Inmates, Covid, Healthcare and The African American

African American Prisoners/Healthcare for COVID-19

I am invisible, understand, simply because people refuse to see me. Like the bodiless heads you see sometimes in circus sideshows, it is as though I have been surrounded by mirrors of hard, distorting glass. When they approach me they see only my surroundings, themselves or figments of their imagination, indeed, everything and anything except me. Ralph Ellison, Invisible Man (1952)

A Personal Story

I think there are great deal of folk that have had the experience of have a male family member incarcerated only to find out that they were not the same young man they knew before the incarceration.  I don’t know that we all can identify when trying to reconnect that not only are they different, but we too have evolved this makes for strange bedfellows.  Personally, I have interacted with a family member only to find myself more frustrated at the behavior of said individual than realizing he is different.  I don’t know what it is like to be incarcerate (in jail) albeit I have my own struggles where I voluntarily opted for incarceration metaphorically.  Non-the-less, I don’t know what it’s like to wake up in the same cage day after day, week after week, month after month, year after year and/or decade after decade.  I haven’t got a clue what it must be like to be controlled i.e. told what to wear, when to get up when to lay down, when I can shower, when I can a make a phone call.  I don’t know what  it’s like to be locked up with nothing but men/women without any freedoms that you and I take for granted on any given day.  I don’t know why the history of Black men has positioned a person to fall into the category of inmate, jail bird, or felon.  I’ve heard the idea that the construction of prisons were/are constructed based on 3rd grade scores – Experts often cite third grade as a decisive year for students and schools. In fact, there is common folklore that asserts that public officials will forecast prison construction based on a state’s third-grade literacy rates.   An article in The Atlantic called this phenomenon “An Urban Myth That Should Be True.” The article goes on to say, “U.S. prison planners don’t use local third-grade reading scores to predict future inmate populations. But maybe they should.” This is a two topic writing on the healthcare of the inmate and that of the Black American and Covid-19.

The persistent and pervasive notion of African American male criminality which was injected into the American consciousness during the post Reconstruction period persists steadfastly today in the United States. It is a driving force behind the nation ’ s post-1970 mass incarceration binge for which economically disadvantaged Black males are the primary victims. It also serves as fuel for insensitive comments, unwarranted surveillance, and other microaggressions such as those now in the media glare. Few African American males, regardless of their achievement, social standing or economic status, are immune to the stress associated with these subtle forms of hostility

Healthcare and the Inmate

Imprisonment, homicide, non-lethal assault and other crime, chronic and infectious disease, substance abuse, suicide, and accidents all contribute to the much wider gap in the community-level sex ratios found among African Americans compared to those observed found among other ethnic and racial groups in the United States. This wide array of causes and correlates of African American male mortality, disability, and confinement suggests that one area in need of interdisciplinary inquiry that examines the intersection between public health and public safety. These lines of inquiry must situate and contextualize the lived experiences of the African American male. Health analysts and social scientists across many disciplines have all studied African Americans and their communities extensively over the past decades because this population has disproportionately high levels of disease, disability, premature death, and exposure to the criminal justice system.

A large body of research has documented black, white disparities in health and mortality in the United States ( Adler & Rehkopf, 2008 ; Frisbie, Song, Powers, & Street, 2004 ; Geruso, 2012 ; Pampel, Krueger, & Denney, 2010 ; Williams & Jackson, 2005 ; Williams & Mohammed, 2009 ). Racial differences in socioeconomic status (e.g., income, education) largely account for these gaps with individual and institutional discrimination, residential segregation, and bias in healthcare settings also explaining some of the variation in black, white disparities (Braveman et al., 2011 ; Williams, 1999 ; Williams & Jackson, 2005 ).

Afro-American Healthcare & COVID-19

Speaking of the disparities in health care among Blacks and Whites brings me to another topic – Covid-19.  As most people in the world are now acutely aware, an outbreak of COVID-19 was detected in mainland China in December of 2019.  Coronaviruses are a family of viruses that can cause mild to moderate upper-respiratory tract illnesses such as the common cold, severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS).  When an infected person coughs or sneezes, the new coronavirus may be transmitted through expelled droplets. These droplets can enter a person’s system through “contact routes,” such as the mouth, eyes, or nose. It is also possible for the droplets to be inhaled into the lungs.

The concept of COVID-19 hit the news airways like the plague.  Folk ran out and emptied the grocery story of every roll of tissue paper, alcohol and contamination cleaning products.  Addictions rose, folks died, both individuals and establishments lost their lives, and the country was shut down.  This would cause the sanest person to question the reason for living. 

Statistical data document that African Americans have a worse health profile and higher rate of death than White Americans for practically every illness. Broader surveys of self-assessed health using a comparative framework have found that African Americans are nearly twice as likely as White Americans to rate their health as “fair” or “poor,” and twice as likely as White Americans to rate their health as “fair” or “poor,” and that self-rated health is a strong predictor of sickness and early death (Bratter and Gorman, 2011).  Middle-class African Americans have a better health profile than their less affluent counterparts, but many report serious health challenges as common in their families.

Much like the prisoner many Black Americans suffer the same inequalities of healthcare whether locked up or free.  With that said how will Black Americans come out as the victor during these turbulent times?

What We Know

Black communities share common social and economic factors, already in place before the pandemic, that increase their risk for COVID-19. Those factors include:

  • Living in crowded housing conditions. “Crowded living conditions are a difficult challenge that is the result of longstanding racial residential segregation and prior redlining policies,” Golden says. “It is difficult for 10 individuals living in a three-room apartment to appropriately physical distance.” She says advocacy on these broader policy issues could help prevent future disparities in disease outcomes.
  • Working in essential fields. Golden notes that people working in environmental services, food services, the transportation sector and home health care cannot work from home. These positions put workers in close contact with others.
  • Inconsistent access to health care due to lack of insurance or underinsurance. Being able to afford doctors’ visits, medications and equipment to manage chronic disease is essential to lowering the risk of death from COVID-19 and other conditions. For instance, a patient with badly controlled diabetes or asthma due to inconsistent treatment is more at risk for severe, even deadly, coronavirus infection.
  • Chronic health conditions. Golden points out that people of color have a higher burden of chronic health conditions associated with a poor outcome from COVID-19, including diabetes, heart disease and lung disease. In a study cited by the U.S. Centers for Disease Control and Prevention (CDC), about 90% of those hospitalized with severe COVID-19 had at least one of these underlying medical conditions.
  • Stress and immunity. Studies have proved that stress has a physiological effect on the body’s ability to defend itself against disease. Income inequality, discrimination, violence and institutional racism contribute to chronic stress in people of color that can wear down immunity, making them more vulnerable to infectious disease.

Distrust

Why is that the Black American holds on to memories of years gone by when it comes to their health.  The now infamous Tuskegee Syphilis study is perhaps the most widely known study exclusive to African Americans males.  Yet in present day the number of references to this experiment in conjunction with the COVID-19 vaccine are astronomical.  African  Americans  have  experienced  something  that others have not: the unique combination  of racism, slavery and segregation. It has caused African  Americans to develop  not  only  different  behavioral patterns, values, and beliefs but also different  definitions, standards, and  differences  in  value  systems  and  perspectives(Randall,  1996). Distrust  of  the health  care  system  by African  Americans  runs  from  the  feelings  or  ill  gains for  participation  in clinical trials to being used  only as guinea  pigs. In addition,  there  are feelings  by  African Americans  whether  the physician,   intentional   or not,  do  treat  minority  patients  differently  than  White patients  (Lake,  Snell,  Perry,  & Associates  2004).  If that is true then the reluctance to take the vaccine is valid.  Additionally many Americans feel that the vaccine was rushed and not enough due diligence has been put forth.

A Coronavirus Story

Will Stone


More than 300,000 people have died from COVID-19 in the United States.

It is the latest sign of a generational tragedy — one still unfolding in every corner of the country — that leaves in its wake an expanse of grief that cannot be captured in a string of statistics.

The numbers do not reflect that these were people. Everyone lost was a father or a mother, they had kids, they had family, they left people behind.

There is no analogue in recent U.S history to the scale of death brought on by the coronavirus, which now runs unchecked in countless towns, cities and states.

We’re seeing some of the most deadly days in American history.

During the past two weeks, COVID-19 was the leading cause of death in the U.S., outpacing even heart disease and cancer.

Yet the most deadly days of the pandemic may be to come, epidemiologists predict.

Some of those deaths could still be averted. If everyone simply began wearing face masks, more than 50,000 lives could be saved, IHME’s model shows. And physical distancing could make a difference too.

No other country has come close to the calamitous death toll in the U.S. And the disease has amplified entrenched inequalities. Blacks and Hispanics/Latinos are nearly three times more likely to die from COVID-19 than whites.

There’s evidence that socioeconomic factors, not underlying health problems, explain the disproportionate share of deaths. The disease, reveals the chronic neglect of Black and brown communities in this country.

Though the numbers are numbing, for bereaved families and for front-line workers who care for people in their dying moments, every life is precious.

tRumps Healthcare Plan

vm.tiktok.com/ZMJmMNY1y/

Digital #Mindfulness

All of us are surrounded by digital devices, and many of us spend a good portion of our day using the internet on our smartphones, tablets, and PCs. Yet our digital wellbeing isn’t something we often think about. Digital technology can impact our health and relationships and shape the society we live in.

Digital mindfulness is about taking charge of your wellbeing and balancing your use of the many devices in your life. Noticing and understanding how you spend your time online and the feelings this produces is an essential part of building a positive digital identity.

For me, I can become sad, depressed, and often times very angry reading and/or viewing images for hours.  It shows in my responses to various posts.

Calming music…

Infection Lapses Rampant in Nursing Homes

Freedom from abuse and neglect —You have the right to be free from verbal, sexual, physical, and mental abuse, involuntary seclusion, and misappropriation of your property by anyone. This includes, but isn’t limited to: SNF staff, other residents, consultants, volunteers, staff from other agencies, family members or legal guardians, friends, or other individuals.

But Punishment Is Rare

Basic steps to prevent infections — such as washing hands, isolating contagious patients and keeping ill nurses and aides from coming to work — are routinely ignored in the nation’s nursing homes, endangering residents and spreading hazardous germs…Continue Reading Here

In McDonald’s and Burger King I often (not always) see a sign indicating that the employees are reminded to wash their hands by a sign posted in the restroom.  Children’s elementary schools are covered with hand sanitizer and I’ve noticed in the high school not only is there a LARGE bottle of hand sanitizer but also an inexpensive bottle of lotion/moisturizer (you know they are two different products??) next to each other.

Ludlowe Center for Health and Rehabilitation is an affiliate of National Health Care Associates, a leader in short-term rehabilitation and skilled nursing care services throughout the Northeast. National Health Care’s signature “Passport Rehabilitation” program was specifically designed to meet the needs of individuals requiring a short-term rehabilitative stay following a surgical procedure or an acute medical episode. While on your short-term “trip” with us, please take full advantage of the amenities and services our center offers.

 What our patients and their families are saying

“I would give you 5 Stars!!! My 95+ year young Mom has considered Sands Point Center her home for many years now. She has made many friends there of both residents and staff. The highly competent staff treats my Mom with dignity, and is welcoming and appreciative of family input. We could not have made a better choice for her ongoing care.”

Now I’m wondering where is the Ludlow Center for Health and Rehabilitation information for Bridgeport, CT?  So I click on “Locations – Connecticut” and this is what I see:

Ludlow is an affiliate of National Health Care Associates, a leader in short-term rehabilitation and skilled nursing care services throughout the Northeast. National Health Care’s signature “Passport Rehabilitation” program was specifically designed to meet the needs of individuals requiring a short-term rehabilitative stay following a surgical procedure or an acute medical episode. While on your short-term “trip” with us, please take full advantage of the amenities and services our center offers.

What’s SNF care?

Skilled care is health care given when you need skilled nursing or therapy staff to treat, manage, observe, and evaluate your care.  Examples of SNF care include intravenous injections and physical therapy. Care that can be given by non‑professional staff isn’t considered skilled care. People don’t usually stay in a SNF until they’re completely recovered because Medicare only covers certain SNF care services that are needed daily on a short ‑term basis (up to 100 days).

What Are Some of Your Rights?

Freedom from abuse and neglect —You have the right to be free from verbal, sexual, physical, and mental abuse, involuntary seclusion, and misappropriation of your property by anyone. This includes, but isn’t limited to: SNF staff, other residents, consultants, volunteers, staff from other agencies, family members or legal guardians, friends, or other individuals.

If you feel you’ve been abused or neglected (your needs were not met), report this to the SNF, your family, your local Long Term Care Ombudsman, or your State Survey Agency. It may be appropriate to report the incident of abuse to local law enforcement or the Medicaid Fraud Control Unit (their phone number should be posted in the SNF.)

Occupational Therapy —Treatment that helps you return to your usual activities (like bathing, preparing meals, and housekeeping) after illness.

Medicare doesn’t cover custodial care if it’s the only kind of care you need. Custodial care is care that helps you with usual daily activities like getting in and out of bed, eating, bathing, dressing, and using the bathroom. It may also include care that most people do themselves, like using eye drops, oxygen, and taking care of colostomy or bladder catheters.

Then I looked to my right and I see this post from the staff who may or may not be giving the patients a bath daily.

Question:  If a patient of a healthy size is in a SNF and is required to perform physical activities after a fall – wouldn’t it be necessary to allow –  if not give that patient a bath/shower daily?

Happy Holidays!!

 

 

 

 

Source: Medicare Coverage of Skilled Nursing Facilities
Ludlow Rehab

 

Updated – Medicaid & CHIP in North Carolina – Family Planning = Birth Control!

North Carolina has not expanded Medicaid coverage to low-income adults and or the homeless

January 5, 2107 – Update –

According to The Christian Monitor – North Carolina Gov. Roy Cooper (D) said Wednesday he plans to expand Medicaid to cover an additional 650,000 people, despite his predecessor having signed a law that expressly prohibits such a move.

Republican State Senate Leader Phil Berger described the governor’s plan as a quote “brazenly illegal attempt to force” Medicaid expansion upon state taxpayers.

Wow, “brazenly illegal” right after attempting to “brazenly” strip the new Governor of North Carolina of his duties – well that’s in another story see – rejection.

Seriously folks, I would like to start with some moments of awareness.  Did you know that in the Middle Ages –  a time between the fall of Rome and the beginning of the Renaissance in the 14th century, mental illness was described as one having a possession of evil spirits?  Interestingly enough the King James Bible states from the book of Corinthians – Wherefore whosoever shall eat of this bread, and drink this cut of the Lord, unworthily, shall be guilty of the body and blood of the Lord.  But let a man examine himself, and so let him eat of that bread, and drink of that cup. For he that eateth and drinketh unworthily, eateth and drinketh damnation to himself, not discerning the Lord’s body.  For this cause many are weak and sickly amoung you, and many , the author, is indicating that those that do not believe when taking communion shall fall to sickness in the body.  There are folks today like Christian Scientists that believe only in prayer and meditation to relieve all sickness vs. making a doctor visit.

I’m not so sure that homeless men and women (including Veterans) mother’s and children in the beautiful state of North Carolina are either Christian Scientists or even believe in prayer and meditation to relieve their mental and/or physical health issues.  Secondly it was the duty of the King (Governor, Senator, etc.)   to protect the land of the idiots and provide them with the basic necessities of life.

The King who would (in the 21st century be known as the “State”) would take or should be taking the responsibilities of the citizens that fall under the mental illness and/or in need of healthcare category.   Additionally, the Elizabethan Poor Laws and the Poor Law of 1601 can fall under the category of DSS, DCF or Medicaid.

The Title 19 program stems from the 13th century. The idea that relief for the poor was the responsibility of the Church yet how many churches can actually show proof positive that they are financially involved in helping with the fudiciary, judiciary or medical needs of the poor.  Sure they have annual coat drives, food pantries, chicken dinners and raffle tickets, but when was the last time a church in your neighborhood took up a collection for wound care or cash payments for medicine for uninsured children and their families?

It would appear that folks have always been thinking of ways to assist those in need. It also appears that perhaps that only happens outside of North Carolina’s uninsured population.

 

Original Story- Medicaid  CHIP in North Carolina – Family Planning = Birth Control!

 

 birth-control

Medicaid is a health and long-term care coverage program that was enacted in 1965. The Children’s Health Insurance Program (CHIP) was established in 1997 to provide new coverage opportunities for children in families with incomes too high to qualify for Medicaid, but who cannot afford private coverage. Both Medicaid and CHIP are administered by states within broad federal guidelines and jointly funded by the federal government and states.

 This page outlines key characteristics of Medicaid and CHIP in North Carolina and provides documents and information relevant to how the programs have been implemented by North Carolina within federal guidelines.

North Carolina Medicaid/CHIPEnrollmentAvg July-Sept2013Total September20160600,0001,200,0001,800,0002,400,000

Period Enrollment
Avg July-Sept 2013 1,595,952
Total September 2016 2,020,076

As of September 2016, North Carolina has enrolled 2,020,076 individuals in Medicaid and CHIP — a net increase of 26.57% since the first Marketplace Open Enrollment Period and related Medicaid program changes in October 2013. North Carolina has adopted one or more of the targeted enrollment strategies outlined in guidance CMS issued on May 17, 2013, designed to facilitate enrollment in Medicaid and CHIP.

The Federally-facilitated marketplace (FFM) offers coverage in North Carolina.

In federal fiscal year (FFY) 2014, North Carolina voluntarily reported 12 of 18 frequently reported health care quality measures in the CMS Medicaid/CHIP Child Core Set. North Carolina voluntarily reported 0 of 10 frequently reported health care quality measures in the CMS Medicaid Adult Core Set.

North Carolina has not expanded coverage to low-income adults… Here’s the thing a homeless woman who is over the age of having children receives 1 physical exam a year and access to birth control – they call it family planning?!

Source: https://www.medicaid.gov/medicaid/by-state/stateprofile.html?state=north-carolina

Is Providing Access to Healthcare After Release from Prison Enough?

Mental Health Care in Jail

Is Providing Access to Healthcare After Release from Prison Enough?

Providing health care after release is a great program, however, most mental illness requires constant review, which does not occur inside the prison walls.  Alana Horowitz Satlin wrote in the Huffington Post, “A 2006 study by the Bureau of Justice Statistics found that over half of all jail and prison inmates have mental health issues; an estimated 1.25 million suffered from mental illness, over four times the number in 1998. Research suggests that people with mental illness are overrepresented in the criminal justice system by rates of two to four times the normal population. The severity of these illnesses vary, but advocates say that one factor remains steady: with proper treatment, many of these incarcerations could have been avoided.”

Connecticut’s Department of Correction’s Disclaimer reads: “The Department of Correction provides comprehensive health care to the offender population that meets a community standard of care, and includes medical, mental health, dental, addiction and ancillary services, in compliance with applicable state and federal laws and consent decrees. This spectrum of health care is carried out through a partnership the Department has established with the services of the University of Connecticut, Correctional Managed Health Care.”

Suicide Prevention

NCIA’s analysis found that only three departments of correction (California, Delaware, and Louisiana) had suicide prevention policies that addressed all six critical components and that an additional five departments of correction (Connecticut, Hawaii, Nevada, Ohio, and Pennsylvania) had policies that addressed all but one critical component.  Thus, only 15 percent of all departments of correction had policies that contained either all or all but one critical component of suicide prevention.  In contrast, 14 departments of correction (27%) had either no suicide prevention policies or limited policies — 3 with none, and 11 with policies that addressed only one or two critical components.  The majority (58%) of DOCs had policies that contained three or four of the critical components.

Medicaid Enrollment for Prisoners

Administration officials moved to improve low Medicaid enrollment for emerging prisoners, urging states to start signups before release and expanding eligibility to thousands of former inmates in halfway houses near the end of their sentences.

Health coverage for ex-inmates “is critical to our goal of reducing recidivism and promoting the public health,” said Richard Frank, assistant secretary for planning for the Department of Health and Human Services.

Advocates praised the changes but cautioned that HHS and states are still far from ensuring that most people leaving prisons and jails are put on Medicaid and get access to treatment.

“It’s highly variable. Some states and jurisdictions are having a lot of success” enrolling ex-prisoners, said Kamala Mallik-Kane, a researcher at the Urban Institute who has studied the process. “Others of them have initiatives in place that aren’t reaching the kinds of numbers that are making a dent.”

The 2010 health law made nearly all ex-prisoners eligible for Medicaid in states that chose to expand the state and federal insurance program for the poor. Many welcomed the chance to cover a group with high rates of chronic disease, mental illness and substance abuse problems.

But prisons and jails, burdened with ineffective computers, understaffing and complicated Medicaid enrollment procedures, have been slow to sign up released inmates.

Federal and state prisons let out more than 600,000 people a year. Millions more cycle through jails. But a study published in Health Affairs found prisons and jails nationwide enrolled only 112,520 emerging inmates between late 2013 up to January 2015.

Much of HHS’ guidance repeats existing policy, reminding states that those on probation or parole are eligible for Medicaid and urging states to keep prisoners’ names in the Medicaid computers while they’re locked up. (That eases re-enrollment.)

Inmates are generally ineligible for Medicaid while incarcerated. Prison and jail medical systems care for them.

HHS is “providing encouragement and a nudge” to states to improve sign-ups as well as money to upgrade enrollment computers, said Colleen Barry, a professor at the Johns Hopkins Bloomberg School of Public Health who has studied ex-inmate enrollment. “They understand that this is a technology issue.”

Making up to 96,000 halfway-house inmates eligible for Medicaid is new policy, designed to connect people with care before they’re fully released. Prisoners often move to halfway houses or home detention near the end of their terms, closely supervised but frequently allowed to shop, apply for jobs and see a doctor.

Under the new policy, “if you have a fair amount of freedom of movement” in a halfway house, “you’re not considered an inmate” for Medicaid purposes, said Sarah Somers, an attorney for the National Health Law Program, an advocacy group. “That will be very helpful for a lot of people who are trying to transition out of incarceration.”

Ex-inmates have extremely high rates of HIV and hepatitis C infection, diabetes, mental illness and substance abuse problems. They are especially vulnerable after they leave the prison medical system and before they connect with community doctors.

One study in Washington state showed that ex-inmates were a dozen times more likely to die than the general population in the first two weeks after their release.

Immediate Medicaid coverage “can mean the difference between life in the community and recidivism and even life and death,” Michael Botticelli, the White House’s director of national drug control policy, told reporters.

HHS has been urging states to enroll ex-inmates in Medicaid for years. But the Affordable Care Act’s Medicaid expansion made many more of them eligible for coverage, giving policymakers a new reason to promote sign-ups, advocates said.

So far 31 states and the District of Columbia have expanded Medicaid under the law.

By Jay Hancock April 29, 2016 Kaiser Health News