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"content": "\u003cp>Prudential Financial Inc., one of the nation’s largest life insurers, plans to announce this week that it will offer traditional individual policies to eligible people living with HIV, a condition that for decades has excluded most of them from any but the skimpiest of coverage, company officials said.\u003c/p>\n\u003cp>It is the first such offering to be publicly announced by a major American insurer, and it signals a growing recognition that HIV/AIDS has evolved from a death sentence into a chronic but manageable disease, HIV advocates and insurance agents said.\u003c/p>\n\u003caside class=\"pullquote alignright\">The announcement from a major insurer comes as World AIDS Day is celebrated.\u003c/aside>\n\u003cp>The coverage, in the form of convertible 10- or 15-year term life insurance policies, will be available to people who are HIV-positive but otherwise healthy, according to the insurer. \u003ca href=\"http://www.dfs.ny.gov/consumer/que_top10/pr_que_life_ter.htm\" target=\"_blank\">“Convertible”\u003c/a> term policies can be converted to permanent policies covering an entire life.\u003c/p>\n\u003cp>The insurer provided no further details Monday on eligibility criteria or the pricing of policies, although some insurance agents said coverage would likely be higher than for completely healthy people.\u003c/p>\n\u003cp>“With advances in the successful treatment of people with HIV, we are now able to offer this population the opportunity to apply for life insurance -- a milestone we see as a significant step in the right direction,” said Mike McFarland, vice president, underwriting, for Prudential Individual Life Insurance, in a prepared statement.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>As World AIDS Day is observed Tuesday, \u003ca href=\"http://www.cdc.gov/hiv/statistics/overview/ataglance.html\" target=\"_blank\">more than 1.2 million Americans are living with HIV\u003c/a>, the virus that causes AIDS, according to statistics from the U.S. Centers for Disease Control. An estimated 50,000 are newly diagnosed with the virus each year.\u003c/p>\n\u003cp>Life expectancies for HIV-positive people now are rising to the point that some American and Canadian patients diagnosed at a young age \u003ca href=\"http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0081355\" target=\"_blank\">can live into their 70s\u003c/a>. But no cure exists for the disease, which requires access and adherence to medication. And the longer that HIV/AIDS patients live, the more they are \u003ca href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4058441/\" target=\"_blank\">at risk for developing other conditions\u003c/a>, including cancer, osteoporosis, and heart, liver and kidney disease.\u003c/p>\n\u003cp>The life insurance industry routinely covers people with other chronic diseases, including cancer and Hepatitis C, although at a higher price than for healthy applicants. But HIV-positive people typically cannot buy individual life insurance policies, beyond minimal coverage, at any price, insurance agents said.\u003c/p>\n\u003caside class=\"pullquote alignright\">'... it seems like a fantastic development for people living with HIV.'\u003cbr>\n\u003ccite>Scott Schoettes, Lambda Legal\u003c/cite>\u003c/aside>\n\u003cp>People with HIV/AIDS can’t legally be excluded from the “guaranteed issue” group life insurance policies offered by some employers, but those policies typically don’t pay out more than $50,000. A positive HIV test remains cause for automatic denial of higher-value individual term life insurance policies that require a medical review, agents said. That’s true even if the applicant has an undetectable viral load.\u003c/p>\n\u003cp>“We have not yet seen the terms of the life insurance product being offered … but it seems like a fantastic development for people living with HIV in need of term life insurance,” said Scott Schoettes, HIV Project National Director of Lambda Legal, an organization that works to protect the rights of the LGBT and HIV/AIDS community.\u003c/p>\n\u003cp>“Finally, an insurance company has realized that this is the right thing to do and that it is profitable from a business perspective to offer this product to people living with HIV. Now that there is one company out there doing this, it will encourage others to do the same when they see that there is money to be made in this market,” Schoettes said.\u003c/p>\n\u003cp>In offering the new coverage, Prudential has partnered with \u003ca href=\"http://myaequalis.com/\" target=\"_blank\">ÆQUALIS\u003c/a>, a financial services startup serving HIV-positive people, which has researched medical underwriting, life expectancy and other data on HIV/AIDS and has been key to developing the product. The startup will provide information to consumers and insurance agents as well as manage the application process for Prudential.\u003c/p>\n\u003cp>In its research, ÆQUALIS co-founder Bill Grant said, the company used data from “viaticals” -- insurance policies sold for their cash value by people after their HIV diagnosis -- to plot new mortality curves. Many of those sold policies haven’t generated income for the buyers because the patients survived much longer than expected. That analysis was convincing to Prudential and to a German re-insurer that will accept some of the financial risk of insuring HIV-positive patients, Grant said.\u003c/p>\n\u003cp>“There’s been just enough history to project long enough into the future to get started on this path,” Grant said.\u003c/p>\n\u003cp>[contextly_sidebar id=\"RgCKn69rGzGIztJxetZu9DSXzLyqG0wj\"]Grant said he started the company with business partner Andrew Terrell to address inequities in coverage and to help change the national conversation about HIV/AIDS. He and insurance agents noted that life insurance often is necessary not just to protect loved ones but also for certain business transactions or to adopt children. Grant said he learned that his brother was HIV-positive only when he was denied life insurance coverage that the two brothers needed to complete a business deal.\u003c/p>\n\u003cp>The \u003ca href=\"http://www.nationalenquirer.com/Charlie-Sheen-HIV-Positive-Cover-Story-New-Issue\" target=\"_blank\">tabloid media coverage\u003c/a> surrounding actor Charlie Sheen’s recent disclosure that he is HIV-positive -- emphasizing his long-kept “secret” -- “is an incredible reminder that this stigma still exists,” he said.\u003c/p>\n\u003cp>Before now, some insurance companies have quietly experimented with underwriting policies for HIV-positive clients, but the criteria have been tough to meet. Potential buyers had to be on aggressive antiretroviral treatment since diagnosis, confirm that their viral loads were undetectable and meet certain CD4 lymphocyte (T cell) counts, in addition to meeting age and other health requirements, according to insurance agents who had sought the coverage.\u003c/p>\n\u003cp>Aaron Baldwin, a San Francisco insurance agent who is open about being HIV-positive and specializes in financial planning for people with HIV, said that he provided health and financial information on 20 HIV-positive prospects in good health to one such company, Lincoln Financial Group. All were rejected, he said.\u003c/p>\n\u003cp>Ed Hinerman, an independent insurance agent in Nathrop, Colorado, said he also sent Lincoln an HIV-positive client whom he believed met the company’s stringent criteria. “The denial came within hours,” Hinerman said.\u003c/p>\n\u003cp>Asked to comment, a Lincoln Financial Group spokesman said he could not speak to the agents’ experiences and added that the company did not currently have a specific underwriting program for HIV-positive people.\u003c/p>\n\u003cp>Baldwin acknowledged, however, that medical underwriting is complex, and data are lacking on the long-term effects of HIV/AIDS drugs. Underwriters may not understand the subtleties of HIV/AIDS treatment research, he said.\u003c/p>\n\u003cp>For example, a patient may temporarily stop HIV/AIDS medications to participate in a study on “structured treatment breaks” to reduce side effects, Baldwin said. An underwriter might see that as noncompliance. Or an underwriter might note an applicant taking an HIV medication and not understand that it’s for prevention, not treatment, Baldwin said.\u003c/p>\n\u003cp>“For an underwriter, it’s probably a hot mess,” Baldwin said.\u003c/p>\n\u003cp>Baldwin said the Prudential/ÆQUALIS initiative “represents new hope” for his clients -- and himself.\u003c/p>\n\u003cp>He is particularly looking forward to obtaining a life insurance policy for one of his clients, a young HIV-positive man whose parents had co-signed on a new round of loans for his medical school education, unaware of his diagnosis. The young man wanted to buy a life insurance policy to protect his parents from that debt if he died.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“The new offerings will continue to open doors and allow HIV-positive people to protect their loved ones, their families and their businesses,” Baldwin said.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Prudential Financial Inc., one of the nation’s largest life insurers, plans to announce this week that it will offer traditional individual policies to eligible people living with HIV, a condition that for decades has excluded most of them from any but the skimpiest of coverage, company officials said.\u003c/p>\n\u003cp>It is the first such offering to be publicly announced by a major American insurer, and it signals a growing recognition that HIV/AIDS has evolved from a death sentence into a chronic but manageable disease, HIV advocates and insurance agents said.\u003c/p>\n\u003caside class=\"pullquote alignright\">The announcement from a major insurer comes as World AIDS Day is celebrated.\u003c/aside>\n\u003cp>The coverage, in the form of convertible 10- or 15-year term life insurance policies, will be available to people who are HIV-positive but otherwise healthy, according to the insurer. \u003ca href=\"http://www.dfs.ny.gov/consumer/que_top10/pr_que_life_ter.htm\" target=\"_blank\">“Convertible”\u003c/a> term policies can be converted to permanent policies covering an entire life.\u003c/p>\n\u003cp>The insurer provided no further details Monday on eligibility criteria or the pricing of policies, although some insurance agents said coverage would likely be higher than for completely healthy people.\u003c/p>\n\u003cp>“With advances in the successful treatment of people with HIV, we are now able to offer this population the opportunity to apply for life insurance -- a milestone we see as a significant step in the right direction,” said Mike McFarland, vice president, underwriting, for Prudential Individual Life Insurance, in a prepared statement.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>As World AIDS Day is observed Tuesday, \u003ca href=\"http://www.cdc.gov/hiv/statistics/overview/ataglance.html\" target=\"_blank\">more than 1.2 million Americans are living with HIV\u003c/a>, the virus that causes AIDS, according to statistics from the U.S. Centers for Disease Control. An estimated 50,000 are newly diagnosed with the virus each year.\u003c/p>\n\u003cp>Life expectancies for HIV-positive people now are rising to the point that some American and Canadian patients diagnosed at a young age \u003ca href=\"http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0081355\" target=\"_blank\">can live into their 70s\u003c/a>. But no cure exists for the disease, which requires access and adherence to medication. And the longer that HIV/AIDS patients live, the more they are \u003ca href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4058441/\" target=\"_blank\">at risk for developing other conditions\u003c/a>, including cancer, osteoporosis, and heart, liver and kidney disease.\u003c/p>\n\u003cp>The life insurance industry routinely covers people with other chronic diseases, including cancer and Hepatitis C, although at a higher price than for healthy applicants. But HIV-positive people typically cannot buy individual life insurance policies, beyond minimal coverage, at any price, insurance agents said.\u003c/p>\n\u003caside class=\"pullquote alignright\">'... it seems like a fantastic development for people living with HIV.'\u003cbr>\n\u003ccite>Scott Schoettes, Lambda Legal\u003c/cite>\u003c/aside>\n\u003cp>People with HIV/AIDS can’t legally be excluded from the “guaranteed issue” group life insurance policies offered by some employers, but those policies typically don’t pay out more than $50,000. A positive HIV test remains cause for automatic denial of higher-value individual term life insurance policies that require a medical review, agents said. That’s true even if the applicant has an undetectable viral load.\u003c/p>\n\u003cp>“We have not yet seen the terms of the life insurance product being offered … but it seems like a fantastic development for people living with HIV in need of term life insurance,” said Scott Schoettes, HIV Project National Director of Lambda Legal, an organization that works to protect the rights of the LGBT and HIV/AIDS community.\u003c/p>\n\u003cp>“Finally, an insurance company has realized that this is the right thing to do and that it is profitable from a business perspective to offer this product to people living with HIV. Now that there is one company out there doing this, it will encourage others to do the same when they see that there is money to be made in this market,” Schoettes said.\u003c/p>\n\u003cp>In offering the new coverage, Prudential has partnered with \u003ca href=\"http://myaequalis.com/\" target=\"_blank\">ÆQUALIS\u003c/a>, a financial services startup serving HIV-positive people, which has researched medical underwriting, life expectancy and other data on HIV/AIDS and has been key to developing the product. The startup will provide information to consumers and insurance agents as well as manage the application process for Prudential.\u003c/p>\n\u003cp>In its research, ÆQUALIS co-founder Bill Grant said, the company used data from “viaticals” -- insurance policies sold for their cash value by people after their HIV diagnosis -- to plot new mortality curves. Many of those sold policies haven’t generated income for the buyers because the patients survived much longer than expected. That analysis was convincing to Prudential and to a German re-insurer that will accept some of the financial risk of insuring HIV-positive patients, Grant said.\u003c/p>\n\u003cp>“There’s been just enough history to project long enough into the future to get started on this path,” Grant said.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>Grant said he started the company with business partner Andrew Terrell to address inequities in coverage and to help change the national conversation about HIV/AIDS. He and insurance agents noted that life insurance often is necessary not just to protect loved ones but also for certain business transactions or to adopt children. Grant said he learned that his brother was HIV-positive only when he was denied life insurance coverage that the two brothers needed to complete a business deal.\u003c/p>\n\u003cp>The \u003ca href=\"http://www.nationalenquirer.com/Charlie-Sheen-HIV-Positive-Cover-Story-New-Issue\" target=\"_blank\">tabloid media coverage\u003c/a> surrounding actor Charlie Sheen’s recent disclosure that he is HIV-positive -- emphasizing his long-kept “secret” -- “is an incredible reminder that this stigma still exists,” he said.\u003c/p>\n\u003cp>Before now, some insurance companies have quietly experimented with underwriting policies for HIV-positive clients, but the criteria have been tough to meet. Potential buyers had to be on aggressive antiretroviral treatment since diagnosis, confirm that their viral loads were undetectable and meet certain CD4 lymphocyte (T cell) counts, in addition to meeting age and other health requirements, according to insurance agents who had sought the coverage.\u003c/p>\n\u003cp>Aaron Baldwin, a San Francisco insurance agent who is open about being HIV-positive and specializes in financial planning for people with HIV, said that he provided health and financial information on 20 HIV-positive prospects in good health to one such company, Lincoln Financial Group. All were rejected, he said.\u003c/p>\n\u003cp>Ed Hinerman, an independent insurance agent in Nathrop, Colorado, said he also sent Lincoln an HIV-positive client whom he believed met the company’s stringent criteria. “The denial came within hours,” Hinerman said.\u003c/p>\n\u003cp>Asked to comment, a Lincoln Financial Group spokesman said he could not speak to the agents’ experiences and added that the company did not currently have a specific underwriting program for HIV-positive people.\u003c/p>\n\u003cp>Baldwin acknowledged, however, that medical underwriting is complex, and data are lacking on the long-term effects of HIV/AIDS drugs. Underwriters may not understand the subtleties of HIV/AIDS treatment research, he said.\u003c/p>\n\u003cp>For example, a patient may temporarily stop HIV/AIDS medications to participate in a study on “structured treatment breaks” to reduce side effects, Baldwin said. An underwriter might see that as noncompliance. Or an underwriter might note an applicant taking an HIV medication and not understand that it’s for prevention, not treatment, Baldwin said.\u003c/p>\n\u003cp>“For an underwriter, it’s probably a hot mess,” Baldwin said.\u003c/p>\n\u003cp>Baldwin said the Prudential/ÆQUALIS initiative “represents new hope” for his clients -- and himself.\u003c/p>\n\u003cp>He is particularly looking forward to obtaining a life insurance policy for one of his clients, a young HIV-positive man whose parents had co-signed on a new round of loans for his medical school education, unaware of his diagnosis. The young man wanted to buy a life insurance policy to protect his parents from that debt if he died.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"disqusTitle": "Kaiser Recruits Members to Help Unlock Autism's Genetic Secrets",
"title": "Kaiser Recruits Members to Help Unlock Autism's Genetic Secrets",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>Thousands of Northern California families of children with autism are being recruited to join a new project to help scientists understand how heredity and environmental factors determine where each youngster falls on the spectrum of the disorder.\u003c/p>\n\u003caside class=\"pullquote alignright\">'Teasing apart the [autism] spectrum, we might makes some leaps forward.'\u003cbr>\n\u003ccite>Lisa Croen, Ph.D., Kaiser Autism Research Program\u003c/cite>\u003c/aside>\n\u003cp>Kaiser Permanente aims to sign up 5,000 children and adults with autism -- along with their biological parents -- to contribute a blood or saliva sample to a “\u003ca href=\"http://autismfamilybiobank.kaiser.org/\" target=\"_blank\">biobank\u003c/a>” that will enable researchers to track and identify common factors in various types of autism.\u003c/p>\n\u003cp>Kaiser Permanente has 3.8 million members in Northern California, with 17,000 children and adults diagnosed with autism. Because participating children are Kaiser health plan members, researchers plan to evaluate their health records in conjunction with the genetic samples in an effort to unlock insights into autism causes, best treatments, medications and possible prevention strategies.\u003c/p>\n\u003cp>“We have a really incredible population to study,” said Lisa Croen, director of the Kaiser Permanente Autism Research Program and a senior research scientist at the Kaiser Permanente Northern California Division of Research. “We have lots of information for them like lab tests, medications taken –- a huge wealth of clinical information. We have the ability to re-contact these families and collect even more.”\u003c/p>\n\u003cp>The project, funded by a $4.6 million grant from the Simons Foundation, will create the autism research bank over the next three years. It will be available as a resource for any researcher. A review committee will consider requests for use of the specimens, Croen said.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>[contextly_sidebar id=\"VMeweA8IIaAbuyJ2sLjO5wsVwYgp93Yq\"]The rising rates of children being diagnosed with autism in the U.S. has been alarming to parents, doctors and educators struggling to understand the vast array of disorders that fall under this heading and how to provide the best care. Researchers believe genetics and environmental triggers combine to cause autism.\u003c/p>\n\u003cp>\u003ca href=\"http://www.cdc.gov/ncbddd/autism/index.html\" target=\"_blank\">Autism\u003c/a> is an umbrella term for a spectrum of neurodevelopmental disorders that emerge in early childhood, affecting social interaction, behavior and communication. Research has shown \u003ca href=\"http://www.cdc.gov/ncbddd/autism/treatment.html#ref\"> \u003c/a> early access to care and intervention can dramatically improve the progress, symptoms and daily functioning of kids with autism.\u003c/p>\n\u003cp>Last week the National Center for Health Statistics released a \u003ca href=\"http://www.cdc.gov/nchs/data/nhsr/nhsr087.pdf\" target=\"_blank\">survey\u003c/a> that found autism rates in children may be higher than experts had thought. The report found that one in 45 children ages 3 to 17 has autism. The U.S. Centers for Disease Control and Prevention had previously pegged the rate at \u003ca href=\"http://www.cdc.gov/ncbddd/autism/data.html\" target=\"_blank\">1 in 68\u003c/a> American children.\u003c/p>\n\u003cp>Over the years studies have identified different genes associated with autism, but much remains to be learned about the interaction between specific genes and environmental factors and how they influence the development of subtypes of autism.\u003c/p>\n\u003cp>Researchers have begun to focus on large-scale collections of data like Kaiser’s project. Such initiatives offer hope that certain factors in subtypes of autism can be identified.\u003c/p>\n\u003cp>“Being told your child has ‘autism’ doesn’t really tell you what you and your child will be dealing with for the rest of your lives,” said Mathew Pletcher, vice president and head of genomic discovery at Autism Speaks, an advocacy group for people with autism. “It’s a broad term that covers a huge number of kids and symptoms. It’s not like being told you have cancer, what type of cancer, what stage of cancer and which drugs best treat it.”\u003c/p>\n\u003cp>[contextly_sidebar id=\"qCp3opWG17SIbFx9VtmUmv4tP1YuzqQv\"]Autism Speaks is working with Google to sequence the DNA of more than 10,000 families living with autism. The \u003ca href=\"https://www.mss.ng/\" target=\"_blank\">data\u003c/a> will be made available to researchers at no cost, Pletcher said.\u003c/p>\n\u003cp>“This data is now allowing us to break apart the spectrum into a much more meaningful diagnosis,” he said. “With trying to understand a complex disorder like autism, it comes down to numbers, the depth and breadth of data out there. There is never enough data. There’s always interest in another effort like the Kaiser study to bring more families in.”\u003c/p>\n\u003cp>The work at Kaiser’s biobank and Google could lead to more tailored treatments to treat autism, researchers say.\u003c/p>\n\u003cp>Autism frequently coexists with physical ailments like gastrointestinal problems, seizures or allergies. Researchers may find that certain genes drive certain combinations of those conditions, Croen said.\u003c/p>\n\u003cp>“Teasing apart the spectrum, we might makes some leaps forward,” she said.\u003c/p>\n\u003cp>For participating Kaiser patients with an autism diagnosis, their biological parents will provide samples of blood or saliva and complete questionnaires. All patient identifiers will be removed before the data is provided to researchers.\u003c/p>\n\u003cp>Joanna Jaeger, who has a 23-year-old son with autism, said she and her family agreed to participate in the study to help other parents.\u003c/p>\n\u003cp>Her son, Alex, who has an \u003ca href=\"http://www.big-als-best.com/big-al-s-best-dark-chocolate-almond-toffee.html\" target=\"_blank\">at-home toffee making business\u003c/a>, used to have difficulty cooperating during blood tests, she said. A blood draw once took “five people 45 minutes,” to make happen. But she says now it’s something he can do without difficulty, so she thought it was especially important to participate.\u003c/p>\n\u003cp>“It’s a great way for parents to give back and advance the information,” said Joanna Jaeger, who lives in Milpitas and is on the community advisory board for the Kaiser Permanente Autism Research Program. “So much of the time we are all overwhelmed and in the moment in day-to-day life. This is something we can do to make things a little easier for families who will deal with autism in the future.”\u003c/p>\n\u003cp>Since recruitment began in July, Kaiser has enrolled 270 families, health plan officials said.\u003c/p>\n\u003cp>“This resource can’t exist without families participating,” Croen said. “Hopefully, together we can all make a difference.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Learn more about \u003ca href=\"http://autismfamilybiobank.kaiser.org\" target=\"_blank\">Kaiser's autism biobank study\u003c/a>.\u003c/em>\u003c/p>\n\n",
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"headline": "Kaiser Recruits Members to Help Unlock Autism's Genetic Secrets",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Thousands of Northern California families of children with autism are being recruited to join a new project to help scientists understand how heredity and environmental factors determine where each youngster falls on the spectrum of the disorder.\u003c/p>\n\u003caside class=\"pullquote alignright\">'Teasing apart the [autism] spectrum, we might makes some leaps forward.'\u003cbr>\n\u003ccite>Lisa Croen, Ph.D., Kaiser Autism Research Program\u003c/cite>\u003c/aside>\n\u003cp>Kaiser Permanente aims to sign up 5,000 children and adults with autism -- along with their biological parents -- to contribute a blood or saliva sample to a “\u003ca href=\"http://autismfamilybiobank.kaiser.org/\" target=\"_blank\">biobank\u003c/a>” that will enable researchers to track and identify common factors in various types of autism.\u003c/p>\n\u003cp>Kaiser Permanente has 3.8 million members in Northern California, with 17,000 children and adults diagnosed with autism. Because participating children are Kaiser health plan members, researchers plan to evaluate their health records in conjunction with the genetic samples in an effort to unlock insights into autism causes, best treatments, medications and possible prevention strategies.\u003c/p>\n\u003cp>“We have a really incredible population to study,” said Lisa Croen, director of the Kaiser Permanente Autism Research Program and a senior research scientist at the Kaiser Permanente Northern California Division of Research. “We have lots of information for them like lab tests, medications taken –- a huge wealth of clinical information. We have the ability to re-contact these families and collect even more.”\u003c/p>\n\u003cp>The project, funded by a $4.6 million grant from the Simons Foundation, will create the autism research bank over the next three years. It will be available as a resource for any researcher. A review committee will consider requests for use of the specimens, Croen said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>The rising rates of children being diagnosed with autism in the U.S. has been alarming to parents, doctors and educators struggling to understand the vast array of disorders that fall under this heading and how to provide the best care. Researchers believe genetics and environmental triggers combine to cause autism.\u003c/p>\n\u003cp>\u003ca href=\"http://www.cdc.gov/ncbddd/autism/index.html\" target=\"_blank\">Autism\u003c/a> is an umbrella term for a spectrum of neurodevelopmental disorders that emerge in early childhood, affecting social interaction, behavior and communication. Research has shown \u003ca href=\"http://www.cdc.gov/ncbddd/autism/treatment.html#ref\"> \u003c/a> early access to care and intervention can dramatically improve the progress, symptoms and daily functioning of kids with autism.\u003c/p>\n\u003cp>Last week the National Center for Health Statistics released a \u003ca href=\"http://www.cdc.gov/nchs/data/nhsr/nhsr087.pdf\" target=\"_blank\">survey\u003c/a> that found autism rates in children may be higher than experts had thought. The report found that one in 45 children ages 3 to 17 has autism. The U.S. Centers for Disease Control and Prevention had previously pegged the rate at \u003ca href=\"http://www.cdc.gov/ncbddd/autism/data.html\" target=\"_blank\">1 in 68\u003c/a> American children.\u003c/p>\n\u003cp>Over the years studies have identified different genes associated with autism, but much remains to be learned about the interaction between specific genes and environmental factors and how they influence the development of subtypes of autism.\u003c/p>\n\u003cp>Researchers have begun to focus on large-scale collections of data like Kaiser’s project. Such initiatives offer hope that certain factors in subtypes of autism can be identified.\u003c/p>\n\u003cp>“Being told your child has ‘autism’ doesn’t really tell you what you and your child will be dealing with for the rest of your lives,” said Mathew Pletcher, vice president and head of genomic discovery at Autism Speaks, an advocacy group for people with autism. “It’s a broad term that covers a huge number of kids and symptoms. It’s not like being told you have cancer, what type of cancer, what stage of cancer and which drugs best treat it.”\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>Autism Speaks is working with Google to sequence the DNA of more than 10,000 families living with autism. The \u003ca href=\"https://www.mss.ng/\" target=\"_blank\">data\u003c/a> will be made available to researchers at no cost, Pletcher said.\u003c/p>\n\u003cp>“This data is now allowing us to break apart the spectrum into a much more meaningful diagnosis,” he said. “With trying to understand a complex disorder like autism, it comes down to numbers, the depth and breadth of data out there. There is never enough data. There’s always interest in another effort like the Kaiser study to bring more families in.”\u003c/p>\n\u003cp>The work at Kaiser’s biobank and Google could lead to more tailored treatments to treat autism, researchers say.\u003c/p>\n\u003cp>Autism frequently coexists with physical ailments like gastrointestinal problems, seizures or allergies. Researchers may find that certain genes drive certain combinations of those conditions, Croen said.\u003c/p>\n\u003cp>“Teasing apart the spectrum, we might makes some leaps forward,” she said.\u003c/p>\n\u003cp>For participating Kaiser patients with an autism diagnosis, their biological parents will provide samples of blood or saliva and complete questionnaires. All patient identifiers will be removed before the data is provided to researchers.\u003c/p>\n\u003cp>Joanna Jaeger, who has a 23-year-old son with autism, said she and her family agreed to participate in the study to help other parents.\u003c/p>\n\u003cp>Her son, Alex, who has an \u003ca href=\"http://www.big-als-best.com/big-al-s-best-dark-chocolate-almond-toffee.html\" target=\"_blank\">at-home toffee making business\u003c/a>, used to have difficulty cooperating during blood tests, she said. A blood draw once took “five people 45 minutes,” to make happen. But she says now it’s something he can do without difficulty, so she thought it was especially important to participate.\u003c/p>\n\u003cp>“It’s a great way for parents to give back and advance the information,” said Joanna Jaeger, who lives in Milpitas and is on the community advisory board for the Kaiser Permanente Autism Research Program. “So much of the time we are all overwhelmed and in the moment in day-to-day life. This is something we can do to make things a little easier for families who will deal with autism in the future.”\u003c/p>\n\u003cp>Since recruitment began in July, Kaiser has enrolled 270 families, health plan officials said.\u003c/p>\n\u003cp>“This resource can’t exist without families participating,” Croen said. “Hopefully, together we can all make a difference.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Learn more about \u003ca href=\"http://autismfamilybiobank.kaiser.org\" target=\"_blank\">Kaiser's autism biobank study\u003c/a>.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Developmentally Disabled People Face Losing Access to Services as Closures Hit",
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"content": "\u003cp>Surrounded by stacks of packages in a brightly lit room, Michael Palone gingerly folded a box and taped it shut. His eyes averted, he shuffled to the front of the warehouse to retrieve scissors, skirting by people and tables in his path.\u003c/p>\n\u003cp>Palone, 26, has mild autism, originally diagnosed as Asperger's syndrome. The condition makes it nearly impossible for him to socialize with others and adjust to the constant changes of a full time job. Instead, he assembles packages with about 40 others at a Union City work center run by The Arc of Alameda County.\u003c/p>\n\u003caside class=\"pullquote alignright\">'If he doesn’t keep going to this program, all of the progress that he’s made over the past two years will just be gone in two weeks.'\u003cbr>\n\u003ccite>Rosemary Palone, mother of 26-year-old son with autism\u003c/cite>\u003c/aside>\n\u003cp>The Arc is a national nonprofit with local chapters across the country, including 21 in California, that offer programs and services for people with developmental disabilities. “It means a lot to me,\" Palone says. \"It gets me out of the house, and it helps me interact with people.\"\u003c/p>\n\u003cp>Before joining the work activity center, Palone mostly stayed at home, in his room, playing computer games all day. He couldn’t complete simple tasks like doing his laundry without his mother’s help. But since he joined The Arc two years ago, his mother, Rosemary, said that the change in his behavior has been remarkable.\u003c/p>\n\u003cp>“When I first found out how good the program was for him, it made me cry,” she said. Now Michael voluntarily joins her on trips to the grocery store, sits with the family in the living room and even washes his own clothes without needing a reminder. Plus, his work is paid. He earns about $300 per month, which he uses to buy magic cards or to treat his niece to lunch. “We talk more now than we ever did throughout his entire childhood,” Rosemary Palone says.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>But she fears that her son will return to his former, reclusive ways. Due to a lack of funding and the increasing cost of living in the San Francisco Bay Area, The Arc can no longer shoulder the costs of running the program, and plans to close the work center in a few months. Rosemary Palone worries that Michael -- and other clients like him -- will have nowhere else to go. “If he doesn’t keep going to this program, all of the progress that he’s made over the past two years will just be gone in two weeks,” she said.\u003c/p>\n\u003cfigure id=\"attachment_114034\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/11/IMG_3159-copy-e1448505797296.jpg\">\u003cimg class=\"size-thumbnail wp-image-114034\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/11/IMG_3159-copy-400x267.jpg\" alt=\"Ron Luter (R) is executive director of The Arc of Alameda County. \" width=\"400\" height=\"267\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Ron Luter (R) is executive director of The Arc of Alameda County. \u003ccite>(Melissa Hellmann)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The work activity center is funded through a combination of state and federal money. But Ron Luter, president and CEO of The Arc of Alameda County, says it's not enough to cover costs, and it's hurting the rest of the agency.\u003c/p>\n\u003cp>“The work activity center is really pulling this facility down,” Luter says.\u003cb>\u003ci> \u003c/i>\u003c/b>During its heyday, the workshop bustled with activity as the main co-packager for Ghirardelli Chocolate, but it lost the contract and the additional revenue when the company moved its packaging facility to Modesto several years ago. Now packaging machines sit in the room collecting dust and have been out of operation for years.\u003c/p>\n\u003cp>Although The Arc of Alameda County’s annual budget is $5 million, Luter said that the four centers he heads throughout the East Bay have collectively lost about $1 million over the past three years. To offset the debt, Luter's been running clothing drives and dipping into savings from the sale of two former Arc of Alameda properties, but the pool of extra money will soon run dry, he says.\u003c/p>\n\u003cp>The Arc of Alameda’s plight echoes that of similar organizations across the state. California was once known as a pioneer for spearheading alternatives to confining people with developmental disabilities in state-run institutions that were notoriously overcrowded and separated patients from their loved ones.\u003c/p>\n\u003cp>In 1965 the California legislature passed AB 691, a pilot program that \u003ca href=\"http://www.dds.ca.gov/Publications/HistoricPub/1969_RCsfortheMR_First2Yrs.pdf\" target=\"_blank\">created the first regional centers\u003c/a>. These agencies were designed to coordinate community-based services so people with developmental disabilities could live independently or with their families. Today there are 21 non-profit regional centers across California that handle case management and program development, among many other services.\u003c/p>\n\u003cp>But in the wake of The Great Recession, more than $1 billion in state budget cuts has threatened the system. In a grimly-titled report, \u003cem>\u003ca href=\"http://arcanet.org/wp-content/uploads/2015/02/on-the-brink-of-collapse.pdf\" target=\"_blank\">On the Brink of Collapse\u003c/a>\u003c/em>, the Association of Regional Center Agencies (ARCA) said California “continues to lose ground” and noted that the state has the lowest funding in the country for individuals with a developmental disability who qualify for services.\u003c/p>\n\u003cp>In addition, provider rates for organizations have been frozen \u003ca href=\"http://www.chhs.ca.gov/DCTFDocs/2_Revised%2520Rate%2520Process%2520Overview.pdf\">since 2003\u003c/a>, meaning that agencies are running on a rate model that was created over a decade ago. The situation is especially pronounced in the expensive Bay Area, yet provider rates are the same statewide, despite the varied costs of living.\u003c/p>\n\u003cp>Eileen Richey, executive director of ARCA, says the lack of funding puts Californians with developmental disabilities at continued risk. “All of these challenges now mean that more people have to wait to get into\u003ci> \u003c/i>a\u003ci> \u003c/i>program,” Richey said. “And everyone throughout the system ends up having to do more with less ... continually worsening the quality of life for people with developmental disabilities and their families.”\u003c/p>\n\u003cp>Richey added that it’s nearly impossible to find qualified, long-term staff to work at the rate the organizations offer. Constant staff turnover makes providing quality care even more challenging.\u003c/p>\n\u003cp>\"The turnover rate is so high,\" Luter of The Arc of Alameda says of his dwindling staff. \"We’re competing with people for jobs at In-N-Out Burger. Half of the people who work for me have two jobs just to survive.\" At his work activity center, Luter said that the ratio of clients to staff should be 10 to 1, but it’s currently double that because he can’t afford to pay any more workers.\u003c/p>\n\u003cp>The work activity center at The Arc of Alameda in Union City is just one of the programs in the Bay Area that will be shutting down over the next few months because of funding issues. Luter also plans on closing his child care program in Hayward, where he said deficits have run between $40,000-$100,000 per year since 2010. The center serves children ages 2-5 with mild to moderate disabilities or developmental delays.\u003c/p>\n\u003cp>\u003cstrong>Brentwood Center Closing Monday\u003c/strong>\u003c/p>\n\u003cp>A combination of factors forced Barbara Maizie, executive director of \u003ca href=\"http://www.contracostaarc.com\" target=\"_blank\">Contra Costa ARC\u003c/a>, to decide to close the Lynn Center, a program serving children 15 months to 5 years with developmental delays and autism. Monday will be its last day.\u003c/p>\n\u003cp>Maizie says the low funding levels had already strained her agency. Then the Lynn Center faced relocation when the elementary school housing its program was taken back by the district. Maizie realized that they couldn’t afford the relocation costs and gave up hope.\u003c/p>\n\u003cp>“There have been many challenges to running this program in the past and we were always able to rise to the occasion,\" she says, \"but the funding has just become so impossible that we can’t any longer.”\u003c/p>\n\u003caside class=\"pullquote alignright\">'California’s developmental disability system has been struggling for many years – it’s time that system sees some benefit from California’s economic recovery.'\u003cbr>\n\u003ccite>Sen. Ed Hernandez, D-West Covina\u003c/cite>\u003c/aside>\n\u003cp>The staff and 14 remaining children are bracing for the last day. Caseworkers at the East Bay Regional Center are scrambling to find replacement programs for each of the kids, but there’s a chance that some might not find an appropriate match.\u003c/p>\n\u003cp>Lynn Center is the fourth closure her agency has seen over the last year, says Ronke Sodipo, director of community services at the Regional Center of the East Bay. The nonprofit agency works with California's Department of Developmental Services to coordinate programs in Alameda and Contra Costa counties for people with developmental disabilities. Out of the 102 clients in the closed programs, she says, up to half have not yet been placed in another center.\u003c/p>\n\u003cp>Sodipo added that recent changes in labor laws have exacerbated funding issues for the scores of organizations that provide services throughout the East Bay. A new statewide \u003ca href=\"http://www.dir.ca.gov/dlse/Paid_Sick_Leave.htm\" target=\"_blank\">paid sick leave law\u003c/a>, the Affordable Care Act requirement that employers with more than 50 full time employees provide health insurance, an increase in overtime pay and the raised minimum wage in Oakland and Emeryville have all created additional costs for the organizations, Sodipo says.\u003c/p>\n\u003cp>“I don’t know that our service providers would be as severely impacted if their costs were taken into consideration and they were given rate adjustments to absorb some of it,” she said.\u003c/p>\n\u003cp>\u003cstrong>Advocating for Change\u003c/strong>\u003c/p>\n\u003cp>Seeking to address the losses from years of underfunding, \u003ca href=\"http://www.lantermancoalition.org\" target=\"_blank\">The Lanterman Coalition\u003c/a> — an alliance of 20 organizations and businesses including agencies that provide services for those with disabilities and advocacy groups — took action earlier this year and lobbied state legislators for a 10 percent across-the-board funding increase for service providers. The proposal was ultimately removed from the state budget that was signed in June. But Brown then called a \"special session\" of the Legislature, to address this funding question and other particularly challenging fiscal issues.\u003c/p>\n\u003cp>\u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201520162SB14\" target=\"_blank\">A bill \u003c/a>proposed by Sen. Ed Hernandez, D-West Covina would impose a $2 per pack tax on cigarettes and provide an annual increase of $230 million for regional centers and service providers. “California’s developmental disability system has been struggling for many years – it’s time that system sees some benefit from California’s economic recovery,” Sen. Hernandez said in an email. “I remain hopeful that we are able to use this special session to provide long overdue relief to the (Department of Developmental Services) community.\"\u003c/p>\n\u003cp>Legislators across party lines seem to be in general agreement that provider rates need to increase, but they differ on how much of an increase is needed -- and strategies for funding it. One issue is that agencies serving people with developmental disabilities have not been required to submit a statement of their annual costs to the regional centers in over 10 years.\u003c/p>\n\u003cp>“That said, it begs the question of: what then is the appropriate rate?” says Mark Newton, a policy analyst from the nonpartisan Legislative Analyst’s Office. “That’s a tough issue in a way, because of a lack of collected and reported cost data that would help address a formulation of an appropriate rate structure.”\u003c/p>\n\u003cp>Although the legislative special session is still open, Legislators have not met since September 11, and there is no sign they will be reconvening before the end of the year. Hernandez's bill to address rate increases for developmental services sits waiting.\u003c/p>\n\u003cp>Luter from The Arc of Alameda County is concerned that programs throughout California will continue to go out of business -- and clients will be turned away -- if the special session remains silent over the next few months.\u003c/p>\n\u003cp>While they wait for the special session to reconvene, \u003ca href=\"http://www.supportedliving.com/page-1149271\" target=\"_blank\">advocates are planning a march\u003c/a> to the state Capitol on Dec. 10. Luter says he will carry a coffin in the protest, symbolizing what he calls the \"death” of the Lanterman Act. “We’re not treating these folks as if they’re part of the fabric of the community,” he says.\u003c/p>\n\u003cp>\u003cstrong>\"Terrified for My Daughter's Future\"\u003c/strong>\u003c/p>\n\u003cp>Valerie deChadenedes, 30, of San Francisco, was diagnosed with Rett syndrome when she was 10. It's a rare neurodevelopmental disorder that inhibits brain growth and motor skills. Her story is a warning for others like Michael Palone in Alameda County or the children from Lynn Center if they’re unable to find other services once their programs close.\u003c/p>\n\u003cfigure id=\"attachment_114035\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/11/Audreyval2-e1448505857674.jpg\">\u003cimg class=\"size-thumbnail wp-image-114035\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/11/Audreyval2-400x267.jpg\" alt=\"Valerie deChadenedes (L) with her mother Audrey.\" width=\"400\" height=\"267\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Valerie deChadenedes (L) with her mother Audrey. \u003ccite>(Melissa Hellmann)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>DeChadenedes is unable to walk, talk or feed herself and needs assistance for many aspects of her life. But her mother, Audrey, says Valerie does enjoy being social with people her own age. She can put words together into sentences through an eye-tracking communication device mounted on her wheelchair.\u003c/p>\n\u003cp>After she completed school eight years ago, she spent four years on a wait list before being placed into a program that could serve someone with her needs. She took art classes there and learned to be more self-sufficient.\u003c/p>\n\u003cp>But five months ago, she was forced to leave the program when it turned out not to be licensed to provide care for medically fragile clients. Her case manager at the Golden Gate Regional Center said that there is no other day program in San Francisco that will be able to address her needs. While it wasn't budget cuts that forced her out, if it's already hard to find services, one wonders how much worse it will get as other programs shut down.\u003c/p>\n\u003cp>Valerie now spends her days at a self-directed program organized by her mother. “If it weren’t for me, what would happen to Valerie?” Audrey deChadenedes wonders. After she was released from the program, Audrey said that Valerie would continuously say, “I feel lonely,” through her communication device.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>Frustrated by what she considered inertia in the legislature, Audrey deChadenedes started writing weekly letters to Gov. Jerry Brown and keeping a blog called \u003ca href=\"https://valeriesweekinreview.wordpress.com/\" target=\"_blank\">\u003ci>Valerie’s Week in Review\u003c/i>\u003c/a>, where she details Valerie’s health and the actions she’s taking to find Valerie a new program and an apartment. In her last blog post on Nov. 3, Audrey closed this way: “As great direct-service people quit to make a living wage, as programs close, as things fall apart all around us, I am terrified for my daughter’s future.”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Surrounded by stacks of packages in a brightly lit room, Michael Palone gingerly folded a box and taped it shut. His eyes averted, he shuffled to the front of the warehouse to retrieve scissors, skirting by people and tables in his path.\u003c/p>\n\u003cp>Palone, 26, has mild autism, originally diagnosed as Asperger's syndrome. The condition makes it nearly impossible for him to socialize with others and adjust to the constant changes of a full time job. Instead, he assembles packages with about 40 others at a Union City work center run by The Arc of Alameda County.\u003c/p>\n\u003caside class=\"pullquote alignright\">'If he doesn’t keep going to this program, all of the progress that he’s made over the past two years will just be gone in two weeks.'\u003cbr>\n\u003ccite>Rosemary Palone, mother of 26-year-old son with autism\u003c/cite>\u003c/aside>\n\u003cp>The Arc is a national nonprofit with local chapters across the country, including 21 in California, that offer programs and services for people with developmental disabilities. “It means a lot to me,\" Palone says. \"It gets me out of the house, and it helps me interact with people.\"\u003c/p>\n\u003cp>Before joining the work activity center, Palone mostly stayed at home, in his room, playing computer games all day. He couldn’t complete simple tasks like doing his laundry without his mother’s help. But since he joined The Arc two years ago, his mother, Rosemary, said that the change in his behavior has been remarkable.\u003c/p>\n\u003cp>“When I first found out how good the program was for him, it made me cry,” she said. Now Michael voluntarily joins her on trips to the grocery store, sits with the family in the living room and even washes his own clothes without needing a reminder. Plus, his work is paid. He earns about $300 per month, which he uses to buy magic cards or to treat his niece to lunch. “We talk more now than we ever did throughout his entire childhood,” Rosemary Palone says.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>But she fears that her son will return to his former, reclusive ways. Due to a lack of funding and the increasing cost of living in the San Francisco Bay Area, The Arc can no longer shoulder the costs of running the program, and plans to close the work center in a few months. Rosemary Palone worries that Michael -- and other clients like him -- will have nowhere else to go. “If he doesn’t keep going to this program, all of the progress that he’s made over the past two years will just be gone in two weeks,” she said.\u003c/p>\n\u003cfigure id=\"attachment_114034\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/11/IMG_3159-copy-e1448505797296.jpg\">\u003cimg class=\"size-thumbnail wp-image-114034\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/11/IMG_3159-copy-400x267.jpg\" alt=\"Ron Luter (R) is executive director of The Arc of Alameda County. \" width=\"400\" height=\"267\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Ron Luter (R) is executive director of The Arc of Alameda County. \u003ccite>(Melissa Hellmann)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The work activity center is funded through a combination of state and federal money. But Ron Luter, president and CEO of The Arc of Alameda County, says it's not enough to cover costs, and it's hurting the rest of the agency.\u003c/p>\n\u003cp>“The work activity center is really pulling this facility down,” Luter says.\u003cb>\u003ci> \u003c/i>\u003c/b>During its heyday, the workshop bustled with activity as the main co-packager for Ghirardelli Chocolate, but it lost the contract and the additional revenue when the company moved its packaging facility to Modesto several years ago. Now packaging machines sit in the room collecting dust and have been out of operation for years.\u003c/p>\n\u003cp>Although The Arc of Alameda County’s annual budget is $5 million, Luter said that the four centers he heads throughout the East Bay have collectively lost about $1 million over the past three years. To offset the debt, Luter's been running clothing drives and dipping into savings from the sale of two former Arc of Alameda properties, but the pool of extra money will soon run dry, he says.\u003c/p>\n\u003cp>The Arc of Alameda’s plight echoes that of similar organizations across the state. California was once known as a pioneer for spearheading alternatives to confining people with developmental disabilities in state-run institutions that were notoriously overcrowded and separated patients from their loved ones.\u003c/p>\n\u003cp>In 1965 the California legislature passed AB 691, a pilot program that \u003ca href=\"http://www.dds.ca.gov/Publications/HistoricPub/1969_RCsfortheMR_First2Yrs.pdf\" target=\"_blank\">created the first regional centers\u003c/a>. These agencies were designed to coordinate community-based services so people with developmental disabilities could live independently or with their families. Today there are 21 non-profit regional centers across California that handle case management and program development, among many other services.\u003c/p>\n\u003cp>But in the wake of The Great Recession, more than $1 billion in state budget cuts has threatened the system. In a grimly-titled report, \u003cem>\u003ca href=\"http://arcanet.org/wp-content/uploads/2015/02/on-the-brink-of-collapse.pdf\" target=\"_blank\">On the Brink of Collapse\u003c/a>\u003c/em>, the Association of Regional Center Agencies (ARCA) said California “continues to lose ground” and noted that the state has the lowest funding in the country for individuals with a developmental disability who qualify for services.\u003c/p>\n\u003cp>In addition, provider rates for organizations have been frozen \u003ca href=\"http://www.chhs.ca.gov/DCTFDocs/2_Revised%2520Rate%2520Process%2520Overview.pdf\">since 2003\u003c/a>, meaning that agencies are running on a rate model that was created over a decade ago. The situation is especially pronounced in the expensive Bay Area, yet provider rates are the same statewide, despite the varied costs of living.\u003c/p>\n\u003cp>Eileen Richey, executive director of ARCA, says the lack of funding puts Californians with developmental disabilities at continued risk. “All of these challenges now mean that more people have to wait to get into\u003ci> \u003c/i>a\u003ci> \u003c/i>program,” Richey said. “And everyone throughout the system ends up having to do more with less ... continually worsening the quality of life for people with developmental disabilities and their families.”\u003c/p>\n\u003cp>Richey added that it’s nearly impossible to find qualified, long-term staff to work at the rate the organizations offer. Constant staff turnover makes providing quality care even more challenging.\u003c/p>\n\u003cp>\"The turnover rate is so high,\" Luter of The Arc of Alameda says of his dwindling staff. \"We’re competing with people for jobs at In-N-Out Burger. Half of the people who work for me have two jobs just to survive.\" At his work activity center, Luter said that the ratio of clients to staff should be 10 to 1, but it’s currently double that because he can’t afford to pay any more workers.\u003c/p>\n\u003cp>The work activity center at The Arc of Alameda in Union City is just one of the programs in the Bay Area that will be shutting down over the next few months because of funding issues. Luter also plans on closing his child care program in Hayward, where he said deficits have run between $40,000-$100,000 per year since 2010. The center serves children ages 2-5 with mild to moderate disabilities or developmental delays.\u003c/p>\n\u003cp>\u003cstrong>Brentwood Center Closing Monday\u003c/strong>\u003c/p>\n\u003cp>A combination of factors forced Barbara Maizie, executive director of \u003ca href=\"http://www.contracostaarc.com\" target=\"_blank\">Contra Costa ARC\u003c/a>, to decide to close the Lynn Center, a program serving children 15 months to 5 years with developmental delays and autism. Monday will be its last day.\u003c/p>\n\u003cp>Maizie says the low funding levels had already strained her agency. Then the Lynn Center faced relocation when the elementary school housing its program was taken back by the district. Maizie realized that they couldn’t afford the relocation costs and gave up hope.\u003c/p>\n\u003cp>“There have been many challenges to running this program in the past and we were always able to rise to the occasion,\" she says, \"but the funding has just become so impossible that we can’t any longer.”\u003c/p>\n\u003caside class=\"pullquote alignright\">'California’s developmental disability system has been struggling for many years – it’s time that system sees some benefit from California’s economic recovery.'\u003cbr>\n\u003ccite>Sen. Ed Hernandez, D-West Covina\u003c/cite>\u003c/aside>\n\u003cp>The staff and 14 remaining children are bracing for the last day. Caseworkers at the East Bay Regional Center are scrambling to find replacement programs for each of the kids, but there’s a chance that some might not find an appropriate match.\u003c/p>\n\u003cp>Lynn Center is the fourth closure her agency has seen over the last year, says Ronke Sodipo, director of community services at the Regional Center of the East Bay. The nonprofit agency works with California's Department of Developmental Services to coordinate programs in Alameda and Contra Costa counties for people with developmental disabilities. Out of the 102 clients in the closed programs, she says, up to half have not yet been placed in another center.\u003c/p>\n\u003cp>Sodipo added that recent changes in labor laws have exacerbated funding issues for the scores of organizations that provide services throughout the East Bay. A new statewide \u003ca href=\"http://www.dir.ca.gov/dlse/Paid_Sick_Leave.htm\" target=\"_blank\">paid sick leave law\u003c/a>, the Affordable Care Act requirement that employers with more than 50 full time employees provide health insurance, an increase in overtime pay and the raised minimum wage in Oakland and Emeryville have all created additional costs for the organizations, Sodipo says.\u003c/p>\n\u003cp>“I don’t know that our service providers would be as severely impacted if their costs were taken into consideration and they were given rate adjustments to absorb some of it,” she said.\u003c/p>\n\u003cp>\u003cstrong>Advocating for Change\u003c/strong>\u003c/p>\n\u003cp>Seeking to address the losses from years of underfunding, \u003ca href=\"http://www.lantermancoalition.org\" target=\"_blank\">The Lanterman Coalition\u003c/a> — an alliance of 20 organizations and businesses including agencies that provide services for those with disabilities and advocacy groups — took action earlier this year and lobbied state legislators for a 10 percent across-the-board funding increase for service providers. The proposal was ultimately removed from the state budget that was signed in June. But Brown then called a \"special session\" of the Legislature, to address this funding question and other particularly challenging fiscal issues.\u003c/p>\n\u003cp>\u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201520162SB14\" target=\"_blank\">A bill \u003c/a>proposed by Sen. Ed Hernandez, D-West Covina would impose a $2 per pack tax on cigarettes and provide an annual increase of $230 million for regional centers and service providers. “California’s developmental disability system has been struggling for many years – it’s time that system sees some benefit from California’s economic recovery,” Sen. Hernandez said in an email. “I remain hopeful that we are able to use this special session to provide long overdue relief to the (Department of Developmental Services) community.\"\u003c/p>\n\u003cp>Legislators across party lines seem to be in general agreement that provider rates need to increase, but they differ on how much of an increase is needed -- and strategies for funding it. One issue is that agencies serving people with developmental disabilities have not been required to submit a statement of their annual costs to the regional centers in over 10 years.\u003c/p>\n\u003cp>“That said, it begs the question of: what then is the appropriate rate?” says Mark Newton, a policy analyst from the nonpartisan Legislative Analyst’s Office. “That’s a tough issue in a way, because of a lack of collected and reported cost data that would help address a formulation of an appropriate rate structure.”\u003c/p>\n\u003cp>Although the legislative special session is still open, Legislators have not met since September 11, and there is no sign they will be reconvening before the end of the year. Hernandez's bill to address rate increases for developmental services sits waiting.\u003c/p>\n\u003cp>Luter from The Arc of Alameda County is concerned that programs throughout California will continue to go out of business -- and clients will be turned away -- if the special session remains silent over the next few months.\u003c/p>\n\u003cp>While they wait for the special session to reconvene, \u003ca href=\"http://www.supportedliving.com/page-1149271\" target=\"_blank\">advocates are planning a march\u003c/a> to the state Capitol on Dec. 10. Luter says he will carry a coffin in the protest, symbolizing what he calls the \"death” of the Lanterman Act. “We’re not treating these folks as if they’re part of the fabric of the community,” he says.\u003c/p>\n\u003cp>\u003cstrong>\"Terrified for My Daughter's Future\"\u003c/strong>\u003c/p>\n\u003cp>Valerie deChadenedes, 30, of San Francisco, was diagnosed with Rett syndrome when she was 10. It's a rare neurodevelopmental disorder that inhibits brain growth and motor skills. Her story is a warning for others like Michael Palone in Alameda County or the children from Lynn Center if they’re unable to find other services once their programs close.\u003c/p>\n\u003cfigure id=\"attachment_114035\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/11/Audreyval2-e1448505857674.jpg\">\u003cimg class=\"size-thumbnail wp-image-114035\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/11/Audreyval2-400x267.jpg\" alt=\"Valerie deChadenedes (L) with her mother Audrey.\" width=\"400\" height=\"267\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Valerie deChadenedes (L) with her mother Audrey. \u003ccite>(Melissa Hellmann)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>DeChadenedes is unable to walk, talk or feed herself and needs assistance for many aspects of her life. But her mother, Audrey, says Valerie does enjoy being social with people her own age. She can put words together into sentences through an eye-tracking communication device mounted on her wheelchair.\u003c/p>\n\u003cp>After she completed school eight years ago, she spent four years on a wait list before being placed into a program that could serve someone with her needs. She took art classes there and learned to be more self-sufficient.\u003c/p>\n\u003cp>But five months ago, she was forced to leave the program when it turned out not to be licensed to provide care for medically fragile clients. Her case manager at the Golden Gate Regional Center said that there is no other day program in San Francisco that will be able to address her needs. While it wasn't budget cuts that forced her out, if it's already hard to find services, one wonders how much worse it will get as other programs shut down.\u003c/p>\n\u003cp>Valerie now spends her days at a self-directed program organized by her mother. “If it weren’t for me, what would happen to Valerie?” Audrey deChadenedes wonders. After she was released from the program, Audrey said that Valerie would continuously say, “I feel lonely,” through her communication device.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Frustrated by what she considered inertia in the legislature, Audrey deChadenedes started writing weekly letters to Gov. Jerry Brown and keeping a blog called \u003ca href=\"https://valeriesweekinreview.wordpress.com/\" target=\"_blank\">\u003ci>Valerie’s Week in Review\u003c/i>\u003c/a>, where she details Valerie’s health and the actions she’s taking to find Valerie a new program and an apartment. In her last blog post on Nov. 3, Audrey closed this way: “As great direct-service people quit to make a living wage, as programs close, as things fall apart all around us, I am terrified for my daughter’s future.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "The Power of Gratitude to Help a Damaged Heart",
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"content": "\u003cp>Back in March of 2013, Natalie Price was going through some hard times. She had just lost her job, was going through a divorce, and she and her two kids had to move back into her parents' house.\u003c/p>\n\u003cp>“I was so stressed out,” says Price, who lives in San Diego. “I remember going to bed that night thinking, ‘Tomorrow when I wake up, I’m going to be stressing all day about how I can’t take care of everything I need to take care of.’ ”\u003c/p>\n\u003cp>Instead, she awoke at 2 a.m. with a pain in her hand and arm. She was having a heart attack.\u003c/p>\n\u003cp>Price recovered at the UC San Diego Medical Center. But the heart attack had weakened her heart enough to put her at risk for\u003ca href=\"http://www.heart.org/HEARTORG/Conditions/HeartFailure/Heart-Failure_UCM_002019_SubHomePage.jsp#\" target=\"_blank\"> heart failure\u003c/a>.\u003c/p>\n\u003cp>That's when she learned about an unusual study that might help her recovery. It wasn't about a new drug. Instead, researchers were looking at the experience of gratitude and how it might affect people at risk for heart failure. One of the things Price and the other participants were asked to do was to write journal entries about what they were grateful for each day.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>For Price, it was hard. She says that on some days she felt like she had nothing to be grateful for. Still, the exercise got her thinking more about the things that made her happy, like walking on the beach and playing music at her church.\u003c/p>\n\u003cp>UC San Diego School of Medicine clinical research coordinator \u003ca href=\"http://fmph.ucsd.edu/integrative-health/coe/people-contacts.html\">Meredith Pung\u003c/a> was a co-author of the gratitude study. She says keeping a gratitude journal is like strength training for the heart. Altogether, researchers looked at 186 people at risk for heart failure.\u003c/p>\n\u003cp>“So they (had) some evidence of structural abnormalities that you can see on their heart if you use an echocardiogram,” Pung says of participants. “But they don’t yet have any signs or symptoms of heart failure.”\u003c/p>\n\u003cp>[soundcloud url=\"https://api.soundcloud.com/tracks/234739716\" params=\"color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" iframe=\"true\" /]Heart failure happens when the heart isn’t getting enough blood. People who have had heart attacks, like Price, are at higher risk of developing it. And half of those with\u003ca href=\"http://www.cdc.gov/DHDSP/data_statistics/fact_sheets/fs_heart_failure.htm\"> heart failure die within five years of diagnosis\u003c/a>.\u003c/p>\n\u003cp>Pung says the study participants who kept a gratitude journal for eight weeks showed signs of a healthier heart afterward. Subjects who didn’t keep a journal did not show improvement. The results were\u003ca href=\"http://www.apa.org/pubs/journals/releases/scp-0000050.pdf\" target=\"_blank\"> published \u003c/a>by the American Psychological Association in its journal, Spirituality in Clinical Practice.\u003c/p>\n\u003cp>“So the heart just needs a break, right?” says Pung. “With grateful contemplation and gratitude journaling, that allows a little break, a physiological break for the heart, and it allows it to continue its job for as long as we need it.”\u003c/p>\n\u003cp>I visited Pung’s lab at UC San Diego to see how the study works.\u003c/p>\n\u003cp>First, participants put on a device called a bio harness, a device connected to a computer that monitored a participant's heart rate. Then Pung asked them to write in a journal for five minutes detailing what they were grateful for.\u003c/p>\n\u003cp>Then researchers looked at heart rate variability onscreen.\u003c/p>\n\u003cp>“While you’re journaling, what it would end up looking like on the screen is the peaks,\" Pung explains. \"Some would be closer together, some would be further apart. Instead of boom, boom, boom, all equal distances apart. And that [variability] is what we want to see in a healthy individual.”\u003c/p>\n\u003cp>Blood analysis from the UCSD study suggests that more grateful patients were at lower risk of heart failure. These patients also reported fewer symptoms of depression, better sleep, and they felt empowered to take care of their health.\u003c/p>\n\u003cp>Natalie Price says gratitude journaling got her out of her depression and back on her feet. Two years ago, she couldn’t walk down the street without gasping for breath. Today, she walks to work almost every day.\u003c/p>\n\u003cp>“And I joined a gym,” she says. “It was enjoyable. I started doing my physical activities, and I became more cognizant of my health, of what I ate. And I still am.”\u003c/p>\n\u003cp>Price’s life hasn’t become easy. She’s still in the middle of a nasty divorce, still trying to make ends meet. But now when she gets stressed out, she picks up a paper and pen and writes about the things she can be grateful for in her life.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This is story is a part of a \u003ca href=\"https://soundcloud.com/ben-manilla-productions/the-science-of-gratitude-full-episode\" target=\"_blank\">one-hour documentary\u003c/a> on the science of gratitude for Public Radio International. It will be broadcast in December on KQED.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Back in March of 2013, Natalie Price was going through some hard times. She had just lost her job, was going through a divorce, and she and her two kids had to move back into her parents' house.\u003c/p>\n\u003cp>“I was so stressed out,” says Price, who lives in San Diego. “I remember going to bed that night thinking, ‘Tomorrow when I wake up, I’m going to be stressing all day about how I can’t take care of everything I need to take care of.’ ”\u003c/p>\n\u003cp>Instead, she awoke at 2 a.m. with a pain in her hand and arm. She was having a heart attack.\u003c/p>\n\u003cp>Price recovered at the UC San Diego Medical Center. But the heart attack had weakened her heart enough to put her at risk for\u003ca href=\"http://www.heart.org/HEARTORG/Conditions/HeartFailure/Heart-Failure_UCM_002019_SubHomePage.jsp#\" target=\"_blank\"> heart failure\u003c/a>.\u003c/p>\n\u003cp>That's when she learned about an unusual study that might help her recovery. It wasn't about a new drug. Instead, researchers were looking at the experience of gratitude and how it might affect people at risk for heart failure. One of the things Price and the other participants were asked to do was to write journal entries about what they were grateful for each day.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>For Price, it was hard. She says that on some days she felt like she had nothing to be grateful for. Still, the exercise got her thinking more about the things that made her happy, like walking on the beach and playing music at her church.\u003c/p>\n\u003cp>UC San Diego School of Medicine clinical research coordinator \u003ca href=\"http://fmph.ucsd.edu/integrative-health/coe/people-contacts.html\">Meredith Pung\u003c/a> was a co-author of the gratitude study. She says keeping a gratitude journal is like strength training for the heart. Altogether, researchers looked at 186 people at risk for heart failure.\u003c/p>\n\u003cp>“So they (had) some evidence of structural abnormalities that you can see on their heart if you use an echocardiogram,” Pung says of participants. “But they don’t yet have any signs or symptoms of heart failure.”\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/234739716&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/234739716'>\n \u003c/iframe>\n \u003c/div>\u003c/p>\u003cp>Heart failure happens when the heart isn’t getting enough blood. People who have had heart attacks, like Price, are at higher risk of developing it. And half of those with\u003ca href=\"http://www.cdc.gov/DHDSP/data_statistics/fact_sheets/fs_heart_failure.htm\"> heart failure die within five years of diagnosis\u003c/a>.\u003c/p>\n\u003cp>Pung says the study participants who kept a gratitude journal for eight weeks showed signs of a healthier heart afterward. Subjects who didn’t keep a journal did not show improvement. The results were\u003ca href=\"http://www.apa.org/pubs/journals/releases/scp-0000050.pdf\" target=\"_blank\"> published \u003c/a>by the American Psychological Association in its journal, Spirituality in Clinical Practice.\u003c/p>\n\u003cp>“So the heart just needs a break, right?” says Pung. “With grateful contemplation and gratitude journaling, that allows a little break, a physiological break for the heart, and it allows it to continue its job for as long as we need it.”\u003c/p>\n\u003cp>I visited Pung’s lab at UC San Diego to see how the study works.\u003c/p>\n\u003cp>First, participants put on a device called a bio harness, a device connected to a computer that monitored a participant's heart rate. Then Pung asked them to write in a journal for five minutes detailing what they were grateful for.\u003c/p>\n\u003cp>Then researchers looked at heart rate variability onscreen.\u003c/p>\n\u003cp>“While you’re journaling, what it would end up looking like on the screen is the peaks,\" Pung explains. \"Some would be closer together, some would be further apart. Instead of boom, boom, boom, all equal distances apart. And that [variability] is what we want to see in a healthy individual.”\u003c/p>\n\u003cp>Blood analysis from the UCSD study suggests that more grateful patients were at lower risk of heart failure. These patients also reported fewer symptoms of depression, better sleep, and they felt empowered to take care of their health.\u003c/p>\n\u003cp>Natalie Price says gratitude journaling got her out of her depression and back on her feet. Two years ago, she couldn’t walk down the street without gasping for breath. Today, she walks to work almost every day.\u003c/p>\n\u003cp>“And I joined a gym,” she says. “It was enjoyable. I started doing my physical activities, and I became more cognizant of my health, of what I ate. And I still am.”\u003c/p>\n\u003cp>Price’s life hasn’t become easy. She’s still in the middle of a nasty divorce, still trying to make ends meet. But now when she gets stressed out, she picks up a paper and pen and writes about the things she can be grateful for in her life.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This is story is a part of a \u003ca href=\"https://soundcloud.com/ben-manilla-productions/the-science-of-gratitude-full-episode\" target=\"_blank\">one-hour documentary\u003c/a> on the science of gratitude for Public Radio International. It will be broadcast in December on KQED.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Sophie Sartain had long worked in documentary filmmaking as a writer and editor. For her first film as a director, she turned the camera on her own family.\u003c/p>\n\u003cp>Starting in 2009, she began filming her grandmother Mimi, then 92, who had cared for Sartain's aunt, Dona, for decades. Dona has an intellectual disability and \"perhaps some undiagnosed autism,\" Sartain says. From there the film \u003cem>\u003ca href=\"http://www.pbs.org/independentlens/films/mimi-and-dona/\" target=\"_blank\">Mimi and Dona\u003c/a>\u003c/em> was born. It was released earlier this week on PBS' \u003ca href=\"http://www.pbs.org/independentlens/films/mimi-and-dona/\" target=\"_blank\">\u003cem>Independent Lens\u003c/em>\u003c/a>.\u003c/p>\n\u003cp>Sartain's grandmother was a \"wonderful moving presence\" who selflessly devoted herself to caring for her daughter. \"Could I be like that?\" Sartain wondered. \"I'm not that good, I'm not that unselfish. How could I measure up to Mimi?\"\u003c/p>\n\u003cp>But soon she would discover how her own path would overlap with that of her grandmother. \"It was during filming that I started to fear my own son might have autism,\" Sartain says. \"And I wondered if I was just beginning a journey that Mimi had just ended.\"\u003c/p>\n\u003cp>Her son Ben was diagnosed with autism. Sartain says she saw how her grandmother could be a role model for her and created this second, shorter, documentary, \u003cem>Sophie and Ben\u003c/em>.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cem>Mimi and Dona\u003ca href=\"http://video.pbs.org/video/2365601272/\" target=\"_blank\"> is streaming online through Dec. 23, 2015.\u003c/a> \u003c/em>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>You can learn more about the film and filmmaker Sophie Sartain by visiting \u003ca href=\"http://www.pbs.org/independentlens/films/mimi-and-dona/\" target=\"_blank\">Independent Lens\u003c/a>. \u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Sophie Sartain had long worked in documentary filmmaking as a writer and editor. For her first film as a director, she turned the camera on her own family.\u003c/p>\n\u003cp>Starting in 2009, she began filming her grandmother Mimi, then 92, who had cared for Sartain's aunt, Dona, for decades. Dona has an intellectual disability and \"perhaps some undiagnosed autism,\" Sartain says. From there the film \u003cem>\u003ca href=\"http://www.pbs.org/independentlens/films/mimi-and-dona/\" target=\"_blank\">Mimi and Dona\u003c/a>\u003c/em> was born. It was released earlier this week on PBS' \u003ca href=\"http://www.pbs.org/independentlens/films/mimi-and-dona/\" target=\"_blank\">\u003cem>Independent Lens\u003c/em>\u003c/a>.\u003c/p>\n\u003cp>Sartain's grandmother was a \"wonderful moving presence\" who selflessly devoted herself to caring for her daughter. \"Could I be like that?\" Sartain wondered. \"I'm not that good, I'm not that unselfish. How could I measure up to Mimi?\"\u003c/p>\n\u003cp>But soon she would discover how her own path would overlap with that of her grandmother. \"It was during filming that I started to fear my own son might have autism,\" Sartain says. \"And I wondered if I was just beginning a journey that Mimi had just ended.\"\u003c/p>\n\u003cp>Her son Ben was diagnosed with autism. Sartain says she saw how her grandmother could be a role model for her and created this second, shorter, documentary, \u003cem>Sophie and Ben\u003c/em>.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>Mimi and Dona\u003ca href=\"http://video.pbs.org/video/2365601272/\" target=\"_blank\"> is streaming online through Dec. 23, 2015.\u003c/a> \u003c/em>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>You can learn more about the film and filmmaker Sophie Sartain by visiting \u003ca href=\"http://www.pbs.org/independentlens/films/mimi-and-dona/\" target=\"_blank\">Independent Lens\u003c/a>. \u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "$1 Billion at Risk in California Fight Over Medi-Cal Managed Care Tax",
"title": "$1 Billion at Risk in California Fight Over Medi-Cal Managed Care Tax",
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"content": "\u003cp>California lawmakers are staring down a $1.1 billion hole in next year’s health budget after failing to come up with a way to replace the state’s “managed care organization tax” on health insurance plans that serve Medi-Cal managed care recipients.\u003c/p>\n\u003cp>It’s a hole big enough that state Gov. Jerry Brown recently used it as a reason to\u003ca href=\"http://ww2.kqed.org/news/2015/10/10/governors-vetoes-poke-lawmakers-on-special-session-failure\" target=\"_blank\"> veto 15 health care and other bills\u003c/a> sent to him by the state legislature. And unless it’s filled, Brown, a Democrat, is expected to issue a preliminary state budget in January with sizeable cuts to health and human services programs.\u003c/p>\n\u003cp>So far, the governor’s efforts to fill the void haven’t paid off. Brown in June had \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/07/06/legislators-take-on-health-spending-in-extraordinary-session/\" target=\"_blank\">called a special legislative session \u003c/a>to find other revenues to replace the tax, which the federal government says doesn’t meet regulations. That session is ongoing, and an informational hearing on the managed care organization tax is scheduled for Dec. 1 in Los Angeles, but getting everyone back to the negotiation table is proving difficult.\u003c/p>\n\u003cp>At the same time, state officials face other pressures on their Medi-Cal program, which has a total budget of $91.6 billion. After much delay, \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/10/31/california-feds-reach-deal-on-medicaid-reform/\" target=\"_blank\">health officials only recently came to agreement in principle\u003c/a> with the federal government on how to fund reforms in Medi-Cal services. And federal officials approved less than half the $17 billion the state had originally sought.\u003c/p>\n\u003cp>Some observers say they don’t expect a deal on the managed care organization tax until the middle of next year, when federal officials have said the tax must end. While there may be closed-door discussions between insurers and state officials to find a solution, no one will talk publicly about them.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“In some ways, people are willing to walk away right now because they still have time,” said Shannon McConville, research associate at the Public Policy Institute of California.\u003c/p>\n\u003cp>The prospect of more than billion in budget cuts, however, could provide motivation for a deal.\u003c/p>\n\u003cp>“It’s unfortunate we got to this place, but when the governor’s budget comes out, there will be tremendous pressure” to fix the tax issue, said Maya Altman, CEO of Health Plan of San Mateo, which serves Medi-Cal managed care recipients.\u003c/p>\n\u003cp>She said budget cuts could make it difficult to raise already-low reimbursement rates for doctors, and almost certainly would reduce services for developmentally delayed children, the elderly and the disabled.\u003c/p>\n\u003cp>The problem is, the way California is taxing health care insurers and providers may be illegal under federal law. For years, the state has required managed care plans serving Medi-Cal recipients to pay a special health care tax. Because the federal government matches state funds spent on Medi-Cal, beefing up the state’s Medi-Cal budget has allowed the state to draw down more money from Washington.\u003c/p>\n\u003cp>The state then in effect reimburses the insurers for those tax payments through a complicated scheme involving payment of insurers’ administrative costs and the services they provide to Medi-Cal patients.\u003c/p>\n\u003cp>But Congress in 2005 changed tax law to try to end this practice, and last year the federal government warned California and other states still assessing these taxes that they have to tax all managed care plans, not just those serving Medicaid patients. The rationale: to lessen the financial burden on the federal Medicaid program and tax health insurance providers more equitably.\u003c/p>\n\u003cp>States with taxes that don’t meet federal guidelines must change or end them, or risk the loss of hundreds of millions of federal Medicaid dollars.\u003c/p>\n\u003cp>But managed care plans that don’t serve Medi-Cal patients – and thus would not benefit from reimbursements under the program – are resisting new state taxes. Those added costs would be passed on to consumers, the insurers have said.\u003c/p>\n\u003cp>A proposal from state health officials and backed by some Democratic state legislators to replace the tax in California with a new tax on all managed care insurers, based on their number of enrollees, \u003ca href=\"http://www.californiahealthline.org/capitol-desk/2015/9/managed-care-tax-left-hanging\" target=\"_blank\">was roundly rejected by the state’s insurers \u003c/a>and the state’s Republican legislators. In opposing the proposal, the California Association of Health Plans cited excessive costs for its members.\u003c/p>\n\u003cp>The opposition drew a stinging statement from Diana Dooley, secretary of the California Health and Human Services Agency.\u003c/p>\n\u003cp>“It is now up to the plans which refused to endorse this proposal, and the Republicans who refused to consider it, to stop drawing lines and start putting solutions on the table,” she wrote.\u003c/p>\n\u003cp>California isn’t the only state in this mess. Pennsylvania was singled out by the U.S. Health and Human Services’ Inspector General for having a tax that didn’t comply with federal law. The Keystone state hasn’t been able to reach a deal with its insurers, either.\u003c/p>\n\u003cp>“Discussions are ongoing,”’ was the terse statement from Doug Furness, director of government affairs for the Insurance Federation of Pennsylvania. A spokeswoman for the Pennsylvania health agency overseeing Medicaid declined to comment.\u003c/p>\n\u003cp>Ohio officials were similarly tight-lipped about negotiations regarding the state’s tax, which, like California’s, can’t pass muster with federal officials. Michigan, as well, is wrestling with a similar health tax that may not be legal.\u003c/p>\n\u003cp>But other states have been able to change their health provider taxes to comply with the law, said Cindy Mann, a former top official with the Centers for Medicare & Medicaid Services who wrote the agency’s 2014 “guidance letter” warning states about the tax issue.\u003c/p>\n\u003cp>In California, Democratic lawmakers have proposed raising taxes on tobacco and cocktails in bars and restaurants to help pay for health services, but the proposals stalled in the legislature. Now, health advocates, lobbying groups and health worker unions including the American Lung Association, the California Medical Association and SEIU are pushing to place a $2-per-pack cigarette tax on the November 2016 ballot, which could raise an estimated $1.5 billion in its first year.\u003c/p>\n\u003cp>In the meantime, the backroom discussions will continue among insurers, legislators and state health officials on how to replace the managed care organization tax’s revenues.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“While it’s possible that this becomes a stalemate, it’s also possible that the health insurance industry acknowledges that a billion dollars in cuts is too much of an apocalypse to not grudgingly come to some kind of compromise,” said Anthony Wright of Health Access, a statewide health advocacy group. “Nobody wants to see what a billion dollars of cuts to our health care system looks like.”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>California lawmakers are staring down a $1.1 billion hole in next year’s health budget after failing to come up with a way to replace the state’s “managed care organization tax” on health insurance plans that serve Medi-Cal managed care recipients.\u003c/p>\n\u003cp>It’s a hole big enough that state Gov. Jerry Brown recently used it as a reason to\u003ca href=\"http://ww2.kqed.org/news/2015/10/10/governors-vetoes-poke-lawmakers-on-special-session-failure\" target=\"_blank\"> veto 15 health care and other bills\u003c/a> sent to him by the state legislature. And unless it’s filled, Brown, a Democrat, is expected to issue a preliminary state budget in January with sizeable cuts to health and human services programs.\u003c/p>\n\u003cp>So far, the governor’s efforts to fill the void haven’t paid off. Brown in June had \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/07/06/legislators-take-on-health-spending-in-extraordinary-session/\" target=\"_blank\">called a special legislative session \u003c/a>to find other revenues to replace the tax, which the federal government says doesn’t meet regulations. That session is ongoing, and an informational hearing on the managed care organization tax is scheduled for Dec. 1 in Los Angeles, but getting everyone back to the negotiation table is proving difficult.\u003c/p>\n\u003cp>At the same time, state officials face other pressures on their Medi-Cal program, which has a total budget of $91.6 billion. After much delay, \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/10/31/california-feds-reach-deal-on-medicaid-reform/\" target=\"_blank\">health officials only recently came to agreement in principle\u003c/a> with the federal government on how to fund reforms in Medi-Cal services. And federal officials approved less than half the $17 billion the state had originally sought.\u003c/p>\n\u003cp>Some observers say they don’t expect a deal on the managed care organization tax until the middle of next year, when federal officials have said the tax must end. While there may be closed-door discussions between insurers and state officials to find a solution, no one will talk publicly about them.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“In some ways, people are willing to walk away right now because they still have time,” said Shannon McConville, research associate at the Public Policy Institute of California.\u003c/p>\n\u003cp>The prospect of more than billion in budget cuts, however, could provide motivation for a deal.\u003c/p>\n\u003cp>“It’s unfortunate we got to this place, but when the governor’s budget comes out, there will be tremendous pressure” to fix the tax issue, said Maya Altman, CEO of Health Plan of San Mateo, which serves Medi-Cal managed care recipients.\u003c/p>\n\u003cp>She said budget cuts could make it difficult to raise already-low reimbursement rates for doctors, and almost certainly would reduce services for developmentally delayed children, the elderly and the disabled.\u003c/p>\n\u003cp>The problem is, the way California is taxing health care insurers and providers may be illegal under federal law. For years, the state has required managed care plans serving Medi-Cal recipients to pay a special health care tax. Because the federal government matches state funds spent on Medi-Cal, beefing up the state’s Medi-Cal budget has allowed the state to draw down more money from Washington.\u003c/p>\n\u003cp>The state then in effect reimburses the insurers for those tax payments through a complicated scheme involving payment of insurers’ administrative costs and the services they provide to Medi-Cal patients.\u003c/p>\n\u003cp>But Congress in 2005 changed tax law to try to end this practice, and last year the federal government warned California and other states still assessing these taxes that they have to tax all managed care plans, not just those serving Medicaid patients. The rationale: to lessen the financial burden on the federal Medicaid program and tax health insurance providers more equitably.\u003c/p>\n\u003cp>States with taxes that don’t meet federal guidelines must change or end them, or risk the loss of hundreds of millions of federal Medicaid dollars.\u003c/p>\n\u003cp>But managed care plans that don’t serve Medi-Cal patients – and thus would not benefit from reimbursements under the program – are resisting new state taxes. Those added costs would be passed on to consumers, the insurers have said.\u003c/p>\n\u003cp>A proposal from state health officials and backed by some Democratic state legislators to replace the tax in California with a new tax on all managed care insurers, based on their number of enrollees, \u003ca href=\"http://www.californiahealthline.org/capitol-desk/2015/9/managed-care-tax-left-hanging\" target=\"_blank\">was roundly rejected by the state’s insurers \u003c/a>and the state’s Republican legislators. In opposing the proposal, the California Association of Health Plans cited excessive costs for its members.\u003c/p>\n\u003cp>The opposition drew a stinging statement from Diana Dooley, secretary of the California Health and Human Services Agency.\u003c/p>\n\u003cp>“It is now up to the plans which refused to endorse this proposal, and the Republicans who refused to consider it, to stop drawing lines and start putting solutions on the table,” she wrote.\u003c/p>\n\u003cp>California isn’t the only state in this mess. Pennsylvania was singled out by the U.S. Health and Human Services’ Inspector General for having a tax that didn’t comply with federal law. The Keystone state hasn’t been able to reach a deal with its insurers, either.\u003c/p>\n\u003cp>“Discussions are ongoing,”’ was the terse statement from Doug Furness, director of government affairs for the Insurance Federation of Pennsylvania. A spokeswoman for the Pennsylvania health agency overseeing Medicaid declined to comment.\u003c/p>\n\u003cp>Ohio officials were similarly tight-lipped about negotiations regarding the state’s tax, which, like California’s, can’t pass muster with federal officials. Michigan, as well, is wrestling with a similar health tax that may not be legal.\u003c/p>\n\u003cp>But other states have been able to change their health provider taxes to comply with the law, said Cindy Mann, a former top official with the Centers for Medicare & Medicaid Services who wrote the agency’s 2014 “guidance letter” warning states about the tax issue.\u003c/p>\n\u003cp>In California, Democratic lawmakers have proposed raising taxes on tobacco and cocktails in bars and restaurants to help pay for health services, but the proposals stalled in the legislature. Now, health advocates, lobbying groups and health worker unions including the American Lung Association, the California Medical Association and SEIU are pushing to place a $2-per-pack cigarette tax on the November 2016 ballot, which could raise an estimated $1.5 billion in its first year.\u003c/p>\n\u003cp>In the meantime, the backroom discussions will continue among insurers, legislators and state health officials on how to replace the managed care organization tax’s revenues.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“While it’s possible that this becomes a stalemate, it’s also possible that the health insurance industry acknowledges that a billion dollars in cuts is too much of an apocalypse to not grudgingly come to some kind of compromise,” said Anthony Wright of Health Access, a statewide health advocacy group. “Nobody wants to see what a billion dollars of cuts to our health care system looks like.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Nineteen people in seven states, including California, have contracted E. coli in an outbreak linked to chicken salad bought at Costco, federal health officials said Tuesday.\u003c/p>\n\u003cp>People who bought chicken salad at any U.S. Costco store on or before last Friday Nov. 20, were advised to throw it away, even if no one has gotten sick.\u003c/p>\n\u003cp>The strain of Shiga toxin-producing E. coli can be life-threatening, but no deaths have been reported in the current outbreak. The Centers for Disease Control and Prevention \u003ca href=\"http://www.cdc.gov/ecoli/2015/o157h7-11-15/index.html\" target=\"_blank\">said five people have been hospitalized\u003c/a> and two have developed a type of kidney failure.\u003c/p>\n\u003cp>The CDC and state health officials were investigating and have not yet determined what ingredient in the rotisserie chicken salad made and sold in Costco Wholesale stores could be the source of the outbreak.\u003c/p>\n\u003cp>Six people have become ill in Montana, five in Utah, four in Colorado and one each in California, Missouri, Virginia and Washington state. The CDC said the illness reports began on Oct. 6 and involved people from age 5 to 84.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The outbreak is \u003ca href=\"http://www.cdc.gov/ecoli/2015/o26-11-15/index.html\" target=\"_blank\">not related to a recent case involving Chipotle restaurants\u003c/a> in which more than 40 people were sickened. That strain was identified as E. coli 026.\u003c/p>\n\u003cp>The current strain has been identified as E. coli 157, which the CDC said is more likely to be life-threatening, especially in young children.\u003c/p>\n\u003cp>A call to Costco headquarters in Washington state seeking comment was not immediately returned.\u003c/p>\n\u003cp>Seattle attorney Bill Marler, who is representing people sickened in the previous Chipotle outbreak, said the current problem appears serious since two people have developed kidney failure. People were hospitalized in the Chipotle outbreak, but no one developed kidney failure.\u003c/p>\n\u003cp>Marler said the new case is a good example of why food safety is so crucial.\u003c/p>\n\u003cp>\"Costco has always been a leader in food safety at retail, it just goes to show you how important controlling your supply chain is,\" Marler said.\u003c/p>\n\u003cp>The human intestines contain hundreds of E. coli and similar bacteria strains. Most are harmless, but a few can cause serious problems.\u003c/p>\n\u003cp>Symptoms of E. coli infection include diarrhea, abdominal cramps, nausea and vomiting.\u003c/p>\n\u003cp>The bacteria are associated with animal waste but aren't just associated with meat. E. coli can be spread in indirect ways on produce.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Health officials say the incubation period is three to seven days from the time of exposure.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Nineteen people in seven states, including California, have contracted E. coli in an outbreak linked to chicken salad bought at Costco, federal health officials said Tuesday.\u003c/p>\n\u003cp>People who bought chicken salad at any U.S. Costco store on or before last Friday Nov. 20, were advised to throw it away, even if no one has gotten sick.\u003c/p>\n\u003cp>The strain of Shiga toxin-producing E. coli can be life-threatening, but no deaths have been reported in the current outbreak. The Centers for Disease Control and Prevention \u003ca href=\"http://www.cdc.gov/ecoli/2015/o157h7-11-15/index.html\" target=\"_blank\">said five people have been hospitalized\u003c/a> and two have developed a type of kidney failure.\u003c/p>\n\u003cp>The CDC and state health officials were investigating and have not yet determined what ingredient in the rotisserie chicken salad made and sold in Costco Wholesale stores could be the source of the outbreak.\u003c/p>\n\u003cp>Six people have become ill in Montana, five in Utah, four in Colorado and one each in California, Missouri, Virginia and Washington state. The CDC said the illness reports began on Oct. 6 and involved people from age 5 to 84.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The outbreak is \u003ca href=\"http://www.cdc.gov/ecoli/2015/o26-11-15/index.html\" target=\"_blank\">not related to a recent case involving Chipotle restaurants\u003c/a> in which more than 40 people were sickened. That strain was identified as E. coli 026.\u003c/p>\n\u003cp>The current strain has been identified as E. coli 157, which the CDC said is more likely to be life-threatening, especially in young children.\u003c/p>\n\u003cp>A call to Costco headquarters in Washington state seeking comment was not immediately returned.\u003c/p>\n\u003cp>Seattle attorney Bill Marler, who is representing people sickened in the previous Chipotle outbreak, said the current problem appears serious since two people have developed kidney failure. People were hospitalized in the Chipotle outbreak, but no one developed kidney failure.\u003c/p>\n\u003cp>Marler said the new case is a good example of why food safety is so crucial.\u003c/p>\n\u003cp>\"Costco has always been a leader in food safety at retail, it just goes to show you how important controlling your supply chain is,\" Marler said.\u003c/p>\n\u003cp>The human intestines contain hundreds of E. coli and similar bacteria strains. Most are harmless, but a few can cause serious problems.\u003c/p>\n\u003cp>Symptoms of E. coli infection include diarrhea, abdominal cramps, nausea and vomiting.\u003c/p>\n\u003cp>The bacteria are associated with animal waste but aren't just associated with meat. E. coli can be spread in indirect ways on produce.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Health officials say the incubation period is three to seven days from the time of exposure.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Wishes for End-of-Life Care Are Common Across Ethnicities",
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"content": "\u003cp>What kind of care do you want at the end of your life?\u003c/p>\n\u003cp>Stanford University researchers put that question to members of three major ethnic groups in the Bay Area and, \u003ca href=\"http://online.liebertpub.com/doi/full/10.1089/jpm.2015.0403\" target=\"_blank\">in an analysis,\u003c/a> found little variation in their responses.\u003c/p>\n\u003caside class=\"pullquote alignright\">'What this study tells us is that all of our patients want us to have these conversations.'\u003cbr>\n\u003ccite>Steven Pantilat, UCSF palliative care program\u003c/cite>\u003c/aside>\n\u003cp>“There is a common humanity –- people want to live as long as they have good quality of life. When it is their time, they want to be consulted so they die in a way that they are respected, and they don’t want their families burdened,” said the study’s lead author, Dr. V.J. Periyakoil, director of the Stanford Palliative Care Education and Training Program and associate director of palliative care services at the VA Palo Alto Health Care Center.\u003c/p>\n\u003cp>Regardless of ethnicity, however, the researchers found that access to high-quality end-of-life care is often hampered by lack of financial means, poor communication with health providers, cultural mores and family conflicts. The study, involving more than 300 white, Asian and African-American seniors, was published last week in the Journal of Palliative Medicine.\u003c/p>\n\u003cp>Periyakoil, whose earlier research focused on \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/04/22/ethnic-differences-thwart-end-of-life-conversations/\" target=\"_blank\">how doctors discuss end-of-life care\u003c/a> with patients from different cultures, said physicians often believe that talking about end-of-life care with patients of certain ethnic groups is taboo and that patients and their families are reluctant to have these sensitive conversations. The new study, though small and limited in geographic scope, suggests otherwise. The participants may have been more affluent and better educated than their counterparts nationwide, given the region’s demographics, Periyakoil noted.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The researchers interviewed 315 people over 50 at senior centers in Fremont, Palo Alto, San Francisco, San Jose and Walnut Creek. The group included 38 African-Americans, 160 Asian-Americans and 117 Caucasians.\u003c/p>\n\u003cp>Interviews were conducted in multiple languages: English, Burmese, Hindi, Mandarin, Tagalog and Vietnamese. Researchers examined participants’ attitudes toward end-of-life care and whether they had experienced barriers to getting quality end-of-life care for relatives or others in their community.\u003c/p>\n\u003cp>\u003cstrong>Finances an Issue for Many\u003c/strong>\u003c/p>\n\u003cp>Researchers are still collecting data on Latino participants and plan to publish a separate study on their views, Periyakoil said.\u003c/p>\n\u003cp>While all of the participants in the study said they valued high-quality end-of-life care, about 60 percent said they had experienced barriers to getting it, most notably financial difficulties and a lack of adequate health insurance. Medicare typically covers only short-term nursing home care and offers hospice benefits to patients whose doctors certify they have six months or less to live and who are willing to forgo treatment intended to cure their terminal illness.\u003c/p>\n\u003cp>There were no statistically significant differences among ethnic groups in reporting barriers to care. But participants with less education were more likely to report that their biggest barrier to care was financial.\u003c/p>\n\u003cp>Patients with more education were more likely to cite doctor behaviors that hampered end-of-life communication. And women were more likely than men to cite barriers to care overall, perhaps because they were more likely to be direct caregivers and have more experience with end-of-life needs.\u003c/p>\n\u003cp>\u003cstrong>'Vague Responses' from Doctors\u003c/strong>\u003c/p>\n\u003cp>Regardless of ethnicity, patients felt that “doctors were just too busy to initiate [end-of-life] conversations, reluctant to listen to their concerns and questions about EOL decision making, and often gave vague responses, making it difficult for the patient to comprehend their choices and make informed decisions,” the researchers wrote.\u003c/p>\n\u003cp>An estimated 2.6 million Americans die every year, but how the American health care system handles their last days is problematic across ethnic groups, according to \u003ca href=\"http://iom.nationalacademies.org/Reports/2014/Dying-In-America-Improving-Quality-and-Honoring-Individual-Preferences-Near-the-End-of-Life.aspx\" target=\"_blank\">“Dying in America,”\u003c/a> a landmark report released in 2014 by the Institute of Medicine. Too many people end up having aggressive treatment that is ineffective and expensive and doesn’t contribute to the patient’s quality of life, the report found. Other research examining\u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/08/25/a-racial-gap-in-attitudes-toward-hospice-care/\" target=\"_blank\"> racial gaps in attitudes toward hospice care\u003c/a> and other studies has found differences among ethnic and religious groups in how they approach end-of-life decisions.\u003c/p>\n\u003cp>[contextly_sidebar id=\"fDtiIK5xkI4TXA1JF0Lq6Kt8zKIAFZ4t\"]But people want to talk about it regardless of background, says Dr. Steven Pantilat, director of UC San Francisco's palliative care program. He was not involved in the study.\u003c/p>\n\u003cp>“What this study tells us is that \u003cem>all\u003c/em> of our patients want us to have these conversations,” Pantilat said. “They’re waiting for their doctors to bring it up, to not be rushed, to communicate sensitively.”\u003c/p>\n\u003cp>A new federal policy may make those conversations easier –- and more routine. Starting in January, \u003ca href=\"http://bigstory.ap.org/article/3c1463f23baa4b79b2f2462ee9fc29ff/medicare-cover-end-life-counseling\" target=\"_blank\">Medicare will reimburse physicians for discussing end-of-life care\u003c/a>. That policy infamously -- and incorrectly -- was derided as promoting “death panels” during the debate over the Affordable Care Act, and a version of it was dropped from the legislation. The counseling will cover what kind of medical care patients want to receive as they approach their last days.\u003c/p>\n\u003cp>Periyakoil urges patients of all backgrounds to prepare for these conversations, and new planning tools are available in different languages to help. Among them is the \u003ca href=\"http://med.stanford.edu/letter.html\" target=\"_blank\">Stanford Letter Project\u003c/a>, which helps patients write a letter to their doctors about the end-of-life care they do and don’t want in languages including English, Spanish, Mandarin, Vietnamese, Hindi, Urdu, Tagalog and Russian.\u003c/p>\n\u003cp>In one redacted letter provided by Periyakoil, a woman named Patricia writes: “I do not want my longevity to be more important than my comfort.”\u003c/p>\n\u003cp>Pantilat advises the doctors he trains that they don’t need deep knowledge of the beliefs of every religion and culture they might encounter, because every patient, of whatever ethnicity, has different goals.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“If we come in with true curiosity, respect and openness, we can learn a lot about how to take care of someone in a sensitive way,” he said. We need to ask: “What do I need to know about your culture and your family to take good care of \u003cem>you\u003c/em>?”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>What kind of care do you want at the end of your life?\u003c/p>\n\u003cp>Stanford University researchers put that question to members of three major ethnic groups in the Bay Area and, \u003ca href=\"http://online.liebertpub.com/doi/full/10.1089/jpm.2015.0403\" target=\"_blank\">in an analysis,\u003c/a> found little variation in their responses.\u003c/p>\n\u003caside class=\"pullquote alignright\">'What this study tells us is that all of our patients want us to have these conversations.'\u003cbr>\n\u003ccite>Steven Pantilat, UCSF palliative care program\u003c/cite>\u003c/aside>\n\u003cp>“There is a common humanity –- people want to live as long as they have good quality of life. When it is their time, they want to be consulted so they die in a way that they are respected, and they don’t want their families burdened,” said the study’s lead author, Dr. V.J. Periyakoil, director of the Stanford Palliative Care Education and Training Program and associate director of palliative care services at the VA Palo Alto Health Care Center.\u003c/p>\n\u003cp>Regardless of ethnicity, however, the researchers found that access to high-quality end-of-life care is often hampered by lack of financial means, poor communication with health providers, cultural mores and family conflicts. The study, involving more than 300 white, Asian and African-American seniors, was published last week in the Journal of Palliative Medicine.\u003c/p>\n\u003cp>Periyakoil, whose earlier research focused on \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/04/22/ethnic-differences-thwart-end-of-life-conversations/\" target=\"_blank\">how doctors discuss end-of-life care\u003c/a> with patients from different cultures, said physicians often believe that talking about end-of-life care with patients of certain ethnic groups is taboo and that patients and their families are reluctant to have these sensitive conversations. The new study, though small and limited in geographic scope, suggests otherwise. The participants may have been more affluent and better educated than their counterparts nationwide, given the region’s demographics, Periyakoil noted.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The researchers interviewed 315 people over 50 at senior centers in Fremont, Palo Alto, San Francisco, San Jose and Walnut Creek. The group included 38 African-Americans, 160 Asian-Americans and 117 Caucasians.\u003c/p>\n\u003cp>Interviews were conducted in multiple languages: English, Burmese, Hindi, Mandarin, Tagalog and Vietnamese. Researchers examined participants’ attitudes toward end-of-life care and whether they had experienced barriers to getting quality end-of-life care for relatives or others in their community.\u003c/p>\n\u003cp>\u003cstrong>Finances an Issue for Many\u003c/strong>\u003c/p>\n\u003cp>Researchers are still collecting data on Latino participants and plan to publish a separate study on their views, Periyakoil said.\u003c/p>\n\u003cp>While all of the participants in the study said they valued high-quality end-of-life care, about 60 percent said they had experienced barriers to getting it, most notably financial difficulties and a lack of adequate health insurance. Medicare typically covers only short-term nursing home care and offers hospice benefits to patients whose doctors certify they have six months or less to live and who are willing to forgo treatment intended to cure their terminal illness.\u003c/p>\n\u003cp>There were no statistically significant differences among ethnic groups in reporting barriers to care. But participants with less education were more likely to report that their biggest barrier to care was financial.\u003c/p>\n\u003cp>Patients with more education were more likely to cite doctor behaviors that hampered end-of-life communication. And women were more likely than men to cite barriers to care overall, perhaps because they were more likely to be direct caregivers and have more experience with end-of-life needs.\u003c/p>\n\u003cp>\u003cstrong>'Vague Responses' from Doctors\u003c/strong>\u003c/p>\n\u003cp>Regardless of ethnicity, patients felt that “doctors were just too busy to initiate [end-of-life] conversations, reluctant to listen to their concerns and questions about EOL decision making, and often gave vague responses, making it difficult for the patient to comprehend their choices and make informed decisions,” the researchers wrote.\u003c/p>\n\u003cp>An estimated 2.6 million Americans die every year, but how the American health care system handles their last days is problematic across ethnic groups, according to \u003ca href=\"http://iom.nationalacademies.org/Reports/2014/Dying-In-America-Improving-Quality-and-Honoring-Individual-Preferences-Near-the-End-of-Life.aspx\" target=\"_blank\">“Dying in America,”\u003c/a> a landmark report released in 2014 by the Institute of Medicine. Too many people end up having aggressive treatment that is ineffective and expensive and doesn’t contribute to the patient’s quality of life, the report found. Other research examining\u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/08/25/a-racial-gap-in-attitudes-toward-hospice-care/\" target=\"_blank\"> racial gaps in attitudes toward hospice care\u003c/a> and other studies has found differences among ethnic and religious groups in how they approach end-of-life decisions.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>But people want to talk about it regardless of background, says Dr. Steven Pantilat, director of UC San Francisco's palliative care program. He was not involved in the study.\u003c/p>\n\u003cp>“What this study tells us is that \u003cem>all\u003c/em> of our patients want us to have these conversations,” Pantilat said. “They’re waiting for their doctors to bring it up, to not be rushed, to communicate sensitively.”\u003c/p>\n\u003cp>A new federal policy may make those conversations easier –- and more routine. Starting in January, \u003ca href=\"http://bigstory.ap.org/article/3c1463f23baa4b79b2f2462ee9fc29ff/medicare-cover-end-life-counseling\" target=\"_blank\">Medicare will reimburse physicians for discussing end-of-life care\u003c/a>. That policy infamously -- and incorrectly -- was derided as promoting “death panels” during the debate over the Affordable Care Act, and a version of it was dropped from the legislation. The counseling will cover what kind of medical care patients want to receive as they approach their last days.\u003c/p>\n\u003cp>Periyakoil urges patients of all backgrounds to prepare for these conversations, and new planning tools are available in different languages to help. Among them is the \u003ca href=\"http://med.stanford.edu/letter.html\" target=\"_blank\">Stanford Letter Project\u003c/a>, which helps patients write a letter to their doctors about the end-of-life care they do and don’t want in languages including English, Spanish, Mandarin, Vietnamese, Hindi, Urdu, Tagalog and Russian.\u003c/p>\n\u003cp>In one redacted letter provided by Periyakoil, a woman named Patricia writes: “I do not want my longevity to be more important than my comfort.”\u003c/p>\n\u003cp>Pantilat advises the doctors he trains that they don’t need deep knowledge of the beliefs of every religion and culture they might encounter, because every patient, of whatever ethnicity, has different goals.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“If we come in with true curiosity, respect and openness, we can learn a lot about how to take care of someone in a sensitive way,” he said. We need to ask: “What do I need to know about your culture and your family to take good care of \u003cem>you\u003c/em>?”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Thousands Enroll in Covered California's New Adult Dental Insurance",
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"content": "\u003cp>Thousands of California adults are signing up for dental insurance \u003ca href=\"http://www.coveredca.com/individuals-and-families/getting-covered/dental-coverage\" target=\"_blank\">offered for the first time\u003c/a> by Covered California, the state's Obamacare marketplace, officials said Wednesday.\u003c/p>\n\u003caside class=\"pullquote alignright\">'This is really going to help a lot of people improve their health.'\u003cbr>\n\u003ccite> Dr. Ariane Terlet, Berkeley dentist and trustee, California Dental Association\u003c/cite>\u003c/aside>\n\u003cp>About 33,000 adults have signed up for the dental plans, including about 6,000 who also are signing up for health insurance on the marketplace for the first time, said Peter Lee, Covered California’s executive director.\u003c/p>\n\u003cp>While dental coverage for children under age 19 is considered an essential benefit under the Affordable Care Act and is included in their health insurance plans, that’s not the case for adults. Most of the nation’s state-run health exchanges now offer separate dental plans serving adults and the federally run exchange, healthcare.gov, also offers adult dental coverage.\u003c/p>\n\u003cp>Covered California is the second to last among the state-run exchanges to offer dental coverage for adults, said Jeff Album, a Delta Dental executive. Now only Washington state does not offer it.\u003c/p>\n\u003cp>In California, adults must purchase a health plan on Covered California to be able to purchase an “add-on” dental policy, and they’ll pay monthly premiums ranging from $11 to $65, Lee said. These premiums are not subsidized like Covered California’s health premiums for lower-income people, but the dental plans can’t turn anyone away because of pre-existing conditions.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The dental plans are optional, and there’s no tax penalty for not enrolling in them.\u003c/p>\n\u003cp>Open enrollment for Covered California health and dental plans started Nov. 1 and ends Jan. 31, and people who sign up by Dec. 15 can have their benefits start on Jan. 1. Lee said Wednesday that 34,000 new consumers had selected a health insurance plan through the exchange since open enrollment began.\u003c/p>\n\u003cp>About 1.3 million Californians, including about 66,000 ages 18 or younger, already \u003ca href=\"http://hbex.coveredca.com/data-research/\" target=\"_blank\">had health insurance\u003c/a> through the exchange before open enrollment started.\u003c/p>\n\u003cp>Five insurers are offering dental plans on Covered California:\u003c/p>\n\u003cul>\n\u003cli>Access Dental Plan\u003c/li>\n\u003cli>Anthem Blue Cross of California\u003c/li>\n\u003cli>Delta Dental of California\u003c/li>\n\u003cli>Dental Health Services\u003c/li>\n\u003cli>Premier Access\u003c/li>\n\u003c/ul>\n\u003cp>The majority of people signed up so far -- 23,000 of 33,000 overall -- have chosen Delta Dental, Album said.\u003c/p>\n\u003cp>All of the plans will offer free preventive and diagnostic dental services for both adults and children. Consumers can choose from dental health maintenance organizations, which typically cost less but have more restricted networks of dentists, or dental preferred provider organizations, which offer more choice but higher out-of-pocket costs.\u003c/p>\n\u003caside class=\"pullquote alignright\">Covered California's open enrollment runs through Jan. 31\u003c/aside>\n\u003cp>A note to parents: You do not have to enroll your children in a family dental plan, because children's dental coverage is already included in their health plan. Still, some parents choose to do so to gain extra coverage.\u003c/p>\n\u003cp>Dr. Ariane Terlet, a Berkeley dentist who serves as chief dental officer for Oakland-based La Clinica de la Raza and as a trustee for the California Dental Association, said that people without dental insurance are four times more likely not to get preventive care. Many Californians have found it difficult to buy dental coverage on the individual market, she added, and the new availability of Covered California’s dental plans expands access to care.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“There isn’t a week that goes by where people don’t ask me what dental coverage is available for individuals,” Terlet said. “Having insurance is a critical step to improving dental care. This is really going to help a lot of people improve their health.”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Thousands of California adults are signing up for dental insurance \u003ca href=\"http://www.coveredca.com/individuals-and-families/getting-covered/dental-coverage\" target=\"_blank\">offered for the first time\u003c/a> by Covered California, the state's Obamacare marketplace, officials said Wednesday.\u003c/p>\n\u003caside class=\"pullquote alignright\">'This is really going to help a lot of people improve their health.'\u003cbr>\n\u003ccite> Dr. Ariane Terlet, Berkeley dentist and trustee, California Dental Association\u003c/cite>\u003c/aside>\n\u003cp>About 33,000 adults have signed up for the dental plans, including about 6,000 who also are signing up for health insurance on the marketplace for the first time, said Peter Lee, Covered California’s executive director.\u003c/p>\n\u003cp>While dental coverage for children under age 19 is considered an essential benefit under the Affordable Care Act and is included in their health insurance plans, that’s not the case for adults. Most of the nation’s state-run health exchanges now offer separate dental plans serving adults and the federally run exchange, healthcare.gov, also offers adult dental coverage.\u003c/p>\n\u003cp>Covered California is the second to last among the state-run exchanges to offer dental coverage for adults, said Jeff Album, a Delta Dental executive. Now only Washington state does not offer it.\u003c/p>\n\u003cp>In California, adults must purchase a health plan on Covered California to be able to purchase an “add-on” dental policy, and they’ll pay monthly premiums ranging from $11 to $65, Lee said. These premiums are not subsidized like Covered California’s health premiums for lower-income people, but the dental plans can’t turn anyone away because of pre-existing conditions.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The dental plans are optional, and there’s no tax penalty for not enrolling in them.\u003c/p>\n\u003cp>Open enrollment for Covered California health and dental plans started Nov. 1 and ends Jan. 31, and people who sign up by Dec. 15 can have their benefits start on Jan. 1. Lee said Wednesday that 34,000 new consumers had selected a health insurance plan through the exchange since open enrollment began.\u003c/p>\n\u003cp>About 1.3 million Californians, including about 66,000 ages 18 or younger, already \u003ca href=\"http://hbex.coveredca.com/data-research/\" target=\"_blank\">had health insurance\u003c/a> through the exchange before open enrollment started.\u003c/p>\n\u003cp>Five insurers are offering dental plans on Covered California:\u003c/p>\n\u003cul>\n\u003cli>Access Dental Plan\u003c/li>\n\u003cli>Anthem Blue Cross of California\u003c/li>\n\u003cli>Delta Dental of California\u003c/li>\n\u003cli>Dental Health Services\u003c/li>\n\u003cli>Premier Access\u003c/li>\n\u003c/ul>\n\u003cp>The majority of people signed up so far -- 23,000 of 33,000 overall -- have chosen Delta Dental, Album said.\u003c/p>\n\u003cp>All of the plans will offer free preventive and diagnostic dental services for both adults and children. Consumers can choose from dental health maintenance organizations, which typically cost less but have more restricted networks of dentists, or dental preferred provider organizations, which offer more choice but higher out-of-pocket costs.\u003c/p>\n\u003caside class=\"pullquote alignright\">Covered California's open enrollment runs through Jan. 31\u003c/aside>\n\u003cp>A note to parents: You do not have to enroll your children in a family dental plan, because children's dental coverage is already included in their health plan. Still, some parents choose to do so to gain extra coverage.\u003c/p>\n\u003cp>Dr. Ariane Terlet, a Berkeley dentist who serves as chief dental officer for Oakland-based La Clinica de la Raza and as a trustee for the California Dental Association, said that people without dental insurance are four times more likely not to get preventive care. Many Californians have found it difficult to buy dental coverage on the individual market, she added, and the new availability of Covered California’s dental plans expands access to care.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“There isn’t a week that goes by where people don’t ask me what dental coverage is available for individuals,” Terlet said. “Having insurance is a critical step to improving dental care. This is really going to help a lot of people improve their health.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Tiny Fort Bragg Bitterly Divided over Downtown Homeless Center",
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"content": "\u003cp>Kevin Scanlon walks out of the main coffee shop in downtown Fort Bragg. One block to the left is the ocean, and miles of trails along the Mendocino coastline. Scanlon turns right, toward the four-block stretch of small shops selling socks, books and tchotchkes.\u003c/p>\n\u003caside class=\"pullquote alignright\">'We didn't say we're against it. We said we're against it here. ... And that's not being prejudiced, just pragmatic.'\u003cbr>\n\u003ccite>Kevin Scanlon, Fort Bragg resident\u003c/cite>\u003c/aside>\n\u003cp>“We’re a tourist town now. Logging’s done. Fishing’s done,” says Scanlon, a general contractor who has worked on many of the local buildings. “So we've got to keep the integrity of downtown.”\u003c/p>\n\u003cp>It’s not only tourists who have taken a liking to Fort Bragg. So have the homeless. And this worries Scanlon.\u003c/p>\n\u003cp>“If you have a lot of transitional people coming, it just turns tourists off,” he says.\u003c/p>\n\u003cp>Scanlon stops outside the historic Old Coast Hotel. It was vacant for years, until the city approved a grant to the nonprofit Mendocino Coast Hospitality Center to buy it. The agency moved in this summer and began providing case management and mental health services to the homeless. It will eventually use the hotel rooms as transitional housing.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The plans threw the town into an uproar. Scanlon, and more than 1,000 other local residents and business owners, signed a petition to keep the homeless out of the hotel.\u003c/p>\n\u003cp>“We didn't say we're against it. We said we're against it here,” Scanlon says. “And that's not being prejudiced, just pragmatic.”\u003c/p>\n\u003cp>The hotel sits at the gateway to the burgeoning downtown commercial district. Scanlon and other opponents say the building should go to a thriving business. Like a hotel, or a restaurant.\u003c/p>\n\u003cp>“You could get bed tax. You could get the food tax,” Scanlon says. “That could be a financial gain for the city, as opposed to a financial drain.”\u003c/p>\n\u003cfigure id=\"attachment_110517\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/11/IMG_1412-e1447893339603.jpg\">\u003cimg class=\"wp-image-110517 size-thumbnail\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/11/IMG_1412-400x300.jpg\" alt=\"Debbie Gibney, 58, is a client and staff member at the Mendocino Coast Hospitality Center. She says has bipolar disease and suffers from post-traumatic stress. \" width=\"400\" height=\"300\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Debbie Gibney, 58, is a client and staff member at the Mendocino Coast Hospitality Center. She says she has bipolar disorder and post-traumatic stress disorder. \u003ccite>(April Dembosky/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Opponents feel so strongly about the hotel that they filed a lawsuit to block the sale. It failed. They threatened to recall the mayor for supporting the project. That didn’t work. Now they’ve put \u003ca href=\"https://cityfortbragg.legistar.com/View.ashx?M=F&ID=4120775&GUID=6C84559B-06CF-4C7D-8958-387E87390BFE\" target=\"_blank\">a measure on next June's ballot\u003c/a> that would ban all social services from downtown.\u003c/p>\n\u003cp>But leaders of the hospitality center say there’s been community pushback at every location they considered.\u003c/p>\n\u003cp>“Part of it is simply that 'not in my backyard,' ” says Executive Director Anna Shaw.\u003c/p>\n\u003cp>But when they landed at the Old Coast Hotel, it really hit a nerve. Shaw says people have nostalgia for watching sports at the polished wood bar, and seeing their teams win. One man proposed to his wife here 20 years ago.\u003c/p>\n\u003cp>“I think some people have a feeling that it’s kind of too good for the homeless and the mentally ill,” Shaw says.\u003c/p>\n\u003cp>[contextly_sidebar id=\"JhJk4DEgS1JJjSpPiBVLsdj0rZNQHVRL\"]The building is more than 100 years old and is considered an architectural gem. The hallway walls are pressed tin. The hotel rooms upstairs still have Victorian details -- layered window dressings, wainscoting, marble fireplaces.\u003c/p>\n\u003cp>Shaw says that when homeless people have a nice place to stay like this, they do better.\u003c/p>\n\u003cp>“Because people's self-esteem is higher. It’s much harder to throw trash on the floor when the room looks beautiful like this,” Shaw says. “If it’s really squalid, there’s no incentive to behave.”\u003c/p>\n\u003cp>She says being downtown is also important. It’s easier for people to get to appointments, and it helps reduce stigma when people are integrated into the community.\u003c/p>\n\u003cp>“Lots of homeless people and people impaired with mental illness feel marginalized,” she says. “It’s important that folk get to come to a place where the value we place on them is expressed through the building.”\u003c/p>\n\u003cp>But Anne Marie Cesario, a retired social worker, says that’s not the way to combat stigma.\u003c/p>\n\u003cp>“That’s like using people as guinea pigs in order to further some liberal’s idea about consciousness raising,” she says. “It's inappropriate.”\u003c/p>\n\u003cp>Cesario is one of several mental health professionals opposed to the downtown location. She says it’s not private enough, especially for people who suffer from paranoia.\u003c/p>\n\u003cp>“They don't want to be seen when they go to the doctor. They don't want to be seen when they go to the therapist,” she says. “That building is on one of the busiest corners in town, and it's a four-way stop.”\u003c/p>\n\u003cp>She, and other members of the Concerned Citizens of Fort Bragg, believe a more appropriate location would be the former social services building on the edge of town, near the hospital and police station. Or an old motel on Highway 1. Or a building 3 miles north of Fort Bragg.\u003c/p>\n\u003cfigure id=\"attachment_110518\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/11/SocisalSign-e1447893767971.jpg\">\u003cimg class=\"size-thumbnail wp-image-110518\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/11/SocisalSign-400x300.jpg\" alt=\"Signs in the window of a downtown Fort Bragg business urge residents to sign a petition for a ballot measure that would prohibit social service agencies in the downtown area. \" width=\"400\" height=\"300\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Signs in the window of a downtown Fort Bragg business urge residents to sign a petition for a ballot measure that would prohibit social service agencies in the downtown area. \u003ccite>(April Dembosky/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The Hospitality Center declined all those properties. And now the Concerned Citizens group is hoping voters will pass their ballot measure prohibiting social services in the downtown commercial district, retroactive to Jan. 1, 2015.\u003c/p>\n\u003cp>But even if the measure does pass, it’s unclear what impact it will have on the Old Coast Hotel. An analysis from the city attorney’s office says that, under legal precedents, the Hospitality Center would most likely be allowed to continue operating at the hotel. It would be grandfathered in under any new zoning rules as a “non-conforming use.”\u003c/p>\n\u003cp>“This will result in nothing but lawsuits,” says Scott Menzies, who runs a tai chi studio in town, and helped organize another group of small business owners, called Go Fort Bragg, who are against the ballot measure.\u003c/p>\n\u003cp>“The measure is so broad-reaching, it will cause far more collateral damage,” he says. “They’re using a cannon that targets every other social services organization in the business district.”\u003c/p>\n\u003cp>All the tension and fighting is frustrating for Debbie Gibney, a client of the Hospitality Center.\u003c/p>\n\u003cp>“I’m bipolar and I have post-traumatic stress syndrome, from being an abused wife,” she says. “I take medication and I see a therapist regularly.”\u003c/p>\n\u003cp>Gibney is 58. A few years ago, she was forced to retire early from her job. Then she lost her home. She got help at the Hospitality Center, and now she’s back on her feet, helping other homeless people at the Old Coast Hotel.\u003c/p>\n\u003cp>“I’m proud to walk in here,” she says. “Because of the beauty of the building, and the reception that we get here, and the way the staff accepts us and loves us unconditionally.”\u003c/p>\n\u003cp>At the agency’s previous location, in a strip mall near the DMV, clients had to wait in an alleyway for appointments. But since moving to the Old Coast Hotel, Gibney notices the clients are more relaxed and more respectful.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“We feel like we're part of the city now,” she says.\u003c/p>\n\n",
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"excerpt": "The Mendocino Coast town will soon vote on whether to ban mental health services in downtown shopping district.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Kevin Scanlon walks out of the main coffee shop in downtown Fort Bragg. One block to the left is the ocean, and miles of trails along the Mendocino coastline. Scanlon turns right, toward the four-block stretch of small shops selling socks, books and tchotchkes.\u003c/p>\n\u003caside class=\"pullquote alignright\">'We didn't say we're against it. We said we're against it here. ... And that's not being prejudiced, just pragmatic.'\u003cbr>\n\u003ccite>Kevin Scanlon, Fort Bragg resident\u003c/cite>\u003c/aside>\n\u003cp>“We’re a tourist town now. Logging’s done. Fishing’s done,” says Scanlon, a general contractor who has worked on many of the local buildings. “So we've got to keep the integrity of downtown.”\u003c/p>\n\u003cp>It’s not only tourists who have taken a liking to Fort Bragg. So have the homeless. And this worries Scanlon.\u003c/p>\n\u003cp>“If you have a lot of transitional people coming, it just turns tourists off,” he says.\u003c/p>\n\u003cp>Scanlon stops outside the historic Old Coast Hotel. It was vacant for years, until the city approved a grant to the nonprofit Mendocino Coast Hospitality Center to buy it. The agency moved in this summer and began providing case management and mental health services to the homeless. It will eventually use the hotel rooms as transitional housing.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The plans threw the town into an uproar. Scanlon, and more than 1,000 other local residents and business owners, signed a petition to keep the homeless out of the hotel.\u003c/p>\n\u003cp>“We didn't say we're against it. We said we're against it here,” Scanlon says. “And that's not being prejudiced, just pragmatic.”\u003c/p>\n\u003cp>The hotel sits at the gateway to the burgeoning downtown commercial district. Scanlon and other opponents say the building should go to a thriving business. Like a hotel, or a restaurant.\u003c/p>\n\u003cp>“You could get bed tax. You could get the food tax,” Scanlon says. “That could be a financial gain for the city, as opposed to a financial drain.”\u003c/p>\n\u003cfigure id=\"attachment_110517\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/11/IMG_1412-e1447893339603.jpg\">\u003cimg class=\"wp-image-110517 size-thumbnail\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/11/IMG_1412-400x300.jpg\" alt=\"Debbie Gibney, 58, is a client and staff member at the Mendocino Coast Hospitality Center. She says has bipolar disease and suffers from post-traumatic stress. \" width=\"400\" height=\"300\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Debbie Gibney, 58, is a client and staff member at the Mendocino Coast Hospitality Center. She says she has bipolar disorder and post-traumatic stress disorder. \u003ccite>(April Dembosky/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Opponents feel so strongly about the hotel that they filed a lawsuit to block the sale. It failed. They threatened to recall the mayor for supporting the project. That didn’t work. Now they’ve put \u003ca href=\"https://cityfortbragg.legistar.com/View.ashx?M=F&ID=4120775&GUID=6C84559B-06CF-4C7D-8958-387E87390BFE\" target=\"_blank\">a measure on next June's ballot\u003c/a> that would ban all social services from downtown.\u003c/p>\n\u003cp>But leaders of the hospitality center say there’s been community pushback at every location they considered.\u003c/p>\n\u003cp>“Part of it is simply that 'not in my backyard,' ” says Executive Director Anna Shaw.\u003c/p>\n\u003cp>But when they landed at the Old Coast Hotel, it really hit a nerve. Shaw says people have nostalgia for watching sports at the polished wood bar, and seeing their teams win. One man proposed to his wife here 20 years ago.\u003c/p>\n\u003cp>“I think some people have a feeling that it’s kind of too good for the homeless and the mentally ill,” Shaw says.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>The building is more than 100 years old and is considered an architectural gem. The hallway walls are pressed tin. The hotel rooms upstairs still have Victorian details -- layered window dressings, wainscoting, marble fireplaces.\u003c/p>\n\u003cp>Shaw says that when homeless people have a nice place to stay like this, they do better.\u003c/p>\n\u003cp>“Because people's self-esteem is higher. It’s much harder to throw trash on the floor when the room looks beautiful like this,” Shaw says. “If it’s really squalid, there’s no incentive to behave.”\u003c/p>\n\u003cp>She says being downtown is also important. It’s easier for people to get to appointments, and it helps reduce stigma when people are integrated into the community.\u003c/p>\n\u003cp>“Lots of homeless people and people impaired with mental illness feel marginalized,” she says. “It’s important that folk get to come to a place where the value we place on them is expressed through the building.”\u003c/p>\n\u003cp>But Anne Marie Cesario, a retired social worker, says that’s not the way to combat stigma.\u003c/p>\n\u003cp>“That’s like using people as guinea pigs in order to further some liberal’s idea about consciousness raising,” she says. “It's inappropriate.”\u003c/p>\n\u003cp>Cesario is one of several mental health professionals opposed to the downtown location. She says it’s not private enough, especially for people who suffer from paranoia.\u003c/p>\n\u003cp>“They don't want to be seen when they go to the doctor. They don't want to be seen when they go to the therapist,” she says. “That building is on one of the busiest corners in town, and it's a four-way stop.”\u003c/p>\n\u003cp>She, and other members of the Concerned Citizens of Fort Bragg, believe a more appropriate location would be the former social services building on the edge of town, near the hospital and police station. Or an old motel on Highway 1. Or a building 3 miles north of Fort Bragg.\u003c/p>\n\u003cfigure id=\"attachment_110518\" class=\"wp-caption alignright\" style=\"max-width: 400px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/11/SocisalSign-e1447893767971.jpg\">\u003cimg class=\"size-thumbnail wp-image-110518\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/11/SocisalSign-400x300.jpg\" alt=\"Signs in the window of a downtown Fort Bragg business urge residents to sign a petition for a ballot measure that would prohibit social service agencies in the downtown area. \" width=\"400\" height=\"300\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Signs in the window of a downtown Fort Bragg business urge residents to sign a petition for a ballot measure that would prohibit social service agencies in the downtown area. \u003ccite>(April Dembosky/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The Hospitality Center declined all those properties. And now the Concerned Citizens group is hoping voters will pass their ballot measure prohibiting social services in the downtown commercial district, retroactive to Jan. 1, 2015.\u003c/p>\n\u003cp>But even if the measure does pass, it’s unclear what impact it will have on the Old Coast Hotel. An analysis from the city attorney’s office says that, under legal precedents, the Hospitality Center would most likely be allowed to continue operating at the hotel. It would be grandfathered in under any new zoning rules as a “non-conforming use.”\u003c/p>\n\u003cp>“This will result in nothing but lawsuits,” says Scott Menzies, who runs a tai chi studio in town, and helped organize another group of small business owners, called Go Fort Bragg, who are against the ballot measure.\u003c/p>\n\u003cp>“The measure is so broad-reaching, it will cause far more collateral damage,” he says. “They’re using a cannon that targets every other social services organization in the business district.”\u003c/p>\n\u003cp>All the tension and fighting is frustrating for Debbie Gibney, a client of the Hospitality Center.\u003c/p>\n\u003cp>“I’m bipolar and I have post-traumatic stress syndrome, from being an abused wife,” she says. “I take medication and I see a therapist regularly.”\u003c/p>\n\u003cp>Gibney is 58. A few years ago, she was forced to retire early from her job. Then she lost her home. She got help at the Hospitality Center, and now she’s back on her feet, helping other homeless people at the Old Coast Hotel.\u003c/p>\n\u003cp>“I’m proud to walk in here,” she says. “Because of the beauty of the building, and the reception that we get here, and the way the staff accepts us and loves us unconditionally.”\u003c/p>\n\u003cp>At the agency’s previous location, in a strip mall near the DMV, clients had to wait in an alleyway for appointments. But since moving to the Old Coast Hotel, Gibney notices the clients are more relaxed and more respectful.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>A woman must abide by an agreement with her ex-husband to destroy five frozen embryos if they got a divorce, despite her contention that they represent her last chance to have children, a San Francisco Superior Court judge ruled Wednesday.\u003c/p>\n\u003cp>\u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/07/21/frozen-embryo-trial-highlights-gaps-in-law-ethics/\" target=\"_blank\">In the closely-watched case\u003c/a>, Judge Anne-Christine Massullo said in a tentative decision that the agreement trumps the woman's desire to now keep the embryos.\u003c/p>\n\u003cp>The couple's story began in 2010 as Mimi Lee and Stephen Findley were about to be married. Lee was diagnosed with breast cancer, and the couple decided to create embryos through in vitro fertilization in hopes of a future family.\u003c/p>\n\u003cp>Instead, the marriage fell apart, leaving the couple with five embryos. In 2013 the couple filed for divorce.\u003c/p>\n\u003cp>Findley wanted to discard the embryos in accordance with the agreement he and Lee signed while married. He worried in part that Lee would use any children to take financial advantage of him, according to the ruling.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Lee's attorneys said no California court had previously ruled in such a case. A Pennsylvania court three years ago \u003ca href=\"http://articles.philly.com/2012-04-14/news/31342260_1_embryos-appeals-court-three-judge-superior-court-panel\" target=\"_blank\">awarded frozen embryos to a woman \u003c/a>who also said they may be her only way to have a child because of breast cancer treatment despite the objections of her ex-husband. An Illinois judge last year \u003ca href=\"http://www.chicagotribune.com/news/local/breaking/ct-embryos-court-ruling-met-20150612-story.html\" target=\"_blank\">also sided with a woman\u003c/a> who was infertile in her fight over embryos with an ex-boyfriend.\u003c/p>\n\u003cp>Massullo said California law is clear that couples must decide what to do with embryos they create in case of separation or divorce.\u003c/p>\n\u003cp>\"Decisions about family and children often are difficult, and can be wrenching when they become disputes,\" the judge wrote. \"The policy best suited to ensuring that these disputes are resolved in a clear-eyed manner ... is to give effect to the intentions of the parties at the time of the decision at issue.\"\u003c/p>\n\u003cp>An attorney for Lee, Peter Skinner, said in a statement his client was disappointed and was evaluating her legal options. Lee had argued that she had a right to change the agreement, and that she had a right to procreate.\u003c/p>\n\u003cp>While Lee might have a right to procreate in other circumstances, she doesn't have a right to procreate with Findley, the judge said.\u003c/p>\n\u003cp>The embryos were being held at UC San Francisco, which in accordance with state law gave Lee and Findley a consent agreement before the fertility treatments. In the agreement, they both said they would like the embryos \"thawed and discarded\" in case they divorced, according to court documents.\u003c/p>\n\u003cp>Lee argued that she thought the agreement was not legally binding. The judge ruled otherwise.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The tentative nature of the ruling gives the parties time to file objections, but such rulings generally become final.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>A woman must abide by an agreement with her ex-husband to destroy five frozen embryos if they got a divorce, despite her contention that they represent her last chance to have children, a San Francisco Superior Court judge ruled Wednesday.\u003c/p>\n\u003cp>\u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/07/21/frozen-embryo-trial-highlights-gaps-in-law-ethics/\" target=\"_blank\">In the closely-watched case\u003c/a>, Judge Anne-Christine Massullo said in a tentative decision that the agreement trumps the woman's desire to now keep the embryos.\u003c/p>\n\u003cp>The couple's story began in 2010 as Mimi Lee and Stephen Findley were about to be married. Lee was diagnosed with breast cancer, and the couple decided to create embryos through in vitro fertilization in hopes of a future family.\u003c/p>\n\u003cp>Instead, the marriage fell apart, leaving the couple with five embryos. In 2013 the couple filed for divorce.\u003c/p>\n\u003cp>Findley wanted to discard the embryos in accordance with the agreement he and Lee signed while married. He worried in part that Lee would use any children to take financial advantage of him, according to the ruling.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Lee's attorneys said no California court had previously ruled in such a case. A Pennsylvania court three years ago \u003ca href=\"http://articles.philly.com/2012-04-14/news/31342260_1_embryos-appeals-court-three-judge-superior-court-panel\" target=\"_blank\">awarded frozen embryos to a woman \u003c/a>who also said they may be her only way to have a child because of breast cancer treatment despite the objections of her ex-husband. An Illinois judge last year \u003ca href=\"http://www.chicagotribune.com/news/local/breaking/ct-embryos-court-ruling-met-20150612-story.html\" target=\"_blank\">also sided with a woman\u003c/a> who was infertile in her fight over embryos with an ex-boyfriend.\u003c/p>\n\u003cp>Massullo said California law is clear that couples must decide what to do with embryos they create in case of separation or divorce.\u003c/p>\n\u003cp>\"Decisions about family and children often are difficult, and can be wrenching when they become disputes,\" the judge wrote. \"The policy best suited to ensuring that these disputes are resolved in a clear-eyed manner ... is to give effect to the intentions of the parties at the time of the decision at issue.\"\u003c/p>\n\u003cp>An attorney for Lee, Peter Skinner, said in a statement his client was disappointed and was evaluating her legal options. Lee had argued that she had a right to change the agreement, and that she had a right to procreate.\u003c/p>\n\u003cp>While Lee might have a right to procreate in other circumstances, she doesn't have a right to procreate with Findley, the judge said.\u003c/p>\n\u003cp>The embryos were being held at UC San Francisco, which in accordance with state law gave Lee and Findley a consent agreement before the fertility treatments. In the agreement, they both said they would like the embryos \"thawed and discarded\" in case they divorced, according to court documents.\u003c/p>\n\u003cp>Lee argued that she thought the agreement was not legally binding. The judge ruled otherwise.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The tentative nature of the ruling gives the parties time to file objections, but such rulings generally become final.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "UCSF Launches Global Institute to Fight Dementia in Developing World",
"title": "UCSF Launches Global Institute to Fight Dementia in Developing World",
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"content": "\u003cp>With dementia cases rising rapidly around the world, UC San Francisco and Ireland's University of Dublin announced Monday the launch of an institute aimed at helping developing countries learn more about the disease and cope with the burden it places on patients, families and caregivers.\u003c/p>\n\u003cp>The Global Brain Health Institute, which will be housed both in San Francisco and Dublin, will train 600 neuroscientists, policymakers, economists and others over 15 years in an effort to help developing countries better understand dementia, as well as how to delay and prevent it. The institute plans to focus initially on countries in Latin America and the Southern Mediterranean region. Training is expected to begin next fall.\u003c/p>\n\u003cp>“A lot of these countries are the ones that are about to really see major shifts in their aging populations,” said Kristine Yaffe, a professor of neurology and psychiatry at UCSF. “And there are very limited dementia experts, or any kind of aging brain experts.”\u003c/p>\n\u003cp>An estimated 46.8 million people are living with dementia worldwide and that number is expected to nearly triple by 2050 as lifespans increase, according to Alzheimer’s Disease International. Nearly 60 percent of all cases are in developing countries.\u003c/p>\n\u003cp>The disease is also increasingly a financial strain for communities and governments. Its estimated cost around the world is expected to reach $818 billion in 2016, according to the organization.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Dementia is becoming as important as communicable diseases and needs a global response, said Bruce Miller, a behavioral neurologist at UCSF who will co-lead the new Global Brain Health Institute. “We are really looking at a massive epidemic,” he said.\u003c/p>\n\u003cp>The institute is being funded with a $177 million gift from Atlantic Philanthropies, which was created by businessman Chuck Feeney. Atlantic Philanthropies' president, Christopher G. Oechsli, said he is hopeful that over time the institute will help improve the quality of life of people living with dementia; support families and caregivers; and change public policy. The institute will also aim to reduce the incidence of the disease across the world, he said.\u003c/p>\n\u003cp>“This is not just a health/science issue,” he said. “This is a societal issue.”\u003c/p>\n\u003cp>Outside organizations, such as the Alzheimer’s Association, will also be involved. The association can show others how advocacy and grassroots volunteerism can raise awareness about the disease and influence government decisions, said Elizabeth Edgerly, chief program officer for the association’s Northern California and Northern Nevada office.\u003c/p>\n\u003cp>“Not only is [the institute] aiming to train medical leaders, but it is going to train people who will go back and help organize community and do what the Alzheimer’s Association has done,” said Edgerly. “Things like volunteerism, which we may take for granted in the United States, is not necessarily familiar in all cultures.”\u003c/p>\n\u003cp>Edgerly said she also looks forward to learning from people in other countries, particularly about government-funded programs that care for people with dementia.\u003c/p>\n\u003cp>The fellows – from the U.S., Ireland and other countries – will be trained in geriatrics, neuroscience, public policy and health economics. They will also get hands-on experience in diagnosing, treating and caring for patients with cognitive disorders. And they will get support implementing programs in their home countries. Some may be modeled on similar projects in San Francisco, including ongoing initiatives on preventing strokes and reducing the stigma of people with dementia.\u003c/p>\n\u003cp>Dementia is the umbrella term for several different types of cognitive disorders. One type is Alzheimer’s disease, for which there is no cure, but research shows that nearly a third of other cases could be prevented by public health and lifestyle interventions, including managing high blood pressure and high cholesterol.\u003c/p>\n\u003cp>As a result, Yaffe of UC San Francisco said the institute will also focus on these lifestyle interventions. “There is a lot that we can do that is a far cry from a new drug,” she said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Anna Gorman is a senior correspondent with \u003c/em>\u003ca href=\"http://khn.org\" target=\"_blank\">\u003cem>Kaiser Health News\u003c/em>\u003c/a>\u003cem>, 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/\" target=\"_blank\">\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>\u003cp>With dementia cases rising rapidly around the world, UC San Francisco and Ireland's University of Dublin announced Monday the launch of an institute aimed at helping developing countries learn more about the disease and cope with the burden it places on patients, families and caregivers.\u003c/p>\n\u003cp>The Global Brain Health Institute, which will be housed both in San Francisco and Dublin, will train 600 neuroscientists, policymakers, economists and others over 15 years in an effort to help developing countries better understand dementia, as well as how to delay and prevent it. The institute plans to focus initially on countries in Latin America and the Southern Mediterranean region. Training is expected to begin next fall.\u003c/p>\n\u003cp>“A lot of these countries are the ones that are about to really see major shifts in their aging populations,” said Kristine Yaffe, a professor of neurology and psychiatry at UCSF. “And there are very limited dementia experts, or any kind of aging brain experts.”\u003c/p>\n\u003cp>An estimated 46.8 million people are living with dementia worldwide and that number is expected to nearly triple by 2050 as lifespans increase, according to Alzheimer’s Disease International. Nearly 60 percent of all cases are in developing countries.\u003c/p>\n\u003cp>The disease is also increasingly a financial strain for communities and governments. Its estimated cost around the world is expected to reach $818 billion in 2016, according to the organization.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Dementia is becoming as important as communicable diseases and needs a global response, said Bruce Miller, a behavioral neurologist at UCSF who will co-lead the new Global Brain Health Institute. “We are really looking at a massive epidemic,” he said.\u003c/p>\n\u003cp>The institute is being funded with a $177 million gift from Atlantic Philanthropies, which was created by businessman Chuck Feeney. Atlantic Philanthropies' president, Christopher G. Oechsli, said he is hopeful that over time the institute will help improve the quality of life of people living with dementia; support families and caregivers; and change public policy. The institute will also aim to reduce the incidence of the disease across the world, he said.\u003c/p>\n\u003cp>“This is not just a health/science issue,” he said. “This is a societal issue.”\u003c/p>\n\u003cp>Outside organizations, such as the Alzheimer’s Association, will also be involved. The association can show others how advocacy and grassroots volunteerism can raise awareness about the disease and influence government decisions, said Elizabeth Edgerly, chief program officer for the association’s Northern California and Northern Nevada office.\u003c/p>\n\u003cp>“Not only is [the institute] aiming to train medical leaders, but it is going to train people who will go back and help organize community and do what the Alzheimer’s Association has done,” said Edgerly. “Things like volunteerism, which we may take for granted in the United States, is not necessarily familiar in all cultures.”\u003c/p>\n\u003cp>Edgerly said she also looks forward to learning from people in other countries, particularly about government-funded programs that care for people with dementia.\u003c/p>\n\u003cp>The fellows – from the U.S., Ireland and other countries – will be trained in geriatrics, neuroscience, public policy and health economics. They will also get hands-on experience in diagnosing, treating and caring for patients with cognitive disorders. And they will get support implementing programs in their home countries. Some may be modeled on similar projects in San Francisco, including ongoing initiatives on preventing strokes and reducing the stigma of people with dementia.\u003c/p>\n\u003cp>Dementia is the umbrella term for several different types of cognitive disorders. One type is Alzheimer’s disease, for which there is no cure, but research shows that nearly a third of other cases could be prevented by public health and lifestyle interventions, including managing high blood pressure and high cholesterol.\u003c/p>\n\u003cp>As a result, Yaffe of UC San Francisco said the institute will also focus on these lifestyle interventions. “There is a lot that we can do that is a far cry from a new drug,” she said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Anna Gorman is a senior correspondent with \u003c/em>\u003ca href=\"http://khn.org\" target=\"_blank\">\u003cem>Kaiser Health News\u003c/em>\u003c/a>\u003cem>, 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/\" target=\"_blank\">\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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"soldout": {
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"title": "SOLD OUT: Rethinking Housing in America",
"tagline": "A new future for housing",
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