Posts Tagged: health care
Fewer than 10% of patients screened for food insecurity during pandemic
Study finds even fewer screened during virtual appointments
As jobless rates rose during the COVID-19 pandemic, millions more Americans experienced food insecurity because they lacked consistent access to food. National health organizations recommend primary care providers screen patients for food insecurity, since not having access to enough food can lead to chronic diseases.
But research from the University of California, Davis, finds that only 7% of primary care providers screened patients for food insecurity. If the appointment was virtual or telehealth, only 3% asked patients about their access to food. The American Journal of Preventive Medicine published the research.
“These rates are surprising and seem relatively small in comparison with what seems like a growing awareness of food insecurity during the pandemic,” said lead author Cassandra Nguyen, an assistant professor of Cooperative Extension in the UC Davis Department of Nutrition.
She said the findings may indicate that health care providers were prioritizing emergency responses to COVID-19. The research showed that once people had access to COVID-19 vaccines, screening for food insecurity increased to 10%.
Barriers to telehealth screenings
Screening for food insecurity at telehealth appointments remained low even after vaccines became available. Nguyen said that may suggest telehealth appointments have unique barriers.
“One of those barriers could be a concern about privacy and whether the patient is alone or feels comfortable discussing a potentially stigmatizing experience such as food insecurity. This may deter a primary care provider from asking about it,” Nguyen said.
Screening might also be more difficult if patients aren't familiar with the technology needed or if there are technological disruptions during telehealth appointments. Nguyen said more study is needed about potential barriers given the increased popularity of telehealth appointments since the pandemic.
The research examined electronic health records and clinic data from a national network of more than 400 community health centers in 16 states. It examined encounters between March 11, 2020, and Dec. 31, 2021. Screening typically involves a primary care provider asking the patient to answer that either or both of the following two statements is often true or sometimes true:
- Within the past 12 months we worried whether our food would run out before we got money to buy more.
- Within the past 12 months the food we bought just didn't last and we didn't have money to get more.
Co-authors include Rachel Gold with OCHIN Inc. and Kaiser Permanente Northwest Center for Health Research; Alaa Mohammad, Dedra Buchwald and Clemma Muller with Washington State University; Molly Krancari, Megan Hoopes and Suzanne Morrissey with OCHIN Inc.
The National Center for Advancing Translational Sciences of the National Institutes of Health, and the National Institute of Diabetes and Digestive and Kidney Diseases supported the research.
/h3>/h3>Latinos Facing Deeper Retirement Security Crisis Than Other Ethnic Groups
Latinos are facing a deeper retirement crisis than other ethnic groups because of lower access to workplace savings plans and other job-related disadvantages in accumulating nest eggs, reports the National Institute on Retirement Security and UnidosUS in a new study.
“Retirement plan participation rate for Latino workers (30.9 percent) is about 22.1 percentage points lower than participation rate of White workers (53% percent), because Latinos face higher access and eligibility hurdles,” the researchers from NIRS and UnidosUS find. Unidos was formerly known as the National Council of La Raza.
In 2014, 53.7 percent of Latinos 21 to 65 who worked for an employer that sponsored a retirement plan compared to 69.8 percent of all workers.
Even when they are working for an employer with a workplace retirement savings plan, Latinos are hurt because they frequently don't meet the eligibility requirements.
Among Latinos with access to a retirement plan, only 60.3 percent satisfy the eligibility requirements versus 72.9 percent for all workers with access.
At the same time, Latino employees who are in workplace retirement plans have about one-third less savings on average than their White workers.
The study warns Latino women are particularly hard hit economically when they reach age 65.
“Without income from work, Latinas age 65 and older would not be able to afford basic expenses. Older Latinas also face poverty rates three times higher than older White women,” the study says.
Smaller than national average incomes also harm Latinos in preparing for their post-workforce future.
“Workers earning low wages and struggling to make ends meet may very well find it difficult to set aside a portion of their income to save for retirement,” the report warns.
The study points out Latinos typically get a late start in saving for retirement.
The majority of Latinos who have access to a workplace retirement plan don't achieve the benefit until age 45.
By 2060, the number of Latinos 65 and over in the U.S. is expected to reach 21.5 million.
Currently, at 57.5 people, Latinos make up 17.8 percent of the nation's population.
Source: Published originally on forbes.com, Latinos Facing Deeper Retirement Security Crisis Than Other Ethnic Groups, by Ted Knutson, December 3rd, 2018.
Special Considerations for Latinos Seeking Elder Care
Government statistics show that Hispanics have a life expectancy of 82 years, longer than non-Hispanic white Americans (78.7 years) and non-Hispanic black Americans (75.1 years). Hispanic women have a life expectancy of 84.3 years. However, according to a poll conducted by Associated Press-NORC Center for Public Affairs Research, fewer than two out of every 10 Hispanics age 40 and older say they are extremely confident that nursing homes and assisted living facilities can meet their needs
Experts believe that the lack of confidence in these facilities stems from two major factors. First, in Latino culture, the social norm discourages the delegation of care for older relatives to outsiders. Second, there is a lack of high-quality providers for this population. Additionally, cultural and language barriers complicate the rendering of appropriate daily care to this growing population.
Nevertheless, according to a Brown University study involving 10 large metropolitan cities, Latinos are entering nursing homes at a growing rate. From 1999 to 2008, the number of elderly Hispanics living in U.S. nursing homes rose by 54.9 percent, while the number of whites decreased by 10 percent. The aging Hispanic/Latino population is expected to grow more rapidly than other ethnic minority group by 2028 and experts say it has grown and will continue to grow,3.9 percent per year from 1990 to 2050.
At first blush the analysis suggests that elderly blacks, Hispanics, and Asians are gaining greater access to nursing home care. Unfortunately, however, the growing proportion of minorities in nursing homes is resulting partly because they do not have the same access to more desirable forms of care as wealthier whites do, said the study's lead author Zhanlian Feng. “We know those alternatives are not equally available, accessible, or affordable to everybody, certainly not to many minority elders,” he said.
This phenomenon makes it crucial for Latinos to become educated on how nursing homes and assisted living facilities operate. Language barriers and unfamiliarity with the American legal system often leave individuals within this community in the dark regarding their loved ones' rights while residents at skilled nursing facilities. They often sign lengthy contracts that are not translated into their native tongue. And, when something terrible occurs, many do not understand how contingency fee plaintiffs' attorneys charge for their services. They often tolerate less than adequate treatment because they believe that even speaking with an attorney will cost money they do not have. Or they feel intimidated by the thought of having to explain their complex situation to an attorney that doesn't speak their language, when they only have basic proficiency in English.
Source: Published originally on The National Law Review , Special Considerations for Latinos Seeking Elder Care, by Alex J. Fajardo on October 23, 2017. COPYRIGHT © 2017, STARK & STARK
CUCSA reviews post-retirement health update changes
Colleagues,
As your delegates to the Council of UC Staff Assemblies (CUCSA), we would like to share information on an issue that was addressed at our September meeting in San Diego last week. The issue concerns post-retirement health benefits and potential changes that have not been widely shared. CUCSA chair Lina Layiktez provided the summary below and links for more information.
What is the change to post-retirement health benefits that is being proposed?
The proposed action item for the July 2017 Regents meeting was to remove the 70 percent floor on the UC contribution to retiree health benefits and place a cap of 3 percent on year-over-year increases to UC costs. This is a policy change to offset the accounting rule changes required in "GASB 75." GASB 75 requires that the full actuarial value of other postemployment benefits (OPEB) be included on the systemwide balance sheet. This means that UC will have a perceived “new” liability of $21 billion, which would affect the system's overall credit rating. A hit to the UC's credit rating has obvious impacts to financing for the university.
The “new” GASB 75 requirement definition is subject to interpretation, since it was already a liability that was disclosed in previous year's financials. The value of this liability under current assumptions/retiree rules is approximately $21 billion. The current assumptions are being driven by the number of retirees in the system plus the number of potential retirees (active staff and faculty) and how much it would cost the system in health-care costs should the current employees retire today.
What does this all mean?
By removing the floor and capping UC's costs, the university effectively transfers rising health-care premiums to retirees. The assumed rate of health-care cost increase is 7 percent. Over the course of 20 years this would flip the proportion that UC pays to ~30 percent and the retiree to ~70 percent. The 70 percent floor was designed to provide some stability to retiree health-care costs.
What do we see happening?
Many UC employees choose to retire after calculating their retirement income. This is necessary because, except for Cost of Living Adjustments (COLA), there is no way for retirees to increase their income from the university. So when out-of-pocket health-care costs go up for retirees, this eats into their living expenses. There are already retirees and survivors of retirees who have to choose between health-care costs and food. To suddenly remove the 70% floor exacerbates this problem.
What can you do?
The campus staff assemblies are collecting feedback locally and sharing this up to the Council of UC Staff Assemblies (CUCSA), who will be coordinating a response to the UC President and/or Board of Regents. We are also working on a list of questions that include queries, such as what OPEB would look like if it grandparented current employees and implemented the changes to future retirees? What does this mean for retention of employees with 10 to 20 years of service?
The most powerful and helpful thing for us now is to hear about your personal concerns and how this impacts you. Would no OPEB mean you are less likely to retire from the UC system and take a job elsewhere for more money now? Will you have to postpone your retirement if, in retirement, you will have to pay a greater portion of your OPEB than you had planned for under the current plan?
Share your questions and stories with us on the UC ANR Staff Assembly website.
What's next?
Fortunately, the July agenda was revised and this item was moved to the November meeting agenda. Moving the item to November will allow for more consultation and discussion. It is unknown what approach the UC Office of the President (OP) will take to solicit feedback and engage in discussion. But as that information becomes available, we will make sure to share it broadly. We are hopeful that CUCSA (and therefore a voice of staff) will be included in the discussions and that OP will convene a task force representing all parties that will be affected by the proposed changes. Stay tuned.
Click here for the original July Regents Meeting Agenda Item (F7), which was then revised to remove the discussion on the 70 percent floor.
The immediate past chair of the systemwide Academic Senate, Jim Chalfant, has already written a letter to the President on this issue. You can read it online here: http://senate.universityofcalifornia.edu/_files/reports/JC-JN-Retiree-Health.pdf.
We can work collectively to inform and educate staff on this important matter. We are stronger together and the more voices that participate, the louder the message will be to those making the decisions that affect all of us.
UC ANR human resources director John Fox also said one important point that isn't addressed in the CUCSA summary is Medicare coverage. “When a UC retiree enrolls in Medicare, the monthly medical premium costs are significantly reduced (both for the retiree and for UC). Much of the future liability that UC is trying to control (and the risk of high monthly costs for the retirees) is during the time between retirement from UC and the start of Medicare eligibility (typically age 65).”
If you would like to share your stories or post a comment on this proposed change, please fill out the form on the UC ANR Staff Assembly website. We will share comments and stories from UC ANR with CUCSA leadership, who will compile it with information from other campuses to share with the UC President and UC Regents.
Sincerely,
Jeannette Warnert, UC ANR senior delegate to CUCSA
LeChé McGill, UC ANR junior delegate to CUCSA
View or leave comments for ANR Leadership at http://ucanr.edu/sites/ANRUpdate/Comments.
This announcement is also posted and archived on the ANR Update pages.
Language and subgroup data critical to ensure optimal health care outcomes among Latinos
Dr. Glenn Flores, Distinguished Chair of Health Policy Research at the Medica Research Institute, addresses these issues in the Journal of Healthcare, Science, and the Humanities in the article, "Getting the Data Right for Latinos: Appropriate Language and Subgroup Data are Critical for Public Health and Social Justice."
In the piece, Dr. Flores examines:
- LEP prevalence among U.S. Latinos
- How language barriers impact health care
- LEP is the best measure for assessing language barriers
- Language and LEP data in clinical settings and research
- The importance of collecting data on Latino subgroups
"Language problems impact multiple aspects of healthcare, including access, health, service use, patient-clinician communication, satisfaction with care, quality, and patient safety," says Dr. Flores. "Limited English proficiency is the best measure of the impact of language on health care. But most hospitals and medical practices do not collect any language data and rarely collect LEP data, and no national surveys collect LEP data."
Dr. Flores (bio) highlights numerous studies and cases in the article that demonstrate the potent impact of language barriers on health. One study showed that Spanish-speaking LEP patients are at a twofold increased risk of serious medical events without an interpreter. These outcomes are illustrated by the case of an 18-year-old who was paralyzed due to misinterpretation of a single Spanish word, and the two-year-old taken from her mother's custody due to misinterpretation of two words about her fractured clavicle.
Latinos are the largest racial and ethnic minority group in America, numbering 56.6 million people and comprising 18 percent of the U.S. population. Failure to collect Latino subgroup data can obscure disparities that affect some subgroups more than others and make them more difficult to address.
"To ensure optimal health care quality and outcomes, ethical care, and equity, Latino subgroup data and LEP data should always be collected for all patients, national surveys, and research," says Dr. Flores.
Source: Published originally on medicaresearchinstitute, Language and subgroup data critical to ensure optimal health care outcomes among Latinos, by Dr. Glenn Flores, April 3, 2017.