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"disqusTitle": "The Assisted Living Reform Bills That Died",
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"content": "\u003cp>\u003cstrong>By Polly Stryker\u003c/strong>\u003c/p>\n\u003cfigure id=\"attachment_20831\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/08/RS11379_photo-scr.jpg\">\u003cimg class=\"size-large wp-image-20831\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/08/RS11379_photo-scr-640x480.jpg\" alt=\"Taking some fresh air in the courtyard at Westchester Villa, an assisted facility in Inglewood. (Rachael Myrow/KQED)\" width=\"640\" height=\"480\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Taking some fresh air in the courtyard at Westchester Villa, an assisted facility in Inglewood. (Rachael Myrow/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>Last Thursday, August 14, was the day that bills still in the state Senate Appropriations Committee sank or swam. The Senate Appropriations Committee is where bills costing $150,000 or more go for consideration. If bills make it out of this committee, then bills are still in play and could make it to the governor’s desk, albeit with potential amendments along the way. If not, they die.\u003c/p>\n\u003cp>Going into the home stretch of this legislative session, 16 bills were on the table that, altogether, constituted the first major overhaul of the assisted living industry in nearly 30 years.\u003c/p>\n\u003cp>Two have already made it to the governor’s desk. \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140AB1523\" target=\"_blank\" rel=\"noopener\">AB1523\u003c/a> mandates liability insurance for all assisted living facilities. Advocates say liability insurance is one of the best ways to improve conditions in the industry. Operators whose violations make buying insurance too expensive will be simply forced out of business. The industry group \u003ca href=\"http://caassistedliving.org/\" target=\"_blank\" rel=\"noopener\">California Assisted Living Association\u003c/a> supported AB1523. \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140AB1572\" target=\"_blank\" rel=\"noopener\">AB1572\u003c/a> mandates facility operators allow and support resident and family councils at assisted living facilities. CALA supported that one as well.\u003c/p>\n\u003cp>Most of the rest of the bills are still swimming. But what about the bills that died?\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003c!--more-->\u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140AB1571\" target=\"_blank\" rel=\"noopener\">AB1571\u003c/a> (Eggman D-Stockton) would have created a more robust online consumer information system than \u003ca href=\"https://secure.dss.ca.gov/CareFacilitySearch/home/selecttype/\" target=\"_blank\" rel=\"noopener\">the one currently offered\u003c/a> by the Department of Social Services.\u003c/p>\n\u003cp style=\"text-align: center\">[\u003cstrong>Related:\u003c/strong> \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/08/05/online-information-about-assisted-living-facilities-hard-to-come-by/\" target=\"_blank\" rel=\"noopener\">Online Information About Assisted Living Facilities Hard to Come By\u003c/a>]\u003c/p>\n\u003cp>“It is very disappointing,\" says Pat McGinnis, executive director of \u003ca href=\"http://www.canhr.org/\" target=\"_blank\" rel=\"noopener\">California Advocates for Nursing Home Reform\u003c/a>, one of the key advocacy organizations sponsoring legislation this year. McGinnis says that there are more than 7,500 licensed facilities in California, \"and absolutely no way for consumers to compare one facility with another. It will be impossible for consumers to try to look up 348 [facilities] in Alameda County, for example, to try to see what violations, deficiencies, et cetera, they might have.”\u003c/p>\n\u003cp>\"I am not at all finished with this issue,” says the bill’s author, Assemblywoman Susan Eggman (D-Stockton). Though she says the DSS has already made changes to its website in response to AB1571, Eggman says she is considering reintroducing similar legislation in the next session. The DSS declined to comment.\u003c/p>\n\u003cp>\u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140AB1454\" target=\"_blank\" rel=\"noopener\">AB1454\u003c/a> (Calderon D-Industry) would have required every facility licensed by the Department of Social Services to be subject to annual, unannounced inspections. DSS licenses many different types of facilities, not just assisted living facilities. Currently, state law requires DSS to visit a facility every five years, barring a complaint which generates a separate visit. The agency says in practice it has an investigator visit about every 2 and a half years.\u003c/p>\n\u003cp>Bill watchers say two concerns appear to have spiked this bill. For one thing, AB1454 would have changed the inspection frequency for \u003cem>every\u003c/em> type of facility DSS visits. For another, that would cost a pretty penny: $20 million, by one state estimate.\u003c/p>\n\u003cp>In a written response, Assemblyman Ian Calderon said, “Although the Legislature provided an increase in funding to the Department of Social Services in the 2014-2015 Budget to protect our children and elderly, annual inspections continue to be urgently needed as part of the oversight process. Without increasing the frequency of unannounced visits, our state will continue to put our most vulnerable populations – children and elderly – at risk.”\u003c/p>\n\u003cp>But there's another bill that addresses this issue, in part. \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140SB895\" target=\"_blank\" rel=\"noopener\">SB895\u003c/a> (Corbett D-Alameda) would phase in unannounced annual visits for assisted living facilities only, by July 1, 2018. That passed out of the Senate Appropriations Committee with amendments.\u003c/p>\n\u003cp>Finally,\u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140AB1554\" target=\"_blank\" rel=\"noopener\"> AB1554\u003c/a> (Skinner D-East Bay) would have required the DSS to investigate complaints that alleged physical or sexual abuse, or imminent physical danger, at assisted living facilities within one working day, instead of 10 -- and report to the complainant promptly.\u003c/p>\n\u003cp style=\"text-align: center\">[\u003cstrong>Related: \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/08/11/crime-in-assisted-living-what-happens-after/\" target=\"_blank\" rel=\"noopener\">Crime in Assisted Living: What Happens After\u003c/a>\u003c/strong>]\u003c/p>\n\u003cp>Assemblywoman Skinner remarks the bills that made it out of the Senate Appropriations Committee put the onus on the industry itself, as opposed to the DSS.\u003c/p>\n\u003cp>“My frustration is, if we have higher expectations on the facilities, if we don’t have responsibility of the agency to enforce, then how are we going to feel assured that these facilities are complying?” Skinner is termed out, so she won’t introduce a similar bill next legislative session. But she adds, note how many legislators were involved in trying to reform assisted living facilities. This issue, Skinner says, isn’t going to go away.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Rachael Myrow contributed to this report.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cstrong>By Polly Stryker\u003c/strong>\u003c/p>\n\u003cfigure id=\"attachment_20831\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/08/RS11379_photo-scr.jpg\">\u003cimg class=\"size-large wp-image-20831\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/08/RS11379_photo-scr-640x480.jpg\" alt=\"Taking some fresh air in the courtyard at Westchester Villa, an assisted facility in Inglewood. (Rachael Myrow/KQED)\" width=\"640\" height=\"480\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Taking some fresh air in the courtyard at Westchester Villa, an assisted facility in Inglewood. (Rachael Myrow/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>Last Thursday, August 14, was the day that bills still in the state Senate Appropriations Committee sank or swam. The Senate Appropriations Committee is where bills costing $150,000 or more go for consideration. If bills make it out of this committee, then bills are still in play and could make it to the governor’s desk, albeit with potential amendments along the way. If not, they die.\u003c/p>\n\u003cp>Going into the home stretch of this legislative session, 16 bills were on the table that, altogether, constituted the first major overhaul of the assisted living industry in nearly 30 years.\u003c/p>\n\u003cp>Two have already made it to the governor’s desk. \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140AB1523\" target=\"_blank\" rel=\"noopener\">AB1523\u003c/a> mandates liability insurance for all assisted living facilities. Advocates say liability insurance is one of the best ways to improve conditions in the industry. Operators whose violations make buying insurance too expensive will be simply forced out of business. The industry group \u003ca href=\"http://caassistedliving.org/\" target=\"_blank\" rel=\"noopener\">California Assisted Living Association\u003c/a> supported AB1523. \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140AB1572\" target=\"_blank\" rel=\"noopener\">AB1572\u003c/a> mandates facility operators allow and support resident and family councils at assisted living facilities. CALA supported that one as well.\u003c/p>\n\u003cp>Most of the rest of the bills are still swimming. But what about the bills that died?\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003c!--more-->\u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140AB1571\" target=\"_blank\" rel=\"noopener\">AB1571\u003c/a> (Eggman D-Stockton) would have created a more robust online consumer information system than \u003ca href=\"https://secure.dss.ca.gov/CareFacilitySearch/home/selecttype/\" target=\"_blank\" rel=\"noopener\">the one currently offered\u003c/a> by the Department of Social Services.\u003c/p>\n\u003cp style=\"text-align: center\">[\u003cstrong>Related:\u003c/strong> \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/08/05/online-information-about-assisted-living-facilities-hard-to-come-by/\" target=\"_blank\" rel=\"noopener\">Online Information About Assisted Living Facilities Hard to Come By\u003c/a>]\u003c/p>\n\u003cp>“It is very disappointing,\" says Pat McGinnis, executive director of \u003ca href=\"http://www.canhr.org/\" target=\"_blank\" rel=\"noopener\">California Advocates for Nursing Home Reform\u003c/a>, one of the key advocacy organizations sponsoring legislation this year. McGinnis says that there are more than 7,500 licensed facilities in California, \"and absolutely no way for consumers to compare one facility with another. It will be impossible for consumers to try to look up 348 [facilities] in Alameda County, for example, to try to see what violations, deficiencies, et cetera, they might have.”\u003c/p>\n\u003cp>\"I am not at all finished with this issue,” says the bill’s author, Assemblywoman Susan Eggman (D-Stockton). Though she says the DSS has already made changes to its website in response to AB1571, Eggman says she is considering reintroducing similar legislation in the next session. The DSS declined to comment.\u003c/p>\n\u003cp>\u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140AB1454\" target=\"_blank\" rel=\"noopener\">AB1454\u003c/a> (Calderon D-Industry) would have required every facility licensed by the Department of Social Services to be subject to annual, unannounced inspections. DSS licenses many different types of facilities, not just assisted living facilities. Currently, state law requires DSS to visit a facility every five years, barring a complaint which generates a separate visit. The agency says in practice it has an investigator visit about every 2 and a half years.\u003c/p>\n\u003cp>Bill watchers say two concerns appear to have spiked this bill. For one thing, AB1454 would have changed the inspection frequency for \u003cem>every\u003c/em> type of facility DSS visits. For another, that would cost a pretty penny: $20 million, by one state estimate.\u003c/p>\n\u003cp>In a written response, Assemblyman Ian Calderon said, “Although the Legislature provided an increase in funding to the Department of Social Services in the 2014-2015 Budget to protect our children and elderly, annual inspections continue to be urgently needed as part of the oversight process. Without increasing the frequency of unannounced visits, our state will continue to put our most vulnerable populations – children and elderly – at risk.”\u003c/p>\n\u003cp>But there's another bill that addresses this issue, in part. \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140SB895\" target=\"_blank\" rel=\"noopener\">SB895\u003c/a> (Corbett D-Alameda) would phase in unannounced annual visits for assisted living facilities only, by July 1, 2018. That passed out of the Senate Appropriations Committee with amendments.\u003c/p>\n\u003cp>Finally,\u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140AB1554\" target=\"_blank\" rel=\"noopener\"> AB1554\u003c/a> (Skinner D-East Bay) would have required the DSS to investigate complaints that alleged physical or sexual abuse, or imminent physical danger, at assisted living facilities within one working day, instead of 10 -- and report to the complainant promptly.\u003c/p>\n\u003cp style=\"text-align: center\">[\u003cstrong>Related: \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/08/11/crime-in-assisted-living-what-happens-after/\" target=\"_blank\" rel=\"noopener\">Crime in Assisted Living: What Happens After\u003c/a>\u003c/strong>]\u003c/p>\n\u003cp>Assemblywoman Skinner remarks the bills that made it out of the Senate Appropriations Committee put the onus on the industry itself, as opposed to the DSS.\u003c/p>\n\u003cp>“My frustration is, if we have higher expectations on the facilities, if we don’t have responsibility of the agency to enforce, then how are we going to feel assured that these facilities are complying?” Skinner is termed out, so she won’t introduce a similar bill next legislative session. But she adds, note how many legislators were involved in trying to reform assisted living facilities. This issue, Skinner says, isn’t going to go away.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Rachael Myrow contributed to this report.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "California Prisons Begin 'Use-of-Force' Reforms for Mentally Ill Inmates",
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"content": "\u003cfigure id=\"attachment_20865\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/08/RS11514_IMG_0176-hpf.jpg\">\u003cimg class=\"size-full wp-image-20865\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/08/RS11514_IMG_0176-hpf.jpg\" alt=\"A psychiatric segregation cell at Sacramento Prison. (Julie Small/KQED)\" width=\"640\" height=\"480\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2014/08/RS11514_IMG_0176-hpf.jpg 640w, https://ww2.kqed.org/app/uploads/sites/27/2014/08/RS11514_IMG_0176-hpf-400x300.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2014/08/RS11514_IMG_0176-hpf-320x240.jpg 320w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">A psychiatric segregation cell at Sacramento Prison. (Julie Small/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Julie Small\u003c/strong>\u003c/p>\n\u003cp>The number of inmates with mild to severe mental illness has grown to 37,000 in California, about a quarter of the prison population.\u003c/p>\n\u003cp>A series of lawsuits brought by inmates against the state over the last two decades has exposed a correctional system poorly equipped to handle their extraordinary needs.\u003c/p>\n\u003cp>Now California is trying to comply with a federal court order to change when and how correctional officers use pepper spray to force uncooperative inmates to leave their cells or follow orders.\u003c/p>\n\u003cp>Pepper spray may have contributed to three inmate deaths and an unknown number of injuries -- unknown because the California Department of Corrections and Rehabilitations doesn’t consider the effects of pepper spray an injury.\u003c!--more-->\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The issue was brought to light last year through graphic videos shown in court in a lawsuit that was begun in 1990, a lawsuit brought by inmates to improve psychiatric care.\u003c/p>\n\u003cp>Prisons record some use of force incidents, according to department policy.\u003c/p>\n\u003cp style=\"text-align: center\">[\u003cstrong>Related:\u003c/strong> \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/08/18/a-day-in-californias-psychiatric-prison-units/\" target=\"_blank\">A Day in California's Psychiatric Prison Units\u003c/a>]\u003c/p>\n\u003cp>One video showed custody staff at Corcoran State Prison struggling to remove an inmate who was hallucinating and refusing to leave his cell in order to receive medication.\u003c/p>\n\u003cp>The inmate had taken off his clothes and smeared feces on himself. When he refused to submit to handcuffs, guards in gas masks sprayed a potent pepper spray into the cell, causing the inmate to gasp for air.\u003c/p>\n\u003cp>The video showed that as the inmate screamed for help, an officer ordered him to “turn around and cuff up.”\u003c/p>\n\u003cp>The inmate screamed back, “Open the door!”\u003c/p>\n\u003cp>When the inmate still wouldn't “cuff up” the officers sprayed him again, repeatedly.\u003c/p>\n\u003cp>Later, the video showed guards rushing in and wrestling the inmate to the floor and into restraints.\u003c/p>\n\u003cp>“He has described this as making him feel like less than an animal,” said Lori Rifkin, an attorney for inmate Jermaine Padilla, who is suing the Department of Corrections.\u003c/p>\n\u003cp>Rifkin says two years on, her client still has flashbacks and nightmares from the process prison officials refer to as a “cell extraction.”\u003c/p>\n\u003cp>Padilla believes the experience at Corcoran worsened his schizophrenia and bi-polar disorder and has permanently damaged him.\u003c/p>\n\u003cp>“It changed something in him,” Rifkin says. “He’d never been treated that badly, and it broke something in him.”\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/163303802&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\">\u003c/iframe>\u003c/p>\n\u003cp>The Padilla video, and five others shown last fall, were the latest revelation in a long history of problems with mental health care in California prisons that have prompted federal court intervention.\u003c/p>\n\u003cp>U.S. District Judge Lawrence Karlton called the video evidence “horrific.” In April, he ordered new restrictions on the use of force. He banned the use of pepper spray on mentally ill inmates in cells and psychiatric holding facilities with few exceptions. He instructed prison officials whenever possible to defer to clinicians about whether to use force.\u003c/p>\n\u003cp>On August 1st, \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/08/01/california-prisons-to-restrict-pepper-spray-segregation-of-mentally-ill-inmates/\" target=\"_blank\">the judge signed of\u003c/a>f on the Department of Corrections’ reform plan.\u003c/p>\n\u003cp>Among the changes: prison staff will be trained to collaborate and to exhaust every reasonable alternative to force.\u003c/p>\n\u003cp>Craig Brown, a lobbyist for the California Correctional Peace Officers Association agrees with this approach. “The critical element is to appropriately train our members to recognize what they’re dealing with,” Brown said.\u003c/p>\n\u003cp>Brown says the union has been pushing for better training for years. He says additional training will help them interact with the growing percentage of mentally ill inmates.\u003c/p>\n\u003cp>“They’ll recognize what’s going on,\" Brown said. \"They’ll know when they need to talk to a mental health professional. They know when they don’t.\"\u003c/p>\n\u003cp>The state department of corrections declined to be interviewed for this story. They referred KQED to their plan filed with the court.\u003c/p>\n\u003cp>Under that plan a mental health clinician must be called in to evaluate an inmate’s mental status to determine whether they’re able to understand directions. This evaluation now must happen before officers can proceed with use of force. If a clinician decides force shouldn’t be used, correctional officers can no longer override that decision. Instead, the conflict will be referred to senior management to resolve.\u003c/p>\n\u003cp>Dr. Alan Abrams says the state’s plan reinforces the values and strategies he used when he was the chief psychiatrist at the California Medical Facility in Vacaville. Abrams, who left the post a couple years ago, says staff at most prisons already collaborate well.\u003c/p>\n\u003cp>Abrams believes the problem is that there have been a limited number of ways to handle violent inmates.\u003c/p>\n\u003cp>“One (inmate) is brutalizing another,\" he explained. \"Yes, they’re labeled mentally ill, but you need to stop the violence very quickly. It’s not a discussion.”\u003c/p>\n\u003cp>In his 12 years working in prisons Abrams says he ordered force numerous times to keep inmates from killing each other or themselves.\u003c/p>\n\u003cp>“What do you do about the inmate who’s in their cell with a t-shirt, in a noose, saying they’re going to kill themselves unless you release them from prison?” says Abrams, “You’re not going to watch him hang himself. You’re not going to release him from prison, and so you say to your custody co-workers ‘You better get them down!’”\u003c/p>\n\u003cp>But Terry Kupers, a national expert on correctional mental health believes the pepper-spraying incidents indicate inadequate mental health care in the prisons. He says prisons can and should mitigate conditions that exacerbate mental illness.\u003c/p>\n\u003cp>“The pepper spray, the cell extractions, the beatings, the violence among prisoners--all those constitute reenactments of trauma in people who were previously traumatized and make them more emotionally disabled,” Kupers said.\u003c/p>\n\u003cp>California prison officials believe they will have fully implemented the reforms by the end of this year. But they’re still negotiating another critical change to how mentally ill inmates are managed.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Judge Karlton wants a proposal by next week that will restrict how often and for how long prisons can house inmates with mental disorders in segregation units -- where their illnesses can and do worsen.\u003c/p>\n\n",
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"description": "By Julie Small The number of inmates with mild to severe mental illness has grown to 37,000 in California, about a quarter of the prison population. A series of lawsuits brought by inmates against the state over the last two decades has exposed a correctional system poorly equipped to handle their extraordinary needs. Now California",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_20865\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/08/RS11514_IMG_0176-hpf.jpg\">\u003cimg class=\"size-full wp-image-20865\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/08/RS11514_IMG_0176-hpf.jpg\" alt=\"A psychiatric segregation cell at Sacramento Prison. (Julie Small/KQED)\" width=\"640\" height=\"480\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2014/08/RS11514_IMG_0176-hpf.jpg 640w, https://ww2.kqed.org/app/uploads/sites/27/2014/08/RS11514_IMG_0176-hpf-400x300.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2014/08/RS11514_IMG_0176-hpf-320x240.jpg 320w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">A psychiatric segregation cell at Sacramento Prison. (Julie Small/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Julie Small\u003c/strong>\u003c/p>\n\u003cp>The number of inmates with mild to severe mental illness has grown to 37,000 in California, about a quarter of the prison population.\u003c/p>\n\u003cp>A series of lawsuits brought by inmates against the state over the last two decades has exposed a correctional system poorly equipped to handle their extraordinary needs.\u003c/p>\n\u003cp>Now California is trying to comply with a federal court order to change when and how correctional officers use pepper spray to force uncooperative inmates to leave their cells or follow orders.\u003c/p>\n\u003cp>Pepper spray may have contributed to three inmate deaths and an unknown number of injuries -- unknown because the California Department of Corrections and Rehabilitations doesn’t consider the effects of pepper spray an injury.\u003c!--more-->\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The issue was brought to light last year through graphic videos shown in court in a lawsuit that was begun in 1990, a lawsuit brought by inmates to improve psychiatric care.\u003c/p>\n\u003cp>Prisons record some use of force incidents, according to department policy.\u003c/p>\n\u003cp style=\"text-align: center\">[\u003cstrong>Related:\u003c/strong> \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/08/18/a-day-in-californias-psychiatric-prison-units/\" target=\"_blank\">A Day in California's Psychiatric Prison Units\u003c/a>]\u003c/p>\n\u003cp>One video showed custody staff at Corcoran State Prison struggling to remove an inmate who was hallucinating and refusing to leave his cell in order to receive medication.\u003c/p>\n\u003cp>The inmate had taken off his clothes and smeared feces on himself. When he refused to submit to handcuffs, guards in gas masks sprayed a potent pepper spray into the cell, causing the inmate to gasp for air.\u003c/p>\n\u003cp>The video showed that as the inmate screamed for help, an officer ordered him to “turn around and cuff up.”\u003c/p>\n\u003cp>The inmate screamed back, “Open the door!”\u003c/p>\n\u003cp>When the inmate still wouldn't “cuff up” the officers sprayed him again, repeatedly.\u003c/p>\n\u003cp>Later, the video showed guards rushing in and wrestling the inmate to the floor and into restraints.\u003c/p>\n\u003cp>“He has described this as making him feel like less than an animal,” said Lori Rifkin, an attorney for inmate Jermaine Padilla, who is suing the Department of Corrections.\u003c/p>\n\u003cp>Rifkin says two years on, her client still has flashbacks and nightmares from the process prison officials refer to as a “cell extraction.”\u003c/p>\n\u003cp>Padilla believes the experience at Corcoran worsened his schizophrenia and bi-polar disorder and has permanently damaged him.\u003c/p>\n\u003cp>“It changed something in him,” Rifkin says. “He’d never been treated that badly, and it broke something in him.”\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/163303802&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\">\u003c/iframe>\u003c/p>\n\u003cp>The Padilla video, and five others shown last fall, were the latest revelation in a long history of problems with mental health care in California prisons that have prompted federal court intervention.\u003c/p>\n\u003cp>U.S. District Judge Lawrence Karlton called the video evidence “horrific.” In April, he ordered new restrictions on the use of force. He banned the use of pepper spray on mentally ill inmates in cells and psychiatric holding facilities with few exceptions. He instructed prison officials whenever possible to defer to clinicians about whether to use force.\u003c/p>\n\u003cp>On August 1st, \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/08/01/california-prisons-to-restrict-pepper-spray-segregation-of-mentally-ill-inmates/\" target=\"_blank\">the judge signed of\u003c/a>f on the Department of Corrections’ reform plan.\u003c/p>\n\u003cp>Among the changes: prison staff will be trained to collaborate and to exhaust every reasonable alternative to force.\u003c/p>\n\u003cp>Craig Brown, a lobbyist for the California Correctional Peace Officers Association agrees with this approach. “The critical element is to appropriately train our members to recognize what they’re dealing with,” Brown said.\u003c/p>\n\u003cp>Brown says the union has been pushing for better training for years. He says additional training will help them interact with the growing percentage of mentally ill inmates.\u003c/p>\n\u003cp>“They’ll recognize what’s going on,\" Brown said. \"They’ll know when they need to talk to a mental health professional. They know when they don’t.\"\u003c/p>\n\u003cp>The state department of corrections declined to be interviewed for this story. They referred KQED to their plan filed with the court.\u003c/p>\n\u003cp>Under that plan a mental health clinician must be called in to evaluate an inmate’s mental status to determine whether they’re able to understand directions. This evaluation now must happen before officers can proceed with use of force. If a clinician decides force shouldn’t be used, correctional officers can no longer override that decision. Instead, the conflict will be referred to senior management to resolve.\u003c/p>\n\u003cp>Dr. Alan Abrams says the state’s plan reinforces the values and strategies he used when he was the chief psychiatrist at the California Medical Facility in Vacaville. Abrams, who left the post a couple years ago, says staff at most prisons already collaborate well.\u003c/p>\n\u003cp>Abrams believes the problem is that there have been a limited number of ways to handle violent inmates.\u003c/p>\n\u003cp>“One (inmate) is brutalizing another,\" he explained. \"Yes, they’re labeled mentally ill, but you need to stop the violence very quickly. It’s not a discussion.”\u003c/p>\n\u003cp>In his 12 years working in prisons Abrams says he ordered force numerous times to keep inmates from killing each other or themselves.\u003c/p>\n\u003cp>“What do you do about the inmate who’s in their cell with a t-shirt, in a noose, saying they’re going to kill themselves unless you release them from prison?” says Abrams, “You’re not going to watch him hang himself. You’re not going to release him from prison, and so you say to your custody co-workers ‘You better get them down!’”\u003c/p>\n\u003cp>But Terry Kupers, a national expert on correctional mental health believes the pepper-spraying incidents indicate inadequate mental health care in the prisons. He says prisons can and should mitigate conditions that exacerbate mental illness.\u003c/p>\n\u003cp>“The pepper spray, the cell extractions, the beatings, the violence among prisoners--all those constitute reenactments of trauma in people who were previously traumatized and make them more emotionally disabled,” Kupers said.\u003c/p>\n\u003cp>California prison officials believe they will have fully implemented the reforms by the end of this year. But they’re still negotiating another critical change to how mentally ill inmates are managed.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Judge Karlton wants a proposal by next week that will restrict how often and for how long prisons can house inmates with mental disorders in segregation units -- where their illnesses can and do worsen.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>\u003c!--more-->\u003cbr>\n\u003ciframe src=\"https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/163042061%3Fsecret_token%3Ds-z9Urx&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false&visual=true\" width=\"100%\" height=\"400\" frameborder=\"no\" scrolling=\"no\">\u003c/iframe>\u003c/p>\n\u003cp>In California, prisoners who repeatedly violate rules or commit new crimes end up in segregation units. These are like prisons within the prison. A federal judge recently ruled that this kind of punishment might pose too great a risk for inmates with serious mental illness -- who often worsen in segregation and become suicidal.\u003c/p>\n\u003cp>Inmates in segregation spend more time in their cells; they’re often in handcuffs and leg chains, and they have to submit to frequent strip searches for weapons and drugs.\u003c/p>\n\u003cp>The California State Prison in Sacramento runs one segregation unit for inmates who committed a serious crime but also have a severe mental illness. KQED News got a rare tour of the facility.\u003c/p>\n\u003cp>\u003cem>Photos and audio by Julie Small, photos of weapons courtesy the California Department of Corrections and Rehabilitation, production by Lisa Pickoff-White\u003c/em>\u003c/p>\n\u003cstyle>\n.single-post #content {width: 100%; }\n.single-post #sidebar {display: none;}\n\u003c/style>\n\u003cp>[ad fullwidth]\u003c/p>\u003cp>\u003c/p>\n",
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"content": "\u003cfigure id=\"attachment_13022\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/05/96226495-e1382074913159.jpg\">\u003cimg class=\"size-full wp-image-13022\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/05/96226495-e1382074913159.jpg\" alt=\"(Getty Images)\" width=\"640\" height=\"427\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2013/05/96226495-e1382074913159.jpg 640w, https://ww2.kqed.org/app/uploads/sites/27/2013/05/96226495-e1382074913159-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2013/05/96226495-e1382074913159-320x214.jpg 320w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>SACRAMENTO, Calif. (AP) — Health insurance plans offered to state employees in California and elsewhere are relatively generous, with government picking up a large share of deductibles and co-pays, according to a report released Tuesday.\u003c/p>\n\u003cp>The \u003ca href=\"http://www.pewtrusts.org/en/research-and-analysis/reports/2014/08/state-employee-health-plan-spending\" target=\"_blank\">report\u003c/a> by The Pew Charitable Trusts and the John D. and Catherine T. MacArthur Foundation was a first-of-its kind survey of state government health insurance plans nationwide. It found that state plans paid on average 92 percent of a typical enrollee's health care costs, which is equivalent to the best offerings — \"platinum\" plans — that the public can purchase on one of the new health insurance exchanges.\u003c/p>\n\u003cp>In California, Pew found that figure was 95 percent and that 68 percent of plan members had no annual deductible.\u003c/p>\n\u003cp>Putting the report into a broader context that can make the data easily understood is difficult.\u003c!--more-->\u003c/p>\n\u003cp>Pew researchers said direct comparisons between states are tricky because myriad factors are in play, including wide differences in the cost of health care delivery across the country, and in the age and health of people in the insurance plans.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Direct cost comparisons to plans offered to employees in the private sector also not available, said Maria Schiff, the project director.\u003c/p>\n\u003caside class=\"pullquote alignleft\">95 percent of health care costs are covered for state employees, and 68 percent of employees paid no deductible.\u003c/aside>\n\u003cp>For example, Pew said the average monthly premium for a state government health care plan in 2013 was $963, with states picking up 84 percent of the cost and workers picking up 16 percent. In California, the average monthly premium that year was $1,092, with the state paying 77 percent and employees paying 23 percent.\u003c/p>\n\u003cp>Pew used the actuarial firm Milliman Inc., which did not have similar premium data for the private sector, Schiff said.\u003c/p>\n\u003cp>Private companies have been shifting more of the cost to employees as health insurance costs rise, offering higher-deductible plans and requiring greater co-pays for visits to primary care providers and specialists. The Pew report said state governments have been slower to offer high-deductible health plans.\u003c/p>\n\u003cp>The Pew report sought to quantify for the first time state employee health care costs nationwide, which it said is second to Medicaid in the amount of money state governments spend on health care. Its study found that 45 percent of state employees across the country were enrolled in plans with no deductible.\u003c/p>\n\u003cp>That includes some plans offered in California, including a Kaiser HMO plan that enrolls 40 percent of state workers. According to Pew, that plan had no annual deductible, $15 co-pays for office visits and an annual out-of-pocket maximum of $1,500.\u003c/p>\n\u003cp>The state offers nine different health care plans, including six HMOs, that provide various levels of premiums, deductibles and co-pays, said Bill Madison, a spokesman for the California Public Employees Retirement System, which administers the state's health program.\u003c/p>\n\u003cp>\"It gives our members more of a variety to choose from so they can find something that will fit within their cost range and still provide them the adequate health care they are looking for and deserve,\" he said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The total cost of health care premiums for employees of California state government, municipalities and school districts for 2014 is projected to be $7.7 billion, up from $7 billion two years ago, according to CalPERS.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_13022\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/05/96226495-e1382074913159.jpg\">\u003cimg class=\"size-full wp-image-13022\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/05/96226495-e1382074913159.jpg\" alt=\"(Getty Images)\" width=\"640\" height=\"427\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2013/05/96226495-e1382074913159.jpg 640w, https://ww2.kqed.org/app/uploads/sites/27/2013/05/96226495-e1382074913159-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2013/05/96226495-e1382074913159-320x214.jpg 320w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>SACRAMENTO, Calif. (AP) — Health insurance plans offered to state employees in California and elsewhere are relatively generous, with government picking up a large share of deductibles and co-pays, according to a report released Tuesday.\u003c/p>\n\u003cp>The \u003ca href=\"http://www.pewtrusts.org/en/research-and-analysis/reports/2014/08/state-employee-health-plan-spending\" target=\"_blank\">report\u003c/a> by The Pew Charitable Trusts and the John D. and Catherine T. MacArthur Foundation was a first-of-its kind survey of state government health insurance plans nationwide. It found that state plans paid on average 92 percent of a typical enrollee's health care costs, which is equivalent to the best offerings — \"platinum\" plans — that the public can purchase on one of the new health insurance exchanges.\u003c/p>\n\u003cp>In California, Pew found that figure was 95 percent and that 68 percent of plan members had no annual deductible.\u003c/p>\n\u003cp>Putting the report into a broader context that can make the data easily understood is difficult.\u003c!--more-->\u003c/p>\n\u003cp>Pew researchers said direct comparisons between states are tricky because myriad factors are in play, including wide differences in the cost of health care delivery across the country, and in the age and health of people in the insurance plans.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Direct cost comparisons to plans offered to employees in the private sector also not available, said Maria Schiff, the project director.\u003c/p>\n\u003caside class=\"pullquote alignleft\">95 percent of health care costs are covered for state employees, and 68 percent of employees paid no deductible.\u003c/aside>\n\u003cp>For example, Pew said the average monthly premium for a state government health care plan in 2013 was $963, with states picking up 84 percent of the cost and workers picking up 16 percent. In California, the average monthly premium that year was $1,092, with the state paying 77 percent and employees paying 23 percent.\u003c/p>\n\u003cp>Pew used the actuarial firm Milliman Inc., which did not have similar premium data for the private sector, Schiff said.\u003c/p>\n\u003cp>Private companies have been shifting more of the cost to employees as health insurance costs rise, offering higher-deductible plans and requiring greater co-pays for visits to primary care providers and specialists. The Pew report said state governments have been slower to offer high-deductible health plans.\u003c/p>\n\u003cp>The Pew report sought to quantify for the first time state employee health care costs nationwide, which it said is second to Medicaid in the amount of money state governments spend on health care. Its study found that 45 percent of state employees across the country were enrolled in plans with no deductible.\u003c/p>\n\u003cp>That includes some plans offered in California, including a Kaiser HMO plan that enrolls 40 percent of state workers. According to Pew, that plan had no annual deductible, $15 co-pays for office visits and an annual out-of-pocket maximum of $1,500.\u003c/p>\n\u003cp>The state offers nine different health care plans, including six HMOs, that provide various levels of premiums, deductibles and co-pays, said Bill Madison, a spokesman for the California Public Employees Retirement System, which administers the state's health program.\u003c/p>\n\u003cp>\"It gives our members more of a variety to choose from so they can find something that will fit within their cost range and still provide them the adequate health care they are looking for and deserve,\" he said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The total cost of health care premiums for employees of California state government, municipalities and school districts for 2014 is projected to be $7.7 billion, up from $7 billion two years ago, according to CalPERS.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"title": "State Reconsiders Letting Catholic Universities Limit Abortion Coverage",
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"content": "\u003cfigure id=\"attachment_20671\" class=\"wp-caption alignnone\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/08/31868593_c758da9bbf_z.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-20671\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/08/31868593_c758da9bbf_z.jpg\" alt=\"Santa Clara University's employee health insurance will stop covering 'elective' abortions next year unless state officials change their minds. (Michael Zimmer/Flickr)\" width=\"640\" height=\"480\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Santa Clara University’s employee health insurance will stop covering ‘elective’ abortions next year unless state officials change their minds. (Michael Zimmer/Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Grace Rubenstein and Mina Kim\u003c/strong>\u003c/p>\n\u003cp>State officials are reviewing whether they made the right call when they approved health plans that limit abortion coverage.\u003c/p>\n\u003cp>California law has strongly protected abortion rights for decades. But in recent years, the state’s Department of Managed Health Care — which oversees health insurance — has approved a handful of plans that exclude coverage for “elective” abortions. That is, abortions that aren’t necessary to protect the health of the mother.\u003c/p>\n\u003cp>Those insurance-plan approvals occurred quietly, with little public attention. Until last year, when officials at two Catholic universities, Santa Clara University and Loyola Marymount in Los Angeles, told faculty and staff that the schools would now only cover abortions that are “medically necessary” for the mother’s health. State officials had approved those insurance plans.\u003c/p>\n\u003cp>The decision surprised and angered hundreds of Santa Clara faculty members, who tried and failed earlier this year to get the school’s Board of Trustees to reverse the decision. And it also appeared to reverse decades of legal precedent in California. Now, officials from the Department of Managed Health Care say they’re going back and reviewing the policy.\u003cbr>\n\u003c!--more-->\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“The question is, are abortions chosen by a woman with the approval of her doctor medically necessary?” said Bob Egelko, a \u003cem>San Francisco Chronicle\u003c/em> reporter who’s been \u003ca href=\"http://www.sfgate.com/news/article/2-California-Catholic-universities-limit-5680932.php\">following the story\u003c/a>. “Until pretty recently it was assumed by insurers that they were.”\u003c/p>\n\u003cp>Anti-abortion groups, such as the Life Legal Defense Foundation, maintain that abortions by choice are not necessary.\u003c/p>\n\u003caside class=\"pullquote alignleft\">‘California law has treated all abortions chosen by the woman as within her rights and … until now.’\u003c/aside>\n\u003cp>California is known for having strong reproductive rights protections. In 1972, the state Supreme Court struck down a law that allowed abortions only to prevent serious physical harm to a woman, not abortions chosen for any other reason.\u003c/p>\n\u003cp>“The court said that standard is vague and violates women’s rights,” Egelko said. “So ever since then California law has treated all abortions chosen by the woman as within her rights and … as medically necessary. It’s pretty much been taken for granted up until now.”\u003c/p>\n\u003cp>And a 1975 state law, the Knox-Keene Health Care Services Plan Act, required health plans to cover all medically necessary procedures.\u003c/p>\n\u003cp>When Anthem Blue Cross applied in 2008 to offer a plan for religious institutions that excluded “elective” abortions, however, the state approved it. Officials approved a Kaiser Permanente plan with a similar exclusion in 2012; that plan is available to any employer with an objection to abortion, religious or not.\u003c/p>\n\u003cp>“They didn’t really explain themselves,” Egelko said of state regulators.\u003c/p>\n\u003cp>\u003cem>California Lawyer\u003c/em> magazine, which \u003ca href=\"http://www.callawyer.com/clstory.cfm?pubdt=201406&eid=935243&evid=1\">first reported\u003c/a> on the universities’ changes in June, spells out the legal complexity of the matter:\u003c/p>\n\u003cblockquote>\u003cp>Despite the public perception of clear state constitutional and statutory protections for abortion in California, private insurance law has a muddier history. …\u003c/p>\n\u003cp>Members of group health plans elsewhere in California may soon find themselves as surprised as [Santa Clara University faculty] to learn how weak protections for access to abortion have become under the state’s health insurance regulators.\u003c/p>\n\u003cp>Knox-Keene spells out the basic health services that insurers must provide to meet medical standards of care. Significantly, the statute contains no religious exception for eliminating abortion access.\u003c/p>\u003c/blockquote>\n\u003cp>Santa Clara University’s new plan doesn’t go into effect until next year. Loyola’s is already in effect, but there’s a provision for employees to pay extra for abortion coverage through a private plan.\u003c/p>\n\u003cp>Meanwhile, nationwide, \u003ca href=\"http://www.becketfund.org/hhsinformationcentral/#BackToTop2\">more than 100\u003c/a> universities and other nonprofit institutions are suing the Obama administration over a birth control conflict that MSNBC \u003ca href=\"http://www.msnbc.com/msnbc/the-next-hobby-lobby\">called\u003c/a> “the next Hobby Lobby.” In short, the federal government created an opt-out form that religious institutions can sign to certify their opposition to contraception; then their insurers directly cover contraceptive costs, taking the employer out of the equation. The employers stay that still results in contraception and thus impinges on their religious liberty, so they’re suing.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>It’s not clear when California officials will announce whether they’ll allow the plans limiting abortion coverage to go on.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_20671\" class=\"wp-caption alignnone\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/08/31868593_c758da9bbf_z.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-20671\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/08/31868593_c758da9bbf_z.jpg\" alt=\"Santa Clara University's employee health insurance will stop covering 'elective' abortions next year unless state officials change their minds. (Michael Zimmer/Flickr)\" width=\"640\" height=\"480\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Santa Clara University’s employee health insurance will stop covering ‘elective’ abortions next year unless state officials change their minds. (Michael Zimmer/Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Grace Rubenstein and Mina Kim\u003c/strong>\u003c/p>\n\u003cp>State officials are reviewing whether they made the right call when they approved health plans that limit abortion coverage.\u003c/p>\n\u003cp>California law has strongly protected abortion rights for decades. But in recent years, the state’s Department of Managed Health Care — which oversees health insurance — has approved a handful of plans that exclude coverage for “elective” abortions. That is, abortions that aren’t necessary to protect the health of the mother.\u003c/p>\n\u003cp>Those insurance-plan approvals occurred quietly, with little public attention. Until last year, when officials at two Catholic universities, Santa Clara University and Loyola Marymount in Los Angeles, told faculty and staff that the schools would now only cover abortions that are “medically necessary” for the mother’s health. State officials had approved those insurance plans.\u003c/p>\n\u003cp>The decision surprised and angered hundreds of Santa Clara faculty members, who tried and failed earlier this year to get the school’s Board of Trustees to reverse the decision. And it also appeared to reverse decades of legal precedent in California. Now, officials from the Department of Managed Health Care say they’re going back and reviewing the policy.\u003cbr>\n\u003c!--more-->\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“The question is, are abortions chosen by a woman with the approval of her doctor medically necessary?” said Bob Egelko, a \u003cem>San Francisco Chronicle\u003c/em> reporter who’s been \u003ca href=\"http://www.sfgate.com/news/article/2-California-Catholic-universities-limit-5680932.php\">following the story\u003c/a>. “Until pretty recently it was assumed by insurers that they were.”\u003c/p>\n\u003cp>Anti-abortion groups, such as the Life Legal Defense Foundation, maintain that abortions by choice are not necessary.\u003c/p>\n\u003caside class=\"pullquote alignleft\">‘California law has treated all abortions chosen by the woman as within her rights and … until now.’\u003c/aside>\n\u003cp>California is known for having strong reproductive rights protections. In 1972, the state Supreme Court struck down a law that allowed abortions only to prevent serious physical harm to a woman, not abortions chosen for any other reason.\u003c/p>\n\u003cp>“The court said that standard is vague and violates women’s rights,” Egelko said. “So ever since then California law has treated all abortions chosen by the woman as within her rights and … as medically necessary. It’s pretty much been taken for granted up until now.”\u003c/p>\n\u003cp>And a 1975 state law, the Knox-Keene Health Care Services Plan Act, required health plans to cover all medically necessary procedures.\u003c/p>\n\u003cp>When Anthem Blue Cross applied in 2008 to offer a plan for religious institutions that excluded “elective” abortions, however, the state approved it. Officials approved a Kaiser Permanente plan with a similar exclusion in 2012; that plan is available to any employer with an objection to abortion, religious or not.\u003c/p>\n\u003cp>“They didn’t really explain themselves,” Egelko said of state regulators.\u003c/p>\n\u003cp>\u003cem>California Lawyer\u003c/em> magazine, which \u003ca href=\"http://www.callawyer.com/clstory.cfm?pubdt=201406&eid=935243&evid=1\">first reported\u003c/a> on the universities’ changes in June, spells out the legal complexity of the matter:\u003c/p>\n\u003cblockquote>\u003cp>Despite the public perception of clear state constitutional and statutory protections for abortion in California, private insurance law has a muddier history. …\u003c/p>\n\u003cp>Members of group health plans elsewhere in California may soon find themselves as surprised as [Santa Clara University faculty] to learn how weak protections for access to abortion have become under the state’s health insurance regulators.\u003c/p>\n\u003cp>Knox-Keene spells out the basic health services that insurers must provide to meet medical standards of care. Significantly, the statute contains no religious exception for eliminating abortion access.\u003c/p>\u003c/blockquote>\n\u003cp>Santa Clara University’s new plan doesn’t go into effect until next year. Loyola’s is already in effect, but there’s a provision for employees to pay extra for abortion coverage through a private plan.\u003c/p>\n\u003cp>Meanwhile, nationwide, \u003ca href=\"http://www.becketfund.org/hhsinformationcentral/#BackToTop2\">more than 100\u003c/a> universities and other nonprofit institutions are suing the Obama administration over a birth control conflict that MSNBC \u003ca href=\"http://www.msnbc.com/msnbc/the-next-hobby-lobby\">called\u003c/a> “the next Hobby Lobby.” In short, the federal government created an opt-out form that religious institutions can sign to certify their opposition to contraception; then their insurers directly cover contraceptive costs, taking the employer out of the equation. The employers stay that still results in contraception and thus impinges on their religious liberty, so they’re suing.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>It’s not clear when California officials will announce whether they’ll allow the plans limiting abortion coverage to go on.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cfigure id=\"attachment_20634\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/08/RS11410_photo-hpf.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-20634\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/08/RS11410_photo-hpf.jpg\" alt=\"CAPTION COMING (Rachael Myrow/KQED)\" width=\"640\" height=\"480\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/27/2014/08/RS11410_photo-hpf.jpg 640w, https://cdn.kqed.org/wp-content/uploads/sites/27/2014/08/RS11410_photo-hpf-400x300.jpg 400w, https://cdn.kqed.org/wp-content/uploads/sites/27/2014/08/RS11410_photo-hpf-320x240.jpg 320w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">A “crime book” maintained by the San Diego advocacy group Consumer Advocates for RCFE Reform. (RCFE is short for Residential Care Facility for the Elderly.) This book contains cases of what CARR calls “egregious neglect” at San Diego assisted living facilities. (Rachael Myrow/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>Over the last 25 years, the number of assisted living facilities in California has nearly doubled. The homes are intended to care for relatively independent, healthy seniors, but that doesn’t describe a lot of the people living in them today.\u003c/p>\n\u003cp>“There’s been a seismic shift in the population they serve,” says Deborah Schoch of the California HealthCare Foundation\u003ca href=\"http://centerforhealthreporting.org/project/medical-errors-weaker-rules-signal-safety-problems-ca-assisted-living-homes\" target=\"_blank\" rel=\"noopener\"> Center for Health Reporting\u003c/a>. Schoch says the system was set up to meet the needs of people who could use some extra help with the tasks of daily living –- and it does. But many of those people need a lot of help.\u003c/p>\n\u003cp>The system, she says, is caring for people “who are frail, who may have dementia, who may be wheelchair bound, who may not be able to turn on their own in bed.”\u003c/p>\n\u003cp>\u003c!--more-->Assisted living facilities are not designed to deliver skilled nursing care, and they do not typically have people with those qualifications on staff. There are no staff-to-resident ratios or many of the other rules that govern nursing homes. While many assisted living facilities do a fine job of delivering care, others are overwhelmed –- or worse. Schoch was the lead reporter for \u003cspan style=\"color: #20497d\">a \u003c/span>series called “\u003ca href=\"http://centerforhealthreporting.org/project/medical-errors-weaker-rules-signal-safety-problems-ca-assisted-living-homes\" target=\"_blank\" rel=\"noopener\">Deadly Neglect\u003c/a>” that detailed 27 deaths in San Diego County assisted living facilities from abuse and neglect.\u003c/p>\n\u003cp>“I worked with \u003ca href=\"http://www.utsandiego.com\" target=\"_blank\" rel=\"noopener\">UT San Diego\u003c/a>, and we were able to get access to a lot of inspection reports: deaths, injuries, elder abuse, people left on the floor for 48 hours in assisted living facilities in San Diego County.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>She’s since come out with more stories detailing more troubling incidents, but that first series had a politically explosive effect. In San Diego, Supervisors voted to fund a special unit in the District Attorney’s office to target crime in the facilities.\u003c/p>\n\u003cp style=\"text-align: center\">[\u003cstrong>Related: \u003c/strong>\u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/08/11/crime-in-assisted-living-what-happens-after/\">Crime in Assisted Living: What Happens After\u003c/a>]\u003c/p>\n\u003cp>In Sacramento, where regulations haven’t changed much in close to 30 years, lawmakers held hearings featuring reform advocates like Aaron Byzak, who started a group called “\u003ca href=\"https://www.facebook.com/HazelsArmy\" target=\"_blank\" rel=\"noopener\">Hazel’s Army\u003c/a>” after his grandmother Hazel died in assisted living. “If somebody parked in my grandmother’s disabled parking lot illegally, they’d be fined $450,” he told reporters in the state capitol. “But they kill her, and it’s $150.”\u003c/p>\n\u003cp style=\"color: #20497d\">\u003cspan style=\"color: #333333\">Lawmakers were also keenly aware of recent headlines from Castro Valley, where 14 bed-ridden residents were \u003ca href=\"http://www.sfgate.com/bayarea/article/Castro-Valley-care-home-patients-abandoned-4929583.php\" target=\"_blank\" rel=\"noopener\">discovered abandoned\u003c/a> after the state ordered the facility closed. It turned out the operators had a long list of violations.\u003c/span>\u003c/p>\n\u003cp>You’ll get no argument from the agency charged with oversight of these facilities that it’s time for a revamp. A number of recommendations made in its last annual budget proposal mirror reform bills now pending in the legislature, such as raising the $150 maximum fine to $15,000, and upgrading the online database available to the public. That’s not all. Pat Leary is the Chief Deputy Director of the California Department of Social Services.\u003c/p>\n\u003cp>[soundcloud url=”https://api.soundcloud.com/tracks/162846042″ params=”color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false” width=”100%” height=”166″ iframe=”true” /]\u003c/p>\n\u003cp>“They’re going to create a medical expertise unit, with a nurse,” Leary said. “We’re establishing a corporate accountability unit. There are a number of these facilities that are owned by corporations that are making decisions on a statewide basis. But the way that we track facilities is on a one-facility-at-a-time basis — we’ve been missing trends.”\u003c/p>\n\u003cp>Two women in San Diego were so frustrated with the lack of data and analysis, they created their own non-profit, and their own database for roughly 700 assisted living facilities in San Diego and Imperial Counties, as well as rural Northern California. CARR, the \u003ca href=\"http://www.rcfereform.org\" target=\"_blank\" rel=\"noopener\">Consumer Advocates for RCFE Reform\u003c/a>, (RCFE stands for residential care facility for the elderly) has managed to do what the state hasn’t yet – build a publicly accessible online database with 30,000 documents\u003ci>, \u003c/i>including inspection, complaint, and civil penalty reports. Their documents formed the basis of “Deadly Neglect.”\u003c/p>\n\u003cp>CARR co-founder Christina Selder echoes a sentiment heard commonly among consumer advocates. “We find that they’re more of a facility protection agency than a consumer protection agency.”\u003c/p>\n\u003cp>“There are a number of cases where facilities will have repeat noncompliance meetings for atrocious activities,” Selder said.\u003c/p>\n\u003cp>Without providing its name, she mentions a facility CARR uses as an example.\u003c/p>\n\u003cp>“This particular facility had one resident who was left on the floor in their apartment for more than 24 hours and bled to death,” she said. “Same facility, a dementia resident who was unable to consent to have sexual relations with another resident but that repeatedly went on. There was a culture of fear among the staff, and so they weren’t cooperating during the investigation with Department of Social Services. That was the third one for this facility. Now, this facility remains open today. There’s no caution tape on the door.”\u003c/p>\n\u003cp>Her partner in CARR, Chris Murphy, chimes in. “I mean it’s almost like ‘what do you have to do to get closed?'”\u003c/p>\n\u003cp>They’ve developed some strong opinions after reviewing so many DSS reports. For instance, despite the claims of some that the worst abuses are likely to be more common in big facilities, especially those owned by corporate chains, Selder and Murphy say small homes are just as likely to fail their residents.\u003c/p>\n\u003cp>Both Murphy and Selder have degrees in gerontology. Both say they’re heartened by all the legislation in Sacramento, especially \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140AB1523\" target=\"_blank\" rel=\"noopener\">the bill they sponsored\u003c/a>, AB 1523, requiring all facilities to carry liability insurance. [UPDATE: That bill passed, and Governor Jerry Brown signed it into law.] But Murphy worries about the fine print on all the legislation. “If it’s not clearly stipulated within the bill, then it’s left to the regulators, then the regulators are going to come up with whatever they come up with. So I would hope that they get serious about having stakeholders meetings, using all of the expertise that’s available in this state.”\u003c/p>\n\u003cp>Selder worries lawmakers are tweaking a system that is fundamentally dysfunctional. If a growing number of elderly need medical care, Selder says, maybe they shouldn’t be in assisted living. Or maybe assisted living should deliver tiered levels of care, with tiered levels of regulation. But that’s not the discussion on the table in Sacramento – at least, not this year.\u003c/p>\n\u003cp>“We are behind the curve,” Selder says. “Other states have rating systems. Other states have assisted living regulated under the Department of Public Health. We’re not there. We’re not even talking about it in the right way yet.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>Polly Stryker contributed to this report.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_20634\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/08/RS11410_photo-hpf.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-20634\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/08/RS11410_photo-hpf.jpg\" alt=\"CAPTION COMING (Rachael Myrow/KQED)\" width=\"640\" height=\"480\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/27/2014/08/RS11410_photo-hpf.jpg 640w, https://cdn.kqed.org/wp-content/uploads/sites/27/2014/08/RS11410_photo-hpf-400x300.jpg 400w, https://cdn.kqed.org/wp-content/uploads/sites/27/2014/08/RS11410_photo-hpf-320x240.jpg 320w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">A “crime book” maintained by the San Diego advocacy group Consumer Advocates for RCFE Reform. (RCFE is short for Residential Care Facility for the Elderly.) This book contains cases of what CARR calls “egregious neglect” at San Diego assisted living facilities. (Rachael Myrow/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>Over the last 25 years, the number of assisted living facilities in California has nearly doubled. The homes are intended to care for relatively independent, healthy seniors, but that doesn’t describe a lot of the people living in them today.\u003c/p>\n\u003cp>“There’s been a seismic shift in the population they serve,” says Deborah Schoch of the California HealthCare Foundation\u003ca href=\"http://centerforhealthreporting.org/project/medical-errors-weaker-rules-signal-safety-problems-ca-assisted-living-homes\" target=\"_blank\" rel=\"noopener\"> Center for Health Reporting\u003c/a>. Schoch says the system was set up to meet the needs of people who could use some extra help with the tasks of daily living –- and it does. But many of those people need a lot of help.\u003c/p>\n\u003cp>The system, she says, is caring for people “who are frail, who may have dementia, who may be wheelchair bound, who may not be able to turn on their own in bed.”\u003c/p>\n\u003cp>\u003c!--more-->Assisted living facilities are not designed to deliver skilled nursing care, and they do not typically have people with those qualifications on staff. There are no staff-to-resident ratios or many of the other rules that govern nursing homes. While many assisted living facilities do a fine job of delivering care, others are overwhelmed –- or worse. Schoch was the lead reporter for \u003cspan style=\"color: #20497d\">a \u003c/span>series called “\u003ca href=\"http://centerforhealthreporting.org/project/medical-errors-weaker-rules-signal-safety-problems-ca-assisted-living-homes\" target=\"_blank\" rel=\"noopener\">Deadly Neglect\u003c/a>” that detailed 27 deaths in San Diego County assisted living facilities from abuse and neglect.\u003c/p>\n\u003cp>“I worked with \u003ca href=\"http://www.utsandiego.com\" target=\"_blank\" rel=\"noopener\">UT San Diego\u003c/a>, and we were able to get access to a lot of inspection reports: deaths, injuries, elder abuse, people left on the floor for 48 hours in assisted living facilities in San Diego County.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>She’s since come out with more stories detailing more troubling incidents, but that first series had a politically explosive effect. In San Diego, Supervisors voted to fund a special unit in the District Attorney’s office to target crime in the facilities.\u003c/p>\n\u003cp style=\"text-align: center\">[\u003cstrong>Related: \u003c/strong>\u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/08/11/crime-in-assisted-living-what-happens-after/\">Crime in Assisted Living: What Happens After\u003c/a>]\u003c/p>\n\u003cp>In Sacramento, where regulations haven’t changed much in close to 30 years, lawmakers held hearings featuring reform advocates like Aaron Byzak, who started a group called “\u003ca href=\"https://www.facebook.com/HazelsArmy\" target=\"_blank\" rel=\"noopener\">Hazel’s Army\u003c/a>” after his grandmother Hazel died in assisted living. “If somebody parked in my grandmother’s disabled parking lot illegally, they’d be fined $450,” he told reporters in the state capitol. “But they kill her, and it’s $150.”\u003c/p>\n\u003cp style=\"color: #20497d\">\u003cspan style=\"color: #333333\">Lawmakers were also keenly aware of recent headlines from Castro Valley, where 14 bed-ridden residents were \u003ca href=\"http://www.sfgate.com/bayarea/article/Castro-Valley-care-home-patients-abandoned-4929583.php\" target=\"_blank\" rel=\"noopener\">discovered abandoned\u003c/a> after the state ordered the facility closed. It turned out the operators had a long list of violations.\u003c/span>\u003c/p>\n\u003cp>You’ll get no argument from the agency charged with oversight of these facilities that it’s time for a revamp. A number of recommendations made in its last annual budget proposal mirror reform bills now pending in the legislature, such as raising the $150 maximum fine to $15,000, and upgrading the online database available to the public. That’s not all. Pat Leary is the Chief Deputy Director of the California Department of Social Services.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003cdiv class='utils-parseShortcode-shortcodes-__shortcodes__shortcodeWrapper'>\n \u003ciframe width='”100%”' height='”166″'\n scrolling='no' frameborder='no'\n src='https://w.soundcloud.com/player/?url=”https://api.soundcloud.com/tracks/162846042″&visual=true&”color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false”'\n title='”https://api.soundcloud.com/tracks/162846042″'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>\u003c/p>\n\u003cp>“They’re going to create a medical expertise unit, with a nurse,” Leary said. “We’re establishing a corporate accountability unit. There are a number of these facilities that are owned by corporations that are making decisions on a statewide basis. But the way that we track facilities is on a one-facility-at-a-time basis — we’ve been missing trends.”\u003c/p>\n\u003cp>Two women in San Diego were so frustrated with the lack of data and analysis, they created their own non-profit, and their own database for roughly 700 assisted living facilities in San Diego and Imperial Counties, as well as rural Northern California. CARR, the \u003ca href=\"http://www.rcfereform.org\" target=\"_blank\" rel=\"noopener\">Consumer Advocates for RCFE Reform\u003c/a>, (RCFE stands for residential care facility for the elderly) has managed to do what the state hasn’t yet – build a publicly accessible online database with 30,000 documents\u003ci>, \u003c/i>including inspection, complaint, and civil penalty reports. Their documents formed the basis of “Deadly Neglect.”\u003c/p>\n\u003cp>CARR co-founder Christina Selder echoes a sentiment heard commonly among consumer advocates. “We find that they’re more of a facility protection agency than a consumer protection agency.”\u003c/p>\n\u003cp>“There are a number of cases where facilities will have repeat noncompliance meetings for atrocious activities,” Selder said.\u003c/p>\n\u003cp>Without providing its name, she mentions a facility CARR uses as an example.\u003c/p>\n\u003cp>“This particular facility had one resident who was left on the floor in their apartment for more than 24 hours and bled to death,” she said. “Same facility, a dementia resident who was unable to consent to have sexual relations with another resident but that repeatedly went on. There was a culture of fear among the staff, and so they weren’t cooperating during the investigation with Department of Social Services. That was the third one for this facility. Now, this facility remains open today. There’s no caution tape on the door.”\u003c/p>\n\u003cp>Her partner in CARR, Chris Murphy, chimes in. “I mean it’s almost like ‘what do you have to do to get closed?'”\u003c/p>\n\u003cp>They’ve developed some strong opinions after reviewing so many DSS reports. For instance, despite the claims of some that the worst abuses are likely to be more common in big facilities, especially those owned by corporate chains, Selder and Murphy say small homes are just as likely to fail their residents.\u003c/p>\n\u003cp>Both Murphy and Selder have degrees in gerontology. Both say they’re heartened by all the legislation in Sacramento, especially \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140AB1523\" target=\"_blank\" rel=\"noopener\">the bill they sponsored\u003c/a>, AB 1523, requiring all facilities to carry liability insurance. [UPDATE: That bill passed, and Governor Jerry Brown signed it into law.] But Murphy worries about the fine print on all the legislation. “If it’s not clearly stipulated within the bill, then it’s left to the regulators, then the regulators are going to come up with whatever they come up with. So I would hope that they get serious about having stakeholders meetings, using all of the expertise that’s available in this state.”\u003c/p>\n\u003cp>Selder worries lawmakers are tweaking a system that is fundamentally dysfunctional. If a growing number of elderly need medical care, Selder says, maybe they shouldn’t be in assisted living. Or maybe assisted living should deliver tiered levels of care, with tiered levels of regulation. But that’s not the discussion on the table in Sacramento – at least, not this year.\u003c/p>\n\u003cp>“We are behind the curve,” Selder says. “Other states have rating systems. Other states have assisted living regulated under the Department of Public Health. We’re not there. We’re not even talking about it in the right way yet.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"disqusTitle": "Why Advocacy Groups Oppose Bill Limiting Use of Antibiotics in Animals",
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"content": "\u003cfigure id=\"attachment_20645\" class=\"wp-caption alignnone\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/08/Calpirg-e1407546646106.jpg\">\u003cimg class=\"wp-image-20645 size-large\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/08/Calpirg-640x480.jpg\" alt=\"The California Public Interest Research Group held a press conference opposing the bill last week in Berkeley. \" width=\"640\" height=\"480\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Garo Manjikian and Corie Radka of CALPIRG speak at a press conference opposing SB835 in Berkeley on Wednesday. CALPIRG is among a dozen organizations calling on the California legislature to take stronger action regulating the use of antibiotics in livestock. (Courtesy: CALPIRG)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Joe Rubin\u003c/strong>\u003c/p>\n\u003cp>Amid growing concern of the use of antibiotics in livestock, California's Assembly will consider on Monday a bill to limit their use. But a coalition of a dozen health and consumer advocacy groups -- the very groups that often back such measures -- are pressing lawmakers to vote it down. The groups say the bill is not aggressive enough and want California to take a more forceful role in the way antibiotics are regulated in meat production.\u003c/p>\n\u003cp>The bill, \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140SB835\" target=\"_blank\">SB 835\u003c/a>, sponsored by San Mateo Senator Jerry Hill, is an endorsement of last year's Food and Drug Administration policy shift. The FDA has asked drug companies \u003ca href=\"http://www.fda.gov/downloads/AnimalVeterinary/GuidanceComplianceEnforcement/GuidanceforIndustry/UCM299624.pdf\" target=\"_blank\">to voluntarily stop \u003c/a>distributing anti-microbial drugs used for the purpose of fattening animals. Around 80 percent of all antibiotics in the U.S are used in the livestock industry. Drug companies say they are complying with the new guidelines.\u003c/p>\n\u003cp>But critics say the Hill bill, like the FDA guidelines, leaves a glaring loophole. Many of the antibiotics used for growth promotion are also used for disease prevention, making for more of a label change than a fundamental shift, critics say. Indeed drugs like tylosin, which have been used for decades as a growth-promoting feed additive for pigs and cows, remain readily available and in use.\u003c!--more-->\u003c/p>\n\u003cp>If the bill passes the legislature, Bill Allayaud, with the Environmental Working Group, says the coalition hopes to sway Gov. Jerry Brown not to sign it. “We hope he agrees that the use of antibiotics in animals for prevention, not treatment, of diseases is a loophole that will not lead to the rapid progress that is needed,” Allayaud said.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Allayaud said there was a competing bill that would have closed those loopholes. \u003ca href=\"http://leginfo.ca.gov/pub/09-10/bill/asm/ab_1401-1450/ab_1437_bill_20100706_chaptered.html\" target=\"_blank\">AB 1437\u003c/a>, sponsored by San Francisco Assemblyman Kevin Mullin, was scheduled to go in front of the assembly agricultural committee in May. That bill was largely based on federal legislation, the \u003ca href=\"https://www.govtrack.us/congress/bills/113/s1256/text\" target=\"_blank\">Preventive Antibiotic Resistance Act\u003c/a>, backed by California Sen. Diane Feinstein. Feinstein has long been an advocate for stiffening regulation of antibiotics used in livestock.\u003c/p>\n\u003cp>But, the Mullin bill faced withering criticism from industry lobbyists and skepticism from Ag Committee members. When it was apparent he didn’t have the votes, the freshman lawmaker withdrew the bill from consideration.\u003c/p>\n\u003cp>\"Our feeling was, better to live another day, and pulling the bill left us in a better position to reintroduce this important piece of legislation in a future session,” said Mullin chief of staff Hugh Bower.\u003c/p>\n\u003cp>As in the early days of the debate around climate change, there is debate around how proactive lawmakers should be about worrisome, if somewhat inconclusive, science. Both the Centers for Disease Control and the World Health Organization say that overuse of antibiotics in livestock is contributing to the rise in so-called superbugs. \u003ca href=\"http://www.cdc.gov/drugresistance/threat-report-2013/pdf/ar-threats-2013-508.pdf\" target=\"_blank\">Some 23,000 Americans die every year\u003c/a> from resistant infections, with many more hospitalized.\u003c/p>\n\u003cp>The problem is that there is debate about how big a role the prolific use of antibiotics in animal husbandry plays in driving antibiotic resistance in people.\u003c/p>\n\u003cp>At a June hearing over the Hill bill, Assemblyman Bill Quirk, a former NASA climate change scientist, articulated some of that skepticism, saying of antibiotic use in animals, \"We can’t show that this is the real problem.”\u003c/p>\n\u003cp>The tensest moment in the June hearing came after testimony from the Natural Resources Defense Council opposing the Hill bill. Sen. Hill responded, saying, “I appreciate the opposition’s medical opinions when antibiotics should or should not be used, but I don’t see a (veterinary degree) after their names or an MD. The FDA says that prevention can be considered a judicious use of antibiotics. Prophylactic antibiotics are often given to patients undergoing such procedures as gastrointestinal surgery, cardiac surgery, dental surgery I mean we have that, take that all the time.\"\u003c/p>\n\u003cp>In Washington, DC, I caught up with New York Congresswoman Louise Slaughter between votes on Capitol Hill. Slaughter is a 14-term veteran of Congress and a microbiologist. She began studying antibiotic resistance back in the 1950’s when she wrote her thesis on rising levels of resistance linked to the overuse of penicillin. Today she is the outspoken co-sponsor of Sen. Feinstein’s Preventive Antibiotic Resistance Act.\u003c/p>\n\u003cp>When I told her of Hill's comments, she bristled. “I would hope that a California legislature would have more sense than to recognize that if a doctor gives antibiotics to you for prevention for surgery, that’s different than feeding antibiotics to your child in their cereal everyday,\" Slaughter said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Sen. Feinstein stayed away from the fray in Sacramento. In a statement she said she was in favor of change addressing the issue, “however incremental.” She did reiterate the seriousness of the problem saying the “overuse of antibiotics by farmers and ranchers contributes to antibiotic resistance in humans and is an important public health issue. I believe antibiotics should be used judiciously and only when necessary.”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_20645\" class=\"wp-caption alignnone\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/08/Calpirg-e1407546646106.jpg\">\u003cimg class=\"wp-image-20645 size-large\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/08/Calpirg-640x480.jpg\" alt=\"The California Public Interest Research Group held a press conference opposing the bill last week in Berkeley. \" width=\"640\" height=\"480\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Garo Manjikian and Corie Radka of CALPIRG speak at a press conference opposing SB835 in Berkeley on Wednesday. CALPIRG is among a dozen organizations calling on the California legislature to take stronger action regulating the use of antibiotics in livestock. (Courtesy: CALPIRG)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Joe Rubin\u003c/strong>\u003c/p>\n\u003cp>Amid growing concern of the use of antibiotics in livestock, California's Assembly will consider on Monday a bill to limit their use. But a coalition of a dozen health and consumer advocacy groups -- the very groups that often back such measures -- are pressing lawmakers to vote it down. The groups say the bill is not aggressive enough and want California to take a more forceful role in the way antibiotics are regulated in meat production.\u003c/p>\n\u003cp>The bill, \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140SB835\" target=\"_blank\">SB 835\u003c/a>, sponsored by San Mateo Senator Jerry Hill, is an endorsement of last year's Food and Drug Administration policy shift. The FDA has asked drug companies \u003ca href=\"http://www.fda.gov/downloads/AnimalVeterinary/GuidanceComplianceEnforcement/GuidanceforIndustry/UCM299624.pdf\" target=\"_blank\">to voluntarily stop \u003c/a>distributing anti-microbial drugs used for the purpose of fattening animals. Around 80 percent of all antibiotics in the U.S are used in the livestock industry. Drug companies say they are complying with the new guidelines.\u003c/p>\n\u003cp>But critics say the Hill bill, like the FDA guidelines, leaves a glaring loophole. Many of the antibiotics used for growth promotion are also used for disease prevention, making for more of a label change than a fundamental shift, critics say. Indeed drugs like tylosin, which have been used for decades as a growth-promoting feed additive for pigs and cows, remain readily available and in use.\u003c!--more-->\u003c/p>\n\u003cp>If the bill passes the legislature, Bill Allayaud, with the Environmental Working Group, says the coalition hopes to sway Gov. Jerry Brown not to sign it. “We hope he agrees that the use of antibiotics in animals for prevention, not treatment, of diseases is a loophole that will not lead to the rapid progress that is needed,” Allayaud said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Allayaud said there was a competing bill that would have closed those loopholes. \u003ca href=\"http://leginfo.ca.gov/pub/09-10/bill/asm/ab_1401-1450/ab_1437_bill_20100706_chaptered.html\" target=\"_blank\">AB 1437\u003c/a>, sponsored by San Francisco Assemblyman Kevin Mullin, was scheduled to go in front of the assembly agricultural committee in May. That bill was largely based on federal legislation, the \u003ca href=\"https://www.govtrack.us/congress/bills/113/s1256/text\" target=\"_blank\">Preventive Antibiotic Resistance Act\u003c/a>, backed by California Sen. Diane Feinstein. Feinstein has long been an advocate for stiffening regulation of antibiotics used in livestock.\u003c/p>\n\u003cp>But, the Mullin bill faced withering criticism from industry lobbyists and skepticism from Ag Committee members. When it was apparent he didn’t have the votes, the freshman lawmaker withdrew the bill from consideration.\u003c/p>\n\u003cp>\"Our feeling was, better to live another day, and pulling the bill left us in a better position to reintroduce this important piece of legislation in a future session,” said Mullin chief of staff Hugh Bower.\u003c/p>\n\u003cp>As in the early days of the debate around climate change, there is debate around how proactive lawmakers should be about worrisome, if somewhat inconclusive, science. Both the Centers for Disease Control and the World Health Organization say that overuse of antibiotics in livestock is contributing to the rise in so-called superbugs. \u003ca href=\"http://www.cdc.gov/drugresistance/threat-report-2013/pdf/ar-threats-2013-508.pdf\" target=\"_blank\">Some 23,000 Americans die every year\u003c/a> from resistant infections, with many more hospitalized.\u003c/p>\n\u003cp>The problem is that there is debate about how big a role the prolific use of antibiotics in animal husbandry plays in driving antibiotic resistance in people.\u003c/p>\n\u003cp>At a June hearing over the Hill bill, Assemblyman Bill Quirk, a former NASA climate change scientist, articulated some of that skepticism, saying of antibiotic use in animals, \"We can’t show that this is the real problem.”\u003c/p>\n\u003cp>The tensest moment in the June hearing came after testimony from the Natural Resources Defense Council opposing the Hill bill. Sen. Hill responded, saying, “I appreciate the opposition’s medical opinions when antibiotics should or should not be used, but I don’t see a (veterinary degree) after their names or an MD. The FDA says that prevention can be considered a judicious use of antibiotics. Prophylactic antibiotics are often given to patients undergoing such procedures as gastrointestinal surgery, cardiac surgery, dental surgery I mean we have that, take that all the time.\"\u003c/p>\n\u003cp>In Washington, DC, I caught up with New York Congresswoman Louise Slaughter between votes on Capitol Hill. Slaughter is a 14-term veteran of Congress and a microbiologist. She began studying antibiotic resistance back in the 1950’s when she wrote her thesis on rising levels of resistance linked to the overuse of penicillin. Today she is the outspoken co-sponsor of Sen. Feinstein’s Preventive Antibiotic Resistance Act.\u003c/p>\n\u003cp>When I told her of Hill's comments, she bristled. “I would hope that a California legislature would have more sense than to recognize that if a doctor gives antibiotics to you for prevention for surgery, that’s different than feeding antibiotics to your child in their cereal everyday,\" Slaughter said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Sen. Feinstein stayed away from the fray in Sacramento. In a statement she said she was in favor of change addressing the issue, “however incremental.” She did reiterate the seriousness of the problem saying the “overuse of antibiotics by farmers and ranchers contributes to antibiotic resistance in humans and is an important public health issue. I believe antibiotics should be used judiciously and only when necessary.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cfigure id=\"attachment_20605\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"https://www.flickr.com/photos/goodlifegarden/9027218041/in/photolist-eKGRqn-eKGR8B-5pvJQs-eKGRfM-eK5iAw-eK5qyN-eK5hxN-eK5auG-eK5h2C-eK5tvY-eK5nuw-eK5i9o-4MJjfo-2G7HEk-9mPRbe-d3nCey-d3nARw-d3nAXh-d3nBch-d3nCb5-d3nCQ3-fDnsXY-eK91J3-eJWB1g-eJWAxk-eK92hb-eJWzeZ-eK91j7-eK92JW-eJWBj4-eJWA6F-eK916h-eJWApa-eK91vb-eJWyNv-eK8ZCo-eK92zq-eK8Zk3-eK8Zp1-eK91DG-eJWzj2-eJWz6Z-eJWAR8-eK91NL-eK91by-eJWAUT-eK8ZWC-eJWzLt-eJWBaB-eJWzo6\">\u003cimg class=\"size-full wp-image-20605\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/08/9027218041_04d775bac3_z.jpg\" alt=\"(UC Davis Gateways Project/Flickr)\" width=\"640\" height=\"425\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2014/08/9027218041_04d775bac3_z.jpg 640w, https://ww2.kqed.org/app/uploads/sites/27/2014/08/9027218041_04d775bac3_z-400x266.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2014/08/9027218041_04d775bac3_z-320x213.jpg 320w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(UC Davis Gateways Project/Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Pauline Bartolone,\u003c/strong> \u003ca href=\"http://capsules.kaiserhealthnews.org/index.php/2014/08/fast-track-for-primary-care-docs-at-one-calif-university/\" target=\"_blank\">Kaiser Health News\u003c/a>\u003c/p>\n\u003cp>Some doctors in California will soon be able to practice after three years of medical school instead of the traditional four. The American Medical Association is providing seed money for the effort in the form of a $1 million, five-year grant to UC Davis.\u003c/p>\n\u003cp>Student Ngabo Nzigira is in his sixth week of medical school and he’s already interacting with patients, as he trains under the guidance of a doctor at Kaiser Permanente in Sacramento.\u003c/p>\n\u003cp>In a traditional medical school, Nzigira wouldn’t be in a clinic until his third year. In this accelerated course, students can shave up to $60,000 off their education debt. Still, Nzigira initially had hesitations.\u003c!--more-->\u003c/p>\n\u003cp>“I thought ‘Oh man, you want me to put the intensity and stress that is medical school in four years, you want me to condense it down to three years? I’m not sure about that,’” Nzigira says. But, after learning more, he became convinced it was a good path for him.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The curriculum cuts out summer vacations, electives and the residency search. It’s designed to get primary care physicians into the field faster, says Dr. Tonya Fancher, director of the program, called Accelerated Competency-based Education in Primary Care, or ACE-PC .\u003c/p>\n\u003cp>“There’s a huge problem, a huge shortage of primary care physicians,” Fancher says.\u003c/p>\n\u003cp>UC Davis says more people gaining health insurance coverage under the Affordable Care Act is expected to compound the need for primary care, and one of the goals of the new curriculum is to make family medicine a more appealing and lasting choice for young doctors.\u003c/p>\n\u003cp>“Students come into medical school, they’re passionate about patients, passionate about primary care, and then that wanes over time,” Fancher says. “Part of it is probably the debt that they accrue in school, and part of it are the models of primary care that they’re traditionally exposed to.”\u003c/p>\n\u003cp>Texas, Georgia and New York also have three-year medical schools. And both the AMA and the Association of American Medical Colleges support these initiatives as part of the redesign of medical education. The physician groups want students to advance based on their competency, not a set time frame.\u003c/p>\n\u003cp>UC Davis’s ACE-PC medical students are guaranteed a residency, another training step before facing patient expectations on their own.\u003c/p>\n\u003cp>Outside the Sacramento health center where Nzigira and other students are getting their first experiences in clinical practice, people were not troubled by the idea of a faster track through medical school. Angela Woodard says even doctors with four years of training may have trouble treating patients.\u003c/p>\n\u003cp>“So them going to school a shorter time is not going to make it any worse,” Woodard said.\u003c/p>\n\u003cp>Patient Joe King isn’t too concerned either, “as long as they maintain the same critieria of standards that primary care doctors have to meet,” he said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Kaiser Health News (KHN) is a nonprofit news organization covering health care policy and politics. It is an editorially independent program of the \u003c/em>\u003ca href=\"http://www.kff.org/\">\u003cstrong>\u003cem>Kaiser Family Foundation\u003c/em>\u003c/strong>\u003c/a>\u003cem>. \u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The curriculum cuts out summer vacations, electives and the residency search. It’s designed to get primary care physicians into the field faster, says Dr. Tonya Fancher, director of the program, called Accelerated Competency-based Education in Primary Care, or ACE-PC .\u003c/p>\n\u003cp>“There’s a huge problem, a huge shortage of primary care physicians,” Fancher says.\u003c/p>\n\u003cp>UC Davis says more people gaining health insurance coverage under the Affordable Care Act is expected to compound the need for primary care, and one of the goals of the new curriculum is to make family medicine a more appealing and lasting choice for young doctors.\u003c/p>\n\u003cp>“Students come into medical school, they’re passionate about patients, passionate about primary care, and then that wanes over time,” Fancher says. “Part of it is probably the debt that they accrue in school, and part of it are the models of primary care that they’re traditionally exposed to.”\u003c/p>\n\u003cp>Texas, Georgia and New York also have three-year medical schools. And both the AMA and the Association of American Medical Colleges support these initiatives as part of the redesign of medical education. The physician groups want students to advance based on their competency, not a set time frame.\u003c/p>\n\u003cp>UC Davis’s ACE-PC medical students are guaranteed a residency, another training step before facing patient expectations on their own.\u003c/p>\n\u003cp>Outside the Sacramento health center where Nzigira and other students are getting their first experiences in clinical practice, people were not troubled by the idea of a faster track through medical school. Angela Woodard says even doctors with four years of training may have trouble treating patients.\u003c/p>\n\u003cp>“So them going to school a shorter time is not going to make it any worse,” Woodard said.\u003c/p>\n\u003cp>Patient Joe King isn’t too concerned either, “as long as they maintain the same critieria of standards that primary care doctors have to meet,” he said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Kaiser Health News (KHN) is a nonprofit news organization covering health care policy and politics. It is an editorially independent program of the \u003c/em>\u003ca href=\"http://www.kff.org/\">\u003cstrong>\u003cem>Kaiser Family Foundation\u003c/em>\u003c/strong>\u003c/a>\u003cem>. \u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Here's a truism: Health care costs are wildly variable and utterly confusing. That's why KQED joined forces with \u003ca href=\"http://www.scpr.org/\" target=\"_blank\">KPCC\u003c/a> and \u003ca href=\"http://clearhealthcosts.com\" target=\"_blank\">ClearHealthCosts.com\u003c/a> to \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/06/23/kqed-launches-project-to-help-make-health-costs-transparent/\" target=\"_blank\">launch PriceCheck\u003c/a>. For the last six weeks we've asked you to submit your costs for common procedures. To compare apples-to-apples, we asked how much your provider charged, how much your insurer paid and how much you paid for common procedures. And you've responded! \u003c/p>\n\u003cp>You've showed us that \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/08/01/pricecheck-how-much-for-a-back-mri-in-the-bay-area-255-or-3700/\" target=\"_blank\">back MRIs can cost\u003c/a> anywhere between $255 and $3,700 in the Bay Area. And that \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/06/23/kqed-launches-project-to-help-make-health-costs-transparent/\" target=\"_blank\">screening mammograms range\u003c/a> from $125 to $801.\u003c/p>\n\u003cp>We've also surveyed hundreds of providers for cash prices — also known as self-pay — throughout California. Now you can sort through our data below as well as \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/06/23/share-your-bill-make-health-costs-transparent-in-california/\" target=\"_blank\">search on our site\u003c/a>. Please help us build our database by \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/06/23/share-your-bill-make-health-costs-transparent-in-california/\" target=\"_blank\">submitting your health care costs\u003c/a>.\u003c/p>\n\u003cp>\u003ciframe src=\"//kqednews.cartodb.com/viz/160ba4aa-1c29-11e4-bb6c-0e10bcd91c2b/embed_map?title=false&description=false&search=false&shareable=true&cartodb_logo=true&layer_selector=false&legends=true&scrollwheel=true&fullscreen=true&sublayer_options=1&sql=&sw_lat=32.75956202565003&sw_lon=-125.22216796875&ne_lat=39.8000959563483&ne_lon=-114.45556640625\" width=\"100%\" height=\"520\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\">\u003c/iframe>\u003c/p>\n\u003cp>\u003c!--more-->\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>To see more providers in your area, zoom in on the map using the arrows or your mouse wheel. Hover over each dot to see the provider name and procedure. Click to find out how much was charged. This map will update once a day with new information.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Here's a truism: Health care costs are wildly variable and utterly confusing. That's why KQED joined forces with \u003ca href=\"http://www.scpr.org/\" target=\"_blank\">KPCC\u003c/a> and \u003ca href=\"http://clearhealthcosts.com\" target=\"_blank\">ClearHealthCosts.com\u003c/a> to \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/06/23/kqed-launches-project-to-help-make-health-costs-transparent/\" target=\"_blank\">launch PriceCheck\u003c/a>. For the last six weeks we've asked you to submit your costs for common procedures. To compare apples-to-apples, we asked how much your provider charged, how much your insurer paid and how much you paid for common procedures. And you've responded! \u003c/p>\n\u003cp>You've showed us that \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/08/01/pricecheck-how-much-for-a-back-mri-in-the-bay-area-255-or-3700/\" target=\"_blank\">back MRIs can cost\u003c/a> anywhere between $255 and $3,700 in the Bay Area. And that \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/06/23/kqed-launches-project-to-help-make-health-costs-transparent/\" target=\"_blank\">screening mammograms range\u003c/a> from $125 to $801.\u003c/p>\n\u003cp>We've also surveyed hundreds of providers for cash prices — also known as self-pay — throughout California. Now you can sort through our data below as well as \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/06/23/share-your-bill-make-health-costs-transparent-in-california/\" target=\"_blank\">search on our site\u003c/a>. Please help us build our database by \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/06/23/share-your-bill-make-health-costs-transparent-in-california/\" target=\"_blank\">submitting your health care costs\u003c/a>.\u003c/p>\n\u003cp>\u003ciframe src=\"//kqednews.cartodb.com/viz/160ba4aa-1c29-11e4-bb6c-0e10bcd91c2b/embed_map?title=false&description=false&search=false&shareable=true&cartodb_logo=true&layer_selector=false&legends=true&scrollwheel=true&fullscreen=true&sublayer_options=1&sql=&sw_lat=32.75956202565003&sw_lon=-125.22216796875&ne_lat=39.8000959563483&ne_lon=-114.45556640625\" width=\"100%\" height=\"520\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\">\u003c/iframe>\u003c/p>\n\u003cp>\u003c!--more-->\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cfigure id=\"attachment_13282\" class=\"wp-caption aligncenter\" style=\"max-width: 620px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/06/166731138-e1371575513819.jpg\">\u003cimg class=\"size-large wp-image-13282\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/06/166731138-620x465.jpg\" alt=\"(Getty Images)\" width=\"620\" height=\"465\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By David Gorn,\u003c/strong> \u003ca href=\"http://www.californiahealthline.org/capitol-desk/2014/8/state-autism-therapy-a-medical-benefit\" target=\"_blank\">California Healthline\u003c/a>\u003c/p>\n\u003cp>State officials Tuesday said autism therapy clearly is a covered Medicaid benefit, and they hope to submit a state plan amendment by Sept. 30 to start the process to make it a benefit for those under age 21, enrolled in the state's Medi-Cal program. Medi-Cal is California's version of Medicaid.\u003c/p>\n\u003cp>According to René Mollow, deputy director of benefits and eligibility at the Department of Health Care Services, Medi-Cal children are entitled to applied behavior analysis -- known as ABA therapy.\u003c/p>\n\u003cp>\"Right now we're working on the development of a state plan amendment. We want to engage the stakeholders in developing that,\" Mollow said. \"We're looking to have it submitted at the end of September, and having it retroactive to July 1.\"\u003c!--more-->\u003c/p>\n\u003cp>Medi-Cal children now receiving ABA therapy likely will have that care retroactively paid for by Medi-Cal.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Mollow said the state also is in touch with CMS on technical clarifications of the \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/07/08/feds-say-autism-aba-therapy-now-covered-as-childrens-medicaid-benefit/\" target=\"_blank\">federal guidance states recently received \u003c/a>from CMS officials -- guidance that led to implementation of autism therapy under Medi-Cal, she said.\u003c/p>\n\u003cp>\"We plan to have a formal meeting with stakeholders on Aug. 29 regarding this policy we're looking to implement,\" Mollow said.\u003c/p>\n\u003cp>The new policy should start by the beginning of next year, Mollow said. Till then, there is a lot to do to develop the provider network and reimbursement rates, she said.\u003c/p>\n\u003cp>\"And the question is what to do in the interim, when people are looking to get services now,\" Mollow said.\u003c/p>\n\u003cp>Autism advocates were understandably delighted.\u003c/p>\n\u003cp>\"We're thrilled that the state is moving in this direction, and very encouraged by the steps they're taking,\" said Kristin Jacobson, president of Autism Deserves Equal Coverage, an advocacy group based in Burlingame. \"We want to work with them to implement this as expeditiously as possible.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"It's important for families to know this is happening,\" said Karen Fessel, executive director of the Autism Health Insurance Project. \"I'm cautiously optimistic. I do believe this is going to happen, and it's a question of when.\"\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_13282\" class=\"wp-caption aligncenter\" style=\"max-width: 620px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/06/166731138-e1371575513819.jpg\">\u003cimg class=\"size-large wp-image-13282\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/06/166731138-620x465.jpg\" alt=\"(Getty Images)\" width=\"620\" height=\"465\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By David Gorn,\u003c/strong> \u003ca href=\"http://www.californiahealthline.org/capitol-desk/2014/8/state-autism-therapy-a-medical-benefit\" target=\"_blank\">California Healthline\u003c/a>\u003c/p>\n\u003cp>State officials Tuesday said autism therapy clearly is a covered Medicaid benefit, and they hope to submit a state plan amendment by Sept. 30 to start the process to make it a benefit for those under age 21, enrolled in the state's Medi-Cal program. Medi-Cal is California's version of Medicaid.\u003c/p>\n\u003cp>According to René Mollow, deputy director of benefits and eligibility at the Department of Health Care Services, Medi-Cal children are entitled to applied behavior analysis -- known as ABA therapy.\u003c/p>\n\u003cp>\"Right now we're working on the development of a state plan amendment. We want to engage the stakeholders in developing that,\" Mollow said. \"We're looking to have it submitted at the end of September, and having it retroactive to July 1.\"\u003c!--more-->\u003c/p>\n\u003cp>Medi-Cal children now receiving ABA therapy likely will have that care retroactively paid for by Medi-Cal.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Mollow said the state also is in touch with CMS on technical clarifications of the \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/07/08/feds-say-autism-aba-therapy-now-covered-as-childrens-medicaid-benefit/\" target=\"_blank\">federal guidance states recently received \u003c/a>from CMS officials -- guidance that led to implementation of autism therapy under Medi-Cal, she said.\u003c/p>\n\u003cp>\"We plan to have a formal meeting with stakeholders on Aug. 29 regarding this policy we're looking to implement,\" Mollow said.\u003c/p>\n\u003cp>The new policy should start by the beginning of next year, Mollow said. Till then, there is a lot to do to develop the provider network and reimbursement rates, she said.\u003c/p>\n\u003cp>\"And the question is what to do in the interim, when people are looking to get services now,\" Mollow said.\u003c/p>\n\u003cp>Autism advocates were understandably delighted.\u003c/p>\n\u003cp>\"We're thrilled that the state is moving in this direction, and very encouraged by the steps they're taking,\" said Kristin Jacobson, president of Autism Deserves Equal Coverage, an advocacy group based in Burlingame. \"We want to work with them to implement this as expeditiously as possible.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"It's important for families to know this is happening,\" said Karen Fessel, executive director of the Autism Health Insurance Project. \"I'm cautiously optimistic. I do believe this is going to happen, and it's a question of when.\"\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cfigure id=\"attachment_20534\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/08/1Lorchid.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-large wp-image-20534\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/08/1Lorchid-640x480.jpg\" alt=\"Lorchid Macri, 70, says she couldn't find any information online when she had to find an assisted living facility for her mother in California. (April Dembosky/KQED)\" width=\"640\" height=\"480\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Lorchid Macri, 70, says she couldn’t find any information online when she had to find an assisted living facility for her mother in California. (April Dembosky/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>Lorchid Macri wasn’t sleeping. Her elderly mother was wandering out of the house in the middle of the night, forgetting to turn the stove off. Macri had to keep watch over her 24/7.\u003c/p>\n\u003cp>“Dementia is a cruel disease,” Macri says.\u003c/p>\n\u003cp>She says the stress of caring for her mother was overwhelming. It wasn’t until she landed in the hospital herself — losing the sight in her right eye for 10 days — that she was ready to confront the fact that it was time to place her mother in assisted living.\u003c/p>\n\u003cp>“It’s gut wrenching to put someone that you love and who has cared for you in a facility with strangers,” she says.\u003c!--more-->\u003c/p>\n\u003cp>Macri lives in central Oregon. But she wanted to find a home for her mother in Southern California where all of her friends and extended family live. Her search started where all consumer searches start these days: on the internet. She wanted to make sure the places she considered had no complaints lodged against them, no violations for neglect or abuse.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“There’s nothing,” she says. “You cannot find anything.”\u003c/p>\n\u003cp>Macri would have had to travel to a regional state office in Southern California and request paper copies of these reports. But from her home in Oregon, California’s website proved useless. \u003c/p>\n\u003cp>“I was dumbfounded at the fact that there were no methods to see if there were any reasons that I would not want to put my mom in any of these facilities,” she says.\u003c/p>\n\u003cp>She says the lack of meaningful information made an already difficult decision even more painful.\u003c/p>\n\u003cp>“You’re placing this individual that you love in a situation where you can only hope and pray that they’re going to be safe, secure, and well cared for.”\u003c/p>\n\u003cp>\u003ciframe loading=\"lazy\" width=\"100%\" height=\"166\" scrolling=\"no\" frameborder=\"no\" src=\"https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/161847361&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\">\u003c/iframe>\u003c/p>\n\u003cp>About a dozen states in the U.S. — including North Carolina, Florida and Ohio — make details about facility violations readily available online. California lawmakers say it’s an embarrassment that a state with the technical genius of Silicon Valley is so far behind.\u003c/p>\n\u003cp>At a press conference in January, Assemblymember Susan Eggman (D-Stockton) introduced a bill, \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140AB1571\" target=\"_blank\" rel=\"noopener\">AB 1571\u003c/a>, that would require the state to build an online rating system where consumers can compare facilities on quality.\u003c/p>\n\u003cp>“We should not depend on Yelp when a loved one needs help,” she said.\u003c/p>\n\u003cp>The bill is one of \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/08/01/down-to-the-wire-lawmakers-have-4-weeks-to-act-on-assisted-living-reforms/\" target=\"_blank\" rel=\"noopener\">several proposed assisted living reforms\u003c/a> currently pending at the State Capital. Lawmakers will vote on it this month, but it’s unclear if they –- or the governor –- will sign off on the million-dollar price tag.\u003c/p>\n\u003cp>“I don’t see how we afford not to do this,” Eggman says, though she conceded that the political will to back technology projects is lacking. “There’s always more needs than there is money. And the state’s encountered budget problems for awhile now. So upgrading technology is not at the top of anyone’s list.”\u003c/p>\n\u003cp>\u003cstrong>Prior Attempt ‘Mind-blowingly Bad”\u003c/strong>\u003c/p>\n\u003cp>This isn’t the first time the state has tried to build a consumer website for assisted living facilities. Several years ago, the Department of Social Services (DSS) received a grant to help collect information from facilities that could be posted online.\u003c/p>\n\u003cp>“The result was mind-blowingly bad,” says Tony Chicotel, an attorney with California Advocates for Nursing Home Reform, an advocacy group that monitors the assisted living industry and \u003ca href=\"http://www.canhr.org/legislation/rcfe_reform_act.html\" target=\"_blank\" rel=\"noopener\">is backing more than a dozen reform bills\u003c/a>.\u003c/p>\n\u003cp>The site only listed names and addresses of facilities. There were no details on services, cost, or past problems.\u003c/p>\n\u003cp>“For consumers, it was completely useless,” Chicotel says.\u003c/p>\n\u003cp>Part of the problem was resistance from the assisted living industry. Most facilities refused to provide information for a website, partly because the technology deployed by the Department of Social Services to collect the information was so bad. But facilities also objected to publishing anything about their rates, says Benson Nadell, program director for the San Francisco \u003ca href=\"http://www.sanfranciscoltcombudsman.org\" target=\"_blank\" rel=\"noopener\">Long-Term Care Ombudsman Program\u003c/a>.\u003c/p>\n\u003cp>“They want interested parties to call up and have an appointment with their marketing person,” \u003cspan class=\"Apple-style-span\" style=\"color: #000000\">\u003cspan class=\"Apple-style-span\"> he says, adding that some sweet-talking salesmen want to prey on peoples’ guilt around placing their parents in a facility. “It’s like buying a car, particularly the nice looking places. They are quite enticing. And suddenly, money is no object.”\u003c/span>\u003c/span>\u003c/p>\n\u003cp>\u003cstrong>Will Lawmakers Greenlight the Funding?\u003c/strong>\u003c/p>\n\u003cp>After more than eight years, the California’s Department of Social Services finally added a new feature to its website in June. It now lists the number of complaints and citations lodged against a facility, but doesn’t say for what.\u003c/p>\n\u003cp>“It lacks specificity,” Nadell says.\u003c/p>\n\u003cp>Nadell says a database is only as good as the information entered into it. And here California has another problem. Current law only requires inspections of assisted living facilities every five years — more frequently only if there’s a complaint. But there’s a constant backlog of complaints that haven’t been investigated. So a lot of helpful information isn’t even being gathered.\u003c/p>\n\u003cp>“Right now it’s pretty hopeless,” Nadell says.\u003c/p>\n\u003cp>The Department of Social Services says it’s trying. Chief deputy director Pat Leary says the agency wants to post more information online, but it’s hamstrung by outdated technology. The department uses Lotus Notes, a database program developed before the internet took off.\u003c/p>\n\u003cp>“We have an antiquated computer system that requires human beings to go in and collect data and create reports by hand,” Leary says.\u003c/p>\n\u003cp>A complete overhaul of the entire system is what’s really needed, advocates say, but the cost of that far exceeds what lawmakers are willing to spend.\u003c/p>\n\u003cp>So consumers like Lorchid Macri are basically on their own. She found a facility in San Bernardino that she thought would be okay for her mother. But it wasn’t.\u003c/p>\n\u003cp>“She lost 17 pounds in 6 months,” she says. “She was not showered daily as she was supposed to be. We often found her in room still in her nightgown at 2 or 3 in the afternoon.”\u003c/p>\n\u003cp>After two facilities in two years, Macri was fed up. She moved her mom back up to a place in Oregon.\u003c/p>\n\u003cp>“I did not want to see another facility in California, because I couldn’t research it,” she says.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>Macri says she knows her mother is doing well now, because she’s stopped asking if she can come home.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_20534\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/08/1Lorchid.jpg\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-large wp-image-20534\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/08/1Lorchid-640x480.jpg\" alt=\"Lorchid Macri, 70, says she couldn't find any information online when she had to find an assisted living facility for her mother in California. (April Dembosky/KQED)\" width=\"640\" height=\"480\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Lorchid Macri, 70, says she couldn’t find any information online when she had to find an assisted living facility for her mother in California. (April Dembosky/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>Lorchid Macri wasn’t sleeping. Her elderly mother was wandering out of the house in the middle of the night, forgetting to turn the stove off. Macri had to keep watch over her 24/7.\u003c/p>\n\u003cp>“Dementia is a cruel disease,” Macri says.\u003c/p>\n\u003cp>She says the stress of caring for her mother was overwhelming. It wasn’t until she landed in the hospital herself — losing the sight in her right eye for 10 days — that she was ready to confront the fact that it was time to place her mother in assisted living.\u003c/p>\n\u003cp>“It’s gut wrenching to put someone that you love and who has cared for you in a facility with strangers,” she says.\u003c!--more-->\u003c/p>\n\u003cp>Macri lives in central Oregon. But she wanted to find a home for her mother in Southern California where all of her friends and extended family live. Her search started where all consumer searches start these days: on the internet. She wanted to make sure the places she considered had no complaints lodged against them, no violations for neglect or abuse.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“There’s nothing,” she says. “You cannot find anything.”\u003c/p>\n\u003cp>Macri would have had to travel to a regional state office in Southern California and request paper copies of these reports. But from her home in Oregon, California’s website proved useless. \u003c/p>\n\u003cp>“I was dumbfounded at the fact that there were no methods to see if there were any reasons that I would not want to put my mom in any of these facilities,” she says.\u003c/p>\n\u003cp>She says the lack of meaningful information made an already difficult decision even more painful.\u003c/p>\n\u003cp>“You’re placing this individual that you love in a situation where you can only hope and pray that they’re going to be safe, secure, and well cared for.”\u003c/p>\n\u003cp>\u003ciframe loading=\"lazy\" width=\"100%\" height=\"166\" scrolling=\"no\" frameborder=\"no\" src=\"https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/161847361&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\">\u003c/iframe>\u003c/p>\n\u003cp>About a dozen states in the U.S. — including North Carolina, Florida and Ohio — make details about facility violations readily available online. California lawmakers say it’s an embarrassment that a state with the technical genius of Silicon Valley is so far behind.\u003c/p>\n\u003cp>At a press conference in January, Assemblymember Susan Eggman (D-Stockton) introduced a bill, \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140AB1571\" target=\"_blank\" rel=\"noopener\">AB 1571\u003c/a>, that would require the state to build an online rating system where consumers can compare facilities on quality.\u003c/p>\n\u003cp>“We should not depend on Yelp when a loved one needs help,” she said.\u003c/p>\n\u003cp>The bill is one of \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/08/01/down-to-the-wire-lawmakers-have-4-weeks-to-act-on-assisted-living-reforms/\" target=\"_blank\" rel=\"noopener\">several proposed assisted living reforms\u003c/a> currently pending at the State Capital. Lawmakers will vote on it this month, but it’s unclear if they –- or the governor –- will sign off on the million-dollar price tag.\u003c/p>\n\u003cp>“I don’t see how we afford not to do this,” Eggman says, though she conceded that the political will to back technology projects is lacking. “There’s always more needs than there is money. And the state’s encountered budget problems for awhile now. So upgrading technology is not at the top of anyone’s list.”\u003c/p>\n\u003cp>\u003cstrong>Prior Attempt ‘Mind-blowingly Bad”\u003c/strong>\u003c/p>\n\u003cp>This isn’t the first time the state has tried to build a consumer website for assisted living facilities. Several years ago, the Department of Social Services (DSS) received a grant to help collect information from facilities that could be posted online.\u003c/p>\n\u003cp>“The result was mind-blowingly bad,” says Tony Chicotel, an attorney with California Advocates for Nursing Home Reform, an advocacy group that monitors the assisted living industry and \u003ca href=\"http://www.canhr.org/legislation/rcfe_reform_act.html\" target=\"_blank\" rel=\"noopener\">is backing more than a dozen reform bills\u003c/a>.\u003c/p>\n\u003cp>The site only listed names and addresses of facilities. There were no details on services, cost, or past problems.\u003c/p>\n\u003cp>“For consumers, it was completely useless,” Chicotel says.\u003c/p>\n\u003cp>Part of the problem was resistance from the assisted living industry. Most facilities refused to provide information for a website, partly because the technology deployed by the Department of Social Services to collect the information was so bad. But facilities also objected to publishing anything about their rates, says Benson Nadell, program director for the San Francisco \u003ca href=\"http://www.sanfranciscoltcombudsman.org\" target=\"_blank\" rel=\"noopener\">Long-Term Care Ombudsman Program\u003c/a>.\u003c/p>\n\u003cp>“They want interested parties to call up and have an appointment with their marketing person,” \u003cspan class=\"Apple-style-span\" style=\"color: #000000\">\u003cspan class=\"Apple-style-span\"> he says, adding that some sweet-talking salesmen want to prey on peoples’ guilt around placing their parents in a facility. “It’s like buying a car, particularly the nice looking places. They are quite enticing. And suddenly, money is no object.”\u003c/span>\u003c/span>\u003c/p>\n\u003cp>\u003cstrong>Will Lawmakers Greenlight the Funding?\u003c/strong>\u003c/p>\n\u003cp>After more than eight years, the California’s Department of Social Services finally added a new feature to its website in June. It now lists the number of complaints and citations lodged against a facility, but doesn’t say for what.\u003c/p>\n\u003cp>“It lacks specificity,” Nadell says.\u003c/p>\n\u003cp>Nadell says a database is only as good as the information entered into it. And here California has another problem. Current law only requires inspections of assisted living facilities every five years — more frequently only if there’s a complaint. But there’s a constant backlog of complaints that haven’t been investigated. So a lot of helpful information isn’t even being gathered.\u003c/p>\n\u003cp>“Right now it’s pretty hopeless,” Nadell says.\u003c/p>\n\u003cp>The Department of Social Services says it’s trying. Chief deputy director Pat Leary says the agency wants to post more information online, but it’s hamstrung by outdated technology. The department uses Lotus Notes, a database program developed before the internet took off.\u003c/p>\n\u003cp>“We have an antiquated computer system that requires human beings to go in and collect data and create reports by hand,” Leary says.\u003c/p>\n\u003cp>A complete overhaul of the entire system is what’s really needed, advocates say, but the cost of that far exceeds what lawmakers are willing to spend.\u003c/p>\n\u003cp>So consumers like Lorchid Macri are basically on their own. She found a facility in San Bernardino that she thought would be okay for her mother. But it wasn’t.\u003c/p>\n\u003cp>“She lost 17 pounds in 6 months,” she says. “She was not showered daily as she was supposed to be. We often found her in room still in her nightgown at 2 or 3 in the afternoon.”\u003c/p>\n\u003cp>After two facilities in two years, Macri was fed up. She moved her mom back up to a place in Oregon.\u003c/p>\n\u003cp>“I did not want to see another facility in California, because I couldn’t research it,” she says.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"disqusTitle": "A Walk Through Assisted Living Facilities in California",
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"content": "\u003cfigure id=\"attachment_20515\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/08/RS11381_photo-hpf.jpg\">\u003cimg class=\"size-full wp-image-20515\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/08/RS11381_photo-hpf.jpg\" alt=\"TV lounge at Westchester Villa, an assisted living facility in Inglewood, near Los Angeles. (Rachael Myrow/KQED)\" width=\"640\" height=\"480\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2014/08/RS11381_photo-hpf.jpg 640w, https://ww2.kqed.org/app/uploads/sites/27/2014/08/RS11381_photo-hpf-400x300.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2014/08/RS11381_photo-hpf-320x240.jpg 320w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">TV lounge at Westchester Villa, an assisted living facility in Inglewood, in Los Angeles County. (Rachael Myrow/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>This week, lawmakers in Sacramento \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/08/01/down-to-the-wire-lawmakers-have-4-weeks-to-act-on-assisted-living-reforms/\" target=\"_blank\">get busy\u003c/a> on 15 bills that together constitute the most comprehensive overhaul of assisted living facility regulation in three decades. But for many Californians, it's not even clear what an assisted living facility is. People often ask if assisted living is the same thing as a nursing home. It's not.\u003c/p>\n\u003cp>In nursing homes, people get round-the-clock medical care from licensed nurses. Assisted living comes in because not everyone who needs help also needs that level of care. Sometimes that assistance doesn't even involve a facility. Sometimes people can receive assistance and remain living in their own homes.\u003c/p>\n\u003cp>Say you've noticed your mother is walking with a new shuffle and dropping things, or that dad is mixing up his medications -- and getting argumentative when you bring it up. Something is going on that must be addressed, even though your parent is still physically healthy and wants to be independent.\u003c!--more-->\u003c/p>\n\u003cp>Heather Angel-Collin is deeply familiar with this scenario. A 25-year veteran social worker, she runs a couple senior-focused programs for \u003ca href=\"http://www.jfsla.org/page.aspx?pid=213\">Jewish Family Service for Los Angeles\u003c/a>, a non-profit social service agency that serves 100,000 people a year, regardless of religion or ability to pay.\u003c/p>\n\u003cp>\"It’s a slow progression of, you know, becoming more frail, or becoming more forgetful.\" she says. \"And those things can be very subtle, especially if you’re not seeing that person on a day-to-day basis.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Angel-Collin says it helps to think of tiers of care. Few people want to move out of their homes. They may not have to -- ever -- if domestic or medical support can be arranged.\u003c/p>\n\u003cp>\"Maybe they need to have medications given every day,\" she says. \"Maybe they need some assistance with taking a shower or bath or getting dressed.\" In California, \u003ca href=\"http://www.cdss.ca.gov/agedblinddisabled/pg1296.htm\" target=\"_blank\">In-Home Supportive Services\u003c/a> provides in-home support for several hours a week, and there are people older than 100 drawing on the services to continue living at home, mostly independently and significantly less expensively than a nursing home would be.\u003c/p>\n\u003cp>Still, there may come a time when your parent's care needs are no longer feasible with continuing to live at home. California has more than 7,500 licensed facilities you can choose from, but where do you start?\u003c/p>\n\u003cp>\u003cstrong>Finding the Right Assisted Living Facility\u003c/strong>\u003c/p>\n\u003cp>There's no one right answer as to the kind of assisted facility you choose. What's available in your area? What can you afford? Does size matter? Many people prefer something small and homey, but larger facilities may offer more services and activities. Your parent may feel more comfortable in a facility that makes a special effort to make people of a certain cultural or career background feel at home. For example, Angel-Collins notes there's a waiting list of Armenian-Americans keen to live at \u003ca href=\"http://ararathome.org/\">Ararat Home of Los Angeles\u003c/a>.\u003c/p>\n\u003cp>Remember that assisted living facilities -- unlike nursing homes -- do not provide skilled medical care. What they can offer includes services like meals and housekeeping, as well as supervised pill distribution, extra attention for patients with dementia, and transportation to the doctor’s office. In California, most families pay for assisted living out-of-pocket.\u003c/p>\n\u003cp>While most assisted living facilities are small, serving six people or less, most Californians who choose assisted living, especially in urban areas, live in large facilities, like \u003ca href=\"http://www.westchestervilla.com/public/\" target=\"_blank\">Westchester Villa\u003c/a>, a 174-bed residential care facility for the elderly in Inglewood, south of Los Angeles.\u003c/p>\n\u003cp style=\"text-align: center\">[\u003cstrong>Related:\u003c/strong> \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/08/01/down-to-the-wire-lawmakers-have-4-weeks-to-act-on-assisted-living-reforms/\" target=\"_blank\">Lawmakers Have 4 Weeks to Act on Assisted Living Reforms\u003c/a>]\u003c/p>\n\u003cp>\u003ciframe src=\"https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/161679382&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>Westchester Villa is centrally located -- just down the street from Inglewood High School, within easy driving distance to restaurants, shopping malls and LAX. It's a modest neighborhood, and the facility reflects that. From the lobby, Westchester Villa looks a lot like a Best Western.\u003c/p>\n\u003cp>Matthew Chinichian is the chief administrator, a soft-spoken, amiable man who is one of three administrators at this facility. That in itself marks Westchester as a cut above many facilities in Los Angeles serving lower income populations, but there are other ways this place stands out. The first thing he notes about Westchester Villa is that it was purpose-built. More commonly, assisted living facilities are in retrofitted apartment buildings or smaller facilities are re-purposed single-family homes.\u003c/p>\n\u003cp>The cafeteria is huge. There are several lounges, not just one, featuring comfortable couches, big screen TVs, book collections, pianos and pool tables. For anybody who's lived in communal situation, the appeal is obvious. If you want a quiet space to think outside your bedroom, you'll find one. If you don't like what's on one TV, you can find another with nobody hogging the remote control.\u003c/p>\n\u003cp>Westchester caters to African-Americans. You don’t have to be black, but three out of four residents are, reflecting the neighborhood and positive word-of-mouth from local churches. In a community room for Bible study, local pastors from various denominations lead sessions \"at least four times a week,\" Chinichian says. \"Actually, our residents enjoy that more than any other type of activity. We have Bible study going all the time.\"\u003c/p>\n\u003cp>If you have the money, there are some fabulous places in California -- with breathtaking views, heated indoor swimming pools, and more. Those can cost $4,000-10,000 a month. A private room at Westchester is more modest: $2,340 a month. A double is $1,750. While most residents cover their own costs, there are some beds available for residents who rely on government support.\u003c/p>\n\u003cp>\u003cstrong>Regulation Lacking\u003c/strong>\u003c/p>\n\u003cp>So let’s imagine you are trying to decide on a place for your mom or dad. How can you be confident in the quality of care? Who regulates assisted living facilities? Critics like Angel-Collin's colleague, Nancy Volpert, say oversight from the state is nowhere near as robust as it needs to be. Volpert is director of public policy at Jewish Family Service of LA, which is co-sponsoring eight of the bills pending in Sacramento. Volpert supports all 15 bills pending.\u003c/p>\n\u003cp>\"We need to have regular inspections,\" Volpert says. \"We need to have a robust complaint process. We need to have staffing sufficient to meet the need. We need to have training. These are facilities that serve all of us and all of our families. Neglect doesn’t know an income bracket.\"\u003c/p>\n\u003cp>Neglect can mean all sorts of things: from simple disorganization to willful failure to protect against injury, or follow up after injury. A series of reports last year from multiple media outlets – \u003ca href=\"http://ww2.kqed.org/news/2013/09/09/whos-protecting-the-abused-elderly/\" target=\"_blank\">KQED/Center for Investigative Reporting\u003c/a>, \u003ca href=\"http://www.utsandiego.com/news/2013/Sep/09/deadly-neglect-assisted-living-homes-san-diego/\" target=\"_blank\">San Diego Union Tribune/Center for Health Reporting\u003c/a> and the \u003ca href=\"http://www.sfgate.com/bayarea/article/Castro-Valley-Janitor-saw-elderly-become-weak-4944795.php#photo-5400480\" target=\"_blank\">San Francisco Chronicle\u003c/a> – all found abuse and neglect, sometimes leading to death, at assisted living facilities around the state.\u003c/p>\n\u003cp>Advocacy groups like \u003ca href=\"http://www.canhr.org/\" target=\"_blank\">California Advocates for Nursing Home Reform\u003c/a> and \u003ca href=\"www.rcfereform.org\" target=\"_blank\">Consumer Advocates for RCFE Reform\u003c/a> seized the momentum these reports created in Sacramento to \u003ca href=\"http://www.californiareport.org/archive/R201401140850/c\">push for reform\u003c/a>. The question now is whether there's enough momentum to carry most of the reforms all the way through and change the laws.\u003c/p>\n\u003cp>Already, Governor Jerry Brown has signed one bill into law, \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140AB1572&search_keywords=\">AB 1572\u003c/a> which requires every assisted living facility, at the request of just two or more residents, to assist in establishing and maintaining a resident council that could bring in family members, advocates, long-term care ombudsmen and others. The new law requires facilities to respond in writing within 14 calendar days regarding any action or inaction taken in response to written concerns or recommendations.\u003c/p>\n\u003cp>While many of the bills sailed through initial hearings and votes uncontested, arguments are \u003ca href=\"http://www.utsandiego.com/news/2014/aug/01/assisted-living-bills-hurdles/?Watchdog\" target=\"_blank\">heating up\u003c/a> over the details as those who back them fight to get the bills through the legislature and on to Gov. Brown's desk for signature.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>Polly Stryker contributed to this report.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_20515\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/08/RS11381_photo-hpf.jpg\">\u003cimg class=\"size-full wp-image-20515\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/08/RS11381_photo-hpf.jpg\" alt=\"TV lounge at Westchester Villa, an assisted living facility in Inglewood, near Los Angeles. (Rachael Myrow/KQED)\" width=\"640\" height=\"480\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2014/08/RS11381_photo-hpf.jpg 640w, https://ww2.kqed.org/app/uploads/sites/27/2014/08/RS11381_photo-hpf-400x300.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2014/08/RS11381_photo-hpf-320x240.jpg 320w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">TV lounge at Westchester Villa, an assisted living facility in Inglewood, in Los Angeles County. (Rachael Myrow/KQED)\u003c/figcaption>\u003c/figure>\n\u003cp>This week, lawmakers in Sacramento \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/08/01/down-to-the-wire-lawmakers-have-4-weeks-to-act-on-assisted-living-reforms/\" target=\"_blank\">get busy\u003c/a> on 15 bills that together constitute the most comprehensive overhaul of assisted living facility regulation in three decades. But for many Californians, it's not even clear what an assisted living facility is. People often ask if assisted living is the same thing as a nursing home. It's not.\u003c/p>\n\u003cp>In nursing homes, people get round-the-clock medical care from licensed nurses. Assisted living comes in because not everyone who needs help also needs that level of care. Sometimes that assistance doesn't even involve a facility. Sometimes people can receive assistance and remain living in their own homes.\u003c/p>\n\u003cp>Say you've noticed your mother is walking with a new shuffle and dropping things, or that dad is mixing up his medications -- and getting argumentative when you bring it up. Something is going on that must be addressed, even though your parent is still physically healthy and wants to be independent.\u003c!--more-->\u003c/p>\n\u003cp>Heather Angel-Collin is deeply familiar with this scenario. A 25-year veteran social worker, she runs a couple senior-focused programs for \u003ca href=\"http://www.jfsla.org/page.aspx?pid=213\">Jewish Family Service for Los Angeles\u003c/a>, a non-profit social service agency that serves 100,000 people a year, regardless of religion or ability to pay.\u003c/p>\n\u003cp>\"It’s a slow progression of, you know, becoming more frail, or becoming more forgetful.\" she says. \"And those things can be very subtle, especially if you’re not seeing that person on a day-to-day basis.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Angel-Collin says it helps to think of tiers of care. Few people want to move out of their homes. They may not have to -- ever -- if domestic or medical support can be arranged.\u003c/p>\n\u003cp>\"Maybe they need to have medications given every day,\" she says. \"Maybe they need some assistance with taking a shower or bath or getting dressed.\" In California, \u003ca href=\"http://www.cdss.ca.gov/agedblinddisabled/pg1296.htm\" target=\"_blank\">In-Home Supportive Services\u003c/a> provides in-home support for several hours a week, and there are people older than 100 drawing on the services to continue living at home, mostly independently and significantly less expensively than a nursing home would be.\u003c/p>\n\u003cp>Still, there may come a time when your parent's care needs are no longer feasible with continuing to live at home. California has more than 7,500 licensed facilities you can choose from, but where do you start?\u003c/p>\n\u003cp>\u003cstrong>Finding the Right Assisted Living Facility\u003c/strong>\u003c/p>\n\u003cp>There's no one right answer as to the kind of assisted facility you choose. What's available in your area? What can you afford? Does size matter? Many people prefer something small and homey, but larger facilities may offer more services and activities. Your parent may feel more comfortable in a facility that makes a special effort to make people of a certain cultural or career background feel at home. For example, Angel-Collins notes there's a waiting list of Armenian-Americans keen to live at \u003ca href=\"http://ararathome.org/\">Ararat Home of Los Angeles\u003c/a>.\u003c/p>\n\u003cp>Remember that assisted living facilities -- unlike nursing homes -- do not provide skilled medical care. What they can offer includes services like meals and housekeeping, as well as supervised pill distribution, extra attention for patients with dementia, and transportation to the doctor’s office. In California, most families pay for assisted living out-of-pocket.\u003c/p>\n\u003cp>While most assisted living facilities are small, serving six people or less, most Californians who choose assisted living, especially in urban areas, live in large facilities, like \u003ca href=\"http://www.westchestervilla.com/public/\" target=\"_blank\">Westchester Villa\u003c/a>, a 174-bed residential care facility for the elderly in Inglewood, south of Los Angeles.\u003c/p>\n\u003cp style=\"text-align: center\">[\u003cstrong>Related:\u003c/strong> \u003ca href=\"http://ww2.kqed.org/stateofhealth/2014/08/01/down-to-the-wire-lawmakers-have-4-weeks-to-act-on-assisted-living-reforms/\" target=\"_blank\">Lawmakers Have 4 Weeks to Act on Assisted Living Reforms\u003c/a>]\u003c/p>\n\u003cp>\u003ciframe src=\"https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/161679382&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>Westchester Villa is centrally located -- just down the street from Inglewood High School, within easy driving distance to restaurants, shopping malls and LAX. It's a modest neighborhood, and the facility reflects that. From the lobby, Westchester Villa looks a lot like a Best Western.\u003c/p>\n\u003cp>Matthew Chinichian is the chief administrator, a soft-spoken, amiable man who is one of three administrators at this facility. That in itself marks Westchester as a cut above many facilities in Los Angeles serving lower income populations, but there are other ways this place stands out. The first thing he notes about Westchester Villa is that it was purpose-built. More commonly, assisted living facilities are in retrofitted apartment buildings or smaller facilities are re-purposed single-family homes.\u003c/p>\n\u003cp>The cafeteria is huge. There are several lounges, not just one, featuring comfortable couches, big screen TVs, book collections, pianos and pool tables. For anybody who's lived in communal situation, the appeal is obvious. If you want a quiet space to think outside your bedroom, you'll find one. If you don't like what's on one TV, you can find another with nobody hogging the remote control.\u003c/p>\n\u003cp>Westchester caters to African-Americans. You don’t have to be black, but three out of four residents are, reflecting the neighborhood and positive word-of-mouth from local churches. In a community room for Bible study, local pastors from various denominations lead sessions \"at least four times a week,\" Chinichian says. \"Actually, our residents enjoy that more than any other type of activity. We have Bible study going all the time.\"\u003c/p>\n\u003cp>If you have the money, there are some fabulous places in California -- with breathtaking views, heated indoor swimming pools, and more. Those can cost $4,000-10,000 a month. A private room at Westchester is more modest: $2,340 a month. A double is $1,750. While most residents cover their own costs, there are some beds available for residents who rely on government support.\u003c/p>\n\u003cp>\u003cstrong>Regulation Lacking\u003c/strong>\u003c/p>\n\u003cp>So let’s imagine you are trying to decide on a place for your mom or dad. How can you be confident in the quality of care? Who regulates assisted living facilities? Critics like Angel-Collin's colleague, Nancy Volpert, say oversight from the state is nowhere near as robust as it needs to be. Volpert is director of public policy at Jewish Family Service of LA, which is co-sponsoring eight of the bills pending in Sacramento. Volpert supports all 15 bills pending.\u003c/p>\n\u003cp>\"We need to have regular inspections,\" Volpert says. \"We need to have a robust complaint process. We need to have staffing sufficient to meet the need. We need to have training. These are facilities that serve all of us and all of our families. Neglect doesn’t know an income bracket.\"\u003c/p>\n\u003cp>Neglect can mean all sorts of things: from simple disorganization to willful failure to protect against injury, or follow up after injury. A series of reports last year from multiple media outlets – \u003ca href=\"http://ww2.kqed.org/news/2013/09/09/whos-protecting-the-abused-elderly/\" target=\"_blank\">KQED/Center for Investigative Reporting\u003c/a>, \u003ca href=\"http://www.utsandiego.com/news/2013/Sep/09/deadly-neglect-assisted-living-homes-san-diego/\" target=\"_blank\">San Diego Union Tribune/Center for Health Reporting\u003c/a> and the \u003ca href=\"http://www.sfgate.com/bayarea/article/Castro-Valley-Janitor-saw-elderly-become-weak-4944795.php#photo-5400480\" target=\"_blank\">San Francisco Chronicle\u003c/a> – all found abuse and neglect, sometimes leading to death, at assisted living facilities around the state.\u003c/p>\n\u003cp>Advocacy groups like \u003ca href=\"http://www.canhr.org/\" target=\"_blank\">California Advocates for Nursing Home Reform\u003c/a> and \u003ca href=\"www.rcfereform.org\" target=\"_blank\">Consumer Advocates for RCFE Reform\u003c/a> seized the momentum these reports created in Sacramento to \u003ca href=\"http://www.californiareport.org/archive/R201401140850/c\">push for reform\u003c/a>. The question now is whether there's enough momentum to carry most of the reforms all the way through and change the laws.\u003c/p>\n\u003cp>Already, Governor Jerry Brown has signed one bill into law, \u003ca href=\"http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140AB1572&search_keywords=\">AB 1572\u003c/a> which requires every assisted living facility, at the request of just two or more residents, to assist in establishing and maintaining a resident council that could bring in family members, advocates, long-term care ombudsmen and others. The new law requires facilities to respond in writing within 14 calendar days regarding any action or inaction taken in response to written concerns or recommendations.\u003c/p>\n\u003cp>While many of the bills sailed through initial hearings and votes uncontested, arguments are \u003ca href=\"http://www.utsandiego.com/news/2014/aug/01/assisted-living-bills-hurdles/?Watchdog\" target=\"_blank\">heating up\u003c/a> over the details as those who back them fight to get the bills through the legislature and on to Gov. Brown's desk for signature.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"info": "For decades, the process for how police police themselves has been inconsistent – if not opaque. In some states, like California, these proceedings were completely hidden. After a new police transparency law unsealed scores of internal affairs files, our reporters set out to examine these cases and the shadow world of police discipline. On Our Watch brings listeners into the rooms where officers are questioned and witnesses are interrogated to find out who this system is really protecting. Is it the officers, or the public they've sworn to serve?",
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"info": "Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. Together in Possible, Hoffman and Finger lead enlightening discussions about building a brighter collective future. The show features interviews with visionary guests like Trevor Noah, Sam Altman and Janette Sadik-Khan. Possible paints an optimistic portrait of the world we can create through science, policy, business, art and our shared humanity. It asks: What if everything goes right for once? How can we get there? Each episode also includes a short fiction story generated by advanced AI GPT-4, serving as a thought-provoking springboard to speculate how humanity could leverage technology for good.",
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"soldout": {
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"title": "SOLD OUT: Rethinking Housing in America",
"tagline": "A new future for housing",
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"tagline": "True-life supernatural stories",
"info": "",
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