Obamacare Brings Medicaid To Skid Row’s Homeless

If you were led blindfolded a few blocks east from Los Angeles’ grand City Hall, you would know instantly when you entered Skid Row.

There is the pungent smell of urine and marijuana smoke, and the sound of music and easy laughter — a carnival rising out of misery.

This is the chaos that Chris Mack plunges into on most days. Once homeless himself, Mack is an outreach worker for the JWCH Institute’s Center for Community Health, a free clinic in the heart of Skid Row.

Mack is part of a concerted push to enroll the nation’s homeless in Medicaid. As of January, the health insurance program that’s jointly funded by federal and state governments is being opened for the first time to all poor adults, not just those with disabilities or dependent children.

The outreach is important, homeless experts say. In addition to safe permanent housing, regular medical care is a critical intervention for getting lost lives back on track.

“A person who is not feeling very well can’t behave or perform very well,” Mack says, “so I think health care is primary.”

The Medicaid expansion was a central provision in the Affordable Care Act, the federal health care law. But after the Supreme Court declared the expansion optional for states, rather than mandatory, 26 states and the District of Columbia have chosen to do so. Even without all the states participating, some 9 million people are expected to enroll in Medicaid across the country, and 1.2 million homeless people could be newly eligible for coverage.

Homeless advocates have cheered the expansion. Men and women living on the streets and in shelters will be able to see a doctor regularly, keep prescriptions filled to treat their asthma, diabetes and schizophrenia, and get referrals to private specialists for lingering ailments.

by Sarah Varney, NPR

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Medicare to Cover More Mental Health Costs

For decades, older adults with depression, anxiety and other psychological conditions have received unequal treatment under Medicare. The program paid a smaller share of the bill for therapy from psychiatrists, psychologists or clinical social workers than it did for medical services. And Medicare imposed strict lifetime limits on stays in psychiatric hospitals, although no such limits applied to medical care received in inpatient facilities.

There was never a good rationale for this disparity, and in 2008 Congress passed the Medicare Improvements for Patients and Providers Act. The law required Medicare to begin covering a larger share of the cost of outpatient mental health services in 2010 and to phase in additional increases over time.

On Jan. 1, that process will be complete, and for the first time since Medicare’s creation seniors who seek psychological therapy will be responsible for 20 percent of the bill while Medicare will pay 80 percent, the same percentage it covers for most medical services. (Payment kicks in once someone exhausts an annual deductible — $147 next year.)

In 2008, Medicare covered 50 percent of the cost of psychological treatment. Last year, it covered 65 percent.

The Medicare change follows new regulations issued last month by the administration for the Mental Health Parity and Addiction Equity Act, which expanded the principle of equal treatment for psychological illnesses to all forms health insurance. But that law does not apply to Medicare.

“Hopefully, older adults who previously were unable to afford to see a therapist will now be more likely to do so,” said Andrea Callow, a policy lawyer with the Center for Medicare Advocacy.

by Judith Graham, The New York Times

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California County Pushes Drugmakers To Pay For Pill Waste

The leftover prescription drugs you have around your house are at the center of a battle between small government and big pharmaceutical companies.

The immediate aim is to have the pharmaceutical companies take care of disposing of extra drugs. But Alameda County in northern California wants to make manufacturers think about the life cycles of their products — from their creation to what happens when they’re no longer needed.

Mary Hill has been accumulating prescription drugs in her Oakland office. A social service coordinator at a retirement home, Hill has been storing leftover drugs from residents who have died or don’t know how to get rid of them safely.

“I have here morphine from people who have cancer. I have Vicodin and methadone,” says Hill, while rummaging through two bags of pill bottles and containers.

Hill doesn’t want the drugs to get into the hands of recreational users, or into drinking water. Her office has no easy way to dispose of them. If she drives away with the drugs, she could be stopped by police for possession of drugs that don’t belong to her.

Alameda County has a prescription drug disposal program. There are a couple dozen locations, but some people don’t think that’s enough.

by Pauline Bartolone, NPR

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A Phrase To Renounce For 2014: ‘The Mentally Ill’

I wince every time I read it. So does the president-elect of the American Psychiatric Association, Dr. Paul Summergrad, he says.

I saw it most recently in The New York Times, in the headline pictured above and a recent masthead editorial: “Equal Coverage For The Mentally Ill.” It’s all over, from The Boston Globe — “New Era for the Mentally Ill“ – to The Wall Street Journal — “Crime and The Mentally Ill.” Just about any media outlet you care to name.

What’s so bad about “the mentally ill”? Isn’t it reasonable shorthand in the usual headline space crunch?

In a word, no, says Dr. Summergrad, psychiatrist-in-chief at Tufts Medical Center and chair of psychiatry at Tufts University School of Medicine. He sees two main problems with it. First, the definite article, “the.”

“Imagine if I said that about any other group. It suggests that people who suffer with these conditions are somehow other than us, and can be put in a discrete and often stigmatized category. It creates a sense of otherness that is not the reality, statistically, of these illnesses.”

Any other group? I try a thought experiment, the headline “Equal coverage for the women.” Weird. “New era for the gays.” Offensive. “Crime and the blacks.” I get the point.

….The Associated Press style guide, which is highly influential in journalism, moved a bit toward “people first” language last year. A summary notes:

The AP’s decision to stop using “illegal immigrant” is part of a larger shift away from labeling people and toward labeling behaviors. For example, the new entry on mental illness says to refer to people “diagnosed with schizophrenia” instead of “schizophrenics.”

by Carey Goldburg, Boston NPR

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What is it That Makes Some of Us Keep Trying to Overcome Despite the Odds?

TED speakers share stories of overcoming a weakness and turning it into a strength in this one-hour NPR radio show.

1. Temple Grandin: Can Autism Be an Asset?

2. Shane Koyczan: What’s It Like to Be Young and Bullied?

3. Eleanor Longden: Is It Possible to Live With the Voices in Your Head?

4. Kakenya Ntaiya: Can One Girl Challenge the Traditions of Her Village?

Radio Show

Cellular Process Gone Awry Tied to Schizophrenia

Researchers have discovered a molecular process that may contribute to the development of schizophrenia.

…. a process called autophagy is reduced in the brain of a person with schizophrenia.  Authophagy — a “cell-maintenance” mechanism — clears out the dysfunctional and needless parts of a cell. When this process is blocked, cells die.

The findings show that patients with schizophrenia have reduced levels of a protein called beclin-1 in the hippocampus (a brain region linked to learning and memory).  Beclin-1 plays an important role in autophagy, the researchers note. This finding suggests that autophagy may be blocked in the brains of schizophrenic patients.

The researchers believe that creating drugs that increase beclin-1 levels and trigger autophagy may lead to a new treatment for schizophrenia.

by Traci Pederson, PsychCentral

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Remaining Safe During a Winter Storm

Remaining Safe During a Winter Storm

–Information from the American Red Cross

  • Listen to a NOAA Weather Radio or other local news channels for critical information on snow storms and blizzards from the National Weather Service (NWS).
  • Bring pets/companion animals inside during winter weather. Move other animals or livestock to sheltered areas and make sure that their access to food and water is not blocked by snow drifts, ice or other obstacles.
  • Running water, even at a trickle, helps prevent pipes from freezing.
  • All fuel-burning equipment should be vented to the outside and kept clear.
  • Keep garage doors closed if there are water supply lines in the garage.
  • Open kitchen and bathroom cabinet doors to allow warmer air to circulate around the plumbing. Be sure to move any harmful cleaners and household chemicals up out of the reach of children.
  • Keep the thermostat set to the same temperature both during the day and at night. By temporarily suspending the use of lower nighttime temperatures, you may incur a higher heating bill, but you can prevent a much more costly repair job if pipes freeze and burst.
  • Go to a designated public shelter if your home loses power or heat during periods of extreme cold.
  • Avoid driving when conditions include sleet, freezing rain or drizzle, snow or dense fog. If travel is necessary, keep a disaster supplies kit in your vehicle.
  • Before tackling strenuous tasks in cold temperatures, consider your physical condition, the weather factors and the nature of the task.
  • Protect yourself from frostbite and hypothermia by wearing warm, loose-fitting, lightweight clothing in several layers. Stay indoors, if possible.
  • Help people who require special assistance such as elderly people living alone, people with disabilities and children.

Caution: Carbon Monoxide Kills

  • Never use a generator, grill, camp stove or other gasoline, propane, natural gas or charcoal-burning devices inside a home, garage, basement, crawlspace or any partially enclosed area. Locate unit away from doors, windows and vents that could allow carbon monoxide to come indoors.
  • The primary hazards to avoid when using alternate sources for electricity, heating or cooking are carbon monoxide poisoning, electric shock and fire.
  • Install carbon monoxide alarms in central locations on every level of your home and outside sleeping areas to provide early warning of accumulating carbon monoxide.
  • If the carbon monoxide alarm sounds, move quickly to a fresh air location outdoors or by an open window or door.
  • Call for help from the fresh air location and remain there until emergency personnel arrive to assist you.

Cold-Related Emergencies

  • Frostbite and hypothermia are two dangerous and potentially life-threatening emergencies. Learn how to care for these emergencies by taking a first aid class.

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DONATE BLOOD and Stay Safe as Winter Blasts Much of U.S. with Snow and Cold

Millions of people across the United States are dealing with cold temperatures and below-zero wind chills as they dig out from heavy snow that buried much of the northern part of the country.

The storm already has forced the cancellation of more than 30 Red Cross blood drives, resulting in the inability to collect as many as 1,250 blood donations.

The Red Cross urges people to be careful during the extreme cold and is working with emergency officials and prepared to respond if necessary. If someone lives in a region unaffected by the weather, they are asked to consider making an appointment to donate blood or platelets.

PLEASE GIVE BLOOD

Despite the storm, hospital patients across the country still need blood. People in a region unaffected by the storm should please consider making an appointment to donate blood or platelets.

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Experimental Tool Uses Light To Tweak The Living Brain

When President Obama announced his BRAIN Initiative in April, he promised to give scientists “the tools they need to get a dynamic picture of the brain in action.”

An early version of one of those tools already exists, scientists say. It’s a relatively new set of techniques called optogenetics that allows researchers to control the activity of brain cells using light.

“This is fantastic,” says Elizabeth Hillman, a biomedical engineer at Columbia University. “We can turn things on, turn things off, read stuff out.” In short, she says, it provides a way to observe and control what brain circuits are doing in real time in a living brain.

Eventually, optogenetics could not only help explain diseases like epilepsy and depression, but offer a way to treat them. But the technique needs some refinement before it can be used in people or in remote parts of the brain, Hillman says.

by Jon Hamilton, NPR

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