Highlights

• Internet Subsidy
• SNAP VM Prompts Change
• TPS Extended for Some
• Social Security Disability Reviews
• New College Savings
• Guide for LGBT Couples Thinking Marriage
• Accessible Workouts
• First Step Employment Program
• MV & Nantucket Medical Transport

Sections

• Program Highlights
• Health Care Coverage
• Policy & Social Issues
• Health & Wellness
• Of Clinical Interest

Questions, comments about the newsletter? Contact Ellen Forman, x6-5807.

In response to advocates' and the Legislature's advocacy efforts, the state Executive Office of Health and Human Services has delayed the Health Safety Net regulatory changes that were set to go into effect on April 1 until June 1.

As previously reported (Health Safety Net Restrictions Planned for April 1st, MGH Community News, February 2016), the cuts include reducing financial eligibility limits, starting deductibles at lower income levels and dramatically reducing retroactive coverage.

Advocates are actively working to reverse these cuts or at least ameliorate their impact, so watch this space for possible future changes.

FCC Approves Broadband Subsidy for Low-Income Households

The Federal Communications Commission this month approved a $9.25 monthly broadband subsidy to help millions of low-income households connect to the Internet, in a move aimed at bridging the digital divide.

The approval, which comes as part of the reform of a fund known as the Lifeline program, is the latest push by the FCC to treat broadband like a public utility. High-speed Internet has become increasingly crucial to households, used for doing homework, finding and maintaining employment, and completing other basic tasks.

Starting in December, those eligible for programs like the Supplemental Nutrition Assistance Program and tribal and veterans benefits will be able to apply for the subsidy. The funds can be used for wireless or fixed-wire broadband.

Families will only be able to receive one subsidy per household, which they can put toward paying for home Internet, phone or smartphone service — or a combination of the three under the program. Many current participants receive free basic cell service because the $9.25 subsidy covers the entire cost, but they would have to cover the remaining cost of a broadband connection. 

Companies like Comcast, which offer their own discounted service for the poor, say price is not the only thing keeping people from obtaining Internet service. Because some individuals do not see a need to use the Internet, the company says, subsidies should be offered alongside literacy training and outreach. 

Today, 1 in 5 people do not have access to broadband at home, and the vast majority of those disconnected are poor. Only about 40 percent of people earning less than $25,000 a year can afford broadband while 95 percent of all households making over $150,000 have high-speed Internet at home, the FCC said.

-See the full Boston Globe article. Additional information from TheHill.com.

The state’s public health commissioner recently announced that she is shoring up the beleaguered ranks of nursing home inspectors, having hired 19 newcomers since July and actively pursuing 10 more, amid concerns about serious gaps in state oversight.

“We need to be fully staffed. We have had a lot of vacancies,” Dr. Monica Bharel, the health commissioner, told the Public Health Council, an appointed board of physicians, academics, and consumer advocates that sets health policy.

Bharel said her agency now has 77 nursing home inspectors. Even after it fills the 10 remaining vacancies, the health department aims to hire an additional seven program support staffers. Bharel did not explain how the cash-strapped department was able to hire so many new inspectors, but a spokesman later said the agency is using existing money to cover the cost.

At the same time, Bharel said her agency this week overhauled its process for scrutinizing companies and executives seeking nursing home licenses.

The state health department’s stepped up monitoring includes a new unit, the Supportive Planning and Operations Team, which will be launched July 1, according to Bharel, and which will conduct surprise inspections targeting problem facilities.The inspections will be in addition to annual visits to each nursing home, she said. That unit, dubbed the SPOT team, will focus on retraining management and staff at struggling nursing homes, Bharel said. The department is hoping to pay for this team with fines collected from nursing homes, but still needs federal approval for this financing plan, Bharel said.

The actions come as advocates question the state’s commitment to ensuring the health and safety of the thousands of elders and disabled residents living in 419 Massachusetts nursing homes.

A series of Boston Globe stories last year showed how an out-of-state chain had assembled a string of nursing homes with scant attention from regulators. That company, Synergy Health Centers, has been beset by reports of substandard care and short-staffing.

“These are good strides in the right direction, but there’s a lot more work that needs to be done here,” Janice Nigro, a Wakefield elder law attorney, said after Bharel’s presentation.

Nigro is among a group of attorneys trying to unearth information about a backlog of complaints filed against Massachusetts nursing homes. She said the attorneys often hear from clients who filed complaints with the health department but never heard back from anyone.

Bharel said her agency received 1,768 consumer complaints about nursing homes last year and an additional 9,947 reports filed by nursing homes about a wide range of problems in their facilities, from issues with food to more serious concerns. She said the complaints are “triaged through a two-tiered review process,” and that inspectors visit the nursing homes “when indicated.” Bharel said an undetermined number of complaints may be forwarded to the state attorney general’s office or the Executive Office of Elder Affairs.

Bharel did not detail how many of the 11,000-plus reports and complaints remain pending.

The department’s pledge to beef up nursing home oversight includes collection of more information about the people and companies applying for nursing home licenses, Bharel said. That information includes details on the criminal and financial backgrounds of the executives running a nursing home’s affiliated realty property companies. The search covers records in Massachusetts and other states.

Affiliates are routinely established to shield nursing home companies from liability if they are sued. An affiliated company legally owns the nursing home property, which makes it harder for someone who is suing to get access to a nursing home’s money, according to attorneys who represent patients who have been harmed.

A recent Globe review of 2014 nursing home finances found the homes often report they are losing money even as they direct cash to these subsidiaries and to help pay executives’ six-figure salaries.

-See the full Boston Globe article.

Sober homes have been around for years, most operating with little, if any, financial help from the state and nonprofit groups. There are few regulations for opening one, and the state doesn’t have authority over them. But as Massachusetts wrestles with a deadly outbreak of heroin and prescription drug abuse, increasing demand for long-term recovery beds has health officials turning to group homes for much-needed housing.Gov. Charlie Baker has called for expanding access to long-term care to battle opioid abuse, which is claiming an average of four lives a day in the Bay State.

State lawmakers passed a bill in 2014 that encourages sober homes to become “voluntarily certified” to ensure that they meet basic health regulations, aren’t overcrowded and don’t take advantage of tenants by charging excessive rent.

To become certified, sober home operators must train and undergo a yearly inspection of their properties. To date 25 homes have done so. Another 60 homes have applied for certification. Those not certified by this September won’t be allowed to accept referrals from state prisons, drug courts or detox facilities.

Richard Winant, president of the Massachusetts Association of Sober Housing, who runs a certified home in Wakefield, calls the state’s stake in sober homes a “work in progress.”

He said there should be a formal grievance procedure, for example, or else operators may appear legitimate but take advantage of tenants.

Another concern is that if the state doesn’t certify enough homes, a backlog of referrals could build, leaving some addicts with no place to go.

Overall, Winant said the attention being paid to sober houses will help improve their public image. They routinely face resistance from local officials and neighbors, many whom don’t understand what they do, he said.

“Drug addicts, needles and the police -- that’s the perception,” he said. “But the reality is just the opposite.”

Some sober home operators welcome the increased attention but also worry that the state’s involvement could lead to over-regulation and bureaucracy.

-See the full Eagle Tribune article.

Special YouTube Videos on how to open and get info on DTA's My Account Page (MAP):

Mass Law Reform Institute’s  AmeriCorps volunteer Zack Ezor has now created two YouTube videos to help you and your clients understand how to create a MAP and what documents and information your clients can find on it. 

Knowing how to set up and use the MAPs can be an essential tool for you and your clients to find out what the status of the SNAP or cash benefits are, what documents DTA has received and processed (or not processed) and to down load notices and forms sent, including recent recertification forms and interim reports. 

• Here's the MLRI webpage: www.masslegalservices.org/MAP with all links
• Video on how to create a MAP.
• Video on what you can view and where to identify case issues 
• And here is MLRI's updated SNAP Advocacy Tools web page with an updated TIPS to Protect your SNAP packet! 

DTA Updates the Interactive Voice Response (IVR) as of April 25

In preparation for the major changes associated with the implementation of the DTA Connect mobile applications, new voice mail enhancements were activated on Monday, April 25 (Phase 1).  Below is a brief summary of the changes:

The menu prompts have changed – many of them are shorter and are more direct in accessing the services needed.  For instance, after indicating the preferred language, the caller will be provided with three choices:  Authenticate with the SSN & year of birth as an existing client; not an existing client; other – such as Hearings, Fraud, Domestic Violence, Disability, etc.

In addition to the menu prompts, when a caller authenticates, they receive a verbal summary of the status of their current case – that is, the status (active, pending, closed); benefit amount, benefit issuance date and date of receipt of the last document in EDMC.

DTA will also generate reminder calls for individuals who have not returned documentation for recertification as well as reminders for scheduled interviews.

DTA anticipates that the shortened menu structure will provide easier access to the information callers are seeking and the benefit information will answer many, albeit not all, questions.

Download the Flyer.

-From: Food/SNAP coalition listserv notice, on Behalf of Pat Baker, MLRI, April 20, 2016.

USCIS announced on March 22 that it would be extending Temporary Protected Status (TPS) for nationals of Guinea, Liberia, and Sierra Leone due to the ongoing effects of the Ebola outbreak in those countries. Individuals who successfully apply for an extension of their existing status will have TPS through November 21, 2016. Nationals of these countries currently on TPS will need to submit an I-821 and I-764 plus filing fees in order to request an extension of their status and will have until May 23, 2016 to submit an application for extension. For more information and links to the necessary forms, please visit the USCIS website.

-From Federal Updates, MIRA Coalition e-mail, April 01, 2016.

Social Security Reminder: How We Review Your Disability Benefits

From the Social Security Administration’s Social Security Matters blog.

 When you receive disability benefits, Social Security will periodically conduct a review of your condition to make sure you still qualify for blind or disability benefits.

When your case comes up for review, we’ll send you a letter asking you to come to your local Social Security office. We’ll ask you about how your medical condition affects you and whether it’s improved. We’ll also ask you to bring information about your medical treatment and any work you have performed since Social Security decided you were disabled.

A disability examiner from your state’s Disability Determination Services will request reports from your medical providers, and will carefully review all the information in your case. If the medical evidence is not complete or current, we may ask you to have a medical exam at no cost to you.

Social Security conducts a disability review of your case approximately every three years depending on the nature and severity of your medical condition and whether it’s expected to improve. If we don’t expect improvement, we’ll review your case every seven years.

When we conduct a disability review, if we find that your medical condition hasn’t improved and is still preventing you from working, you’ll continue to receive benefits. Your benefits only stop if the evidence shows your medical condition has improved and you are able to work regularly.

If you disagree with our decision, you can appeal and ask us to look at your case again. When we notify you of our decision, we will explain how you can appeal that decision.
You can visit us online for more information, or read our publication What You Need to Know When You Get Social Security Disability Benefits.

- From How We Review Your Disability Benefits, Social Security Matters, April 14, 2016.

State officials are touting a new program they say could help Massachusetts students save an average of about $5,000 off the cost of obtaining a bachelor’s degree.

The initiative, dubbed “Commonwealth Commitment,” will give qualifying undergraduates a 10 percent rebate at the end of each semester they complete. Students would earn an associate’s degree at one of the state’s community colleges, then transfer with a tuition waiver to a four-year Massachusetts state university or the UMass system. In addition, their tuition and mandatory fees on any campus would be frozen at the date they start the program.

Students would need to maintain a cumulative grade point average of 3.0 or higher. To continue in the program, students must earn an associate degree from the community college in 2 1/2 years or less, and complete their bachelor's degree at any state university within 4 1/2 years.

The program will start this fall with 14 available majors. Ten more will be added in fall 2017.

The plan, which state officials say is the first of its kind in the nation, was announced this month in Lowell by Gov. Charlie Baker, Lt. Gov. Karyn Polito and public higher education officials. It was developed by faculty members and administrators from all three branches of the state’s public higher education system: the University of Massachusetts, state universities such as Worcester State and community colleges such as Middlesex.

“This program was designed to decrease the cost of a college degree and accelerate on-time completion for students across the Commonwealth, creating more opportunities and helping more people get into the workforce with the skills they need,” Gov. Baker said in a statement. “The Commonwealth Commitment will make it even easier for students to go to school full-time and begin their careers with less debt and we are pleased that our higher education officials have worked collaboratively to make this program a reality.”

 “Our hope is that through programs like the Commonwealth Commitment, not only will students get the benefit of a lower cost degree, but also be able to fill more of the high-demand job of the future, including in STEM,” Polito said in a statement.

Most engineering majors and nursing degrees are not included, state officials said, because of their high costs and the high demand for them.

See the website for additional information, including FAQs and Program Terms.

-See the full WBUR story.
-See the full  WGBH story.

More than half of all LGBT older people are afraid they won't have enough money for retirement. SAGEFinance, a new national effort to improve financial security for the LGBT community, helps people prepare for the future.

Download SAGE's new financial literacy toolkit, Talk Before You Walk: Considerations for LGBT Older Couples Before Getting Married.

- From SAGE (Services and Advocacy for GLBT Elders), April 25, 2016.

Scammers are trying to get personal information from people by pretending to help with applications for disability benefits and claims. A recent alert from the Social Security Inspector General warns of this phishing scam, and — whether or not you’ve started an application for benefits — these scammers could contact you. They’re taking a shot in the dark, hoping that you have started an application, and hoping you’ll give them a little more info over the phone. To “complete the process,” they might ask you to give, or confirm, your Social Security number or bank account numbers.

If scammers get your information, you could face identity theft and benefit theft. Pressured to provide your information? That’s a sure sign of a scam. Hang up immediately and report it to the Social Security Fraud Hotline and the FTC.

If you have questions about disability benefits, or get calls offering help with them, call the Social Security Administration at 1-800-772-1213.

- From: https://www.consumer.ftc.gov/blog/scammers-offering-help-disability-applications

State regulators are investigating whether nurses falsified patient records, and then lied about their actions, at a troubled Wilmington nursing home where two residents died, according to the Massachusetts Department of Public Health.

That agency has referred the case to the Board of Registration in Nursing, which has the power to strip nursing licenses.

The investigation highlights a troubling and all-too-common problem at nursing homes — inconsistent and sometimes manufactured nursing notes — say attorneys who have represented families of patients harmed at other facilities.

Federal regulators last week closed their investigation of Woodbriar Health Center, saying the nursing home submitted acceptable plans to correct significant health and safety problems linked to two patient deaths since December. But documents from that investigation indicate inspectors doubted the veracity of nursing notes Woodbriar submitted to the health department during its review.

The company that owns the nursing home, Synergy Health Centers of New Jersey, did not respond to a request for comment.

The federal Centers for Medicare & Medicaid Services fined Woodbriar $288,400 for health and safety violations in connection with the February patient death and a resident death in December.

Three families with relatives in Woodbriar said staff members in recent weeks have worked hard to address problems at the facility.

“I truly have noticed a huge improvement in the past few weeks,” wrote one family member who asked that her name not be used because she worries it will affect her mother’s care. “I have also noticed a lot of new staff who display a much better understanding of dealing with the patients than I had previously observed.”

-See the full Boston Globe article.

AccessSport America (ASA) offers personal training sessions year-round for people with a variety of disabilities every Monday and Friday 9:00 a.m. to 2:00 p.m. a the YMCA in Oak Square in Brighton. It is accessible by T. Financial aid is available, but additionally their goal is to get you to work out as often as possible; thus the fee is negotiable if you commit to two sessions a week.

Ross Lilley founded ASA in 1995. He is an innovator in creating adaptive equipment for many sports, which are custom fit to an individual’s disability. They have developed an adaptive device that works with any treadmill which simulates gait training.

-Adapted from AccessSports America by Mary Jane Fietze, Disability Issues, Volume 36, no 1, Winter 2016.

For more information: www.accessportamerica.org

Community Living Options (CLO) is a private-pay geriatric care management service that serves the Greater Boston Area and the North Shore. The program also provides home care services at a discounted rate to Somerville and Cambridge residents. CLO is program of Somerville-Cambridge Elder Services (SCES).

CLO offers a variety of solutions for common post-discharge needs, such as insurance advice, selecting care providers, and in-home chronic disease management. Staffed by licensed social workers, CLO monitors the patient’s health, acting as a liaison between the family and health care providers ..

Sample services might include

• Ensuring patients attend medical appointments, from scheduling to escorting them to appointments
• Arranging home modifications in preparation for discharge
• Facilitating difficult family discussions about care decisions
• 24/7 helpline, including holidays

Members benefit from CLO’s unique relationship with the non-profit mission of SCES. If hired for a home assessment, CLO will assess for free and low-cost services including those available from SCES. Additionally, CLO clients who are residents of Boston, Somerville or Cambridge may hire from existing SCES home care providers. CLO clients from other areas can take advantage of SCES’s pre-existing relationships with other staffing agencies. CLO also claims to charge less than the average Boston area hourly rate.

Through its Pathway to Employment initiative, Goodwill offers a range of job training programs, support services and placement and post-placement services for individuals with barriers to employment. Services are accessible for individuals with disabilities, and are focused on placing them on a path to employment  and independence.

Participants are recruited on an ongoing basis throughout the year. Many are referred through government agencies such as the Massachusetts Rehabilitation Commission, the Massachusetts Department of Developmental Services, and the Department of Transitional Assistance. Others are referred by one-stop career centers, churches, and community groups. Participants also come to Goodwill through word-of-mouth recommendations of family and other community members.

After an initial screening for skills and interest. Individuals are assigned a case manager, who helps them develop an individual training and employment plan, and choose trainings and supports. Case managers meet with participants regularly and participants move through the employment services components at a pace consistent with their individual needs.

The First Step Job Readiness training course runs numerous times throughout the year, for four weeks, Monday-Friday from 9am to 3pm, and then students are enrolled in a 3-5 week internship.  Download the First Step flyer.

The schedule and duration of training for those in longer term, on-the-job training programs in retail, housekeeping and maintenance, food service and light assembly are more individualized and services are offered in accordance with an individual service plan.

Placement services are made available as soon as an individual is nearing readiness for competitive employment in the community. Following placement, post-placement supports are provided for a year or more, with career services available at Boston Career Link thereafter.

For more information, please email Jessica Castro at jcastro@goodwillmass.org or call 617-541-1276.

Note: We previously reported on Goodwill’s  Human Services Employment Ladder Program  (HELP), (MGH Community News, June 2015), which runs quarterly, for eight weeks, Monday-Friday from 9am-3pm. Download the HELP flyer.

NOTE: funds are exhausted for FY 16. IF new funds are appropriated for FY 17 (begins July 1) Martha's Vineyared Community Services expect to be able to accept applications starting in August.

Introduced in January, a new grant-funded program can help patients from the islands with transportation expenses for medical treatment off-island. The Transportation Access Program (TAP)  is designed to help individuals and families with excessive travel costs due to long-term illness, health or mental health needs requiring services not available on the Islands, chronic illness that requires regular off-Island appointments, and acute health emergencies. The program is meant to provide help when other assistance like health insurance coverage has been exhausted, or other transportation and assistance is not adequate or appropriate.

TAP is available through Martha’s Vineyard Community Services.  If approved, the program will pay up to $750 per year for transportation and hotels for patients  who live on Martha’s Vineyard or Nantucket who need to travel off-island for medical care.

Completed MV applications may take up to 5 business days to process. Though their website says “Please contact us ASAP if this is an emergency so that we can better assist you”.

Funding was made available through state Rep. Tim Madden and the state Executive Office of Health and Human Services.

More information and applications.

-Thanks to Martha Southworth for sharing this resource.

Without significant changes, Baker administration officials say, the costs of MassHealth will continue to grow faster than state revenues, squeezing out other important programs. MassHealth accounts for 40 percent of the state budget. Their solution is to move MassHealth away from a system that predominantly pays for each medical service provided. Instead, the administration wants to more widely implement a model known as accountable care, in which doctors and hospitals are paid set budgets to treat patients.

The idea is to compensate health care providers to coordinate care for patients, which could help cut much of the waste and unnecessary hospital visits that bloat the costs of the current fee-for-service system. State and federal officials and many analysts argue that accountable care (also called alternative or value-based payment models) can improve patient care even while containing spending. In moving away from fee-for-service, MassHealth will follow Medicare, the government program for the elderly, and commercial insurers, which have already begun to adopt new payment models.  

The shift will affect MassHealth patients in ways big and small. The transition to accountable care is likely to lead to narrower provider networks that give patients less choice over where they can see specialists. State officials say patients will be able to choose their primary care physicians and whether they want to participate in accountable care models. But their goal is to move the vast majority of MassHealth members into such models, by convincing members the new models will provide better, more coordinated care.

The state is already experimenting with accountable care, including in a pilot program called One Care, which provides extra health benefits to some of the most complex patients on MassHealth in an effort to avoid costly hospital visits.

The redesign of MassHealth, scheduled to begin in October 2017, is dependent on federal funding, which is slated to run out next summer. State officials are seeking an agreement with federal officials for five years of funding.

The administration’s plan generally has the support of the health care industry, though many people are waiting to read the details. Lynn Nicholas, chief executive of the Massachusetts Hospital Association, said her group supports the state’s move to accountable care, as long as hospitals are paid adequately under the new models. Hospitals have long complained that Medicaid payment rates fail to meet their costs of providing care.

Audrey Shelto, president of the Blue Cross Blue Shield of Massachusetts Foundation, a research organization endowed by the Blue Cross insurance company, said the move to accountable care is necessary.“The current fee-for-service system can result in very disjointed care with a variety of providers, none of whom communicate with each other,” Shelto said. “Any movement from paying for volume and focusing on paying for value is the right thing to do.”

-See the full Boston Globe article.

Recently, the Centers for Medicare & Medicaid Services (CMS) Innovation Center proposed a demonstration to test new strategies to pay for medications that are covered under Part B. Most prescription medications are covered under Medicare Part D, but some (mostly those administered by a doctor) are paid for under the outpatient Part B benefit.

Common Part B prescription drugs treat cancer, macular degeneration, anemia, and arthritis. Part B medications tend to be very expensive—in 2013, Medicare and its beneficiaries spent $19 billion on Part B prescriptions. The proposed demonstration is designed to evaluate different strategies for pricing medications to discover the policy that will best ensure that people with Medicare receive the highest value Part B medications available.

Currently, Medicare pays for Part B prescription drugs according to a simple formula—the Average Sales Price of the prescription drug plus a 6 percent markup to cover the cost of handling and administration. The proposed demonstration has two phases. First, the Innovation Center will alter the percentage markup to a flat handling fee plus 2.5 percent of the cost of the medicine. CMS hopes that this will decrease the incentive for providers to choose more expensive medicines under the current payment strategy.
In the second phase, the Innovation Center will test strategies to adjust the base price to reflect the medication’s value to beneficiaries. These include:

• reducing the base beneficiary cost-sharing of 20 percent for high-value options;
• setting a standard price for medications that function similarly;
• paying more for a medication that is used to treat a condition when it has high effectiveness, and less for the same medication that is used to treat illnesses when it may be less successful; and
• obtaining rebates or refunds from pharmaceutical companies if medications are less effective than expected.

As a long-time advocate for solutions to lower the cost of Part B medications, Medicare Rights supports the proposed demonstration and will provide comments to the Innovation Center on how to proceed with testing to ensure that beneficiaries continue to receive the treatments best suited to their needs.

- CMS Proposes New Ways to Pay for Part B Covered Medications, Medicare Rights blog, March 31, 2016.

A child’s birthday is supposed to be a happy occasion. But for parents of children with autism, one birthday — the 22nd — is often a source of dread.

That’s the day publicly funded special education programs in Massachusetts and most states come to an end, and with them, so many other things. Jobs and volunteer opportunities that were set up by the school — corralling shopping carts at a grocery store, maybe, or helping first-graders recycle — are typically over. Generally gone, too, are those social connections, the familiar teachers, and other supportive players. For young adults who’ve been living in a residential program, it’s usually time to move out.

Turning 22 is such a significant milestone for individuals with autism and other disabilities that there’s even a state program called “Turning 22” that helps families transition into the adult service system.

The challenge — and the differences in services and funding for children versus adults — was summed up by Susan Senator , a Brookline mother of a 26-year-old son with severe autism, Nat, and a nationally recognized author.

 “Basically, pre-22 you are wrapped in the inclusive and proud American educational system and the accompanying mandated funding,” said Senator, who just published “Autism Adulthood: Strategies and Insights for a Fulfilling Life.”

“Post-22,” she continued, “you have the thin, stretched-out Medicaid...safety net [which pays for weekday rehabilitation programs] and maybe a few other supports — if you are able to advocate for them.”

Rick Glassman, director of advocacy at the Disability Law Center, said more work needs to be done to include people with other developmental disabilities for adult services at the Department of Developmental Services. But, he added, the state’s Autism Omnibus Bill — signed in 2014 — has made things somewhat easier for families by changing the eligibility criteria for department services to include adults with autism. Before the autism bill, he said, "there was no agency that had a specific mission to provide services for adults with autism."

Parents of young autistic adults can and do line up new situations for their children, of course — a group home, for example, or a job at a company that hires individuals with special needs. But figuring out which federal or state agencies might provide funding for housing or transportation or services isn’t easy. Nor is advocating for that money or finding a good housing situation and something interesting for the young adult to do during the day.

The stakes for lining up appropriate housing and engaging daytime activities could not be higher, said Senator, the author. The prospect of a child having nowhere to go or killing time in day rehab setting doing make-work crafts “is not only depressing,” she said, “but terrifying. You might be looking at regression” of skills that were learned in school — such as self-calming, communication, and reading. If they are not reinforced, Senator said, “they are at risk.”

All is not gloomy. With research, effort, and doggedness, families can turn the feared “cliff” into a “bridge,” she added.

-See the full Boston Globe article.

The employees who do much of the backbreaking work in Massachusetts nursing homes are lucky if they make $13 an hour — many make considerably less. Nearly half of those who bathe, feed, and care for residents need food stamps or other government assistance to survive.

Now, nursing home owners are lobbying for millions of dollars in Medicaid money to boost compensation for poorly paid workers, a campaign that has won the support of powerful advocates. But it will be up to an overwhelmed state agency to make sure the money really goes to workers, and that is fueling concerns, even among backers of the proposal.

The trade group for the nursing home industry, the Massachusetts Senior Care Association, is urging lawmakers to earmark $90 million in the state budget for the worker pay campaign, and suggests a complex formula for how the money should be raised and spent.
Nursing home owners have pledged to devote most of the money to workers.

“We are calling on state leaders to invest in our workforce at a minimal cost to the state,” Ned Morse, the association’s president, said in a statement. “A living wage will help us retain dedicated staff, which maintains quality of life for our residents.”

The union that represents workers in some of the state’s 400-plus nursing homes recently joined with nursing home owners to fight for the increase after expressing earlier concerns. Leaders from 1199SEIU United Healthcare Workers East said they wanted assurances most of the money will go to higher wages for workers.

The nursing home association said many owners are having trouble recruiting and retaining workers for these jobs because of low pay, and owners say a state freeze on Medicaid payments to nursing homes since 2009 is the primary reason wages have stagnated.

The nursing home association’s plan calls for the state’s health and human services department to monitor the program. It is not clear how the health agency, which has weathered cutbacks in recent years, would manage oversight of the wage initiative. The last batch of annual nursing home financial reports to be audited by the state were from 2010.

A Globe review of 2014 nursing home finances found facilities frequently report they are losing money. But records from companies affiliated with the nursing homes show they are directing cash to subsidiaries and to help pay executives’ six-figure salaries.

-See the full Boston Globe article.

In a state where whites make up two-thirds of criminal convictions, one pocket of the criminal justice system – drug court – is overwhelmingly white. According to the trial court, few minorities were enrolled in drug courts in 2015. A sample of drug court participants found that 87 percent were non-Hispanic white.

Massachusetts has been steadily expanding the use of drug courts. Today, the state has 22 courts where adults convicted of a crime related to their substance abuse enter intensely supervised probation and treatment instead of jail. They check in regularly with a judge and work with a team that includes a probation officer, a clinician, a defense lawyer, law enforcement and others.

The trial court is beginning work with a University of Massachusetts research center and the state probation department to figure out, as part of an evaluation of specialty courts, why drug courts are so heavily white.

Peter Elikann, a Boston criminal defense lawyer and chairman of the Massachusetts Bar Association's criminal justice section, said if the 87 percent figure is true, he considers it "an area of very serious concern."

The state should encourage more people to go through drug courts, Elikann said, because they are effective. National statistics show 75 percent of drug court graduates remain arrest-free for two years after leaving the program, and drug courts reduce crime by up to 45 percent compared to other sentencing options.

"You want to encourage more participation in drug court because with a lower recidivism rate, the public safety of law-abiding citizens is better protected," Elikann said.

-See the full MassLive article.

Owners of assisted-living facilities are lobbying lawmakers for authority to provide several highly sought medical services — a campaign that is sparking concern among patient advocates and dividing the industry.

Unlike nursing homes, which provide round-the-clock medical care by nurses, assisted-living centers are designed and regulated in Massachusetts as private apartments that offer assistance with daily activities, such as bathing, cooking, dressing, and managing medications. Such facilities are home to roughly 14,000 residents in Massachusetts.

Proposed legislation would allow assisted-living facilities to provide limited medical services that include injections, catheter replacement, applying medication and sterile dressing for wounds and skin problems, and administering oxygen to patients with serious ailments.

Supporters say the changes would allow a growing number of elderly residents to live more independently and avoid nursing homes by receiving medical attention in their own assisted-living apartments.

But opponents worry the Executive Office of Elder Affairs, which regulates the state’s 241 assisted-living centers, may not have the capacity to safely monitor the proposed medical care. The agency has struggled in the past to address consumer complaints because of a lack of staff.

Many states regulate assisted-living residences as health care facilities. Massachusetts remains among a handful that still consider the facilities more similar to apartment living. While current state rules bar the facilities from offering medical procedures, assisted-living residents can hire visiting nurses to provide more skilled care.

James Fuccione, director of a trade association that represents home care companies, said that if assisted-living facilities are allowed to offer medical services, state oversight of the industry should be strengthened and shifted to the Department of Public Health, which regulates nursing homes and other health care facilities.

The Massachusetts Senior Care Association, which represents assisted-living facilities and nursing homes, recently raised similar concerns in written testimony it submitted to lawmakers.

The 1994 law that established state oversight of assisted-living facilities envisioned residents moving on to nursing homes as they became more frail. But many elders who once would have moved when their health declined are instead choosing to remain in assisted living, often because the cost is significantly less.

The state elder affairs agency last year updated some rules to reflect the shift in population, mandating expanded training for assisted-living facility workers and requiring detailed emergency evacuation plans. But regulators backed off one of the most hotly contested provisions, which would have prohibited assisted-living facilities from accepting residents, or allowing them to remain there, if they require more than 90 consecutive days of skilled nursing care provided by a visiting nurse.

-See the full Boston Globe article.

Suicide in the United States has surged to the highest levels in nearly 30 years, a federal data analysis has found, with increases in every age group except older adults. The rise was particularly steep for women. It was also substantial among middle-aged Americans, sending a signal of deep anguish from a group whose suicide rates had been stable or falling since the 1950s.

The suicide rate for middle-aged women, ages 45 to 64, jumped by 63 percent over the period of the study, while it rose by 43 percent for men in that age range, the sharpest increase for males of any age. The overall suicide rate rose by 24 percent from 1999 to 2014, according to the National Center for Health Statistics, which released the study Friday.

Researchers also found an alarming increase among girls 10 to 14, whose suicide rate, while still very low, had tripled. The number of girls who killed themselves rose to 150 in 2014 from 50 in 1999. “This one certainly jumped out,” said Sally Curtin, a statistician at the center and an author of the report.

The data analysis provided fresh evidence of suffering among white Americans. Recent research has highlighted the plight of less educated whites, showing surges in deaths from drug overdoses, suicides, liver disease, and alcohol poisoning, particularly among those with a high school education or less. The new report did not break down suicide rates by education, but researchers who reviewed the analysis said the patterns in age and race were consistent with that recent research and painted a picture of desperation for many in American society.

“This is part of the larger emerging pattern of evidence of the links between poverty, hopelessness, and health,” said Robert D. Putnam, a professor of public policy at Harvard and the author of “Our Kids,” an investigation of new class divisions in America.

Policy makers say efforts to prevent suicide across the country are spotty. While some hospitals and health systems screen for suicidal thinking and operate good treatment programs, many do not.

“We have more and more effective treatments, but we have to figure out how to bake them into health care systems so they are used more automatically,” said Dr. Jane Pearson, chairwoman of the National Institute of Mental Health’s Suicide Research Consortium, which oversees the National Institutes of Health funding for suicide prevention research. “We’ve got bits and pieces, but we haven’t really put them all together yet.”

She noted that while NIH funding for suicide prevention projects had been relatively flat — rising to $25 million in 2016 from $22 million in 2012 — it was a small fraction of funding for research of mental illnesses, including mood disorders like depression.

-See the full Boston Globe article.

Artificial sweeteners are frequently used around the world to try to decrease glucose exposure, increase glycemic control, and decrease the tendency for obesity. In fact, what we are seeing is that these artificial sweeteners actually have a profound effect on metabolism by disturbing the microbiome. The ingested substance may actually be toxic due to the metabolic waste products that the bacteria generate and may knock off some other bacteria or may favor some of the bad bacteria, creating what we call intestinal dysbiosis. This dysbiosis drives a number of different pathways that can possibly increase risk of developing diabetes or exacerbation of glycemic control in patients with diabetes, and the same for obesity.

As we strive to try to improve these disease states, we actually may be making them worse. To conclude, buyer beware to patients with diabetes or obesity. These artificial sweeteners certainly may be a part, if not the crux, of the problem, and patients should discuss using these sweeteners with their physician. Physicians who recommend these sweeteners need to take a step back and really re-evaluate their recommendations, especially among their patients with diabetes and obesity. In fact, we may be dealing with a wolf in sheep's clothing.

-See the full Medscape commentary.

In a controlled pilot study, mindfulness-based exposure therapy (MBET) has again been shown to favorably modify thought patterns that perpetuate posttraumatic stress disorder (PTSD).

"People with PTSD ruminate, and rumination is all about not being present. It's all about focusing on something terrible that happened in the past or something frightening that will happen in the future, so these patients are stuck in a rut," Anthony King, PhD, assistant research professor, University of Michigan, in Ann Arbor, told Medscape Medical News.

"My personal bias is that mindfulness-based therapy has a big effect on rumination, and decreasing rumination allows people to experience the present moment, which expands their awareness of different possibilities and increases their ability to pay attention to things they have avoided in the past," he said.

The research was presented at the Anxiety and Depression Association of America (ADAA) Conference 2016.

Commentary

Commenting on this therapeutic approach for Medscape Medical News, Simon Rego, PsyD, director of psychology training, Montefiore Medical Center/Albert Einstein College of Medicine, New York City, told Medscape Medical News that both studies are preliminary and that more work needs to be done to explore the potential benefits of this particular approach in these patient groups.

Still, he said, the study by Dr King and colleagues was big enough to show that the dropout rate was impressively less than it was for the control group.

Both studies also showed that the mindfulness-based approach did improve symptoms of PTSD, which was of interest.

"The idea of using mindfulness is really appropriate here, as it helps people to redefine their relationship with their private experiences," Dr Rego noted.

"Whether you have people who get very uncomfortable with either memories of the traumatic event or physiological symptoms related to triggers of the event, or whether it's all about cravings ― in this case, it was with substance use, but in other studies, the approach could work for people who engage in binge eating or bodily-focused habits, where people get intense feelings of discomfort," Dr Rego said.

"Mindfulness teaches people not to suppress or fight their feelings but rather allows them to be present and create some space for themselves so they can redefine their relationship with cravings so that the cravings are not pushing them to do things. People can decide what to do in spite of the fact that the carvings are there."

-See the full Medscape summary article.

Interpersonal psychotherapy (IPT), which was developed initially for the treatment of depression, may have some efficacy in the treatment of other mental disorders, such as anxiety or eating disorders, new research shows.

"This is the largest meta-analysis ever conducted for IPT," coauthor Myrna M. Weissman, PhD, the Diane Goldman Kemper Family Professor of Epidemiology in Psychiatry at Columbia University Medical Center, in New York City, told Medscape Medical News.

"The take-home message from the analysis is that this is one of the reasonable, evidence-based treatments available, but, just as we see with drugs, the treatment works better for some patients and situations than others."

The study was published online April 1 in the American Journal of Psychiatry.

Important, Useful Study

The analysis adds a valuable look at the comprehensive evidence on IPT and helps highlight how it is most useful, commented Jeffrey Borenstein, MD, who is president and CEO of the Brain and Behavior Research Foundation, in New York City.

"I think it's an important and useful study, because we really want to be able to have evidence-based care, and this provides good information on IPT," he told Medscape Medical News.

"In particular, the findings about the prevention of new depressive disorders and relapse, as well as improved outcome of IPT with 10 or more sessions, are especially important for clinicians interested in using IPT," he added.

Future research should strive to better define the best candidates for IPT, Dr Borenstein said.

"While the analysis provides very good information, more work needs to be done, in particular, looking at the types of patients more likely to benefit from IPT vs other modalities," he said. "Our hope is to be able to develop biomarkers or other clinical determinants that would show a greater likelihood of response of treatment A vs treatment B."

-See the full Medscape summary article.

Nearly all doctors believe it’s important to talk with patients about the care they want in their final days. But most physicians work in systems that provide little help, and often they don’t know what to say or when to say it, according to a survey released this month.

The findings come as Medicare begins paying for end-of-life conversations and as many aging people fear spending their last days tethered to machines in a hospital. Questioning a representative sampling of 736 physicians in 50 states, the study identified an array of barriers, practical and emotional, to having the painful talk about care near death.

 “These conversations are just insanely difficult, whether in the emergency room or the hospital or the office,” said Dr. Ziad Obermeyer, an emergency physician and Harvard Medical School professor, who was not involved with the survey. Obermeyer’s own research has shown that physicians play a critical role in end-of-life decisions.
The new survey found three-quarters of physicians believe they are responsible for initiating end-of-life conversations. But almost half frequently or sometimes feel unsure of what to say.

Most doctors in the survey, 95 percent, support the Medicare reimbursement for end-of-life conversations, and 75 percent say the new benefit, which started in January, makes them more likely to have those conversations. But only 14 percent had billed for such conversations in the first two months.

Doctors should start talking in a general way with patients when they first seek any kind of care, said Dr. Anthony Back, codirector of the Cambia Palliative Care Center of Excellence at the University of Washington, which is connected with one of the survey’s sponsors. When the patient develops a serious illness, those conversations should resume, with more intensity as the illness progresses.

The early talks might focus on patients’ values and how they would like to spend their final days. After patients become seriously ill, doctors can start addressing specific questions, such as whether they will want a feeding tube or ventilator.

-See the full Boston Globe article.