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MGH Community News |
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MGH Community News |
| October 2022 | Volume 26 • Issue 10 |
Highlights
Sections
Social Service staff may direct resource questions to the Community Resource Center, Hannah Perry, 617-726-8182. Questions, comments about the newsletter? Contact Ellen Forman, 617-726-5807. |
Election day is November 8 – Helping Inpatients Vote
Patients who are admitted to a healthcare facility within 1 week of an election may use an emergency absentee ballot, but it requires a trusted person to make trips between the local election office and the hospital. Emergency Absentee Ballots Official Absentee Ballot Application (PDF) - Source and for more information https://www.sec.state.ma.us/ele/eleabsentee/absidx.htm
Fuel Assistance Programs are Open Home Energy Assistance (LIHEAP) online application is now open! The link goes to a Department of Housing and Community Development (DHCD) page where you can search for your local LIHEAP agency. For more information including fiscal year 2023 (this heating season) eligibility and a list of LIHEAP agencies, see the 2022 – 2023 Cold Relief Brochure. Also see FY2023 income eligibility and benefits level charts (rev 12/5/22)
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LIHEAP helps qualifying households pay for a portion of winter heating bills. The application is available online and in person, and free application support is available from local administering organizations. The LIHEAP application also qualifies households for three additional programs: the household water assistance program (LIHWAP), which may help eligible households pay a portion of their overdue water and sewer bills, the Heating System Repair and Replacement Program (HEARTWAP) and the Weatherization Assistance Program (WAP). - From Reminder of Available Resources, DHCD Partner Update, October 13, 2022 with additional material added.
Child Tax Credit Still Available with Simple form Through Nov 15 The Child Tax Credit is still available with a simple tax form through Nov. 15: It is not too late for people to claim their Child Tax Credit (up to $3600/child) or stimulus money ($1400/person) using a simple tax form. Now through November 15, applicants are still eligible to use this quickly completed (~15 minutes) form rather than filing a full tax return. - From Reminder of Available Resources, DHCD Partner Update, October 13, 2022 with additional material added.
SSI and Social Security Language Access Issue Brief The Supplemental Security Income (SSI) program is vital for extremely low-income people who cannot work due to age or disability. The maximum federal benefit is just $841 a month for an individual, which is supposed to cover rent, utilities, food, and other basic needs (though some states, including Massachusetts, supplement the benefit). Not only is the monthly benefit too low, but there are strict eligibility rules that keep people from being able to fully access the SSI benefit. Justice in Aging is authoring a series of briefs highlighting areas where SSI policies should be improved. - From New Issue Brief: Improving Language Access for SSI and Social Security Beneficiaries, Justice in Aging, October 12, 2022.
What to Know Now that Hearing Aids are Available Over the Counter Hearing aids are now available to buy over the counter across the U.S. The major shift in hearing health care is due to a recent rule change by the Food and Drug Administration, which in August cleared the way for the devices to be sold in retail stores without the need for buyers to see a doctor first. The move is being hailed as a win for those with hearing loss, which afflicts millions of people across the country, but experts say customers need to be cautious about what products they purchase as sales begin. "I hate to use the words 'buyer beware,' so instead it's 'buyer be educated' about what you're doing, what your needs are," said Kate Carr, president of the Hearing Industries Association, a trade group representing hearing aid manufacturers. You won't need a prescription or an exam to buy a hearing aidThe new rule applies to products for adults who believe they have mild to moderate hearing impairment. That could include people who have trouble hearing in groups or on the telephone, who need to turn up the TV volume louder than others and whose friends and family say they regularly don't understand speech or ask others to repeat themselves, according to the nonprofit Hearing Loss Association of America. The over-the-counter hearing devices won't be suitable for children or people with severe hearing impairment. Under the new rules, there is no longer a requirement to undergo a medical exam, obtain a prescription or be fitted for a device by an audiologist. People can still get hearing aids by seeing a doctor first, and experts say there are advantages to this option, such as being professionally fitted for a hearing aid based on your individual needs and having a doctor monitor the progression of your hearing loss. But HLAA executive director Barbara Kelley says that if the new rules lead more people to buy hearing aids, that's a good thing. "When someone finds out they have hearing loss, they often wait five to seven years before they get a hearing aid," Kelley told NPR. "So if this would inspire people or motivate people because they see these hearing aids in the mainstream, that should be more affordable or at a different price point, they might take that first step sooner rather than later," she added. There will be lots of options, so it pays to do your researchThe rule change will mean that existing hearing aids as well as new products will be available to buy in stores, pharmacies and online. Experts are urging customers to do their research. Companies' websites may have more detailed information about their products. Also, sellers are required to include any details about their return policy — if they have one — on the box. It can take three to four weeks to properly adjust a hearing aid, the HLAA says. The association also suggests people consider whether the hearing aid requires the use of a smartphone to operate it and whether a battery is rechargeable or long-lasting. Additionally, consumers should know the difference between hearing aids and personal sound amplification products, or PSAPs, which are currently sold over the counter and intended not for people with hearing loss but rather for those with normal hearing who want to amplify sounds, such as hunters. - See the full WBUR story.
SNAP and College Students: New Outreach Flyers College students are continuing to struggle with tuition costs and shrinking financial aid. Many students are eligible for SNAP benefits but are not accessing them. This updated MassLegalService college student webpage explains eligibility - especially during COVID - and how to apply. Mass Law Reform Institute AmeriCorps member Katie Kelly, has created five new SNAP for students fliers available on this Google Drive that you can share widely. - Adapted from [FoodSNAPcoalition] Organizational sign on letter to THANK Rep McGovern re WH Conference; SNAP calculator, SNAP College Student fliers!, Pat Baker, MLRI, October 4, 2022.
All DTA Offices Should Now Have Video Remote Interpreter (ASL) Access The Mass. Department of Transitional Assistance (DTA) which administers SNAP, TAFDC and EAEDC, recently procured a new language line vendor, Lionbridge. Through this new vendor, DTA has expanded Video Remote Interpreter (VRI) access from five to all local DTA offices. VRI is an auxiliary aid that provides video remote American Sign Language (ASL) interpreter services. Accessibility Information on Local Office Pages To help improve residents’ knowledge of features available at a local office, DTA has updated our mass.gov local office pages to include accessibility information. This new section includes information on the eight-language client-facing pictorial communication board, access to a Client Assistant Coordinator (CAC - disability access specialists), availability of clear masks, and that VRI technology is available as well as the ability to request an ASL interpreter or CART provider. - From: DTA October 2022 Advisory Board Updates, shared by Victoria Negus, MLRI, October 18, 2022.
US Removes Trump-Era Barriers to Citizenship-Test Waivers for Disabled Immigrants U.S. Citizenship and Immigration Services has rolled out several changes to make the naturalization process more accessible for applicants with disabilities. After months of public feedback, the federal agency has shortened and simplified its disability waiver, which is used to exempt immigrants with physical, mental or learning disabilities from the English and civics test requirements. The revisions largely undo efforts by the former Trump administration to expand requirements for disabled applicants seeking to naturalize. Among the steps to become voting citizens, immigrants are tested on how well they read, write and understand English and how much they grasp U.S. history and government. Since 1994, the federal government has allowed immigrants with disabilities to receive waivers for such requirements. In 2020, the Trump administration nearly doubled the length of the disability waiver and added unnecessary complexity, Burdick said. USCIS itself has described some parts of the application as "redundant" and has said they "no longer have practical utility." Questions such as how the applicant's disability affects their daily life, a description of the severity of the disability and how frequently they are treated by medical professionals have since been eliminated. Another policy change gives applicants who did not properly complete their waiver the option to simply resubmit their form with updated information, rather than fill out entirely new paperwork. But there's more work to do, she added. Among her organization's concerns are the limited types of medical professionals allowed to certify accommodations. "Many of the immigrants that we serve receive their primary care from a nurse practitioner, since they are often more accessible than medical doctors, especially in low-income communities," she said. - See the full WBUR story.
US Creates a Legal Pathway for Venezuelan Migrants, but Most Won't Qualify and Some Will be Quickly Expelled The Biden administration has announced an agreement with Mexico aimed at reducing the record number of Venezuelan migrants crossing the border illegally. That deal includes a new legal pathway for up to 24,000 Venezuelans — if they can find a financial sponsor in the U.S. But immigration experts say that won't be easy for many Venezuelans. "They're starting over in very precarious circumstances," said Andrew Selee, the president of the Migration Policy Institute, a nonprofit in Washington, D.C., "because they don't have the social networks in the United States that other migrants generally do." The latest wave of Venezuelan migrants is very different from Mexican and Central American migrants who've come before, says Selee. Those migrants usually have friends or family in the U.S. and have talked to them before they arrive. This mass migration of Venezuelans is relatively new for the U.S., but it's been happening for several years in Latin America. U.S. officials say nearly 8 million people have left Venezuela — more than a quarter of the population — to Colombia, Peru, Ecuador and Chile, as the country's economy has collapsed under its authoritarian government and the impact of U.S. sanctions. The Biden administration wants to discourage migrants from making this long and perilous journey. This month the U.S. and Mexico announced a deal that would allow immigration authorities to quickly expel Venezuelan migrants if they cross the border illegally. Until now, the administration could not expel Venezuelan migrants under the pandemic border restrictions known as Title 42, because Mexico was refusing to take them in. And the U.S. can't send them back to Venezuela either, because the government won't accept them. At the same time, immigration authorities announced a new legal pathway for up to 24,000 Venezuelan migrants to live and work in the U.S. But the new arrangement will accept a relatively small number of Venezuelan migrants, compared with the more than 150,000 who've crossed the U.S.-Mexico border in the past year. Migrants will also have to pass strict requirements in order to qualify. They must apply from abroad; any migrants who cross the U.S. border illegally are disqualified. They also need a financial sponsor in the U.S. who can support them. - See the full WBUR story.
Student Loan Relief Application It's hard to imagine a more anticipated form than the one tens of millions of federal student loan borrowers will need to complete to qualify for President Biden's debt relief plan. The application is now available at: https://studentaid.gov/debt-relief/application and is available in English and Spanish. Per the website, due to a court order, the application is open, but debt discharge is paused. “We encourage you to apply if you are eligible. We will continue to review applications. We will quickly process discharges when we are able to do so and you will not need to reapply.” The application will be available through Dec. 31, 2023. What the application asks for: It requires only basic information, including name, birth date, Social Security number, phone number and an e-mail address. Borrowers will NOT need what's known as an FSA ID to log into the application, nor will they need to upload any documents, including tax records. Will borrowers need to prove they meet the plan's income requirements? Instead of having to provide documents that verify that you, as an individual, earned less than $125,000 in 2020 or 2021 or, as a couple, less than $250,000, the application simply asks borrowers to check a box to "certify under penalty of perjury under the laws of the United States of America that all of the information provided on this form is true and correct." A senior administration official told reporters that the U.S. Department of Education will closely match the information applicants provide with loan and income information it already has on file. In case of discrepancies, the department "will work with borrowers to secure additional documentation." The official said roughly 95% of borrowers should meet those income thresholds, though it's not clear how many the department will flag for additional income verification. How long will it take the department to process each application? When asked by NPR how long borrowers who fill out the application will have to wait before they see their debts canceled, one senior administration official said, "a matter of weeks." Timing matters because the department wants to discharge as many debts as possible before student loan payments resume in January. How long will the court block last? A federal appeals court has temporarily blocked President Biden's student loan forgiveness plan — halting any debt from being erased. But the administration is encouraging people to continue submitting their applications. One of two things can happen in the upcoming days: either the court can issue an injunction and the pause will last longer or it can dismiss the case and the program can carry on. The federal appeals court is expected to announce a ruling as soon as early next week. More information: https://studentaid.gov/manage-loans/forgiveness-cancellation/debt-relief-info - See the full WBUR story and additional WBUR story about the court injunction.
New State Loan Repayment Plan for Mental Health and Substance Use Disorder Counselors A new state program will pay off college loans for mental health and substance use disorder counselors to help ease a chronic shortage of health care professionals. A $4 billion pandemic relief bill signed by Gov. Charlie Baker in December 2021 included $110 million for a college loan repayment program for mental health professionals who work in community health centers. The 2021 law didn’t include professionals who work in substance abuse settings, but Health and Human Services Secretary MaryLou Sudders pushed to get $15 million diverted from a state fund that collects money from opioid settlements to cover workers who provide acute care, stabilization services and residential treatment for substance use disorders. The move is aimed at recruiting and retaining new workers in a sector of the state’s health care system that is traditionally among the lowest paid. The state Department of Health and Human Services is currently negotiating a contract with a private company to run the new program, which will also be available for substance abuse counselors, recovery coaches and others who work in psychiatric units at acute care hospitals or at an in-patient psychiatric hospital. In a letter to legislative leaders, Sudders said the agency expects eligible workers will be able to apply for loan repayment funds from the state by the “end of the year.” Nurses, nurse practitioners, advanced practice nurses, physician assistants and social workers with master’s degrees who are employed in mental health settings can get between $25,000 to $50,000 in loan repayment. Workers in those professions with bachelor’s degrees can get between $15,000 and $30,000. Those who qualify must commit to working for at least four years in the state under a “service commitment” to receive the financial relief. That employment can be with up to two different employers, according to the state agency. - See the full Salem News article.
US Extends Public Health Emergency Another 90 Days- Into January 2023 The Biden Administration has extended the COVID-19 pandemic's status as a public health emergency (PHE) for another 90 days, thereby preserving measures like expanded Medicaid and SNAP beneficiaries receiving the maximum benefit for their household size. The toll of the COVID-19 pandemic has diminished significantly since early in Biden's term when more than 3,000 Americans per day were dying, as enhanced care, medications and vaccinations have become more widely available. But hundreds of people a day continue to die from the coronavirus in the United States, according to the U.S. Centers for Disease Control and Prevention. The Administration has indicated that they will give at least 60 days’ notice of the end of the PHE. Advocates expect to hear from the administration by mid-November if it will be extended beyond January 2023. - See the original Reuters article.
De Novo - Free or Low Cost Counseling and Torture Treatment Program If you are uninsured or having difficulty accessing affordable counseling through your insurance, call De Novo at (617) 661-1010 from 9:00 am to 5:00 pm, Monday through Friday, and say you are interested in counseling. Appointments can usually be scheduled within one week of your call. Weekday and evening appointments are available. De Novo assists clients who are experiencing anxiety, depression, social isolation, relationship difficulties, family troubles, work problems, trauma associated with violence, or have other concerns. Fees Fees range from $2 to $60 per visit. No one is turned away due to inability to pay. Certain refugee and immigrant victims of crime such as domestic violence, political trauma and torture, are able to receive counseling and social services free of charge. De Novo does not accept any type of health insurance. Torture Treatment Program De Novo provides specialized services for survivors of torture, victims of crime, and individuals affected by war and other types of human rights violations. De Novo is a member of the National Consortium of Torture Treatment Programs (NCTTP) and the International Rehabilitation Council for Torture Victims (IRCT). For more information about resources and services for survivors of torture, you can visit: healtorture.org or IRCT.org. De Novo's Center for Global Human Rights and Resilience provides:
- Source and for more information: Services — De Novo
Be Inspired Together Offers Therapy Scholarships Be Inspired Together is a nonprofit, created in 2022 in the post-pandemic aftermath, to provide desperately needed mental health services to individuals and families at no cost, reducing the financial barrier that is often prohibitive in accessing services. Founded in 2017, Be Inspired Counseling is a client-centered, strength-based therapy practice located in Mansfield, MA and Stoughton, MA, serving the surrounding towns of Easton, Canton, Sharon, Randolph, Attleboro, Taunton, Whitman, Dedham, Westwood, Norwood, and Brockton, and now across the state of Massachusetts via telehealth visits. Scholarship eligibility will be re-evaluated quarterly. Session frequency is clinically discussed and recommended based on need, severity of the presenting issues, as well as what commitment the client can commit to (i.e.: weekly, every other week). Treatment progress and need is reviewed every 90 days, with accordance of the Best Practices of the profession. In addition to direct counseling services for patients, Be Inspired Together also provides broader community services such as workshops and support groups to the general public on a sliding “pay what you can” fee scale, partnering with local schools and community organizations for the recruitment of participants to ensure diversity, equity, inclusion and belonging. - Learn more on the Be Inspired Together website.
Mental Health Connections for MGB Employees and Their Families Mental Health Connections, a new clinical assessment service, helps connect Mass General Brigham employees, their spouses, partners and dependents with the most appropriate and accessible behavioral health treatment, both within and outside the Mass General Brigham system. Employees do not need to be enrolled in a Mass General Brigham health plan to use this service. Since its soft launch earlier this year, the Mental Health Connections triage service has helped more than 200 employees and their family members. The goal is to create a low-barrier central pathway to inquire about the wide range of resources that exist and work with a clinician to determine treatment needs and preferences. If interested in learning more, email mentalhealthmatters@partners.org. Our team will respond within three business days. Learn more about Mental Health Connections and other mental heath and well-being resources on The Pulse. - From Today's News & Highlights: Hurricane assistance in Florida and Puerto Rico, New clinical assessment service, BRIght Futures Prize, Broadcast MGB, October 3, 2022.
Medicare Reminder: Filling Gaps in Part D Drug Coverage If you are enrolled in Part D and having trouble affording your prescriptions or finding plans that will cover your drugs, there are several ways you may be able to fill the gaps in your coverage:
Keep in mind that after reaching catastrophic coverage, costs for your covered drugs will drop significantly. Learn more on Medicare Interactive (Medicare Rights Center) - From Medicare Watch: This Open Enrollment Season Has Cost-Saving Changes for Both Medicare and ACA Plans, Medicare Rights Center, October 13, 2022.
New Rule Addresses Obamacare “Family Glitch” More families will be able to access Affordable Care Act subsidies next year, under a final rule recently issued by the Biden administration. The final rule aims to address a longstanding problem with Obamacare’s (the Affordable Care Act or ACA) regulations pertaining to the affordability of employer coverage, known as the “family glitch.” Under the ACA, workers who don’t have “affordable” health insurance options through their jobs can qualify for subsidized coverage on the Obamacare exchanges. A work-based policy is considered “affordable” if it costs the employee less than 9.5% of his or her income for single coverage. However, the Affordable Care Act doesn’t take into account the increase in premiums for adding family members to the policy, even if it pushes the cost above the threshold. In these cases, workers and their families aren’t eligible for financial assistance to buy Affordable Care Act coverage. The new rule allows family members of workers who are offered affordable single coverage but unaffordable family policies to qualify for subsidies on the Obamacare exchanges. The average annual premium for a single worker was just over $7,700 in 2021 but topped $22,000 for a family, according to the Kaiser Family Foundation. Some 5.1 million Americans, a majority of them children, are affected by the family glitch, according to Kaiser. In addition to affordability of job-based coverage, the final rule specifies that family members must be offered policies that meet minimum value requirements and have substantial coverage of hospitalizations and physician services, said Karen Pollitz, a senior fellow at Kaiser. Open enrollment for the Affordable Care Act marketplace begins Nov. 1. People may enroll outside of open enrollment if they are eligible for subsidized coverage or have a “qualifying life event” such as marriage, birth of child, loss of other coverage.
Lawsuit Says Mass. Residents ‘Unnecessarily Institutionalized’ in Nursing Homes Should Have Options for Independent Living Six Massachusetts residents with disabilities who say they’ve been unnecessarily institutionalized in nursing facilities for prolonged periods have filed a class action lawsuit in federal court calling for the state to expand its residential programs so they, and others with disabilities, can return to living in a community setting, according to the complaint. The lawsuit filed in US District Court in Boston alleges Governor Charlie Baker and other top state officials have failed to provide adequate services and support to help individuals with physical or mental disabilities progress from a nursing facility, where they are segregated from the community, to more independent living, while still having access to medical care through the state’s Home and Community-Based Services programs. About 22,000 adults with disabilities are institutionalized in nursing facilities across the state, the lawsuit claims, and their paths to those facilities can vary. Steven Schwartz of the Center for Public Representation said he hopes the lawsuit will reach a similar conclusion as prior litigation has on behalf of people who were placed in nursing homes with brain injuries and intellectual disabilities. The state settled those cases in 2008, opening the door for thousands of people to leave nursing facilities and move into an apartment, family home, or group setting. “The critical part of the settlements in those cases was for the state to create a process by which people could make meaningful, informed choices,” Schwartz said. Currently, “that does not exist for anyone else.” The lawsuit asserts that the state should be capable of expanding its residential programs to include all individuals with disabilities considering it has already done so for people with brain injuries and intellectual development issues. - See the full Boston Globe article.
Facts About the Greater Boston Housing Crisis We well know that the housing crisis in Greater Boston has only deepened in the years since the pandemic first struck. Home prices have soared, housing production has remained stagnant, and inequality has deepened. But the latest version of the new The Boston Foundation’s annual Greater Boston Housing Report Card gave us an even clearer picture of just how bad things are right now. Here are some key takeaways from the report: Boston has some of the highest rents in the nation. A fact with which we are all too familiar. There’s some disagreement among firms that measure rental data about where exactly Greater Boston stands among the nation’s most expensive rental markets — a recent Zillow report, for example, had Greater Boston at fourth-highest in the US, while others have placed the region as high as second — but it seems fairly clear that we’re squarely among the top five. After some communities saw a dip at the very beginning of the pandemic, rents have risen unceasingly across every neighborhood in the state, now sitting at record highs in many places. That’s thanks to the pandemic, the report says, and the ways in which it shifted demand for rental housing. For example, the rise of remote work attracted people to lower-cost regional urban centers like Marlborough, where they could find more space for less money. The bottom line: rents are sky-high just about everywhere in Massachusetts. To underscore the point, a separate new report released this week finds Boston is now the second-most expensive city in the country for renters. Data from the report shows that Boston jumped ahead of San Francisco over the past month when it comes to one bedroom median rent prices. The report was issued by Zumper, a national platform that connects renters with new properties. Median one bedroom rent in Boston rose to $3,060 last month, the report shows. This is a 5.9% increase. Boston’s two bedroom median is now $3,500, which is a 4.2% increase over last month. The analysis from Zumper points to Boston’s ongoing housing crisis as the root of these rising prices. Like many cities, the housing market in Boston is undersupplied. That shortage is more apparent and harder to overcome in Boston due to “prohibitive zoning laws that favor single-family homes,” according to the report. On top of that, new properties becoming available are skewed towards the luxury market, which further increases the median price of Boston’s rental units. “We expect to see some moderation of prices in Boston in coming months (due to seasonality and broader economic trends), but relative to the rest of the country Boston will continue to be among the most expensive markets,” Amy Mueller, VP of Marketing & Communications at ApartmentAdvisor said in an email. Nationally, price cuts appear to be increasing. However, Boston was not among the cities with the highest percentage of price cuts. Just 5.2% of Boston units had price cuts in September, according to the report. In San Francisco, 7.7% of listings had a price cut that month. Other major cities like Los Angeles, Chicago, and Miami all had a higher percentage of price cuts than Boston. Housing inequality has deepened significantly. While the eviction moratorium and other renter protections staved off the wave of evictions and homelessness some feared the pandemic would bring, housing inequality has only deepened in the last couple of years, largely thanks to soaring rents and home prices. The statistics in the Boston Foundation report are stunning. About 45 percent of renters in Greater Boston spend more than 30 percent of their income on rent — “cost-burdened,” in housing parlance — and the share of non-white renters that fall into that category is even greater. About 52 percent of Black renters and 53 percent of Latino renters are considered cost-burdened. What’s more, the report found that over the last decade, the rise in housing costs has fallen harder on the region’s poorest residents. For Greater Boston’s lowest-earning 10 percent, housing costs increased 19 percent, the same rate as their overall income between 2011 and 2021. The wealthiest ten percent, meanwhile, saw incomes grow three times as fast as housing costs. Vacancy Rates Re Some of the Lowest in the Country Greater Boston consistently has some of the lowest rental and homebuyer vacancy rates in the country, a stark sign of the region’s supply shortage. The rental vacancy rate, which sat around 4.5 percent in 2021, is comparable only to metro New York City and Los Angeles. The homeowner vacancy rate was around 0.5 percent that same year, by far the lowest of the major metropolitan areas in the US. The impacts of those consistently low rates are seen in regional housing costs, but also in how homes and rentals fly off the market. In May of this year, the typical home sold in Greater Boston was listed for just 16 days before going under contract. In New York, it was 43 days. - See the full Boston Globe article and this related Boston Globe story.
Wave of Evictions Feared The money and legal protections ushered in by the Baker administration to fend off a feared “tsunami of evictions” during the depths of the COVID-19 pandemic are disappearing in dribs and drabs, making it harder for people to stay in their homes. Many of the changes were triggered after the $846 million Massachusetts received from federal COVID relief funding began to run dry. The state closed applications for that money in April. That leaves a much smaller and less generous state program, called Residential Assistance for Families in Transition, or RAFT, as the main source of housing aid. It has $210 million available for the fiscal year ending next June. With the federal fund mostly gone, the income threshold for applicants reverted to the much lower state one: 50 percent or less of the area median income ($70,100 for a household of four in Boston), compared to 80 percent or $111,850, under the federal program. And RAFT now requires applicants to have received an eviction warning from their landlords. It is also stingier with distribution. Households can no longer use funds to cover more than one month of upcoming rent, for example. The federal program, by contrast, could be put toward up to 18 months of both overdue rent and upcoming payments, as well as $2,500 of utility bills. It had no set dollar limit on the amount of aid, while RAFT caps relief off at $10,000. In a statement, the DHCD said the amendments are necessary to preserve waning funds for “households most in need.” But housing attorneys and advocates said the changes feel like a step back from 2020, when officials tweaked complicated aid programs to reduce the documentation requirements. It leaves thousands of tenants who are grappling with enduring pandemic issues, inflation, and sky-high rents at risk of losing shelter. Since the rules tightened, eviction filings have crept up, and the number of households helped dropped sharply from 23,000 in May to 9,000 in August, according to state data. While economic conditions have improved for many, inflation and rising rents mean some tenants are as much at risk as they were two years ago. “We’re moving in the wrong direction,” said Kelly Turley, associate director of the Massachusetts Coalition for the Homeless, “particularly for households with no leverage, who may not feel like they have any power or agency to push back.” ‘The power of the NTQ’ The most drastic change to rent relief is the one Bertelson faced: the requirement tenants receive a Notice To Quit. It’s the first step in Massachusetts’ legal process of eviction. If tenants submit an application without one, they are all but guaranteed to be turned down within weeks. That’s a sharp reversal from the past two years, when applicants could provide other “proof of arrears,” such as a ledger from a landlord confirming they’re behind on rent. Prior to the pandemic, RAFT required a court summons for eligibility. So DHCD sees the notice policy as “a middle ground” between the more freewheeling COVID era and the pre-pandemic system, a spokesperson said. But advocates say the requirement is already inflicting harm. Legally, notices are not enough to boot tenants from their homes, said Andrea Park, a staff attorney at the Massachusetts Law Reform Institute. Yet most are threaded with strong legalistic language that threatens eviction. As a result, she added, some tenants leave their apartments in fear, rather than staying put and fighting. And for tenants, there’s also the stain of an eviction on their record. Landlords are required to send a copy of a Notice To Quit to the state, and getting a notice dramatically increases the chances of a tenant facing an actual eviction proceeding, which lives on indefinitely in court filings as a black mark. Often, the processing time for a RAFT application takes longer than the duration of the notice; in August, it was an average of 35 days. So even if a tenant is ultimately approved for aid and receives relief weeks later, they are stuck with a record. Park, the Mass. Law Reform attorney, said the state failed to consider how requiring the notice could trigger other problems, such as the impact on tenants’ credit scores and their ability to secure housing in the future. “There’s this perception that it’s just a letter,” she added. “But that’s underselling the power of the NTQ.” The new RAFT requirements make it nearly impossible for tenants who live in unconventional situations — extra bedrooms or couches with informal leases — to get help. Their landlords, DesRosiers said, rarely issue notices or cooperate with the relief system. “What we’ve seen so far from people is fear. Total fear,” said the Rev. Myrlande DesRosiers, the director of the Everett Haitian Community Center. “They are being denied, denied, denied.” Though problems abound, advocates acknowledge that Massachusetts went beyond the call of duty to help households during the pandemic. Rachel Heller, executive director of the Citizens Housing & Planning Association, said Massachusetts stretched federal dollars to the end when “not every state had that level of commitment.” Moreover, the state-level RAFT fund is much larger today than its pre-pandemic level of $20 million. Plus, lawmakers are making permanent one change that protects tenants from eviction if they have a pending RAFT application. But now, many say, is not the time to pull support. A band of organizations in May urged state lawmakers to put $600 million toward a modified program that melded a few tenets of the federal effort with RAFT. That didn’t happen. It makes little sense to Michael Kane, the director of the Mass Alliance of HUD Tenants, who noted that the state is awash with a $5 billion budget surplus and leftover American Rescue Plan dollars from the White House. If we’re going to try something bold, he suggested, try today. “Putting on punitive requirements is counterproductive. It’s nickel-and-diming poor people to save the money the state doesn’t need to save,” Kane said. “We should have learned something from the pandemic. Period. Instead, here we are.” - See the full Boston Globe article.
Editorial- Home Health Care Workforce Needs Ongoing Pay Boost It is difficult to appreciate the toll of caring for an ailing, elderly relative until you’ve lived through it. That’s part of what makes home health care and other kinds of at-home support — help bathing and doing laundry and preparing meals — such important work. It’s a respite for families in some of the most difficult periods of their lives. And the service has taken on even greater importance during the pandemic years, allowing older people to stay out of congregate settings where the coronavirus can spread to deadly effect. As demand has spiked, the agencies that provide these services have struggled to find workers to meet it. In Massachusetts, government-set reimbursement rates translate into pay of about $15 to $19 per hour for home health aides, who help clients get around their living rooms and bedrooms and provide them with medication reminders, and workers known as homemakers, who wash and fold clothes or make sandwiches at lunchtime. Jobs at Walmart and Dunkin’ pay at similar rates, without the same physical and emotional demands. And it can be hard to compete. Federal and state governments, to their credit, have supported the fragile industry these past few years by providing “add-ons,” or temporary funding boosts — with much of the money targeted to increased pay for home health aides and homemakers. But as the country moves into a different phase of the pandemic, and as an aging society comes to terms with the growing need for at-home supports, those temporary bumps won’t do. Something more sustainable is required. State lawmakers could, and should, take a couple of important steps. The first is to approve a Senate measure, tucked into a stalled economic development bill, that would create a $250 million reserve to enhance pay for some of these vital workers and other human service workers. The money would have to be spent over the next two years, but it could mark the start of a longer-term commitment. The second is a measure that would create standards for a rate-setting process that’s pretty opaque at the moment. State officials would be required, for instance, to analyze the cost of similar services provided in other health care settings — like hospitals and nursing homes. And they would have to provide reports to state lawmakers about how they arrived at the rates. The hope is that the standards and transparency will tilt the system toward better pay for front-line workers over time. Given the importance of what they do, better pay should be an urgent priority for the state. - See the full Boston Globe editorial.
When it Comes to Addiction, Word Choices are Part of the Problem Who gets better medical care in the United States: “addicts,” or “people with substance use disorders”? The terms, of course, mean functionally the same thing. But in the field of addiction medicine, the question presents something of a crisis. Even as drugs and alcohol claim 200,000 lives each year, many who seek addiction treatment are greeted by the harsh, stigmatizing labels that many Americans don’t think twice about: Words like addict, alcoholic, junkie, abuser, or worse. Even as the nation’s substance use crisis has escalated, however, new research has emerged showing that simple word choices can have a big impact on the way health professionals view their patients and, accordingly, the care they receive. And in recent years, a coalition of doctors, recovery advocates, researchers, and even government officials has pushed to swap out stigmatizing terms like “addict” in favor of language that recognizes addiction as a medical condition — and acknowledges those who suffer from it as human beings. “Words matter tremendously, and much of the language we use when we talk about addiction is very dissimilar from the language we use for other health conditions,” said Sarah Wakeman, the medical director of the Massachusetts General Hospital Substance Use Disorder Initiative. “Many of the words that are commonplace when talking about addiction are incredibly pejorative and stigmatizing.” Advocates say that changing the country’s addiction vocabulary would represent a major step toward advancing compassion and evidence-based care — and, more broadly, advancing Americans’ understanding of addiction as a disease, not a moral failing. The effort, they are quick to stress, is not just rooted in political correctness. Research shows that health workers who use terms like “substance abuser” or “addict,” as opposed to more neutral language, are more likely to exhibit bias against patients struggling with addiction. “Language has an impact — it influences the way people feel, the way they think, the decisions they’re likely to make,” said Robert Ashford, a researcher who has written extensively about the language used in addiction-care settings. “We’re just asking people to modify the type of language they use so that we can set people up in our systems for success.” Some highly pejorative terms, like “crackhead” or “junkie,” are now widely viewed as unacceptable. But other judgmental terminology remains pervasive, advocates say, including words as commonplace as “alcoholic” or “addict,” which they argue reduces people’s identity to the name of their medical condition. Indeed, when it comes to language, the field of addiction medicine largely stands alone. Cancer patients are not referred to as cancers. People who experience strokes or heart attacks aren’t referred to by the name of their disease, either. The same is true even in the highly stigmatized world of mental health: People with depression are not depressives, and people with schizophrenia are no longer commonly referred to as schizophrenics. Even terms as simple as “substance abuse,” advocates say, imply that people are always making willful, considered choices to consume drugs or alcohol, leveling a moral judgment against them instead of recognizing the medical reality of addiction. “Relapse,” too, is out of vogue. Many researchers and clinicians now favor terms like “return to use” or “resumption of use,” saying that the former term can feel judgmental and that people often experience ups and downs in their recovery. The use of “clean” to denote abstinence from drug use is also becoming less popular, largely because it implies people currently using drugs or alcohol are “dirty.” “This isn’t about being politically correct, it’s not about being nice or polite,” said Michael Botticelli, the former director of the White House Office of National Drug Control Policy who wrote a 2017 memo directing federal agencies to use more neutral language when referring to people with addiction. “Our language really colors how we think about people, and colors policy.” One pillar of addiction care, Wakeman said, is fundamentally mislabeled: medication-assisted treatment, or the practice of prescribing drugs like methadone or buprenorphine to reduce opioid cravings and withdrawal symptoms. Patients who take methadone and buprenorphine are 59% and 38% less likely to die of overdose, respectively, than those not prescribed medication — meaning that in the context of almost any other epidemic, they’d be seen as extraordinarily effective. “‘Medication-assisted treatment’ implies that medication is not treatment in its own right, and that it’s a corollary to something else, when in fact we know that medication is incredibly effective and saves lives,” Wakeman said. “We don’t talk about insulin-assisted diabetes treatment, or chemotherapy-assisted cancer treatment. So to just use language as we would with any other condition is a good litmus test.” Some doctors now use terms like “medications for opioid use disorder” or “pharmacotherapy,” though the term “medication-assisted treatment” is still commonly used in official government language and in research papers. There’s at least one community in which terms like “addict” and “alcoholic” are commonplace: People with substance use disorders, or people in recovery. In particular, some people who participate in peer support groups like Alcoholics Anonymous or Narcotics Anonymous have at least partially “reclaimed” the terms. It’s not uncommon, either, for patients in addiction-treatment settings and other people who use drugs to refer to themselves as addicts — a choice that experts say health workers should respect but not necessarily emulate. “When you’re a member of a community, you have certain liberties in terms of what you call yourself, and those liberties are not extended, necessarily, to other people,” said Botticelli, who was the first ONDCP director to identify as a person in recovery. Even within the recovery community, however, it’s a sensitive topic. While some use the terms proudly, others have cautioned that even though people in recovery are free to refer to themselves however they like, using terms like “addict” or “alcoholic” can still take a toll. - See the full Stat News story.
Some Doctors are Reluctant to Care for Patients with Disabilities Dr. Lisa Iezzoni pulled her wheelchair up to the screen and asked the physicians on the video call about their experiences and attitudes caring for people with disabilities. Iezzoni’s wheelchair was out of view as the physicians spoke candidly and shockingly about their experiences. Not only did several of the 22 doctors say they did not have the equipment or training to care for people with disabilities, but some felt burdened by the work. Some clinicians openly talked about how to avoid caring for the population altogether. Details of the three focus groups she moderated made public this week offer disturbing and eye-opening details about the challenges individuals with disabilities face when seeking care. “[Physicians] don’t necessarily know about making accommodations,” said Iezzoni, a professor at Harvard Medical School and a longtime disability researcher, who has multiple sclerosis. “For almost 25 years now people have been asking me, ‘Why is health care so far behind every other industry?’ You go to see a Celtics game or Fenway and they have great disability access. But health care facilities, not so much.” The focus groups, conducted by scientists from Northwestern Medicine in collaboration with Iezzoni, a senior author, and colleagues from the University of Massachusetts, were conducted to help design a national online survey. The focus groups identified barriers patients might encounter when receiving health care and found that physicians are often unfamiliar with how to accommodate individuals with disabilities. Other barriers that patients with disabilities might encounter included short appointment times, bias, and a lack of training. The subsequent national study, which ran from October 2019 to June 2020, surveyed over 700 physicians online, revealing that over a third knew little or nothing about their responsibilities under the Americans with Disabilities Act, and nearly 70 percent believed they were at risk of lawsuits under the ADA because of a lack of accommodations. The research was published in the journal Health Affairs in January. The researchers then published the focus group data separately in Health Affairs on Monday, because the inflammatory comments weren’t cited in the national study and were important on their own, said Dr. Tara Lagu, professor of medicine at the Northwestern University Feinberg School of Medicine and a lead author of the study. Researchers conducted video interviews with three groups of physicians, asking them about their experiences caring for patients with mobility, vision, and hearing impairments as well as mental illness and intellectual disabilities. What they discovered were barriers to providing care at nearly every part of the encounter, undergirded by negative attitudes some had toward people with disabilities. All clinicians reported physical barriers to providing proper health care, such as nonadjustable height exam tables and scales that couldn’t accommodate a person in a wheelchair. Some reported using workarounds. Some physicians said they sent patients to a supermarket, grain elevator, zoo, or cattle processing plant to obtain a weight. Communication also proved a challenge. None of the physician participants provided written materials in Braille to their patients, and only a few offered them in large type. Physicians frequently said they relied on caregivers or turned to written communication, such as using a white board for people with hearing loss. Some accommodations created hurdles of their own. One physician reported hiring a sign language interpretation service, and found that it cost $30 more than the reimbursement for the entire visit. Clinicians also lacked knowledge, experience, and skills necessary to provide proper care and frequently mentioned concerns about how to move patients with mobility issues. All the problems were compounded by structural issues, with physicians feeling they didn’t have the time to properly address such concerns within a 15-minute visit. Electronic medical records also don’t currently ask about disabilities or accommodations, and often physicians were unaware patients requiring accommodations had been scheduled for an appointment. The focus groups additionally revealed negative attitudes among some doctors toward people with disabilities, with some saying that providing care to such individuals was burdensome. Some participants said they denied care to people with disabilities or attempted to discharge them from their practice, saying they were no longer taking new patients. Lagu envisions a comprehensive set of solutions to change attitudes and environments. Reimbursements for seeing patients with a disability should increase, and electronic medical records should have ways to collect data on disabilities and accommodations. Not only would that help medical practices prepare for such visits, but it would enable researchers to track whether individuals with disabilities have poorer health outcomes. Groups need more and better incentives to buy accessible equipment, Lagu said, and staff should also receive training on how to work with disabled populations. Additionally, disability training is not currently required as part of accredited medical school education or graduate medical education. Despite this, disability advocacy group The Arc has been working with medical schools in Massachusetts to provide instruction on caring for individuals with intellectual and developmental disabilities, including autism. Because it isn’t part of the accredited curriculum, The Arc is generally not paid for the work, though legislation has been pending for several sessions that would codify the program and establish state funding for it. Another piece of legislation would establish standards of care in hospitals for patients with autism, and intellectual and developmental disabilities and create a committee to come up with continuing education requirements. - See the full Boston Globe article.
The Case for Redefining Hospital "Never Events" to Include Never Sending Debt Collectors After Low-Income Patients When is it acceptable for a hospital to send debt collectors after low-income patients? The answer should be "never," argues a new article published in JAMA Health Forum. Why it matters: Health systems around the country — particularly nonprofits — have come under fire in recent years for aggressively pursuing debt collections, and even suing, patients who can't pay their bills. At least 40% of Americans surveyed earlier this year said they struggled to pay medical bills or were paying off medical debt, according to The Commonwealth Fund. The big picture: The authors framed the issue using the National Quality Forum's "never events" framework that came out 20 years ago. That defined patient safety events, like leaving a sponge inside a patient, as events that should "never" happen.
Between the lines: Other proposed "never events" at hospitals, they said, should include not falling short on community benefit spending, never paying their employees less than a living wage, never flouting price transparency laws and avoiding racially segregated care. Yes, but: This comes at a time when hospitals of all stripes have been reporting financial hardship caused by the pandemic. The authors acknowledge those challenges but said that's why clarifying principles are needed.
- From Axios.
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