Tag Archives: medical

End the Pink Tax on Moms & Babies

Amid a pandemic that has pushed millions of mothers out of the workplace, caused fertility rates to plunge and heightened the risk of death for pregnant women, California Gov. Gavin Newsom and Democratic lawmakers are seeking a slate of health proposals for low-income families and children.

Newsom, a self-described feminist and the father of four young children, has long advocated family-friendly health and economic policies. Flush with a projected budget surplus of $75.7 billion, state politicians have come up with myriad legislative and budget proposals to make poorer families healthier and wealthier.

They include ending sales taxes on menstrual products and diapers; adding benefits such as doulas and early childhood trauma screenings to Medi-Cal, the state’s Medicaid program; allowing pregnant women to retain Medi-Cal coverage for a year after giving birth; and a pilot program to provide a universal basic income to low-income new parents.

“COVID-19 laid inequity bare for all to see,” Assembly member Wendy Carrillo (D-Los Angeles) said in a written statement. She is the co-author of Senate Bill 65, led by Sen. Nancy Skinner (D-Berkeley), which would pour hundreds of millions of dollars into family and health care programs annually, focusing on minority groups that Carrillo said were “pushed out of the social safety net by the prior White House.”

Newsom and the Democratic-controlled legislature are unified on major health care and social safety-net expansions, which would direct billions in health benefits and cash assistance to the state’s most vulnerable residents and low-income parents. Legislative Democrats for years have pushed a progressive agenda to help struggling parents and families, featuring proposals like those to permanently end taxes on menstrual products and diapers — expected to cost the state millions.

“We don’t need to balance the budget on half of the population that has a uterus,” said Assembly member Cristina Garcia (D-Bell Gardens), who has for years sought an endto the “pink tax” on diapers and menstrual products.

Skinner, chair of the Senate budget committee, is among the powerful lawmakers who’ve put forward legislation to make childbirth safer and parenthood more affordable. Her bill, which cleared the Senate and was up for consideration this week in the state Assembly, has several features that would dramatically expand maternal health care (transgender men also get pregnant and give birth).

Before the pandemic, Medi-Cal covered mothers only up to 60 days after their pregnancies ended unless their income fell below a certain line or they had a mental health diagnosis. Skinner’s bill, part of a broader national push to improve birth outcomes, would expand full Medi-Cal coverage to 12 months after the end of a pregnancy. Other parts of the bill would intensify state reporting and reviews of fetal and pregnancy-related deaths and severe maternal morbidity, expand housing benefits for families that have a pregnant member, and increase training programs for midwives.

Newsom’s $268 billion budget blueprint includes about $200 million a year to fully implement the expansion of Medi-Cal coverage for new mothers, with matching dollars from the federal government until those funds expire in 2027. If the expansion were not renewed, the state would revert to previous Medi-Cal qualifications.

Medi-Cal covered 45% of all births in California in 2017, the last year for which data could be found.

“Not all postpartum issues end at 60 days, and when patients lose insurance, we can’t address them in the usual way,” said Dr. Yen Truong, an OB-GYN who works with the American College of Obstetricians and Gynecologists on legislative issues in California.

About half of pregnancy-related deaths occur during the pregnancy or on the day of delivery, but about 12% take place between seven weeks and a year after giving birth, according to the Centers for Disease Control and Prevention.

The U.S. had 17.4 early maternal deaths per 100,000 live births in 2018, according to the most recent CDC data with state figures. California’s rate, 11.7 per 100,000, was among the lowest in the nation, but the state collects data on maternal deaths in a way that could result in underestimates.

California’s overall numbers also obscure stark racial disparities. Statewide, Black infants averaged 7.8 deaths per 1,000 live births, compared with an average of three deaths among white babies. Data from 2013 from Los Angeles County showed Black women had pregnancy-related deaths at rates more than four times as high as the overall rate in the state’s largest county.

“Given our state’s wealth and medical advancements, this is unacceptable,” Skinner, vice chair of the Legislative Women’s Caucus, said in a news release.

Democrats also appear unified on another aspect of Skinner’s bill: a pilot program to test a universal basic income program for struggling families. The bill would give $1,000 a month to low-income expectant and new parents with kids under 2 years old in counties that decide to participate. Newsom has also proposed $35 million over five years for pilot programs for universal basic income.

These issues could play well, especially among women, and improve Newsom’s standing going into a recall election later this year, said Rose Kapolczynski, a longtime campaign consultant to former U.S. Sen. Barbara Boxer who has worked on reproductive health care issues in Sacramento.

Indefinitely rescinding sales taxes on diapers and menstrual products — the taxes have been temporarily lifted since early last year — is a particular no-brainer because of its bipartisan appeal, she said.

“It’s hard for Republicans to attack something that is a tax cut, and sales taxes are regressive, so progressives would like it,” Kapolczynski said.

As for Medi-Cal expansions, Kapolczynski said that even though it wouldn’t affect most Californians, the pandemic has made health care even more important to voters. “The budget surplus is allowing many things that were called impossible to be possible, and that includes health care bills,” she said.

Investing in California’s young families could help close the racial gap in maternal and infant mortality, said Nourbese Flint, executive director of the Black Women for Wellness Action Project, which endorsed Skinner’s bill.

Flint is especially excited about the possibility of covering doulas through Medi-Cal. Doulas, trained as emotional and physical supports for women in pregnancy and postpartum, have been linked to lower odds of cesarean births and greater satisfaction with the birth experience. If doulas saved Medi-Cal money by reducing cesarean births, that could enable the state to renegotiate payments for labor and delivery, according to an analysis by the independent California Health Benefits Review Program. Under Newsom’s proposed budget, Medi-Cal coverage of doulas would cost about $4.4 million a year.

California’s would become the first Medicaid program to include “full spectrum” doula coverage, meaning it would include care for women who have abortions, miscarriages and stillbirths, said Amy Chen, a senior attorney at the National Health Law Program.

“California has always led the country and been a little bit in front of where our federal government is when it comes to covering folks,” Flint said.

California Healthline correspondent Angela Hart contributed to this report.

This story was produced by KHN (Kaiser Health News), a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

 

Why Should You and I Care About Palliative Care?

Sukham Blog – A monthly column focused on South Asian health and wellbeing.

My wife’s oncologist recommended a palliative-care consultation during one of her checkups. This was the first time we heard about it and my wife, subsequently, received beneficial palliative care alongside her ongoing treatment for cancer. Since then, I’ve continued to learn more about palliative care and how it helps patients living with various kinds of serious illnesses. I’ve also realized that most people know very little, or are misinformed about palliative care. We need to understand this relatively new medical specialty; it can do a lot for us and our loved ones in the event of a serious health issue. 

Palliative care is specialized care for people living with a serious illness. It is a type of care focused on providing relief from the symptoms and stress of different kinds of serious and chronic, progressive illnesses, and is provided in addition to, and concurrent with, ongoing medical care. It supports the patient’s ability to feel better while undergoing treatments which could be intense and sometimes not well tolerated. The goal of palliative care is to improve quality of life for both the patient and the family.

To palliate is to make something – for example, a disease or its symptoms – less severe or unpleasant. Palliative Medicine is relatively new. It has its roots in the work of Cecily Saunders and Elisabeth Kübler-Ross in the 1960s. The term Palliative Care was coined in 1974 by Dr. Balfour Mount, a surgical oncologist at The Royal Victoria Hospital in Montreal, Canada. It was recognized as a field of specialty medicine in Great Britain in 1987, the same year that Cleveland Clinic started the first Palliative Medicine service in the United States. It became a board-certified subspecialty of medicine in the United States in 2006, just 15 years ago.

Let me repeat: Palliative care is specialized care for someone living with a serious or chronic progressive illness, focused on providing relief from the symptoms and stress of the illness, to improve quality of life for both the patient and the family. It is based on the needs of each individual patient and can be provided at any time during his or her illness, along with the treatment he or she is already receiving, regardless of the prognosis, expected trajectory of the disease, or age of the patient.

What, specifically, does palliative care do? It provides relief from pain, nausea, constipation, neuropathy, shortness of breath, or other side effects and symptoms caused by the illness and/or treatment. It helps when patients and their families have trouble coping with the illness and are anxious, depressed, stressed, or fatigued, and enables them to better carry out their daily tasks and do the things they want. Palliative care can also improve the quality of life for both the patient and his or her family. 

What is meant by quality of life? That depends on the patient! He or she defines what is important at that moment and in the future. The palliative care team works with the patient and his or her family to understand what’s important and what matters most to them, and takes that into account to formulate a treatment plan and provide the best possible support to help realize those goals.

I used the phrase palliative-care team.  Care is provided by a specially-trained, multidisciplinary team that typically includes doctors, nurses, medical assistants, social workers, chaplains, and other specialists. This is because palliative care extends beyond a patient’s physiological and medical needs and addresses other factors that may be affecting their quality of life, including psychological, spiritual, and social needs. These needs vary from patient to patient. In addition, they can vary over time for a given patient.

Needs could include: help with figuring out what medications should be taken and when; thinking things through, and weighing options when faced with decisions on a suggested next step in treatment; help navigating the complexity of a large hospital when referred to different specialists or when various tests are ordered. Sometimes stress can overwhelm the patient, caregiver, or another family member, and they could benefit from having a caring listener, or just a hand to hold for a while. The costs of treatment are a huge concern for many of us, so the assistance of a qualified individual to sort through financial questions might be valuable. When serious illness brings up existential and spiritual questions, trained chaplains could provide answers, solace, comfort, and a compassionate presence. Nutritionists who understand the patient’s diagnosis and condition can help address dietary concerns.   

Palliative-care specialists treat people living with many types of serious and chronic illnesses, regardless of their age, stage of the disease, and whether or not they are still receiving curative treatment; these include cancer, congestive heart failure, chronic obstructive pulmonary disease (COPD), kidney failure, Alzheimer’s, Parkinson’s, Amyotrophic Lateral Sclerosis (ALS), and other life-limiting diseases. Pediatric palliative care is an upcoming specialty. During the current pandemic, it’s an essential part of treatment for those who have contracted COVID-19.

Many confuse palliative care with hospice and believe a recommendation for palliative care implies the patient has a condition that will imminently end his or her life. This is not correct. Palliative care can be very useful for those managing a long-term illness. Quality research provides evidence that the early introduction of palliative care provides all the benefits described above, and results in fewer hospitalizations, a reduced burden on the family, and greater satisfaction overall. Hospice is a form of palliative care for those patients judged to be approaching end of life – and typically have six months or less left to live – who decide to focus on comfort instead of prolonging treatments.

Most private insurance plans, as well as Medicare and Medicaid, cover palliative-care services in hospitals and nursing homes. However, you should always consult with your insurance provider to understand your coverage in detail.

I hope this has helped you better understand Palliative Care and dispel any related misconceptions. 

Mukund Acharya is a regular columnist for India Currents. He is also President and a co-founder of Sukham, an all-volunteer non-profit organization in the Bay Area that advocates for healthy aging within the South Asian community. Sukham provides curated information and resources on health and well-being, aging, and life’s transitions, including serious illness, palliative and hospice care, death, and bereavement. Contact the author at sukhaminfo@gmail.com

Sincere thanks to Drs. Neelu Mehra at Kaiser Permanente, and Kavitha Ramchandran & Grant Smith at Stanford Health Care – Palliative Care Physicians who have contributed greatly to my understanding of Palliative Care.

With sincere thanks to Trung Nguyen at Pexels for the use of her beautiful photograph.

Rising Healthcare Costs Make Patient Care Difficult for Visiting Parents

U.S. President Donald Trump and presidential candidate, Vice President Joe Biden, are united by one issue at least – the rising cost of medication.   

This July, prices rose 3.1 percent on average for 67 drugs compared to the same period last year. GoodRx points out that the increases came on the heels of a 6.8% surge, on average, from January to June 30 of this year – manufacturers raise prices in January and July annually. And for many Americans, this means not filling their prescriptions. In a new poll by Best Health and the Global Strategy Group of 4,200 potential voters in Arizona, Colorado, Georgia, Iowa, Maine, Montana, and North Carolina, the main battleground states for the Senate, 22 percent of the respondents said they couldn’t afford medications prescribed by their doctors. More than a quarter (26%) said they or their family members were unable to seek treatment for a health problem in the last year due to cost concerns.

Rising costs have also affected another demographic – parents from India visiting their offspring. Thousands of older Indians have had to extend their stay as a result of travel restrictions amidst the pandemic earlier this year.

“My father is 75 years old and has had benign prostate hyperplasia (BPH) for about 10 years. His urologist made the very unwise decision to perform surgery for my father’s BPH right before he came to visit me. He’s been experiencing complications from that ever since,” says Dr. Debyani Chakravarty, a new mother and a faculty member in the department of pathology at the Memorial Sloan Kettering Cancer Center in New York. “I bought both my parents’ travel insurance but since these are complications from surgery, nothing is covered. I pay $300 per consultation with a doctor here, $300 for my dad’s cystoscopy, $100 for labs, and $200 for his meds so far. In Pune, their medication (alone) would cost at least ten times less.”

Another set of parents visiting their daughter, also a new mother in New York, were Sushima Sekhar and her husband from Chennai. Both had to postpone their return and were running out of their diabetes, blood pressure, and cholesterol medication they’d brought from India. 

Their daughter’s physician, Sekhar says, asked to see them in order to prescribe. “The consult per person was $250, quite steep,” she recalls. “In the meantime, we got the number of a COVID Tamil Task Team which was doing an unbelievably great service to stranded Indians here. They had chemists and doctors in their group. All we had to do was give them our Indian prescription, and they would find the equivalent generic low-cost drug, double-check with their doctors, (and issue us a prescription here). We kept them as a last resort because the price of meds, however low, was way too high when converted in Indian rupees – anywhere between five to fifteen times higher.”

Sekhar eventually succeeded in getting the medication couriered from India, after that avenue opened up following a lockdown there. 

But for many others, obtaining affordable medication in time without missing dosages would have been impossible but for voluntary groups such as the COVID-19 Tamil Task Team, and Non-Resident Indian doctors in the Telugu community. 

Dr. Saraswathi Lakkasani, a Telugu NRI doctor who is helping parents visiting from India.

“The federal government relaxed telemedicine rules (as a result of the pandemic), and I wanted to help these people stranded here. For one prescription to go out, we had ten volunteers working on it,” says Dr. Saravanan Ramalingam, a trauma surgeon in New York who helped launch the service. The initiative gained momentum after the group had a conference call with Shatrughna Singha, Deputy Consul General of India, New York, who was keen that Indian-origin doctors provide help to visiting older Indians in need of healthcare and medication, Ramalingam points out.  

Vasudevan Kothandaraman, an IT professional in New Jersey, helps to co-ordinate within a group of around 30 volunteers. The quality checks are stringent, he says, and prescription requests are routed through the app Freshdesk. Volunteers verify the Indian prescription and refer patients to a telemedicine team of doctors if required. A group sends the list to local pharmacies to find out if an American equivalent of the drug is available. If it is, the verification team, consisting of doctors, nurses, and pharma PhDs search for a cheaper, generic alternative. The prescription team reviews the process, and a doctor faxes a prescription to a pharmacy nearest to the patient’s home. “If the cost is really high, we provide them with GoodRx type of discount coupons,” Kothandaraman says. “We have issued 400 prescriptions (at the start of the pandemic lockdown).”        

Now, a fall surge expected by the Centers for Disease Control and Prevention could again intensify the struggles of older Indians visiting in the U.S., and those who have extended their visas to be with family. 

Doctors are standing by to help. 

“One Telugu lady, a mother visiting her family in North Carolina, had recurring urinary tract infection. She was stuck here because of the lockdown and had no clue where to go and what to do,” says Dr. Saraswathi Lakkasani, an internist who was recently awarded a fellowship in gastroenterology and hepatology by the New York Medical College. “I heard her medical history – she had co-morbidities – and prescribed antibiotics at a CVS Pharmacy close to her. Told her to drink plenty of water and some cranberry juice; her symptoms were gone within a week.”

Lakkasani pauses, adding reflectively: “She is an elderly stranger, she is talking in my language. It moves you.”  

Sujata Srinivasan is a business and healthcare journalist in Connecticut. Find her on Twitter @SujataSrini.

Featured Image by Harsha K R.

IP Law and Trade Policies Compete With Medical Needs

The role of Intellectual Property Law and Trade Policies in Innovation and the access to medicines and medical technologies compete against each other in the Corona impacted world.

COVID-19 has shaken the world and medical technological breakthroughs with new vaccines or drugs would be the only way to save mankind. A global health crisis always triggers concerns over patented medicines and treatments that may impede access to affordable healthcare. A global pandemic or a health crisis stimulates the need for better access to medicines, creating a gray area between the protection of ideas, investments, and access to medicines for the larger good of public health. 

The Emerging Issue     

Intellectual Property Rights awards exclusivity to the inventor or the owner to manufacture and sell their invention.  

Almost a decade ago when HIV/AIDS had become a global crisis, concerns of better access to medicines were raised. Developing nations had concerns with regard to the implementation of strong Intellectual Property regimes as it would have a negative effect on the efforts to improve public health, thereby making it difficult for governments to have policies for affordable healthcare.

The major problem in developing nations is that the prime population pays for their own drugs and state provisions are selective and constrained. Though the concept of state health insurance schemes is blooming, its effectiveness, to date, is questionable. 

A similar situation exists in the current scenario for COVID-19 where not only are the beds in each hospital limited, but extravagant costs have to be borne by patients.

In Tamil Nadu, India, private hospitals are charging a whopping amount of Rs 30,000 per day, even though government orders state otherwise, capping the charges at Rs 7500 for mildly asymptomatic patients and in case they have been admitted to Intensive Care Unit then the charges are capped at maximum Rs. 15,000 per day. Claims of unfair charges are popping up every day where hospitals are being accused of merely robbing patients.

Not only that, exploitative pricing has become a common predicament in most Asian Countries where hospitals are overcharging in COVID-19 rapid tests. The rapid test packages offered by hospitals have been differing from 500,000 rupiah to 5.7 million rupiah ($32 to $365). Exorbitant pricing remains an issue in the United States as well, where an individual faced a $1.1 million hospital bill.

Access to proper healthcare has already started becoming a concern with hospitals turning the major crisis into a money minting machine, even when there is no absolute drug or vaccine for the disease. The concern is, if every entity starts to look at this crisis as an opportunity, sustaining public policy will be a distant task for the government.

The Exclusivity of a Patent 

The key objective of the patent system is to reward exclusively to the innovator for an invention that is novel and has some industrially enhanced efficacy to it. The patented innovation could be a product or a process, as engraved in the TRIPs (Trade-Related Aspects of Intellectual Property Right) Agreement, 1995. The patentee creates a solution to a problem and as an incentive, an exclusive right is given to the owner, to produce and sell it, for 20 long years. The pharmaceutical industry is majorly dependent on the patent system to recover its research and development cost and to generate profits for future innovation.

The Competing Interest: Public Health

Compulsory licensing is an act where the government authorizes a third-party to use, make and sell a patent without the permission of the patentee or the owner, when the medicine is not available at a reasonable and affordable price or when it is not obtainable in a justified quantity. Compulsory Licensing and competition from generic or biosimilar products are general issues that threaten many patent holders. A competing interest is involved here, where on one side, there is a greater good of public interest where the ownership of technological innovation should be with the public, and on the other side, there is private ownership of patents fuelling further innovations. 

Biosimilar and generic drugs are sold at a cheaper price and are said to have a trade-distorting effect. However, the provision of consensual licensing instead of any legal compulsion might be a silver lining to this whole circumstance. The possibility stems from the current world scenario where corporate social responsibilities on Multinational Corporations (MNC’s) are an obligation and a single-minded pursuit of business is no more encouraged. This can definitely balance the competing interests of the right holders and the public interest at large. 

With the current COVID-19 scenario, the World Health Organization has accepted a proposal for patent pooling in order to collectively share the patent right, test data, and information required to create drugs and vaccines. It showcases an attempt towards navigating patent rights for all countries thereby making new innovations available to everyone.

Patent Pooling is a framework where one or two patent holders enter into an agreement to share their innovation by means of licensing with each other or with a third party in order to provide fruitful technological solutions. Patent pooling can even help in the scenario where technology is not entirely developed and thereby lead to new innovations without any hindrance to access.

However, with the United States trying to quit the World Health Organization, a question emerges – ‘in case they do terminate their relationship, how is the patent pool going to function?’ We all know what happened to the International Trade Organization when the United States chose not to be a part of it and now with the changes in the current arrangement, the question emerges again. The world is approaching multilateralism and is finally able to compromise with nationalism in order to work in solidarity. 

Lahama Mazumdar is currently working as a Teaching Assistant in National University of Study and Research in Law, Ranchi and is a doctoral student at National Law University Odisha. 

How We Come Together: Teen’s PPE Initiative

While young people are less likely to suffer the consequences of the coronavirus pandemic, it is their responsibility to protect vulnerable, immunocompromised communities. And that’s precisely what Presentation High School student Mitthra Senthil is trying to do. After the transition to distance learning, it would have been easy for Mitthra to focus on the onslaught of AP exams, finals, and projects that are typical of any high school workload. Instead, she directed her passion for STEM towards addressing the current deficiency in medical supplies. 

The coronavirus outbreak has threatened the resources, staffing, and support available to medical facilities all over the Bay Area. To date, there have been 2,120 confirmed cases in our community — a number that can only be the lowest possible estimate. According to the Los Angeles Times, healthcare and sanitation workers are being forced to reuse N95 masks, thus endangering the lives of the individuals trying to protect ours. Although Gov. Newsom recently announced a large purchase of masks for the state of California, the reuse of medical gear runs rampant in some of the area’s largest facilities. And healthcare workers are not the only ones in desperate need of masks. Shelters, soup kitchens, and food banks in California struggle to accommodate the growing population of homeless individuals vulnerable to the virus. 

It is amid this environment that Mitthra Senthil used her STEM and sewing skills to make masks of her own. “The idea came to fruition when Mitthra’s mother was at a grocery store and a few of the workers and customers asked where they could buy their own masks because they didn’t have access to reusable masks to wear – especially when working. So, with her grandmother (who taught her how to sew), Mitthra contacted family friends at hospitals and had them send an approved template/design that would be effective for all users”, says a representative from Presentation High School. 

With the help of her family, Mitthra has distributed 100 cloth masks to local hospitals, and more than 150 to homeless shelters and the general public. Even better, these masks are available to all communities. “The cost of the masks ($3) is put directly toward the purchasing of supplies.” Although the future of the pandemic is nebulous, it is heartening to know that young people are using the wealth of resources and knowledge available to them to bring out the best in our humanity. Mitthra continues to make masks for the Bay Area. To request masks, you can email mitthrasenthil@gmail.com or place an order on her website. 

Kanchan Naik is a junior at the Quarry Lane School in Dublin, California. Aside from being the Youth Editor at India Currents, she is also the Editor-In-Chief of her school newspaper The Roar and the Teen Poet Laureate of Pleasanton.

The Greying Population of India Hit with COVID-19

While parents left behind in India are terrified of COVID-19, their NRI children are impatient in a distant land to return back to them. We are worried about our loved ones staying far away. Recently, NRIs settled in US, UK, France, dealt with the rapid transmission of COVID-19. The nightmare of a rapid influx of positive COVID-19 cases among potential foreign returnees is petrifying and we must be wary for the most vulnerable populations in India.

In India, the number of working-age populations suffering from COVID-19 is substantial because of its large middle-aged populace, yet the elderly are just as likely of getting the infection, resulting in fatality; this is due to weaker immunity systems, presence of comorbidities, and slower recoveries from diseases.

A handful of research supports that 60+ people with pre-existing comorbidities like chronic lung, liver, kidney diseases, hypertension, cardiovascular illnesses, cerebrovascular diseases, diabetes, and those dependent on immunosuppressive drugs have a higher chance of COVID-19 infection than the rest.

According to the Center for Disease Control and Prevention (CDC), 80% of COVID-19 associated deaths are among more than 65 years’ age group, with increased deaths in elderly males. Thereby, it becomes a challenge to fight the disease for India where the number of the elderly population is close to the combined population of UK and Italy.

The Health Ministry opined in April that “8.61% cases are between 0-20 years, 41.88% cases are between 21 to 40 years, 32.82% cases are between 41 to 60 years and 16.69% cases above 60 years“. Simple statistics from the current population structure can establish the vulnerability of the greying population- about 8% of Indian population above 60 years’ accounts 17 % of COVID 19 patients; while about 62% Indians 20-60 years have approximately 73% COVID-19 cases. Hence, the elderly is at no less risk than the middle-aged to this novel disease.

India has a propounding 140 million (UN projection, 2020) 60+ population. Majority of the districts across India have 7-10% percent elderly. While, many districts of Southern states – Maharashtra, Himachal, Uttarakhand, Punjab – have more than a 10% elderly population (Fig1: a). Based on 2011 Census, our map indicates that many districts of Rajasthan Madhya Pradesh, Chhattisgarh, Orissa, Gujarat, Kerala, Andhra Pradesh, and Telangana have a high proportion of 60+ elderly who are disabled (seeing, hearing, speech, movement, mental retardation, and mental illness; Fig1: b). Districts with a higher proportion of elderly, especially disabled elderly, require special focus and regular monitoring in the framework of tackling pandemic.

Elderly Population in India, 2011.

(a) Proportion of 60+ elderly; (b) Proportion of 60+ elderly disable

Source: Based on Census 2011
Source: Based on Census 2011
disability-crop

 

Impacts on the elderly are layered. World Health Organization (WHO) has identified mental health as an integral part of overall health in correspondence with physiological, behavioral, and psychological wellbeing of older adults. Gerontological studies have established the association of inadequate social wellbeing and poor elderly health.

Proportion of Elderly Living Alone and The Prevalence of Different Diseases Per 1000

State Living Alone Mental Illness Depressive symptoms Hypertension Diabetes Asthma
Assam 386.90 20.80 656.20 252.80 59.00 80.10
Karnataka 343.10 117.40 592.90 237.90 141.60 72.10
Maharashtra 341.50 5.40 557.00 179.00 90.60 110.10
Rajasthan 378.30 6.10 452.00 142.90 42.00 78.60
Uttar Pradesh 316.00 28.20 552.00 133.60 28.80 100.50
West Bengal 350.00 4.10 567.30 245.10 67.30 64.30
India 341.00 26.80 554.30 181.60 65.70 89.80

 

 

  Source: Calculated from WHO-SAGE 2007 Data

The long lockdown in India is vital to avoid burdening the healthcare system and to suppress the chain of transmission of infection. It is mandatory to take “extra care” of the elderly because social distancing may lead to depression, anxiety, and mental illness, especially among the elderly who are living alone and/or are disabled. The vulnerability of the elderly with less social support can escalate in instances of accessing medical support, transportation, banking, food access, etc.

Income, medical security, and social support are major challenges during and beyond the lockdown period. Although, the central government has announced some financial-welfare schemes and guidelines/instructions in the light of the COVID-19 crisis, the helplessness of the aged needs special consideration.

During this tough time, it is necessary for the government, stakeholders, social welfare organizations, and communities to stand in solidarity to provide the essential supplies (groceries, vegetables- fruits and medicines) to the elderly at their doorstep. We need to take precautionary steps to avoid infecting the older adults by sanitizing and frequently cleaning their belongings like, clothes, spectacles, canes, walkers, beds, toilets, chappals, etc. and encouraging them to get engaged in possible physical activities/works within the home.

In order to bolster our elderly loved ones, we need to assist them through social and mental connectivity. The void of connectedness can be minimized through phone, online calls, messages, or encouraging them to interact with friends/neighbors keeping a safe distance.  We all should stay connected with the aged while staying away to keep the world positive.

Subhojit Shaw is a doctoral fellow at the International Institute for Population Sciences in Mumbai, India (IIPS, Mumbai). His academic quest revolves around population aging, child health, and environmental health.

Aparajita Chattopadhyay with her two decades of teaching and research experience, has contributed well in the fields of public health, gender issues, aging, environment-development, and nutrition. She is a faculty of the International Institute for Population Sciences.

All views expressed are personal.

The Caregiver Crisis

Are you caring for someone – perhaps an elder – who is seriously ill? Do you look after a disabled son or daughter? Perhaps you’re in the ‘sandwich generation,’ raising children while you worry about and care for a parent? If you answered yes, you’re already in the Caregiver Club. If you said no, consider changing your answer to no, not yet.  To quote Rosalynn Carter, President of the Rosalynn Carter Institute for Caregiving, and former First Lady of the US:

“There are only four kinds of people in the world: those who have been caregivers, those who are currently caregivers, those who will be caregivers, and those who will need caregivers.”

The Caregiver Crisis in the United States is rapidly getting worse. Each day another child, spouse, relative, or friend is faced with providing care for someone who can no longer look after themselves because of increased frailty, illness, or trauma. They become responsible for that individual’s physical, psychological, and social needs. Experts warn of the increasing strain this trend will place on society in the coming decades. About 43 million friends or family members in the US are primary caregivers today for adults and children with disabilities, or someone recovering from surgeries and illnesses, or coping with Alzheimer’s and other chronic diseases. Many are themselves aging. Caregivers – primarily women – provide 37 billion hours of unpaid care annually – $500 billion in economic value, according to one estimate. 10,000 baby boomers turn 65 each day. The growing population of people who will need 24-hour personal care has been likened to an approaching “slow-moving tsunami that has no end.”

Caring for a loved one can be enriching and rewarding; the experience creates opportunities for personal growth. Caregiving brings out the best in us; we approach it with love and compassion and are devoted and determined to do our best. However, long-term care demands sustained attention and is physically exhausting and emotionally draining for both the giver and receiver of care. Relationships are affected. Significant changes need to be made in daily lives to adapt to new realities. Caregivers are frequently unable to pursue normal relationships or lead normal lives. Life can become stifling with increased stress and anxiety. Caregivers themselves need support, without which they face burnout or become ill. Caregivers in the South Asian community additionally deal with unique social and cultural issues that need to be addressed in a targeted and sensitive way, making the problem more challenging. 

As we grow older, we all want to “age in place;” live safely, comfortably and independently in our own homes and community, in our comfortable environments. The reality is that we will lose this ability at some point. Many of us also worry if another: an aging parent, relative, or friend can continue to age in place.  We worry about the day when their ability to manage their own lives independently begins to diminish, and about what would happen then. The question is not if this will happen, but when. These concerns are often triggered by changes we observe in their behavior. 

Gerontologists, geriatricians and other aging experts offer excellent advice on how to prepare for such an eventuality – advice we should heed.  The first consideration is the elder’s ability to independently care for him- or herself – to carry out what are known as the Activities of Daily Living (ADLs). Can they feed themselves? Move about on their own, get in and out of a bed or chair? Bathe or shower? Use the toilet? Dress and groom themselves? Next, evaluate other activities necessary for independent functioning, known as Instrumental Activities of Daily Living (IADLs). These include remembering things, cooking and preparing meals, cleaning and maintaining the home, shopping and buying necessities, running errands, managing money and paying bills, speaking or communicating on the phone, and correctly taking prescribed medications. If any of these present challenges for your loved one, then he or she needs some kind of support and/or care. 

When a concern is identified, experts recommend a family meeting with everyone involved, including the elder, to have open and honest discussions with the goal of getting the best possible care for the elder.  Discuss his or her requirements and anticipate future needs. Consider all the available options and constraining factors to meet those needs. These discussions should include financial and estate plans, care planning, and Advance Directives. The costs of keeping the elder at home together with professional assistance if required, have to be weighed against the financial and emotional cost of moving him or her into an assisted-living facility. Perhaps a phased approach could be implemented. If dementia or serious illness are considerations, medical professionals should be consulted and their advice factored into the decision making. The more prepared we are, the more advance planning we do, the less stressful and more rewarding caregiving will be.

If you answered “yes” to my questions above, you’ve already experienced the challenges of caregiving, and I have an important message for you. It’s critical to start with self-care and self-compassion, otherwise, you will burn out. Linda Abbit provides excellent advice in her recent book The Conscious Caregiver. As you take on these roles and responsibilities, she says, it is important that you understand, recognize, and address your emotions. At various times you will feel guilt, resentment, fear, grief, depression, anger, or embarrassment. It is okay if you do. Address your feelings consciously, and discuss them. Be kind to yourself. Make time daily for self-care. Abbit recommends making a happiness list. Put down all the things you like, and make time to enjoy them. Meditate. Adopt breathing practices. Listen to music. Eat healthy and sleep well. Stay active and get exercise. Commune with nature. Practice gratitude. Pamper and reward yourself occasionally. It’s okay to vent; bottling up your emotions will affect your health. It is essential that you accept help – even seek it – from others. You cannot do it all. Delegate to others what and when you can. Be an advocate for both yourself and your loved one. Learn to let go of what you cannot control. By first taking care of yourself, you will be a better caregiver.

The tsunami is coming! Will you be ready?

Sukham Blog – This is a monthly column focused on health and wellbeing.  

Mukund Acharya is a co-founder of Sukham, an all-volunteer non-profit organization in the Bay Area established to advocate for healthy aging within the South Asian community. 

Verma Attacks Critics Of Medicaid Work Requirement, Pushes For Tighter Eligibility

Seema Verma, the Trump administration’s top Medicaid official, Tuesday sharply attacked critics of her plan to force some Medicaid enrollees to work, a policy that led to thousands of people losing coverage in Arkansas.

“We cannot allow those who prefer the status quo to weaponize the legal system against state innovation,” the administrator of the Centers for Medicare & Medicaid Services said in a fiery speech to the nation’s 56 state and territorial Medicaid directors in Washington, D.C.

A federal judge shut down the short-lived work requirement initiative in Arkansas and stopped it from launching in Kentucky last spring. Several states including Indiana, Arizona and New Hampshire that had won federal approval have put their implementation plans on hold pending an appellate court ruling.

Advocates for the poor argue work requirement policies are illegal and unfairly add hurdles to people who qualify for coverage in the federal-state health program.

But those opponents are seeking “to manipulate Medicaid into the prototype of a single-minded, single-payer nirvana – a utopia of open-ended government run health care,” Verma said. “Part of my mission is to fight such under-handed tactics and preserve the right of states to shape your programs in ways that are consistent with the needs of your residents, your cultures and your values. Anything less stifles innovation.”

That would be “a disservice to the millions of people on Medicaid today and those who will need it in the years and decades to come,” she added.

The federal government has approved work requirement plans in 10 states and requests are pending from 10 others. Most of those initiatives are directed at the low-income adults who gained coverage through the Medicaid expansion initiated by the Affordable Care Act.

Verma first announced plans to open the door to work requirements in a speech to Medicaid directors in 2017.

Medicaid – like Medicare – is an open-ended entitlement program, which means federal funding increases as costs and enrollment rise.

In addition to doubling down on the controversial work requirements, Verma renewed her interest in letting states get Medicaid funding through a block grant system. Block grants would give states more flexibility to limit enrollment and enforce eligibility rules, she added.

Critics have said such a change would cut Medicaid funding, limit coverage, hurt beneficiaries and lead to lawsuits.

But Verma said CMS would soon publish guidance to states to allow them to get block grant funding for “certain optional adult populations.”

“Many states have expressed a willingness to be held accountable for improving outcomes in exchange for greater flexibility and budget certainty,” Verma said. “Block grants and per capita cap proposals are two such alternative financing approaches.”

Also Tuesday, CMS issued a proposed rule that would overhaul so-called supplemental payments that many states receive to help their hospitals, nursing homes and doctors get extra funding beyond those received when caring for Medicaid enrollees.

The federal government spent about $48.5 billion on such supplemental payments in 2016 for states.

The payments – as a share of total Medicaid fee-for-service expenditures for health providers – ranged from 1% in North Dakota to 65% in Tennessee, according to a Congressional Research Service report.

CMS and congressional investigators have said the payments allow states to game the system to help bring in additional revenue for these providers without showing how they spend the money.

“I recognize that these schemes often have their roots in self-interested providers, egged on by opportunistic consultants seeking to leverage regulatory loopholes or hide behind a lack of transparency,” Verma said. “I know that most state leaders want to make sure every dollar is supporting value and improving care for Medicaid beneficiaries, and those of you that are doing the right thing have nothing to worry about. We have your back.”

The supplemental Medicaid payment system has come under criticism for many years because of the lack of transparency at the state level. However, efforts to curtail the spending has faced pushback from both states and providers fearful of losing dollars.

Matt Salo, executive director of the National Association of Medicaid Directors, said state officials are open to efforts to bring more transparency but they will be cautious about anything that severely reduces their funding.

“The challenge is how do you do this in a thoughtful, real world way?” Salo said. “We have to do it in a way that is achievable, but that does not jeopardize patient care in the process.”

Verma acknowledged that the uninsured rate among children has grown in the past two years despite the strong economy. She said the solution is to lower health costs to make it easier for their parents to afford private coverage.

Patient advocates have blamed states’ efforts to tighten Medicaid eligibility as a leading factor in the drop in coverage.

Nonetheless, Verma said she would push states to further limit eligibility to make sure only those eligible are getting benefits.

“Lax eligibility practices jeopardize the sustainability of the program,” she said.

CMS will “ensure that states conduct timely redeterminations and make use of appropriate data sources to verify ongoing income eligibility.”

Salo said state Medicaid directors agree with the need for appropriate safeguards to make sure people are not getting assistance who are not eligible. But, he added, forcing enrollees to go through more steps to get and retain coverage will come at a cost of losing people who truly deserve to get help.

“You want government to work for people and want to create a system that if you are eligible it should be easy to get on,” he said. “And if you set barriers and hurdles you will lose a lot of people who are eligible but could not deal with the paperwork.”

This story was produced by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.