A comment period has just opened, through September 30, on proposed minimum standards for medical respite centers for the homeless. Medical respite centers provide an indoor, supported home where discharged homeless hospital patients can convalesce instead of immediately returning to the street.
Experts on homelessness says strong standards and compliance with them can result in not just reducing hospital readmission for discharged homeless patients, but also an increase in permanent housing solutions for people who entered the hospital without a place to call home. In fact, about 80 percent of homeless people who enter a respite facility move onto housing options instead of back to the street, according to Sabrina Eddington, director of special projects at the National Health Care for the Homeless Council (NHCHC).
Eddington says that having the standards in place is critical. An estimated 150,000 people who have no permanent address are discharged from the hospital each year, based on state estimates. Going back to the street can mean reinfection, hospital readmission and an inability to keep up with care, such as daily medication that could improve, stabilize and even cure both physical and emotional health problems.
Medical respite care centers range from free-standing centers to sections of homeless shelters, and even vouchers for motels and hotels with home visits by medical and social support staff.
The proposed minimum standards were published on September 1 and a comment period runs through September 30. The NHCHC will hold a webinar tomorrow, September 12, from 1-2:30 EST. Click here to register.
The goals of the guidelines for the respite care centers are to:
- Align with other health industry standards related to patient care
- Represent the needs of the patients being served in the medical respite centers.
- Promote quality care and improved health
- Create standards for a range of respite center types with varying degrees of resources
NHCHC has dozens of stories about previously homeless patients who were discharged to medical respite care and are now living in stable housing, often with no need for hospital readmission. Take Ahmed. After losing his family and business, Ahmed moved to the street, where he struggled with alcoholism and depression. In 2005, Ahmed had a stroke and was hospitalized. Following discharge he was back on the street until an outreach team brought him to a medical respite program, where he was medically stabilized; received help for his depression; and referred to a program that specializes in treating co-occurring mental illness and addiction. Ahmed is now in supportive housing and participating in a recovery program. He continues to visit his primary care clinic and psychiatrist and has not been hospitalized since the stroke occurred.
There are now dozens of medical respite facilities throughout the community, and NHCHC is hopeful about expanding the models.
“We advocate that medical respite services be available in all communities serving homeless clients,” said Eddington.
Earlier this summer, NHCHC was one of 39 Health Care Innovation Award recipients announced by the U.S. Department of Health and Human Services. The $2.6 million award is administered by the Center for Medicare and Medicaid Innovation and will be used to demonstrate improved health outcomes and reduced spending when homeless patients have access to medical respite care following a hospital stay. The three-year project will test a model that will provide medical respite care for homeless Medicaid and Medicare beneficiaries, following discharge from a hospital, with the goal of improving health, reducing readmissions and reducing costs.
EBOLA UPDATE: Gates Foundation Commits $50M to Fight Ebola Epidemic
(NewPublicHealth is monitoring the public health crisis in West Africa.)
The Bill & Melinda Gates Foundation will commit $50 million to combat the ongoing Ebola outbreak in West Africa. The flexible funds will enable United Nations agencies and international organizations to purchase supplies and scale up their operations; the funds will also go toward the development of Ebola treatments. The foundation has already committed $5 million to the World Health Organization for emergency operations and R&D assessments and $5 million to the U.S. Fund for UNICEF to support public health efforts in Liberia, Sierra Leone and Guinea. “We are working urgently with our partners to identify the most effective ways to help them save lives now and stop transmission of this deadly disease,” said Sue Desmond-Hellmann, CEO of the Gates Foundation, in a release. “We also want to accelerate the development of treatments, vaccines and diagnostics that can help end this epidemic and prevent future outbreaks.” Read more on Ebola.
CDC: Millions of U.S. Kids Don’t Receive Proper Preventive Care
Millions of U.S. infants, children and adolescents do not receive key clinical preventive services, according to the U.S. Centers for Disease Control and Prevention’s (CDC) latest Morbidity and Mortality Weekly Report (MMWR) Supplement. Preventive services from doctors, dentists, nurses and allied health providers help prevent and detect diseases in their earliest stages, when they are the most treatable. Among the report’s findings:
- In 2007, parents of 79 percent of children aged 10-47 months reported that they were not asked by health care providers to complete a formal screen for developmental delays in the past year.
- In 2009, 56 percent of children and adolescents did not visit the dentist in the past year and 86 percent of children and adolescents did not receive a dental sealant or a topical fluoride application in the past year.
- 47 percent of females aged 13-17 years had not received their recommended first dose of HPV vaccine in 2011.
- Approximately 31 percent of outpatient clinic visits made by 11-21 year-olds during 2004–2010 had no documentation of tobacco use status; 80 percent of those who screened positive for tobacco use did not receive any cessation assistance.
- Approximately 24 percent of outpatient clinic visits for preventive care made by 3-17 year olds during 2009-2010 had no documentation of blood pressure measurement.
“We must protect the health of all children and ensure that they receive recommended screenings and services. Together, parents and the public health and healthcare communities can work to ensure that children have health insurance and receive vital preventive services,” said Stuart K. Shapira, MD, PhD, chief medical officer and associate director for science in CDC’s National Center on Birth Defects and Developmental Disabilities. “Increased use of clinical preventive services could improve the health of infants, children and teens and promote healthy lifestyles that will enable them to achieve their full potential.” Read more on pediatrics.
GAO: More Data Needed to Help Veterans Readjust to Civilian Life
More information is needed in order to best provide services to military veterans readjusting to civilian life, according to a new review by the U.S. Government Accountability Office (GAO). The review found that while many veterans readjust with little difficulty, others experience financial, employment, relationship, legal, housing and substance abuse difficulties. While the U.S. Department of Veterans Affairs is working to improve veteran wellness and economic security, “there is limited and incomplete data to assess the extent to which veterans experience readjustment difficulties,” according to the GAO. Read more on the military.
With Classes Well Underway, It’s a Good Time for Colleges and Universities to Think about their Campus Tobacco Policies
Just a few weeks ago the Bloomberg School of Public Health at Johns Hopkins University announced that it had launched the Tobacco-Free Campus Initiative, which prohibits the use of any tobacco product—not just cigarettes—in all buildings, facilities and vehicles. The initiative also forbids e-cigarettes and discourages the use of tobacco products on all outdoor campus grounds. Organizers of the initiative say that deterring the use of tobacco in all forms is crucial to protect the health of the students and workforce of the campus community.
“By keeping out all tobacco products, the initiative ensures that the School doesn’t unintentionally encourage or reinforce tobacco addiction among students, faculty and staff,” according to a statement released by the school.
However, the rest of the university won’t be taking the same steps, at least for now. In 1991, all Johns Hopkins campuses followed the example first set by the School of Public Health in becoming smoke-free, said Dennis O’Shea, a spokesman for the university, adding that the “school could follow the new initiative, but no decision has been made.”
Hopkins is not the only college deliberating. While there are a few states that require state campuses to adopt smoke-free policies most campuses voluntarily adopt them, according to Cynthia Hallett, the executive director of Americans for Non-Smokers Rights (ANR). According to ANR, there are a little more than 4,000 colleges and universities in the United States, and as of July 2014 there were 1,372 smoke-free campuses in the United States, of which 938 are 100 percent tobacco-free and 176 prohibit the use of e-cigarettes anywhere on campus. That’s up from 446 smoke-free campuses in 2010; reporting on tobacco-free campuses began in 2012, when there were 608.
Credit some of that change to the Tobacco-Free College Campus Initiative (TFCCI) of the U.S. Department of Health and Human Services (HHS), launched two years ago to promote and support the adoption and implementation of tobacco-free policies at colleges and universities. TFCCI is a partnership of HHS, the American College Health Association and the University of Michigan, with sponsorship from the American Legacy Foundation.
While support for making campuses smoke- and even tobacco-free is growing, it’s hardly a slam dunk, especially when the move requires students to vote. Universities say opposition can come from foreign students who are sometimes more likely to smoke than their U.S. counterparts or contract employees who don’t want to be barred from smoking on campus. It can even come from the media. Two years ago, when UCLA announced its campus-wide tobacco free policy, the Los Angeles Times published an editorial titled “A Smoke Free UC Goes too Far” which said that “[s]moking is a detestable, dangerous habit—but it's also a legal one, and there is plenty to say in defense of allowing adults to make bad decisions if they're not breaking the law or harming others.”
Hoping to get the initiatives to pick up steam, TFCCI has launched challenges aimed at getting more campuses—and their students, faculty and employees—to give up their smokes.
- Read a NewPublicHealth interview with former HHS Assistant Secretary Howard Koh on the goals for Tobacco-Free College Campus Initiative.
- Download TFCCI resource toolkits on how to make campuses tobacco-free.
EBOLA UPDATE: Death Toll Now to at Least 2,296
(NewPublicHealth is monitoring the public health crisis in West Africa.)
The death toll from the ongoing Ebola outbreak in West Africa is now at least 2,296, according to the World Health Organization. However, the global health agency does not have the latest figures from Liberia—the country that has been hit hardest by the disease—making the true toll likely much higher. "It remains a very grave situation," said Liberian President Ellen Johnson Sirleaf on Tuesday, according to Reuters. "It is taking a long time to respond effectively .... We expect it to accelerate for at least another two or three weeks before we can look forward to a decline." As of Sept. 6 there were 4,293 recorded cases in five countries. Read more on Ebola.
Johns Hopkins Bloomberg School of Public Health, Clinton Foundation Announce Consensus Statement on Treating Prescription Drug Abuse and Misuse
The Johns Hopkins Bloomberg School of Public Health and the Clinton Foundation have released a consensus statement calling for a public health frame to analyze and disseminate proven, evidence-based intervention to combat prescription drug abuse and misuse. The statement is in response to President Clinton’s call-to-action on the subject in May of this year. “Prescription drug abuse and misuse, as well as widespread addiction and diversion of these products to the illicit market, represents one of the greatest challenges to our country’s public health in recent memory,” said Michael J. Klag, MD, MPH, dean of the Johns Hopkins Bloomberg School of Public Health, in a release. “This consensus statement marks a continuation of our school’s commitment, as well as that of the Clinton Foundation, to address epidemic rates of poisonings and deaths that are occurring due to prescription opioids and other prescription drugs that are highly prone to abuse and misuse.” According to the U.S. Centers for Disease Control and Prevention, drug overdoses killed 41,430 people in 2011, making it the leading cause of injury deaths. Read more on substance abuse.
CDC: 90% of Youth Ages 6-18 Consume Too Much Sodium
Approximately 9 in 10 U.S. children ages 6-18 consume more than the recommended amount of sodium, according to a new report from the U.S. Centers for Disease Control and Prevention (CDC). The report also found that approximately 43 percent of the sodium comes from the ten foods they eat the most often: pizza; bread and rolls; cold cuts/cured meats; savory snacks; sandwiches; cheese; chicken patties/nuggets/tenders; pasta mixed dishes; Mexican mixed dishes; and soups. “Too many children are consuming way too much sodium, and the result will be risks of high blood pressure and heart disease in the future,” said CDC Director Tom Frieden, MD, MPH, in a release. “Most sodium is from processed and restaurant food, not the salt shaker. Reducing sodium intake will help our children avoid tragic and expensive health problems.” Read more on nutrition.
Almost every day brings reports of new cases of Ebola, the often-fatal virus now impacting multiple countries in West Africa. According to the U.S. Centers for Disease Control and Prevention (CDC), the 2014 Ebola outbreak is the largest Ebola outbreak in history. Spread of the disease to the United States is unlikely—although not impossible—and efforts are underway to find vaccines and cures, including scale-ups of drug development and manufacturing, as well as human trials for vaccines both in the United States and around the world. However, in West Africa the epidemic is impacting lives, economies, health care infrastructure and even security as countries try a variety of methods—including troop control—to get citizens to obey quarantines and other potentially life-saving instructions.
Late last week, NewPublicHealth spoke with Laurie Garrett, senior fellow for global health at the Council on Foreign Relations. Garrett has written extensively on global health issues and was on the ground as a reporter during the Ebola outbreak in Zaire in 1995.
NewPublicHealth: What are your key concerns with respect to the current Ebola outbreak?
Laurie Garrett: My main concern has been about the nature of the international response, which could be characterized as non-response until very recently. And now that the leadership of the international global health community has finally taken the epidemic seriously, it’s too late to easily stop it. We’ve gone through the whole list of all the usual ways that we stop Ebola and every single one of them was initiated far too late with far too few resources and far too few people—and now we’re in uncharted territory. We’re now trying to tackle a problem that has never reached this stage before and we don’t know what to do. The international response is pitiful, disgusting and woeful.
NPH: How do you account for such a poor response?
Garrett: First of all, the World Health Organization (WHO) is a mere shadow of its former self. When I was involved in the Ebola epidemic in 1995 in Kikwit, Zaire, the WHO was recognized worldwide as the leader of everything associated with outbreaks and infection, and it acted aggressively. It didn’t have a huge budget, but it still was able to take the problem very seriously and the resources that were needed were available, and more importantly a very talented leadership team combining the resources of the U.S. Centers for Disease Control and Prevention; WHO; Medicin San Frontiers (Doctors Without Borders); and the University of Kinshasa, Zaire, came together. They respected each other. They were on board together. They worked very closely with the local Red Cross, and they were able to conquer the problem pretty swiftly.
EBOLA UPDATE: Liberia Experiencing an Exponential Increase in Infections
(NewPublicHealth is monitoring the public health crisis in West Africa.)
The World Health Organization (WHO) estimates that Liberia will see thousands of new Ebola cases over the next several weeks. "Transmission of the Ebola virus in Liberia is already intense and the number of new cases is increasing exponentially," according to a WHO statement. "The number of new cases is moving far faster than the capacity to manage them in Ebola-specific treatment centers." So far, 1,089 people have died of the disease in Liberia—the highest toll for any country. Approximately 2,100 people have been killed overall, and WHO estimates that as many as 20,000 people could be infected before public health workers are able to bring the epidemic under control. Read more on Ebola.
CDC Expands National Violent Death Reporting System to Cover 32 States
The U.S. Centers for Disease Control and Prevention (CDC) has awarded $7.5 million to expand the National Violent Death Reporting System (NVDRS) to cover 32 states. The NVDRS—which currently covers 18 states—links data from law enforcement, coroners, medical examiners, crime laboratories and other sources to help states understand when and how violent deaths occur. “More than 55,000 Americans died because of homicide or suicide in 2011. That’s an average of more than six people dying a violent death every hour,” said Daniel M. Sosin, MD, MPH, FACP, acting director of CDC’s National Center for Injury Prevention and Control, in a release. “This is disheartening and we know many of these deaths can be prevented. Participating states will be better able to use state-level data to develop, implement, and evaluate prevention and intervention efforts to stop violent deaths.” Read more on violence.
NIAAA to Conduct Trials on New Alcohol Use Disorder Treatment
The National Institute on Alcohol Abuse and Alcoholism (NIAAA) is preparing to conduct clinical trials of a potential treatment for alcohol use disorders. “Current medications for alcohol dependence are effective for some, but not all, patients. New medications are needed to provide effective therapy to a broader spectrum of alcohol dependent individuals,” said George F. Koob, PhD, director of the NIAAA, a part of the National Institutes of Health (NIH), in a release. “Prior clinical studies of gabapentin, the active metabolite of the molecule called gabapentin enacarbil, have shown positive results in patients with AUD. We believe that the time is right to conduct a multi-site, well-controlled clinical trial.” The NIH estimates that approximately 17 million people in the United States are affected by an alcohol use disorder, with lost productivity, health care costs and property damage costs amounting to an estimated societal cost of $223.5 billion annually. Real more on alcohol.
A new Kaiser Health News (KHN) article describes the challenges of helping people who have never had health insurance sign up for coverage. The KHN profile looks at the Arab Community Center for Economic & Social Services (ACCESS) a nonprofit agency that is helping the large Arab-American population in Dearborn, Mich., sign up for coverage and access care.
The group has found that many of the people they are helping are immigrants who know little to nothing about health insurance concepts such as enrollment, copays and deductibles—an issue that also applies to millions of other people new to health insurance across the country. Immigrant and uninsured populations all over the country face cultural and language barriers to understanding and adopting U.S. insurance practices.
Ten million non-citizens living legally in the U.S. are expected to gain health insurance under the Affordable Care Act, according to KHN. The navigators at ACCESS are also trained to teach immigrants about free public health screenings for conditions such as breast cancer, which requires specialized training and conversations because of cultural stigmas associated with cancer.. At the ACCESS center in Dearborn, for example, women coming for free mammograms enter through an unmarked door.
Read the Kaiser Health News article.
- Kaiser Health News recently reported that, on average, premiums will decline in 16 major cities for the 2015 coverage year.
- Advertising for health insurance plans has already started across the country. Sign up for the 2015 coverage year begins October 15, 2014 and ends February 15, 2015, a period that is roughly three months shorter than last year’s enrollment period. Find information at healthcare.gov.
Mandatory Policies Increase Flu Shot Rates for Health Care Workers
Hospitals can improve their flu vaccination rate among health care workers by using a mandatory employee vaccination policy, according to a study by researchers at the Henry Ford Health System in Detroit. At Henry Ford, getting the flu shot is a condition of employment and the health system now has a 99 percent compliance rate. Nationally, only 63 percent of health care workers were immunized against the flu in the past two years, according to the Centers for Disease Control and Prevention, which poses a risk to patients. The study was presented this weekend at the Interscience Conference on Antimicrobial Agents and Chemotherapy in Washington D.C.
Before making flu vaccination mandatory, the vaccination rate at Henry Ford was between 41 percent and 55 percent. An increasing number of health systems are making flu shots mandatory for employees. At Henry Ford, employees can opt out for religious or medical reasons so long as they have documentation from clergy or a physician and then must take other precautions against the flu, such as wearing a mask when caring for patients.
Many doctors’ offices, pharmacies and clinics already have the flu shot on hand for the upcoming flu season. The HealthMap flu shot locator has been updated for the 2014-2015 flu season.
Read more on the flu.
Study: Alcohol Ad Reminders to “Drink Responsibly” Promote Drinking
A new study by researchers at the Johns Hopkins School of Public Health finds that magazine ads from the alcohol industry that advise readers to “drink responsibly” or “enjoy in moderation” fail to convey important information about dangers associated with alcohol consumption.
The study, published in Drug and Alcohol Dependence, analyzed all alcohol ads that appeared in U.S. magazines from 2008 to 2010 to determine whether messages about responsibility define responsible drinking or provide clear warnings about the risks associated with alcohol consumption.
According to the study, 87 percent of the ads analyzed included a responsibility message, but none actually defined responsible drinking or promoted abstinence at particular times or in certain situations. When responsibility messages were accompanied by a product tagline or slogan, the messages were displayed in smaller font than the company’s tagline or slogan 95 percent of the time.
Responsibility statements are voluntary and are also frequently included in ads appearing in other media including radio and online ads. The researchers say more effective ads would have prominently placed tested warning messages that directly address behaviors and that do not reinforce marketing messages. “We know from experience with tobacco that warning messages on product containers and in advertising can affect consumption of potentially dangerous products,” say Katherine Clegg Smith, a professor at the Johns Hopkins Bloomberg School of Public Health and a lead author of the study. “We should apply that [tobacco ad] knowledge to alcohol ads and provide real warnings about the negative effects of excessive alcohol use.”
Read more on alcohol.
NYC Health Department Investigating Meningitis Outbreak among HIV Positive Men
The New York City Health Department is currently investigating a cluster of meningitis cases among HIV-positive men who have sex with men. Three cases of meningitis have occurred in Brooklyn and Queens since August 24, with the last two cases reported since early September.
Meningitis is a severe bacterial infection that has a high fatality rate. A previous outbreak of the disease among men who have sex with men ended in February 2013 after 22 cases were reported, including seven fatal cases.
The Health Department recommends meningitis vaccination for all HIV-positive men who have sex with men. Meningitis vaccinations are also recommended for men, regardless of HIV status, who regularly have intimate contact with other men met through a website, digital application (“app”), or at a bar or party.
People living with HIV are at a greater risk than the general population of acquiring meningitis and, if infected, dying from infection. This disease is spread by prolonged close contact with nose or throat discharges from an infected person.
Read more on sexual health.
Earlier this year, Durham County, N.C., was chosen by the Robert Wood Johnson Foundation (RWJF) as a Culture of Health Prize winner for its efforts to ensure that its most vulnerable residents have access to the county’s repository of world-class health resources, high-skilled jobs and places to exercise. As part of an ongoing series, Health Affairs blog has featured a piece by local Durham leader Erika Samoff on the community’s health successes.
While Durham is home to a wealth of health care resources—so much so that it’s been dubbed “The City of Medicine”—a 2004 health assessment found high rates of cardiovascular disease and other chronic conditions; HIV/AIDS and other sexually transmitted diseases; and infant mortality. In addition, a 2007 evaluation found that nearly one in three of Durham’s adults were obese, with the rate especially high in its African-American population, at 42 percent. Half of the adults surveyed pointed to a lack of opportunities for physical activity as a contributing factor to their condition.
County leaders responded to these findings by creating the Partnership for a Healthy Durham. It is an alliance of more than 150 nonprofits, hospitals, faith-based organizations and businesses. The partnership’s efforts include:
- Turning an empty, run-down junior high school into the Holton Career & Resource Center, which offers mentoring programs, internships and hands-on career training to high school students
- Creating new bike lanes, bike racks and sidewalks to encourage physical activity and help combat chronic obesity
- Creating Project Access of Durham County to provide access to specialty care for uninsured residents
- Passing smoke-free legislation
To learn more about Durham’s prize-winning efforts to improve health, read the Health Affairs blog post.
- Learn more about the 2014 RWJF Culture of Health Prize winners and read NewPublicHealth coverage of the prize announcement.
- Read Everyday Health’s post, “How Healthy Is Your Hometown?: What you can do to create a culture of health in your community – and win a prize for it.”
>>Bonus Content: Watch a NewPublicHealth video on Durham’s efforts to build a Culture of Health.
Last June, the Washington Post held a live event, Health Beyond Health Care, which brought together doctors, bankers, architects, teachers and others to focus on health beyond the doctor’s office. The goal of the Washington, D.C., event—which was co-sponsored by the Robert Wood Johnson Foundation others—was to showcase examples of communities working with partners to create cultures of health.
Healthy Detroit is a shining example. The project is a 501(c)(3) public health organization dedicated to building a culture of healthy, active living in the city of Detroit. It was formed less than a year ago in response to the U.S. Surgeon General’s National Prevention Strategy (NPS.) The NPS offers guidance on choosing the most effective and actionable methods of improving health and well-being, and envisions a prevention-oriented society where all sectors recognize the value of health.
NewPublicHealth recently spoke with Nicholas Mukhtar, founder and CEO of Healthy Detroit.
NewPublicHealth: How did Healthy Detroit get its start?
Nicholas Mukhtar: I was just about to the MPH part of a joint MPH/MD degree and had always wanted to be a surgeon. But as I started living in the city and getting more involved in the community, I really saw a different side of health care, and to me it just became more rewarding to focus on the systemic issues in the health care system, more so than treating people once they already got sick. I’ve now finished the MPH part of my degree, and am starting on my MD degree.
So I started sending out a number of emails to different people and reached out to Dr. Regina Benjamin, then the U.S. Surgeon General, as well as local individuals. And then we established our mission, which was really to build a culture of prevention in the city while implementing the National Prevention Strategy.