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Desperate Families Search for Affordable Home Care



Reed Abelson, The New York Times
Mon, 04 Dec 2023 10:00:00 +0000

It's a good day when Frank Lee, a retired chef, can slip out to the hardware store, fairly confident that his wife, Robin, is in the hands of reliable . He spends nearly every hour of every day anxiously overseeing her care at their home on the Isle of Palms, a barrier island near Charleston, South Carolina.

Robin Lee, 67, has had dementia for about a decade, but the was able to take overseas trips and enjoy their marriage of some 40 years until three years ago, when she grew more agitated, prone to sudden outbursts, and could no longer explain what she needed or wanted. He struggled to care for her largely on his own.

“As Mom's condition got more difficult to navigate, he was just handling it,” said Jesse Lee, the youngest of the couple's three adult children. “It was getting harder and harder. Something had to change, or they would both perish.”


Frank Lee's search for trustworthy home health aides — an experience that millions of American families face — has often been exhausting and infuriating, but he has persisted. He didn't entirely trust the care his wife would get in an assisted living facility. Last August, when a respite program paid for her brief stay in one so Frank, 69, could take a trip to the mountains, she fell and fractured her sacrum, the bone that connects the spine to the pelvis.

There is precious little assistance from the for families who need a home health aide, unless they are poor. The people working in these are often woefully underpaid and unprepared to help a frail, older person with dementia bathe and use the bathroom, or to defuse an angry outburst.

Usually, it is family that steps into the breach — grown children who cobble together a fragile chain of visitors to help an ailing father; a middle-aged daughter who returns to her childhood bedroom; a son-in-law working from home who keeps a watchful eye on a confused parent; a wife who can barely manage herself looking after a faltering husband.

Frank Lee finally found two aides on his own, with no help from an agency. Using the proceeds from the sale of his stake in a group of restaurants, including the popular Charleston bistro Slightly North of Broad, he pays them the going rate of about $30 an hour. Between his wife's care and medical expenses, he estimates he's spending between $80,000 and $100,000 a year.


“Who the hell can afford this?” he asked. “There's no relief for families unless they have great wealth or see their wealth sucked away.” He worries that he will run out of money and be forced to sell their home of more than three decades. “Funds aren't unlimited,” he said.

Credited with emphasizing local ingredients and mentoring young chefs in Charleston, Lee retired in 2016, a few years after his wife's diagnosis.

In an interview at the time, he said, “My wife has given up her life to help me in my career, and now I need to pay attention to her.”

In 2020, he contacted a half-dozen home care agencies. Some couldn't fill the position. Others sent aides who were quickly overwhelmed by his wife's behavior. Doctors told the family they believed she has frontotemporal dementia, which appeared to affect her language and how she behaved.


One woman seemed promising, only to quit after a week or two. “We never saw her again,” Lee said. He tried a friend of the family for a time, but she left when her grandmother developed liver cancer.

“It was the whole year of going through different caregivers,” said son Jesse.

Finally, Frank found two women to help. One of them, Ronnie Smalls, has more than a dozen years of experience and is trained in dementia care. She has developed a rapport with Robin, who seems reassured by a quick touch. “We have a really good bond,” Smalls said. “I know her language, her expression.”


One day at the Lees' cozy one-story house, decorated with furniture made by Robin, and with a yard overflowing with greenery, Smalls fed her lunch at the kitchen table with her husband and daughter. Robin seemed to enjoy the company, murmuring in response to the conversation.

At other times, she seemed oblivious to the people around her. She can no longer walk on her own. Two people are often needed to help her get up from a chair or go to the bathroom, transitions she often finds upsetting. A day without an aide — out because of illness or a family emergency — frays the tenuous links that hold the couple's life together.

Lee said his wife barely resembles the woman he married, the one who loved , skiing, and gardening, and who started a neighborhood preschool while raising their three children. A voracious reader, she is now largely silent, staring into space.


The prognosis is bleak, with doctors offering little to hang onto. “What's the end game look like?” Lee asks, wondering if it would be better if his wife had the right to die rather than slowly disappear before his eyes. “As she disintegrates, I disintegrate,” he said. She recently qualified for hospice care, which will involve weekly visits from a nurse and a certified nursing assistant paid under Medicare.

Charleston is flush with retirees attracted by its low taxes and a warm climate, and it boasts of ways to care for them with large for-profit home health chains and a scattering of small agencies. But many families in Charleston and across the nation can't find the help they need. And when they do, it's often spotty and far more expensive than they can afford.

Most Americans want to remain in their own homes, living independently, for as long as possible. They want to avoid nursing homes, which they see as providing poor care, polls have found. And the ranks of older people who need such help will grow. By 2030, 1 in 5 Americans will be at least 65 as millions in the baby boomer generation retire.

In dozens of interviews, families described a desperate and sometimes fruitless search for aides to help loved ones with simple tasks on a predictable schedule at an hourly rate they can afford.


Roughly 8 million people 65 and older had dementia or needed help with two or more activities of basic daily life, like getting out of bed, according to an analysis of a federally funded survey of older Americans by KFF Health News and The New York Times. Only a million received paid help outside of a nursing home, and nearly 3 million had no help at all.

Most families can't afford what agencies charge — about $27 an hour, according to Genworth, a long-term care insurance company. So, many take their chances on untrained caregivers found through word-of-mouth, Craigslist, or other resources.

A Scarcity of Workers

One of the main obstacles to finding paid help is the chronic shortage of workers. Some 3.7 million people had jobs as aides in home health or personal care in 2022, with half of them earning less than $30,000 year, or $14.51 an hour, according to the Bureau of Labor Statistics. The number of people needed is expected to increase by more than 20% over the next decade. But the working conditions are hard, the pay is usually bad, and the hours are inconsistent.


About 3 million people are working in private homes, according to a 2023 analysis by PHI, a nonprofit that studies and acts as an advocate for the workforce, although official estimates may not count many workers paid off the books or hired outside of an agency by a family. Eighty-five percent of home care workers are women, two-thirds are people of color, and roughly a third are immigrants. The pay is often so low that more than half qualify for public assistance like food stamps or Medicaid.

Dawn Geisler, 53, has made only $10 an hour working as a home health aide in the Charleston area for the past four years, without ever getting a raise. She declined to name the agency that employs her because she doesn't want to lose her job.

Geisler discovered she liked the work after caring for her mother. Unlike an office job, “every day is just a little bit different,” she said. She now juggles two clients. She might accompany one to the doctor and keep the other one company. “I'm taking care of them like they were my own family,” she said.

The agency provides no guarantee of work and doesn't always tell her what to expect when she walks through the door, except to say someone has Alzheimer's or is in a wheelchair. Her supervisors often fail to let her know if her client goes to the hospital, so families know to call her cellphone. She has waited weeks for a new assignment without getting paid a penny. She herself has no health insurance and sometimes relies on food banks to put meals on the table.


“I'm not making enough to pay all the bills I have,” said Geisler, who joined an advocacy group called the Fight for $15, which is pushing to raise the minimum wage in South Carolina and across the country. When her car broke down, she couldn't afford to get it fixed. Instead, she walked to work or borrowed her fiancé's bicycle.

Most home health agencies nationwide are for-profit and are often criticized for ignoring the needs of workers in favor of the bottom line.

“The business models are based on cheap labor,” said Robyn Stone, senior vice president of research for LeadingAge, which represents nonprofit agencies. The industry has historically tolerated high turnover but now can't attract enough workers in a strong, competitive job market. “I think there has been a rude awakening for a lot of these companies,” she said.

Many agencies have also refused to pay overtime or travel costs between jobs, and many have been accused of wage theft in lawsuits filed by home care workers or have been sanctioned by state and federal agencies.


Medicaid, the federal-state program that provides for the poor, is supposed to provide home aides but faces shortages of workers at the rates it pays workers. At least 20 states pay less than $20 an hour for a personal care aide, according to a recent state survey by KFF. Aides are often paid less under Medicaid than if they care for someone paying privately.

With low pay and few benefits, many people would rather work the checkout line in a supermarket or at a fast-food chain than take on the emotionally demanding job of caring for an older person, said Ashlee Pittmann, the chief executive of Interim HealthCare of Charleston, a home health agency. She said that she recently raised wages by $2 an hour and had had more success keeping employees, but that she still worried that “we may not be able to compete with some larger companies.”

The Biden administration failed to obtain an additional $400 billion from Congress for home- and community-based services to shift emphasis away from institutional care. President Joe Biden signed an executive order this year to encourage some reforms, and federal have proposed requiring home health agencies to spend 80 cents of every government dollar on paying workers under Medicaid. But so far, little has changed.

Falling Through the ‘Doughnut Hole


Long-term care coverage for most Americans is a yawning gap in government programs. And the chasm is widening as more Americans age into their 70s, 80s, and 90s.

The government's main program for people 65 and older is Medicare, but it pays for a home aide only when a medical condition, like recovery from a stroke, has made a person eligible for a nurse or therapist to come to the home. And the aide is usually short-term. Medicare doesn't cover long-term care.

Medicaid, which does pay for long-term care at home, is limited to serving the poor or those who can demonstrate they have hardly any assets. But, again, the worker shortage is so pervasive that waiting lists for aides are years long, leaving many people without any option except a nursing home.

So millions of Americans keep trying to hang in and stay home as long as they can. They're not poor enough to qualify for Medicaid, but they can't afford to hire someone privately.


Many fall through what April Abel, a former home health nurse from Roper St. Francis Healthcare in Charleston, described as “the doughnut hole.”

“I feel so bad for them because they don't have the support system they need,” she said.

She tried fruitlessly for months to find help for Joanne Ganaway, 79 and in poor health, from charities or state programs while she her at home. Ganaway had trouble seeing because of a tear in her retina and was often confused about her medications, but the small pension she had earned after working nearly 20 years as a state employee made her ineligible for Medicaid-sponsored home care.

So Ganaway, who rarely leaves her house, relies on friends or family to get to the doctor or the store. She spends most of her day in a chair in the living room. “It has been difficult for me, to be honest,” she said.


Turning to Respite Services

With no hope of steady help, there is little left to offer overstretched wives, husbands, sons, and daughters other than a brief respite. The Biden administration has embraced the idea of respite services under Medicare, including a pilot program for the families of dementia that will begin in 2024.

One nonprofit, Respite Care Charleston, provides weekday drop-off sessions for people with dementia for almost four hours a day.

Lee's wife went for a couple of years, and he still makes use of the center's support groups, where caregivers talk about the strain of watching over a loved one's decline.


On any given morning, nearly a dozen people with dementia gather around a table. Two staff members and a few volunteers work with the group as they play word , banter, bat balls around, or send a small plastic jumping frog across the table.

Their visits cost $50 a session, including lunch, and the organization's brief hours keep it under the minimum state requirements for licensing.

“We're not going to turn someone away,” Sara Perry, the group's executive director, said. “We have some folks who pay nothing.”

The service is a godsend, families say. Parkinson's disease and a stroke have left Dottie Fulmer's boyfriend, Martyn Howse, mentally and physically incapacitated, but he enjoys the sessions.


“Respite Care Charleston has been a real key to his keeping going,” she said, “to both of us, quite frankly, continuing to survive.”

By: Reed Abelson, The New York Times
Title: Desperate Families Search for Affordable Home Care
Sourced From: kffhealthnews.org/news/article/dying-broke-desperate-families-search-for-affordable-home-care/
Published Date: Mon, 04 Dec 2023 10:00:00 +0000

Kaiser Health News

Pregnancy Care Was Always Lacking in Jails. It Could Get Worse.



Renuka Rayasam
Fri, 23 Feb 2024 10:00:00 +0000

It was about midnight in June 2022 when police showed up at Angela Collier's door and told her that someone anonymously requested a welfare check because they thought she might have had a miscarriage.

Standing in front of the concrete steps of her home in Midway, , Collier, initially barefoot and wearing a baggy gray T-shirt, told officers she planned to see a doctor in the morning because she had been bleeding.

Police body camera footage obtained by KFF through an open records request shows that the officers then told Collier — who was 29 at the time and enrolled in online classes to study psychology — to turn around.


Instead of taking her to get medical care, they handcuffed and arrested her because she had outstanding warrants in a neighboring county for failing to appear in court to face misdemeanor drug charges three weeks earlier. She had missed that court date, medical records show, because she was at a hospital receiving treatment for pregnancy complications.

Despite her symptoms and being about 13 weeks pregnant, Collier spent the next day and a half in the Walker County Jail, about 80 miles north of Houston. She said her bleeding worsened there and she begged repeatedly for medical attention that she didn't , according to a formal complaint she filed with the Texas Commission on Jail Standards.

“There wasn't anything I could do,” she said, but “just lay there and be scared and not know what was going to happen.”

Collier's experience highlights the limited oversight and absence of federal standards for reproductive care for pregnant women in the criminal justice system. Incarcerated people have a constitutional right to , yet only a half-dozen states have passed laws guaranteeing access to prenatal or postpartum medical care for people in custody, according to a review of reproductive health care legislation for incarcerated people by a research group at Johns Hopkins School of Medicine. And now abortion restrictions might be putting care further out of reach.


Collier's arrest was “shocking and disturbing” because officers “blithely” took her to jail despite her miscarriage concerns, said Wanda Bertram, a spokesperson for the Prison Policy Initiative, a nonprofit organization that studies incarceration. Bertram reviewed the body cam footage and Collier's complaint.

“Police arrest people who are in medical emergencies all the time,” she said. “And they do that regardless of the fact that the jail is often not equipped to care for those people in the way an emergency room might be.”

After a decline during the first year of the pandemic, the number of women in U.S. jails is once again rising, hitting nearly 93,000 in June 2022, a 33% increase over 2020, according to the Department of Justice. Tens of thousands of pregnant women enter U.S. jails each year, according to estimates by Carolyn Sufrin, an associate professor of gynecology and obstetrics at Johns Hopkins School of Medicine, who researches pregnancy care in jails and prisons.

The health care needs of incarcerated women have “always been an afterthought,” said Dana Sussman, deputy executive director at Pregnancy Justice, an organization that defends women who have been charged with crimes related to their pregnancy, such as substance use. For example, about half of states don't provide free menstrual products in jails and prisons. “And then the needs of pregnant women are an afterthought beyond that,” Sussman said.


Researchers and advocates worry that confusion over recent abortion restrictions may further complicate the situation. A nurse cited Texas' abortion laws as one reason Collier didn't need care, according to her statement to the standards commission.

Texas law allows treatment of miscarriage and ectopic pregnancies, a life-threatening condition in which a fertilized egg implants outside the uterus. However, different interpretations of the law can create confusion.

A nurse told Collier that “hospitals no longer did dilation and curettage,” Collier told the commission. “Since I wasn't hemorrhaging to the point of completely soaking my pants, there wasn't anything that could be done for me,” she said.

Collier testified that she saw a nurse only once during her stay in jail, even after she repeatedly asked jail staffers for . The nurse checked her temperature and blood pressure and told her to put in a formal request for Tylenol. Collier said she completed her miscarriage shortly after being released.


Collier's case is a “canary in a coal mine” for what is happening in jails; abortion restrictions are “going to have a huge ripple effect on a system already unequipped to handle obstetric emergencies,” Sufrin said.

‘There Are No Consequences'

Jail and prison health policies vary widely around the country and often fall far short of the American College of Obstetricians and Gynecologists' guidelines for reproductive health care for incarcerated people. ACOG and other groups recommend that incarcerated women have access to unscheduled or emergency obstetric visits on a 24-hour basis and that on-site health care providers should be better trained to recognize pregnancy problems.

In Alabama, where women have been jailed for substance use during pregnancy, the state offers pregnancy tests in jail. But it doesn't guarantee a minimum standard of prenatal care, such as access to extra food and medical visits, according to Johns Hopkins' review.


Policies for pregnant women at federal facilities also don't align with national standards for nutrition, safe housing, and access to medical care, according to a 2021 report from the Government Accountability Office.

Even when laws exist to ensure that incarcerated pregnant women have access to care, the language is often vague, leaving discretion to jail personnel.

Since 2020, Tennessee law has required that jails and prisons provide pregnant women “regular prenatal and postpartum care, as necessary.” But last August a woman gave birth in a jail cell after seeking medical attention for more than an hour, according to the Montgomery County Sheriff's Office.

Pregnancy complications can quickly escalate into life-threatening situations, requiring more timely and specialized care than jails can often provide, said Sufrin. And when jails fail to comply with laws on the books, little oversight or enforcement may exist.


In Louisiana, many jails didn't consistently follow laws that aimed to improve access to reproductive health care, such as providing free menstrual items, according to a May 2023 report commissioned by state lawmakers. The report also said jails weren't transparent about whether they followed other laws, such as prohibiting the use of solitary confinement for pregnant women.

Krishnaveni Gundu, as co-founder of the Texas Jail Project, which advocates for people held in county jails, has lobbied for more than a decade to strengthen state protections for pregnant incarcerated people.

In 2019, Texas became one of the few states to require that jails' health policies include obstetrical and gynecological care. The law requires jails to promptly transport a pregnant person in labor to a hospital, and additional regulations mandate access to medical and mental health care for miscarriages and other pregnancy complications.

But Gundu said lack of oversight and meaningful enforcement mechanisms, along with “apathy” among jail employees, have undermined regulatory protections.


“All those reforms feel futile,” said Gundu, who helped Collier prepare for her testimony. “There are no consequences.”

Before her arrest, Collier had been to the hospital twice that month experiencing pregnancy complications, a bladder infection, her medical records show. Yet the commission found that Walker County Jail didn't violate minimum standards. The commission did not consider the police body cam footage or Collier's personal medical records, which support her assertions of pregnancy complications, according to investigation documents obtained by KFF Health News via an open records request.

In making its determination, the commission relied mainly on the jail's medical records, which note that Collier asked for medical attention for a miscarriage once, in the morning on the day she was released, and refused Tylenol.

“Your complaint of no medical care is unfounded,” the commission concluded, “and no further action will be taken.”


Collier's miscarriage had ended before she entered the jail, argued Lt. Keith DeHart, jail lieutenant for the Walker County Sheriff's Office. “I believe there was some misunderstanding,” he said.

Brandon Wood, executive director of the commission, wouldn't comment on Collier's case but defends the group's investigation as thorough. Jails “have a duty to ensure that those records are accurate and truthful,” he said. And most Texas jails are complying with heightened standards, he said.

Bertram disagrees, saying the fact that care was denied to someone who was begging for it speaks volumes. “That should tell you something about what these standards are worth,” she said.

Last year, Chiree Harley spent six weeks in a Comal County, Texas, jail shortly after discovering she was pregnant and before she could get prenatal care, she said.


I was “thinking that I was going to be well taken care of,” said Harley, 37, who also struggled with substance use.

Jail officials put her in the infirmary, Harley said, but she saw only a jail doctor and never an OB-GYN, even though she had previous pregnancy complications including losing multiple pregnancies at around 21 weeks. This time she had no idea how far along she was.

She said that she started leaking amniotic fluid and having contractions on Nov. 1, but that jail officials waited nearly two days to take her to a hospital. Harley said officers forced her to sign papers releasing her from jail custody while she was having contractions in the hospital. Harley delivered at 23 weeks; the baby boy died less than a day later in her arms.

The whole experience was “very scary,” Harley said. “Afterwards we were all very, very devastated.”


Comal County declined to send Harley's medical and other records in response to an open records request. Michael Shaunessy, a partner at McGinnis Lochridge who represents Comal County, said in a statement that, “at all times, the Comal County Jail provided Chiree Harley with all appropriate and necessary medical treatment for her and her unborn child.” He did not respond to questions about whether Harley was provided specialized obstetric care.

‘I Trusted Those People'

In states like Idaho, Mississippi, and Louisiana that installed near-total abortion bans after the Supreme Court eliminated the constitutional right to abortion in 2022, some patients might have to wait until no fetal cardiac activity is detected before they can get care, said Kari White, the executive and scientific director of Resound Research for Reproductive Health.

White co-authored a recent study that documented 50 cases in which pregnancy care deviated from the standard because of abortion restrictions even outside of jails and prisons. Health care providers who worry about running afoul of strict laws might tell patients to go home and wait until their situations worsen.


“Obviously, it's much trickier for people who are in jail or in prison, because they are not going to necessarily be able to again,” she said.

Advocates argue that boosting oversight and standards is a start, but that states need to find other ways to manage pregnant women who get caught in the justice system.

For many pregnant people, even a short stay in jail can cause lasting trauma and interrupt crucial prenatal care.

Collier remembers being in “disbelief” when she was first arrested but said she was not “distraught.”


“I figured I would be taken care of, that nothing bad was gonna happen to me,” she said. As it became clear that she wouldn't get care, she grew distressed.

After her miscarriage, Collier saw a mental health specialist and started medication to treat depression. She hasn't returned to her studies, she said.

“I trusted those people,” Collier said about the jail staff. “The whole experience really messed my head up.”

By: Renuka Rayasam
Title: Pregnancy Care Was Always Lacking in Jails. It Could Get Worse.
Sourced From: kffhealthnews.org/news/article/pregnancy-care-jails-prisons-incarcerated-women/
Published Date: Fri, 23 Feb 2024 10:00:00 +0000

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Kaiser Health News

Florida Defies CDC in Measles Outbreak, Telling Parents It’s Fine to Send Unvaccinated Kids to School



Amy Maxmen
Fri, 23 Feb 2024 10:00:00 +0000

With a brief memo, Florida Surgeon General Joseph Ladapo has subverted a public standard that's long kept measles outbreaks under control.

On Feb. 20, as measles spread through Manatee Bay Elementary in South Florida, Ladapo sent a letter granting them permission to send unvaccinated to school amid the outbreak.

The Department of Health “is deferring to parents or guardians to make decisions about school attendance,” wrote Ladapo, who was appointed to head the agency by Florida Gov. Ron DeSantis, whose name is listed above Ladapo's in the letterhead.


Ladapo's move contradicts advice from the Centers for Disease Control and Prevention.

“This is not a parental rights issue,” said Scott Rivkees, Florida's former surgeon general who is now a professor at Brown University. “It's about protecting fellow classmates, teachers, and members of the community against measles, which is a very serious and very transmissible illness.”

Most people who aren't protected by a vaccine will get measles if they're exposed to the virus. This vulnerable group includes children whose parents don't get them vaccinated, infants too young for the vaccine, those who can't be vaccinated for medical reasons, and others who don't mount a strong, lasting immune response to it. Rivkees estimates that about a tenth of people in a community fall into the vulnerable category.

The CDC advises that unvaccinated students stay home from school for three weeks after exposure. Because the highly contagious measles virus spreads on tiny droplets through the and on surfaces, students are considered exposed simply by sitting in the same cafeteria or classroom as someone infected. And a person with measles can pass along an infection before they develop a fever, cough, rash, or other signs of the illness. About 1 in 5 people with measles end up hospitalized, 1 in 10 develop ear infections that can to permanent hearing loss, and about 1 in 1,000 die from respiratory and neurological complications.


“I don't know why the health department wouldn't follow the CDC recommendations,” said Thresia Gambon, president of the Florida chapter of the American Academy of Pediatrics and a pediatrician who practices in Miami and Broward, the county affected by the current measles outbreak. “Measles is so contagious. It is very worrisome.”

Considering the dangers of the disease, the vaccine is incredibly safe. A person is about four times as likely to die from being struck by lightning during their lifetime in the United States as to have a potentially -threatening allergic reaction to the measles, mumps, and rubella vaccine.

Nonetheless, last year a record number of parents filed for exemptions from school vaccine requirements on religious or philosophical grounds across the United States. The CDC reported that childhood immunization rates hit a 10-year low.

In addition to Florida, measles cases have been reported in 11 other states this year, including Arizona, Georgia, Minnesota, and Virginia.


Only about a quarter of Florida's counties had reached the 95% threshold at which communities are considered well protected against measles outbreaks, according to the most recent data posted by the Florida Department of Health in 2022. In Broward County, where six cases of measles have been reported over the past week, about 92% of children in kindergarten had received routine immunizations against measles, chickenpox, polio, and other diseases. The remaining 8% included more than 1,500 kids who had vaccine exemptions, as of 2022.

Broward's local health department has been offering measles vaccines at Manatee Bay Elementary since the outbreak began, according to the county school superintendent. If an unvaccinated person gets a dose within three days of exposure to the virus, they're far less likely to get measles and spread it to others.

For this reason, government have occasionally mandated vaccines in emergencies in the past. For example, Philadelphia's deputy health commissioner in 1991 ordered children to get vaccinated against their parents' wishes during outbreaks traced to their faith-healing churches. And during a large measles outbreak among Orthodox Jewish communities in Brooklyn in 2019, the New York City health commissioner mandated that anyone who lived, worked, or went to school in hard-hit neighborhoods get vaccinated or face a fine of $1,000. In that ordinance, the commissioner wrote that the presence of anyone lacking the vaccine in those areas, unless it was medically contraindicated, “creates an unnecessary and avoidable risk of continuing the outbreak.”

Ladapo moved in the opposite direction with his letter, deferring to parents because of the “high immunity rate in the community,” which data contradicts, and because of the “burden on families and educational cost of healthy children missing school.”


Yet the burden of an outbreak only grows larger as cases of measles spread, requiring more emergency care, more testing, and broader quarantines as illness and hospitalizations mount. Curbing a 2018 outbreak in southern Washington with 72 cases cost about $2.3 million, in addition to $76,000 in medical costs, and an estimated $1 million in economic losses due to illness, quarantine, and caregiving. If numbers soar, death becomes a burden, too. An outbreak among a largely unvaccinated population in Samoa caused more than 5,700 cases and 83 deaths, mainly among children.

Ladapo's letter to parents also marks a departure from the norm because local health departments tend to take the lead on containing measles outbreaks, rather than or federal authorities. In response to queries from KFF Health News, Broward County's health department deferred to Florida's state health department, which Ladapo oversees.

“The county doesn't have the power to disagree with the state health department,” said Rebekah Jones, a data scientist who was from her post at the Florida health department in 2020, over a rift regarding coronavirus data.

DeSantis, a Republican, appointed Ladapo as head of the state health department in late 2021, as DeSantis integrated skepticism about covid vaccines into his political platform. In the months that followed, Florida's health department removed information on covid vaccines from its homepage, and reprimanded a county health director for encouraging his staff to get the vaccines, leading to his resignation. In January, the health department website posted Ladapo's call to halt vaccination with covid mRNA vaccines entirely, based on notions that scientists call implausible.


Jones was not surprised to see Ladapo pivot to measles. “I think this is the predictable outcome of turning fringe, anti-vaccine rhetoric into a defining trait of the Florida government,” she said. Although his latest runs contrary to CDC advice, the federal agency rarely intervenes in measles outbreaks, entrusting the task to states.

In an email to KFF Health News, the Florida health department said it was working with others to identify the contacts of people with measles, but that details on cases and places of exposure were confidential. It repeated Ladapo's decision, adding, “The surgeon general's recommendation may change as epidemiological investigations continue.”

For Gambon, the outbreak is already disconcerting. “I would like to see the surgeon general promote what is safest for children and for school staff,” she said, “since I am sure there are many who might not have as strong immunity as we would hope.”

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.



This story can be republished for free (details).

By: Amy Maxmen
Title: Florida Defies CDC in Measles Outbreak, Telling Parents It's Fine to Send Unvaccinated Kids to School
Sourced From: kffhealthnews.org/news/article/florida-defies-cdc-measles-outbreak/
Published Date: Fri, 23 Feb 2024 10:00:00 +0000

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Kaiser Health News

KFF Health News’ ‘What the Health?’: Alabama Court Rules Embryos Are Children. What Now?



Thu, 22 Feb 2024 20:00:00 +0000

The Host

Julie Rovner
KFF Health News


Read Julie's stories.


Julie Rovner is chief Washington correspondent and host of KFF Health News' weekly health policy news , “What the Health?” A noted expert on health policy issues, Julie is the author of the critically praised reference book “Health Care Politics and Policy A to Z,” now in its third edition.

The Alabama Supreme Court's groundbreaking ruling last that frozen embryos have legal rights as people has touched off a national debate about the potential fallout of the “personhood” movement. Already the of Alabama-Birmingham has paused its in vitro fertilization program while it determines the ongoing legality of a that has become increasingly common for those wishing to start a family. 

Meanwhile, former President Donald Trump is reportedly leaning toward endorsing a national, 16-week ban. At the same time, former aides are planning a long agenda of reproductive health restrictions should Trump win a second term.

This week's panelists are Julie Rovner of KFF Health News, Lauren Weber of The Washington Post, Rachana Pradhan of KFF Health News, and Victoria Knight of Axios.



Victoria Knight


Read Victoria's stories.

Rachana Pradhan
KFF Health News



Read Rachana's stories.

Lauren Weber
The Washington Post



Read Lauren's stories.

Among the takeaways from this week's episode:

  • The Alabama Supreme Court's on embryonic personhood could have wide-ranging implications beyond reproductive health care, with potential implications for tax deductions, child payments, criminal law, and much more.
  • Donald Trump is considering a national abortion ban at 16 weeks of gestation, according to recent reports. It is unclear whether such a ban would go far enough to please his conservative supporters, but it would be far enough to give Democrats ammunition to campaign on it. And some are looking into using a 19th-century anti-smut law, the Comstock Act, to implement a national ban under a new Trump presidency — no action from Congress necessary.
  • New reporting from KFF Health News draws on many interviews with clinicians at Catholic hospitals about how the Roman Catholic Church's directives dictate the care they may offer patients, especially in reproductive health. It also draws attention to the vast number of religiously affiliated hospitals and the fact that, for many women, a Catholic hospital may be their only option.
  • Questions about 's cognitive health are drawing attention to ageism in politics — as well as in American , with fewer people taking precautions against the covid-19 virus even as it remains a serious threat to vulnerable people, especially the elderly. The mental fitness of the nation's is a valid, relevant question for many voters, though the questions are also fueled by frustration with a political system in which many offices are held by older people who have been around a long time.

Plus, for “extra credit” the panelists suggest health policy stories they read this week that they think you should read, too:

Julie Rovner: Stat's “New CMS Rules Will Throttle Access Researchers Need to Medicare, Medicaid Data,” by Rachel M. Werner.

Lauren Weber: The Washington Post's “They Take Kratom to Ease Pain or Anxiety. Sometimes, Death Follows,” by David Ovalle.


Rachana Pradhan: Politico's “Red States Hopeful for a 2nd Trump Term Prepare to Curtail Medicaid,” by Megan Messerly.

Victoria Knight: ProPublica's “The Year After a Denied Abortion,” by Stacy Kranitz and Kavitha Surana.

Also mentioned on this week's podcast:


Francis Ying
Audio producer

Emmarie Huetteman


To hear all our podcasts, click here.

And subscribe to KFF Health News' “What the Health?” on SpotifyApple PodcastsPocket Casts, or wherever you listen to podcasts.

Title: KFF Health News' ‘What the Health?': Alabama Court Rules Embryos Are Children. What Now?
Sourced From: kffhealthnews.org/news/podcast/what-the-health-335-alabama-ruling-embryos-children-february-22-2024/
Published Date: Thu, 22 Feb 2024 20:00:00 +0000

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