San Jose Police Crack Down On Violence

The San Jose Police Department is cracking down on violent crime after the city's 25th homicide this year.

KQED Launches Affordable Care Act Guide

Are you confused about Obamacare? KQED and The California Report created a guide to help answer your questions about the Affordable Care Act.

Proposed California Law Would Regulate E-Cigarettes as Tobacco

A bill introduced Monday by State Senator Mark Leno would ban electronic cigarettes in the same places that traditional cigarettes are banned, including restaurants, bars and workplaces. A recent study by the New England Journal of Medicine found that users of e-cigarettes can be exposed to high levels of the carcinogen formaldehyde. Supporters of e-cigarettes say they are far safer than regular tobacco products and help users kick their cigarette habits.

California Revisits Right-to-Die Legislation

After the highly publicized death of Brittany Maynard, the California woman who moved to Oregon to end her life legally, California lawmakers have unveiled a bill to allow physician-assisted death for terminally ill patients. The bill legalizes the prescription of fatal medications to mentally competent patients with less than six months to live. We look at what this latest bill means for California and the debate over the right to die.

PBS NewsHour

A push to use the human genome to make medicine more precise

Are vitamin drinks providing too many vitamins?

Photo by Flickr user Kristi Berry

Photo by Flickr user Kristi Berry

Health and sports drinks like Vitaminwater and Naked Juice pride themselves for containing high amounts of vitamins or nutrients. But a new study finds that many of these beverages often have excessive amounts of vitamins, sometimes in harmful dosages.

A study published in the journal Applied Physiology, Nutrition, and Metabolism looked at 46 drinks sold next to bottled water in grocery stores. Researchers found that 18 of the drinks had three times the recommended dosage of B6, and 11 had three times the suggested amount of B12.

In general, the study noted, the vitamins often included in sports drinks include vitamins plentiful in the average person’s diet, making the need to add some vitamins in drinks somewhat unnecessary. Combined with multivitamin supplements, excessive vitamin intake can add up. In some cases, the body will simply eliminate vitamins if there are too many, but for others too much can be harmful.

“When consumed in excess, some water-soluble vitamins like B and C are excreted in the urine,” a New York Times article explained. “But fat soluble-vitamins — including A, D, E and K — accumulate in the tissues, posing potential risks.”

Consuming an excessive amount of vitamins by eating natural food is nearly impossible, but some vitamin drinks have the recommended amount, some even more, of particular vitamins, including Vitaminwater’s Formula 50, which includes 120 percent of the recommended amount of Vitamin C, B6 and B12.

The post Are vitamin drinks providing too many vitamins? appeared first on PBS NewsHour.

Why hospice care could benefit your loved one sooner than you think

Many families overlook the scope of hospice services available to them, often through Medicare, Medicaid, the Department
         of Veterans Affairs or private health plans. Photo by BSIP/UIG via Getty Images

Many families overlook the scope of hospice services available to loved ones and their caregivers. Photo by BSIP/UIG via Getty Images

Bettina’s dad Paul (89 years), a once robust and active man, was getting weaker every day due to heart failure. They met with a surgeon to consider his options but the proposed medical intervention was fraught with complications and no guarantee of being able to return him to his one passion: square dancing. He opted instead to continue taking medications to treat the problem and ponder how he could hide his increasing weakness so as not to be a burden to Bettina. Recently, a friend asked if she had considered looking into hospice. Bettina was taken aback. She always thought that hospice was just for people who were terminally ill …

Promoting independence and “successful aging” is a laudable goal for many and a common media headline. But it’s not the reality for people caring for anyone diagnosed with a terminal illness or a relative who struggles to manage day to day as a result of debilitating health conditions and growing frailty. Most people would prefer to talk about wellness rather than illness, so we tend to avoid planning for advanced illness and ultimately death. One valuable, often overlooked, and generous Medicare benefit for those caring for a family member or friend is hospice care.

Adult children tell me that if they bring up the subject of end-of-life planning, their parent will think they want to “push them aside” or “be done with them.” Spouses have told me that they worry that even thinking about it will somehow hasten death or cause their partner to die sooner. The reality is, given the right opportunity, those living with illness and frailty often welcome the opportunity to share their preferences about their end-of-life choices. Listening without judgment to the individual’s worries or advice can be a gift to them. Researching what is available to help care for a family member living with advanced illness relieves the individual from having to do the work themselves.

Medicare coverage for hospice

Since 1983, Medicare has paid for most hospice care received in the United States. Other payers of hospice care include Medicaid (in most states), the Department of Veterans Affairs and most private insurance plans. Typically, no one is turned away from receiving hospice. Private contributions and donations are used to help cover the cost of care for those who have no other ways to pay for this service.

Beneficiaries are eligible for hospice care when they are entitled to Medicare Part A and are certified by a physician as having a life expectancy of six months or less if the illness runs its normal course. However, living longer than six months doesn’t mean the patient loses the benefit. After the initial certification period, each beneficiary receives an unlimited number of additional 60-day periods.

A good example of this was my friend’s mother, who lived in an assisted living residence. At an advanced age and consumed by Alzheimer’s disease, she “graduated” not once but twice from hospice. Both times she was diagnosed with pneumonia, kept comfortable but without aggressive treatment to cure her. Both times she appeared to be at “death’s door” but rallied to wellness. Throughout the experience, the hospice team oversaw her mother’s care while keeping the family well-informed and supported.

Although cancer patients used to make up the vast majority of hospice recipients, that is no long the case. An increasing number of people diagnosed with late-stage Alzheimer’s disease, non-Alzheimer’s dementia, heart disease, stroke, Parkinson’s and other conditions benefit from hospice. More hospice eligibility criteria can be found here.

Hospice is underutilized

People often wait too long before seeking hospice care. In the United States, the average length of hospice care is less than 60 days with 30 percent of those who elect hospice care dying in seven days or fewer. It seems that misinformation about the benefit coupled with our general discomfort talking about end of life prevents Medicare beneficiaries and their family from taking advantage of the valuable benefit.

What services are provided?

An interdisciplinary team of health and social service professionals joined by volunteers work together to provide the following:

  • Comfort care for pain and symptom management
  • Maintenance care for existing chronic conditions such as diabetes or emphysema
  • Support for emotional, social, psychological and spiritual needs and issues related to dying
  • Needed drugs, medical supplies and equipment
  • Mentoring for the individual, his or her family, and friends on best practices in patient care
  • Services like speech and physical therapy, which can be accessed when needed
  • If receiving hospice at home, payment for short-term inpatient care is available when symptoms become too much to manage or when caregivers need a respite break to take care of themselves
  • Grief counseling is available and can take the form of a support group, one-to-one therapeutic counseling, spiritual counseling, phone check-in calls and educational materials to surviving family and friends.

    Those receiving care are allowed to keep their regular physician or nurse practitioner to oversee their care or to receive care from the doctor associated with the hospice organization.

    Hospice is offered by both for-profit and not-for-profit organizations and can take place:

  • At the home of the patient, a family member, or friend
  • At a stand-alone hospice center
  • In a hospital
  • In a skilled nursing facility or other assisted care residence

    If you think you or a friend or relative may be using hospice services in the near future and you are fortunate enough to have more than one hospice provider in your community, it’s a good idea to contact or visit two or three. You will want to look for an organization that most closely matches your preferences. Although the core services provided by every hospice are essentially the same, each organization will have its own character, driven by their business model and organizational values.

    Typically, hospice care starts as soon as a formal request or a ‘referral’ is made by the patient’s doctor. Some questions to ask a potential hospice provider:

  • Is this hospice program Medicare-certified?
  • How many years has the agency been serving your community?
  • Be sure to ask for references from families served and professionals (hospital or community social workers). Ask for specific names and telephone numbers and follow up with these people to ask about their experience with this provider.
  • Does the hospice organization require a designated family primary caregiver as a condition of admission? If so, what are their expectations of what the family is responsible for? What can they offer if the primary caregiver is working or has other obligations and can’t be present all of the time?
  • Ask about the hospice policies. Are they centered on your needs or focused more on the needs of the agency? If the hospice imposes a specific set of conditions that do not feel comfortable or right for your situation, it may not be a good fit. Be sure to discuss your concerns.
  • An excellent list of questions to select from is offered by the American Cancer Society.

    Benefits for caregivers

    An important part of taking care of yourself is taking breaks. Your hospice team will offer to have volunteers come and sit with the patient or help with chores to make things easier for you. They are there to assist your family member or friend — and you — so be sure to tell them how they can help.

    Hospice will be there to provide comfort and support following your loved one’s death. Bereavement services are offered to caregivers and families for at least one year. These services can take a variety of forms, including telephone calls, visits, support groups and written materials about grief.

    For residential hospice, take note that the Medicare hospice benefit does not cover room and board in an assisted care facility (nursing home, hospice center), but will pay for care related to the terminal illness. However, there must be a contract between Medicare and the hospice providing the care.

    New in 2015: Medicare Care Choices Model

    Included in the Affordable Care Act (2010) is a pilot project called the Medicare Care Choices Model. According to the Centers for Medicare and Medicaid Services (CMS), in 2015 a select group of hospice providers will offer a new option. Medicare beneficiaries will receive palliative care services while concurrently receiving services provided by their regular physician and health care team.

    Palliative care, if you are unfamiliar with the term, is a method of care that, like hospice, focuses on comfort of the patient and support and education for the caregiver. But palliative care can begin when a diagnosis is given and while treatments are being evaluated and selected. By comparison, hospice care traditionally begins after active treatment of a condition has stopped and the patient is not expected to survive the illness for longer than six months.

    According to CMS, the goal of the two-year demonstration project, Medical Care Choices, is to see “whether Medicare beneficiaries who qualify for coverage under the Medicare hospice benefit would elect to receive the palliative and supportive care typically provided by a hospice if they could continue to seek services from their curative care providers.”

    Anticipated announcement for at least 30 rural and urban hospices selected to offer the Medical Care Choices benefit is slated to occur early this year (2015).

    Pursuing the Medicare benefit and accepting help from hospice can feel like a major change in how the person receiving care and their family considers the remaining time they have together. Caring for someone with serious illness and at the end of life is a daunting task, both mentally and physically. Having a dedicated, skilled and caring team of professionals to help can allow you to focus more on quality time with the person and less on the care and maintenance of the disease. Accepting help can make a difference in everyone’s well-being.

    In a future column, we will address more issues facing those caring for a parent, spouse or other important person living with advanced illness.

    More Information & Resources

    MedlinePlus: U.S. National Library of Medicine – National Institutes of Health

    National Hospice and Palliative Care Organization

    Caring Connection

    Center for Medicare Advocacy

    Family Caregiver Alliance fact sheet: End of Life Decision Making

    Long-Term Care Options Explored on PBS NewsHour:

    More Helpful Publications from Family Caregiver Alliance:

    About Family Caregiver Alliance

    Family Caregiver Alliance
    National Center on Caregiving
    785 Market Street, Suite 750
    San Francisco, CA 94103
    (415) 434-3388
    (800) 445-8106

    Family Caregiver Alliance (FCA) offers an extensive online library of free educational materials for caregivers. The publications, webinars and videos offer families the kind of straightforward, practical help they need as they care for relatives with chronic or disabling health conditions.

    Family Care Navigator is FCA’s online directory of resources for caregivers in all 50 states. It includes information on government health and disability programs, legal resources, disease-specific organizations and more.

    Leah Eskenazi, MSW, is Director of Planning and Operations for Family Caregiver Alliance, based in San Francisco, Calif.

    The post Why hospice care could benefit your loved one sooner than you think appeared first on PBS NewsHour.

    Why a promising heroin addiction treatment is unavailable in many states

    Re-enactment of heroin user burning heroin on spoon

    Watch Video

    JUDY WOODRUFF: Here in the U.S., there’s been growing concern in a number of states about a rise in the use of heroin and, in some places, a jump in overdoses.

    Hari Sreenivasan has a look at a new investigative report out that explores not just what’s behind those numbers, but what could be done to help break addiction.

    HARI SREENIVASAN: Compared to other drug use, heroin is by no means among the most commonly used drugs. Exact statistics vary, but studies find anywhere from about 300,000 to a million-plus Americans regularly use heroin each month.

    But its toll is well known and increasingly worrisome. Its rise has been confirmed in published studies. And in a study of 28 states, the number of heroin deaths jumped by a substantial percentage since 2010.

    The Huffington Post is out with a major piece reported by Jason Cherkis. He is looking at its rise in Kentucky and specifically about a debate there and elsewhere over breaking addiction.

    One medication being viewed as an alternative to methadone is known as Suboxone, but there is not agreement. And some experts believe a substance-free approach is the only way to go.

    Ryan Grim is the Washington bureau chief for The Huffington Post and the editor of the article, joins me now.

    So, how significant of a problem are we looking at, when statistics are so hard to find, especially when there are so many other drugs and other drug problems in America that out — kind of outweigh heroin?

    RYAN GRIM, The Huffington Post: Particularly in rural areas, this is — this is becoming a serious problem. The media does have a habit of exaggerating, you know, crises as they relate to drugs, but this is a serious one.

    You had some 400,000 people who went to emergency rooms the last year for heroin overdoses. More than 8,000 of those died. That’s a 39 percent jump from the last year. And there’s no reason to think that those numbers aren’t going to continue to go up, as we’re seeing more heroin coming into the country. We’re seeing prices drop.

    And heroin addicts themselves are, paradoxically, the best salesmen for heroin, because they’re broke. They need money. They go out and find other people that they can try to go in on a buy with, and that’s how it spreads. This is a serious problem; 8,000 is a lot of people.

    HARI SREENIVASAN: OK, so I made a reference to this drug named Suboxone. What’s the difference between — between Suboxone and methadone, which we are familiar with?

    RYAN GRIM: Sure.

    Methadone, quite simply, gives you a lot more of a buzz. It’s much — it’s much easier to abuse methadone. And methadone might be the appropriate drug for somebody that has a more significant or serious addiction.

    Suboxone, though, is mixed with naloxone, which you have probably heard a little bit about. That’s the one that they use to revive people from overdoses. So, in other words, they have put it into a film which can’t be split up, so that if you take too much Suboxone, then naloxone kicks in. And it’s just a miserable time for the person.

    So, the act of abusing it leads to a terrible time, and it’s not something that somebody would want to do twice. And because there’s naloxone in it, you can’t die from simply a Suboxone overdose.

    HARI SREENIVASAN: In the report, you spoke to several different characters and several different experts and you also had a video version.

    I want to play out a couple of clips, if I can, for our audience. You talked to a couple of characters that really summed up the argument and the tension there. You spoke to a judge who says that she doesn’t feel that there is any place for drugs in the treatment process, and then you also spoke to a doctor who wants to be able to prescribe this.

    Let’s take a listen.

    JUDGE KAREN THOMAS, Campbell County, Kentucky: I personally feel that when you’re talking about Suboxone and methadone, you’re talking about replacing one opioid for another.

    With heroin, you have to keep it a level just to feel decent. It’s not even feeling high anymore. It’s just to feel OK. And so when you detox somebody in a jail facility, you’re not giving them any treatment, you’re not giving them any course of conduct to overcome the cravings. You’re just housing and detoxing, basically.

    And I have talked to more than one heroin addict that has told me the same thing, that the memory of how difficult detoxing was, was one of the things that actually got them through not using again. Now, to get to that point is pretty hard.

    DAVID SUETHOLZ, Kenton County, Kentucky, Coroner: The problem that I see is this lack of being more open-minded to the medical treatment of the problem. We’re not contributing to the addiction. What we’re giving people is a light at the end of the tunnel.

    If I have urges once I leave a treatment program, these urges could potentially kill me. So, if I have a medication that can reduce those urges and allow a person to participate in life normally, what’s wrong with that?

    HARI SREENIVASAN: There’s a lot of people that feel probably the same way the judge does, that the idea that, whether it’s methadone or Suboxone, we’re essentially just displacing one addiction for another, and then we’re going to be on the hook paying for a lifelong addiction in some cases for some people.

    So what’s the — what’s been the response from people like the doctor to that?

    RYAN GRIM: Right. That’s exactly right.

    And there is a lot of discomfort with the notion that you would do what’s called maintenance. The drug war started about 100 years ago, and it’s common now for people to say, look, the drug war has failed, we need to focus on treatment over incarceration.

    But the same kind of impulses that drove the drug war are actually now driving treatment, and that’s looking at drug use through a prism of morality or politics. And that’s kind of what the judge is doing there. She’s saying, like, this — this seems wrong to me, or it seems wrong that we should be paying for somebody’s addiction.

    But the doctor is saying, no, this is a medical issue. Step aside, allow the medical community to deal with it. And I said earlier that you simply can’t die from Suboxone. You can — that’s too much. You can die from aspirin. You can die from anything. You should obviously be careful with whatever.

    But the doctor and others are saying, this is a medical issue. Take politics and take morality out of it and deal with it based on the evidence.

    HARI SREENIVASAN: So, how — let’s take an apples-to-apples comparison, if that’s possible. How effective is Suboxone vs. the standard of care that we have today, which is kind of a 30-day 12-step program? What kind of relapse rates or dropout rates? How do we compare the two?

    RYAN GRIM: So, the success rate for abstinence-based treatment — this is the 30 days and then you go home and attend meetings — you know, it’s hard to find precise numbers, but the consensus is, it’s less than — less than 10 percent.

    So that means more than 90 percent of these people are going to relapse, and they’re in a very dangerous situation. Because they have gone, they have — because they have gone through detox, they have gone cold turkey, now, all of a sudden, when they use the exact same amount of heroin that they used to, their tolerance is way down, and that’s why an overdose can be fatal.

    So just looking at keeping people alive, Suboxone’s success rate is staggeringly higher because it has this naloxone within it. Dropout rates, Dr. Suetholz has said his dropout rate is around 8 percent. There stills need to be a lot more studies done of it, but it’s much more effective than the status quo.

    HARI SREENIVASAN: All right, Ryan Grim, Washington bureau chief of The Huffington Post, who edited this article, thanks so much for joining us. e

    RYAN GRIM: Thank you.

    The post Why a promising heroin addiction treatment is unavailable in many states appeared first on PBS NewsHour.