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"content": "\u003cfigure id=\"attachment_20349\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/07/islavista-2-e1401137755639.jpg\">\u003cimg class=\"size-full wp-image-20349\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/07/islavista-2-e1401137755639.jpg\" alt=\"An impromptu memorial in Isla Vista, Calif. for a victim of the mass shooting May 23, 2014. (Diane Block/KQED)\" width=\"640\" height=\"480\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2014/07/islavista-2-e1401137755639.jpg 640w, https://ww2.kqed.org/app/uploads/sites/27/2014/07/islavista-2-e1401137755639-400x300.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2014/07/islavista-2-e1401137755639-320x240.jpg 320w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">An impromptu memorial in Isla Vista, Calif. for a victim of the mass shooting May 23, 2014. Incidents such as these have raised the issue of how well law enforcement officers are trained to deal with people with severe mental illness. (Diane Block/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Stephanie O’Neill\u003c/strong>\u003c/p>\n\u003cp>Debbie is a Ventura County mother of a 23-year-old son diagnosed with bipolar disorder. At times his condition becomes so severe that he gets delusional and requires hospitalization.\u003c/p>\n\u003caside class=\"pullquote alignleft\">\"They weren’t threatening; they didn't scare him. It stayed really, really calm.\"\u003c/aside>\n\u003cp>\"He doesn’t understand that he’s ill and that he needs help,\" Debbie says. \"He thinks he’s fine.\"\u003c/p>\n\u003cp>Debbie, who asked that her last name be withheld for privacy reasons, says when that happens, she calls the sheriff’s department for help -- as she did earlier this year. Their response, she says, was heartening.\u003c/p>\n\u003cp>\"The police officers ... were so great, because they kept telling him, ‘You’re not in trouble, we’re here to help you,' \" she says. \"So they weren’t threatening; they didn't scare him. It stayed really, really calm.\"\u003c!--more-->\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>And that allowed the deputies to take Debbie's son to the county psychiatric hospital for emergency observation without incident.\u003c/p>\n\u003cp>\"As far as a bad experience goes, it was as good a bad experience as was possible in this situation,\" she says.\u003c/p>\n\u003cp>Among the responding deputies were several who had received special training in what's known as a \"Crisis Intervention Team\" program or CIT. In the training, the deputies had learned how to better handle people suffering from mental illness. The training is based on \u003ca href=\"http://www.citinternational.org/training-overview/163-memphis-model.html\" target=\"_blank\">a renowned model started in Memphis, Tennessee\u003c/a> in 1988 that is now taught internationally.\u003c/p>\n\u003cp>In the CIT training, first responders learn skills that have been shown to help in increasing jail diversion in people with mental illness and improve the likelihood that people will continue treatment with mental health professionals in the community. The training also resulted in decreased rates of injury among police officers.\u003c/p>\n\u003cp>Tragedies such as \u003ca href=\"http://ww2.kqed.org/news/uc-santa-barbara-shootings\" target=\"_blank\">the Isla Vista mass-killings\u003c/a> in late May; the 2011 \u003ca href=\"http://www.scpr.org/news/2013/06/07/37624/trial-set-for-ex-fullerton-cops-in-homeless-beatin/\" target=\"_blank\">beating death of a homeless man\u003c/a> by police in Orange County and the\u003ca href=\"http://www.10news.com/news/u-s-world/video-shows-chp-officer-punching-woman-on-los-angeles-freeway\" target=\"_blank\"> recent video\u003c/a> of a CHP officer repeatedly punching a woman who had run onto a Los Angeles freeway have raised the issue of how well police officers are trained to deal with people who are mentally ill.\u003c/p>\n\u003cp>\u003ca href=\"http://www.post.ca.gov\" target=\"_blank\">California’s Commission on Peace Officer Standards and Training\u003c/a> (POST) requires that all peace officers undergo a minimum of six hours of mental health training while in the academy.\u003c/p>\n\u003cp>The amount and type of additional training required by any agency, however, varies widely:\u003c/p>\n\u003cul>\n\u003cli>Orange County offers a 16-hour modified CIT program offered to law enforcement\u003c/li>\n\u003cli>San Diego Police and Sheriff Departments adopted a 24-hour Psychiatric Emergency Response Team (PERT) training\u003c/li>\n\u003cli>San Francisco Police Department as well as law enforcement agencies in Monterey and Ventura adopted a 40-hour CIT program\u003c/li>\n\u003c/ul>\n\u003cp>\"The idea is to … deescalate and slow down the situation,\" says Kiran Sahota, who oversees CIT training in Ventura County where 72 percent of officers have completed the program. \"Sometimes by just knowing ahead of time that (law enforcement officers) are going to be listening and spending a little extra time, it really can defuse a situation.\"\u003c/p>\n\u003cp>\u003cstrong>\"Sometimes People Fall Through the Cracks\"\u003c/strong>\u003c/p>\n\u003cp>But even so, breakdowns still happen.\u003c/p>\n\u003cp>In Debbie’s case, she says the Ventura County psychiatric hospital released her son before the end of his 14-day hold. Then while he was still in a delusional state, she says, he broke into a neighbor’s vacant house that he thought was his own. He was later arrested and now faces criminal charges.\u003c/p>\n\u003cp>\"He’s never done anything illegal,\" Debbie says. \"If he was in his right mind, he would be mortified.\"\u003c/p>\n\u003cp>A county spokeswoman says patient privacy laws prevent the hospital from commenting on the case.\u003c/p>\n\u003cp>\"Sometimes people fall through the cracks,\" said Devon Corpus, crisis supervisor for Monterey County and an expert in the field of Crisis Intervention Team training. \"You might have officers that have received great training. They’re doing this good work and then they do a hand off to an agency, and there really isn’t a collaboration or team approach to that hand-off.\"\u003c/p>\n\u003caside class=\"pullquote alignright\">\"He was out of his mind. He began to bang his head on the wall, saying, 'If you don’t get me out of here, I’m going to kill myself.'\"\u003c/aside>\n\u003cp>That may have been what happened late last year when Stephanie –- who also lives in Ventura County -- called authorities for help with her 26-year-old son who has bipolar disorder.\u003c/p>\n\u003cp>Stephanie, whose last name was omitted for privacy reasons, says for several days prior to the incident, she and other family members had tried to get her then-suicidal son into a psychiatric hospital.\u003c/p>\n\u003cp>\"But he hadn’t really acted up enough,\" she said. \"And you really have to essentially be out of your mind for them to take you without violating personal rights.\"\u003c/p>\n\u003cp>Ultimately, her son had a fight with his father that became the grounds the family needed to make the call for help.\u003c/p>\n\u003cp>Crisis Intervention Team officers from the Ventura Police Department responded. As happened with Debbie's son, Stephanie says, they were able to calm her son and the situation.\u003c/p>\n\u003cp>But the assault meant her son had to be booked into county jail before being transferred to the psychiatric hospital. Stephanie says the officers told her he would be in jail for just three or four hours before the transfer.\u003c/p>\n\u003cp>\"So I went to bed for the first time in about six weeks with a peaceful mind,\" says Stephanie. \"'Okay, this one’s done. He’s in the hospital. I know he doesn’t love it there, but he’s safe.'\"\u003c/p>\n\u003cp>\u003ciframe src=\"https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/160271846&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" frameborder=\"no\" scrolling=\"no\">\u003c/iframe>\u003c/p>\n\u003cp>But, as it turned out, Stephanie says her son wasn't in the hospital, or safe.\u003c/p>\n\u003cp>\"He wound up being in the Ventura County Jail for 28 to 29 hours -- no medication,\" she said. \"They stripped him naked because they thought he might kill himself, somehow, with his clothing. ... So not only was he completely ashamed and out of his mind, he began to bang his head on the wall, saying, 'If you don’t get me out of here, if you don’t get me out of here, I’m going to kill myself.'\"\u003c/p>\n\u003cp>Stephanie says her son’s self-inflicted injuries left him with a severe concussion, a swollen face and two black eyes. A spokesman for the Ventura County Sheriff’s Department, which runs the jail, says the agency could not comment on the case.\u003c/p>\n\u003cp>California Senator Darrell Steinberg (D-Sacramento) says stories like Stephanie’s and Debbie’s are a too-common byproduct of a fragmented and overcrowded mental health system.\u003c/p>\n\u003cp>“The issue of mental illness in the criminal justice system have gotten far too little attention and far too few resources,” Steinberg said.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>Steinberg and other lawmakers introduced a series of budget proposals to address the needs of those with mental illness. While none creates a uniform standard for additional statewide training of law enforcement officers, one of the measures adopted in the new state budget provides $12 million to train law enforcement and prison personnel in better handling those with mental illness.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_20349\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/07/islavista-2-e1401137755639.jpg\">\u003cimg class=\"size-full wp-image-20349\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/07/islavista-2-e1401137755639.jpg\" alt=\"An impromptu memorial in Isla Vista, Calif. for a victim of the mass shooting May 23, 2014. (Diane Block/KQED)\" width=\"640\" height=\"480\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2014/07/islavista-2-e1401137755639.jpg 640w, https://ww2.kqed.org/app/uploads/sites/27/2014/07/islavista-2-e1401137755639-400x300.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2014/07/islavista-2-e1401137755639-320x240.jpg 320w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">An impromptu memorial in Isla Vista, Calif. for a victim of the mass shooting May 23, 2014. Incidents such as these have raised the issue of how well law enforcement officers are trained to deal with people with severe mental illness. (Diane Block/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Stephanie O’Neill\u003c/strong>\u003c/p>\n\u003cp>Debbie is a Ventura County mother of a 23-year-old son diagnosed with bipolar disorder. At times his condition becomes so severe that he gets delusional and requires hospitalization.\u003c/p>\n\u003caside class=\"pullquote alignleft\">\"They weren’t threatening; they didn't scare him. It stayed really, really calm.\"\u003c/aside>\n\u003cp>\"He doesn’t understand that he’s ill and that he needs help,\" Debbie says. \"He thinks he’s fine.\"\u003c/p>\n\u003cp>Debbie, who asked that her last name be withheld for privacy reasons, says when that happens, she calls the sheriff’s department for help -- as she did earlier this year. Their response, she says, was heartening.\u003c/p>\n\u003cp>\"The police officers ... were so great, because they kept telling him, ‘You’re not in trouble, we’re here to help you,' \" she says. \"So they weren’t threatening; they didn't scare him. It stayed really, really calm.\"\u003c!--more-->\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>And that allowed the deputies to take Debbie's son to the county psychiatric hospital for emergency observation without incident.\u003c/p>\n\u003cp>\"As far as a bad experience goes, it was as good a bad experience as was possible in this situation,\" she says.\u003c/p>\n\u003cp>Among the responding deputies were several who had received special training in what's known as a \"Crisis Intervention Team\" program or CIT. In the training, the deputies had learned how to better handle people suffering from mental illness. The training is based on \u003ca href=\"http://www.citinternational.org/training-overview/163-memphis-model.html\" target=\"_blank\">a renowned model started in Memphis, Tennessee\u003c/a> in 1988 that is now taught internationally.\u003c/p>\n\u003cp>In the CIT training, first responders learn skills that have been shown to help in increasing jail diversion in people with mental illness and improve the likelihood that people will continue treatment with mental health professionals in the community. The training also resulted in decreased rates of injury among police officers.\u003c/p>\n\u003cp>Tragedies such as \u003ca href=\"http://ww2.kqed.org/news/uc-santa-barbara-shootings\" target=\"_blank\">the Isla Vista mass-killings\u003c/a> in late May; the 2011 \u003ca href=\"http://www.scpr.org/news/2013/06/07/37624/trial-set-for-ex-fullerton-cops-in-homeless-beatin/\" target=\"_blank\">beating death of a homeless man\u003c/a> by police in Orange County and the\u003ca href=\"http://www.10news.com/news/u-s-world/video-shows-chp-officer-punching-woman-on-los-angeles-freeway\" target=\"_blank\"> recent video\u003c/a> of a CHP officer repeatedly punching a woman who had run onto a Los Angeles freeway have raised the issue of how well police officers are trained to deal with people who are mentally ill.\u003c/p>\n\u003cp>\u003ca href=\"http://www.post.ca.gov\" target=\"_blank\">California’s Commission on Peace Officer Standards and Training\u003c/a> (POST) requires that all peace officers undergo a minimum of six hours of mental health training while in the academy.\u003c/p>\n\u003cp>The amount and type of additional training required by any agency, however, varies widely:\u003c/p>\n\u003cul>\n\u003cli>Orange County offers a 16-hour modified CIT program offered to law enforcement\u003c/li>\n\u003cli>San Diego Police and Sheriff Departments adopted a 24-hour Psychiatric Emergency Response Team (PERT) training\u003c/li>\n\u003cli>San Francisco Police Department as well as law enforcement agencies in Monterey and Ventura adopted a 40-hour CIT program\u003c/li>\n\u003c/ul>\n\u003cp>\"The idea is to … deescalate and slow down the situation,\" says Kiran Sahota, who oversees CIT training in Ventura County where 72 percent of officers have completed the program. \"Sometimes by just knowing ahead of time that (law enforcement officers) are going to be listening and spending a little extra time, it really can defuse a situation.\"\u003c/p>\n\u003cp>\u003cstrong>\"Sometimes People Fall Through the Cracks\"\u003c/strong>\u003c/p>\n\u003cp>But even so, breakdowns still happen.\u003c/p>\n\u003cp>In Debbie’s case, she says the Ventura County psychiatric hospital released her son before the end of his 14-day hold. Then while he was still in a delusional state, she says, he broke into a neighbor’s vacant house that he thought was his own. He was later arrested and now faces criminal charges.\u003c/p>\n\u003cp>\"He’s never done anything illegal,\" Debbie says. \"If he was in his right mind, he would be mortified.\"\u003c/p>\n\u003cp>A county spokeswoman says patient privacy laws prevent the hospital from commenting on the case.\u003c/p>\n\u003cp>\"Sometimes people fall through the cracks,\" said Devon Corpus, crisis supervisor for Monterey County and an expert in the field of Crisis Intervention Team training. \"You might have officers that have received great training. They’re doing this good work and then they do a hand off to an agency, and there really isn’t a collaboration or team approach to that hand-off.\"\u003c/p>\n\u003caside class=\"pullquote alignright\">\"He was out of his mind. He began to bang his head on the wall, saying, 'If you don’t get me out of here, I’m going to kill myself.'\"\u003c/aside>\n\u003cp>That may have been what happened late last year when Stephanie –- who also lives in Ventura County -- called authorities for help with her 26-year-old son who has bipolar disorder.\u003c/p>\n\u003cp>Stephanie, whose last name was omitted for privacy reasons, says for several days prior to the incident, she and other family members had tried to get her then-suicidal son into a psychiatric hospital.\u003c/p>\n\u003cp>\"But he hadn’t really acted up enough,\" she said. \"And you really have to essentially be out of your mind for them to take you without violating personal rights.\"\u003c/p>\n\u003cp>Ultimately, her son had a fight with his father that became the grounds the family needed to make the call for help.\u003c/p>\n\u003cp>Crisis Intervention Team officers from the Ventura Police Department responded. As happened with Debbie's son, Stephanie says, they were able to calm her son and the situation.\u003c/p>\n\u003cp>But the assault meant her son had to be booked into county jail before being transferred to the psychiatric hospital. Stephanie says the officers told her he would be in jail for just three or four hours before the transfer.\u003c/p>\n\u003cp>\"So I went to bed for the first time in about six weeks with a peaceful mind,\" says Stephanie. \"'Okay, this one’s done. He’s in the hospital. I know he doesn’t love it there, but he’s safe.'\"\u003c/p>\n\u003cp>\u003ciframe src=\"https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/160271846&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" frameborder=\"no\" scrolling=\"no\">\u003c/iframe>\u003c/p>\n\u003cp>But, as it turned out, Stephanie says her son wasn't in the hospital, or safe.\u003c/p>\n\u003cp>\"He wound up being in the Ventura County Jail for 28 to 29 hours -- no medication,\" she said. \"They stripped him naked because they thought he might kill himself, somehow, with his clothing. ... So not only was he completely ashamed and out of his mind, he began to bang his head on the wall, saying, 'If you don’t get me out of here, if you don’t get me out of here, I’m going to kill myself.'\"\u003c/p>\n\u003cp>Stephanie says her son’s self-inflicted injuries left him with a severe concussion, a swollen face and two black eyes. A spokesman for the Ventura County Sheriff’s Department, which runs the jail, says the agency could not comment on the case.\u003c/p>\n\u003cp>California Senator Darrell Steinberg (D-Sacramento) says stories like Stephanie’s and Debbie’s are a too-common byproduct of a fragmented and overcrowded mental health system.\u003c/p>\n\u003cp>“The issue of mental illness in the criminal justice system have gotten far too little attention and far too few resources,” Steinberg said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Steinberg and other lawmakers introduced a series of budget proposals to address the needs of those with mental illness. While none creates a uniform standard for additional statewide training of law enforcement officers, one of the measures adopted in the new state budget provides $12 million to train law enforcement and prison personnel in better handling those with mental illness.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cfigure id=\"attachment_15508\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/10/coveredca.jpg\">\u003cimg class=\"size-full wp-image-15508\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/10/coveredca.jpg\" alt=\"Screenshot from CoveredCA.com, the website of Covered California.\" width=\"640\" height=\"360\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2013/10/coveredca.jpg 640w, https://ww2.kqed.org/app/uploads/sites/27/2013/10/coveredca-400x225.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2013/10/coveredca-320x180.jpg 320w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Screenshot from CoveredCA.com, the website of Covered California.\u003c/figcaption>\u003c/figure>\n\u003cp>Former foster youth lined up at Covered California's last board meeting to complain about the hoops they have to jump through to enroll in Medi-Cal, the state's health plan for the poor.\u003c/p>\n\u003cp>“Navigating adulthood is challenging enough, let alone trying to find insurance to cover your medical needs,” said Vanessa Hernandez, who spent 14 years in foster care. She says her younger brother tried twice to sign up online before he gave up.\u003c/p>\n\u003cp>“Currently the process is very unclear, it’s hard to navigate, and it’s not very accessible,” she said.\u003c!--more-->\u003c/p>\n\u003cp>For most young people, The Affordable Care Act allows them to stay on their parents’ insurance until they turn 26. But when California foster youth \u003ca href=\"http://www.childsworld.ca.gov/res/pdf/AB12FactSheet.pdf\" target=\"_blank\">age out of the system\u003c/a> between ages 18 and 21, they often have no one. So federal lawmakers added a special provision to the health law that allows these young adults to stay on Medicaid -- called Medi-Cal in California -- until age 26, regardless of their income.\u003c/p>\n\u003cp>“Former foster youth are extremely vulnerable,” says Jessica Haspel a policy associate at the advocacy nonprofit Children Now. She says any obstacles or delays to enrollment are especially problematic for foster youth. Many have special health needs stemming from a history of abuse or neglect and may rely on important medication for things like diabetes or anxiety. \u003ca href=\"http://www.ncd.gov/newsroom/PolicyCorner/05062013\" target=\"_blank\">Studies show \u003c/a>nearly one in three former foster youth exhibit signs of post-traumatic stress disorder -- which is itself about twice the rate of American war veterans.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003ciframe src=\"https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/160128590&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" frameborder=\"no\" scrolling=\"no\">\u003c/iframe>\u003c/p>\n\u003cp>“They may have been offered counseling when they were a child, but were not in a position where they were really able or ready to process it,” Haspel says. “As an adult, they want to take advantage of counseling and services to help them deal with everything that they’ve been through.”\u003c/p>\n\u003cp>She says the Covered California website isn't programmed properly to enroll former foster youth into coverage. And call center employees aren't educated about the new provision. As a result, some youth are being told they don't qualify when they do, or they are put in a queue when they should be fast-tracked into coverage.\u003c/p>\n\u003cp>“We are constantly working hard to resolve some of those issues,” says Anne Gonzales, Covered California spokesperson.\u003c/p>\n\u003cp>She says the agency is beefing up training and updating its guide for service center reps. Website fixes are scheduled for the winter.\u003c/p>\n\u003cp>“We are currently urging anyone who thinks they missed out on benefits to sign up now,” she says.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>But youth advocates are advising young people to sidestep Covered California altogether, and to go to their county social services office instead to sign up for Medi-Cal in person.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_15508\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/10/coveredca.jpg\">\u003cimg class=\"size-full wp-image-15508\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/10/coveredca.jpg\" alt=\"Screenshot from CoveredCA.com, the website of Covered California.\" width=\"640\" height=\"360\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2013/10/coveredca.jpg 640w, https://ww2.kqed.org/app/uploads/sites/27/2013/10/coveredca-400x225.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2013/10/coveredca-320x180.jpg 320w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Screenshot from CoveredCA.com, the website of Covered California.\u003c/figcaption>\u003c/figure>\n\u003cp>Former foster youth lined up at Covered California's last board meeting to complain about the hoops they have to jump through to enroll in Medi-Cal, the state's health plan for the poor.\u003c/p>\n\u003cp>“Navigating adulthood is challenging enough, let alone trying to find insurance to cover your medical needs,” said Vanessa Hernandez, who spent 14 years in foster care. She says her younger brother tried twice to sign up online before he gave up.\u003c/p>\n\u003cp>“Currently the process is very unclear, it’s hard to navigate, and it’s not very accessible,” she said.\u003c!--more-->\u003c/p>\n\u003cp>For most young people, The Affordable Care Act allows them to stay on their parents’ insurance until they turn 26. But when California foster youth \u003ca href=\"http://www.childsworld.ca.gov/res/pdf/AB12FactSheet.pdf\" target=\"_blank\">age out of the system\u003c/a> between ages 18 and 21, they often have no one. So federal lawmakers added a special provision to the health law that allows these young adults to stay on Medicaid -- called Medi-Cal in California -- until age 26, regardless of their income.\u003c/p>\n\u003cp>“Former foster youth are extremely vulnerable,” says Jessica Haspel a policy associate at the advocacy nonprofit Children Now. She says any obstacles or delays to enrollment are especially problematic for foster youth. Many have special health needs stemming from a history of abuse or neglect and may rely on important medication for things like diabetes or anxiety. \u003ca href=\"http://www.ncd.gov/newsroom/PolicyCorner/05062013\" target=\"_blank\">Studies show \u003c/a>nearly one in three former foster youth exhibit signs of post-traumatic stress disorder -- which is itself about twice the rate of American war veterans.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003ciframe src=\"https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/160128590&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" frameborder=\"no\" scrolling=\"no\">\u003c/iframe>\u003c/p>\n\u003cp>“They may have been offered counseling when they were a child, but were not in a position where they were really able or ready to process it,” Haspel says. “As an adult, they want to take advantage of counseling and services to help them deal with everything that they’ve been through.”\u003c/p>\n\u003cp>She says the Covered California website isn't programmed properly to enroll former foster youth into coverage. And call center employees aren't educated about the new provision. As a result, some youth are being told they don't qualify when they do, or they are put in a queue when they should be fast-tracked into coverage.\u003c/p>\n\u003cp>“We are constantly working hard to resolve some of those issues,” says Anne Gonzales, Covered California spokesperson.\u003c/p>\n\u003cp>She says the agency is beefing up training and updating its guide for service center reps. Website fixes are scheduled for the winter.\u003c/p>\n\u003cp>“We are currently urging anyone who thinks they missed out on benefits to sign up now,” she says.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>But youth advocates are advising young people to sidestep Covered California altogether, and to go to their county social services office instead to sign up for Medi-Cal in person.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "California Ranks 40th in Children's Well-Being",
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"content": "\u003cfigure id=\"attachment_18470\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/04/health-equity.jpg\">\u003cimg class=\"size-large wp-image-18470\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/04/health-equity-640x436.jpg\" alt=\"(Getty Images)\" width=\"640\" height=\"436\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Getty Images) \u003ccite>(Getty Images)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By April Laissle\u003c/strong>\u003c/p>\n\u003cp>California is well behind almost every other state when it comes to caring for its kids, according to an\u003ca href=\"www.childrennow.org/2014_kcdb\" target=\"_blank\"> annual report\u003c/a> from the Annie E. Casey Foundation and its Oakland-based partner, Children Now.\u003c/p>\n\u003cp>The report looks at four indicators of children's well-being: family stability, economic stability, health, and education. This year, California inched up one spot to 40th overall, \u003cspan class=\"Apple-style-span\" style=\"color: #000000\">\u003cspan class=\"Apple-style-span\">but ranked 26th in the health category.\u003c/span>\u003c/span>\u003c/p>\n\u003cp>Some of that progress is due to the expansion of health insurance under the Affordable Care Act, though advocates say there is still work to be done.\u003c/p>\n\u003cp>\"We have increased the number of children now that are on Medi-Cal,\" said Jessica Mindnich, research director at Children Now. \"But do these kids actually have access to doctors and to dentists? Are they able to get in in a timely manner?\"\u003c!--more-->\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>California dropped several small health care programs for children during the recession, including one that provided dental care to low-income kids at their schools. These losses, Mindnich says, can affect many aspects of children's well-being.\u003c/p>\n\u003cp>\"We need to restore our safety net programs that we had for kids, so that we can make sure all kids are healthy, that all kids are safe, and that all kids are in school and learning,\" said Mindnich.\u003c/p>\n\u003cp>The state did make strides in one area. California's teen birth rate has fallen 63 percent since 1990, the largest decline of all states. Mindnich attributes the progress to improved sex education policies and wider access to contraceptives.\u003c/p>\n\u003cp>\"It's because we had committed leadership, and we had sustained efforts dating back to 1992,\" said Mindnich. \"So we know that we can see these numbers improve.\"\u003c/p>\n\u003cp>Other states have bumped up their rankings by getting more kids into early education and ensuring they have full access to quality health care.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"California is a unique state. We're much more diverse, and much larger than a state like Massachusetts. And I think because of our size and diversity, I don't think it's going to be as simple as it may be in other states. Our policies will need to be more nuanced.\"\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_18470\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/04/health-equity.jpg\">\u003cimg class=\"size-large wp-image-18470\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/04/health-equity-640x436.jpg\" alt=\"(Getty Images)\" width=\"640\" height=\"436\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Getty Images) \u003ccite>(Getty Images)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By April Laissle\u003c/strong>\u003c/p>\n\u003cp>California is well behind almost every other state when it comes to caring for its kids, according to an\u003ca href=\"www.childrennow.org/2014_kcdb\" target=\"_blank\"> annual report\u003c/a> from the Annie E. Casey Foundation and its Oakland-based partner, Children Now.\u003c/p>\n\u003cp>The report looks at four indicators of children's well-being: family stability, economic stability, health, and education. This year, California inched up one spot to 40th overall, \u003cspan class=\"Apple-style-span\" style=\"color: #000000\">\u003cspan class=\"Apple-style-span\">but ranked 26th in the health category.\u003c/span>\u003c/span>\u003c/p>\n\u003cp>Some of that progress is due to the expansion of health insurance under the Affordable Care Act, though advocates say there is still work to be done.\u003c/p>\n\u003cp>\"We have increased the number of children now that are on Medi-Cal,\" said Jessica Mindnich, research director at Children Now. \"But do these kids actually have access to doctors and to dentists? Are they able to get in in a timely manner?\"\u003c!--more-->\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>California dropped several small health care programs for children during the recession, including one that provided dental care to low-income kids at their schools. These losses, Mindnich says, can affect many aspects of children's well-being.\u003c/p>\n\u003cp>\"We need to restore our safety net programs that we had for kids, so that we can make sure all kids are healthy, that all kids are safe, and that all kids are in school and learning,\" said Mindnich.\u003c/p>\n\u003cp>The state did make strides in one area. California's teen birth rate has fallen 63 percent since 1990, the largest decline of all states. Mindnich attributes the progress to improved sex education policies and wider access to contraceptives.\u003c/p>\n\u003cp>\"It's because we had committed leadership, and we had sustained efforts dating back to 1992,\" said Mindnich. \"So we know that we can see these numbers improve.\"\u003c/p>\n\u003cp>Other states have bumped up their rankings by getting more kids into early education and ensuring they have full access to quality health care.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"California is a unique state. We're much more diverse, and much larger than a state like Massachusetts. And I think because of our size and diversity, I don't think it's going to be as simple as it may be in other states. Our policies will need to be more nuanced.\"\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Sonoma County Has Highest Whooping Cough Rate in Statewide Epidemic",
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"content": "\u003cfigure id=\"attachment_20212\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"https://www.flickr.com/photos/ethansparrow/4957499682/in/photolist-8y5tWs-8iYQHE-7T23S8-mhYq6b-e8s4T4-ejD8mX-bmq17n-5Xdf3C-dmfcNe-fngGKR-8y6kE5-ay3keW-bDwxda-frnE1E-eRVdxu-iGj2s3-4PaZm3-ejD8n8-9mbH2q-fr8ms2-6ijRSy-bMNTGn-9sVBc2-byNCUs-e96wUn-9XuUWF-cufQ97-hYXu5g-aqrdSm-cD8TMf-8ucatF-eg4g1e-6KNycu-bWMYNR-94zxe7-enWety-cLhR67-eZDpUb-dNg7wp-ebjL8c-itAX6Q-dNGjyE-ebqoZA-m3j1fV-nKV4E6-6HsnSH-hP5Hfv-7Gjpkm-awim1M-af5Whz\">\u003cimg class=\"wp-image-20212 size-large\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/07/4957499682_c983513f8a_bcrop-640x388.jpg\" alt=\"Napa has the second highest rate of the disease. (Esparrow1/Flickr)\" width=\"640\" height=\"388\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Napa has the second highest rate of the disease. (Esparrow1/Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Lynne Shallcross\u003c/strong>\u003c/p>\n\u003cp>It’s been a little over a month since California \u003ca href=\"http://ww2.kqed.org/news/2014/06/13/whooping-cough-reaches-epidemic-level-in-california/\" target=\"_blank\">declared a whooping cough epidemic\u003c/a>, and according to the most recent data from the state, three neighboring Bay Area counties have the highest rates of the disease statewide: Sonoma, Napa and Marin.\u003c/p>\n\u003cp>Sonoma County's rate of whooping cough, also known as pertussis, is almost 120 cases per 100,000 people. Napa County's rate is 90 per 100,000, and Marin's rate is 65 per 100,000.\u003c/p>\n\u003cp>Sonoma County's interim health officer, Karen Holbrook, says the number of cases reported each week has peaked and is now declining.\u003c/p>\n\u003cp>“It’s not what the state is experiencing as a whole, but we are coming down,” Holbrook says. “Will that hold indefinitely remains to be seen.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Holbrook says California is seeing a whooping cough epidemic partly because the disease is cyclical, with cases spiking every three to five years.\u003c!--more-->\u003c/p>\n\u003cp>Additionally, Holbrook says, the immunity from the current vaccine, introduced in the 1990s, \u003ca href=\"http://ww2.kqed.org/stateofhealth/2012/08/03/todays-whooping-cough-vaccine-may-be-safer-but-less-effective-than-the-old-one/\" target=\"_blank\">fades more quickly\u003c/a> than the previous version. The current vaccine has fewer side effects.\u003c/p>\n\u003cp>Holbrook says she also thinks clinicians in her county are doing a good job of recognizing and diagnosing cases. “I can’t prove that relative to the other counties, but I honestly feel that that’s contributing to our (higher) rate,” she said.\u003c/p>\n\u003cp>Marin County Public Health Officer Matthew Willis says not all communities will have the same incidence of pertussis because of different factors and vulnerabilities, both known and unknown. Of the known factors, Willis echoes Holbrook’s points — and adds one more: vaccination rates.\u003c/p>\n\u003cp>“In Marin, it’s likely that pertussis was able to establish more of a foothold because of lower vaccination rates,” Willis says. \u003ca href=\"http://ww2.kqed.org/news/2013/08/21/marin-vaccinations/\" target=\"_blank\">Marin’s rate of personal belief exemptions\u003c/a>, which allow parents to opt out of vaccines for their children, is among the highest in the state, according to statewide data.\u003c/p>\n\u003cp>One thing is clear, he says: Vaccination is the most effective way to prevent pertussis. The vaccine does not provide lifetime immunity and boosters are needed.\u003c/p>\n\u003cp>Of those who should be vaccinated, babies and pregnant women are of particular importance, says Jennifer Henn, an epidemiologist with Napa County's Public Health Division. “Infants, especially infants under six months of age, are especially vulnerable to severe disease and even death if they become infected with the pertussis bacteria.”\u003c/p>\n\u003cp>Infants generally cannot get their first pertussis vaccine until they are eight weeks, but in light of the epidemic, \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/06/27/whooping-cough-epidemic-continues-1100-new-cases-in-last-two-weeks/\" target=\"_blank\">state health officers said \u003c/a>babies can be vaccinated as young as six weeks. Pregnant mothers should be vaccinated in the third trimester of every pregnancy in order for their children to receive antibodies in the womb. People who are around infants, such as other members of the household or caregivers, should also be vaccinated.\u003c/p>\n\u003cp>\u003ciframe src=\"https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/159002693&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" frameborder=\"no\" scrolling=\"no\">\u003c/iframe>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>[contextly_auto_sidebar id=\"Ng1M7L5S1Gy1LBl1ZTFiYhPZNt6CsCYd\"]\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_20212\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"https://www.flickr.com/photos/ethansparrow/4957499682/in/photolist-8y5tWs-8iYQHE-7T23S8-mhYq6b-e8s4T4-ejD8mX-bmq17n-5Xdf3C-dmfcNe-fngGKR-8y6kE5-ay3keW-bDwxda-frnE1E-eRVdxu-iGj2s3-4PaZm3-ejD8n8-9mbH2q-fr8ms2-6ijRSy-bMNTGn-9sVBc2-byNCUs-e96wUn-9XuUWF-cufQ97-hYXu5g-aqrdSm-cD8TMf-8ucatF-eg4g1e-6KNycu-bWMYNR-94zxe7-enWety-cLhR67-eZDpUb-dNg7wp-ebjL8c-itAX6Q-dNGjyE-ebqoZA-m3j1fV-nKV4E6-6HsnSH-hP5Hfv-7Gjpkm-awim1M-af5Whz\">\u003cimg class=\"wp-image-20212 size-large\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/07/4957499682_c983513f8a_bcrop-640x388.jpg\" alt=\"Napa has the second highest rate of the disease. (Esparrow1/Flickr)\" width=\"640\" height=\"388\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Napa has the second highest rate of the disease. (Esparrow1/Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Lynne Shallcross\u003c/strong>\u003c/p>\n\u003cp>It’s been a little over a month since California \u003ca href=\"http://ww2.kqed.org/news/2014/06/13/whooping-cough-reaches-epidemic-level-in-california/\" target=\"_blank\">declared a whooping cough epidemic\u003c/a>, and according to the most recent data from the state, three neighboring Bay Area counties have the highest rates of the disease statewide: Sonoma, Napa and Marin.\u003c/p>\n\u003cp>Sonoma County's rate of whooping cough, also known as pertussis, is almost 120 cases per 100,000 people. Napa County's rate is 90 per 100,000, and Marin's rate is 65 per 100,000.\u003c/p>\n\u003cp>Sonoma County's interim health officer, Karen Holbrook, says the number of cases reported each week has peaked and is now declining.\u003c/p>\n\u003cp>“It’s not what the state is experiencing as a whole, but we are coming down,” Holbrook says. “Will that hold indefinitely remains to be seen.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Holbrook says California is seeing a whooping cough epidemic partly because the disease is cyclical, with cases spiking every three to five years.\u003c!--more-->\u003c/p>\n\u003cp>Additionally, Holbrook says, the immunity from the current vaccine, introduced in the 1990s, \u003ca href=\"http://ww2.kqed.org/stateofhealth/2012/08/03/todays-whooping-cough-vaccine-may-be-safer-but-less-effective-than-the-old-one/\" target=\"_blank\">fades more quickly\u003c/a> than the previous version. The current vaccine has fewer side effects.\u003c/p>\n\u003cp>Holbrook says she also thinks clinicians in her county are doing a good job of recognizing and diagnosing cases. “I can’t prove that relative to the other counties, but I honestly feel that that’s contributing to our (higher) rate,” she said.\u003c/p>\n\u003cp>Marin County Public Health Officer Matthew Willis says not all communities will have the same incidence of pertussis because of different factors and vulnerabilities, both known and unknown. Of the known factors, Willis echoes Holbrook’s points — and adds one more: vaccination rates.\u003c/p>\n\u003cp>“In Marin, it’s likely that pertussis was able to establish more of a foothold because of lower vaccination rates,” Willis says. \u003ca href=\"http://ww2.kqed.org/news/2013/08/21/marin-vaccinations/\" target=\"_blank\">Marin’s rate of personal belief exemptions\u003c/a>, which allow parents to opt out of vaccines for their children, is among the highest in the state, according to statewide data.\u003c/p>\n\u003cp>One thing is clear, he says: Vaccination is the most effective way to prevent pertussis. The vaccine does not provide lifetime immunity and boosters are needed.\u003c/p>\n\u003cp>Of those who should be vaccinated, babies and pregnant women are of particular importance, says Jennifer Henn, an epidemiologist with Napa County's Public Health Division. “Infants, especially infants under six months of age, are especially vulnerable to severe disease and even death if they become infected with the pertussis bacteria.”\u003c/p>\n\u003cp>Infants generally cannot get their first pertussis vaccine until they are eight weeks, but in light of the epidemic, \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/06/27/whooping-cough-epidemic-continues-1100-new-cases-in-last-two-weeks/\" target=\"_blank\">state health officers said \u003c/a>babies can be vaccinated as young as six weeks. Pregnant mothers should be vaccinated in the third trimester of every pregnancy in order for their children to receive antibodies in the womb. People who are around infants, such as other members of the household or caregivers, should also be vaccinated.\u003c/p>\n\u003cp>\u003ciframe src=\"https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/159002693&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" frameborder=\"no\" scrolling=\"no\">\u003c/iframe>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>[contextly_auto_sidebar id=\"Ng1M7L5S1Gy1LBl1ZTFiYhPZNt6CsCYd\"]\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cfigure id=\"attachment_19968\" class=\"wp-caption alignnone\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/07/IMG_0172-e1404333661648.jpg\">\u003cimg class=\"wp-image-19968 size-large\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/07/IMG_0172-640x480.jpg\" alt=\"IMG_0172\" width=\"640\" height=\"480\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Bernice Arnett, school nurse for the Newman-Crows Landing Unified School District, is in charge of student health at the district's seven public schools. (Ryder Diaz/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cem>Editor's Note: School nursing is more than Band-Aids and ice packs. Nurses help students with complex medical conditions and tough home lives. Bernice Arnett is a nurse for seven schools in Newman-Crows Landing Unified School District -- two Central Valley towns just south of Modesto. This month, our ongoing health series called \u003cstrong>\u003ca href=\"http://ww2.kqed.org/stateofhealth/series/vital-signs/\">Vital Signs\u003c/a> \u003c/strong>focuses on prevention. Arnett talks about how she's working to keep students and families in her community healthy.\u003c/em>\u003c/p>\n\u003cp>\u003cstrong>By Bernice Arnett\u003c/strong>\u003c/p>\n\u003cp>There have been days where I have visited all seven sites in one day. But I was doing reactive nursing rather than proactive nursing. There were times that I'd have to actually triage in my head what I should go do first.\u003c/p>\n\u003cp>You treat the whole student. Sometimes you treat the whole family. And a lot of times, families are desperate. They don't know where to turn.\u003c!--more-->\u003c/p>\n\u003cp>They're overwhelmed and sometimes it's as simple as making a phone call and getting three bags of groceries for them for the weekend. It's almost like they see the light of day again.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Many of our children come from single parent homes. Some come from domestic violence, and some of these little people come to school worried about their parents.\u003c/p>\n\u003cp>I had a little boy that just could not sit in class. It was just day in and day out he was in my office, crying. He had a stomach ache. It was this and that, and I thought, 'Something does not feel right.'\u003c/p>\n\u003cp>Well, the parents had separated. Dad had made a threatening remark to the mom and the child had heard it. And so every day she made him come to school. And everyday he was in school sick -- physically ill at the thought that Mom may be injured.\u003c/p>\n\u003cp>I contacted Mom and had to give her directions on how to file a restraining order. It took some doing to finally to get this little person to understand that he could come to school and learn again.\u003c/p>\n\u003cp>Sometimes it might not be under the \"nursing category,\" but if it needs to be done, you do it.\u003c/p>\n\u003cp>\u003cem>This story was reported by Ryder Diaz.\u003c/em>\u003c/p>\n\u003cp>\u003ciframe width=\"100%\" height=\"166\" scrolling=\"no\" frameborder=\"no\" src=\"https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/157979872&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\">\u003c/iframe>\u003c/p>\n\u003cp>\u003ca style=\"font-weight: bold;color: #114999\" href=\"http://ww2.kqed.org/stateofhealth/series/vital-signs/\" target=\"_blank\">Share your own story about health in your community on the radio.\u003c/a>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp> \u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_19968\" class=\"wp-caption alignnone\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/07/IMG_0172-e1404333661648.jpg\">\u003cimg class=\"wp-image-19968 size-large\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/07/IMG_0172-640x480.jpg\" alt=\"IMG_0172\" width=\"640\" height=\"480\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Bernice Arnett, school nurse for the Newman-Crows Landing Unified School District, is in charge of student health at the district's seven public schools. (Ryder Diaz/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cem>Editor's Note: School nursing is more than Band-Aids and ice packs. Nurses help students with complex medical conditions and tough home lives. Bernice Arnett is a nurse for seven schools in Newman-Crows Landing Unified School District -- two Central Valley towns just south of Modesto. This month, our ongoing health series called \u003cstrong>\u003ca href=\"http://ww2.kqed.org/stateofhealth/series/vital-signs/\">Vital Signs\u003c/a> \u003c/strong>focuses on prevention. Arnett talks about how she's working to keep students and families in her community healthy.\u003c/em>\u003c/p>\n\u003cp>\u003cstrong>By Bernice Arnett\u003c/strong>\u003c/p>\n\u003cp>There have been days where I have visited all seven sites in one day. But I was doing reactive nursing rather than proactive nursing. There were times that I'd have to actually triage in my head what I should go do first.\u003c/p>\n\u003cp>You treat the whole student. Sometimes you treat the whole family. And a lot of times, families are desperate. They don't know where to turn.\u003c!--more-->\u003c/p>\n\u003cp>They're overwhelmed and sometimes it's as simple as making a phone call and getting three bags of groceries for them for the weekend. It's almost like they see the light of day again.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Many of our children come from single parent homes. Some come from domestic violence, and some of these little people come to school worried about their parents.\u003c/p>\n\u003cp>I had a little boy that just could not sit in class. It was just day in and day out he was in my office, crying. He had a stomach ache. It was this and that, and I thought, 'Something does not feel right.'\u003c/p>\n\u003cp>Well, the parents had separated. Dad had made a threatening remark to the mom and the child had heard it. And so every day she made him come to school. And everyday he was in school sick -- physically ill at the thought that Mom may be injured.\u003c/p>\n\u003cp>I contacted Mom and had to give her directions on how to file a restraining order. It took some doing to finally to get this little person to understand that he could come to school and learn again.\u003c/p>\n\u003cp>Sometimes it might not be under the \"nursing category,\" but if it needs to be done, you do it.\u003c/p>\n\u003cp>\u003cem>This story was reported by Ryder Diaz.\u003c/em>\u003c/p>\n\u003cp>\u003ciframe width=\"100%\" height=\"166\" scrolling=\"no\" frameborder=\"no\" src=\"https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/157979872&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\">\u003c/iframe>\u003c/p>\n\u003cp>\u003ca style=\"font-weight: bold;color: #114999\" href=\"http://ww2.kqed.org/stateofhealth/series/vital-signs/\" target=\"_blank\">Share your own story about health in your community on the radio.\u003c/a>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp> \u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cfigure id=\"attachment_19874\" class=\"wp-caption alignnone\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/06/smile-in-crops-e1404169943328.jpg\">\u003cimg class=\"wp-image-19874 size-large\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/06/smile-in-crops-640x480.jpg\" alt=\"smile in crops\" width=\"640\" height=\"480\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Cha Deng Vang, 68, tends to the community garden at Fresno Interdenominational Refugee Ministries. Working in the garden helps Vang, a refugee from Laos, relieve anxiety and get exercise. (Annabelle Beecher/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cem>Editor's Note: Refugees face unique challenges building lives in the United States. Cha Deng Vang fled Laos in 1987 after fighting as soldier in the US-backed forces. As part of our ongoing health series, \u003ca href=\"blogs.kqed.org/stateofhealth/series/vital-signs/\">\u003cstrong>Vital Signs\u003c/strong>\u003c/a>, we hear from 68-year-old Vang who has found that a community garden for Hmong refugees at\u003ca href=\"http://www.firminc.org/\"> Fresno Interdenominational Refugee Ministries\u003c/a> has helped him build community and relieve stress. Chong Vang and Sam Chang helped to translate his story.\u003c/em>\u003c/p>\n\u003cp>\u003cstrong>By Cha Deng Vang\u003c/strong>\u003c/p>\n\u003cp>On this side we are growing Hmong pumpkin. They're very round and very big compared to the American version.\u003c/p>\n\u003cp>Growing up my parents taught me how to garden and farm. As soon as I turned 18, I became a soldier, and that was basically my entire life.\u003c/p>\n\u003cp>When I first came to America, I had no education. I couldn't find a job which equals no money to help my family. So with no financial support, it was a lot of stress on the entire family. And on top of that we also had a lot of illness in the family, which also caused a lot of stress on me as well.\u003c!--more-->\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>When I come to the community garden and I start doing hard labor, like digging and fixing things, it makes me sweat and it releases my stress because it cools my body down at the same time.\u003c/p>\n\u003cp>When I have anxiety, I come here and it relaxes me. It also helps with my health. Due to a lot of the injuries I've had as a soldier, this helps me with exercise. So, it's basically what helps me get through the day.\u003c/p>\n\u003caside class=\"pullquote alignleft\">Since 1975, roughly 200,000 Hmong refugees have left Laos -- 90 percent of them have resettled in the US.\u003c/aside>\n\u003cp>The majority of the people that utilize this community garden are older like me and are using Social Security Income. So, the garden also provides fresh produce for my family.\u003c/p>\n\u003cp>In Laos, everything was very green and lush. And coming here during the summer, everything turns yellow.\u003c/p>\n\u003cp>When I come here to the community garden and I see all the corn and all the beans and everything's so green, it just helps relieve all of that stress and it helps clear my mind. So, I absolutely love it here.\u003c/p>\n\u003cp>\u003cem>This story was reported by Sasha Khokha.\u003c/em>\u003c/p>\n\u003cp>\u003ca style=\"font-weight: bold;color: #114999\" href=\"http://ww2.kqed.org/stateofhealth/series/vital-signs/\" target=\"_blank\">Share your own story about health in your community on the radio.\u003c/a>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003ciframe width=\"100%\" height=\"166\" scrolling=\"no\" frameborder=\"no\" src=\"https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/157314143&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\">\u003c/iframe>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_19874\" class=\"wp-caption alignnone\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/06/smile-in-crops-e1404169943328.jpg\">\u003cimg class=\"wp-image-19874 size-large\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/06/smile-in-crops-640x480.jpg\" alt=\"smile in crops\" width=\"640\" height=\"480\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Cha Deng Vang, 68, tends to the community garden at Fresno Interdenominational Refugee Ministries. Working in the garden helps Vang, a refugee from Laos, relieve anxiety and get exercise. (Annabelle Beecher/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cem>Editor's Note: Refugees face unique challenges building lives in the United States. Cha Deng Vang fled Laos in 1987 after fighting as soldier in the US-backed forces. As part of our ongoing health series, \u003ca href=\"blogs.kqed.org/stateofhealth/series/vital-signs/\">\u003cstrong>Vital Signs\u003c/strong>\u003c/a>, we hear from 68-year-old Vang who has found that a community garden for Hmong refugees at\u003ca href=\"http://www.firminc.org/\"> Fresno Interdenominational Refugee Ministries\u003c/a> has helped him build community and relieve stress. Chong Vang and Sam Chang helped to translate his story.\u003c/em>\u003c/p>\n\u003cp>\u003cstrong>By Cha Deng Vang\u003c/strong>\u003c/p>\n\u003cp>On this side we are growing Hmong pumpkin. They're very round and very big compared to the American version.\u003c/p>\n\u003cp>Growing up my parents taught me how to garden and farm. As soon as I turned 18, I became a soldier, and that was basically my entire life.\u003c/p>\n\u003cp>When I first came to America, I had no education. I couldn't find a job which equals no money to help my family. So with no financial support, it was a lot of stress on the entire family. And on top of that we also had a lot of illness in the family, which also caused a lot of stress on me as well.\u003c!--more-->\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>When I come to the community garden and I start doing hard labor, like digging and fixing things, it makes me sweat and it releases my stress because it cools my body down at the same time.\u003c/p>\n\u003cp>When I have anxiety, I come here and it relaxes me. It also helps with my health. Due to a lot of the injuries I've had as a soldier, this helps me with exercise. So, it's basically what helps me get through the day.\u003c/p>\n\u003caside class=\"pullquote alignleft\">Since 1975, roughly 200,000 Hmong refugees have left Laos -- 90 percent of them have resettled in the US.\u003c/aside>\n\u003cp>The majority of the people that utilize this community garden are older like me and are using Social Security Income. So, the garden also provides fresh produce for my family.\u003c/p>\n\u003cp>In Laos, everything was very green and lush. And coming here during the summer, everything turns yellow.\u003c/p>\n\u003cp>When I come here to the community garden and I see all the corn and all the beans and everything's so green, it just helps relieve all of that stress and it helps clear my mind. So, I absolutely love it here.\u003c/p>\n\u003cp>\u003cem>This story was reported by Sasha Khokha.\u003c/em>\u003c/p>\n\u003cp>\u003ca style=\"font-weight: bold;color: #114999\" href=\"http://ww2.kqed.org/stateofhealth/series/vital-signs/\" target=\"_blank\">Share your own story about health in your community on the radio.\u003c/a>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003ciframe width=\"100%\" height=\"166\" scrolling=\"no\" frameborder=\"no\" src=\"https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/157314143&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\">\u003c/iframe>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cfigure id=\"attachment_20002\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/07/4-Jamie-Eng-M.D.-with-patient-in-CODE-BLACK-a-Long-Shot-release-2014.jpg\">\u003cimg class=\"size-large wp-image-20002\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/07/4-Jamie-Eng-M.D.-with-patient-in-CODE-BLACK-a-Long-Shot-release-2014-640x360.jpg\" alt='Dr. Jamie Eng with patient in the documentary \"Code Black.\"' width=\"640\" height=\"360\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Dr. Jamie Eng with patient in the documentary \"Code Black.\"\u003c/figcaption>\u003c/figure>\n\u003cp>Don't eat a sandwich before you sit down to watch the documentary \"\u003ca href=\"http://codeblackmovie.com\" target=\"_blank\">Code Black\u003c/a>.\" In one of the first scenes, we watch a team of doctors and nurses cut into a patient. It's a bloody business, and the camera doesn't turn away. That's because this film is about the brilliant chaos of emergency care, and the people drawn to this work.\u003c/p>\n\u003cp>For all the debate over health care in America, it's relatively rare to hear from doctors on the front lines, and even more rare to hear from young doctors about a field they've recently chosen to devote their lives to. “Code Black,” a documentary by a doctor when he was a resident at LA County's USC Medical Center, delivers that perspective with punch and passion. It promises a look into \"America's busiest ER.\"\u003c!--more-->\u003c/p>\n\u003cp>Ryan McGarry is now an assistant professor and physician at The Weill Medical College of Cornell University. Possibly, his penchant for storytelling has something to do with his bachelor's degree in English at Pennsylvania State University. His decision to become a doctor was inspired in part by his experience as a Stage IV cancer patient while an undergraduate. Even though he switched gears professionally, he finds poetry in his new field.\u003c/p>\n\u003cp>\u003ciframe src=\"https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/157165060&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" frameborder=\"no\" scrolling=\"no\">\u003c/iframe>\u003c/p>\n\u003cp>His training ground for emergency medicine is “C-Booth”, a now-closed but legendary trauma bay, where “more people have died and more people have been saved than in any other square footage in the United States,” McGarry tells us in his voice over.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The film is a first-person reflection of McGarry's personal choices: of his respect for the students and teachers around him, of how jazzed he is to be doing emergency medicine, of how anxious he is about the primacy of money and politics over human values in medicine today.\u003c/p>\n\u003cp>We also hear from McGarry's fellow interns, like Jamie Eng, speaking with an almost dreamy calm about what motivates her to charge into a scene that would send most people running. \"When I rotated here as a medical student, I saw how the seniors just commanded the place. And I thought, 'I want to be that person. I want to be that calm. That cool. That collected. That knowledgeable. That confident.'”\u003c/p>\n\u003cfigure id=\"attachment_20004\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/07/3-Danny-Cheng-M.D.-Dave-Pomeranz-M.D.-Ryan-McGarry-M.D.-Billy-Mallon-M.D.-at-bedside-in-CODE-BLACK-a-Long-Shot-Factory-release-2014.jpg\">\u003cimg class=\"size-medium wp-image-20004\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/07/3-Danny-Cheng-M.D.-Dave-Pomeranz-M.D.-Ryan-McGarry-M.D.-Billy-Mallon-M.D.-at-bedside-in-CODE-BLACK-a-Long-Shot-Factory-release-2014-300x169.jpg\" alt='From L to R: Danny Cheng, M.D., Dave Pomeranz, M.D., Ryan McGarry, M.D., Billy Mallon, M.D. at bedside in C-Booth in the documentary \"Code Black.\"' width=\"300\" height=\"169\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">From L to R: Danny Cheng, M.D., Dave Pomeranz, M.D., Ryan McGarry, M.D., Billy Mallon, M.D. at bedside in C-Booth in the documentary \"Code Black.\"\u003c/figcaption>\u003c/figure>\n\u003cp>That's everything you want to believe about doctors: that smart, soulful, driven people will be doing their darndest to keep you or your loved one alive in that critical moment of need. Whether you can pay or not.\u003c/p>\n\u003cp>LA County/USC is a public hospital, and it's cheering to see how much the interns care for their patients, no matter how poor. But time marches on. A new hospital was built. It’s clean. It’s quiet. It meets modern codes for earthquake safety. Still, whatever rules the old hospital could be exempted from because it was so old and so small, the doctors have to follow modern rules in the new hospital. Perhaps predictably, they hate them, particularly the bureaucratic documentation required for every last, little thing that happens in the ER.\u003c/p>\n\u003cp>Eng laments, \"I just had a patient with the simplest of complaints. It took me about two minutes to see her. I saw her standing right here in the hallway. I don’t even need a room for her. 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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_20002\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/07/4-Jamie-Eng-M.D.-with-patient-in-CODE-BLACK-a-Long-Shot-release-2014.jpg\">\u003cimg class=\"size-large wp-image-20002\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/07/4-Jamie-Eng-M.D.-with-patient-in-CODE-BLACK-a-Long-Shot-release-2014-640x360.jpg\" alt='Dr. Jamie Eng with patient in the documentary \"Code Black.\"' width=\"640\" height=\"360\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Dr. Jamie Eng with patient in the documentary \"Code Black.\"\u003c/figcaption>\u003c/figure>\n\u003cp>Don't eat a sandwich before you sit down to watch the documentary \"\u003ca href=\"http://codeblackmovie.com\" target=\"_blank\">Code Black\u003c/a>.\" In one of the first scenes, we watch a team of doctors and nurses cut into a patient. It's a bloody business, and the camera doesn't turn away. That's because this film is about the brilliant chaos of emergency care, and the people drawn to this work.\u003c/p>\n\u003cp>For all the debate over health care in America, it's relatively rare to hear from doctors on the front lines, and even more rare to hear from young doctors about a field they've recently chosen to devote their lives to. “Code Black,” a documentary by a doctor when he was a resident at LA County's USC Medical Center, delivers that perspective with punch and passion. It promises a look into \"America's busiest ER.\"\u003c!--more-->\u003c/p>\n\u003cp>Ryan McGarry is now an assistant professor and physician at The Weill Medical College of Cornell University. Possibly, his penchant for storytelling has something to do with his bachelor's degree in English at Pennsylvania State University. His decision to become a doctor was inspired in part by his experience as a Stage IV cancer patient while an undergraduate. Even though he switched gears professionally, he finds poetry in his new field.\u003c/p>\n\u003cp>\u003ciframe src=\"https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/157165060&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" frameborder=\"no\" scrolling=\"no\">\u003c/iframe>\u003c/p>\n\u003cp>His training ground for emergency medicine is “C-Booth”, a now-closed but legendary trauma bay, where “more people have died and more people have been saved than in any other square footage in the United States,” McGarry tells us in his voice over.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The film is a first-person reflection of McGarry's personal choices: of his respect for the students and teachers around him, of how jazzed he is to be doing emergency medicine, of how anxious he is about the primacy of money and politics over human values in medicine today.\u003c/p>\n\u003cp>We also hear from McGarry's fellow interns, like Jamie Eng, speaking with an almost dreamy calm about what motivates her to charge into a scene that would send most people running. \"When I rotated here as a medical student, I saw how the seniors just commanded the place. And I thought, 'I want to be that person. I want to be that calm. That cool. That collected. That knowledgeable. That confident.'”\u003c/p>\n\u003cfigure id=\"attachment_20004\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/07/3-Danny-Cheng-M.D.-Dave-Pomeranz-M.D.-Ryan-McGarry-M.D.-Billy-Mallon-M.D.-at-bedside-in-CODE-BLACK-a-Long-Shot-Factory-release-2014.jpg\">\u003cimg class=\"size-medium wp-image-20004\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/07/3-Danny-Cheng-M.D.-Dave-Pomeranz-M.D.-Ryan-McGarry-M.D.-Billy-Mallon-M.D.-at-bedside-in-CODE-BLACK-a-Long-Shot-Factory-release-2014-300x169.jpg\" alt='From L to R: Danny Cheng, M.D., Dave Pomeranz, M.D., Ryan McGarry, M.D., Billy Mallon, M.D. at bedside in C-Booth in the documentary \"Code Black.\"' width=\"300\" height=\"169\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">From L to R: Danny Cheng, M.D., Dave Pomeranz, M.D., Ryan McGarry, M.D., Billy Mallon, M.D. at bedside in C-Booth in the documentary \"Code Black.\"\u003c/figcaption>\u003c/figure>\n\u003cp>That's everything you want to believe about doctors: that smart, soulful, driven people will be doing their darndest to keep you or your loved one alive in that critical moment of need. Whether you can pay or not.\u003c/p>\n\u003cp>LA County/USC is a public hospital, and it's cheering to see how much the interns care for their patients, no matter how poor. But time marches on. A new hospital was built. It’s clean. It’s quiet. It meets modern codes for earthquake safety. Still, whatever rules the old hospital could be exempted from because it was so old and so small, the doctors have to follow modern rules in the new hospital. Perhaps predictably, they hate them, particularly the bureaucratic documentation required for every last, little thing that happens in the ER.\u003c/p>\n\u003cp>Eng laments, \"I just had a patient with the simplest of complaints. It took me about two minutes to see her. I saw her standing right here in the hallway. I don’t even need a room for her. Basically, it took me four times as long to document as it took me to talk to her and do the exam at the same time.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"I've worked on both coasts now,\" McGarry says, \"and whether it be a primary care office or a busy emergency department, the thing that physicians and other providers are talking the most right now is the disconnection from us and patients.\" How did it come to be, he wonders, \"that insurance companies and administrators and everybody else who isn't as invested, arguably, is sort of running that experience?\"\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cfigure id=\"attachment_19724\" class=\"wp-caption alignnone\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/06/teri-lim-photo-e1403652569566.jpg\">\u003cimg class=\"wp-image-19724 size-large\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/06/teri-lim-photo-640x480.jpg\" alt=\"teri lim photo\" width=\"640\" height=\"480\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Teri Lim, an attorney in Los Angeles, had a tough time finding a nursing home for her mother. After a stroke, her mother needed constant care but many nursing homes in the area were ill-equipped to deal with Korean-speaking patients. (Ryder Diaz/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cem>Editor's Note: Finding a nursing home for a loved one can be a daunting task. The job becomes more complicated when that family member doesn't speak English. As part of our ongoing health series, \u003ca href=\"http://ww2.kqed.org/stateofhealth/series/vital-signs/\">\u003cstrong>Vital Signs\u003c/strong>\u003c/a>, we hear from Teri Lim who immigrated with her parents to Los Angeles from Korea. After her mother had a stroke two years ago, Lim started searching for a place to give her mom around-the-clock care. \u003c/em>\u003c/p>\n\u003cp>\u003cstrong>By Teri Lim\u003c/strong>\u003c/p>\n\u003cp>I found this great rehabilitation home, and I took her there (but) she couldn't last a day because she couldn't speak English. When she pressed her button for help, someone would peek in, but my mom was not able to really fully articulate what was wrong with her, and they would just leave. Then she would press the button again.\u003c/p>\n\u003cp>After a while my mom was perceived as kind of a difficult patient because her needs were not met. She was so frustrated. I could just see in her face that she was very strained.\u003c/p>\n\u003cp>\u003c!--more-->\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>It was hard to find a place where my mom felt comfortable. But I finally found a nursing home in Koreatown. There are Korean nurses, and they hire interpreters. There are enough nurses out there that my mom is able to communicate.\u003c/p>\n\u003cp>There are a lot of below-average nursing homes. I was surprised to find that this one, and the other one I visited in Koreatown, are (among) the few that received an average rating.\u003c/p>\n\u003cp>They have services, like church services where Korean pastors come. They also have an activities person, who does activities in Korean. My mom is starting to take advantage of it, a little bit.\u003c/p>\n\u003cp>It took her a long time to accept the fact that she'll never be able to go home. But lately she's been smiling a little and kind of accepting the fact that it's okay to be there.\u003c/p>\n\u003cp>There's a saying in Korean that you need to be helpful to your parents while they're alive, and when they're gone, even if you cry on their grave, it's useless. So, with that in mind, I always remind myself that I'm going to be there when she needs me, not when she's gone.\u003c/p>\n\u003cp>\u003cem>That story was reported by Susan Valot. \u003c/em>\u003c/p>\n\u003cp>\u003ciframe src=\"https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/157006413&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" frameborder=\"no\" scrolling=\"no\">\u003c/iframe>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003ca style=\"font-weight: bold;color: #114999\" href=\"http://ww2.kqed.org/stateofhealth/series/vital-signs/\" target=\"_blank\">Share your own story about health in your community on the radio.\u003c/a>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>It was hard to find a place where my mom felt comfortable. But I finally found a nursing home in Koreatown. There are Korean nurses, and they hire interpreters. There are enough nurses out there that my mom is able to communicate.\u003c/p>\n\u003cp>There are a lot of below-average nursing homes. I was surprised to find that this one, and the other one I visited in Koreatown, are (among) the few that received an average rating.\u003c/p>\n\u003cp>They have services, like church services where Korean pastors come. They also have an activities person, who does activities in Korean. My mom is starting to take advantage of it, a little bit.\u003c/p>\n\u003cp>It took her a long time to accept the fact that she'll never be able to go home. But lately she's been smiling a little and kind of accepting the fact that it's okay to be there.\u003c/p>\n\u003cp>There's a saying in Korean that you need to be helpful to your parents while they're alive, and when they're gone, even if you cry on their grave, it's useless. So, with that in mind, I always remind myself that I'm going to be there when she needs me, not when she's gone.\u003c/p>\n\u003cp>\u003cem>That story was reported by Susan Valot. \u003c/em>\u003c/p>\n\u003cp>\u003ciframe src=\"https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/157006413&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" frameborder=\"no\" scrolling=\"no\">\u003c/iframe>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003ca style=\"font-weight: bold;color: #114999\" href=\"http://ww2.kqed.org/stateofhealth/series/vital-signs/\" target=\"_blank\">Share your own story about health in your community on the radio.\u003c/a>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Whooping Cough Epidemic Continues -- 1,100 New Cases in Last Two Weeks",
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"content": "\u003cfigure id=\"attachment_17600\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/02/104228158-e1392067906728.jpg\">\u003cimg class=\"size-large wp-image-17600\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/02/104228158-640x425.jpg\" alt=\"A vial containing the acellular pertussis vaccine. (Robyn Beck/AFP/Getty Images)\" width=\"640\" height=\"425\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">A vial containing the acellular pertussis vaccine (Robyn Beck/AFP/Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>In the two weeks since California health officials \u003ca href=\"http://ww2.kqed.org/news/2014/06/13/whooping-cough-reaches-epidemic-level-in-california/\" target=\"_blank\">declared a whooping cough epidemic\u003c/a>, the state has added 1,100 more cases, officials with the California Department of Public Health said Friday.\u003c/p>\n\u003cp>That brings the total number of cases to 4,558. A third infant died of the disease recently. The baby, from Sacramento County, had started showing symptoms at just 3 weeks of age. The baby was hospitalized for more than a year and then passed away.\u003c/p>\n\u003cp>Infants are at particular risk because they cannot be vaccinated until they are several weeks old. Generally, the recommendation is that babies receive the first dose of vaccine at 8 weeks, but in light of the epidemic, state health officials say babies can be vaccinated at 6 weeks.\u003c/p>\n\u003cp>\u003c!--more-->In addition, state epidemiologist Dr. Gil Chavez urged all pregnant women to be vaccinated against whooping cough, also called pertussis, in their third trimester of pregnancy. A mother's antibodies can transfer some immunity to the baby.\u003c/p>\n\u003cp>\"Vaccination of pregnant women is the most important thing that can be done to protect infants until they are old enough to be vaccinated,\" Chavez said.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>[contextly_sidebar id=\"7455d8aa2ed6216eb4324f02dc422ec3\"]\u003c/p>\n\u003cp>Women should receive a pertussis vaccine with every pregnancy, Chavez added. So even if a woman bore a child in the last few years, she needs to be revaccinated in the third trimester of a new pregnancy to help give each baby immunity from whooping cough.\u003c/p>\n\u003cp>Of the 4,558 cases, 142 have been hospitalized and more than 80 percent of those hospitalized are infants less than 4 months old.\u003c/p>\n\u003cp>While a great deal of attention has been paid to those who choose not to vaccinate their children, Chavez said the most important drivers of this year's epidemic are more likely the cyclical nature of whooping cough as an illness and the fact that the vaccine against whooping cough wanes over time. It does not confer lifetime immunity, and boosters are needed.\u003c/p>\n\u003cp>Chavez said the Centers for Disease Control and Prevention's Advisory Committee on Immunization is reviewing whether boosters of this newer whooping cough vaccine, introduced in the late 1990s because it reduces side effects, might need more frequent boosters. \"We just have to wait and see if and when they make a different recommendation,\" Chavez said.\u003c/p>\n\u003cp>The three counties in the state with the highest rates of whooping cough are Marin, Napa and Sonoma.\u003ca href=\"http://ww2.kqed.org/news/2013/08/21/marin-vaccinations/\" target=\"_blank\"> Marin has the highest vaccine-refusal rate\u003c/a> in the Bay Area and one of the highest in the state. California last had a whooping cough epidemic in 2010. In later research, scientists determined that vaccine refusals \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/09/30/vaccine-refusals-fueled-california-whooping-cough-epidemic-personal-belief-exemption///\" target=\"_blank\">helped to fuel that epidemic\u003c/a>.\u003c/p>\n\u003cp>State health officials said they don't yet know if this year's epidemic will be worse than in 2010. In the meantime, officials say people should make sure vaccines for themselves and especially their children are up to date. The Centers for Disease Control and Prevention has an easy-to-use \"\u003ca href=\"http://www.vaccines.gov/more_info/features/healthmapvaccinefinder.html\" target=\"_blank\">adult vaccine finder\u003c/a>\" available to anyone. County health departments often provide vaccinations as well.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp> \u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_17600\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/02/104228158-e1392067906728.jpg\">\u003cimg class=\"size-large wp-image-17600\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/02/104228158-640x425.jpg\" alt=\"A vial containing the acellular pertussis vaccine. (Robyn Beck/AFP/Getty Images)\" width=\"640\" height=\"425\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">A vial containing the acellular pertussis vaccine (Robyn Beck/AFP/Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>In the two weeks since California health officials \u003ca href=\"http://ww2.kqed.org/news/2014/06/13/whooping-cough-reaches-epidemic-level-in-california/\" target=\"_blank\">declared a whooping cough epidemic\u003c/a>, the state has added 1,100 more cases, officials with the California Department of Public Health said Friday.\u003c/p>\n\u003cp>That brings the total number of cases to 4,558. A third infant died of the disease recently. The baby, from Sacramento County, had started showing symptoms at just 3 weeks of age. The baby was hospitalized for more than a year and then passed away.\u003c/p>\n\u003cp>Infants are at particular risk because they cannot be vaccinated until they are several weeks old. Generally, the recommendation is that babies receive the first dose of vaccine at 8 weeks, but in light of the epidemic, state health officials say babies can be vaccinated at 6 weeks.\u003c/p>\n\u003cp>\u003c!--more-->In addition, state epidemiologist Dr. Gil Chavez urged all pregnant women to be vaccinated against whooping cough, also called pertussis, in their third trimester of pregnancy. A mother's antibodies can transfer some immunity to the baby.\u003c/p>\n\u003cp>\"Vaccination of pregnant women is the most important thing that can be done to protect infants until they are old enough to be vaccinated,\" Chavez said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Women should receive a pertussis vaccine with every pregnancy, Chavez added. So even if a woman bore a child in the last few years, she needs to be revaccinated in the third trimester of a new pregnancy to help give each baby immunity from whooping cough.\u003c/p>\n\u003cp>Of the 4,558 cases, 142 have been hospitalized and more than 80 percent of those hospitalized are infants less than 4 months old.\u003c/p>\n\u003cp>While a great deal of attention has been paid to those who choose not to vaccinate their children, Chavez said the most important drivers of this year's epidemic are more likely the cyclical nature of whooping cough as an illness and the fact that the vaccine against whooping cough wanes over time. It does not confer lifetime immunity, and boosters are needed.\u003c/p>\n\u003cp>Chavez said the Centers for Disease Control and Prevention's Advisory Committee on Immunization is reviewing whether boosters of this newer whooping cough vaccine, introduced in the late 1990s because it reduces side effects, might need more frequent boosters. \"We just have to wait and see if and when they make a different recommendation,\" Chavez said.\u003c/p>\n\u003cp>The three counties in the state with the highest rates of whooping cough are Marin, Napa and Sonoma.\u003ca href=\"http://ww2.kqed.org/news/2013/08/21/marin-vaccinations/\" target=\"_blank\"> Marin has the highest vaccine-refusal rate\u003c/a> in the Bay Area and one of the highest in the state. California last had a whooping cough epidemic in 2010. In later research, scientists determined that vaccine refusals \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/09/30/vaccine-refusals-fueled-california-whooping-cough-epidemic-personal-belief-exemption///\" target=\"_blank\">helped to fuel that epidemic\u003c/a>.\u003c/p>\n\u003cp>State health officials said they don't yet know if this year's epidemic will be worse than in 2010. In the meantime, officials say people should make sure vaccines for themselves and especially their children are up to date. The Centers for Disease Control and Prevention has an easy-to-use \"\u003ca href=\"http://www.vaccines.gov/more_info/features/healthmapvaccinefinder.html\" target=\"_blank\">adult vaccine finder\u003c/a>\" available to anyone. County health departments often provide vaccinations as well.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp> \u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Covered California Needs Better Outreach to Limited-English Speakers, Advocates Say",
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"content": "\u003cfigure id=\"attachment_16988\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/01/CoveredCA_Spanish-e1388775098705.jpg\">\u003cimg class=\"size-large wp-image-16988\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/01/CoveredCA_Spanish-640x480.jpg\" alt=\"A report from Berkeley's Greenlining Institute called on Covered California to make its enrollment website available in more languages than English and Spanish. \" width=\"640\" height=\"480\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">A report from Berkeley's Greenlining Institute called on Covered California to make its enrollment website available in more languages than English and Spanish.\u003c/figcaption>\u003c/figure>\n\u003cp>Covered California may have had strong overall enrollment, but people who do not speak English as a first language are underrepresented in the state's health insurance marketplace, according to an analysis from Berkeley's Greenlining Institute.\u003c/p>\n\u003cp>The\u003ca href=\"http://greenlining.org/wp-content/uploads/2014/06/iHealth-Report-print-friendly.pdf\" target=\"_blank\"> report \u003c/a>relied on Covered California data, which showed that 20 percent of enrollees do not speak English as a primary language. That's compared with\u003ca href=\"http://censusreporter.org/profiles/04000US06-california/\" target=\"_blank\"> 44 percent of Californians\u003c/a> overall.\u003c/p>\n\u003cp>\"We know California is a diverse state ethnically and linguistically,\" said Jordan Medina, a health policy fellow with Greenlining and lead author of the study. \"Moving forward, if the Affordable Care Act is going to work in California, we have to make sure those populations are represented in the health insurance marketplace.\"\u003c!--more-->\u003c/p>\n\u003cp>As part of its analysis, Greenlining interviewed certified enrollment counselors working to help people sign up for insurance through Covered California. While online sign-up was available in English and Spanish, people who spoke other languages had only printed material available. Counselors reported that they ran out of materials in at least some languages.\u003c/p>\n\u003cp>Counselors said they preferred helping people sign up by using the online portal, but since it was available only in English and Spanish, it slowed them down. A counselor with an agency that worked with Japanese-Americans told Greenlining, \"We tried to use the website, because that's what Covered California suggested we do, but the line-by-line translation with elderly Japanese-Americans made the process extremely tedious.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Greenlining called on Covered California to make the online sign-up available in the 13 most common languages spoken in California.\u003c/p>\n\u003cp>Covered California spokeswoman Anne Gonzales said the agency is looking into this, \"\u003cspan class=\"Apple-style-span\" style=\"color: #000000\">\u003cspan class=\"Apple-style-span\">but there is no firm date on when that functionality will be added, or which languages will be added.\"\u003c/span>\u003c/span>\u003c/p>\n\u003cp>Problems with both the Spanish-language marketing campaign and the Spanish-language website were\u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/02/17/missteps-in-covered-californias-marketing-campaign-to-latinos/\" target=\"_blank\"> widely reported\u003c/a> earlier this year, and Greenlining mentioned these issues. Gonzales pointed to a Spanish-language working group at Covered California that \"recalibrated and focused resources\" on making improvements in these areas. She said Covered California is currently reviewing its resources for Asian-language translations as well, including Mandarin, Korean, Vietnamese and Hmong.\u003c/p>\n\u003cp>Curiously, one of the major issues Greenlining pointed out has already been addressed by the Covered California board. In the first open enrollment period, certified enrollment counselors were paid $58 for every person they enrolled in a plan. But counselors told Greenlining that the fee did not compensate them for the level of work required.\u003c/p>\n\u003cp>Gonzales said that Covered California is \"moving away from that business model.\" During the first open enrollment, there was a division between outreach/education and enrollment. Covered California grantees doing educational events could not also sign people up for insurance.\u003c/p>\n\u003cp>That's changing now. Covered California is \u003ca href=\"http://board.coveredca.com/meetings/2014/6-19/PDFs/PPT%20-%20Covered%20California%20Policy%20and%20Action%20Items_June%2019,%202014.pdf\" target=\"_blank\">instituting a \"navigator\" mode\u003c/a>l and will award a total of $16.9 million in grants to organizations that will handle \"outreach, education and enrollment.\"\u003c/p>\n\u003cp>Greenlining also called on Covered California to move forward on hiring a diversity officer.\u003c/p>\n\u003cp>\"At the end of the day, this helps with accountability,\" Medina said. \"If you have someone whose sole responsibility it is to make sure that all materials -- whether that be on the Web or printed materials -- if there’s one person in charge of that, it makes it really easy for community groups to partner with Covered California to make sure it’s done in an equitable way.”\u003c/p>\n\u003cp>Greenlining credited Covered California, saying that the state \"led the nation in implementing the Affordable Care Act,\" but Medina also observed that the rollout was always expected to be a multi-year effort. \"As we move farther into implementation, Covered California is going to have to really pay attention to hard-to-reach groups,\" he said. \"That's particularly crucial to outreach to Californians who don't speak English well.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>[contextly_auto_sidebar id=\"N6YDe3GBE9KI5r58HlM0Xrvwzvipav7x\"]\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_16988\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/01/CoveredCA_Spanish-e1388775098705.jpg\">\u003cimg class=\"size-large wp-image-16988\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/01/CoveredCA_Spanish-640x480.jpg\" alt=\"A report from Berkeley's Greenlining Institute called on Covered California to make its enrollment website available in more languages than English and Spanish. \" width=\"640\" height=\"480\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">A report from Berkeley's Greenlining Institute called on Covered California to make its enrollment website available in more languages than English and Spanish.\u003c/figcaption>\u003c/figure>\n\u003cp>Covered California may have had strong overall enrollment, but people who do not speak English as a first language are underrepresented in the state's health insurance marketplace, according to an analysis from Berkeley's Greenlining Institute.\u003c/p>\n\u003cp>The\u003ca href=\"http://greenlining.org/wp-content/uploads/2014/06/iHealth-Report-print-friendly.pdf\" target=\"_blank\"> report \u003c/a>relied on Covered California data, which showed that 20 percent of enrollees do not speak English as a primary language. That's compared with\u003ca href=\"http://censusreporter.org/profiles/04000US06-california/\" target=\"_blank\"> 44 percent of Californians\u003c/a> overall.\u003c/p>\n\u003cp>\"We know California is a diverse state ethnically and linguistically,\" said Jordan Medina, a health policy fellow with Greenlining and lead author of the study. \"Moving forward, if the Affordable Care Act is going to work in California, we have to make sure those populations are represented in the health insurance marketplace.\"\u003c!--more-->\u003c/p>\n\u003cp>As part of its analysis, Greenlining interviewed certified enrollment counselors working to help people sign up for insurance through Covered California. While online sign-up was available in English and Spanish, people who spoke other languages had only printed material available. Counselors reported that they ran out of materials in at least some languages.\u003c/p>\n\u003cp>Counselors said they preferred helping people sign up by using the online portal, but since it was available only in English and Spanish, it slowed them down. A counselor with an agency that worked with Japanese-Americans told Greenlining, \"We tried to use the website, because that's what Covered California suggested we do, but the line-by-line translation with elderly Japanese-Americans made the process extremely tedious.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Greenlining called on Covered California to make the online sign-up available in the 13 most common languages spoken in California.\u003c/p>\n\u003cp>Covered California spokeswoman Anne Gonzales said the agency is looking into this, \"\u003cspan class=\"Apple-style-span\" style=\"color: #000000\">\u003cspan class=\"Apple-style-span\">but there is no firm date on when that functionality will be added, or which languages will be added.\"\u003c/span>\u003c/span>\u003c/p>\n\u003cp>Problems with both the Spanish-language marketing campaign and the Spanish-language website were\u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/02/17/missteps-in-covered-californias-marketing-campaign-to-latinos/\" target=\"_blank\"> widely reported\u003c/a> earlier this year, and Greenlining mentioned these issues. Gonzales pointed to a Spanish-language working group at Covered California that \"recalibrated and focused resources\" on making improvements in these areas. She said Covered California is currently reviewing its resources for Asian-language translations as well, including Mandarin, Korean, Vietnamese and Hmong.\u003c/p>\n\u003cp>Curiously, one of the major issues Greenlining pointed out has already been addressed by the Covered California board. In the first open enrollment period, certified enrollment counselors were paid $58 for every person they enrolled in a plan. But counselors told Greenlining that the fee did not compensate them for the level of work required.\u003c/p>\n\u003cp>Gonzales said that Covered California is \"moving away from that business model.\" During the first open enrollment, there was a division between outreach/education and enrollment. Covered California grantees doing educational events could not also sign people up for insurance.\u003c/p>\n\u003cp>That's changing now. Covered California is \u003ca href=\"http://board.coveredca.com/meetings/2014/6-19/PDFs/PPT%20-%20Covered%20California%20Policy%20and%20Action%20Items_June%2019,%202014.pdf\" target=\"_blank\">instituting a \"navigator\" mode\u003c/a>l and will award a total of $16.9 million in grants to organizations that will handle \"outreach, education and enrollment.\"\u003c/p>\n\u003cp>Greenlining also called on Covered California to move forward on hiring a diversity officer.\u003c/p>\n\u003cp>\"At the end of the day, this helps with accountability,\" Medina said. \"If you have someone whose sole responsibility it is to make sure that all materials -- whether that be on the Web or printed materials -- if there’s one person in charge of that, it makes it really easy for community groups to partner with Covered California to make sure it’s done in an equitable way.”\u003c/p>\n\u003cp>Greenlining credited Covered California, saying that the state \"led the nation in implementing the Affordable Care Act,\" but Medina also observed that the rollout was always expected to be a multi-year effort. \"As we move farther into implementation, Covered California is going to have to really pay attention to hard-to-reach groups,\" he said. \"That's particularly crucial to outreach to Californians who don't speak English well.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>[contextly_auto_sidebar id=\"N6YDe3GBE9KI5r58HlM0Xrvwzvipav7x\"]\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Coordinated Care for Those Nearing Life's End — But Does It Save Money?",
"title": "Coordinated Care for Those Nearing Life's End — But Does It Save Money?",
"headTitle": "State of Health | KQED News",
"content": "\u003cfigure id=\"attachment_19725\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/06/Bob_april-e1403652651481.jpg\">\u003cimg class=\"wp-image-19725 size-large\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/06/Bob_april-e1403652651481-640x480.jpg\" alt=\"Sutter nurse Aileen Capuyan listens to Bob Martinez’s lungs. (April Dembosky/KQED)\" width=\"640\" height=\"480\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Sutter nurse Aileen Capuyan listens to Bob Martinez’s lungs. (April Dembosky/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>Bob Martinez has been in the hospital so many times, the surgical staff treats him like a regular at a coffee shop.\u003c/p>\n\u003cp>“They all know me!” he says. “If I go in there today, they’d say, ‘How’re ya doing Mr. Martinez?' ”\u003c/p>\n\u003caside class=\"pullquote alignleft\">'I’m so sick and tired of being in hospitals. I don’t want to go back no more. I said, God, no more.'\u003c/aside>\n\u003cp>Martinez is 81, a long-retired life insurance salesman. In the last few years, he's had more than a dozen surgeries on his right leg, including a foot amputation, a casualty of severe diabetes. His heart disease has warranted almost half a dozen heart procedures. After one of his recent operations, he said he'd had enough.\u003c/p>\n\u003cp>“I’m so sick and tired of being in hospitals,” he says shaking his head. “I don’t want to go back no more. I said, God, no more. No more.”\u003c/p>\n\u003cp>That’s when hospital staff told him about a program through Sutter Health that would send people to take care of him at home. It’s called the Advanced Illness Management program, or AIM. It’s designed for people like Martinez who have multiple chronic illnesses.\u003c!--more-->\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>It’s not hospice. That’s for people who doctors say have six months or less to live. This program is for the pre-hospice population, people estimated to be in the last 18 months of life. The AIM program assigns a team of doctors, nurses and social workers to help patients transition home after hospital stays, manage medication, and carefully coordinate care, at home and over the phone, to help keep patients out of the hospital.\u003c/p>\n\u003cp>Martinez’ nurse, Aileen Capuyan, and social worker, Ally Chu, come to his home in Oakland once a week.\u003c/p>\n\u003cp>“Are you coughing? Do you have any shortness of breath?” Capuyan asks as she listens to Martinez’s lungs.\u003c/p>\n\u003cp>He sits in the brown leather armchair in his living room while she takes his temperature and checks his blood pressure. Meanwhile, Chu is in the kitchen talking with Martinez's son, Jimmy, who takes care of him. Jimmy is making tamales. Then Capuyan and Chu switch.\u003c/p>\n\u003cp>Most of the visit is spent talking: about the pain in Martinez’s leg, how his dominoes game is going at the senior center, and about more sensitive things, like what happens when his health gets worse — what kind of care he wants at the end of life and what care he doesn’t want.\u003c/p>\n\u003cp>“I don’t want to be resuscitated,” Martinez says. “When my time comes — let it go.”\u003c/p>\n\u003cp>\u003ciframe src=\"https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/155994604&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" frameborder=\"no\" scrolling=\"no\">\u003c/iframe>\u003c/p>\n\u003cp>The founders of the AIM program hope that these ongoing visits build the kind of trust where patients can fully explore these questions. Chief program executive Betsy Gornet says this avoids rushed decisions that don’t capture a person’s real values.\u003c/p>\n\u003cp>“Spending fifteen minutes in a doctor's office or in an ICU in a crisis isn’t necessarily the way to do advanced care planning,” she says. “We do know that a dialogue over time does help foster the right kind of information.”\u003c/p>\n\u003cp>She says that means patients get the kind of care they want, and get help before their conditions reach a crisis level.\u003c/p>\n\u003cp>“We’ve been able to track very consistently a 30 percent reduction in emergency room visits by these patients, 70 to 80 percent reduction in ICU days, 50 percent reduction in hospitalizations,” she says.\u003c/p>\n\u003cp>That in turn has saved money.\u003c/p>\n\u003cp>“We’ve seen the total cost of care go down anywhere from $3,600 to $5,000 dollar per patient over the course of 90 days,” she says.\u003c/p>\n\u003cp>This is the kind of talk that has sparked fiery debates in Washington. Back in 2009, the idea of doctors even talking to their patients about their end-of-life wishes spurred fears of “\u003ca href=\"http://www.washingtonpost.com/wp-dyn/content/article/2009/07/31/AR2009073103148.html\" target=\"_blank\">death panels\u003c/a>” rationing care.\u003c/p>\n\u003cp>But today, the tone is shifting, according to health policy lobbyist Andrew MacPherson.\u003c/p>\n\u003cp>“We’re seeing a death of the death panels,” he says. “We’re in a totally new place today.”\u003c/p>\n\u003cp>[contextly_sidebar id=\"392e700af225e5a57a941f70d559db24\"]\u003c/p>\n\u003cp>He says lawmakers are having real bipartisan discussions about overhauling the American way of death, especially now that more and more politicians are shepherding their own parents through the end of life.\u003c/p>\n\u003cp>“It’s personal stories,” MacPherson says. “People's personal stories about their mother, about their father are really what bring folks to table to say, 'Look, we need to have a health care system that is responsive to patients’ values and preferences and wishes when they’re really seriously ill.' ”\u003c/p>\n\u003cp>He says officials in Washington are keeping an eye on the Sutter program as a model that might be replicated across the country. The Medicare program, which pays for health care for people over 65, gave the AIM program a $13 million grant from a fund created under the Affordable Care Act. In return, they want to see the program generate savings for Medicare of at least $29 million.\u003c/p>\n\u003cp>“The big question is whether or not it will pan out,” says Suzanne Delbanco, executive director of the nonprofit group Catalyst for Payment Reform.\u003c/p>\n\u003cp>The Medicare grants are one way the government is trying to move away from paying for health care on a fee-for-service basis, which Delbanco says incentivizes doctors to order more tests and procedures to drive up their revenues. Instead, interest is growing to develop more holistic payment models — things like “care management fees,” “bundled payments” and “shared savings” — that reward doctors based on the overall care they provide and outcomes where their patients ultimately get better.\u003c/p>\n\u003cp>“It’s almost as if we’re going from an a la carte menu to a pre-fixe meal where you pay a set amount for all your courses,” Delbanco says.\u003c/p>\n\u003cp>But there are two big unknowns.\u003c/p>\n\u003cp>First, it's not clear if these new models of care really will cost less in the long run. “We don’t know for sure whether or not financially it will end up being beneficial in an effort to curtail our health care costs,” Delbanco says.\u003c/p>\n\u003cp>Second, Sutter has to find a way to operate the AIM program that works for its own bottom line. When Sutter saves money for Medicare, by reducing hospitalizations and ER visits, it takes a financial hit on its own revenues. Many of the new services it provides to achieve those savings — the telephone coordination, some home care and some social work services — are not reimbursed under Medicare’s current payment system.\u003c/p>\n\u003cp>Sutter declined to reveal operation costs or budget figures for the AIM program, although the federal Agency for Healthcare Research and Quality reports it costs about $900 monthly, for each patient, on average.\u003c/p>\n\u003cp>AIM chief executive Betsy Gornet says the program does operate at a loss in some regions and has stayed afloat so far through foundation grants and investments from Sutter. But its goal this year, as part of the government grant, is to become self-sustaining, and to propose a new payment model for Medicare that balances savings for the government and still keeps its own program in business.\u003c/p>\n\u003cp>“We want to get the right care to the right patient at the right time,” Gornet says. “That will help save everybody’s resources.”\u003c/p>\n\u003cp>Gornet says the ultimate goal is to keep patients like Bob Martinez as comfortable and vibrant as possible until he reaches the end of his life.\u003c/p>\n\u003cp>Martinez says he's been thinking about death a lot lately, especially since his wife, Josie, died two years ago — at home, with her husband at her side.\u003c/p>\n\u003cp>“God’s got a plan for everybody, different plans,\" Martinez says. \"Some die at home. Some die in a hospital. I want to be home like she was. If it comes to that. But anyway, I’ll take it any way. I just want to be with her now.\"\u003c/p>\n\u003cp>Martinez died in May. He was at home, in his living room, surrounded by family.\u003c/p>\n\u003cp>\u003cem>This report was produced with support from \u003c/em>\u003cem>the MetLife Foundation Journalists in Aging Fellowships, a program of New America Media and the Gerontological Society of America.\u003c/em>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp> \u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_19725\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/06/Bob_april-e1403652651481.jpg\">\u003cimg class=\"wp-image-19725 size-large\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/06/Bob_april-e1403652651481-640x480.jpg\" alt=\"Sutter nurse Aileen Capuyan listens to Bob Martinez’s lungs. (April Dembosky/KQED)\" width=\"640\" height=\"480\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Sutter nurse Aileen Capuyan listens to Bob Martinez’s lungs. (April Dembosky/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>Bob Martinez has been in the hospital so many times, the surgical staff treats him like a regular at a coffee shop.\u003c/p>\n\u003cp>“They all know me!” he says. “If I go in there today, they’d say, ‘How’re ya doing Mr. Martinez?' ”\u003c/p>\n\u003caside class=\"pullquote alignleft\">'I’m so sick and tired of being in hospitals. I don’t want to go back no more. I said, God, no more.'\u003c/aside>\n\u003cp>Martinez is 81, a long-retired life insurance salesman. In the last few years, he's had more than a dozen surgeries on his right leg, including a foot amputation, a casualty of severe diabetes. His heart disease has warranted almost half a dozen heart procedures. After one of his recent operations, he said he'd had enough.\u003c/p>\n\u003cp>“I’m so sick and tired of being in hospitals,” he says shaking his head. “I don’t want to go back no more. I said, God, no more. No more.”\u003c/p>\n\u003cp>That’s when hospital staff told him about a program through Sutter Health that would send people to take care of him at home. It’s called the Advanced Illness Management program, or AIM. It’s designed for people like Martinez who have multiple chronic illnesses.\u003c!--more-->\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>It’s not hospice. That’s for people who doctors say have six months or less to live. This program is for the pre-hospice population, people estimated to be in the last 18 months of life. The AIM program assigns a team of doctors, nurses and social workers to help patients transition home after hospital stays, manage medication, and carefully coordinate care, at home and over the phone, to help keep patients out of the hospital.\u003c/p>\n\u003cp>Martinez’ nurse, Aileen Capuyan, and social worker, Ally Chu, come to his home in Oakland once a week.\u003c/p>\n\u003cp>“Are you coughing? Do you have any shortness of breath?” Capuyan asks as she listens to Martinez’s lungs.\u003c/p>\n\u003cp>He sits in the brown leather armchair in his living room while she takes his temperature and checks his blood pressure. Meanwhile, Chu is in the kitchen talking with Martinez's son, Jimmy, who takes care of him. Jimmy is making tamales. Then Capuyan and Chu switch.\u003c/p>\n\u003cp>Most of the visit is spent talking: about the pain in Martinez’s leg, how his dominoes game is going at the senior center, and about more sensitive things, like what happens when his health gets worse — what kind of care he wants at the end of life and what care he doesn’t want.\u003c/p>\n\u003cp>“I don’t want to be resuscitated,” Martinez says. “When my time comes — let it go.”\u003c/p>\n\u003cp>\u003ciframe src=\"https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/155994604&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" frameborder=\"no\" scrolling=\"no\">\u003c/iframe>\u003c/p>\n\u003cp>The founders of the AIM program hope that these ongoing visits build the kind of trust where patients can fully explore these questions. Chief program executive Betsy Gornet says this avoids rushed decisions that don’t capture a person’s real values.\u003c/p>\n\u003cp>“Spending fifteen minutes in a doctor's office or in an ICU in a crisis isn’t necessarily the way to do advanced care planning,” she says. “We do know that a dialogue over time does help foster the right kind of information.”\u003c/p>\n\u003cp>She says that means patients get the kind of care they want, and get help before their conditions reach a crisis level.\u003c/p>\n\u003cp>“We’ve been able to track very consistently a 30 percent reduction in emergency room visits by these patients, 70 to 80 percent reduction in ICU days, 50 percent reduction in hospitalizations,” she says.\u003c/p>\n\u003cp>That in turn has saved money.\u003c/p>\n\u003cp>“We’ve seen the total cost of care go down anywhere from $3,600 to $5,000 dollar per patient over the course of 90 days,” she says.\u003c/p>\n\u003cp>This is the kind of talk that has sparked fiery debates in Washington. Back in 2009, the idea of doctors even talking to their patients about their end-of-life wishes spurred fears of “\u003ca href=\"http://www.washingtonpost.com/wp-dyn/content/article/2009/07/31/AR2009073103148.html\" target=\"_blank\">death panels\u003c/a>” rationing care.\u003c/p>\n\u003cp>But today, the tone is shifting, according to health policy lobbyist Andrew MacPherson.\u003c/p>\n\u003cp>“We’re seeing a death of the death panels,” he says. “We’re in a totally new place today.”\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>He says lawmakers are having real bipartisan discussions about overhauling the American way of death, especially now that more and more politicians are shepherding their own parents through the end of life.\u003c/p>\n\u003cp>“It’s personal stories,” MacPherson says. “People's personal stories about their mother, about their father are really what bring folks to table to say, 'Look, we need to have a health care system that is responsive to patients’ values and preferences and wishes when they’re really seriously ill.' ”\u003c/p>\n\u003cp>He says officials in Washington are keeping an eye on the Sutter program as a model that might be replicated across the country. The Medicare program, which pays for health care for people over 65, gave the AIM program a $13 million grant from a fund created under the Affordable Care Act. In return, they want to see the program generate savings for Medicare of at least $29 million.\u003c/p>\n\u003cp>“The big question is whether or not it will pan out,” says Suzanne Delbanco, executive director of the nonprofit group Catalyst for Payment Reform.\u003c/p>\n\u003cp>The Medicare grants are one way the government is trying to move away from paying for health care on a fee-for-service basis, which Delbanco says incentivizes doctors to order more tests and procedures to drive up their revenues. Instead, interest is growing to develop more holistic payment models — things like “care management fees,” “bundled payments” and “shared savings” — that reward doctors based on the overall care they provide and outcomes where their patients ultimately get better.\u003c/p>\n\u003cp>“It’s almost as if we’re going from an a la carte menu to a pre-fixe meal where you pay a set amount for all your courses,” Delbanco says.\u003c/p>\n\u003cp>But there are two big unknowns.\u003c/p>\n\u003cp>First, it's not clear if these new models of care really will cost less in the long run. “We don’t know for sure whether or not financially it will end up being beneficial in an effort to curtail our health care costs,” Delbanco says.\u003c/p>\n\u003cp>Second, Sutter has to find a way to operate the AIM program that works for its own bottom line. When Sutter saves money for Medicare, by reducing hospitalizations and ER visits, it takes a financial hit on its own revenues. Many of the new services it provides to achieve those savings — the telephone coordination, some home care and some social work services — are not reimbursed under Medicare’s current payment system.\u003c/p>\n\u003cp>Sutter declined to reveal operation costs or budget figures for the AIM program, although the federal Agency for Healthcare Research and Quality reports it costs about $900 monthly, for each patient, on average.\u003c/p>\n\u003cp>AIM chief executive Betsy Gornet says the program does operate at a loss in some regions and has stayed afloat so far through foundation grants and investments from Sutter. But its goal this year, as part of the government grant, is to become self-sustaining, and to propose a new payment model for Medicare that balances savings for the government and still keeps its own program in business.\u003c/p>\n\u003cp>“We want to get the right care to the right patient at the right time,” Gornet says. “That will help save everybody’s resources.”\u003c/p>\n\u003cp>Gornet says the ultimate goal is to keep patients like Bob Martinez as comfortable and vibrant as possible until he reaches the end of his life.\u003c/p>\n\u003cp>Martinez says he's been thinking about death a lot lately, especially since his wife, Josie, died two years ago — at home, with her husband at her side.\u003c/p>\n\u003cp>“God’s got a plan for everybody, different plans,\" Martinez says. \"Some die at home. Some die in a hospital. I want to be home like she was. If it comes to that. But anyway, I’ll take it any way. I just want to be with her now.\"\u003c/p>\n\u003cp>Martinez died in May. He was at home, in his living room, surrounded by family.\u003c/p>\n\u003cp>\u003cem>This report was produced with support from \u003c/em>\u003cem>the MetLife Foundation Journalists in Aging Fellowships, a program of New America Media and the Gerontological Society of America.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"disqusTitle": "Clues to Dementia Often Missed in Vulnerable Older Adults",
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"content": "\u003cfigure id=\"attachment_19576\" class=\"wp-caption alignnone\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/06/IMG_0224-e1403051350292.jpg\">\u003cimg class=\"wp-image-19576 size-large\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/06/IMG_0224-640x480.jpg\" alt=\"IMG_0224\" width=\"640\" height=\"480\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Dr. Anna Chodos, a UCSF geriatrician, has worked with many seniors who lived in dangerous situations due to lack of awareness and early screening for dementia. (Ryder Diaz/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cem>Editor's Note: As Californians live longer, the number of dementia, a disease that destroys not only memory but also critical-thinking skills will grow. As part of our ongoing series on health, called \u003ca href=\"blogs.kqed.org/stateofhealth/series/vital-signs/\">\u003cstrong>Vital Signs\u003c/strong>\u003c/a>, we hear from Anna Chodos, a physician specializing in geriatrics. She says that social services can often keep people with dementia safe in their homes, but many older adults aren't getting the diagnosis they need. \u003c/em>\u003c/p>\n\u003cp>\u003cstrong>By Anna Chodos\u003c/strong>\u003c/p>\n\u003cp>To diagnosis [dementia] early is to give people a chance to be a part of planning for the future in a very meaningful way. And that's exactly what I'm \u003cem>not\u003c/em> seeing. I'm seeing people stuck in situations where they now don't have the ability to engage with you in complicated decision making and they’re not making safe decisions for themselves.\u003c/p>\n\u003cp>Dementia can affect your ability to remember to pay bills. It affects your ability to comply with your medical plan.\u003c!--more-->\u003cspan>You know, just the other day, I heard of a woman who received multiple notices that she hadn't paid her rent. And at the end of the week, on a Friday evening, she was in the offices of one of her local senior centers, without a clue of what else to do saying, 'I think I was just evicted. They won't let me back into my home.' And she was effectively homeless after not really understanding what had happened.\u003c/span>\u003c/p>\n\u003cp>I tend to see [these patients] when it's a crisis. And everybody finally notices it when it's a crisis--a safety issue like a fall or a broken arm or an eviction. But prior to that, in a lot of ways, everybody was doing their job. And yet this person was very vulnerable.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The landlord wasn't really doing anything wrong providing that person with notices that they didn't pay rent. And their friends weren't doing anything wrong by letting them live the life they seemed to want to lead. And the doctor wasn't doing anything wrong by treating their medical conditions. But where is the real safety net when someone is slowly declining at home and they end up in these very precarious situations?\u003c/p>\n\u003cp>I do think that this is an all-eyes, all-ears-open kind of thing. Do we feel like we could have people in the community understand signs -- warning signs -- and alert appropriate people in city services and in city agencies?\u003c/p>\n\u003cp>What is keeping me up at night thinking about these vulnerable adults: it's worrying that and knowing that there are some people who we're not catching in time.\u003c/p>\n\u003cp>\u003cem style=\"font-weight: inherit\">That story was reported by Ryder Diaz.\u003c/em>\u003c/p>\n\u003cp>\u003ciframe src=\"https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/155822191&color=ff5500&auto_play=false&hide_related=false&show_artwork=true&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" frameborder=\"no\" scrolling=\"no\">\u003c/iframe>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003ca style=\"font-weight: bold;color: #114999\" href=\"http://ww2.kqed.org/stateofhealth/series/vital-signs/\" target=\"_blank\">Share your own story about health in your community on the radio.\u003c/a>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_19576\" class=\"wp-caption alignnone\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/06/IMG_0224-e1403051350292.jpg\">\u003cimg class=\"wp-image-19576 size-large\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/06/IMG_0224-640x480.jpg\" alt=\"IMG_0224\" width=\"640\" height=\"480\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Dr. Anna Chodos, a UCSF geriatrician, has worked with many seniors who lived in dangerous situations due to lack of awareness and early screening for dementia. (Ryder Diaz/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cem>Editor's Note: As Californians live longer, the number of dementia, a disease that destroys not only memory but also critical-thinking skills will grow. As part of our ongoing series on health, called \u003ca href=\"blogs.kqed.org/stateofhealth/series/vital-signs/\">\u003cstrong>Vital Signs\u003c/strong>\u003c/a>, we hear from Anna Chodos, a physician specializing in geriatrics. She says that social services can often keep people with dementia safe in their homes, but many older adults aren't getting the diagnosis they need. \u003c/em>\u003c/p>\n\u003cp>\u003cstrong>By Anna Chodos\u003c/strong>\u003c/p>\n\u003cp>To diagnosis [dementia] early is to give people a chance to be a part of planning for the future in a very meaningful way. And that's exactly what I'm \u003cem>not\u003c/em> seeing. I'm seeing people stuck in situations where they now don't have the ability to engage with you in complicated decision making and they’re not making safe decisions for themselves.\u003c/p>\n\u003cp>Dementia can affect your ability to remember to pay bills. It affects your ability to comply with your medical plan.\u003c!--more-->\u003cspan>You know, just the other day, I heard of a woman who received multiple notices that she hadn't paid her rent. And at the end of the week, on a Friday evening, she was in the offices of one of her local senior centers, without a clue of what else to do saying, 'I think I was just evicted. They won't let me back into my home.' And she was effectively homeless after not really understanding what had happened.\u003c/span>\u003c/p>\n\u003cp>I tend to see [these patients] when it's a crisis. And everybody finally notices it when it's a crisis--a safety issue like a fall or a broken arm or an eviction. But prior to that, in a lot of ways, everybody was doing their job. And yet this person was very vulnerable.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"soldout": {
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