Investigating lack of aging services in rural Colorado

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About Shannon Najmabadi

Shannon Najmabadi is a rural economy reporter for the Colorado Sun. Previously, she worked at The Texas Tribune, in Austin, Texas, covering higher education, health care, politics and policy.

I was working as a reporter in Texas when the pandemic began, where I spoke to the families of those in long-term care facilities and investigated the disproportionate death toll of coronavirus-infected residents in state veterans’ homes overseen by George B. Bush. 

In reporting on those stories, I heard repeatedly from experts that aspects of the nursing home industry are broken and that it would be better to let people age in smaller settings or at home. 

Those thoughts were rattling around in my head when I moved to a new job in Colorado, one of the fastest aging states in the country. When one of my colleagues saw a press release that suggested a 1,870 square mile rural county had been without a home health or hospice provider for the better part of a year, we thought it would be a good opportunity to write about the availability of these services in the state’s rural areas as baby boomers age.

Unsurprisingly, the picture is bleak. 

It takes providers far longer to commute from home to home in a rural area, especially on roads that become treacherous in snowy and icy conditions. There is a smaller patient volume overall and it fluctuates based on need, making it difficult for a cash-strapped agency to retain the appropriate number of staff at all times. And providers make little more than minimum wage to offer intimate, hands-on care that can be emotionally draining. 

All of this quickly became clear as I began calling various aging agencies across the state. But we [editors at the Colorado Sun] wanted to go beyond the numbers and policy statements to see what this all looked like on the ground. 

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Homelessness may drive extended hospitalizations among people with severe mental illness

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About Katti Gray

Katti Gray (@kattigray) is AHCJ's core topic leader for behavioral and mental health. A former Rosalynn Carter Mental Health Journalism Fellow, Gray is providing resources to help AHCJ members expand their coverage of mental health amid ongoing efforts to de-stigmatize mental illness and to place mental health care on par with all health care.

Photo by Michael Tefft via Flickr.

Recent years have seen an uptick in the nation’s count of homeless people, a population with a greater portion of people with mental illness than in the general population.

The Substance Abuse and Mental Health Services Administration’s still widely referred to 2011 estimate suggests that 26% of unsheltered persons had severe mental illness compared with roughly 5% of people with housing. And when the tally of homeless people with less debilitating mental disorders is added to that equation, the rate jumps as high as 45%.

Published online last fall in Psychiatric Services, a University of California, Los Angeles analysis concluded that homeless people in court-ordered in-patient psychiatric care wound up in psychiatric hospitals for months longer than other involuntarily admitted psychiatric patients.

“Mental Health Conservatorship Among Homeless People With Serious Mental Illness,” an observational study, analyzed hospital administration data for 795 patients, 18 and older, admitted involuntarily to one Los Angeles safety-net hospital between 2016 and 2018. While involuntarily committed patients comprised 6% of the sample population, they accounted for 41% of inpatient days spent hospitalized.

In-patients without housing spent an average of 154.8 days involuntarily in the hospital, while in-patients with homes were hospitalized for an average of 25.6 days.

What’s more, researcher Kristin Choi, Ph.D., M.S., R.N., said, according to a Jan. 2 University of California, Los Angeles (UCLA) press release, “There are very few long-term housing options for people who are disabled by mental illness and in need of supportive housing in Los Angeles. When these individuals are stabilized and ready for a lower level of community-based care, there is no place for them to go.”

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New year, new Freelance Center content

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About Barbara Mantel

Barbara Mantel (@BJMantel), an independent journalist, is AHCJ’s freelance community correspondent. Her work has appeared in CQ Researcher, Rural Health Quarterly, Undark, Healthline, NBCNews.com and NPR, among others. She helps members find the resources they need to succeed as freelancers and welcomes your suggestions.

Photo by Isaac Smith via Unsplash.

The new year is off to a swift start at the Freelance Center. I have added four new market guides and a tip sheet. As always, I encourage freelance members to email me with suggestions for Freelance Center content. The latest market guides are for the following publications:

Leaps

Medical innovation is the heart of Leaps’ coverage. The nonprofit’s articles range in length from 750 to 1,500 words, and the fee is $1 per word, slightly more for experienced, award-winning writers. “A new drug for some disease wouldn’t be a big enough deal for us to cover, but if it represented a whole new approach, or revealed a way to treat something that was previously untreatable or had something really notable like that, then we would probably be interested in it,” Editor-in-Chief Kira Peikoff said. Articles should have a relatable human element, such as a patient’s or researcher’s story.

MedPage Today

This digital news outlet negotiates fees based on the nature of the article and the experience of the writer. Articles range in length from 800 to 1,000 words. The target audience is physicians and other health professionals such as nurse practitioners and physician assistants. “We are looking for articles that impact the daily practice of medicine,” said Joyce Frieden, MedPage Today Washington editor and AHCJ board member.

Science

This publisher of science research and news pays a minimum of $0.75 a word for online stories, going up to $1 a word or more for its regular writers. Fees for print stories start at $1.25 per word. Writers are paid for the length of the final product. As a writer whose work is usually lengthened and not shortened during the editing process, I am in favor of that policy. Others may disagree. “We’re looking for outside-the-ordinary stories that are not being covered by everyone,” Managing News Editor JohnTravis said. Narrative features are becoming more common in Science, but the stories are told less from a patient perspective and more from a scientist’s perspective.

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One-year postpartum Medicaid coverage: Are states ready to offer  it soon?

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About Kerry Dooley Young

Kerry Dooley Young (@kdooleyyoung) is AHCJ's core topic leader on patient safety. She has written extensively about the Food and Drug Administration, medical research, health policy and quality measurements. Her work has appeared in Medscape Medical News, Congressional Quarterly/CQ Roll Call and Bloomberg News.

Photo by Toshimasa Ishibashi via Flickr.

April 1 marks the kickoff date for a federal option that makes it easier for states to extend postpartum Medicaid coverage to one year after childbirth from the current 60-day standard.

Journalists can now find out how well their states have prepared to take advantage of this Medicaid-expansion pathway, which Congress created as part of last year’s American Rescue Plan legislation. Here are several good websites to track the progress states have made in winning needed Centers for Medicare and Medicaid Services (CMS) permission for the one-year postpartum coverage.

  • The National Academy for State Health Policy (NASHP) has a website dedicated to tracking efforts to expand postpartum Medicaid coverage. It offers detailed summaries of the status of efforts within state legislatures to make the needed legal changes for the coverage expansion.
  • Kaiser Family Foundation (KFF): It’s always a good idea to check the website of the nonprofit Kaiser Family Foundation (KFF) when covering a Medicaid issue. KFF is keeping tabs on state efforts as well through its Medicaid Postpartum Coverage Extension Tracker.
  • American College of Obstetricians and Gynecologists (ACOG) : ACOG is advocating for wide use of the new pathway, calling “critical” as many states as possible implement the required state plan amendment for the April 1 start date, ACOG said on a webpage dedicated to building support for a permanent expansion.

There’s been significant interest in recent years in addressing the reasons why U.S. maternal mortality rates have risen, running counter to global trends of falling rates — at least in the years before the pandemic.

“No mother should have to fight for her coverage or care during pregnancy or while caring for a newborn,” CMS Administrator Chiquita Brooks-LaSure said in a Dec. 7 statement, noting that unnecessary postpartum illnesses and deaths “disproportionately harm people of color.”

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AHCJ launches search for new executive director as Smiley resigns

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About Felice J. Freyer

Felice J. Freyer is AHCJ's president and a health care reporter for The Boston Globe.

Andrew Smiley

Andrew Smiley, AHCJ’s executive director who led the association through the challenges of a continuing pandemic and critical personnel changes, is resigning effective Jan. 28.

We are grateful for Smiley’s excellent work since he took the post in September 2020. His accomplishments include increasing reserves, helping run a new fellowship program, quickly implementing a virtual platform to offer workshops during the pandemic, and hiring three top-notch staffers — Katherine Reed, director of education and content; Andrea Waner, director of engagement, and Erica Tricarico, managing editor.

Smiley said he had not expected to leave so soon but had been recruited into a “life-changing” new job. As we search for a replacement, the AHCJ board of directors has put in place a transition plan that will keep the association operating smoothly without any changes to our offerings and activities.

Katherine Reed                    Andrea Waner

Reed has agreed to serve as interim executive director and Waner will be interim deputy executive director. Senior Advisor and former Executive Director Len Bruzzese has agreed to increase his time with us, and Jeff Porter, recently retired education director, will assist with conference planning.

As a result, our daily Covering Health blog, our fellowship programs, the annual Excellence in Health Care Journalism awards, and planning for our annual conference will all continue apace. The conference will take place in Austin April 28 – May 1.

I have appointed a search committee, which I am chairing, to look nationwide for a new executive director. Search committee members also include immediate past president Ivan Oransky, former president Karl Stark, vice president Gideon Gil, board member Marlene Harris-Taylor, and Mark Horvit, a professor at the Missouri School of Journalism, where AHCJ is based.

I’m expecting many applicants will be drawn to the opportunity to lead a vibrant organization that supports and educates journalists at a time when our work has never been more important. I urge AHCJ members to spread the word and encourage prospective candidates to submit their applications. To apply for the job, go to https://hrs.missouri.edu/find-a-job/staff, click on “prospective employees” and search for job no. 39998.