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MGH Community News |
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MGH Community News |
| August 2015 | Volume 19 • Issue 8 |
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. |
US Backs Retroactive Social Security Benefits for Same-Sex Spouses Same-sex married couples who were living in states that did not recognize their unions and who previously filed claims for Social Security benefits will be able to collect those payments, the government said Thursday. The Justice Department told lawyers for two plaintiffs seeking benefits that the Social Security Administration would apply the Supreme Court’s June ruling declaring that marriage is a constitutional right, Obergefell v. Hodges, retroactively. It would apply to individuals with pending claims who were married before the decision and living in states that did not recognize same-sex marriages. Details were not yet available, and it was not clear when the Social Security Administration would enact the policy. But the rules are expected to be applied to previously filed claims that are pending in the administrative process or litigation, according to Lambda Legal, a gay rights advocacy group that represented the plaintiffs. The Social Security Administration was not available for comment. The Obergefell case came after the landmark Windsor decision in 2013, in which the court declared that same-sex couples were entitled to federal benefits. But even with that ruling, many couples were still shut out: The Social Security Administration typically looks to the states to determine marital status, so couples living in states that did not recognize same-sex marriage were not deemed eligible to receive spousal-related benefits. There were 11 states that did not recognize same-sex marriage before the ruling, according to a chart on the Social Security Administration’s website. -See the full Boston Globe article.
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TAFDC September Clothing Allowance Now $200, and Income Limit Increases for the Month This year the TAFDC September clothing allowance will increase to $200 (it has been $150 for many years). TAFDC clients under age 19 (except for “family cap” children and SSI recipients) who are eligible on September 1, 2015 will receive the full amount, as will those later determined eligible as of September 1. Those found eligible for dates later in September will receive a prorated amount, so applicants should apply by September 1 or as soon as possible. The TAFDC income eligibility limits will increase for September; the amount of the increase depends on the number of applicants or recipients under age 19 in the household. This means that many low-income working families that normally are income-ineligible for TAFDC benefits will become eligible for the clothing allowance. Although these families will not receive cash benefits, they may be able to receive one year of MassHealth benefits and subsidized child care, in addition to the clothing allowance. Please note: The clothing allowance benefit is considered income under Supplemental Nutrition Assistance Program (SNAP) rules. As with other increases in income, the receipt of the clothing allowance can lead to a temporary decrease in SNAP benefits for some families. -Sources http://www.masslegalservices.org/system/files/library/OLGT%202015-45.pdf and http://mahomeless.org/files/2014-08-26_tafdc_clothing_allowance.pdf
New Limits on Nursing Home Memory Care Ads Massachusetts nursing homes will no longer be allowed to advertise “memory care” or similar services if they have not complied with requirements to ensure appropriate dementia care, under state rules issued last week aimed at clarifying widespread confusion. The action by the Department of Public Health follows a July review by the Alzheimer’s Association of Massachusetts and New Hampshire of how the state’s nursing homes advertise their services. That review found nearly 60 percent of facilities that advertised memory, dementia, or cognitive care had not documented that they had, in fact, completed the training, staffing, or design changes required to be called a dementia special care facility. The association’s findings were similar to a smaller Globe review conducted in February. A letter sent this month to all nursing homes by the department states, “A facility which does not operate a dementia special care unit may not include a reference to dementia care or memory care in a list of provided services . . . even with a disclaimer that the facility does not operate a dementia special care unit.” The letter acknowledged that state regulators had previously advised nursing homes they would be allowed to include references to dementia care in their advertising — even if they had not completed the more stringent requirements — as long as they added the disclaimer. The letter said nursing home advertising will still be allowed to include “dementia” in a list outlining the types of residents a facility admits, so long as it includes a disclaimer that it does not offer specialized care, and does not imply that it offers services specifically for residents with dementia. Nursing homes that advertise dementia services face additional mandates that include the hiring of an activities director dedicated to the dementia unit to ensure meaningful activities for residents, an expanded common space room, and a fenced-in outdoor area. The Alzheimer’s Association spent years lobbying for the law, which was designed to close a loophole that had allowed nursing homes to advertise dementia care services without specific training for their workers, specialized activities for residents, or safety measures to prevent residents from wandering. -See the full Boston Globe article.
Fisher House and Fisher House Foundation- Lodging for Veterans and their Families Fisher House, on the grounds of the West Roxbuy campus of the Veteran's Administration Boston Healthcare System, provides 20 living suites, at no cost, to family members of hospitalized veterans and military members who are receiving care through the VA. On a case-by-case basis they may also be able to host patients being treated outside the VA system. They also can identify other existing resources for these families as appropriate, such as eligibility for their "Hotels for Heroes" program which pays for rooms from donated hotel reward points, and if appropriate, refer to the Fisher House Foundation, which may offer additional assistance as funding allows. Some of our social workers report that the Foundation has on occasion paid for military families to stay local to MGH. Fisher House contact: elizabeth.stpierre@va.gov. More information: Fisher House Please note that Fisher house has requested NOT to be included on our accommodations list at this time. Social Service staff can find this information, as well as information about other programs that have asked not to be listed, on our Accommodations Page on the Staff Access area of our website. -Thanks to Jeff Horowitz and Elaine Shwartz for reminding us about this program, and to Kitty Craig-Comin for initially bringing it to our attention.
Assisted Living and Home Care Bridge Loans According to PayingforSeniorCare.com , as of 2015, Elderlife Financial is the only organization offering a loan product that is specifically designed as a Senior Care Bridge Loan. The “Elderlife Bridge Loan” was created to help seniors’ families with the cost of assisted living, home care or skilled nursing on a short term basis, while awaiting the sale of a home or the receipt of Veteran’s benefits for example. With a bridge loan, the majority of funds are sent directly to the care provider such as the assisted living community or home care agency. Some cash from the loan can be provided directly to the family to help pay for relocation, incidental and unexpected costs. This loan is unique in that up to six family members or friends can share the cost of paying for an elder’s care. The loan is unsecured, meaning it is not backed by a home or vehicle, is typically made on a short term basis for periods of three years or less and generally is approved within a matter of days. Typical Scenarios Elderlife's loan product is designed to serve as a bridge until more permanent financial resources can be arranged. What follows are examples of situations in which using an eldercare loan product might make economic sense.
Pros The Elderlife Line of Credit is unsecured, meaning it is not backed by a home or vehicle. Therefore a fairly strong credit score is required for approval if there is a single borrower. However, the loan is also designed to allow for multiple co-borrowers to share the cost of paying for the senior’s care. Having multiple co-borrowers lessens the need for a strong credit score from any one borrower. Since there are multiple individuals to share the risk; the more co-borrowers, the easier it is to be approved. These loans also have an extremely fast approval process. Families can be approved within 1-2 days. A final benefit of a bridge loan is that it can eliminate complexity when applying for VA pensions or Medicaid. This is especially relevant if the alternative to a bridge loan is a family loan. VA pensions and Medicaid consider the applicant's income and past asset transfers as eligibility factors. If not very carefully structured and documented, money accepted from family members to pay for care can be counted as income which can hurt a VA application. Monies re-paid to family members can be considered an illegal asset transfer by Medicaid. The federal government and the Department of Veterans Affairs recognize Elderlife's financial product as a loan and this can, relative to a family loan, reduce complexity in the application process. If one is considering a VA pension or Medicaid in the future, it is strongly recommended to consult with a planning expert. Cons The largest drawback of this option is the interest rate of the loan which is considered by some to be high. However, interested individuals must consider this to be a relative statement. The interest rate when compared to a home equity loan might be high but when compared relative to a credit card or personal loan, it is very reasonable. Loans can be re-paid at any time without penalty. Furthermore some assisted living communities will pay the interest on the loan as an incentive for the senior to move into their community. More Information and How to Apply Learn more on PayingforSeniorCare.com. At the bottom of that page interested parties can submit their contact information to request an advisor to contact them.
Cancer Connection- a Cancer Support Community Serving the Pioneer Valley Located in Northampton, Cancer Connection offers a haven where people living with cancer and their loved ones can learn how to navigate the complicated cancer journey through education, peer support (support groups), complementary therapies and expressive arts programs to strengthen body and spirit. All offerings are free of charge. More at: www.cancer-connection.org/ -Thanks to Devon Punch, Health Educator, Massachusetts General Hospital Cancer Center, for sharing this resource.
Heroes Circle – Free Martial Arts Training for Seriously Ill Children and Siblings The Heroes Circle provides classes for children age three to twenty-three in the mind-body techniques found in the martial arts. Their mission is to ease the pain of very sick children while empowering them to heal physically, spiritually and emotionally. Specially trained black belt martial artists teach breathing, visualization, and relaxation techniques, in addition to traditional martial arts moves, to help empower the children and provide them with a sense of power, peace, and purpose. Using martial arts therapy, the Heroes Circle program teaches seriously ill or injured children and their siblings to:
All programming, including uniforms, is free of charge & siblings are welcome. Classes are held at Esposito’s Karate Fitness Center, 230 Adams St, Newton, MA. To register or for more information please contact Rob Brockman, the Boston Program Coordinator at (978) 314-3135 or rbrockman@kidskickingcancer.org or see http://kidskickingcancer.org/ -Thanks to Abby Losordo and the American Cancer Society for sharing this resource.
Online Children’s Book Helps Talk About Death of a Parent A new downloadable e-book from The National Child Traumatic Stress Network, Rosie Remembers Mommy: Forever in Her Heart tells the story of a young girl who is struggling with childhood traumatic grief after the death of her mother. By reading Rosie Remembers Mommy: Forever in Her Heart to a child experiencing traumatic grief, a parent can help him or her understand the many feelings associated with the loss of a loved one, ask questions about the death, and know that their surviving parent is available to hear about all feelings—even upsetting ones. Download at: www.nctsn.org/products/rosie-remembers-mommy-forever-her-heart A brief summary and link have been added to the bereavement section of our Resources for Final Arrangements packet, that is available in the community resources section of our public website www.mghsocialwork.org. -Thanks to Mary Susan Convery for sharing this resource.
Substance Use Disorder Online Information and Support for Families Some websites that give useful information and advice for families struggling with a loved-one’s addiction: Stop Addiction or call 1-800-327-5050 (TTY: 1-800-439-2370) Monday-Friday 8am-10pm, Weekends 9am-5pm. The goal of this website is to give you information on how to prevent and identify opioid misuse and where to go for help. Learn to Cope has peer-led family support chapters throughout Massachusetts. Every Learn to Cope chapter holds weekly support meetings run by experienced facilitators who have been there. These free meetings offer family members support, education, resources and hope. Learn to Cope also offers naloxone (Narcan), a medication to reverse overdose, and training in how to use it. Allies in Recovery provides online support, along with skills training, for loved ones of those with substance use disorders. With support from the Bureau of Substance Abuse Services, Massachusetts residents now have unlimited membership in this online resource; their zip codes are the promotional codes that alowifull access to the site. Online resources and supports can help those concerned about adults or adolescents. This site provides resources to: gain communication skills; reduce substance use; get loved ones into treatment; reduce anger, pain and worry. (Note this is a subscription service, but free to MA residents- us MA as promo code) -Thanks to Elaine Shwartz for sharing these resources.
Updated Guide Examines Problems in Nursing Homes and How to Resolve Them Justice in Aging recently released an updated guide for consumers: 20 Common Nursing Home Problems and How to Resolve Them. The guide includes strategies to deal with the most common problems found in nursing homes. Some of the common problems include: substandard or inappropriate care, disregard for patient preferences, improper use of physical restraints or behavior-modifying medication, excessive charges, and more. To receive the best possible quality of care, a nursing home resident or resident’s family member should be familiar with the protections of the federal Nursing Home Reform Law. The newly updated guide helps consumers and advocates navigate the legalities of nursing home practices, and offers practical tips on how to resolve issues that come up. Justice in Aging is a national non-profit legal advocacy organization that fights senior poverty through law. Formerly the National Senior Citizens Law Center, since 1972, Justice in Aging has worked for access to affordable health care and economic security for older adults with limited resources, focusing especially on populations that have traditionally lacked legal protection such as women, people of color, LGBT individuals, and people with limited English proficiency. Download 20 Common Nursing Home Problems and How to Resolve Them (registration required). -From Medicare Watch, Volume 6, Issue 30, The Medicare Rights Center, August 06, 2015.
MassHealth Redeterminations – Progress Report, Schedule and Additional Updates As previously reported (2015 MassHealth Renewals for People with Disabilities, MGH Community News, July 2015) MassHealth is working its way through the backlog of federally required MassHealth redeterminations. MassHealth is about half-way through the process for 1.2 million members. Phase 1 ended June 30. MassHealth recently released preliminary results on the first 500,000 MassHealth beneficiaries to have their eligibility renewed in the new computer eligibility system. The positive spin is that 80% of people who were required to reapply, responded in some way, and that of those who completed an application 83% were still eligible for MassHealth. The negative spin is that over 200,000 people lost MassHealth; that's a little over 40% of the total in phase 1. Some completed an application and were found to be ineligible, but 70% (over 140,000 people) lost benefits because they did not reapply or worse (about 40,000) tried to reapply but didn't complete the process. People who lost benefits are free to reapply at any time to regain benefits going forward. Phase 2 began August 1 with MassHealth sending notices to reapply to about 36,000 households that include one or more individuals with disabilities (about 64,000 individuals) who have until Sept 15 to complete a reapplication. Advocates strongly encourage applying on-line with the help of a navigator or certified application counselor such as our Patient Financial Services staff. Renewal Timeline for the remainder of 2015:
On-Line MCO/PCC Selection Form MassHealth beneficiaries no longer have to call customer service to select or change a managed care plan. They can submit an on-line form or print out and mail the form (no fax option yet). MassHealth says plan choices are being processed within 1 business day of submission/receipt. There is a new "Enroll in a Plan" link on the MassHealth home page: http://www.mass.gov/eohhs/consumer/insurance/enroll-in-a-health-plan/enroll-in-a-health-plan.html Proof of Residence Self-Attestation Affidavits Now Requires Notarization; May Not Be Legal To qualify for MassHealth, Health Safety Net or Connector coverage, applicants must be residents of Massachusetts. This means they live in Massachusetts and are not just here for a temporary visit. Unless an applicant indicates he or she is homeless, the new HIX system attempts to link the applicant's address to him or her in various data sources; if nothing is found, the applicant is asked to submit proof of residence. The applicant can be enrolled in the meantime. The MassHealth regulations give examples of different documents that can be used to prove residence including "an affidavit supporting residency signed under pains and penalties of perjury." 130 CMR 503.002 (F)(10). Recently, MassHealth has announced that it will require residence affidavits to be notarized. The regulation has not been amended and this new requirement appears to conflict with the regulation. Mass. Law Reform Institute is interested in understanding more about situations where obtaining notarization of a residence affidavit has been burdensome. Staff who have seen such cases, are asked to contact Vicky Pulos at vpulos@mlri.org or 617-357-0700 Ext. 318. -Adapted from e-mail correspondence from Vicky Pulos, Mass Law Reform Institute, August 12 and August 20, 2015.
Medicare Reminder: Qualifying for Medicare There are multiple ways to qualify for Medicare. The most common way is when you turn 65. When you turn 65, you become eligible for Medicare if:
If you are under 65, you qualify for Medicare if you are eligible for Medicare if you are a U.S. citizen or have your resident visa, have lived in the U.S. for five years in a row and:
Learn More on Medicare Interactive -Adapted from Medicare Watch, Volume 6, Issue 30, The Medicare Rights Center, August 06, 2015.
Medicare Reminder- Durable Medical Equipment and Oxygen Coverage Oxygen equipment is considered durable medical equipment (DME), and Medicare will help cover its costs. Specifically, Medicare Part B covers DME as long as the equipment is:
It is important to note that Medicare only pays for DME if you get it from the right kind of supplier. For Original Medicare, this depends on where you live. If you live in a region that is part of the competitive bidding demonstration, you will have to get your DME from a supplier that participates in the program. If you live in a region that is not part of the demonstration, you must get your DME through a supplier that has approval from Medicare. You can find a Medicare-approved supplier by visiting www.medicare.gov/supplier. Note that if you have a Medicare Advantage Plan you should contact your plan to find a certified supplier. Although supplier restrictions are the same for oxygen equipment as for other types of DME, other coverage rules and the process are different. Unlike other types of DME, oxygen equipment is always rented in a five-year cycle. Medicare will pay the supplier a monthly rental fee for the first 36 months. The fee includes all equipment, oxygen, and supplies. You must pay 20 percent of each month’s rental fee. For the next 24 months, the supplier must allow you to keep the equipment, but Medicare rental payments stop. You pay no more rental fees, although the supplier still owns the equipment. Also, if you use oxygen tanks or cylinders, you must pay a 20 percent coinsurance for liquid or gaseous oxygen each month. Finally, at the end of five years, you will have the choice to either get new oxygen equipment from your supplier or change to a different supplier. Throughout this five-year period, the supplier must keep your equipment in good working order. During the first 36 months of the rental period, the supplier must provide you with supplies and maintenance free of charge. During the last 24 months of the rental period, providers are allowed to bill you for in-home maintenance visits every six months. Learn more about how Medicare pays for DME on Medicare Interactive. -From Dear Marci, Medicare Rights Center, August 10, 2015 (archive not available online).
Can Health Care Be Cured of Racial Bias? Even as the health of Americans has improved, the disparities in treatment and outcomes between white patients and black and Latino patients are almost as big as they were 50 years ago. Doctors, nurses and other health workers don't mean to treat people differently, says Howard Ross, founder of management consulting firm Cook Ross, who has worked with many groups on diversity issues. But all these professionals harbor stereotypes that they're not aware they have, he says. Everybody does. "This is normal human behavior," Ross says. "We can no more stop having bias than we can stop breathing." Unconscious bias often surfaces when we're multitasking or when we're stressed, research shows. It comes up in tense situations where we don't have time to think – which can happen frequently in a hospital. "You're dealing with people who are frightened, they're reactive," Ross says. "If you're doing triage in the emergency room, for example, you don't have time to sit back and contemplate, 'Why am I thinking about this?' You have to instantaneously react." Doctors are trained to think fast, and to be confident in their decisions. "There's almost a trained arrogance," Ross says. But some medical schools are now training budding physicians and other health professionals to be a bit more reflective — more alert to their own prejudice. Places like the University of Texas Medical School at Houston, the University of Massachusetts, and the University of California, San Francisco now include formal lessons on unconscious bias as part of the curriculum. Traditional Diversity Training Didn't Work — And Sometimes Backfired The UCSF curriculum is based on a training program designed by Howard Ross, the diversity consultant. He says he developed the new "unconscious bias" approach to sensitizing people to their own predjudices after realizing that the traditional diversity training he was doing in the '80s and '90s wasn't working. "People who seemed to have transformative responses to those [earlier] trainings, to have that kind of 'aha' moment — particularly people in the dominant group, [of] whites, men, heterosexuals — often, if you talk to them a month or two later, they actually felt quite wounded by the experience," Ross says. In some cases, he adds, participants seemed to become more defensive and hardened in their biases after those early trainings, not less prejudiced. A 2007 study described in the Harvard Business Review examined diversity training programs at more than 800 companies over 30 years, and the results underscore Ross's point. Overall, such programs seemed to do nothing to change people's prejudices or improve diversity. Instead, in some cases, they reinforced bias. "What happens is, ultimately, we feel bad about ourselves, or bad about the person that made us feel that way," Ross says. So rather than making people feel bad or awkward, Ross and Salazar say that, more than anything, they want people to accept that having biases is part of being human. "You know we all have them," Salazar tells his class in San Francisco. "It's important to pause for a second and normalize this. And be OK with this." Salazar emphasizes that unconscious bias can't be eliminated, but it can be managed. "So how do we address our bias? What do we do?" One student says, "Slow down." "Yeah," Salazar responds. "A trick that I use is that I pause before I walk in, take 10 seconds even, 15 seconds, just to try to clear your mind and go in with that clean slate." It's too early to know if these new types of trainings that explore unconscious bias are actually having any effect on what goes on in the exam room. Participants fill out evaluation forms after the class, and these anecdotal self-reports are often positive. But, so far, there have been no formal studies to measure if anything in patient care has actually changed. "What happens when that door closes? What happens in the interaction when I can't see the patient and the doctor talking?" Salazar says. "That's a little hard to capture." Still, UCSF is betting the technique will help. Salazar and other leaders believe the younger generation of health care providers could help shift medicine — by learning early how to keep their own biases in check.
Food Insecurity and High Healthcare Costs Go Hand in Hand People with severe food insecurity, who struggle the most to put food on the table, have healthcare costs more than twice as high as people who are food secure, according to a new Canadian study. People who have food insecurity, meaning inadequate or insecure access to food due to low income, “have poorer (physical and mental) health, this is documented extensively for adults and children,” said lead author Valerie Tarasuk of the University of Toronto. “We finally have been able to quantify the healthcare expenditures associated with it,” Tarasuk told Reuters Health by phone. In countries like the U.S., low income might be tied to both food insecurity and poorer access to the healthcare system, which would complicate the analysis, she said. But in Canada, low income people have equal access to the publicly funded health system. The new study included 67,033 adults in Ontario ages 18 to 64 who had participated in the Canadian Community Health Survey in 2005, 2008 or 2010. As food insecurity worsened, healthcare utilization and total healthcare costs increased, Tarasuk and colleagues reported in CMAJ. During the year before each survey, researchers estimated, food secure individuals cost the healthcare system an average of $1,608, compared to $2,806 for moderately food insecure and almost $4,000 for severely food insecure individuals. All costs were calculated in 2012 Canadian dollars. Food insecurity is “certainly more common” in the U.S. than in Canada, said Graham Riches of the School of Social Work at the University of British Columbia in Vancouver. Riches was not part of the new study. In 2011, one in six Americans lived in a food insecure household, compared to one in eight in Canada, he told Reuters Health by email. “Health care providers such as physicians or registered dietitians could play a role by screening patients for food insecurity and then assisting them to access social workers, publicly funded food assistance programs (where available) or charitable food programs, such as food banks,” she said. -See the full Reuters article.
Is DCF Better or Worse Off Than a Year Ago? Have things improved since last year’s call for reforms? Not as much as hoped. The deaths of Jeremiah Oliver and two other children being monitored by the DCF set off urgent demands for change, including the appointment of a new commissioner and an independent review of the agency. Since then, the state has tried to address the agency’s core problems, but along the way it has met some unexpected challenges. Reducing caseloads: Central to the reform plan was an effort to reduce the number of cases assigned to each social worker. But while caseloads did dip for a few months, they’ve risen throughout 2015 and are now roughly where they were a year ago. The reason? Even though the DCF added over 200 new full-time-equivalent employees since May 2014, the number of cases has increased just as quickly, according to information assembled by the DCF and provided by the social worker’s union. (See accompanying story.) Updating technology: A lack of modern equipment was making it hard for DCF workers to submit forms, enter case notes, and upload pictures while out in the field checking on kids. New department-issued iPads are beginning to make a difference, and a program introduced this summer is providing cellphones to social workers, so that they no longer have to rely on their personal cellphones — which can jeopardize their privacy, for instance if they have to give their personal numbers to the families they’re supervising. Improving management: Last year’s independent review of the DCF highlighted a variety of managerial concerns, including a lack of vision and weak systems of oversight. Those concerns were seconded by social workers in a December survey, where they disagreed with both of the following statements: “Management is as committed to exceptional service as they expect me to be” and “DCF is committed to maintaining high levels of employee satisfaction.” These managerial problems may get worse before they get better: Dozens of experienced managers have left the agency in recent months, enticed by the state’s early retirement program. Does DCF get enough money? Planning a budget for the DCF can be tricky, because it’s hard to predict how many children will need protection in any given year. An additional $18 million is being made available this year to hire and pay social workers, which should be enough to expand the workforce by several hundred people. Whether that translates into a drop in average caseloads, however, will depend on the number of new cases. Other parts of the DCF aren’t seeing the same funding improvements.Take training costs. In any organization, a big influx of new hires means a lot of training — particularly as the agency is committed to getting all its social workers properly licensed. Yet while this year’s budget does include some new money for training, the overall funding level is well below where it was in the prerecession years. It’s the same story for what’s called “Family Support and Stabilization,” which helps families on the brink of dysfunction get the resources and skills they need to keep from falling apart. Funding for these programs is growing, but it remains below prerecession levels. Are there other ways to improve outcomes for kids? The DCF plays a critical role in protecting the most vulnerable kids, but perhaps more important is to prevent children and families from needing assistance in the first place. Antipoverty measures, stronger economic growth, and more affordable housing would make a difference. So, too, would a better integration of state services. Roughly three-quarters of DCF cases involve parents or caregivers struggling with substance abuse, which shows the value of aligning child protection and addiction services. Yet, even with the most far-reaching reforms, tragedies will happen. That’s just the nature of the job the DCF does. The agency is asked to take care of kids in the throes of terrible crisis, kids with no strong voices of their own and no committed adults to fight for their interests. In such circumstances, things will sometimes go wrong. -See the full Boston Globe column
DCF Social Workers' Caseloads Said to be at Crisis Levels "The numbers are alarming," said Jason Stephany, spokesman for the SEIU. "And even more alarming than the numbers is the trend." The ratios of cases per DCF social worker he said, are increasing. "The trend is not moving in the right direction," he said. According to figures provided by the state, the average weighted caseload in June 2015 was more than 21 families for each caseworker. However, that is not necessarily 21 families. The same document states 18 weighted cases equals approximately 15 families. DCF also cited an increase in so-called 51-A (abuse) reports. The agency and Stephany also cited an increase in opioid-related cases as well. The agency is seeing an increase in the number of babies born who are substance exposed. But Stephany pointed to management issues, as well. In the aftermath of the Oliver case, to avoid more scrutiny, the then-administration ordered that every report would be followed up on by an investigation. That was not the case before, Stephany and Peter MacKinnon, a social worker and president of the local SEIU chapter said. Prior to Oliver, complaints were screened for false reports. And those reports are not uncommon, MacKinnon said, like an ex-spouse looking to alter an outcome in court, or a neighbor involved in a dispute looking to cause problems. Issues that were determined by the screener to require more attention, were passed on to caseworkers, a process known as "screened in." "Before, about half of the calls we received would be screened in," MacKinnon said. "After Oliver, as many as 90 percent of the calls were screened in. "That's nine out of every 10 complaints that require an open case," MacKinnon said. "It was five in 10 before. Even if we missed some legitimate complaints, we didn't miss that many." An open case means an investigation by a social worker," MacKinnon said. While he acknowledged that more reporting is a good thing for abused children, the amount of time this takes away from legitimate cases is heavy. -See the full MassLive.com article on DCF Caseloads.
DCF Paperwork Backup Delays New Foster Homes A paperwork bottleneck at the Massachusetts Department of Children and Families is causing a significant delay in getting the necessary waivers to bring new foster homes online, according to several workers at the outside agencies that arrange for intensive foster care. They say that’s in part because the central office at DCF was hit hard by early retirement packages offered by the state. Nearly 100 managers, administrators and other central office staff jumped at the opportunity to leave the agency. And people from those intensive foster care agencies, who didn’t feel comfortable speaking on tape, describe a gaping hole in leadership left by those retirements. At the same time, Gail Garinger, the state’s child advocate, says DCF procedures, including things like fingerprinting and background checks, have gotten tougher for new foster homes. "I think it’s a combination of having fewer people to do it, with a bit more stringent process at the same time," she said. And you put that combination together, and I have heard that it is creating some delays, and longer delays than had been occurring previously for approval of homes." The recent death of foster child Avalena Conway-Coxon in Auburn has put a spotlight on the state’s foster care system. But people focused on the welfare of children in the state say the real problem isn’t that foster homes are unsafe — it’s that there’s not enough of them. At a press conference last week following the death of , Health and Human Services Secretary Mary Lou Sudders said her agency has struggled with a spike in child welfare cases. “Since December of 2013, there’s been a 30 percent increase in the ongoing cases at the Department of Children and Families," Sudders said. "That’s a huge increase.” So where are all these new kids in the system going? The answer is complicated. There are multiple levels of state care, including foster homes contracted by DCF, then more intensive foster care, which private providers are contracted to run, and then group, or congregate care placements. "Anecdotally, I’ve heard that they’ve perhaps needed to bump certain children up a level," Garinger said. What Garinger means is that kids in departmental foster care might be moved to intensive foster care, while some of the kids there might be moved to group homes.As of last week there were more than 1600 kids living in congregate care settings. That’s 23 percent more than in June of 2013. But the state had previously moved away from placing kids in group settings. Mary Collins, an associate dean at Boston University’s School of Social Work, says that’s because research has shown a foster home placement is almost always better than group care. -See or listen to the full WGBH story.
More Scrutiny Proposed for Nursing Home Sales, Closures Companies aiming to sell or close Massachusetts nursing homes would be required to first notify residents, families, and a wide array of officials, under proposed new rules detailed by regulators this month, a year after state lawmakers directed them to create a more public process. The rules come amid mounting concerns by patient advocates that elder care is suffering as the state’s nursing home industry experiences an upheaval, with many facilities being sold and some closed. Representative Denise Garlick, chair of the Legislature’s Joint Committee on Elder Affairs, recently addressed the Public Health Council, an appointed body of academics, consumer advocates, and physicians that writes health regulations. In an interview after she spoke at the council’s monthly meeting, Garlick, who is also a registered nurse, said she is concerned that the state health department may not have enough inspectors to adequately monitor nursing homes amid the changes. State records indicate at least 13 inspectors recently applied for early retirement under the Baker administration’s plan to bridge a state budget shortfall. Under the proposed new rules, nursing home owners intending to sell or close a facility would be required to provide written notice to residents, their families, resident and family councils, nursing home staff, unions representing staffers, elected state and local officials, and the state Ombudsman’s office. A public hearing would be required before a sale if at least 10 people petitioned the state health department. Such hearings would be mandatory — without a petition — for proposed closings of any nursing homes. The proposed new rules will undergo a public comment period before the council votes whether to adopt them. Roughly 40,000 residents live in the state’s 400 nursing homes. Senate majority leader Harriette Chandler, and other advocates said they are concerned about Synergy Health Centers, a New Jersey company with no track record of owning nursing homes before it bought 11 Massachusetts facilities in the past 2½ years. Since then, Synergy has racked up citations for dozens of violations involving patient safety and care. Ray Cryan, a former state health department manager who oversaw nursing home sales and closures before he retired three years ago, said the Synergy sales highlight the department’s anemic monitoring of nursing home sales since then. “I am embarrassed and ashamed for the department,” Cryan said. “With Synergy, you let them buy one home, and see how they do. But not 11, and let them screw it up,” Cryan said. “Given the present [state review] process, whatever the heck it is, maybe a public hearing would be good.” But Cryan said the proposed new rules requiring a public hearing before a nursing home is allowed to close may jeopardize patients’ health and safety — especially if the hearing process is drawn out. “The bills won’t get paid, staff will leave, and it will end up in receivership,” Cryan said. “You want it done as quickly as possible, so you can get residents to another facility.” -See the full Boston Globe article.
Court Revives Overtime Pay for Personal Care Attendants Nearly 2 million home health care workers across the country, including 55,000 in Massachusetts, are eligible for federal minimum wage and overtime protections, according to a ruling Friday by a federal appeals court in Washington, D.C. The ruling revives a Department of Labor regulation that was set to go into effect Jan. 1 granting home care workers the right to be paid minimum wage and earn time and a half for hours worked above 40 a week. A federal judge rejected the Labor Department rules earlier this year, saying the agency exceeded its authority. Friday’s ruling overturned that decision. In Massachusetts, 35,000 home care workers employed through the MassHealth personal care attendant program are now eligible for overtime for the first time. Many of these workers paid through MassHealth, the state’s Medicaid program, are part time or work less than 40 hours a week, but at least 5,000 work overtime hours that were previously paid at their regular rate. The 20,000 Massachusetts home care workers who work for private agencies are already covered by state laws guaranteeing overtime pay. The new federal minimum wage protection, requiring workers to be paid at least $7.25 an hour will have no impact on Massachusetts home care workers because they already make at least $9 under state law. Lobbyists for the $84 billion home health care industry have argued that the new rules would make it difficult for families to afford home care and could reduce caregivers’ pay if companies limit their shifts to avoid paying overtime. Rebecca Gutman, vice president of Service Employees International Union Local 1199, which represents MassHealth home care workers, called the court decision “part of a tapestry of efforts to bring dignity to the home care workforce.” In Massachusetts, personal care attendants also recently won an agreement to earn a $15-an-hour starting wage, the first state to impose that threshold for home care workers. -See the full Boston Globe article.
Obamacare Not Killing Full-Time Jobs President Obama's health-care reform hasn't meant less time on the job for American workers, according to three newly published studies that challenge one of the main arguments raised by critics of the Affordable Care Act. One provision of the law, which is widely known as Obamacare, requires businesses with more than 50 employees to offer health insurance to those working at least 30 hours a week. That mandate took effect this year. Republicans, and some Democrats, worried that employers would look for ways to get around the mandate, either by giving their employees fewer than 30 hours, or by hiring fewer people. Either result would be bad for workers, one reason that Republican nominee Mitt Romney called Obamacare a "job-killer" during the last presidential campaign. Other Republicans issued similarly bleak warnings. So far, though, researchers say employers have not changed how they hire and schedule their workers in response to the law. "The data, to date, basically say that that hasn't happened, at least on aggregate basis -- that there really hasn't been nearly the change that some people were expecting," said Chris Ryan, a vice president at the payroll-management firm ADP. Analysts at ADP studied the payrolls of the firms' clients, about 75,000 U.S. firms and organizations. They expected that as businesses prepared for the mandate to take effect, they would adjust their employees' schedules, limiting them to no more than 30 hours a week. Yet ADP found no overall change in employees' weekly schedules between 2013 and last year. According to ADP's analysis, shifts in scheduling were trivial in every sector of the economy, even in industries that rely heavily on part-time work, such as leisure and hospitality. Ryan explained that qualified workers have more options as the economy improves, and they're getting pickier. As a result, the priority for employers is attracting the best possible workforce. Hiring and retaining good employees means giving them what they want -- often, health insurance and full-time work.
Bowen Garrett, an economist at the Urban Institute, and his colleague Robert Kaestner recently published an analysis of federal survey data. They found that circumstances for workers last year were what you would predict based on overall economic conditions in 2013. In other words, the economy has recovered steadily, and if Obamacare has had an effect, it has been too small to measure. Yet the Urban analysis did not find significant differences between states that expanded Medicaid and those that did not. "There's been a lot of talk about the ACA reducing the number of jobs, or killing some jobs, and we simply don't see the evidence of that in the data that we've been able to examine up to 2014," Garrett said. -See the full Washington Post article.
Worry That Airbnb Will Reduce Housing Supply The vast majority of people who advertise Boston homes on the online rental website Airbnb list just a single property — presumably to occasionally rent out their home or an extra room. But 15 percent have posted multiple listings, according to a Globe review, highlighting concerns that the site is being used to run substantial lodging businesses while avoiding regulation and taxes. Another concern: that landlords and investors seeking more profits are turning traditional housing into short-term units, further reducing the housing supply in Boston’s already tight real estate market. Even with the surging popularity of new Web-based services, short-term rental properties account for “a tiny, tiny fraction of the overall housing stock,” said Matt Curtis, director of government relations for the vacation-rental website HomeAway. There are more than 265,000 housing units in Boston, compared with about 2,000 listings on Airbnb, HomeAway, and FlipKey combined. -See the full Boston Globe article.
Mindfulness-Based Therapy for PTSD Trumps Usual Care Veterans with posttraumatic stress disorder (PTSD) experience clinically significant improvements in symptoms with a mindfulness-based therapy over and above those seen with a standard intervention, preliminary findings from a US study indicate. Compared with patient-centered group therapy, the researchers found that mindfulness-based stress reduction (MBSR) was associated with significant improvements in self-reported symptoms that persisted beyond the 9-week course and translated into clinically significant improvements in many cases. Although the results are promising and warrant further study, it was noted that the therapy did not improve rates of patients no longer classified as having PTSD on clinician assessment. "Among veterans with PTSD, mindfulness-based stress reduction therapy, compared with present-centered group therapy, resulted in a greater decrease in PTSD symptom severity," the investigators write. "However, the magnitude of the average improvement suggests a modest effect," they add. The research was published online August 4 in JAMA. Speaking to Medscape Medical News, Melissa A. Polusny, PhD, of the Minneapolis Veterans Affairs Health Care System, noted: "I think one of the interesting findings that wasn't particularly expected was that, while both the treatments resulted in improvements in what veterans described as their quality of life, gains in quality of life were maintained for veterans in the mindfulness-based stress reduction 2 months after the treatment." "But when the veterans ended present-centered therapy...their perceptions of their quality of life went back down to baseline, so those improvements weren't sustained for that group once they ended therapy. "I think that points to the idea that in mindfulness-based stress reduction, veterans are learning skills in being mindful that are helping them to have a different relationship with their symptoms, that those mindfulness skills are related to the improvements that they see in PTSD symptoms, depression, and quality of life," she added. She continued: "We found that the dropout rate from mindfulness-based stress reduction was only 22%, compared to the 30% to 50% we see with some of these other treatments." -See the full Medscape summary article.
What Makes People Gay? (An Update) And is Gender Dysphoria Persistent? Reporter Neil Swidey wrote an influential piece “What Makes People Gay?” that appeared in the Globe Magazine in 2005. Ten years later he revisits the state of the research, excerpted here.
There has been some real movement in the last decade, though, as usual for a field built on small, poorly funded and sometimes contradictory studies, the difficulty is in synthesizing all these fragments into a coherent framework. The difference that jumps out at me right away is the new appreciation for “fluidity.” The binary view of sexual orientation that dominated the field a decade ago has softened. Back then, there was real skepticism about men who reported being anything other than heterosexual or homosexual. This modest move away from the binary view of sexual orientation suggests something of a revival of the continuum advanced by Alfred Kinsey in 1948. His Kinsey Scale offers a numerical range of 0 to 6, with 0 being entirely heterosexual (and by far most common) and 6 being entirely homosexual. Despite the increased acceptance of non-straight individuals, the percentage of the population that identifies as heterosexual has remained remarkably stable, around 95 percent or more. A 2011 review of nine large, reputable surveys found that about 3.5 percent of Americans identified as gay, lesbian, or bisexual. Researchers suggest, however, that those more flexible “Kinsey 1s” or “mostly straights” likely identify as heterosexual in these types of traditional surveys. After all, that same 2011 review found that 11 percent of Americans acknowledged at least some same-sex attraction, and 8 percent reported having engaged in same-sex behavior. And for women, this growth in reports of same-sex experience has been particularly dramatic, with one British study showing it rose from 4 percent in 1990 to 16 percent in 2010. New Attention to Those Who Identify as Asexual Another group that is attracting lots of research attention in 2015, after being essentially ignored in 2005, is asexuals. Lori Brotto of the University of British Columbia tells me she initially assumed people claiming to be asexual were like the men and women she treats in her clinic for low sex drive. But the more time she spent studying them, the more she came to appreciate that they make up a distinct, if very small, category. Asexuals report no history of crushes or sexual attraction, even during adolescence, when hormones are typically raging. Also, unlike those people whose low libidos cause them distress, asexuals say that if a pill were available to give them desire, they would decline to take it. Born Gay A decade ago, I learned that the most promising frontier in sexual orientation research didn’t focus on genes or the environment in the traditional sense, but rather the environment of the womb. Crucially, the fetal brain is being organized, with sex hormones keeping it in its default female state or sending it along the male path. Researchers have suspected for some time that the exposure to sex hormones during this organizational period plays an important role in the baby’s ultimate sexual orientation. Here there are all kinds of tantalizing clues. But the indicator that has become more and more robust over the years is the so-called fraternal birth order effect, or FBO. In 1996, Canadian researchers Anthony Bogaert and Ray Blanchard showed that the more older brothers a man has, the more likely he is to be gay. If a man with no older brothers has a 2 percent chance of being gay, that number scales up with each older brother, so that a guy with four older brothers would have a 6 percent chance of being gay. In the two decades since, that finding has been consistently replicated cross-culturally, and numerous alternative explanations for the effect have been ruled out. It’s about as solid an effect as any in this often murky world of sex orientation research. In 2006, Bogaert, of Brock University in Ontario, scored yet another victory for nature over nurture by showing this FBO effect applies even to biological brothers who had been raised in separate households, but not to adoptive brothers raised under the same roof. But why? He and Blanchard have offered the maternal immune hypothesis, suggesting that a pregnant mother develops an immune reaction to something important to male fetal development, and this reaction becomes more likely with each male pregnancy. They believe the mother generates an antibody that binds to a protein produced on the fetus’s Y chromosome involved in the development of heterosexual attraction, altering that piece of the differentiation process. Yet even this robust FBO effect has some serious limitations. It applies only to gay men, not lesbians. And, interestingly, although gays are lefthanded at a higher rate than straights, this FBO effect applies only if the gay younger brother is righthanded. (Handedness is set before birth, Bogaert tells me, noting that prenatal images of thumb-sucking preferences beautifully match the general population breakdown of 90 percent righty, 10 percent lefty.) Birth order hardly tells the whole story. The portion of men whose homosexuality can be attributed to the FBO effect is estimated to be between 15 and 29 percent. So how can we integrate all of these disparate pre-birth signals into an explanation that makes sense? For help, I go back to Qazi Rahman, a psychologist at King’s College in London. When we last spoke a decade ago, he and his coauthor were just finishing their book Born Gay. He had included a question mark after that same title in his earlier research, but today he is only more convinced that the punctuation hedge isn’t necessary. “Some gay people owe their sexual orientation to the fraternal birth order effect, others to genetics, some to prenatal hormonal factors or other neurodevelopmental factors,” Rahman says, “and many to interactions between these.” Transgender Children- is Gender Dysphoria Persistent? Probably the most dramatic change in public attitudes in recent years has been around the issue of transgendered children. When I wrote my 2005 story, the concept of trans kids was such a foreign one that I didn’t include it because my editor and I agreed we didn’t have enough space for a sufficient explanation. These days, many children with gender dysphoria begin taking pubertal blockers (which have not yet been approved for this use by the Food and Drug Administration) around 10 or 12 before moving on to cross-sex hormone injections starting in the 13 to 16 age range. For children whose gender dysphoria will persist, this aggressive treatment seems both prudent and humane. Research shows that if the dysphoria lasts well into adolescence, it’s very likely to continue into adulthood. Presumably, the earlier that person is able to transition to his or her target gender, the better the odds are for reducing elevated rates of depression and suicide. However, there is simply no accurate way to predict which children will see their gender dysphoria persist and which ones will see it go away. Some researchers, including Eric Vilain and Mike Bailey, worry that the dramatic shift in public opinion may be persuading parents the only compassionate response is to get on the rapidly moving trans train of blockers and (effectively irreversible) cross-sex hormones and genital surgery, when that approach might not turn out to be in their child’s best interest. More recent studies continue to suggest that most gender dysphoric kids will outgrow their gender-bending behavior — with the majority of the boys turning out to be gay or bisexual — and have no lingering gender identity confusion. A 2011 review of research published in the International Journal of Transgenderism found that, of children who exhibited gender dysphoria, it persisted into adulthood in only 6 to 23 percent of boys and 12 to 27 percent of girls. For parents, deciding how to respond to a child’s distress about being in the wrong body can be a brutally tough call. -See the full Boston Magazine article.
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