HHS Climate and Health Outlook tackles climate-related hazards

Published in RINews Today on July 25, 2022

Over two and a half months ago, the Biden administration launched a new initiative, called the Climate and Health Outlook, to serve as a resource to help people, health professionals, and communities protect individual and community health impacted by climate events.

On May 6, 2022, the U.S. Department of Health and Human Services’ (HHS) Office of Climate Change and Health Equity (OCCHE) launched the first installment of its new public information series called the Climate Health Outlook – https://www.hhs.gov/sites/default/files/climate-health-outlook-may-2022.pdf (Outlook). HHS’s new Outlook series connects weather forecasts to health resources to create actionable data they say will saves lives and reduces illness and health risks associated with climate-related hazards like extreme heat, wildfires, hurricanes, droughts, and vector-borne diseases that impact human health.

According to HHS, this inaugural edition of the Outlook will take on extreme heat, which has been a key target of the Biden administration’s efforts to build resilience to the impacts of climate change. As part of this and future editions, the Outlook series will add a health lens to seasonal weather and climate outlooks from the National Oceanic and Atmospheric Administration (NOAA) to inform health professionals and the public about weather- and climate-related health risks months in advance and provide resources to prepare.

“We’ve seen what exposure to extreme heat can do,” said HHS Secretary Xavier Becerra in a statement announcing the new federal initiative. “It can lead to illness and death and makes it much harder to do a day’s work outdoors. Many people in the United States have jobs that require them to work outside to feed their families regardless of the weather. Our new Climate and Health Outlook protects people and their health by giving advance notice to the communities that will be most impacted in the coming months.” she said.

“Our communities across the country will soon be facing heatwaves that will be an additional strain on our health systems,” adds  Assistant Secretary for Health Admiral Rachel Levine. “This information will save lives when used by public health officials, employers with outdoor workers, and schools and local health departments and the individuals they serve. Having information in advance can reduce illness and deaths from extreme heat exposure,” she says.

The Outlook illustrates where the greatest health risks from heat will be in the United States during the early 2022 heat season, presenting estimates of which U.S. counties are expected to experience extremely hot days and identifies the vulnerable populations in those counties that could be impacted by heat exposure. It also provides a set of actionable resources from HHS that are targeted to the public, specific populations, health care professionals, and public health officials to reduce health risks from heat.

HHS says that the Outlook will be updated and improved regularly as future data and feedback are collected. Future editions will address other climate-related threats to the health of people living in the United States, with a focus on those most vulnerable. For a copy of  HHS’s Office of Climate Change and Health Equity’s May issue of Climate and Health Outlook: Extreme Heat, go  to https://www.hhs.gov/sites/default/files/climate-health-outlook-may-2022.pdf.

On a Personal Note… Surviving the Dog Days of Summer

Just days ago, Rhode Island officials announced its first heat wave  It took 3 days of 90 degrees or above to make this call. 

Despite the fact that 618 people throughout the nation killed by extreme heat annually, according to the U.S. Centers for Disease Control and Prevention (CDC), says heat-related deaths and illnesses are preventable.  

The following tips provided by CDC’s website provide sound tips for helping us stay safe when the temperatures soar.

During an ongoing heat wave, seniors, infants and young children, and people with mental illness, those overweight, and chronic diseases (including heart disease) are at the highest risk of heat-induced illness that can cause a person to become confused or lose consciousness. Seek medical attention immediately for anyone showing signs of heat stroke. Heat stroke can be life-threatening.

With temperatures rising, wear appropriate clothing that is lightweight, light-colored and loose fitting. 

During extreme heat and humidity, stay in your air-conditioned house or air-conditioned room, if you have that option. Electric fans may provide temporary comfort, but when the outside temperature soars into the high 90s, they won’t prevent heat-related illnesses. Try taking a cool shower or bath. 

Keep in mind: Use your stove and oven less during the heatwave to reduce the inside temperature. Try traveling to an air-conditioned place like a shopping mall, movie theatre, or even go to your local library or cooling shelter? Each city and town, or one nearby, should have cooling centers open. In Providence pools and splash pads have extended hours. For a listing of cooling shelters by city and town, go to https://riema.ri.gov/planning-mitigation/resources-businesses/cooling-centers  (If you need additional assistance call 2-1-1). Even being in a cool space for just a few hours can help your body stay cooler when you have to go back outside.

During a heatwave, go to your local gym to exercise so you can limit your outdoor activities. If you go outside, do this in the morning or evening hours when it’s cool. Start your working or exercise slowly and slowly pick up the pace. If the heat makes your heart pound and you gasp for breath, stop all activity. Go immediately to a shady area especially if you become lightheaded, confused, weak or faint, to cool off, this will allow your body to recover from the heat. Drink water.

Sunburn can affect your body’s ability to cool down and can make you dehydrated. So, when going outside, wear a wide-brimmed hat, sunglasses, and put on sunscreen of SPF 15 (“broad spectrum” or “UVA/UVB protection”) or higher 30 minutes before going outside.  Continue to reapply it according to the package directions. 

Hot heavy meals can heat up your body. When going outside drink plenty of fluids, regardless of how active you are.  Don’t wait until you’re thirsty to drink. Most important, if your doctor limits the amount you drink or has you on water pills, ask how much you should drink while the weather is hot.

Also, stay away from very sugary or alcoholic drinks because they cause you to lose more body fluid. You might consider avoiding cold drinks, because they can cause stomach cramps. Room temperature water is better now.

Finally, heavy sweating removes salt and minerals from your body, and they need to be replaced.  A sports drink can replace the salt and minerals you lose when sweating. If you are on a low-salt diet, have diabetes, high blood pressure, or other chronic conditions, always talk with your doctor before drinking a sports beverage or taking salt tablets. 

Do not leave children or your pets in cars that can quickly heat up to dangerously high temperatures even with a window cracked open. You put them at risk of getting heat stroke or dying. If you leave your pets outside, leave them plenty of water and in a shaded area. Watch metal pieces in your car, like seatbelts, which can heat up to unbelievably high – and even burning to the skin – temperatures.

During a heat wave, always visit or get in touch with older adults (family or friends) at risk at least twice a day and closely watch them for signs of heat exhaustion or heat stroke. Infants and young children, of course, need much more frequent watching.

For CDC’s website page on “Extreme Heat” go to https://www.cdc.gov/disasters/extremeheat/.

For warning signs and symptoms of heat-related illness and what to do, go  to https://www.cdc.gov/disasters/extremeheat/warning.html.

Nursing facilities gear up for October vaccination deadline

Published in RI News Today on September 20, 2021

Over a month ago, the U.S. Centers for Disease Control and Prevention (Centers for Disease Control and Prevention) issued a Health Alert Network (HAN) Health Advisory to public health practitioners and clinicians about the urgent need to increase COVID-19 vaccination coverage across the United States to prevent surges in new infections that could increase COVID-19 related morbidity and mortality, overwhelm health care capacity, and widen existing COVID-19-related health disparities.

According to the July 27 Health Advisory, there is growing medical evidence that the Delta variant is at least twice as contagious as the original SARS-CoV-2 virus. It is reported that most cases of COVID-19 hospitalizations and death are in unvaccinated people; however, there are breakthrough infections in vaccinated people because of the surge of infections among the unvaccinated. This is a particular concern in nursing homes, where vaccinated residents are infected by unvaccinated staff.

The Biden Administration announced plans in August to require COVID-19 vaccinations for nursing home staff as a condition for those facilities to continue receiving federal Medicare and Medicaid funding. Rhode Island Governor Daniel J. McKee, along with other states’ leadership, took similar steps to protect nursing home residents by requiring all healthcare staff to be vaccinated and the new federal mandate will ensure consistent and equitable standards throughout the country. At a COVID-19 update held at the state capitol in early August, McKee called for the new vaccine mandate (as a term of employment) to take effect.

COVID Cases Rise in Rhode Island Nursing  Homes

Coronavirus continues to increase in nursing homes, warns AARP Rhode Island in a statement issued on September 17. According to the latest data from AARP’s Nursing Home COVID-19 Dashboard, in the four weeks ending August 22, resident cases increasing from 0.05 to 0.34 per 100 residents and staff cases increasing from 0.11 to 0.88 per 100 residents since the mid-July report.

Nationally, cases are concentrated among the unvaccinated, and those residents were three times as likely to contract COVID-19 last month compared to residents who are fully vaccinated.

The last eight months have shown vaccines to be the most effective tool in preventing COVID-19 related deaths, says AARP Rhode Island’s statement. There were modest increases in vaccination rates during this four-week period, with 92% of Rhode Island Nursing Home residents and 76% of staff fully vaccinated as of August 22.

“This month’s dashboard underscores why all staff and residents in long-term care facilities must be vaccinated as quickly as possible,” said AARP Rhode Island State Director, Catherine Taylor. “For unvaccinated nursing home residents, their risk of an infection is back up to the levels we saw a year ago. Too many people in Rhode Island who lived and worked in nursing facilities have died from COVID-19, and no one wants to see that tragedy repeated,” said Taylor.

The AARP Nursing Home COVID-19 Dashboard also found over a 300% increase in RI nursing homes reporting an urgent need for PPE in the period ending August 22, with almost 10% of facilities in Rhode Island reporting they did not have sufficient PPE.

Nursing Facilities Struggling to Maintain Adequate Staffing

While the Rhode Island Health Care Association supports Governor McKee’s decision to mandate COVID-19 vaccinations across the health care continuum, says John E. Gage, President and CEO of the Rhode Island Health Care Association, representing 64 of the 77 nursing facilities in the Ocean State, nursing homes are struggling to maintain their staffing levels to meet the state’s direct care requirements, but many are struggling to maintain that level, he says, noting that next month’s deadline requiring nursing facility staff will further strain the already “precarious staffing crisis in the state’s nursing facilities”.

Gage noted that the state’s Department of Health has surveyed facilities this week regarding the number of staff that will be unable to enter facilities in two weeks because they are unvaccinated. “It is reported that nursing facilities will lose 7% of their workforce – 706 staff of 10,137 in the workforce across all disciplines,” says Gage, noting that 495 out of the 706 are clinical staff members.

According to Gage, “Rhode Island nursing facilities are ranked the fourth best state for resident vaccinations and fifth best state for staff vaccination rates in the country. He notes, when taking a look at the Centers for Medicare and Medicaid Services data released last week, in Rhode Island 92.65% of residents are fully vaccinated compared to 84.1% nationwide. As to staff, 78.99% of Rhode Island’s nursing facility staff are fully vaccinated compared to 63.7% nationwide.

Gage says, “The vaccine mandate will further add to the challenge of staff retention and recruitment. We are facing the implementation of a minimum staffing mandate to take effect 1/1/22. There’s not adequate staff available to hire, and the legislature did not provide for adequate funding to achieve the upcoming mandate”. 

Finally, Gage notes that while visitation is currently open at Rhode Island nursing facilities there are many factors that make it difficult to stop the spread of COVID-19 from staff to residents. “Our staff are members of each and every community in Rhode Island  They interact with others outside of work who may or may not be vaccinated, and many have children under the age of 12 who are not eligible for vaccination. To further complicate matters, there are breakthrough cases among those who are fully vaccinated, especially now with the prevalence of the Delta variant,” says Gage.

“Rhode Island facilities will continue to take all steps necessary to mitigate the risks of COVID-19 infections,” says Gage, noting that vaccinations are the key to eradicating this pandemic, together with the proper use of personal protective equipment.  

The AARP Nursing Home COVID-19 Dashboard analyzes federally reported data in four-week periods going back to June 1, 2020. Using this data, the AARP Public Policy Institute, in collaboration with the Scripps Gerontology Center at Miami University in Ohio, created the dashboard to provide snapshots of the virus’ infiltration into nursing homes and impact on nursing home residents and staff, with the goal of identifying specific areas of concern at the national and state levels in a timely manner.

The full Nursing Home COVID-19 Dashboard is available  www.AARP.org/nursinghomedashboard, and an AARP story about this month’s data is available here. For more information on how COVID is impacting nursing homes and AARP’s advocacy on this issue, visit www.aarp.org/nursinghomes.

Seniors would benefit in President Biden’s $6 trillion budget

Published in RINewsToday on June 14, 2021

On May 28, with the release of a $6 trillion budget for fiscal year (FY) 2022, President Joe Biden outlined his values and vision as to how he proposes to revive the nation’s sputtering economic engine as it emerges from the devastating impact of the COVID-19 pandemic. The 72-page budget document, “Budget of the United States,” (with more than a 1,400-page appendix) details his spending priorities that begin next Oct. 1. Biden’s generous budget depends on increasing taxes on America’s corporations (from 21 to 28 percent) and high earners, who received significant tax breaks from the President Trump/GOP tax cuts of 2017.

With the FY 2022 Budget pushing federal debt to the highest levels since World War 1I, Republican lawmakers quickly called the proposal “dead on arrival” in Congress.  However, Cecilia Rouse, chair of President Biden’s Council of Economic Advisors says the Biden Administration is willing to live with a budget deficit to invest in the economy now, especially with low interest rates to borrow; deficits can be reduced later. 

President Biden’s new spending under the just released proposed FY 2022 budget, recognizing his Administration’s priorities, reflects the major proposals already outlined under the administration’s $2.3 trillion American Jobs Plan and $1.8 trillion American Families Plan. Provisions in these two proposals would overhaul the nation’s aging infrastructure and invest in education, childcare, paid family and medical leave, fight climate change. 

President Biden’s spending plan also recognizes priorities outlined in the American Rescue Plan passed earlier this year as well as the Administration’s “skinny” discretionary budget request released in April. Most importantly, it reflects a commitment from the president to safeguard Medicare, Medicaid and Social Security.

Loving It or Hating It Depends on Where You Sit

In remarks delivered Thursday in Cleveland, President Biden made the case for his budget request and what he describes as an investment in the country’s future. “Now is the time to build [on] the foundation that we’ve laid to make bold investments in our families and our communities and our nation,” he said. “We know from history that these kinds of investments raise both the floor and the ceiling over the economy for everybody.”

In the FY 2020 Budget proposal’s “Message from the President”, Biden says, “The Budget invests directly in the American People and will strengthen the nation’s economy and improve our long run fiscal health. It reforms our broken tax code to reward work instead of wealth while fully paying for the American Jobs and American Family Plans over a 15- year period. It will help us build a recovery that is broad-based, inclusive, sustained, and strong,”

Of course, response to Biden’s Spending plan depends on which side of the aisle you are sitting.

House Speaker Nancy Pelosi (D-CA) released a statement strongly endorsing Biden’s fiscal blueprint. “Congressional Democrats look forward to working with the Biden-Harris Administration to enact this visionary budget, which will pave the path to opportunity and prosperity for our nation. The Biden Budget is a budget for the people,” she said.

On the other hand, Senate Minority Leader Mitch McConnell strongly opposing Biden’s Budget proposal. “Americans are already hurting from far-left economics that ignores reality,” said McConnell, in a statement. “The Administration’s counterproductive ‘COVID relief bill’ has slowed rehiring. Families are facing painful inflation, just as experts warned the Democrats’ plans might cause. And the Administration wants to triple down on the same mistakes?” said the six-term Republican Kentucky Senator.

With the Democrats holding the slim majorities in the House and Senate and controlling the White House, Biden’s FY 2022 Budget proposal will have more weight than if the Republicans were in the majority, says Dan Adcock, Government Relations and Policy Director at the Washington, DC-based National Committee to Preserve Social Security and Medicare (NCPSSM).

According to Adcock, Biden’s funding numbers will change as his FY 2022 budget proposal goes through the appropriation process in the upcoming months. With its release, Congress can now begin negotiating funding levels and spending bills. Competition for a finite amount of funding will ultimately result in funding level ultimately allotted to programs and agencies by each of the 12 appropriations under their jurisdiction. Funding for most programs important to older Americans is under the jurisdiction of the Subcommittee on Labor, Health and Human Services and Education.

“With 10,000 Baby Boomers turning 65 every day – and the number of seniors projected to double by 2050 – it’s clear that President Biden understands the need to safeguard the older Americans he calls ‘pillars of every community – now and into the future.” Says Max Richtman, NCPSSM’s President and CEO.

Slashing Drug Costs to Pay for Expanding Medicare Coverage

Richtman says that Biden’s fiscal blueprint calls on Congress to allow Medicare to negotiate prices for certain high-cost, life-saving drugs that many seniors currently cannot afford and to require manufacturers to pay rebates when drug prices rise faster than inflation. These reforms could yield over half a trillion in federal savings over 10 years, which could help pay for coverage expansions and improvements, including access to dental, hearing, and vision coverage in Medicare,” he notes. Today, traditional Medicare does not cover routine care like dental checkups or hearing aids.

According to Richtman, President Biden’s budget also includes more than $400 billion in new spending over ten years to expand Home and Community-based Services (HCBS) for low-income seniors and people with disabilities who prefer to receive skilled care in the comfort of their homes and communities, even moreso after the devastation COVID wrought on nursing homes.  

In states that have not taken advantage of Affordable Care Act (ACA) opportunities to expand Medicaid, the budget proposes providing premium-free, Medicaid-like coverage through a federal public option, along with incentives for states to maintain their existing expansions. 

Biden’s FY 2022 budget also urges Congress to improve customer service for Social Security beneficiaries to prescription drug pricing reform to expanded HCBS, adds Richtman.  It also proposes a $1.3 billion (or 9.7%) funding increase for the Social Security Administration.  The increase seeks to improve customer service, including services at SSA’s field offices, state disability determination services, and teleservice centers.

 The Older Americans Act (OAA) provides funding for a wide range of home and community-based services, such as meals-on-wheels and other nutrition programs, in-home services, transportation, legal services, elder abuse prevention and caregivers’ support. These programs help seniors stay as independent as possible in their homes and communities. 

For details about Biden’s FY 2022 Budget proposal and OAA funding levels, made available from the Washington, DC-based National Association of Area Agencies on Aging, go to: https://www.n4a.org//Files/FY22%20PresBudget%20and%20historical%20Labor-HHS%20Appropriations%20Chart.pdf

 Stay Tuned 

The House continues its work on hammering out appropriation bills through subcommittees in June and in the full House in July.  The Senate’s work is expected to begin in mid-Summer and to continue well into September. If the appropriate bills are not passed and signed into law by Oct. 1, Congress will need to pass a continuing resolution to fund the federal government into the first months of FY 2022.

Like most Budget proposals, especially in a partisan Congress, Biden’s spending plan will need to be rewritten to win support from lawmakers on both sides of the aisle. However, it will serve as a roadmap for a Democratic controlled Congress in crafting 12 appropriation spending bills. Partisan bickering during the appropriations process may well force passage of a continuing resolution before Oct. 1 to block a government shutdown.