 |
MGH Community News |
|
MGH Community News |
| April 2014 | Volume 18 • Issue 4 |
Highlights
Sections
Social Service staff may direct resource questions to the Community Resource Center, Lindsey Streahle, x6-8182. Questions, comments about the newsletter? Contact Ellen Forman, x6-5807. |
Fuel Assistance (LIHEAP) Application Deadline Extended The Massachusetts Department of Housing and Community Development (DHCD) announced recently that to coincide with the Department of Public Utilities’ (DPU) extension of winter shut-off protection until April 1st, DHCD has extended the LIHEAP (fuel assistance) application deadline from April 30, 2014 to Thursday, May 15, 2014. The service dates for LIHEAP assistance remain unchanged (November 1st through April 30th). The following corresponding dates also have been extended:
-Forwarded by Charles Harak, National Consumer Law Center to the Utility Network lisserv, April 02, 2014. |
Case Corner: SSI Reminder- Helping Patients Keep Full SSI Benefits When Temporarily Institutionalized The patient was at risk of losing her leg due to infection if she didn’t go to rehab to receive IV antibiotics and monitoring, but she was refusing to go. One key concern- the last time she had been to rehab she had gotten a letter saying her SSI benefits would be reduced to $30 because she was institutionalized. Now she was afraid she’d lose her apartment if her SSI was reduced. Social worker Berney Graham contacted resource specialist Lindsey Streahle to ask how long can patients be in a hospital before their SSI benefits are reduced? Lindsey informed her that typically SSI benefits are reduced to $30 a month when one is in a nursing home, hospital, or other medical facility where Medicaid pays for more than half of the cost of care. However, full benefits may be maintained for up to 90 days if the placement will be for 90 days or less and if maintaining full benefits is necessary to maintain the home or living arrangement while in the facility. |
To retain full benefits, one must notify the Social Security Administration (SSA) that this will be a temporary stay and submit relevant documentation before discharge or by the 90th day, whichever is earlier. Required documentation includes a doctor’s note that the expected stay is 90 days or less and a statement from the patient (or someone knowledgeable about the circumstances) to the effect that full SSI benefits are needed to maintain the living situation. See the SSI Spotlight on Continued SSI Benefits for Persons Who Are Temporarily Institutionalized.This information is also on the staff access area of the Social Service Department’s website. See SSI/For those already on SSI. This key piece of information made all the difference to this patient. It allayed her fears and with Berney’s help to notify SSA, allowed her to accept the medical team’s recommendation to transfer to rehab, potentially saving her leg. -Thanks to Berney Graham for permission to share this case. Medicare Benefits Now Available for Same-Sex Married Couples
The U.S. Department of Health and Human Services (HHS) announced this month that Medicare for the first time will be available for people in same-sex marriages. The move comes in response to the June 26 ruling by the Supreme Court in the case of U.S. vs. Windsor that struck down a section of the Defense of Marriage Act that banned marriage between people of the same gender. With the court’s ruling, the government is no longer prevented from recognizing same sex-marriages when determining eligibility for Medicare. The Social Security Administration works with the Centers for Medicare & Medicaid Services (CMS) to enroll people in Medicare, and will now begin processing Medicare enrollment, requests for Special Enrollment Periods, and requests for reductions in late-enrollment penalties for many same-sex spouses. Eligibility for Medicare Part A and Part B coverage is particularly important for these families, who are disproportionately likely to be uninsured. Medicare Part A coverage is often available without paying a monthly premium, making it important for the many lesbian, gay, and bisexual people who struggle to afford coverage. This change also impacts some people who previously applied for a Special Enrollment Period but were denied eligibility because of DOMA. For some of these couples, Social Security will be able to approve a second request for a Special Enrollment Period, giving more immediate access to Medicare coverage. For couples in domestic partnerships or civil unions this announcement offers some, but not all of the same opportunities for enrolling in Medicare coverage. Domestic partnerships and civil unions are not recognized for the purposes of Special Enrollment Periods for applicants 65 or older, but for those applicants with disabilities who are under 65, Special Enrollment Periods are available as long as the applicant has coverage through their partner’s current employer. HHS and CMS have been acting to implement the Windsor decision since last year, expanding coverage for many same-sex couples. HHS announced last month that plans sold through Marketplaces established by the Affordable Care Act must offer coverage to all same-sex spouses starting in 2015. In September of last year, CMS sent a letter to state Medicaid directors granting discretion to recognize same-sex marriages according to the laws of their state. More information is available on the Medicare homepage. Adapted from:
SSA Removes Barriers to Transgender Spousal Benefits The Social Security Administration (SSA) recently updated its policies and procedures regarding the ability of transgender individuals to receive benefits through their spouses. This announcement comes after months of advocacy by Lambda Legal on behalf of Robina Asti, a 92-year-old transgender woman who was denied survivor benefits by the SSA after her husband's death. "This is a critical development for all married transgender people, but is especially important for transgender older adults, who rely on the safety net of Social Security benefits," said Karen Loewy, Lambda Legal Senior Attorney and Seniors Program Strategist. "The old policy subjected every claim for spousal benefits by a transgender claimant to lengthy and excessive scrutiny, presuming that a spouse's gender transition was a barrier to receiving benefits. This new policy does a 180 degree turn - it presumes the validity of most marriages regardless of whether a spouse is transgender and ends the discriminatory special treatment experienced only by transgender spouses." In the announcement, the SSA clarified that although its "past policy was to refer all marriage-based claims involving transgender individuals for a legal opinion from the Regional Chief Counsel[,] [o]ur new policy allows us to process most claims...without the need for a legal opinion." "The extension of Social Security spousal retirement and survivor benefits to older transgender adults can be lifesaving. This new policy allows for transgender seniors to receive their benefits as quickly as possible, and to age with greater certainty and security, rather than with fear," added Loewy. Lambda Legal's client, Robina Asti, was denied the survivor benefits she should have received after her husband's death for two long years. She finally received her benefits on Valentine's Day after Lambda Legal filed an appeal and advocated on her behalf. "Transgender marriages are no longer treated as suspect in the eyes of the SSA. The content and tone of the new guidance shows that the SSA has taken a big step forward in cultural competency about the transgender community. This important federal agency is providing greater dignity and demonstrating greater respect for transgender people," said Dru Levasseur, Transgender Rights Project Director. "Today's announcement removes many hurdles that transgender people had to overcome when they filed claims for spousal benefits. We hope no one has to ever again endure the disrespect that Ms. Asti experienced." Adapted from, and for more information: http://www.lambdalegal.org/news/us_20140402_ssa-updates-procedures-for-transgender-spouses Boston’s Only Public Methadone Clinic Slated to Close More than 400 opiate addicts in Boston who receive daily doses of methadone from a public clinic on Frontage Road will be steered to a for-profit facility by summer, health officials said. The addiction services will now be handled by Community Substance Abuse Centers (CSAC) as the state confronts a startling rise in heroin overdoses and deaths. The move is designed, in part, to shift $300,000 in city spending on the clinic to the proposed Office of Recovery Services, which Mayor Martin J. Walsh envisions as an umbrella agency to address a wide range of substance abuse and prevention needs. In a statement, Walsh said that advances in addiction treatment, as well as the emergence of more providers, have given city officials a chance to reconsider funding priorities and strengthen services that no other provider can offer. “By opening an Office of Recovery Services,” Walsh said, “we’ll be able to strengthen coordination and collaboration among our partners to improve access to care, identify barriers to treatment, and increase outreach efforts to the people that need it most.” Rita Nieves, director of addiction services for the Boston Public Health Commission, said most Frontage Road clients are expected to transfer by July 1 to the new facility, near the Suffolk County House of Correction at South Bay. “This is a complex transaction, and we will work this plan until the last client has been transferred,” Nieves said. “We’re not married to a particular date. . . . The more important thing here is that the transfer happens with no interruption” in service. The plan needs approval by the state Department of Public Health, which has been closely involved in the ongoing discussions, Nieves said. The switch has generated concerns that a private company might sacrifice quality for profit and that clients without insurance coverage might be denied continued service. The state currently provides an annual grant to cover much of the methadone program’s $2.4 million budget to ensure that the uninsured and underinsured are treated. The city’s share of $300,000 is used mostly to pay for overhead, health officials said. Nieves said discussions with CSAC have resulted in a guarantee that all clients can transfer seamlessly to the new facility on Bradston Street. The state health department would reimburse CSAC for shortfalls in insurance coverage, just as it did with the Public Health Commission, Nieves said. The company will offer on-site counseling and other recovery services for methadone clients, in addition to daily doses of the drug. Those clients currently shuttle between the city clinic at Frontage Road, off the Southeast Expressway near Massachusetts Avenue, and health commission offices on nearby Albany Street for counseling and other services. “The big story here is that our clients will go there under one roof in a one-stop-shop model,” Nieves said. “They’ll be able to receive primary care in one site, to get comprehensive services in one site.” CSAC also will continue the city’s partnership with Boston Medical Center to serve pregnant and postpartum women, and to treat pregnant inmates at the Suffolk County House of Correction. See the full Boston Globe articles:
Senate Panel Hears About Addiction Treatment Gaps A severe shortage of medium- and long-term addiction treatment options is a top obstacle for drug addicts seeking medical help and can wind up preventing or thwarting treatment, local health professionals and addiction treatment advocates told a state Senate panel recently. Local professionals in law enforcement, education, health care and addiction treatment, along with parents of addicts and recovering addicts, spoke to a panel of state senators touring the state to gather ideas for tackling a substance abuse problem about which Gov. Deval Patrick this month declared a public health emergency. They described institutions overwhelmed by the rise in opiate addiction in Massachusetts and financially unprepared and ill equipped to deal with a range of related issues. As law enforcement described a spike in sales and public usage and school officials described children of addicts in need of counseling, parents, recovering addicts and health care professionals said the state’s deficiency of beds for 28-day programs and longer-term addiction treatment means many seeking help are turned away. Phil Lahey, a Methuen father of a recovering addict, said there are few options to get medium-term treatment, a stabilizing time between the initial detoxification and a long-term residential program. “After the five-day spin dry, we’re stuck again,” he said. “That’s the missing piece,” said Nick Costello, executive director of John Ashford Link House, which has residential addiction treatment programs in Salisbury, Newburyport, Amesbury and Gloucester. “If you take someone out of detox and put them in a halfway house, it’s not going to work,” he said. “They’re not stable. And the problem with a waiting list is if you don’t get them in right away, they’re gone.” State Sen. Jennifer Flanagan, D-Leominster, said the committee’s previous two meetings led the senators to shift focus from a state law allowing family members to involuntarily commit relatives addicted to drugs to finding solutions to the gap in treatment. Essex County Sheriff Frank Cousins told the panel that drug and alcohol abuse is a common thread among the vast majority of prisoners in the Sheriff’s Office’s custody. “Ninety percent have drug and alcohol problems, and 70 percent are there for drug- and alcohol-related crimes,” he said. Cousins said he spends a little more than 10 percent of his $54 million annual budget on substance abuse and health care needs for about 1,600 people, one of the largest populations in the state. “You’re one of the top providers of addiction services in Massachusetts because people are arrested and sent to you,” Flanagan said. State Rep. Linda Dean Campbell, D-Methuen, filed legislation to divert people in custody accused of crimes out of jail and into other detention facilities pending their court dates. -See the full Eagle Tribune article... Cited in/linked from: Massterlist, Mike Deehan, April 03, 2014. Paying Taxes If You Don’t Have a SSN- Apply for an Individual Taxpayer Identification Number (ITIN) While the 2013 tax season is over, it is still important to know that those without social security numbers may be required to pay income taxes. And it is more important than ever that they know how to do so. Those required to file income taxes can apply for an Individual Taxpayer Identification Number (ITIN). An ITIN is a tax processing number issued by the IRS regardless of immigration status. ITIN applicants and holders are protected by privacy requirements that limit the information the IRS can share with other agencies. Taxpayer privacy is an important cornerstone of the U.S. tax system; section 6103 of the Internal Revenue Code states that the IRS is not authorized to release taxpayer information to other government agencies except for providing information to the Treasury Department for investigations that pertain to tax administration, or under a court order related to a non-tax criminal investigation (more information). To apply for an ITIN, submit Form W-7 with a completed tax return. Forms are available in English or Spanish. ITINs and the ACA Those who will receive a Premium Tax Credit under the Affordable Care Act are required to file taxes for the year in which they receive the tax credits (e.g., by April 15, 2015 for credits received in 2014). Some immigration statuses (including DACA, certain applicants for statuses, and undocumented) are not eligible for the Tax Credit. However, in mixed status families, an ineligible person may apply for the Tax Credit on behalf of his or her eligible family members. ITINs can also help in other ways. For example, they can make it possible to open a bank account. -Adapted from e-mail from the MIRA Coalition, on behalf of Shannon Erwin, March 31, 2014. Advocacy Tips: Divorce Assistance for Those with Low-Incomes Due to budget constraints, legal service agencies generally have to prioritize the types of cases they can accept. Typically they are able to assist in divorce cases only if there is some additional complicating factor such as child custody, domestic violence, guardianship, etc. Massachusetts allows some divorce-related fees and costs to be waived for certain low-income residents. Those on welfare or with incomes 125% or less of the Federal Poverty Guidelines, or those who can show that paying the filing fee would keep them from being able to buy necessary food, shelter or clothing, may file for a divorce without paying the filing fee or other basic costs. One can request these waivers by filing an Affidavit of Indigency, and, in some cases, an additional supplement. (For more information and links to the forms see MassLegalHelp #7 "Does it cost money to file for divorce or separate support?") As a reminder, legal service agencies provide free legal assistance for low-income people and elderly residents for non-criminal matters. To qualify, one must have income below 125% of the Federal Poverty Guidelines or must be age 60 or over. Find a local legal service agency (Massachusetts). Find a legal service agency in another state. Other Types of Legal Representation Those who are over-income or who chose to pay for a divorce lawyer for a simple divorce may find representation through a lawyer referral service. Individuals faced with criminal charges who cannot afford an attorney may be eligible for free representation from public defenders. How You Can Use Your Social Security Benefits as an Interest-Free Loan One little-known Social Security retirement benefits rule is the so-called “do-over rule.” Under this rule, an individual 62 years or older can start collecting benefits but stop the benefits within 12 months of the start, repay the benefits collected, and then still be eligible for their higher benefit amount when they collect at full retirement age or older. This is a one-time option. What’s the advantage if the benefits must all be immediately repaid? The strategy can work as a short-term interest fee loan. It makes sense, for example, in cases where an individual has a need for income in the immediate short term, due to an emergency such as a sudden loss of employment, but they anticipate income (i.e. finding a new job or collecting a pension), within the year which would allow for full repayment. For many individuals in the their early 60s, a majority of their assets are tied up in retirement and investment accounts and withdrawals from these accounts would trigger hefty penalties. After “emergency” liquid funds run out, the do-over rule offers a short-term solution. What if you are unable to pay back the benefits after the 12 months are up? You may still be able to suspend your benefits and increase your ultimate pay-out amount. For example, if you start collecting at 62 but no longer need the income at 66, you could suspend benefits until 70. Then, between the ages of 66 and 70, you would earn delayed retirement credits which would increase the ultimate benefit amount when you collect at age 70.
For more information on how to collect, suspend and pay-back benefits, contact or visit your local Social Security district office.
-See the full Elder Law Answers article... Cited in/Linked from Margolis & Bloom e-newsletter, April 29, 2014.
Motion Sensors May Help Seniors Live Independently To eliminate the need for seniors to wear cumbersome emergency call pendants around their necks or wrists, some companies have created motion sensors that can be placed around seniors’ homes. These sensors alert caregivers via smart phone or computer if something out of the ordinary happens. For example, the sensors can signify a possible fall in the shower by detecting inactivity in the bathroom for an extended time. They can even monitor use of food or medicine cabinets, what time the elder gets out of bed, and comings and goings from the front door. Some companies provide emergency call buttons as well. These remote sensors can allow seniors to live independently at home without the inconvenience or stigma of wearing a medical alarm. An online search can help you locate companies that offer such services. Below is a small sampling:
Medicare Reminder: Medicare PT, OT, Speech Caps A therapy cap is a limit placed on the amount of outpatient physical therapy, speech-language pathology, and occupational therapy that Medicare will cover in a given year. After reaching the cap, Medicare may not pay for additional therapy, unless a therapist or doctor tells Medicare that additional therapy is medically necessary. The cap applies to those in Original Medicare receiving therapy in an outpatient setting. Medicare Advantage plans, also known as Medicare private health plans, may apply caps, but are not required to do so. Those with a Medicare Advantage plan, can contact their plan directly to learn how it covers these types of therapy. Therapy caps change each year. In 2014, one can get $1,920 worth of combined physical therapy and speech-language pathology services and a separate cap of $1,920 worth of occupational therapy from outpatient health care providers. Note that physical therapy and speech-language pathology services are combined to meet the therapy cap, while occupational therapy services are counted separately to meet the cap. Those denied coverage under the cap have the right to file an appeal. -Adapted from What is a therapy cap?, Dear Marci column, Medicare Rights Center, April 07, 2014. Special ACA Enrollment Period for DV Victims Applying for Premium Tax Credits In general, people who are married can only qualify for a premium tax credit if they file a joint tax return with their spouse. However, these rules have recently changed for anyone who is the victim of domestic violence. Filing a tax return separately from a spouse will no longer prevent domestic violence victims from being able get help paying for coverage through premium tax credits. Because this rule was recently announced, the Health Connector will have a special enrollment period from April 1, 2014, to May 31, 2014, for anyone that this situation applies to. The special enrollment period allows victims of domestic violence to apply for and enroll in health insurance outside of the recently closed open enrollment period. For victim of domestic violence who did NOT apply for coverage through the Health Connector during open enrollment: Go to MAhealthconnector.org and fill out a new application
For victims of domestic violence who:
Please call Health Connector Customer Service at 1-877 MA ENROLL (1-877-623-6765), TTY: 1-877-623-7773. Applicants will be able to change their tax filing status from their original application and will be able to shop for a new plan with help paying for coverage, if they qualify. -Adapted from Health Connector Update Regarding New Rules for Victims of Domestic Violence, MA Health Care Training Forum, April 11, 2014. (Note- best viewed in browser other than Internet Explorer.)
State Commission on LGBT Aging Launched A year after advocates with MassEquality and the LGBT Aging Project called on state lawmakers to create an LGBT Elder Commission, the Commission has been inaugurated. In the initial appeal, advocates noted that approximately 3.8-7.6% of the total elder population is LGBT and this is expected to double by 2030 as the baby boomers, the first generation of post-Stonewall, openly LGBT older adults continues to age. (“Outing Age: Public Policy Issues Affecting Lesbian, Gay, Bisexual and Transgender Elders,” National Gay and Lesbian Task Force, 2010.) Additionally, according to the report, “Disparities and Resilience among Lesbian, Gay, Bisexual and Transgender Older Adults” (Fredrickson-Goldsen, 2012), more than 20% of LGBT older adults do not disclose their sexual orientation or gender identity to their physician. Also, 68% of those surveyed reported that they experienced verbal harassment and 43% experienced physical violence. Advocates also report that less than half of lesbian and gay Boomers are strongly confident that health care professionals would treat them with dignity and respect, while 12% have no confidence that they will be treated with respect and dignity (“Improving the lives of LGBT Older Adults,” SAGE and MAP, 2010). The new special state commission will focus on long-term care needs of the older lesbian, gay, bisexual and transgender community. In addition to long-term care needs, the commission will also investigate, analyze and study the health, housing, financial, and psychosocial needs of these populations. It will also examine the impact of state policies and regulations on LGBT older adults and make recommendations to ensure equality of access, treatment, care and benefits. The LGBT Aging Commission consists of 20 members, representing the executive and legislative branches of government, advocacy groups such as; MassEquality; LGBT Aging Project, AARP of Massachusetts, Gay & Lesbian Advocates & Defenders and National Association on HIV Over Fifty, to name a few. As part of their work, the commission will hold public meetings, fact-finding hearings and other public forums and formulate and its recommendations, including recommendations for legislation, with the clerks of the House of Representatives and Senate within the next 12 months. Adapted from, and for More Information
State Seeks to Move Homeless Families from Hotel Rooms to Group Homes Michelle Espada has gained 70 pounds since she moved to the Bedford Plaza Hotel. "Eating microwaveable food. I can't walk much anymore," she said. "It makes me cry sometimes, because it feels like you're drowning all the time." The mother of two young boys, Espada couldn't afford rent. She's been on waiting lists for affordable housing for four years. Sixteen months ago Espada's family became homeless, and she applied to the state for help. But Massachusetts has no room left for homeless families. The state's 2,000 shelters filled up during the recession as parents who lost their jobs, got foreclosed on, got sick, or just couldn't earn enough became homeless along with their children. So, like roughly 2,000 other families, Espada is living in a hotel paid for by the state. Massachusetts Undersecretary of Housing Aaron Gornstein said they can't stay there much longer. Under pressure from communities with participating hotels, Gornstein wants to move them to new "congregate shelters" — group homes where several families each have a bedroom and share kitchens and other common areas. To make that happen, Gornstein wants to dramatically expand the state's system of congregate shelters at a total cost of $91 million. And he wants to have the new shelters in place by spring to meet a pledge he made two years ago to have families out of hotels by this July. Once the new shelters are in place, Massachusetts will have to spend millions of dollars more annually to maintain them. “We’re resizing our shelter system to accommodate more families so we don’t have to place them in motels," Gornstein said. But, he added, “If we need to maintain the hotel program because there’s still a need for emergency shelter, we will do so.” For Gornstein's plan to work, the state legislature needs to approve the cost of 1,000 shelters. But 650 are already being set up by nonprofit contractors, including Heading Home. The wait for affordable or subsidized housing can now be as long as a decade. The state gives homeless families in shelters expedited status that can reduce their wait to about two years, but that means others on the list wait longer. As an example of the demand, Gornstein said 95,000 families are on the waiting list for one type of subsidized housing, Section 8. “There is an important issue of how we balance our housing policy to make sure that those who have been waiting also have a chance,” he said. There’s also the issue of affordable housing being affordable enough, said Chris Norris, executive director of the Metropolitan Boston Housing Partnership — the state’s largest regional provider of rental assistance. “If you dig deeply at the numbers, the majority of housing built under almost any of our programs does not serve the lowest income families,” Norris said. “And ...the majority of (those in shelter) will not be served by the housing that’s being built.” Libby Hayes, executive director of Homes for Families, the state association of shelters, agreed the state failed to make a big enough investment in long-term affordable housing, even after a special commission appointed by Governor Deval Patrick found in 2008 that the most efficient use of taxpayer money was placing homeless families in permanent homes. So, when the homelessness crisis hit, the state had to take costly temporary measures, Hayes said.“Congregate housing is the new affordable housing,” she said. “Money is being wasted in the sense that we’re spending so much on short-term solutions and so much on hotels. But we can’t just stop everything and put children in the street and say, ‘Hold on, we’re going to build housing now.’ So it’s hard, and that’s the trap.” -See the full WGBH News story...
Hospitals Take Steps to Set Healthy Examples for Patients In an effort to practice what they preach, Boston-area hospitals have begun to adopt widespread changes to encourage healthier eating among patients, visitors, and staff and to make their own facilities less damaging to the environment. Sugary sodas, candy bars, harsh cleaning agents, and disposable surgical tools are being phased out in favor of more local produce, fruit-infused water stations, solar panels, and reusable instruments. More than 40 hospitals in Massachusetts, including all 10 in the Partners HealthCare system, and 900 hospitals nationwide have joined a healthier hospitals initiative, launched in 2012. “Hospitals have healing as their core value, yet they unwittingly contribute to chronic disease in our society by selling junk food, being enormous users of toxic chemicals and energy resources, and generating a ton of waste,” said Gary Cohen, president of the nonprofit group Health Care Without Harm that organized the initiative. Participating hospitals pledge to take on certain challenges such as providing more produce and less red meat to patients, staff, and visitors; using safer chemicals in their cleaning products; increasing recycling efforts; or installing energy-efficient heating and cooling systems. Some area hospitals have implemented more sweeping changes than others. On one end, Boston Medical Center has focused its efforts on reducing red meat consumption among patients, visitors, and staff and organizing weekly farmers markets in the hospital lobby. Hospital staff plan to implement more nutritious menus during the coming year. Spaulding Rehabilitation Hospital, on the other end, implemented a variety of healthier upgrades after moving into a new environmentally friendly building in Charlestown last April. It has a roof partially covered with vegetation to reduce storm water runoff — a source of pollution — and provide extra insulation. Its raised floor and landscaped lawns protect against a rising sea level and storm surges due to climate change. Fried foods are no longer served to Spaulding visitors, staff, or patients — nor is any kind of sugar-sweetened beverage, and bread is only wheat or whole grain. Dunkin’ Donuts, which occupied the hospital’s old lobby, is nowhere to be found in the new one. Hospitals participating in the initiative have promised to decrease their carbon footprint not only by serving fewer animal products but also by reducing the medical waste they contribute to landfills. When four Partners hospitals switched last year to reusable “sharps” containers to get rid of used needles in patient rooms, that move alone led to the removal of more than 112,080 pounds of plastics from the disposable containers every year from landfills. Spaulding’s new facility was designed to run on 42 percent less power than what the average hospital in America uses. Newer buildings at Massachusetts General Hospital and Brigham and Women’s Hospital — and one being designed at North Shore Medical Center — also meet the US Green Building Council’s standards for energy and waste conservation. In developing the healthier hospitals initiative, Cohen said he believes it’s the larger mission of hospitals to lead the way toward sustainability. “We started with hospitals, but we’re hoping this idea will spread to other institutions.” -See the full Boston Globe article...
What’s the Skinny on Saturated Fat? Remember the fat-free boom that swept the country in the 1990s? Most of the experts were recommending a low-fat diet to prevent heart disease. Many avoided all kinds of foods with fat: cheese, eggs, meat, even nuts and avocados. And, as a result, diets were full of sugar (lots of fat-free, sugary yogurt) and carbohydrates, like bagels. But, by the mid-1990s, says Walter Willett, who is chairman of the department of nutrition at the Harvard School of Public Health, there were already signs that the high-carb, low-fat approach might not lead to fewer heart attacks and strokes. Now, nearly two decades later, a more complicated picture has emerged of how fats and carbohydrates contribute to heart disease. For instance, it's clearer that some fats, namely plant-based fats found in nuts and olive oil, as well as those found in fatty fish, are beneficial. Willett says there's strong evidence that they help reduce the risk of heart disease. But here's where it gets interesting: "We've learned that carbohydrates aren't neutral," explains Dariush Mozaffarian, an epidemiologist at Harvard Medical School. "[Carbs] were the base of the pyramid," says Mozaffarian. The message was "eat all carbohydrates you want." "But carbohydrates worsen glucose and insulin — they have negative effects on blood cholesterol levels," he says. The thinking that it's OK to swap saturated fats for these refined carbs "has not been useful advice." He says it's clear that saturated fats can raise LDL cholesterol, the bad cholesterol. But that's only one risk factor for heart disease. There's now evidence that — compared with carbs — saturated fat can raise HDL cholesterol (the good cholesterol) and lower trigylcerides in the blood, which are both countering effects to heart disease, he says. "When you put all of this together," says Mozaffarian, what you see is that saturated fat has a relatively neutral effect compared with carbs. He says it's "not a beneficial effect but not a harmful effect. And I think that's what the recent studies show." He points to a review of studies published in and to a highly publicized recent meta-analysis that concludes there's no convincing evidence to support the dietary recommendations to limit saturated fat. The findings in that paper have created quite a bit of controversy. For instance, the American Heart Association says it stands by its recommendations to limit saturated fat.
"This research simply means that we lack the data from controlled clinical trials that truly test this question of how much saturated fat is acceptable," writes Linda Van Horn, a spokesperson for the American Heart Association. Mark Bittman, an author and op-ed contributor to the New York Times, wrote a column titled "Butter is Back" based on the findings of the recent meta-analysis. This didn't sit well with Alice Lichtenstein, a nutrition science and policy researcher at Tufts University, who wrote a letter to the editor arguing that green-lighting the return to butter and fatty pork was off.
So, given the kerfuffle, is there some consensus? Yes, it turns out. Like Willett and Mozafarrian, she makes the case that "substituting polyunsaturated fatty acids [which are found in nuts, seeds, fish and leafy greens] for saturated fat is associated with a benefit." So, the message here seems to be: Cut back on all those refined carbs, and remember that some fat is good. After all, the heart-healthy Mediterranean diet, which includes lots of nuts, olive oil, fish, fruits, vegetables and legumes, and small amounts of cheese and meat, turns out to be a pattern of eating that includes 40 percent to 45 percent of calories from fat. That's hardly low-fat! Experts say remember this big picture: Too many calories from any source, whether it's fats or carbohydrates, can lead to weight gain. And it's that extra weight that increases the risk of heart disease. -See the full NPR blog post...
MGH Addiction Specialist Defends 12-Step Programs In an opinion piece published last month (Opinion: With Sobering Statistics Doctor Debunks 12-Step Programs, MGH Community News, March, 2014) Dr. Lance Dodes argued that AA “has one of the worst success rates in all of medicine” and said it helps only one in ten people who enter the program — and can actually be harmful to everyone else. He appeared on WBUR’s Radio Boston and “touch(ed) a nerve” with their listeners. Radio Boston invited comment. Among the respondents was Dr. John Kelly, program director of Addiction Recovery Management Services at Massachusetts General Hospital. In Defense Of 12 Steps: What Science Really Tells Us About AddictionBy John F. Kelly and Gene Beresin Guest Contributors In a recent WBUR interview, Dr. Lance Dodes discussed his new book, which attempts to “debunk” the science related to the effectiveness of 12-step mutual-help programs, such as Alcoholics Anonymous, as well as 12-step professional treatment. He claims that these approaches are almost completely ineffective and even harmful in treating substance use disorders. What he claims has very serious implications because hundreds of Americans are dying every day as a result of addiction. If the science really does demonstrate that the millions of people who attend AA and similar 12-step organizations each week are really deluding themselves as to any benefit they may be getting, then this surely should be stated loud and clear. In fact, however, rather than support Dr. Dodes’ position, the science actually supports the exact opposite: AA and 12-step treatments are some of the most effective and cost-effective treatment approaches for addiction. In his book, Dr. Dodes commits the same misguided offenses he condemns. His critique of the science behind treatment of addiction is deeply flawed, and ironically, his own psychoanalytic model of an approach to solve the “problem of addiction” has no independent scientific proof of effectiveness, particularly in comparison to other methods of treatment. Below, we address some of the specific pronouncements he made on Radio Boston and in his book in order to convey what well-conducted science actually tells us about how to treat addiction. What he says: 12-Step programs do not work, are not backed by science, and are probably harmful. The evidence is overwhelming that AA, and treatments that facilitate patients’ engagement with groups like AA, are among the most effective and best studied treatments for helping change addictive behavior. This conclusion is consistent with the views of prominent organizations such as the National Institute of Health (NIH), the Substance Abuse and Mental Health Services Administration (SAMHSA), the American Psychiatric Association (APA), and the Department of Veterans Affairs Health Care System (VAHCS), all of whom recommend patients’ participate in AA or similar groups to aid recovery. Dr. Dodes begins his criticism of AA and related treatment by citing a 1991 study published in the prestigious New England Journal of Medicine. This paper studied the treatment of a large number of individuals with alcohol problems. Dr. Dodes notes in his book that compulsory inpatient treatment had a better outcome than AA alone. But what he fails to mention is that the inpatient unit is a 12-step-based program with AA meetings during treatment, and requirements to attend AA meetings three times a week after discharge in the year following treatment. Importantly, too, when you compare the alcohol outcomes (average number of daily drinks, number of drinks per month, number of binges, and serious symptoms of alcohol use), AA alone was just as good as the AA-based inpatient treatment. Yet Dr. Dodes uses this study to argue that AA is poor while inpatient treatment is good — a bizarrely distorted, misleading and incorrect interpretation of the study’s findings. Dr. Dodes then cites a review article from another prestigious entity, the Cochrane Collaboration, to condemn AA and 12-step treatment. The Cochrane group is considered by health professionals to be the “gold standard” of good scientific procedure in its series of reviews. The article reviewed 8 studies from 1991-2004, comparing AA and 12-step treatment to other approaches, such as cognitive-behavioral relapse prevention therapies. He concludes from this important paper that AA and 12-step treatment were ineffective. However, the study actually concluded that AA and 12-step treatment were shown to be as effective as anything else to which they were compared. Perhaps not surprisingly, given his apparent agenda, Dr. Dodes doesn’t acknowledge the more recent randomized controlled trials of addiction treatment (that is, studies in which individuals with addictions were randomly assigned to different treatment approaches, comparing outcomes. See here, here, and here. Such studies are considered the most reliable sort of research.) These studies show that 12-step treatment improves outcomes by up to 20% for as long as two years post-treatment via its ability to engage patients, and also tends to produce much higher rates of continuous abstinence than other forms of treatment. Finally, in the largest randomized controlled study of treatment for alcohol use disorder ever undertaken (Project MATCH), which he does mention, he fails to state that compared to the cognitive-behavioral and motivational-enhancement treatments included in that study, the 12-step treatment had more than double the number of patients who were continuously abstinent at one year after treatment and about one third more at three years after treatment. -See the full response on WBUR’s CommonHealth blog...
The Hospital-Dependent Patient Over the last 30 years, American hospitals have become a showcase of medical progress, saving lives that not long ago would have been lost. “Rapid response teams,” drilled in precision teamwork and the latest techniques of critical care, have become commonplace. Cardiac and respiratory monitors, once found only in intensive care units, are now standard equipment on most wards and even in many patient rooms. CAT scanners and M.R.I. machines, once rare, have become de rigueur. But up to one-fifth of patients treated with these new medical advances and then deemed well enough to leave the hospital end up being re-admitted within 30 days of their discharge, at considerable cost. Insurers and third-party payers have begun penalizing health care systems for these quick re-admissions; and hospitals, in response, have begun significant efforts to improve the transition from hospital to home, creating clinics that remain open beyond usual working hours and marshaling teams of care coordinators, post-discharge pharmacists and “care transition coaches.” The problem persists, though, because our spectacular advances in medical science have led to a growing population of patients who are “hospital-dependent,” according to the authors of a recent Perspective piece in The New England Journal of Medicine titled “The Hospital-Dependent Patient.” Hospital-dependent patients are those who, a generation ago, were doomed to die. Now they are being saved. But they are not like the so-called hot spotters, a group of patients more commonly associated with frequent re-admissions who return to the hospital because of inadequate follow-up care, failure to take prescriptions correctly or difficult socioeconomic circumstances. Instead, hospital-dependent patients come back because they are so fragile, their grasp on health so tenuous, that they easily “decompensate,” or deteriorate under stress, when not in the hospital. Medical advances can snatch them from the clutches of death, but not necessarily free them from dependence on near-constant high-tech monitoring and treatments. “They are like a house of cards,” said Dr. David B. Reuben, lead author of the article and chief of the division of geriatrics at the Geffen School of Medicine at the University of California, Los Angeles. “When one thing goes wrong, they collapse.” Not surprisingly, hospital-dependent patients feel more secure and are happier in the hospital than at home. While clinicians and even family members may judge theirs a diminished existence, these patients find their quality of life acceptable, relishing their time with friends and family or engaged in passive hobbies like watching sports or reading the newspaper, albeit in the hospital. Over time, however, their recurring presence can result in conflicted feelings among those who were responsible for saving them in the first place. Some clinicians even begin to resent their obligation to continue administering resource-intensive care. “Physicians are socialized to cure patients, then move on,” Dr. Reuben observed. “They want to treat patients, not adopt them.” Dr. Reuben and his co-author offer potential solutions, such as specialized wards or facilities that would be more intensive than skilled nursing homes yet less costly than a hospital. But they are quick to add that more research must also be done. Their concept of “hospital-dependency” is a new one, so no research is available to help identify patients at risk of becoming hospital-dependent, estimate the percentage of early re-admissions they are responsible for or calculate the costs they incur. Even without studies, it’s clear that the numbers of these patients are increasing. With every triumphant medical advance, there are patients who are cured but who remain too fragile to live beyond the immediate reach of the technology that saved them. Until we begin making different decisions regarding how we allocate our resources, their presence will be a constant reminder of which medical research and health care we consider worthy and which we do not. -See the full The New York Times blog entry... Cited in/Linked from: HEALTH CARE WEEKLY UPDATE, Barbara Roop & John Goodson, Health Care for Massachusetts, April 04, 2014.
Attitudes Toward 'Talk Therapies' Increasingly Negative Despite large increases in depression and other mental health problems across the United States, today's college students are less comfortable about seeking mental health services, such as talk therapy, than their counterparts of 40 years ago, a new study shows. Results of the 40-year cross-temporal meta-analysis of 22 studies that included nearly 6800 university students contradict previous research suggesting that individuals are becoming more comfortable with the idea of seeking treatment of mental illness. The researchers found a strong decrease over time in positive attitudes toward seeking mental health treatment — "a robust finding," according to lead author Corey Mackenzie, PhD, a psychologist at the University of Manitoba. Presented at the Anxiety and Depression Association of America (ADAA) Conference 2014, the study results likely reflect the increasing trend to treat depression more often with pharmacotherapy and less often with psychotherapy, Dr. Mackenzie told conference delegates. "We argue that public education efforts to think of mental illness as a biological problem needing biological treatment are driving these changing attitudes," he said. Psychotherapy use in the United States fell from 71% in 1987 to 43% in 2007, according to the Medical Expenditure Panel Survey. During the same period, the nation's rate of antidepressant use more than doubled. Dr. Mackenzie said efforts to remove the stigma of mental illness included "the medicalization of depression." In addition, direct-to-consumer advertising of prescription medications by drug makers increased in the United States after a 1997 change in guidelines by the US Food and Drug Administration. "The initial goal to medicalize mental illness was well intentioned, but maybe it has had some negative effects," he said, referring to the decrease in positive attitudes toward specialty mental health care. "We need to look at what this means for our field 10 or 20 years from now." Coordinated Effort Needed Commenting on the study for Medscape Medical News, Aaron Heller, PhD, a postdoctoral fellow at the Sachler Institute for Developmental Psychology at Cornell Medical School, New York City, said he did not believe that "emphasizing that mental illness is biologically based is necessarily a bad thing. But we need further education of the public that there are many ways to change the brain." -See the full Medscape article... BIDMC Pilots Mental Health Notes Shared with Patients As part of an ongoing effort to make care more transparent, clinicians at Beth Israel Deaconess Medical Center have begun posting mental health clinicians’ notes in patients’ electronic medical records, allowing the patients immediate access to the summaries at home. On March 1, about 40 providers started sharing their notes with more than 650 patients. Some are eagerly reading every word, clinicians said, while others have no interest. “We all had some reservations,’’ said Dr. Michael Kahn, a psychiatrist who has worked at Beth Israel Deaconess for 20 years. “What about if a patient misinterpreted a note? Would they be upset about it? Would it confuse them?’’ But ultimately, he and his colleagues decided that sharing the notes could improve care by encouraging patients to more actively participate in their treatment, while inspiring providers to describe patients nonjudgmentally. Patients can correct mistakes, such as a wrong medication dose. And rather than write a word such as “paranoid,'’ which to many people “means crazy or bad,’’ Kahn said he now uses less-loaded terms such as “persecutory anxiety.’’ Primary care providers at the Boston hospital, along with those at a handful of medical centers and physicians groups nationally, have been posting notes from medical visits in patients’ secure online medical records for several years — with mostly positive results. But except for the Veterans Health Administration, which gives veterans online access to mental health notes, providers have hesitated to share psychiatric notes out of a belief that this approach is a minefield for patients. They worry patients will be rattled upon learning that their firm convictions are seen as delusions, or angered by diagnoses that feel harsh and stigmatizing. In an opinion piece published in the Journal of the American Medical Association, Kahn and three colleagues argued that sharing notes could be particularly beneficial for patients who abuse drugs or alcohol, who are “often so used to being lectured that they tune out real-time discussions of harmful consequences.’’ Allowing them to read a doctor’s assessment in private “may diminish the need for defensive maneuvers,’’ the authors said. Still, not all mental health providers are ready for this level of openness with patients. Nina Douglass, who works in obstetrics and gynecology at Beth Israel Deaconess, is one of five social workers who declined to participate — for now. Some of her patients are addicted to drugs, while others are in abusive relationships. Douglass tells them at the outset that she is required to report abuse or neglect of a child to state officials. If she writes about a specific concern in a note, and the patient reads it, Douglass is worried the patient might flee rather than risk losing custody of the child. “I absolutely share the hospital ethic of transparency,’’ she said. “But I want more time to see how this works.’’ Partners HealthCare, the largest health care system in Massachusetts, is moving toward putting medical notes online, but is still debating whether to post mental health notes in patients’ records. One unanswered question is whether a psychiatrist’s notes are still useful and precise for other doctors, including those in the emergency room, if they are written with the knowledge that the patient can read them, said Dr. Gregg Meyer, chief clinical officer. “First and foremost we have to make sure patient care is not compromised. We are watching their experience closely.’’ At Beth Israel Deaconess, doctors still have the option of putting certain notes in a locked area of the record, which patients cannot see and other doctors can access only if they provide written justification. -See the full Boston Globe article... Cyberbullying Resources for Youth and Their Families The American Academy of Pediatrics (2013) recommends that health professionals provide education and counseling for parents and youth regarding bullying, including strategies for how to deal with it. A recent article in the Journal of Pediatric Health Care identified a number of antibullying campaigns with websites and resources tailored to the developmental level and interests of young children through young adults. The authors note that most sites use a variety of technologies to advance the understanding of youth about bullying, including interactive modules, games, discussion forums, blogs, and celebrity testimonials. Several sites also include trained peer mentors to serve as positive role models to help bullied youth. The article encourages readers to set aside some time to review these sites and materials to increase their own understanding about the digital resources available for children, adolescents, and young adults. Most of these sponsoring organizations also provide information and educational resources for parents and educators. See the link to Table 1 on http://www.medscape.com/viewarticle/821741_5 for sponsoring organization(s) and selected resources for youth about bullying prevention and/or online safety. -See the full Medscape summary article... The State of Transgender Health Care
Daphna Stroumsa, MD, MPH reviews the current status of transgender people's access to health care in the United States and analyzes federal policies regarding health care services for transgender people and the limitations thereof in a recent issue of the American Journal of Public Health. Highlights include:
-See the full Medscape article... |