Improving Older Adults’ Mental and Emotional Well-Being with Home Health Care

Seniors go through a lot of changes that can impact their mental and emotional health. Some of these changes are minor and occur gradually, while others are significant and abrupt.

Below are some of the challenges older adults face that may compromise their psychological well-being.

Challenges That Impact Seniors’ Emotional and Mental Health

Isolation and Loneliness

Different factors can fuel feelings of loneliness and isolation among older adults. These include:

– the death of their spouse, relatives, or close friends
– losing their jobs
– retiring from careers that defined their identity and gave them a sense of purpose and self-worth
– the absence of people they can regularly talk to and confide in
– mobility and transportation challenges that also lead to decreased social activities

Prolonged loneliness can have detrimental effects on seniors’ health. It can weaken their immune system and put them at higher risk of chronic diseases.

Loss of independence

As their health continues to decline, older adults find themselves unable to do things on their own. They may need help cleaning the house, rely on others for transportation, or require assistance when using the toilet or taking a bath. Others may be suffering from chronic illnesses or recovering from injuries that keep them in bed for weeks or months.

All these may leave your elderly loved one feeling helpless and frustrated. They may fear losing their independence and having less control over their lives.

Memory issues

Occasional memory lapses are a normal part of aging. But factors like illnesses, lack of sleep, or depression may worsen older adults’ forgetfulness.

These memory issues can frustrate older adults and even pose threats to their health and safety. They may forget to take medications on time, or accidentally leave stoves and ovens on.

Vulnerability to stress and mental health concerns

Aside from the changes mentioned above, other challenges can increase stress among the elderly.

Their fear of slipping or getting injured can make them more anxious to go to the bathroom alone or leave the house without a companion.

Financial concerns may also weigh them down. They may be worried about not being able to pay for growing medical and living costs or long-term care.

Chronic stress can increase the risk of mental health issues among seniors. According to the World Health Organization, 7 percent of adults over 60 years are suffering from depression and 3.8 percent from anxiety disorders. Data from the Centers for Disease Control and Prevention also revealed that men 85 years or older had the highest suicide rate of any age group.

Chronic illnesses also leave seniors more vulnerable to depression and other mental health concerns. These mental health issues can further impact their physical health and recovery. For instance, seniors suffering from loneliness and depression have higher mortality rates. Depression also affects the success and duration of cardiovascular treatment in older adults. It can even aggravate insomnia and memory loss.

Augmenting Psychosocial Support for the Elderly Through Home Health Care

The benefits home care workers provide go beyond physical assistance. They become additional sources of psychosocial support, helping seniors navigate challenges that come with aging.

Regular emotional support

Having someone to talk to may help older adults manage difficult emotions like loneliness, fear, and frustration. Moreover, having constant emotional support can help reduce their risk of developing mental and physical issues.

Companionship and socialization

The companionship home care workers provide can alleviate chronic loneliness among seniors. They can also help older adults maintain an active social life by:

– driving them to community activities or visits to family and friends
– accompanying them during walks
– helping them use video chat tools to keep in touch with relatives and friends

These activities help seniors stay connected, keeping feelings of isolation and loneliness at bay. Participating in social activities gives them something to look forward to and allows them to create new memories and connections.

Supporting healthy routines

Healthy eating and exercise keep seniors strong and improve their balance. These also keep their memory sharp, boost their mood and help them relax and manage stress.

In-home senior caregivers and home health aides can help older adults stay fit and stick to healthy routines. For example, they can prepare nutritious meals and ensure these meet seniors’ dietary requirements. They assist them during light exercises, accompany them during walks, and inspire them to resume their hobbies.

Physical support to maintain their independence and quality of life

Aging in place allows seniors to retain their sense of independence and control over decisions that affect their lives. Living in a familiar place, surrounded by things that bring them comfort, may also give them a sense of security amidst the changes they are going through.

Home care workers help seniors stay independent while reducing the risks and difficulties that come with aging in place. They help older adults keep their homes clean and safe by handling light housekeeping tasks and removing hazards like electrical cords and rugs. They help them maintain personal hygiene by assisting them with bathing and dressing.

Home health care agencies provide seniors and their loved ones with cost-effective home care options. This flexibility in terms of the type of care and cost can reduce seniors’ financial stress. Clients can decide how often to request these services and what tasks they need help with. Older adults who are recovering from injuries or illnesses can also save on hospitalization costs through in-home skilled nursing care.

Promoting Holistic Health for Seniors

Changes that come with aging can hurt your elderly loved one’s mental and emotional well-being.

This is an area where home care can help. Home care workers become constant sources of social support for seniors, helping them experience healthy aging and a better quality of life.

National Academies Study Recognizes Social Workers as Specialists in Social Care

Family care

WASHINGTON, D.C. – The National Association of Social Workers (NASW) applauds a study released today by the National Academies of Sciences, Engineering and Medicine – Integrating Social Care into the Delivery of Health Care: Moving Upstream to Improve the Nation’s Health.

Professional social workers for more than a century have been indispensable in advancing the nation’s health, providing much-needed services both within and outside health care settings. Moreover, social workers have been leaders in addressing the social determinants of health: economic stability, education, social community context, health care access and environmental factors. NASW is pleased that the profession’s valuable contributions in providing social care, especially in promoting health equity and access, are recognized in this major national study.

“The social determinants of health account for more than 50 percent of health outcomes. It is therefore important to acknowledge the valuable role of social workers in improving the nation’s health. As the study notes, social workers are specialists in providing social care,” said NASW Chief Executive Officer Angelo McClain, PhD, LICSW.

The study defines social care as “activities that address health-related social risk factors and social needs,” and outlines five goals to advance the effort to better integrate social care into health care delivery, including:

  1. Designing health care delivery to integrate social care into health care
  2. Building a workforce to integrate social care into health care delivery
  3. Developing a digital infrastructure that is interoperable between health care and social care organizations
  4. Financing the integration of health care and social care
  5. Funding, conducting and translating research and evaluation on the effectiveness and implementation of social care practices in health care settings.

The study further outlines numerous recommendations for how these goals can be achieved.

Study Committee member Robyn Golden, LCSW, associate vice president of Population Health and Aging at Rush University Medical Center, said “It was truly gratifying to participate in this consensus report and work with prominent, nationally-recognized professionals from across the health care spectrum. As the study articulates, social workers are essential in this arena, and in creating partnerships between the medical and social service worlds.”

One of the study’s key recommendations is that social workers be adequately paid for providing social care. NASW agrees with this recommendation.

We, therefore, urge Congress to pass the Improving Access to Mental Health Act (S. 782/H.R. 1533). This much-needed legislation, co-sponsored by Senators Debbie Stabenow, MSW (D-MI) and John Barrasso, MD (R-WY), and Rep. Barbara Lee, MSW (D-CA), will enable clinical social workers to receive Medicare Part B reimbursement for providing Health and Behavior Assessment and Intervention (HBAI) services, which are within the clinical social work scope of practice.

This much-needed legislation will also enable clinical social workers to receive Medicare Part B reimbursement for services provided to skilled nursing facility residents, many of whom experience anxiety, depression, and other mental health challenges.

In addition, NASW implores the Centers for Medicare and Medicaid Services (CMS) not to implement its proposed payment cuts to clinical social workers participating in Medicare Part B. Clinical social workers are currently reimbursed at only 75 percent of the physician fee schedule, the lowest payment rate of any mental health clinician in this major federal program, despite providing equivalent services.

The Improving Access to Mental Health Act, which Congress should enact as soon as possible, would increase this rate to 85 percent. To ensure a sufficient workforce to meet the social and clinical care needs of older Americans, CMS needs to increase, not decrease, these reimbursement rates.

Finally, NASW urges regulators and other policymakers to adopt the study’s recommendation to enlarge the scope of practice for the nation’s 700,000 social workers to include social care.

“This is a very significant study to which policymakers on the local, state and federal level should pay careful attention,” McClain said. “We look forward to continuing to partner with these and other key stakeholders to ensure that the study’s recommendations are realized, for the benefit of people from all walks of life.”

The National Association of Social Workers (NASW), in Washington, DC, is the largest membership organization of professional social workers. It promotes, develops, and protects the practice of social work and social workers. NASW also seeks to enhance the well-being of individuals, families, and communities through its advocacy.

CHIP Demise Devastating to Millions of American Children

Congress allowed the federal Children’s Health Insurance Program (CHIP) to expire Oct. 1, leading to the demise of one of the most successful government programs ever implemented, said an expert on health economics at Washington University in St. Louis.

“CHIP has led to a substantial reduction in the uninsured rate for children, to the point where children now have only a 5 percent uninsured rate — the lowest ever,” said Tim McBride, professor at the Brown School and director of the Center for Health Economics and Policy. He also serves as chair of the oversight committee for Missouri’s Medicaid program called MOHealthNET.

An estimated 9 million children are now covered by the CHIP program across the U.S. In Missouri, more 624,000 children are covered by a combination of CHIP and Medicaid, though most children are covered by Medicaid.

What if funding is not restored?

A move to rescue the program hit a snag in the U.S. House of Representatives this week, lowering hopes that it might be restored quickly.

“In the short run, most states can continue to pay for the program for at least a few weeks if not months, using funds carried forward from previous years,” McBride said. “But at some point, those funds will dry up and states will face cutting the program, which will mean children will lose their health insurance.

“States likely do not have the funds to make up for the loss of federal dollars. The impact of this would be devastating, to say the least, on these children and their families. But it would create a huge financial problem for the health care system — physicians, providers and those who care for them.

It should be obvious that this is a great investment in our future because if medical problems can be avoided when children are young, they are much more likely to do better in school, be more productive members of society.

“It should be obvious that this is a great investment in our future because if medical problems can be avoided when children are young, they are much more likely to do better in school, be more productive members of society,” McBride said. “Also, it would be penny-wise, pound-foolish to not deal with this problem now, since covering children is a lot cheaper than covering anyone else, and it costs more if medical care is delayed.”

The state of Missouri reportedly would not run out of funding to finance the CHIP program until the first quarter of 2018, if not a little later, he said. But, in other states, the end of federal funds for CHIP will come considerably sooner, maybe within weeks.

Will Congress eventually come around?

“I would bet that Congress eventually will do something to reauthorize the program, based on previous experience, and I know they are working on legislation right now,” McBride said. “They have had to reauthorize this program many times before, and it has garnered bipartisan support.

“However, these days there is so much partisanship, and Washington is much less functional, so I am afraid to make any definitive predictions now.”

The FCA and the American Health Care System: Finding the Balance

Medicare fraud, you see it in the news every day, but many believe it is individual recipients costing the government billions of dollars. When in fact, doctors and other health care professionals are billing the government for services they never performed or for services and tests that were unnecessary. Billions of taxpayer dollars that were meant to serve actual needs go into pockets of unscrupulous health care professionals. It often goes unnoticed for years before someone discovers fraud.

The False Claims Act (FCA) is a law that oversees government contractors and prosecutes any false claims submitted to the government. It was passed in 1863 in an effort to address rampant fraud, such as double-billing and other deceptive business practices. In 1986, it was amended to address the fraudulent military spending under the Reagan administration.

Is Disagreement Fraudulent?

Over the past eight years, the Department of Justice reports it has recovered $19.3 billion in fraudulent health care claims. This accounts for 57 percent of the total amount of money recovered over the past 30 years, leading many people to suggest that the FCA has overreached its authority.

Lack of medical necessity is often cited in claims that are deemed fraudulent, but who decides what is and is not necessary? Shouldn’t that be a doctor’s decision? Certainly doctors have filed egregious fraudulent claims, but do we want our health care professionals second-guessing their decisions because they are worried about being prosecuted for fraud? One doctor may choose one course of action or set of tests while another may disagree and choose another. Should either of these decisions be considered fraudulent?

Whistleblowers Must Be Protected

No one is pro-fraud. Even criminals don’t want others to defraud them. When it comes to stopping the wanton theft of taxpayer money, both Democrats and Republicans support the False Claims Act and have done so for the more than 30 years the act has been in place. While there are concerns about its scope and reach, politicians in general can cite its obvious merits.

One part both sides mostly agree on is the protection of whistleblowers, people from inside a business environment who see and report suspected fraud. Without them and without protecting them, taxpayer money would be fraudulently spent without ever being noticed.

Whistleblowers can report suspected fraud directly to the government and not have to go through channels at their place of employment, where they could be ignored, or even worse, face retaliation. Even good, honest people might choose to keep quiet or turn a blind eye if they fear losing their job or being otherwise retaliated against.

Whistleblowers Reap Rewards?

A criticism of this is that people who report suspected fraud are legally protected and often end up receiving large financial settlements. This may unintentionally create a financial incentive to report fraud even when it may not exist. Disgruntled employees may report fraud that does not exist just to cause their employer trouble. The people who suffer most from this are those on government health care whose doctors may undertreat them or not treat them all out of fear of prosecution.

Costs Continue to Rise

Guess who pays for all of this: You do. Fraud and the prosecution of suspected fraudulent claims cause health care providers and insurance companies to raise their prices. These price increases are passed on to the consumer.

Health care costs continue to rise, putting financial pressure on employers and business owners. Health care spending in the United States is expected to grow from $2.9 trillion in 2013 to $5 trillion in 2022. Prescription drug costs have increased 10 percent, partly due to marketing and increased specialty of treatment. The government has done little to stop the increase in drug prices.

The FCA is necessary in order to protect taxpayer money from being fraudulently spent. Everyone can agree to that. However, let’s give doctors and other health care providers some leeway and support how they decide to treat a patient. We need that. Otherwise, costs and insurance premiums will continue to rise, and patient care will suffer.

Encourage whistleblowers to support suspected fraud, but let’s rein in the bountiful cash settlements they may receive in order to sustain honesty in the FCA. Let’s be as strict about fraudulent claims of fraud as we are about fraudulent medical claims. Protect the whistleblowers, but establish strict penalties for abuse. It’s all about ensuring quality care while protecting our tax dollars.

Proposed Trump Cuts Imperil Mental Health, Health Care, Education and More

The budget proposed by President Donald J. Trump threatens critical health, scientific research and education programs that contribute to the social safety net for millions of Americans, according to the American Psychological Association.

“This budget, if enacted, would jeopardize our nation’s educational, scientific and health enterprises and limit access to critically needed mental and behavioral health services,” said APA President Antonio E. Puente, PhD. “These cuts would disproportionately affect people living in poverty, people with serious mental illness and other disabilities, women, children, people living with HIV/AIDS, older adults, ethnic and racial minorities, immigrants, and members of the LGBTQ community.”

“While every administration must make difficult budget decisions, any attempts to balance the federal budget should increase, not decrease, the number of Americans who have access to high-quality education, health care and social support,” said APA CEO Arthur C. Evans Jr., PhD. “APA calls on Congress to reject this budget proposal and replace it with one that protects and increases access to services and care for all Americans.”

Among the cuts denounced by APA:

•    $7.2 billion from the National Institutes of Health, approximately a 21 percent decrease from the FY 2017 level, which would result in 1,946 fewer grants. The National Science Foundation would receive a cut of approximately $820 million compared to FY 2017, a decrease of 11 percent.

•    More than $600 billion in reductions over the next decade from the Medicaid program, which could eliminate Medicaid benefits for about 7.5 million people. The proposal also includes the option for states to choose between a per capita cap or a block grant beginning in FY 2020. Medicaid is the single largest payer for behavioral health services in the United States, accounting for over 25 percent of behavioral health spending.

•    Elimination of the Graduate Psychology Education Program, the Behavioral Health Workforce Education and Training Program, and the Geriatric Workforce Enhancement Program, which together would reduce mental health workforce training by nearly $100 million.

•    Almost $400 million from the Substance Abuse and Mental Health Services Administration, including a roughly 22 percent reduction from the Community Mental Health Services Block Grant.

•    14 percent ($9.2 billion) from the U.S. Department of Education, eliminating investments in educational equity and quality, including slashing other key programs that support gifted students, effective teaching and professional development.

•    Elimination of the Public Service Loan Forgiveness program and programmatic changes that would prolong repayment periods for students with graduate school loans.

•    13.2 percent cut from the U.S. Department of Housing and Urban Development, including elimination of the Community Development Block Grant.

•    $200 million reduction for the Special Supplemental Nutrition Program for Women, Infants and Children.

•    Elimination of 75 employees from the Office of Justice Programs, including a cut of over 30 percent, reducing the office’s budget from $1.8 billion to $1.3 billion. The agency administers critical juvenile and criminal justice grants and houses the Bureau of Justice Statistics, Bureau of Justice Assistance and National Institute of Justice.

“A strong educational system is the foundation of a globally competitive workforce that fosters innovation, discovery and research,” Puente said. “As other countries continue to invest in education as part of their economic and workforce development strategies, the need for increased federal investment in American education has never been more important to our nation’s economic stability, national security and public health.”

“APA looks forward to working with Congress to ensure a more balanced approach to addressing our nation’s fiscal 2018 budget priorities, including making progress on increasing access to mental health care and addressing the opioid epidemic, investing in the scientific enterprise and expanding access to higher education for all Americans,” Evans added.

Researchers Find Improved Preventive Care From Obamacare Medicaid Expansion

Medicaid proponents rally in Ohio (Credit: Columbus Dispatch)

BLOOMINGTON, Ind. — More Americans are taking steps to prevent disease because of the insurance expansions of the Affordable Care Act, according to a new, groundbreaking study by Indiana University and Cornell University researchers.

With Congress considering the future of the ACA, also known as Obamacare, this research is the first to estimate the impact of the ACA-facilitated expansions of Medicaid on preventive care and health behaviors.

Kosali Simon Photo Credit: Indiana University

Researchers Kosali Simon and Aparna Soni of Indiana University and John Cawley of Cornell University determined that low-income childless adults have benefited in numerous ways from the Medicaid expansions: They are 17 percent more likely to have health insurance, 7 percent more likely to have a personal doctor and 11 percent less likely to report that cost was a barrier to their health care. Their self-assessed health also improved, and they reported fewer days of poor health or restricted activities.

Participants were also more likely to undertake preventive care such as getting a flu vaccination, having an HIV test or visiting a dentist. The ACA mandates that health insurance plans, including Medicaid, cover these preventive services without cost-sharing.

“Our findings indicate that the Medicaid expansions under the ACA succeeded in some of their goals, but other goals remain hard to achieve,” said Simon, a health economist at IU’s School of Public and Environmental Affairs. “More people are seeing doctors and taking steps to safeguard their health. But there’s been no detectable reduction in obesity, smoking or heavy drinking, at least through our study period.”

Conversely, there was no worsening of those risky behaviors; one might be concerned that the newly insured would be more likely to engage in risky behaviors because they now pay less out of pocket for health care. There was no evidence of this phenomenon, which economists call moral hazard, in the data.

The data for the research came from the Behavioral Risk Factor Surveillance System telephone survey conducted by the Centers for Disease Control and Prevention and state governments, through the end of 2015. Thirty states and the District of Columbia expanded Medicaid benefits in 2014.

Their article, “The Impact of Health Insurance on Preventive Care and Health Behaviors: Evidence from the First Two Years of the ACA Medicaid Expansions,” is scheduled for publication in the Journal of Policy Analysis and Management and is available online.

Trauma-Informed Care for Veterans

By Kate Hendricks Thompson and Sarah Plummer Taylor


An increase in trauma-informed care leads to more efficient and effective response at every level of patient care, and thus, a reduction of wait times at VA Hospitals.

Rebecca served nine years as a Marine Officer, and had relied upon the Veterans Administration Medical Center (VAMC) for her health care since departing active duty.  She was a devoted runner trying to get back in shape, but a few months into this well-intentioned effort she found herself calling the VAMC appointment line.  Her Achilles tendon was swollen and painful, and she found herself limping through busy days. The first call to the appointment line resulted in a referral, a message taken, and the promise of a call back. The nurse who called back wasn’t authorized to book anything beyond 24-hours out, and the promise of a return call was again offered. A week later, the phone had not rung, and Rebecca was still limping along without an appointment.

Military veterans consistently report access problems with Veterans Affairs (VA) hospitals and outpatient clinics.  Patients in Phoenix reportedly died while waiting for slow cancer care.  The issue is an administrative and ethical conundrum; veteran satisfaction rates and overall patient wait times must be improved.

The solution is not entirely structural, though more infrastructure and staff would directly reduce wait times because more providers are available.  The answer to date has been the bandage of increased oversight – stipulating tighter regulation and monitoring of recorded wait times. The intention of such accountability measures is consistently undermined by employees incentivized to modify the numbers, and it is a rare whistle-blower willing to call attention to the statistical maneuvering.

If adding more directives to reduce wait times has been met with maintenance of the defunct status quo, how can we improve accountability while working within the current system reality?

The answer involves expanding the standard of care and embracing holistic wellness. First and foremost, we need to make the process of receiving care easier, more effective, and more efficient, and one of the best and most empirically validated ways to do so is to offer trauma-informed care. Trauma-informed means knowing the history of past and current abuse or trauma in the life of the consumer with whom one is working and to understand the role that violence and victimization play in the lives of most consumers of mental health and substance abuse services, thereby utilizing that understanding to design service systems that accommodate the vulnerabilities of trauma survivors and allow services to be delivered in a way that will facilitate consumer participation in treatment. With trauma at the center of understanding, all parties – clients, providers, clinicians, and programs – will benefit.

We must begin providing trauma-informed care at all levels of care, from point A to point Z in the care cycle for our veterans, working with existing VA employees, staff, and providers. Our veterans are coming from a place of trauma, be that trauma combat or simple transition.

VA hospitals are not public hospitals. Therefore, trauma-informed care must be a requirement for any person in the VA.

 Research has convincingly shown that it is not just mental health care providers who need a trauma-informed approach, and sadly even many of those providers do not have this background. For instance, psychiatrists are not taught to account for cultural, environmental, economic, gender, or trauma history differences among clients. Social workers, for example, are exclusively trained and educated from this perspective of the prevalence of trauma and the impact of environmental factors.

How does this impact wait times?  Education of the entire staff is required, not just the person the veteran encounters after the 5th stage of waiting (multiple phone calls, an employee they encounter in the parking lot, the volunteer at the front desk, employees inside the building, the receptionist at the clinic office) because all of those stages of interaction impact how care is sought, followed up with or not, or perceived by the patient.  Part of wait time computation involves the actual time but some of it is the perception of time – sometimes a 2 hour wait can feel worse than a week long wait; it depends on how the person who is addressing you talks to you. Veteran perceptions are important and impact how they feel about care received.

  • Improving the staff’s trauma-informed perspective improves wait times by improving and tailoring the environment. Frankly, this trauma-informed paradigm can be used as an incentive to the care provider because the whole process becomes more humane to them. As they are trauma-informed they address people differently.
  • Trauma-informed personnel are more likely to address issues more effectively and efficiently. As empathy and understanding increase, so does efficiency because veterans come in to be treated, feel safe doing so, are being treated one time, versus becoming overwhelmed and leaving, necessitating another visit. For instance, if a veteran enters the hospital and is yelled at by the person behind the desk, or harassed by a janitor, he or she very well may turn around and leave. The veteran will then have to call in again, make another appointment, likely be perceived as disrupting the system and be chastised for not showing up for their appointment. The whole process not only may be re-traumatizing, but will add to the backlog of appointments.
  • Trauma-informed care creates safer environments. Feelings of safety are fundamental to effective health care, especially effective mental health care. Thus, veterans are more likely to feel comfortable coming in for proactive and preventative care versus waiting until they find themselves in a most extreme case which then often requires more resources for a longer amount of time, resulting in more pressure on the system again.
  • Trauma-informed care creates better-informed clients. Veteran patient clients, when treated with the respect a trauma-informed model demands, are well-informed at every stage of care, from administrative matters to the care itself. Lack of information leads to confusion and threatens the basic need for feelings of safety. Waiting for return phone calls that never come, or waiting in a waiting room for hours on end well after their scheduled appointment time, are re-traumatizing (and common) occurrences for veterans seeking care at VA hospitals. Trauma-informed care standards would mandate that appointment times be honored, that waiting room facilities are safe and comfortable, and that a patient is communicated to regularly and with respect about the process required to receive care.

Every single employee at a VA hospital needs some trauma-informed education and training, not just psychiatrists. Through a trauma-informed lens, any staff member can see issues more clearly and solve problems where they occur. This would mean, for instance, having a person at the entrance of the VA Hospital who is calm, clear and helpful; not an untrained, random volunteer. Having staff members who are trained in harm reduction and de-escalation techniques is also critical to trauma-informed training, education, and care provision. To shift culture, you cannot just train the leaders. All employees at the VA should receive at least a basic level of training of trauma-informed care. This absolutely also includes care providers.

We do not need more regulations and stipulations on time-frames, which are already in place and already not being followed. Veterans and the families who support them are calling for a true cultural shift in care, one that can be achieved with training and standard of care expansion.

Editor’s note: This article was jointly authored. Sarah Plummer Taylor, MSW is an established leader in the field of resilience building, holistic wellness, and leadership training. Learn more at SEMPER Sarah®. Kate Hendricks Thomas, PhD is an Assistant Professor of Public Health at Charleston Southern University. 

The Presidential Policy Series: Affordable Care Act

Hillary Clinton and Donald Trump clinched the Democratic and Republican presidential nominations.

In less than 18 months, the field of candidates vying to win the 2016 presidential election has narrowed from over two dozen contenders to two major opponents. Now, with fewer than two months before Election Day on November 8th (remember to vote!), we’re exploring the Republican and Democratic candidates’ positions on healthcare policy.

The Presidential Policy Series, we will share where the Democratic and Republican nominees, Hillary Clinton and Donald Trump, respectively, stand on healthcare policy. In this post, we will be discussing the most divisive healthcare issue, the Patient Protection and Affordable Care Act, commonly referred to as the Affordable Care Act (ACA).

The ACA, colloquially known as Obamacare, has been hotly debated for over six years. Advocates and opponents of the law often fall along party line. The law, which represents the largest regulatory change to the industry since Medicare and Medicaid were introduced in 1965, was designed to bring quality and affordable health care to everyone by transforming delivery to focus on value and expanding insurance coverage.

Budget Busting

From a party standpoint, the Republican Party platform views the plan as a “Euro-style bureaucracy to manage unworkable, budget-busting, conflicting provisions.” Many conservatives believe it has raised insurance premiums, increased deductibles, and inflated drug prices while limiting an individual’s access to care within narrow provider networks. Republicans have long called for the law to be repealed, and Mr. Trump, despite previously expressing support for the individual insurance mandate, has fully endorsed a repeal of Obamacare.

In the Trump healthcare plan, he vows to repeal the ACA during his first day in the Oval Office and work with Congress to implement reforms that follow free market trades. He’s specifically mentioned modifying the existing law that inhibits the sale of health insurance across state lines, implementing health savings accounts and individual deduction for health insurance premium payments, requiring full price transparency, and letting states control Medicaid.

Rather than expanding Medicaid, Trump says he’d like to focus on policy that grows the economy and provides more jobs. As his health plan currently states, “the best social program has always been a job – and taking care of our economy will go a long way towards reducing our dependence on public health programs.”

Not Far Enough

Secretary Clinton, on the other hand, has vigorously defended the ACA and has expressed a desire to work with Congress to get legislation passed that would expand aspects of the ACA. Like most Democrats, Clinton believes the health law has been an important step toward the goal of universal health care, for which she has been a longtime advocate.

She introduced the unsuccessful Health Security Act in 1993, which was a comprehensive plan to provide universal health care to all Americans. She later helped create and pass the Children’s Health Insurance Program in 1997, which now provides coverage to more than 8.4 million children.

In the Clinton healthcare plan, she vows to continue these efforts to improve healthcare access.  Clinton plans to work with governors to continue the expansion of Medicaid on the state level and enroll more eligible Americans. She wants to further enact policies that will expand access to affordable health care regardless of immigration status.

Clinton has also called for the funding of primary care services at community health centers to double over the next decade and has expressed support for President Obama’s charge to triple funding for the National Health Service Corps, the government program that aims to address physician shortage in areas around the country. To address health costs, Clinton supports authoritative action to block or modify premium increases, capping prescription drug costs, and limiting excessive out-of-pocket costs for families.

Finally, Clinton has stated that she will pursue efforts to make a “public option” of healthcare possible, and expand Medicare by allowing individuals above the age 55 being able to buy into Medicare program.

New York Community Trust Gives One Million Dollars to Help Train Social Workers

Students with bachelor’s and master’s degrees in social work attended the Social Work HEALS Student Policy Summit in Washington, D.C., in November. Social Work HEALS, a program implemented by NASW and the Council on Social Work Education,with funding from New York Community Trust, trains and educates students to strengthen the delivery of health care services in the U.S. Here, students pose at the NASW national office in Washington. /Photo by Paul R. Pace, NASW News

WASHINGTON, D.C. – The New York Community Trust (NYCT), one of the nation’s largest community foundations, has renewed a grant through the National Association of Social Workers (NASW) and the Council on Social Work Education (CSWE) to educate and train more social workers to strengthen the delivery of health care services in the United States.

NYCT will award the two social work organizations $1 million over the next two years to continue the Social Work HEALS initiative. Part of the grant will be used to bring two fellows to Washington, D.C. to directly engage in health care policy work on Capitol Hill.

“This project will strengthen the delivery of health care services by enhancing the preparation of health care social workers” says Natasha Lifton, senior program officer at The New York Community Trust. “This work also will fill a critical gap as the population lives longer and needs more care.”

“Social workers make up an important part of our nation’s health care system, ensuring thousands of consumers each year get the best possible health care both in the hospital and when recovering at home,” said NASW CEO and NASW Foundation President Angelo McClain, PhD, LICSW. “We are excited The New York Community Trust has renewed the grant and CSWE and NASW will continue working together to ensure social workers shape and improve our nation’s health care for generations to come.”

CSWE President and CEO Darla Spence Coffey, PhD, MSW, added, “We are grateful for the NYCT’s continued support of Social Work HEALS and the opportunity to continuing partnering with NASW. Social Work HEALS is particularly impactful because it targets every level of the social work profession, from baccalaureate students to post-doctoral policy fellows. We expect that this will build a pipeline of social work leaders who can transform all aspects of health care—from direct practice to policy—to better meet the needs of underserved populations.”

The New York Community Trust supports an array of effective nonprofits that help make New York City a vital and secure place to live, learn, work, and play, while building permanent resources for the future. Two couples, Robert and Ellen Popper and Lois and Samuel Silberman, created permanent funds in The Trust to make the field of social work more effective by using scholarships and training. The New York Community Trust combines part of their gifts to fund this program.

The New York Community Trust grant allows NASW, CSWE and 10 partner schools to provide field instruction, course work and leadership opportunities so more social workers are ready to become a key part the U.S. health care delivery system and provide better services to clients. Social workers are trained to provide culturally competent, evidence-based practice in health care settings.

NASW and CSWE also use the grant to foster the next generation of social work academic and practice leaders by developing five-year partnerships with the 10 schools. Through funding at the baccalaureate and master’s levels, about 200 students will have the opportunity to take part in education and training, connect with peers, advocate for policy issues, and practice as a member of an interprofessional health care team.

For instance, more than 40 social work students who take part in the program came to Washington, D.C. in October 2015 to meet with social workers engaged in health care policy and learn about health care legislation important to social workers, including the Improving Access to Mental Health Care Act of 2015. These students also arranged visits with Congressional staffers to discuss social work and health care-related legislative issues.

NASW and CSWE will host the next summit of program participants in 2017.

“We are delighted The New York Community Trust is showing leadership and vision by investing in the social work profession,” McClain said. “This grant is already making an impact by giving social workers in the program a chance to truly have an opportunity to influence our nation’s health care policy and improve the health and well-being of millions of people.”

New Medicaid Guidance Improves Access to Health Care for Justice-Involved Americans Reentering their Communities


On April 28, 2016, the U.S. Department of Health and Human Services (HHS) strengthened access to health care for individuals transitioning from incarceration back to their communities. New Medicaid guidance released today updates decades-old policy and clarifies that individuals who are currently on probation, parole or in home confinement are not considered inmates of a public institution. It also extends coverage to Medicaid-eligible individuals living in community halfway houses where they have freedom of movement, improving access to care for as many as 96,000 individuals in Medicaid expansion states over the course of the year.

Historically, the vast majority of justice-involved individuals have been uninsured, while experiencing disproportionately high rates of chronic conditions, infectious disease and behavioral health issues. Studies show that roughly half of incarcerated individuals struggle with mental health and substance abuse conditions. Access to the health benefits the Medicaid program covers can play a key role in improving the health of these individuals, and states that expand Medicaid coverage are able to better support the health needs of this population.

“As we celebrate National Re-Entry Week, it is important to understand the critical role access to health care plays in successful returns to the community for so many Americans trying to change their lives,” said Richard Frank, HHS Assistant Secretary for Planning and Evaluation. “Today’s actions will immediately begin to give as many as 96,000 of American’s most vulnerable citizens access to needed health care through Medicaid, including mental health and substance use disorder treatment, reducing the risk they will be re-incarcerated or hurt.”

According to a report released by HHS, there are 2.2 million people currently incarcerated and 4.7 million people under probation or parole in the United States. Because over 95 percent of incarcerated individuals will eventually return to the community, their access to quality health care post-release is an important public health issue. Medicaid coverage connects individuals to the care they need once they are in the community and can help lower health care costs, hospitalizations and emergency department visits, as well as decrease mortality and recidivism for justice-involved individuals.

Through the Affordable Care Act, states have the opportunity to expand Medicaid coverage to individuals, including single childless adults, with household incomes at or below 138 percent of the federal poverty level. Federal funds cover 100 percent of health care costs for the newly eligible population in 2016, scaling down to 90 percent in 2020 and beyond. Medicaid expansion is an important step states can take to address behavioral health needs, including serious mental illness and opioid and other substance use disorders. Nearly 2 million low-income uninsured people with a substance use disorder or a mental illness lived in states that had not yet expanded Medicaid in 2014.

The Obama Administration has taken major steps to make our criminal justice system fairer, more efficient, and more effective at reducing recidivism and helping formerly incarcerated individuals contribute to their communities.  To highlight this important work, the Justice Department has designated the week of April 24-30, 2016, as National Reentry Week.

For more information on the Medicaid clarification guidance, visit:

For the report on the importance of Medicaid coverage for criminal justice-involved individuals reentering their communities, visit:

Honouring Humanity in Human Resources: It Matters.


No matter what you do for a living or where you work, you are likely involved with a human resources division in your organization. These departments are centrally focused on the management of people – how they are hired (and fired) – how they are paid and how much – how they are provided with the tools to meet the requirements of their job descriptions.

Nowadays, many organizations are committed to supporting the training and wellness needs of employees. It’s like we are actually starting to get it – that healthy and happy people are capable of high quality service. Smart.

People Trump Paper and Process Every Time

Why do we spend so much time and energy caring for equipment, processes, policies and procedures than we do for human beings? We’ll spend countless hours cleaning our computers of viruses while we ignore the slow poisoning of our relationships?

We expect employees to grieve the loss of a loved one in 3 – 5 days and get their butts back to work at top performance. We say that we want employees to take risks, to be creative, to stretch themselves and contribute at their highest level, but when this happens, we buckle under the threat of change and take steps to put that person back in their place.

I think this happens because it is easier. It’s that simple.

In the field of helping professions, this takes on even greater importance. We are talking about people working with other people to provide services to people. It is one big pot of humanity. And humanity can be messy at times. Messy and unpredictable. And ultimately divine.

The Shared Human Experience

Many of the challenges that often lead people to access social services and health care can be the same kinds of challenges faced by those people providing the services. This is the truth.

But, we continue to go by the old adage telling us that as helping professionals we need to compartmentalize these challenges – don’t bring this into the workplace – put it on the back burner. What if we took the time to sit with our challenges – to see the connection between what causes us despair and what breaks the hearts of those who come to us for help? How can we do this without losing sight of our role as a professional helper? How do we maintain integrity in the face of struggle? What can our organizations do to support the human experience of their employees?

Struggle and challenge aside. How much time do you spend cultivating your unique gifts – looking for opportunities for meaningful contribution? Do you have the opportunity to live from your source of inspiration – to serve from this source of inspiration?

Want to be an Organization that Celebrates Your Human Resources?

One of the most powerful things that human services organizations can do is to honour and uplift their human resources. Create opportunities for self-expression and personal fulfillment for employees. I am convinced that people who feel inspired and fulfilled in their work are people who live on the cutting edge of their creativity. Who wouldn’t want a workforce filled with those people?

The most valuable resource contained in health care and human services organizations are human.

How does your organization care for its human resources?

Department of Health and Human Services Plan to Invest 157 Million into Social Work


Can social workers’ knowledge of health-related issues be useful in achieving better health outcomes?  The Department of Health and Human Services (HHS) thinks so, and it will provide up to $157 million in funding to 44 bridge organizations over a five-year period to determine how effective these organizations are in connecting consumers of clinical services with social service agencies addressing issues related to clients’ wellbeing.  Funding for the Accountable Health Communities Model will be provided through the Affordable Care Act to assess the efficacy of social work interventions addressing social determinants of health and well as clinical practice.

The federal government’s interest in the social determinants of health was underscored at the 2013 White House briefing hosted by the Council on Social Work Education (CSWE) entitled: Addressing the Social Determinants of Health in a New Era: The Role of Social Work Education. The focus of the briefing was the need to prepare the next generation of social workers for healthcare reform spurred by the Affordable Care Act’s emphasis on integrative healthcare models.

One panel on New Expectations for Health Care focused on what the new era of health care will look like with respect to integrated care, interprofessional health care teams, and consideration of social determinants of health.  Panelists emphasized the importance of linkages and connectors between the community and health care providers and the value of social workers in making those connections.

The Center for Medicare and Medicaid Services (CMS) will implement and test a three-track model of service delivery.  The first track (Track 1 Awareness) will focus on a participating organization working to increase awareness among community residents through referrals and information dissemination.  Track 2 (Assistance) will rely on navigators to actively assist high-risk resident in connecting with available resources in the community.

The third track (Track 3 Alignment) will involve organizations working to align community partners to ensure services are beneficial and accessible to community residents.  Funds are not allowed to be spent of the services required by consumers.  CMS will award 44 cooperative agreements ranging from $1 million for a Track 1 initiative to $3.5 million for a Track 3 initiative.

All participating organizations are expected to identify and partner with clinical delivery sites (CDS).  They must conduct comprehensive social needs screenings, make referrals for eligible Medicare and Medicaid beneficiaries, and connect community residents with specific unmet health-related social needs to community service providers that might be able to address those needs.

Track 3 organizations must also align effective partners to maximize community capacity to address health-related social needs in the core areas of housing instability and quality, food insecurity, utilities, interpersonal violence and transportation shortages.  Applicants will partner with state Medicaid agencies, clinical delivery sites, and community service providers and are responsible for coordinating community efforts to improve linkage between clinical care and community services.

Eligible applicants include community-based organizations, healthcare provider practices, hospitals and health systems, institutions of higher education, local government entities, tribal organizations and for-profit and not-for-profit local and national entities from all 50 states, U.S. Territories, and the District of Columbia.  CMS will award renewable one-year cooperative agreements to successful applicants.

Organizations may apply for funding in one or two tracks, but will be selected to participate in a single track only that will run for a five-year period.  Detailed information about the various track can be obtained from the Funding Opportunity Announcement (FOA).  Interested organizations have until February 8 to submit and non-binding Letter of Intent (LOI).  CMS will be accepting applications until March 31, 2016.

Questions about the model and applications can be submitted Interested parties can register for a January 27 webinar on the application process.

Remembering 911 and Social Workers on the Frontlines of Disaster


Another year has passed since the two jets crashed into the Twin Towers of the World Trade Center on September 11, 2001. As a longtime New York City resident, I was devastated by what I saw on television from my Washington, DC apartment. I watched in utter dismay and hopelessness as the buildings burned. I prayed for the people who were inside—that they would somehow find a way out of those buildings.

Many were rescued, but many died. Nearly 3,000 people lost their lives in the single greatest terrorist attack on American soil. There were innumerous acts of bravery and self-sacrifice. Thousands of photographs captured police officers, firefighters, and emergency medical personnel sifting through smoldering rubble, carrying people and bodies, comforting the grieving.

There were many social workers on the scene but they were mostly unidentifiable. They wore no badges or uniforms. They went about their grim tasks, virtually unnoticed. They were there doing what they always do during disasters—helping children find parents, helping wives, husbands and loved ones find each other, dealing with the shock, grief and trauma that are the byproducts of catastrophe.

They were rarely, if ever, mentioned in speeches and media accounts of September 11, 2001. Like many social workers who meet the needs of people in distress daily, they went about their work without fanfare—not looking for reward or recognition. They were faceless angels among the hordes of volunteers I watched on my television miles away in Washington, DC.

I had just moved to DC a year before and had not long been in one of the towers visiting my daughter Cyndia who was employed on one of the top floors of the Twin Towers. Riding the elevator on my way to see her, I marveled at the engineering feat that created these two gigantic steel monoliths. Views of New York City from that height are breathtaking. I had no worries then about the Twin Towers. They were built to withstand anything—well, almost anything. They were not able to withstand the shock and heat from the burning fuel that eventually caused them to crumble into a pile of debris of flesh and metal. They were not indestructible after all.

I think back to 1968 or 1969 when as a teenager I worked in the post office in Greenwich Village. One of my coworkers had a buddy guarding the construction site as the towers were nearly being completed. One night, we rode a wooden elevator to the top of one of the buildings that was still under construction. There were no panes in the window frames and there were holes in the floor, so we had to be very careful where we walked. I did not walk far but got to see New York City from the sky that night. It was an amazing feeling of awe and fright and I always felt I had a special relationship with those buildings after that experience.

I remember countless trips from New York City to destination south and back. Whether I was driving or riding the Amtrak, it was always a relief when I first saw those towers—sometimes peeking through the clouds—but always standing tall and magnificent. I knew home was just minutes away when I saw those towers.

If I was driving and fighting fatigue, I would get a second wind because I knew that it not be long before I would be back in the comfort of familiar surroundings and the warmth of my bed. The first trip back to New York City after 9/11 was a shocker when I saw the hole in the skyline. It seemed so bizarre and it saddened me to be reminded of the deaths, pain and suffering caused by the removal of those towers. I had lost my comforting signpost that home was just around the bend.

Today we commemorate another anniversary of that tragic and historical event. Much has transpired since that day—some of which we can be proud, some of which we want to forget. Many of the survivors and first responders on September 11, 2001 had to wait nearly a decade for the passage of the James Zadroga 9/11 Health and Compensation Act of 2010 that provided resources for the ailments they incurred during and in the aftermath of the tragedy.

A bill to extend those benefits waits among the many pieces of legislation needing action by Congress while the House leadership deems debating the defunding of Planned Parenthood to be more urgent. Without the reauthorization of the Zadroga Act, thousands may go without the medical care they need. Let’s not forget, many of them are social workers.

When Basic Living is Considered a Utopia for the Poor


With our fast paced lives in a technological age of instant gratification and easy distraction, it’s no wonder news channels are beginning to advertise “distractify” sections on their web pages. It’s not difficult to see how quiet unassuming people may get pushed aside, and their needs relegated to the back burner. We assume that they’ll get social security which will provide some basic living. After all, we are told that all Americans can get social security once they retire. Right?

But, retiring means that you have worked, and social security is based on earnings over your lifetime. For homemakers, this doesn’t help much. We assume that they’ll receive Medicare, and yes we might even hear about the problems and costs associated with what Medicare doesn’t cover. We might even assume that the elderly will get food stamps without realizing just how meager food stamp grants really are. In an age of cuts to social programs, not only are all of these so-called entitlements at risk, programs such as food banks, meals on wheels, and utility assistance are also at risks which leads me to tell you about Mrs. Jones.

Mrs. Jones* is a vibrant and lovely elderly woman, free with stories of years gone by and quick with an ear for friends and neighbors. She loves working in her garden and sitting on her porch chatting with passers-by. Many in her community in Atlanta look forward to the spritely older woman and her tales. Many more loved her homespun wisdom and down home recipes, both of which she’s quick to share.

So, it was with great shock and profound sadness that the community witnessed its first day without the fixture that was Mrs. Jones and the loss was palpable. The shock and sadness only increased as the story behind Mrs. Jones’ absence spread.

In all the time she was cornerstone of the community, the very bedrock that most communities seek to cultivate, no one guessed she might have a secret. Mrs. Jones was used to being relied upon in her community and never thought to ask for anything in return. While her neighbors were friendly, caring, and even supportive of her, no one thought to inquire into how this lovely elderly woman, a widow who’d largely been a homemaker, was fairing. Sadly though, Mrs. Jones is one of countless citizens in an unenviable position. She is one of the 3.4 million citizens aged 65 and over in our country who live in poverty making her part of an extremely vulnerable population and one that is often forgotten in our society.

As a widow she did qualify for survivor’s benefits, but as someone who was largely a homemaker, her social security was meager at best. She did happen to qualify for Medicare, but was judged to be over the resource limit for food stamps. Living alone without dependent children reduced her benefits limit to the point that she was deemed to make too much. In short, after a lifetime of raising children, keeping house, and being a good and supportive wife to her husband all things lauded as family values to be protected, the system failed Mrs. Jones.

On the night where we pick up Mrs. Jones’ story, the night before her community witnessed the absence of its cornerstone, Mrs. Jones dialed 911 in a panic. She was having incapacitating abdominal cramps coupled with vomiting. When she arrived at the emergency room she was quickly diagnosed with a bowel obstruction and raced into emergency surgery. Afterward she was admitted to the ICU to recover from surgery and to stabilize her condition. A few days after she was admitted, a concerned friend came to visit and that’s when the true tragedy of Mrs. Jones case was revealed.

Her neighbor, perhaps one of her closest friends, knew that Mrs. Jones had been diagnosed with a heart condition, and that the treatment course was not covered by her insurance. This is not uncommon among the elderly who frequently have too many medical bills and not enough money or insurance. Many Americans think that supplemental insurance like Medicare part D picks up the rest, but the truth is it doesn’t cover everything and creates what some call the Medicare donut. In this position, Mrs. Jones was left to decide between medication and other necessities like food, which also is not uncommon among the elderly.

What makes this story less common, but by no means unheard of, is how Mrs. Jones decided to solve the problem. With too many financial needs and too few dollars at her command, Mrs. Jones decided that she would have to resort to eating dog food to afford her medications. That’s right, as she was trading recipes with her neighbors, offering an ear to all and being the foundation of her community, Mrs. Jones had resorted to eating dog food.

Mrs. Jones had been failed by the very society of whom she was a bedrock. Even more tragically, she is now saddled with even more medical debt which lead to her illness in the first place. Only time will tell how Mrs. Jones’ story will end. With her grown children having moved away and her husband  now deceased, it is very likely her community will forever lose its cornerstone. The debt she’s incurred will drive her to even more austere measures and ultimately lead to her being placed in assisted living.

Mrs. Jones’ story and the stories of millions like her doesn’t have to end this way. It doesn’t have to be a story of poverty, increased health care costs, and increased demand for limited assisted living spaces. The only solution that eliminates poverty and corrects societal tragedies like Mrs. Jones story is a universal basic income.

Had Mrs. Jones lived in a country that provided a guaranteed basic income for its citizens, Mrs. Jones would not live in poverty. She’d receive a stipend that guaranties her a comfortable existence where she could afford food and adequate health insurance. Insurance where her medication is covered, thus eliminating the strain of poverty on our health care system.

Clearly our current system, which leaves 3.4 million of our elderly in poverty, estimates as many as 44% of seniors would be living in poverty if it were not for social security. As stated in the findings by Center for American Progress, the system is broken, and it’s time to find a solution. 

Editors Note: *Mrs. Jones and staff at Emory University Hospital spoke to me on condition of anonymity. Mrs. Jones name was changed to protect her privacy.

Blue Cross Report: Social Services Critical to Improving Health


In a new report by the Blue Cross Blue Shield Foundation, social, behavioral, and environmental factors are shown to determine a staggering 60% of one’s overall health. The report provides overwhelming support for increased investment in, and collaboration with, social services as a way of improving overall individual and community health.

The report’s key findings include:

-Providing housing support for low-income, high-need individuals can result in net savings due to reduced health care costs. The net savings range from $9,000 per person per year to nearly $30,000 per person per year for the Housing First model, a harm-reduction approach in which adults who are homeless and who have behavioral health conditions are provided supportive housing.

-Nutritional assistance for high-risk women, infants, and children as well as older adults and people with disabilities lowers infant mortality rates, improves birth weights, reduces nursing home admissions, and significantly lowers federal and state Medicaid costs.

-Vulnerable populations experience health gains when their care is coordinated across primary, specialty, behavioral, and social services and that hospitalizations and emergency department visits are demonstrably reduced.

-Partnerships between health care and social service providers, particularly housing service providers, have been effective in improving health outcomes in certain high-need populations.

-Income support programs, specifically the Earned Income Tax Credit (EITC) and Supplemental Security Income (SSI), were associated with better health outcomes for those individuals who qualify for such programs.

By attributing 60% of one’s health to social, behavioral, and environmental factors, Blue Cross Blue Shield is making known that social workers and social service programs are the key to improving the health of individuals and communities. The report opens the door for unprecedented collaboration between social workers and private sector health insurers, who can work together to address patient care as a whole unit.

The report adds to the increasing evidence that integrated healthcare is the future of care delivery. Integrated care involves primary care providers and behavioral/mental health providers working in unison to treat the whole patient. Social workers, who are trained in interdisciplinary collaboration, are uniquely qualified to serve in this capacity.

Most importantly, the message of the report is clear: achieving optimal health is impossible without increased investment in social service programs, especially for vulnerable populations. This provides a major opportunity to advocate on behalf of increased investment in programs that improve health while reducing healthcare costs. When one of the nation’s largest health insurers says that social service programs are critical to the health of our nation, policy makers will have to listen.

Paid Maternity Leave: A Policy Imperative

Living in a country so focused on the reproductive behaviors of women, from contraception to abortion, it seems preposterous that despite the myriad policy imperatives that want to control women’s fertility, there is no federal policy that supports our decision to give birth by granting us paid maternity leave.

Maternity Leave in America: Where are we at?This policy gap is even more significant given that the USA is the only industrialized nation not to mandate paid maternity leave and is one of only a handful of countries globally that does not. The countries that are members of the Organization for Economic Cooperation and Development (OECD) average 18 weeks of paid maternity leave. Maternity leave is a social, economic and health policy that has broad and significant impacts for individuals, families, organizations and nations.

(For reasons of brevity and simplicity I am deliberately focusing on maternity leave but it is important to note that many national and organizational ‘maternity’ leave polices are subsumed within parental policies that apply to both mothers and fathers).

Family and Medical Leave

In the USA, the primary policy related to maternity leave is the Family and Medical Leave Act (FMLA) which puts various kinds of family-related leaves into one unpaid 3 month pot which includes leave for caring for a parent and leave for caring for an child. However, New Jersey, Rhode Island and California provide state-funded paid family and medical leave that includes pregnancy and childbirth. These policies are paid for by employee-paid payroll taxes and distributed through disability programs – with ‘disability’ being an unfortunate, if economically useful, way of categorizing pregnancy and birth.

If they do not work for one of the top law firms of the Vault 100 or a Fortune 500 corporation that competes for top talent and grant paid maternity leave to attract and retain employees, women are generally out of luck. If you are a woman with a ‘regular’ job, what do you do when you get pregnant or have just given birth? You have to take upaid leave at a time when your expenses have increased. Thus many women return to work within weeks of birth. Though some women try to continue to breastfeed, not many workplaces allow for convenient pumping and so women find themselves having to wean their infants because of workplace conditions in addition to their ‘early’ return to the paid workforce.

Many feminist activists do not want to ‘provoke’ a paid maternity leave policy because they think it makes women stand out as needing different (special) treatment than men. The fact is we are different from men and therefore need different policies related to our health and well-being. We incubate human beings for 9 months. We also have breasts that can be the sole nutritional source for infants for more than 6 months. This highly differentiates women’s parenting roles from that of males, regardless of how egalitarian a construct we may consider parenting to be.

Gender and Class Differences

In order for women to get the policies we want, we should acknowledge the difference, own the power in that difference, and demand what we need to take care of the next generation. The absence of child benefits, dearth of subsidized high-quality childcare, costly access to healthcare, low-performing public schools and high tuition costs for tertiary education are evidence of a government that talks about supporting families while neglecting the policies that would do so.

Not many women can afford to take unpaid leave and the women who work for companies were paid leave is a perk are more likely to be able to afford to take an extended leave without being paid while doing so. By making work incompatible with motherhood, women are forced to make hard choices between taking care of their children and being in the workforce, and men are forced to make this choice. Leaving the workforce because of motherhood not only reduces present income, it also limits lifetime income on which pensions are calculated while maintaining and expanding the income gap throughout the lifespan.

Our social welfare policies push poor women to work and yet social norms push middle class and wealthy women to stay home. Taking care of one’s own child should not be an economic luxury. Our economic and social policies recognize childcare as a ‘job’ only if someone other than a parent is taking care of a child. If a woman is taking care of her own child, her contribution to the economy and society is not ‘officially’ acknowledged by society at large.

For women who qualify for subsidized childcare, it is counterproductive and expensive to pay so much more money for a non-parent to care for a child while being unwilling to support a woman to take care of her own child. With regard to paid maternity leave and subsidized childcare, it is clearly not just about money, but it is about values.

The Wage Gap

Maternity leave is a key factor in the gender gap in wages and employment and in the ‘family gap’ in income that exists between women with children and women without children. Forty to fifty percent  of the gender gap income can be explained by the family gap differential due to marital and parental status among women.

The absence of paid maternity leave in the USA has been perceived by feminists and public health professionals as anti-woman, anti-child and anti-family because it does not provide income for woman post-childbirth nor does it support the 6-month breast-feeding recommendations of the American Pediatric Association.

Health Outcomes

There is no coincidence in having no paid maternity leave and the poor health outcomes we have for infants/children in this country. This is not to say that this is the only policy to blame as health policies are also significant contributors to poor health outcomes in mothers, infants and children. Policy ‘obsession’ with humans in utero do not continue once children are born.

There is little regard for comprehensive sexual health education for children and adolescence and too much attention paid to contraceptive choice and abortion. Once the child is born, our social welfare and health policies leave all but the poorest of mothers to fend on their own. The poorest women qualify for Medicaid and WIC (Women, Infants and Children). This is reflected in lack of affordable, high-quality childcare, poor performing public schools, juvenile justice facilities that are full to overflowing, low high school graduation rates and college costs that leave young adults mired in debt.

The Price of Motherhood

The price of motherhood should not be so financially challenging. Is possible women in developing nations will simply choose to opt out of the motherhood game altogether? Though the fact that American women continue to give birth at such high rates despite a social welfare net that has very large holes is a social policy paradox that is not easily understood. The demographic and economic challenges of low birthrates are not so easily fixed by social policy. Doing research on this topic for an economics class on gender and family, it was really hard to find a rationale for the resistance to paid maternity leave in the USA so I’m not sure why we are stuck in some sort of policy dark age along with universal access to health care.

Where Do We Go From Here?

In 2010, Ernst and Young was listed among the top 10 family friendly companies by Working Mother Research Institute, provides new mothers with 12 weeks paid leave and 10 weeks unpaid leave. Bank ofAmerica, which was also on the top 10, gives a paid leave to either gender of 12 weeks and allows them to take a total of 26 weeks. These organizations are profit-making institutions that would not be handing out benefits if they did not make economic sense. Getting good benefits lead to staff loyalty that reduces the costs of staff turnover. Furthermore, the costs of educating and training women get recouped over time when women are retained in the workforce.

For women who are joining the workforce, paid maternity leave should be a consideration when deciding on potential employers because the economic, social, health, personal and family benefits that result from such policies contribute much to our overall well-being and that of our families and society at large.

As is the norm in the USA, paid maternity leave is a social and health policy that is attached to employment and an employer. This leaves women at the whim of the workforce. Paid maternity leave should be a federal concern and not dependent on the whims of workplace or state policies.

Mississippi Crumbling: The Inheritance of Inequity in The Magnolia State

“Everybody in the Mississippi Delta was a racist, white or black. Racism was built into our bones. It is a thing we will never recover from having committed, but it also had its side that we always benefitted from…I lived in a society that was filled with horrors, as you look back on it. They were not horrors at the time.” – Shelby Foote

They say that time heals all wounds, but the maxim only applies if the wounds are properly tended to. You can’t just leave a gaping sore open to the influence of the oppressive environment in which it was born and it expect it to get better. No, a wound left untended amongst a sea of malignant influences is sure to bloom with miasmatic glory before long. By the same token, no healing is going to take place if the regeneration of flesh is interrupted by a public that believes the best course of action is to perpetually pick at the wound with their cruddy, unwashed fingertips, waiting until little rivulets of pus and blood begin to run down their arm before they finally stop long enough to let it to scab over again. Time alone is sufficient for the mending of paper cuts and carpet burns, but when it comes to the deep, ravenous gashes that cut down to the bone, it is nothing more than an incubation period. The reality is that time is a neutral agent—something that possesses the ability to help and harm our collective injuries in equal measure. It does not heal. It does not hurt. It merely facilitates.

During his Second Inaugural, President Lincoln spoke of the necessity of “binding up the nation’s wounds” and caring for those who had borne the battle if we were ever to see a prolonged peace. He acknowledged the contradictions of war and spoke to the absurdities that spring from it, asking how it could be that two groups of men who read the same Bible and worshiped the same god could pray for victory over their enemy and expect Him to answer one group’s prayer, but not the other. By the end of his address, Lincoln had framed the Civil War and all of the suffering attendant to it as a sort of divine reckoning that had come and would come to pass over a nation which had harvested the fruits of slavery for 250 years,saying:

“Fondly do we hope, fervently do we pray, that this mighty scourge of war may speedily pass away. Yet, if God wills that it continue until all the wealth piled by the bondsman’s two hundred and fifty years of unrequited toil shall be sunk, and until every drop of blood drawn with the lash shall be paid by another drawn with the sword, as was said three thousand years ago, so still it must be said ‘the judgments of the Lord are true and righteous altogether.'”

It has been nearly 150 years since President Lincoln let his countrymen know the debt he believed we owed to our creator and, 150 years later, we have yet to pay it off. Well, to be fair, we’ve already paid one half of the debt off. Or at least I hope we have. Call me an optimist, but I would think that the Civil War itself would be enough to atone for all of the blood that had been drawn by the lash during the course of American slavery. That’s not to say that the country didn’t immediately start accruing more cosmic debt from the moment Reconstruction started, but I’d like to think that more than 700,000 gallons of blood in a 4 year span would satiate whatever bloodlust god had up to the point.(1) It’s that whole accumulation of ill-gotten wealth from 250 years unrequited toil part that we’ve never really made a lot of progress on.

A depiction of Lincoln’s 2nd Inauguration in the US Capitol’s Great Experiment Hall

Earlier in his Second Inaugural, Lincoln made a covert dig at the morality of the Confederate position on slavery when he commented on the strangeness of a people asking, “a just God’s assistance in wringing their bread from the sweat of other men’s faces.” To a modern reader, it might seem like a strange choice of words, but his audience in 1865 was likely to pick up on the biblical allusion Lincoln was making. In the Book of Genesis, god puts a curse upon the ground after discovering that Adam and Eve have eaten from the Tree of Knowledge, telling Adam that, “In the sweat of thy face shalt thou eat bread, till thou return unto the ground; for out of it wast thou taken: for dust thou art, and unto dust shalt thou return.”With this as context, it would seem that Lincoln is painting the practice of slavery as a violation of god’s will as it is an economic system designed to absolve one group of people from the curse of god on the land by making another group bear twice the burden. It is not so much a condemnation of the particular institution of slavery as it is the practice of systematically exploiting the labor of your fellow-man for unearned personal gain. Had he lived through Reconstruction, I have little doubt that Lincoln would have been just as disgusted with the practices of sharecropping and convict leasing as he was with slavery and that he would have done everything in his power as President to stifle their spread through the South.

But, Lincoln did not live through Reconstruction. In fact, he didn’t even make it through the second month of his second term, thanks to a deranged Confederate sympathizer named John Wilkes Booth who decided it was incumbent upon himself to avenge Old Dixie by assassinating our 16th President in the middle of a showing of Our American Cousin. Tragically, Booth’s nerve was not shared by one of his co-conspirators, George Atzerodt, who was supposed the kill Vice President Andrew Johnson on that same night, but got cold feet. Thus, we had a situation in which the greatest President our nation had ever known was assassinated, only to be replaced by a man who would prove to be the one of the worst we’ve ever had to endure.

From his quick and largely consequence free reinstatement of former Confederate leaders and endorsement of discriminatory Black Codes in many Southern states, to his vetoing of legislation that proposed civil rights increases and an extension for the Freedman’s Bureau, Johnson played the part of the white supremacist savior, effectively killing off any hope that the civil rights of blacks in this country would go beyond mere emancipation in the near future. The slaves had been nominally given their freedom, but Johnson was determined that they shouldn’t be given anything else. Under his watch, the rights and opportunities available to white men would not be extended to any other race and the ascendency of a new American hatred would begin.

In the span of three years, our country went from a President who urged his fellow Americans to have malice towards none and charity towards all to a President who demonized one section of the population for the benefit of another and unironically warned that if the black race, “obtains the ascendency over the [white race], it will govern with reference only to its own interests for it will recognize no common interest–and create such a tyranny as this continent has never yet witnessed.” In Andrew Johnson’s words you can hear the contempt and revulsion for his fellow-man burbling out in a sea of incoherent hatred. You can see his words spurring on the basest nature of the white southern plebians from which he sprang, settling in them a vicious enmity towards their black brothers and sisters that would cause them to ignore the grave injustices being perpetrated against them by their patrician white fellows. Most of all, you can feel that scar tissue that was built up after Gettysburg and Appomatox and Shiloh begin to slowly crack open, exposing those tender wounds of ours to infection and disease and rot. There would be no healing there.


Despite the inevitable protestations of some of their neighboring states in the deep south, I think there is no question that the State of Mississippi is the most enduring legacy of the Confederacy. Sure, South Carolina can lay claim to being the first state to secede from the union and Alabama can hold tight to the knowledge that their state legislature still meets in the building that was once the Confederate Capitol, but they can’t quite compare with the sheer scope and volume of Mississippi’s rebel worship. South Carolina wants to offend some folks by continuing to fly the Confederate flag at their state capitol? Well, that just means Mississippi’s going to have to one up them and actually stick the stars and bars in the design of their own state flag. Alabama’s feeling pretty good because it named a community college after Jefferson Davis? Mississippi named an entire county after the son of a bitch. Hell, the nickname for the University of Mississippi’s sports teams is the Rebels and, until 2010, the mascot for the school was an antebellum plantation owner named “Colonel Reb”.

But all of those are just some of the cosmetic heirlooms of Mississippi’s Confederate past. Yes, they are racially and culturally insensitive and, yes, they honor the legacies of some of the most oppressive bigots in our nation’s history, but at the end of the day they’re still largely symbolic. The Magnolia State’s true antebellum inheritance can be seen in the day to day lives of the majority of its nearly 3 million residents, who are still shouldering the burden of a white ruling class that has consistently thumbed their nose at President Lincoln’s words of warning by continuing to pile up tarnished wealth from the bondsman’s unrequited toil, even if the bondsman has been relabeled a sharecropper or a minimum-wage worker.

Statistically speaking, Mississippi is the most downtrodden and depressing state in all of America.

No matter which direction you go, the signs and symptoms of this perpetual oppression will make themselves readily apparent to you. Drive yourself southeast from Greenville to Gulfport or northwest from Clinton to Corinth—it doesn’t matter. You can drive in concentric circles around Jackson for all I care, because regardless of where you want to start off from or where you plan on going, the end product will be the same: poverty. With nearly 1 in 4 Mississippians living below the poverty line, the Magnolia State is far and away the most impoverished in America, besting the state with the 2nd largest percentage of impoverished residents by more than 3 percentage points. Mississippi can also lay claim to an unmatched ubiquity of poverty as well, as every one of Mississippi’s 82 counties—save DeSoto, Madison and Rankin Counties—has a poverty rate that is above the national average of 15.9%.

Of course, being the poorest state in the union, it should come as no surprise that Mississippi comes in dead last—or first, depending on how you look at it—in a slew of other unenviable categories, but I have to admit that it is still shocking to see just how much worse off Mississippians are then everyone else in the country. How bad is it? Well, Mississippi ranks last in median household income, per capita personal income, overall health outcomes,diabetes rates, obesity rates, average life expectancy, cardiovascular deaths, infant mortality, infants with low birthweight, teen pregnancy rate and high school graduation rates. Statistically speaking, Mississippi is the most downtrodden and depressing state in all of America. The only consolation they can glean from their collective misfortune is that the rest of the South is, to varying degrees, experiencing the same health, wealth and education disparities as they are. In fact, things are so bad in the South that the region is responsible for 11 of the 12 twelve states with the lowest life expectancies(2) and can point to only one state (Virginia) that has a median household income higher than the national average. I’m not positive on this one, but I’m pretty sure that dropping out of high school, having a baby when you’re 15, getting a meager paycheck and dying early isn’t what folks mean when they talk about preserving “the Southern way of life.”


(1) For those wondering where the 700,000 gallon number came from and want to nerd out, keep reading. If the average percentage of the human body that is blood is about 7% and the average Civil War soldier weighed 143 lbs, that would mean that the average Civil War soldier had roughly 10 lbs of blood in him. Now, if you know that there are 8.85 lbs in a gallon of blood, then you can figure out that 10 lbs of blood—or one soldier—is about 1.13 gallons Then, all you have to do is multiply those 1.13 gallons by the number of casualties in the Civil War, which was about 620,000, and you have the final figure of 700,600 gallons of blood.

(2) The abberant 12th state here is West Virginia, who is pretty well situated just above Mississippi as the 2nd worst in many of these metrics. West Virginia could be classified as part of a very loosely defined South, but for the most part it’s simply an Appalachian no man’s land, with no definitive association with folks on either side of the Mason-Dixon line.

Top Three Barriers to Quality Treatment for Mental Illness

Silver Linings Playbook Movie Poster-Weinstein Company
Silver Linings Playbook Movie Poster-Weinstein Company

In 2012 when Silver Linings Playbook was released, Social Work Helper examined how lack of financial resources and health insurance would have produced an entirely different outcome for the characters in the movie.

The movie utilized a holistic approach between the court system, hospital, therapist, and family in providing treatment options for Pat which allowed him to find his silver lining.  Imagine if Pat was homeless and without healthcare while dealing with pending charges he had in the movie? It would have been another episode of Cops instead of an uplifting movie about overcoming challenges due to mental illness. Read Full Article

In today’s society, mental illness is becoming more romanticized in the media. Many media outlets go as far as to embellish the truth about how mental illness really impacts the lives of those suffering from it. Often, the media fails to broadcast the barriers that are present that prevents certain social groups from obtaining quality treatment for their mental illness. I am going to tell you about what I find to be the top three barriers and how we can work together to break them.


About 2 out of 3 people with mental illness never get any form of professional treatment. Stigma is the number one barrier that enables people from getting the help they deserve. Society makes people feel like they are weak for asking for help.  The social groups that suffer from mental health stigma the most are men, minorities, and those who are told they need to “be strong”. Stigma makes people feel ashamed and hopeless. Based on the stigma on mental illness many people are impeded from recovery and this needs to stop.


When compared to other health services the demand for mental health care is the most responsive to cost. A major player in this barrier is health insurance. Many have found that insurance companies place many restrictions to obtaining mental health treatment.

Mental Health System

Many of the barriers faced by those with mental illnesses are caused by the mental health system itself. This causes frustrations, long waiting time and a very disorganized system. The foundations of this failed system came from previous reform movements, disproportionate distributions of funds, and isolated health care. Mental health professionals are not communicating well with other health professionals. Another thing that needs improvement is the transition from inpatient to outpatient care.

These barriers prevent people from starting their journey to recovery. One way we can break down these barriers to get people to speak up about their issues. As a society we can work on educating the public about the truth. We can also break down these barriers by reaching out to someone in need and letting them know they no longer have to suffer in silence.

Finding the Consumer in the Midst of Medicare

The consumer is often caught in the middle when it comes to a provider presenting a reasonably priced product while striving to stay out of the red.  The American government is no different when it comes to Medicare and its beneficiaries.  The Medicare program provided assistance to over 49,000,000 people in 2012,1 and this number is expected to continue to increase as Baby Boomers become eligible for the federal program.  Our government is currently struggling with how to assess this growing demand with limited financial resources.  In all the budget and deficit debates, it can be easy to forget the most important part of the equation which is the medicare beneficiaries.

Medicare recipients currently pay different premiums for each of the four parts of Medicare.  Most individuals do not pay a monthly premium for Medicare Part A if they or their spouse have paid into the Medicare system via payroll taxes.  Individuals that do not meet this criteria can purchase Part A for $441 per month.

Many people pay the standard premium of $104.90 per month for Part B, but some individual’s will have to pay more if their income from the previous two years is above $85,000.2  Premiums for Parts C and D differ depending on the individual plan that a consumer decides to purchase.  The four parts are designed to offer beneficiaries the most comprehensive insurance program that they can afford.

What if you can’t afford Medicare premiums and deductibles?  Federal assistance, in the form of Medicaid, is available for low-income individuals.  Medicare also has an Extra Help program available to assist with prescription drugs.  Some states also help their Medicare beneficiaries by means of two state programs:  the Medicare Savings Programs pays Part A and Part B deductibles while the State Pharmacy Assistance Program provides financial assistance for prescription drugs.3

Both federal and state governments have options available for Medicare beneficiaries who are limited by their financial resources.  However, the state programs are not offered in every state and some lower-income seniors may still find themselves receiving few health care options while individuals with more money have the ability to pick and choose an insurance plan that best fits their medical needs.  The federal plan that was originally created to help all seniors and other eligible citizens does not help all recipients equally.

Regardless of any underlying inequalities, Medicare is still a more affordable and efficient health insurance provider than many private companies.  In fact, Medicare is viewed quite favorably among the general public.  While more than half of Americans agree that the federal deficit should be corrected with a combination of increased taxes and decreased spending, 58% oppose any spending cuts to Medicare or Social Security.  Three quarters said the deficit could be cut without any major reductions to Medicare.4

The overall general approval of this welfare policy ensures, to a certain degree, that the program will continue to assist the elderly and the disabled in the struggle to have affordable health care.  General opinion also encourages politicians and policy makers to take a more unique approach when considering how to make the program easier on the government’s wallet without directly cutting funds.

Many different ideas are being tossed around in Congress when it comes to making Medicare more affordable.  Some propose adjusting the age requirement from 65 to 67.  Others argue that Medicare should be a means-tested program with higher income individuals testing out.  Some also argue that spending cuts can be removed from the equation all together if the issue of Medicare fraud is thoroughly corrected.  Consumers should expect to hear more about major changes to the Medicare program within the next few months but should not expect to see a decrease in their premiums or deductibles.

Medicare is a complex federal program and this complexity sheds some light onto how challenging it can be for consumers to afford health care in America.  This leads to an interesting debate on how to more effectively serve American citizens.  Should the focus be on reducing Medicare costs or on reducing the cost of health care as a whole?

There is a growing opinion that health care is an overall wasteful, inefficient, and poor quality institution that is in need of reform.  Such a reform could have huge implications for eligible Medicare beneficiaries and other Americans.  Unfortunately, it is much easier for politicians and Congress to discuss how to change Medicare rather than how to improve the entire American health care system.  In the meantime, consumers continue to get caught in the crossfire between the debate over Medicare coverage and Medicare cost.

Photo Credit: Medicare Prospective Payment System

1The Henry J. Kaiser Family Foundation. (2013). Total number of Medicare beneficiaries, 2012. Retrieved from

2Social Security Administration. Social Security Administration, (2012). Medicare premiums: rules for higher-income beneficiaries (SSA Publication No.05-10536). Retrieved from Social Security Administration website:

3Medicare Resource Center. (n.d.). Frequently-asked medicare questions. Retrieved from

4Wessel, D. (2013, January 24). Whose budget fix is more popular?. The Wall Street Journal. Retrieved from

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