Kaiser Health News

He Thinks His Wife Died in an Understaffed Hospital. Now He’s Trying to Change the Industry.

Published

2 weeks ago

April 19, 2024

Kate Wells, Michigan Public
Fri, 19 Apr 2024 09:00:00 +0000

For the past year, police Detective Tim Lillard has spent most of his waking hours unofficially investigating his wife's death.

The question has never been exactly how Ann Picha-Lillard died on Nov. 19, 2022: She succumbed to respiratory failure after an infection put too much strain on her weakened lungs. She was 65.

For Tim Lillard, the question has been why.

Lillard had been in the hospital with his wife every day for a month. Nurses in the intensive care unit had told him they were short-staffed, and were constantly rushing from one patient to the next.

Lillard tried to pitch in where he could: brushing Ann's shoulder-length blonde hair or flagging down help when her tracheostomy tube gurgled — a sign of possible respiratory distress.

So the day he walked into the ICU and saw staff members huddled in Ann's room, he knew it was serious. He called the couple's adult children: “It's Mom,” he told them. “Come now.”

All he could do then was sit on Ann's bed and hold her hand, watching as staff members performed chest compressions, desperately trying to save her life.

A minute ticked by. Then another. Lillard's not sure how long the CPR continued — long enough for the couple's son to arrive and take a seat on the other side of Ann's bed, holding her other hand.

Finally, the intensive care doctor called it and the team stopped CPR. Time of death: 12:37 p.m.

Lillard didn't know what to do in a world without Ann. They had been married almost 25 years. “We were best friends,” he said.

Just days before her death, nurses had told Lillard that Ann could be discharged to a rehabilitation center as soon as the end of the week. Then, suddenly, she was gone. Lillard didn't understand what had happened.

Lillard said he now believes that overwhelmed, understaffed nurses hadn't been able to respond in time as Ann's condition deteriorated. And he has made it his mission to fight for change, joining some nursing unions in a push for mandatory ratios that would limit the number of patients in a nurse's care. “I without a doubt believe 100% Ann would still be here today if they had staffing levels, mandatory staffing levels, especially in ICU,” Lillard said.

Last year, Oregon became the second state after California to pass hospital-wide nurse ratios that limit the number of patients in a nurse's care. Michigan, Maine, and Pennsylvania are now weighing similar legislation.

But supporters of mandatory ratios are going up against a powerful hospital industry spending millions of dollars to kill those efforts. And hospitals and health systems say any staffing ratio regulations, however well-intentioned, would only put patients in greater danger.

Putting Patients at Risk

By next year, the United States could have as many as 450,000 fewer nurses than it needs, according to one estimate. The hospital industry blames covid-19 burnout, an aging workforce, a large patient population, and an insufficient pipeline of new nurses entering the field.

But nursing unions say that's not the full story. There are now 4.7 million registered nurses in the country, more than ever before, with an estimated 130,000 nurses having entered the field from 2020 to 2022.

The problem, the unions say, is a hospital industry that's been intentionally understaffing their units for years in order to cut costs and bolster profits. The unions say there isn't a shortage of nurses but a shortage of nurses willing to work in those conditions.

The nurse staffing crisis is now affecting patient care. The number of Michigan nurses who say they know of a patient who has died because of understaffing has nearly doubled in recent years, according to a Michigan Nurses Association survey last year.

Just months before Ann Picha-Lillard's death, nurses and doctors at the health system where she died had asked the Michigan attorney general to investigate staffing cuts they believed were leading to dangerous conditions, including patient deaths, according to The Detroit News.

But Lillard didn't know any of that when he drove his wife to the hospital in October 2022. She had been feeling short of breath for a few weeks after she and Lillard had mild covid infections. They were both vaccinated, but Ann was immunocompromised. She suffered from rheumatoid arthritis, a condition that had also caused scarring in her lungs.

To be safe, doctors at DMC Huron Valley-Sinai Hospital wanted to keep Ann for observation. After a few days in the facility, she developed pneumonia. Doctors told the couple that Ann needed to be intubated. Ann was terrified but Lillard begged her to listen to the doctors. Tearfully, she agreed.

With Ann on a ventilator in the ICU, it seemed clear to Lillard that nurses were understaffed and overwhelmed. One nurse told him they had been especially short-staffed lately, Lillard said.

“The alarms would go off for the medications, they'd come into the room, shut off the alarm when they get low, run to the medication room, come back, set them down, go to the next room, shut off alarms,” Lillard recalled. “And that was going on all the time.”

Lillard felt bad for the nurses, he said. “But obviously, also for my wife. That's why I tried doing as much as I could when I was there. I would comb her hair, clean her, just keep an eye on things. But I had no idea what was really going on.”

Finally, Ann's health seemed to be stabilizing. A nurse told Lillard they'd be able to discharge Ann, possibly by the end of that week.

By Nov. 17, Ann was no longer sedated and she cried when she saw Lillard and her daughter. Still unable to speak, she tried to mouth words to her husband “but we couldn't understand what she was saying,” Lillard said.

The next day, Lillard went home feeling hopeful, counting down the days until Ann could leave the hospital.

Less than 24 hours later, Ann died.

Lillard couldn't wrap his head around how things went downhill so fast. Ann's underlying lung condition, the infection, and her weakened state could have proved fatal in the best of circumstances. But Lillard wanted to understand how Ann had gone from nearly discharged to dying, seemingly overnight.

He turned his dining room table into a makeshift office and started with what he knew. The day Ann died, he remembered her medical team telling him that her heart rate had spiked and she had developed another infection the night before. Lillard said he interviewed two DMC Huron Valley-Sinai nurse administrators, and had his own doctor look through Ann's charts and test results from the hospital. “Everybody kept telling me: sepsis, sepsis, sepsis,” he said.

Sepsis is when an infection triggers an extreme reaction in the body that can cause rapid organ failure. It's one of the leading causes of death in U.S. hospitals. Some experts say up to 80% of sepsis deaths are preventable, while others say the percentage is far lower.

Lives can be saved when sepsis is caught and treated fast, which requires careful attention to small changes in vital signs. One study found that for every additional patient a nurse had to care for, the mortality rate from sepsis increased by 12%.

Lillard became convinced that had there been more nurses working in the ICU, someone could have caught what was happening to Ann.

“They just didn't have the time,” he said.

DMC Huron Valley-Sinai's director of communications and media relations, Brian Taylor, declined a request for comment about the 2022 staffing complaint to the Michigan attorney general.

Following the Money

When Lillard asked the hospital for copies of Ann's medical records, DMC Huron Valley-Sinai told him he'd have to request them from its parent company in Texas.

Like so many hospitals in recent years, the Lillards' local health system had been absorbed by a series of other corporations. In 2011, the Detroit Medical Center health system was bought for $1.5 billion by Vanguard Health Systems, which was backed by the private equity company Blackstone Group.

Two years after that, in 2013, Vanguard itself was acquired by Tenet Healthcare, a for-profit company based in Dallas that, according to its website, operates 480 ambulatory surgery centers and surgical hospitals, 52 hospitals, and approximately 160 additional outpatient centers.

As health care executives face increasing pressure from investors, nursing unions say hospitals have been intentionally understaffing nurses to reduce labor costs and increase revenue. Also, insurance reimbursements incentivize keeping nurse staffing levels low. “Hospitals are not directly reimbursed for nursing services in the same way that a physician bills for their services,” said Karen Lasater, an associate professor of nursing in the Center for Health Outcomes and Policy Research at the University of Pennsylvania. “And because hospitals don't perceive nursing as a service line, but rather a cost center, they think about nursing as: How can we reduce this to the lowest denominator possible?” she said.

Lasater is a proponent of mandatory nurse ratios. “The nursing shortage is not a pipeline problem, but a leaky bucket problem,” she said. “And the solutions to this crisis need to address the root cause of the issue, which is why nurses are saying they're leaving employment. And it's rooted in unsafe staffing. It's not safe for the patients, but it's also not safe for nurses.”

A Battle Between Hospitals and Unions

In November, almost one year after Ann's death, Lillard told a room of lawmakers at the Michigan State Capitol that he believes the Safe Patient Care Act could save lives. The health policy committee in the Michigan House was holding a hearing on the proposed act, which would limit the amount of mandatory overtime a nurse can be forced to work, and require hospitals to make their staffing levels available to the public.

Most significantly, the bills would require hospitals to have mandatory, minimum nurse-to-patient ratios. For example: one nurse for every patient in the ICU; one for every three patients in the emergency room; a nurse for triage; and one nurse for every four postpartum birthing patients and well-baby care.

Efforts to pass mandatory ratio laws failed in Washington and Minnesota last year after facing opposition from the hospital industry. In Minnesota, the Minnesota Nurses Association accused the Mayo Clinic of using “blackmail tactics”: Mayo had told lawmakers it would pull billions of dollars in investment from the state if mandatory ratio legislation passed. Soon afterward, lawmakers removed nurse ratios from the legislation.

While Lillard waited for his turn to speak to Michigan lawmakers about the Safe Patient Care Act in November, members of the Michigan Nurses Association, which says it represents some 13,000 nurses, told lawmakers that its units were dangerously understaffed. They said critical care nurses were sometimes caring for up to 11 patients at a time.

“Last year I coded someone in an ICU for 10 minutes, all alone, because there was no one to help me,” said the nurses association president and registered nurse Jamie Brown, reading from another nurse's letter.

“I have been left as the only specially trained nurse to take care of eight babies on the unit: eight fragile newborns,” said Carolyn Clemens, a registered nurse from the Grand Blanc area of Michigan.

Nikia Parker said she has left full-time emergency room nursing, a job she believes is her calling. After her friend died in the hospital where she worked, she was left wondering whether understaffing may have contributed to his death.

“If the Safe Patient Care Act passed, and we have ratios, I'm one of those nurses who would return to the bedside full time,” Parker told lawmakers. “And so many of my co-workers who have left would join me.”

But not all nurses agree that mandatory ratios are a good idea.

While the American Nurses Association supports enforceable ratios as an “essential approach,” that organization's Michigan chapter does not, saying there may not be enough nurses in the state to satisfy the requirements of the Safe Patient Care Act.

For some lawmakers, the risk of collateral damage seems too high. State Rep. Graham Filler said he worries that mandating ratios could backfire.

“We're going to severely hamper health care in the state of Michigan. I'm talking closed wards because you can't meet the ratio in a bill. The inability for a hospital to treat an emergent patient. So it feels kind of to me like a gamble we're taking,” said Filler, a Republican.

Michigan hospitals are already struggling to fill some 8,400 open positions, according to the Michigan Health & Hospital Association. That association says that complying with the Safe Patient Care Act would require hiring 13,000 nurses.

Every major health system in the state signed a letter opposing mandatory ratios, saying it would force them to close as many as 5,100 beds.

Lillard watched the debate play out in the hearing. “That's a scare tactic, in my opinion, where the hospitals say we're going to have to start closing stuff down,” he said.

He doesn't think legislation on mandatory ratios — which are still awaiting a vote in the Michigan House's health policy committee — are a “magic bullet” for such a complex, national problem. But he believes they could help.

“The only way these hospitals and the administrations are gonna make any changes, and even start moving towards making it better, is if they're forced to,” Lillard said.

Seated in the center of the hearing room in Lansing, next to a framed photo of Ann, Lillard's hands shook as he recounted those final minutes in the ICU.

“Please take action so that no other person or other family endures this loss,” he said. “You can make a difference in saving lives.”

Grief is one thing, Lillard said, but it's another thing to be haunted by doubts, to worry that your loved one's care was compromised before they ever walked through the hospital doors. What he wants most, he said, is to prevent any other family from having to wonder, “What if?”

This article is from a partnership that includes Michigan Public, NPR, and KFF Health News.

——————————
By: Kate Wells, Michigan Public
Title: He Thinks His Wife Died in an Understaffed Hospital. Now He's Trying to Change the Industry.
Sourced From: kffhealthnews.org/news/article/nurse-ratios-understaffed-hospitals-michigan-legislation-detective-wife/
Published Date: Fri, 19 Apr 2024 09:00:00 +0000

Post Views: 58

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Robert F. Kennedy Jr. Is Wrong About a Ban on NIH Research About Mass Shootings

Published

2 hours ago

May 2, 2024

Staff Editor

Louis Jacobson, PolitiFact
Thu, 02 May 2024 09:00:00 +0000

“Congress prohibits the NIH from researching the cause of mass shootings.”

Robert F. Kennedy Jr. in an April 21 post on X

The National Institutes of Health is the federal government's main agency for supporting medical research. Is it barred from researching mass shootings? That's what presidential candidate Robert F. Kennedy Jr. said recently.

Kennedy, whose statements about conspiracy theories earned him PolitiFact's 2023 “Lie of the Year,” is running as an independent third-party candidate against President Joe Biden, the presumptive Democratic candidate, and the presumptive Republican nominee, former President Donald Trump.

On April 21 on X, Kennedy flagged his recent interview with conservative commentator Glenn Beck, which touched on gun policy. Kennedy summarized his gun policy views in the post, writing, “The National Institutes of Health refuses to investigate the mystery; in fact, Congress prohibits the NIH from researching the cause of mass shootings. Under my administration, that rule ends — and our kids' safety becomes a top priority.”

But this information is outdated.

In 1996, Congress passed the “Dickey Amendment,” an appropriations bill provision that federal officials widely interpreted as barring federally funded research related to gun violence (though some observers say this was a misinterpretation). Congress in 2018 clarified that the provision didn't bar federally funded gun-related research, and funding for such efforts has been flowing since 2020.

Kennedy's campaign did not provide evidence to support his statement.

What Was the Dickey Amendment?

After criticizing some federally funded research papers on firearms in the mid-1990s, pro-gun advocates, including the National Rifle Association, lobbied to halt federal government funding for gun violence research.

In 1996, Congress approved appropriations bill language saying that “none of the funds made available for injury prevention and control at the Centers for Disease Control and Prevention may be used to advocate or promote gun control.” The language was named for one of its backers, Rep. Jay Dickey (R-Ark).

But the Dickey Amendment, as written, did not ban all gun-related research outright.

“Any honest research that was not rigged to produce results that helped promote gun control could be funded by CDC,” said Gary Kleck, a Florida State University criminologist. But CDC officials, experts said, interpreted the Dickey Amendment as banning all gun-related research funding.

This perception meant the amendment “had a chilling effect on funding for gun research,” said Allen Rostron, a University of Missouri-Kansas City law professor who has written about the amendment. Federal agencies “did not want to take a chance on funding research that might be seen as violating the restriction” and so “essentially were not funding research on gun violence.”

Also, the Dickey Amendment targeted only the CDC, not all other federal agencies. Congress expanded the restriction to cover NIH-funded research in 2011.

Although the Dickey Amendment didn't bar gun-related research, federal decision-makers acted as though it did by not pursuing such research.

Moving Past the Dickey Amendment

Over time, critics of the gun industry made an issue of the Dickey Amendment and gathered congressional support to clarify the amendment.

In 2018, lawmakers approved language that said the amendment wasn't a blanket ban on federally funded gun violence research. By 2020, federal research grants on firearms began to be issued again, starting with $25 million to be split between the CDC and NIH.

By now, the CDC and NIH are funding a “large portfolio” of firearm violence-related research, said Daniel Webster, a professor at the Johns Hopkins Bloomberg School of Public Health.

Also, the Justice Department's National Institute of Justice has funded the largest study of mass shootings to date, Webster said, and is seeking applications for studies of mass shootings.

Our Ruling

Kennedy said, “Congress prohibits the NIH from researching the cause of mass shootings.”

Although the Dickey Amendment, a provision of appropriations law supported by the gun industry, didn't prohibit all federally supported, gun-related research from 1996 to 2018, decision-makers acted as though it did.

However, in 2018, Congress clarified the provision's language. And since 2020, CDC, NIH, and other federal agencies have funded millions of dollars in gun-related research, including studies on mass shootings.

We rate Kennedy's statement False.

Our Sources

Robert F. Kennedy Jr. post on X, April 21, 2024

National Institutes of Health, “NIH Awards Additional Research and Training Grants to Support Firearm Injury and Mortality Prevention Science,” Sept. 20, 2023

National Institute of Justice, “Public Mass Shootings: Database Amasses Details of a Half Century of U.S. Mass Shootings with Firearms, Generating Psychosocial Histories,” Feb. 3, 2022

National Institute of Justice, “NIJ FY24 Research and Evaluation on Firearm Violence and Mass Shootings,” Feb. 5, 2024

Centers for Disease Control and Prevention, “Funded Research,” accessed April 22, 2024

American Psychological Association, “A Thaw in the Freeze on Federal Funding for Gun Violence and Injury Prevention Research,” April 1, 2021

Allen Rostron, “The Dickey Amendment on Federal Funding for Research on Gun Violence: A Legal Dissection” (American Journal of Public Health), July 2018

Email interview with Gary Kleck, a Florida State University criminologist, April 22, 2024

Email interview with Daniel W. Webster, professor at the Johns Hopkins Bloomberg School of Public Health, April 22, 2024

Email interview with Jaclyn Schildkraut, executive director of the Regional Gun Violence Research Consortium at the Rockefeller Institute of Government, April 22, 2024

Email interview with Mike Lawlor, University of New Haven criminologist, April 22, 2024

Email interview with Allen Rostron, University of Missouri-Kansas City law professor, April 22, 2024

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.

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This story can be republished for free (details).

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By: Louis Jacobson, PolitiFact
Title: Robert F. Kennedy Jr. Is Wrong About a Ban on NIH Research About Mass Shootings
Sourced From: kffhealthnews.org/news/article/fact-check-rfk-jr-wrong-nih-research-mass-shootings-gun-control-dickey-amendment/
Published Date: Thu, 02 May 2024 09:00:00 +0000

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Kaiser Health News

‘Breaking a Promise’: California Deficit Could Halt Raises for Disability Workers

Published

4 hours ago

May 2, 2024

Staff Editor

Vanessa G. Sánchez
Thu, 02 May 2024 09:00:00 +0000

SACRAMENTO, Calif. — Families of people with intellectual and developmental disabilities say Gov. Gavin Newsom is reneging on a scheduled raise for the workers who care for their loved ones, and advocates warn of potential lawsuits if disability services become harder to get.

Citing California's budget deficit, the Democratic governor wants to save around $613 million in state funds by delaying pay increases for a year for about 150,000 disability care workers. The state will forgo an additional $408 million in Medicaid reimbursements, reducing funding by over $1 billion.

Some lawmakers say this decision will increase staff turnover and vacancies, leaving thousands of children and adults with disabilities without critical services at home and in residential facilities. Disability advocates warn it could violate the Lanterman Act, California's landmark law that says the state must provide services and resources to people with disabilities and their families.

Newsom is “breaking a promise,” said Felisa Strickland, 60, who has been searching for more than a year for a day program for her 23-year-old daughter, Lily, who has autism and cerebral palsy. “It's creating a lot of physical and mental health problems for people, and it's a lot of undue stress on aging parent caregivers like myself.”

Disability care workers, known as direct support professionals, provide daily, hands-on caregiving to help children and adults with intellectual and developmental disabilities, such as autism, cerebral palsy, and epilepsy, remain independent and integrated into their communities.

In California, more than 400,000 people with disabilities need accommodation, and this population, along with seniors, is increasing. It's not clear how big the worker shortage is because the state hasn't released workforce data. As the demand for these workers grows generally, experts predict a shortage of between 600,000 and 3.2 million direct care workers by 2030.

Advocates say California pays most providers from $16 to $20 an hour, which meets the state's minimum wage but falls short of what some economists consider a living wage. In 2021, the state committed to raising wages after identifying a $1.8 billion gap between the rates received by nonprofits that contract with the state to provide care and the rates deemed adequate.

Thus far, the state has provided around half that total, most of which has gone to raising wages and benefits. Workers had been expecting one more increase, of $2-$4 an hour, in July, until Newsom proposed a delay.

Also, nonprofits say California has made it harder to compete for workers after raising wages in other service and health industries. Newsom approved a $20 minimum wage for fast-food workers that went into effect in April and he struck a deal last year with unions and hospitals to begin raising health care workers' wages to a minimum of $25 an hour.

Ricardo Zegri said Taco Bell would pay him more than the $19 an hour he makes as a disability care worker in a supervisory position.

“Every paycheck, it's a discussion at home about what bills we need to prioritize and whether it's time to start looking for work that pays more,” said Zegri, who works a second job as a musician in the San Francisco Bay Area.

Newsom wants to preserve key health initiatives, including the state expansion of Medi-Cal to low-income immigrants regardless of legal status, and CalAIM, an ambitious $12 billion experiment to transform Medi-Cal into both a health insurer and a social services provider. However, the rate delay for providing disability care is the largest savings in the Health and Human Services budget as Newsom and legislative leaders look to cuts, delays, and shifts in funding to close a deficit estimated between $38 billion and $73 billion.

Dozens of legislators from both parties are asking Newsom and legislative leaders to preserve the increase. Assembly member Stephanie Nguyen, a Democrat from Elk Grove, signed a letter supporting the raise. Although lawmakers are negotiating with the administration, she said reversing the decision to delay the pay boost is unlikely. Everybody “has to take a hit somewhere,” Nguyen said.

Krystyne McComb, a spokesperson for the Department of Developmental Services, said even though the state would lose federal matching funds this year, it would resume drawing funds when the state reinstates the plan in 2025.

The department did not respond to questions about how it plans to retain workers and fill vacancies.

Newsom's proposal risks a collapse of the disability service system, which would violate the Lanterman Act and make the state vulnerable to lawsuits, said Jordan Lindsey, executive director of the Arc of California, a statewide disability rights advocacy organization.

Families say the state has already fallen short on services they need. Strickland quit her job to care for Lily, the Santa Barbara mother said. “It's not reasonable to expect someone to care for somebody else 24 hours a day, seven days a week,” she said.

Lily graduated from high school and in 2022 completed a program that prepares youth with disabilities to transition into adult life. She had been looking forward to joining a day program to make new friends but has yet to find a spot. And due to a shortage of workers, Lily receives only four hours a week at home with a provider, who is paid around $16 an hour.

When Lily hangs out with the provider, her demeanor changes to the happy person she used to be, Strickland said.

“The system is already in crisis,” she said. “There are tons and tons of people that are sitting at home because there's nowhere for them to go.”

——————————
By: Vanessa G. Sánchez
Title: ‘Breaking a Promise': California Deficit Could Halt Raises for Disability Workers
Sourced From: kffhealthnews.org/news/article/california-disability-worker-pay-delay-deficit/
Published Date: Thu, 02 May 2024 09:00:00 +0000

Post Views: 26

Kaiser Health News

AC, Power Banks, Mini Fridges: Oregon Equips Medicaid Patients for Climate Change

Published

1 day ago

May 1, 2024

Staff Editor

Samantha Young
Wed, 01 May 2024 06:00:00 +0000

Oregon is shipping air conditioners, air purifiers, and power banks to some of its most vulnerable residents, a first-in-the-nation experiment to use Medicaid money to prevent the potentially deadly health effects of extreme heat, wildfire smoke, and other climate-related disasters.

The equipment, which started going out in March, expands a Biden administration strategy to move Medicaid beyond traditional medical care and into the realm of social services.

At least 20 states, including California, Massachusetts, and Washington, already direct billions of Medicaid dollars into programs such as helping homeless people get housing and preparing healthy meals for people with diabetes, according to KFF. Oregon is the first to use Medicaid money explicitly for climate-related costs, part of its five-year, $1.1 billion effort to address social needs, which also includes housing and nutrition benefits.

State and federal health officials hope to show that taxpayer money and lives can be saved when investments are made before disaster strikes.

“Climate change is a health care issue,” so helping Oregon's poorest and sickest residents prepare for potentially dangerous heat, drought, and other extreme weather makes sense, said Health and Human Services Secretary Xavier Becerra on a visit to Sacramento, California, in early April.

Becerra said the Biden administration wants states to experiment with how best to improve patient health, whether by keeping someone housed instead of homeless, or reducing their exposure to heat with an air conditioner.

But Medicaid's expansion into social services may duplicate existing housing and nutrition programs offered by other federal agencies, while some needy Americans can't get essential medical care, said Gary Alexander, director of the Medicaid and Health Safety Net Reform Initiative at the Paragon Health Institute.

“There are 600,000 or 700,000 intellectually disabled people in the United States waiting for Medicaid services. They're on a waitlist,” said Alexander, who oversaw state health agencies in Pennsylvania and Rhode Island. “Meanwhile Medicaid has money for housing and food and air conditioners for recipients. Seems to me that we should serve the intellectually disabled first before we get into all of these new areas.”

Scientists and public health officials say climate change poses a growing health risk. More frequent and intense floods, droughts, wildfires, extreme temperatures, and storms cause more deaths, cardiovascular disease from poor air quality, and other problems, according to the federal government's Fifth National Climate Assessment.

The mounting health effects disproportionately hit low-income Americans and people of color, who are often covered by Medicaid, the state-federal health insurance program for low-income people.

Most of the 102 Oregonians who died during the deadly heat dome that settled over the Pacific Northwest in 2021 “were elderly, isolated and living with low incomes,” according to a report by the Oregon Health Authority, which administers the state's Medicaid program, with about 1.4 million enrollees. The OHA's analysis of urgent care and emergency room use from May through September of 2021 and 2022 found that 60% of heat-related illness visits were from residents of areas with a median household income below $50,000.

“In the last 10-plus years, the amount of fires and smoke events and excessive heat events that we've had has shown the disproportionate impact of those events on those with lower incomes,” said Dave Baden, the OHA's deputy director for programs and policy.

And, because dangerously high temperatures aren't common in Oregon, many residents don't have air conditioning in their homes.

Traditionally, states hit by natural disasters and public health emergencies have asked the federal government for permission to spend Medicaid dollars on back-up power, air filters, and other equipment to help victims recover. But those requests came after the fact, following federal emergency declarations.

Oregon wants to be proactive and pay for equipment that will help an estimated 200,000 residents manage their health at home before extreme weather or climate-related disaster hits, Baden said. In addition to air conditioning units, the program will pay for mini fridges to keep medications cold, portable power supplies to run ventilators and other medical devices during outages, space heaters for winter, and air filters to improve air quality during wildfire season.

In March, the Oregon Health Plan, the state's Medicaid program, began asking health insurers to find patients who might need help coping with extreme weather. Recipients must meet federal guidelines that categorize them as “facing certain life transitions,” a stringent set of requirements that disqualify most enrollees. For example, a person with an underlying medical condition that could worsen during a heat wave, and who is also at risk for homelessness or has been released from prison in the past year, could receive an air conditioner. But someone with stable housing might not qualify.

“You could be in a housing complex, and your neighbor qualified for an air conditioner and you didn't,” Baden said.

At the offices of insurer AllCare Health in Grants Pass, Oregon, air conditioners, air filters, and mini fridges were piled in three rooms in mid-April, ready to be handed over to Medicaid patients. The health plan provided equipment to 19 households in March. The idea is to get the supplies into people's homes before the summer fire season engulfs the valley in smoke.

Health plans don't want to find themselves “fighting the masses” at Home Depot when the skies are already smoky or the heat is unbearable, said Josh Balloch, AllCare's vice president of health policy.

“We're competing against everybody else, and you can't find a fan on a hot day,” he said.

Oregon and some other states have already used Medicaid money to buy air conditioners, air purifiers, and other goods for enrollees, but not under the category of climate change. For example, California offers air purifiers to help asthma patients and New York just won federal approval to provide air conditioners to asthma patients.

Baden said Oregon health officials will evaluate whether sending air conditioners and other equipment to patients saves money by looking at their claim records in the coming years.

If Oregon can help enrollees avoid a costly trip to the doctor or the ER after extreme weather, other state Medicaid programs may ask the federal government if they can adopt the benefit. Many states haven't yet used Medicaid money for climate change because it affects people and regions differently, said Paul Shattuck, a senior fellow at Mathematica, a research organization that has surveyed state Medicaid directors on the issue.

“The health risks of climate change are everywhere, but the nature of risk exposure is completely different in every state,” Shattuck said. “It's been challenging for Medicaid to get momentum because each state is left to their own devices to figure out what to do.”

A California state lawmaker last year introduced legislation that would have required Medi-Cal, the state's Medicaid program, to add a climate benefit under its existing social services expansion. The program would have been similar to Oregon's, but AB 586, by Assembly member Lisa Calderon, died in the Assembly Appropriations Committee, which questioned in a staff analysis whether “climate change remediation supports can be defined as cost-effective.”

The cost savings are clear to Kaiser Permanente. After the 2021 heat wave, it sent air conditioners to 81 patients in Oregon and southwest Washington whose health conditions might get worse in extreme heat, said Catherine Potter, community health consultant at the health system. The following year, Kaiser Permanente estimated it had prevented $42,000 in heat-related ER visits and $400,000 in hospital admissions, she said.

“We didn't used to have extreme heat like this, and we do now,” said Potter, who has lived in the temperate Portland area for 30 years. “If we can prevent these adverse impacts, we should be preventing them especially for people that are going to be most affected.”

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

——————————
By: Samantha Young
Title: AC, Power Banks, Mini Fridges: Oregon Equips Medicaid Patients for Climate Change
Sourced From: kffhealthnews.org/news/article/oregon-medicaid-patients-climate-benefits/
Published Date: Wed, 01 May 2024 06:00:00 +0000

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