike Hennessy, responded to the report of a man threatening to jump from the walkway along the eastbound lanes of the bridge’s upper level at 1:58 p.m. as they were reopening westbound lanes following a tractor-trailer accident, said a Port Authority spokesman, Joseph Pentangelo.
Guzman and Hennessy were participants in a course the New Jersey Crisis Intervention Training Center of Excellence had offered at the Bergen County Law and Public Safety Institute in Mahwah from Sept. 12-16. The center is comprised of law enforcement officials and mental health professionals, according to its website.
The man, a Manhattan resident whose name was not provided by authorities, was transported to NewYork-Presbyterian Hospital/Columbia University Medical Center to be evaluated, authorities said.
He had climbed over the railing on the walkway, just west of the tower on the New York side of the bridge, and was standing on a ledge overlooking the Hudson River when officers arrived, authorities said. Guzman “engaged the suicidal subject in conversation and established an immediate rapport,” Pentangelo said. Hennessey also participated in helping to talk the man out of jumping, authorities said.
Neither Guzman nor Hennessey were available to discuss the rescue on Friday night, Pentangelo said. The man was reported to the Port Authority police by a tractor-trailer driver who was travelling slowly in the westbound lanes because of the accident and fuel spill, authorities said.