Legislators waive chance to set up repeal of expanded Medicaid services, and are talking with administration officials about it

University of Kentucky dental Dean Jeffrey Okeson, left, spoke to
a legislative committee in August unsupport of expanded Medicaid
dental services along with Dr. Margaret Hill center, dental dean at
the University of Louisville, and Dr. Pamela Stein, dental dean at
the University of Pikeville. (Kentucky Lantern photo by Deborah Yetter)

By Deborah Yetter

Kentucky Lantern

Around 400 patients every week, most covered by Medicaid, flood the University of Kentucky’s dental clinic seeking care they can’t find elsewhere for advanced tooth decay or other oral disease.

Some are in such critical condition they must be airlifted to UK, Dr. Melvyn Yeoh, the university’s chairman of oral-health science, recently told state legislators. Swelling from dental infection threatens some patients’ airways, leaving them unable to survive an hours-long ambulance ride to Lexington from rural Kentucky.

Others arrive with advanced oral cancers that could have been detected and treated sooner with regular dental care.“Bad teeth cause life-threatening infections,” said Yeoh, who testified Sept. 12 before a legislative committee in support of expanded Medicaid dental benefits.

“With late-stage oral cancer diagnosis, people can die,” Yeoh added, noting that Kentucky has the nation’s second highest rate of oral cancer. It ranks 49th in overall oral health.

Some patients wind up in intensive care for days or weeks, Yeoh said, and such cases run up hundreds of thousands of dollars in medical bills, often paid by Medicaid, in cases that might have been addressed earlier at far less cost in a dentist’s office.

“It’s actually driving up the costs of health care,” he said.

Yeoh was one of the latest health professionals to speak on behalf of expanded Medicaid dental services, as well as broader hearing and vision care, introduced this year by Gov. Andy Beshear.

“I am extremely excited about it,” Yeoh told the committee. “We think it can do a lot for us as providers of dentistry in Kentucky.”

But the Democratic governor's changes have run into a wall of opposition from Republican legislators who control the General Assembly and claim he usurped their authority by expanding care through executive order.

Legislators can’t take any action to override the expanded benefits until they meet in the next legislative session in January, but some continue to blast Beshear, who is seeking a second term in the Nov. 7 election.

‘At home on their couch’

An outspoken critic, Rep. Randy Bridges, R-Paducah, said at the Sept. 12 hearing that Beshear’s effort was “a loophole or political move” to avoid going through proper legislative channels.

Senate Majority Floor Leader Damon Thayer complained that Medicaid — which covers health care for some 1.6 million low-income Kentuckians, about one-third of the state’s population — has grown too large and includes enrollees simply unwilling to work.

“When I continue to see these stories about 18- to 34-year-old white men who’d rather sit at home on their couch with their Netflix remote and their DoorDash, it really aggravates me that they are living on the taxpayers’ money when they are able-bodied and should be out there working,” Thayer said.

Thayer didn’t cite any source for that claim, and Medicaid money goes to providers, not patients. Advocates who spoke that day said his characterization was inaccurate because most Medicaid beneficiaries who are not disabled work at low-wage jobs that don’t include health coverage. 

To get better jobs, they need better health benefits, which may help them get into the labor market, advocates said.

“We’re talking about workforce readiness here,” said Sheila Schuster, executive director of the Kentucky Mental Health Coalition. “If we want people to get back, as Senator Thayer has suggested, into the real workforce, the full-time workforce, we need to make sure they can see and hear and are not suffering from dental pain.”

The expanded benefits include services such as dentures, fillings, root canals, and crowns not previously covered by Medicaid, which for years covered only one annual checkup and tooth extraction for adults.

A shortage of dentists, and Medicaid's low reimbursement rates, causing many dentists to opt out of the federal-state health plan, has created an oral health crisis in Kentucky, they say. Even with the expanded benefits introduced this year, patients can’t find providers who take Medicaid.

“It’s an enormous problem that we have here and it’s not getting any better,” Dr. Jeffrey Okeson, dean of the UK dental school, told lawmakers at a hearing in August before the Administrative Regulation Review Subcommittee.

Okeson was joined by the deans of the University of Louisville dental school, and a new one in development at the University of Pikeville, in urging support for the expansion of Medicaid dental services.

One patient ‘alive today’

Meanwhile, advocates say such services are especially needed for vulnerable adults struggling to escape circumstances including domestic violence and addiction.

Ann Perkins, executive director of Safe Harbor of Northeast Kentucky, one of the state’s 15 regional domestic-violence shelters, said dental as well as vision and hearing services are essential for clients who need them to succeed in school, job training and employment.

“This is how our state can actually do something productive,” Perkins told legislators. “Your money will never be better spent.”

She said some of her clients are in dire situations, including a woman suffering from lung cancer who could not undergo chemotherapy until she got treatment for abscessed, infected gums. The client had called every dentist in the region but none who accepted Medicaid could fit her in, Perkins said.

Perkins used $500 in Safe Harbor funds to pay for the dental treatment, which the woman later repaid, she said. “She’s doing great,” Perkins said. “She’s just one example of how important dental care was for her to be alive today.”

John Bowman, Kentucky coordinator for Dream.org, a national non-profit that works for criminal-justice reform, said such benefits are “huge” for people recovering from addiction, including himself.

“It gives people a sense of self-worth,” he said. “If we want people to be productive members of society, we need to back them with these services.”

‘To us, it was a win’

Legislators took no action on the regulations expanding Medicaid benefits at the Sept. 12 meeting. They could have found them “deficient,” setting them up to be voted down when the legislature next meets. So iIt appears that an effort is uderway to keep the benefits in place.

Rep. Derek Lewis, R-London, co-chair of the committee, said discussions have begun with Beshear administration officials, following complaints by lawmakers they had not been consulted. Lewis said he and co-chair Sen. Stephen WestR-Paris, were contacted recently by Eric Friedlander, secretary of the Cabinet for Health and Family Services, and Medicaid Commissioner Lisa Lee, to discuss the issue.

“I think that goes a long way toward working this out,” Lewis said.

Rather than voting to disapprove the regulations on Sept. 12, the commitete sent them for further review to the joint Health Services Committee, which is unlikely to take them up for several months.

Yeoh, the UK dental official, said he views it as a good sign the committee didn’t reject them outright.

“To us it was a win,” he said. “We’re extremely happy about that.”

Fall is vaccine season; doctors say it's OK to get immunizations for Covid-19 and flu at same time; new RSV vaccine available

The timing of vaccines matters.
(Wall Street Journal illustration, from iStock images)

Covid-19, influenza and respiratory syncytial virus (RSV) are circulating, so the vaccine season is upon us. To get the maximum protection, start with a game plan.

"Doctors generally suggest getting your flu and Covid shots before the end of October and say it's OK to get both those shots at the same time," reports Sumathi Reddy of The Wall Street Journal. "The most important thing, doctors say, is to get vaccinated. If you're in a doctor's office or a drugstore and can get your shots, it usually makes sense to do it."

For Covid shots, "Sooner rather than later is good. . . especially if you are a senior or immunocompromised," Reddy reports. One exception: Over the summer, there was an increase in Covid cases, and if you've been recently infected, putting off getting a booster for three to six months is wise. "If your level of antibodies is quite high, the booster does very little good. You're kind of wasting your shot," John Wherry, director of the Institute for Immunology at the University of Pennsylvania, told Reddy. 

"The newly approved booster targets the dominant strains now circulating," Reddy notes. "Covid-19 test positivity rates have hovered around 14% for the past month, according to CDC data, up from 4% in June. Covid boosters from Pfizer and Moderna have already rolled out. The Novavax booster is expected later this fall."

The annual flu vaccine is recommended in September or October. "Flu cases usually start ticking up in November and peak in January before trailing off at the end of March," Reddy notes. "If you get sick with the flu before you've been vaccinated, you should still get the vaccine about a month later, he says. That's because the flu vaccine typically protects against four types or strains of influenza."

RSV vaccines are approved for seniors and some pregnant women; doctors say opting to have the vaccines sooner is best, Reddy reports, "because activity is picking up, and RSV tends to peak earlier than the other respiratory viruses, says Wherry. There is also a new RSV drug approved to protect infants. Cases are already starting to increase in the Southeast, according to the CDC."

Ga. professor develops model to show how much you need to walk each day to achieve a specific reduction in your weight

Step counts and weight loss have an inconsistent relationship.
(Photo by Jose Carlos Cedeno Martinez, Getty Images)

By Bob Buresh
The Conversation

Over the last decade, smartphones have become ubiquitous not just for sending texts and staying abreast of news, but also for monitoring daily activity levels.

Among the most common, and arguably the most meaningful, tracking method for daily physical activity is step counting.

Counting steps is far more than a fad. The U.S. Department of Health and Human Services dedicated a sizable portion of its most recent physical activity guidelines to documenting the relationship between daily step counts and several chronic diseases.

Unfortunately, the guidelines have little to say about how step counts might be used to aid in weight management, an outcome of critical importance given the high rates of overweight and obesity in the U.S.

In the early 1980s, fewer than 14% of adults in the U.S. were classified as having obesity. Today, just over 40 years later, the prevalence of obesity is greater than 40% in the adult population, and current trends suggest that almost half of adults in the U.S. will be obese by 2030.   

I am a professor of exercise science at Georgia's Kennesaw State University, and our lab has been conducting studies examining relationships among step counts and a number of health outcomes.

While the evidence is clear that increasing numbers of adults are living in a chronic energy surplus that leads to weight gain, a key question is – why? What has changed so dramatically since 1980 that could explain why obesity rates have tripled?

Although the American diet is likely a key contributor, a wealth of research points to a reduction in physical activity as a major culprit behind the expanding waist lines – and step counts are an excellent indicator of physical activity.

 
Step counts may – or may not – lead to weight loss

A number of recent studies have looked at whether increasing step counts can lead to weight loss over a certain period of time. One large-scale study called a meta-analysis concluded that increasing physical activity by way of step counts was effective for attaining modest weight loss. However, many if not most studies examining the effect of exercise on weight loss report modest outcomes, with results that are variable and often disappointing.

That may be in part because the step count targets used in many weight management studies are most often set in an arbitrary manner, such as targeting 10,000 steps per day. Or, if they’re individualized at all, they’re based on initial behavioral characteristics, like adding a given number of steps to what a person is already accumulating in a typical day. Rarely, if ever, are the step targets in research studies based on any physical attributes of the participants.

My team’s research has compiled weight, body-fat percentages and average step counts for large numbers of adults between 19 and 40 years of age. From that data, we have identified a way to determine specific step count goals based on key physical attributes – namely, baseline body weight and composition, and the desired body composition.

When it comes to health, it is important to remember that body weight does not tell the whole story. In fact, body composition is much more predictive of health status than body weight. Someone who weighs more than another person may be in better health if they have more muscle mass and a lower percentage of body fat than the other person who weighs less but has a higher proportion of body fat.

Parsing the numbers

We have used our data to develop a model that predicts average daily step counts per unit of fat mass from body-fat percentage. We believe that this model can be used to determine how much people would need to walk to achieve a specific amount of weight and body fat reduction.

Take, for instance, a man who weighs 175 pounds (80 kilograms), of which 25% is fat. Our model suggests that he walks an average of 10,900 steps a day. Then consider another man who weighs 220 pounds (100 kilograms), of which 20% is fat. Although they have different amounts of lean mass, both men have about 44 pounds (20 kilograms) of fat. So our model predicts that the heavier man walks an average of 15,300 steps a day. In other words, the heavier person has a lower percentage of body fat and walks more to maintain that leaner body composition.

A person’s body fat percentage is every bit as important as their weight. That’s because how much muscle you have affects how hungry you get, as well as how many calories you burn. Muscle mass requires energy to maintain, and this requirement leads to increased appetite, which means taking in more calories. In this example, the heavier man probably eats more than the lighter man in order to maintain his lean muscle mass, and he must walk more to maintain his lower body fat percentage.

If you want to lose body fat, and therefore weight, you basically have two choices: You can eat less, or you can move more. Eating less means you’ll be hungry a lot, and that’s uncomfortable, unpleasant and, for most people, not sustainable. Moving more, on the other hand, can allow you to eat until you’re full and keep body fat off – or even lose it.

Therefore, we wanted to know how much a person who eats until they’re full might have to move to offset the calories they’re eating.

It’s easy to add in extra steps – for example, park a little farther from the grocery store or take an extra trip to the mailbox.

Step counts for weight loss

Currently, our model applies to young adults, but we are now collecting data for middle-aged and older adults too. To use this model, you need to first have your body composition determined, a service that is being offered by increasing numbers of fitness centers and medical practices. With our model, you must determine your body weight and fat weight in kilograms – to do this, simply divide your weight in pounds by 2.2.

With this information in hand, our model can provide a step count target that is specific to a person’s current body weight and body fat percentage, and their goal for fat loss and weight reduction.

For example, our model predicts that a woman weighing 155 pounds (70 kilograms) with 30% body fat currently accumulates an average of about 8,700 steps per day. If she wants to lose about 10 pounds and reach a body fat percentage around 25%, she could consult the model and discover that people who maintain that body composition accumulate an average of about 545 steps per kilogram of fat per day. Since she currently has about 46 pounds (21 kilograms) of fat, her goal would be to accumulate a total of 11,450 steps per day.

While that may seem at first glance to be a sizable increase in daily steps, most people can accumulate 1,000 steps in 10 minutes or less. So even with a comfortable pace, this additional daily dose of walking would take fewer than 30 minutes. Furthermore, steps can be accumulated throughout the day, with longer or more frequent trips, or both, to restrooms, vending machines and the like.

While steps certainly can be accumulated in dedicated walking sessions, such as a 15-minute walk during lunch hour and another 15-minute walk in the evening, they can also be accumulated in shorter, more frequent bouts of activity.

Researchers have learned a great deal in the past 70 years about appetite and energy expenditure: Appetite imposes a drive for food based largely on our fat-free mass, no matter how active or inactive we are, and we must accumulate enough physical activity to counter the calories that we take in through our diet if we want to maintain an energy balance – or exceed our intake to lose weight.

The Conversation is a platform for journalism by academics.

'The only way we can take care of others is if we first take care of ourselves," UK President Eli Capilouto says in a health message

Kentucky Health News

Before he became an academic and a university administrator, Eli Cailouto was a public-health dentist. He returned to his roots in his latest campus-wide message as University of Kentucky president, promoting preventive measures as the weather cools, we spend more time inside and viruses circulate more. It's aimed at the UK campus but is generally applicable to everyone.

Dr. Eli Capilouto

By Eli Capilouto

As we continue to settle into the academic year, I encourage you to prioritize taking care of yourself.

Be healthy.

Listen to your body. Pay attention when you don’t feel well or when something doesn’t seem right — when in doubt, check it out. We have an outstanding, world-class health care system that is here to take care of you.

Get outdoors. Visit a garden, go to the park, take a walk. Exercising outdoors can help reduce stress and anxiety, improve sleep and ease your mind. The arboretum — open daily from dawn until dusk — has beautiful gardens, a two-mile paved path and a half-mile trail through its woods.

Prepare yourself. Vaccines are safe, effective and an important way to stay healthy. Employees have access to multiple pharmacies and clinics that offer flu, Covid-19, RSV and other vaccines. Flu shots are also available to UK students at University Health Service, UK retail pharmacies and various on-campus flu shot clinics. Find more information here.

The only way we can take care of others is if we first take care of ourselves.

I hope you will join me in making every effort to stay healthy this fall and winter season.

Ky. children 10-17 have nation's 2nd highest obesity rate, 19.6%; adult rate of 37.7% is 9th highest, a slight improvement from 2021

Map from Trust for America's Health State of Obesity report

Kentucky Health News graph from state data

By Melissa Patrick

Kentucky Health News

Kentucky ties with Wisconsin for the nation's ninth-highest adult obesity rate, an improvement from second-highest last year, but Kentucky children aged 10-17 still have one of the nation's highest rates, No. 2, after ranking first last year.

The 20th annual State of Obesity report from Trust for America's Health says 37.7% of Kentucky adults are obese and nearly 72% of the state's adults are either obese or overweight, tied for sixth place with Delaware. Among the state's high-school students, 19.6% of them are obese and 16.2% are overweight.

Nationally, the report says the number of obese adults continues to rise, noting that 22 states had an 2022 adult obesity rate at or above 35%, up from 19 states in 2021. A a decade ago no state had an adult obesity rate at or above 35%, the report says.

"Since TFAH’s initial report, published in 2004, the national adult obesity rate has increased by 37 percent and the national youth obesity rate increased by 42 percent," says the report. 

The national adult obesity rate is 42% and the national rate for children ages 2 to 19 is nearly 20%, according to the report.  

The good news is that from 2021 to 2022, Kentucky's adult obesity rate declined 6.4%, or 2.6 percentage points, to 37.7% from 40.3%. But that was still above the levels of 2018, 2019 and 2020.

West Virginia (41%), Louisiana (40.1%), Oklahoma (40.0%), and Mississippi (39.5%) have the highest rates of adult obesity. The District of Columbia (24.3%), Colorado (25.0%), and Hawaii (25.9%) have the lowest adult obesity rates.

“It’s critical to recognize that obesity is a multifactored disease involving much more than individual behavior,” Dr. J. Nadine Gracia, president and CEO of Trust for America's Health, said in a news release. “In order to stem the decades-long trend of increasing obesity rates we have to acknowledge that the obesity crisis is rooted in economic, health, and environmental inequities. Ensuring all people and communities have equitable opportunity and access to healthy food and physical activity is fundamental to addressing this crisis.”

Kentucky continues to struggle with all of these conditions. It ranks fifth worst for the percentage of adults with diabetes (15%) and hypertension (40.3%), and nearly 27% of its adults are physically inactive, ninth worst. 

The report shows that more adult men than adult women are obese in Kentucky: 38.7% of men and 36.7% of women, a switch from last year's report. Kentucky's adult men have the second highest obesity rate in the nation; its women rank 18th, tied with Texas.

By age, Kentucky adults between 45 and 64 have the highest obesity rate, 42%. That's followed by those 25-44 (41.2%), 65 and older (33.7%) and 18 to 24 (24.1%). 

"Solving the nation’s obesity crisis will require addressing the economic and structural factors that impact where people live and their access to employment, transportation, healthcare, affordable and healthy food, and places to be physically active," says the report, which includes policy steps to address the crisis that they say should be taken by federal, state and local officials and stakeholders. They include: 

• Fully fund the Centers for Disease Control and Prevention's proven chronic disease and obesity prevention programs so they reach every state.
• Make healthy school meals available for all students and increase access to Supplemental Nutrition Assistance Program (SNAP) and other nutrition support programs.
• Implement a mandatory front-of-package labeling system on food packaging to help consumers make informed choices.
• Close tax loopholes and eliminate business-cost deductions for advertising unhealthy food to children.
• Make physical activity and the built environment safer and more accessible for everyone, including by increasing federal education funding for health and physical education and investing in active transportation projects like pedestrian and bike paths.

Answers to questions about the updated Covid-19 vaccines

Updated Covid-19 vaccines from Pfizer/BioNTech and Moderna have rolled out to pharmacies. The Food and Drug Administration approved the mRNA vaccines for everyone 6 months and older. The Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices voted 13-1 to recommend that everyone 6 months and older should get the shots, and the CDC endorsed that recommendation.

Lori Robertson and Catalina Jaramillo of FactCheck.org, a service of the Annenberg Public Policy Center at the University of Pennsylvania. Robertson and Jaramillo compiled a list of common questions and answers about the vaccines, and here's a condensed version of their report:

How are these updated shots different from the last one? All of the Pfizer/BioNTech and Moderna Covid-19 vaccines — the originals, the bivalent boosters and the latest updates — use the same mRNA technology to trigger an immune response to the spike protein of SARS-CoV-2, the virus that causes Covid-19. The spike protein is what the virus uses to enter cells.

The difference between the versions of the vaccines is in what type of spike protein they prompt the body to make. The mRNA in the 2023-2024 vaccines instructs cells to make the spike protein of omicron variant XBB.1.5. The variant became a concern at the end of last year, when the CDC projected it made up 40.5% of new CCovid-19 cases in the U.S., a figure that rose to nearly 90% by early March.

Who is eligible to get an updated vaccine? Everyone 6 months of age and older is eligible for these vaccines.The FDA said those age 5 and older can get a single dose of either mRNA vaccine if at least two months have passed since the prior Covid-19 vaccine dose. Unvaccinated people can also get a single dose. Children ages 6 months through 4 years who previously were vaccinated are eligible to get one or two doses, depending on which vaccines they have received and when. Children in this age group who haven’t been vaccinated against Covid-19 can get three doses of the latest Pfizer vaccine or two doses of Moderna’s. . . . Those who are immunocompromised can also receive additional doses.

What evidence supports the use of the updated vaccines? The FDA said it approved and authorized the latest formulas of the vaccines based on its evaluation of manufacturing data and data showing the immune response to these vaccines against prevalent variants is similar to that of previous versions of the vaccines against prior variants.. . . . The FDA is using a similar approach to the annual influenza vaccines, which are tweaked each year to combat the influenza strains expected for that season. Flu vaccines are approved each year without clinical studies because the changes, compared with prior vaccines, are small and because it wouldn’t be possible to test the vaccines each year in people before the flu season.

How effective are they? We don’t have vaccine effectiveness data for the updated vaccines specifically, but data on similar, previous vaccines show they were quite effective at preventing severe disease. And the research. . . .by Moderna and Pfizer/BioNTech shows the updated version increases neutralizing antibodies against the new and emerging variants.

How safe are they? Moderna’s clinical trial for the latest vaccine showed that the percentage of participants reporting mild side effects, such as pain, swelling, headache, fatigue and muscle aches, was similar to or, in many cases, lower than the reporting rates for the prior Covid-19 vaccines. But, the safety evaluation of this formula is based on hundreds of millions of doses of Covid-19 vaccines administered over the past few years.

Are the shots still free, and where can I get one? The vaccines are no longer provided by the federal government for free, but private insurance companies, Medicare and Medicaid, and some CDC programs will cover them.

For more detailed explanations and questions, read the full article here. 

Governor declares Recovery Month, says he has 'grave concerns' about opioid-settlement spending as opioid commission meets

Gov. Andy Beshear posed with members of the recovery community on Sept. 22 in the Capitol rotunda as he proclaimed September as Recovery Month in Kentucky. (Photos by Melissa Patrick) 

By Melissa Patrick
Kentucky Health News

More than 200 people attended an event to mark National Recovery Month on Friday, Sept. 22 in the state Capitol, hearing a message that recovery is possible -- along with "grave concerns" from Gov. Andy Beshear about how the Opioid Abatement Advisory Commission may spend the millions coming to the state from lawsuit settlements with opioid makers and distributors.

Later that day, the commission approved nearly $14 million in 34 grants, but only by application numbers and amounts, saying the names of the grantees would not be announced until early October. 

The recovery event was opened by Dr. Katherine "Katie" Marks, commissioner of the Department for Behavioral Health, Developmental and Intellectual Disabilities, saying Kentucky is leading the way when it comes to access to recovery, and that by working together, recovery is possible. 

"Seven out of 10 people, of adults, who have experienced substance-use or mental health conditions . . . are in recovery; they are here with us. We are those people. It reminds us over and over that recovery is not just possible, it is probable," said Marks, who ran the state Opioid Response Effort before becoming commissioner. 

Gov. Andy Beshear

Before signing a proclamation recognizing September as Recovery Month in Kentucky, Gov. Andy Beshear touted a number of the programs in the state to help people who are in recovery or seeking recovery. He noted the addition of six more Recovery Ready Communities, bringing that number to seven.

"For the first time I can remember, we in the commonwealth have a bed for anyone ready to go into treatment," Beshear said to rousing applause. 

Beshear said that in his previous job, he sued "more opioid companies than any other attorney general in the country." He called the funds coming from settlements of those lawsuits "blood money" and said it must be spent in the "right way." 

"It is so critical that we use the hundreds of millions of dollars that we will receive in the right way to support recovery, to support treatment. And please lift your voice in the committee that is making decisions right now that I have grave concerns about," he said, referring to the opioid commission.

"When we haven't seen $10 million going into treatment, spending $40 million to support some company's private patent for a drug that the FDA will not and does not approve is not the way we ought to be spending these funds."

Beshear was referring to the proposal by the commission's chair and executive director, Bryan Hubbard, to spend $42 million of the settlement money for research to get ibogaine, a psychedelic drug that is anecdotally reported to stop withdrawal symptoms, approved for use in the United States.

Hubbard is an employee of, and the commission is housed in the office of, Attorney General Daniel Cameron, the Republican nominee for governor against Democrat Beshear in the Nov. 7 election.

The commission has held two full days of public hearings on the proposal, but has not acted on it. 

Beshear said at the Capitol event, "We ought to be spending to lift up the groups that are here, that do the hard work day in and day out, and you know what, save people one life at a time. It's important that we spend every single one of these dollars right, because I saw what these dollars can be. Sometimes just a little help, just a hand up, to the folks that are already doing the hard work can unlock the potential to do so much more."

Half of the money from the settlement is going to cities and counties. Van Ingram, head of the state Office of Drug Control Policy, encouraged counties to use their money to create more Recovery Ready Communities.

"All of your communities where you live are coming into the opioid abatement dollars. I submit to you that there's no better way to spend the money than to look at the things you're missing in your communities," Ingram said to a thundering round of applause. 

Dr. Steven Stack

Health Commissioner Steven Stack opened his remarks at the recovery event by reminding people that substance abuse is a medical problem, not a moral failure. 

"People do not choose to have substance-use disorder and all of the terrible things that go along with it," Stack said. "These chemicals are powerful. They alter brain chemistry. And they impair decision-making in ways that are not human failings; they are biological realities." 

Stack wrapped up by encouraging people seeking help to use one of the many resources available in Kentucky, including findhelpnowky.org; findrecoveryhousingnowky.org; the Kentucky Opioid Assistance and Resource Hotline at 1-800-854-6813, which is available 24/7; or the 988 suicide/crisis hotline. 

Medicaid Commissioner Lisa Lee told the story of her 55-year-old brother who died of an opioid overdose 10 years ago,. four months before Kentucky expanded Medicaid to anyone with income up to 138% of the federal poverty line. She said her brother didn't have insurance, so he didn't have access to substance-use-disorder treatment like thousands of people do now because of the expansion.

Lee encouraged he listeners to reach out to anyone they know on Medicaid and to ask them to make sure the state has their correct contact information so they don't lose coverage. Her agency has resumed its annual renewal process, following the end of pandemic rules that allowed continuous enrollment without contact for renewal.

"We want everyone who is eligible to be enrolled in Medicaid and stay on the program to get the services they need," Lee said. 

Five people talked about their recovery journey, with a common message to "recover out loud." 

Alex Elswick

The first was Alex Elswick, an assistant extension professor for substance-use prevention and recovery at the University of Kentucky, who is in long-term recovery.

"I want to make sure that I do the thing that I think is most important, which is that we recover out loud," Elswick said. "That we stand up without any shame, without any fear and say 'This is who I am. This is the problem that I struggled with. This is the way that I found help, and hopefully shine the light for someone else.'" 

He also said addiction doesn't discriminate, but recovery does.

"I see it every single day," he said. "We've created an artificial division between my friends who are in recovery and my friends who still struggle with active addiction," who he later added are just as deserving of access to resources and recovery capital. 

In closing, Elswick said, " We know that addiction is a chronic disorder. And what I've learned is that means it's a chronic disorder for me also. And that means that tonight when I leave here, if God forbid I return to use, I hope that there are very many pathways there for me and not just one. I hope that your response won't be to throw me in jail. I hope that your response won't be to punish me, to demand perfection. I hope you'll give me an opportunity."

State doctors' group calls for more gun control, repeal of Second Amendment 'sanctuary' law; passes resolutions on many topics

By Melissa Patrick

Kentucky Health News

The Kentucky Medical Association called mass shooting and gun violence "a public-health crisis" and called for more gun control in one of nine resolutions on the topic at its annual convention.

Voting delegates representing the state's doctors also adopted resolutions addressing sex education, abortion care and more at their meeting Aug. 25-27 in Louisville.

Kentucky has the “14th-highest rate of gun deaths” in the nation, according to one of the resolutions.

 

KMA joined several other groups in declaring the public-health crisis, in a resolution that supports "A ban of assault (semi-automatic) weapons and killing-enhancement features, including high-capacity magazines, rapid-fire increases ('bump stocks'), silencers, and guns without serial numbers ('ghost' and 3-D printed guns)."

The resolution also calls for background checks without loopholes, waiting periods and safety training on all firearm transfers (retail, internet, gun-show purchases, lending and gifts); and extreme-risk protective orders ('red flag' laws) "to disarm persons who pose risks of gun violence to self or others."

Before the convention, Alex Acquisto of the Lexington Herald-Leader talked to KMA Executive Vice President Patrick Padgett about how KMA passes resolutions and what it means. 

Padgett said the association, by definition, is an advocacy organization to promote the well-being of patients, doctors and the community at large, and the resolutions represent the consensus of an organization that represents thousands of doctors statewide. Padgett said KMA members regularly conduct grassroots advocacy with legislators about health-related bills.

The group's rules say any KMA member can propose a policy change, which is then reviewed by a group of more than 100 doctors in KMA’s House of Delegates, which votes on resolutions in deliberations that are closed to the public. KMA is a private organization, not a public agency coveregd by the state Open Meetings Act.  

Acquisto notes that the KMA's suggested firearm legislation goes against the long-prevailing views in the General Assembly. 

Other resolutions support creation of a statewide gun-safety office to reduce firearm-related deaths;  eliminating ghost-gun loopholes; supporting legislation that promotes the implementation of "domestic violence prohibition laws;" screening during medical visits for presence of guns in the home; and research and educational campaigns about firearms, including safe storage.

"Gov. Andy Beshear, a Democrat, has called for the legislature to pass  to this end multiple times since he became governor — as far back as 2019 after two mass shootings in El Paso, Texas, and Dayton, Ohio, left dozens of people dead, and again this year, after a gunman in downtown Louisville killed five people," Acquisto reports.

Such laws are not popular "in a state that has historically championed the proliferation of and freedom to possess firearms," she adds. "Beshear’s predecessor, Republican Gov. Matt Bevin, said in 2019 that red flag laws are an 'erosion of our constitutional rights' and signed" into a law a bill repealing the requirement for a separate permit or training to carry a concealed deadly weapon.

"In 2020, a bipartisan bill to enact a red-flag law in Kentucky failed to get traction," Acquisto notes. "Earlier this year, legislators enacted a law making Kentucky a 'Second Amendment Sanctuary' state."

The legislation, which Beshear allowed to become law without his signature, says local and state officials and their employees shall not "enforce, assist in the enforcement of, or otherwise cooperate in the enforcement of a federal ban on firearms, ammunition, or firearm accessories."

One of the KMA resolutions calls for Kentucky to repeal the law, saying it and one to ban local gun laws "substantially weaken protection of our schoolchildren, citizens and police officers from mass shootings and gun violence." 

Abortion resolutions

Last year's KMA meeting, two months after the U.S. Supreme Court overturned federal abortion protections, allowing Kentucky's trigger law banning abortion except to save the life of the mother to become law, "could not reach consensus to take a bold stance in opposition to state laws restricting it," Acquisto reports. 

Five abortion-related resolutions were proposed at that meeting, and most were not adopted. This year, the KMA House of Delegates passed two of three abortion-related proposals. 

The first one "supports the protection of OB/GYN residents in Kentucky to have comprehensive education and training in obstetrics and gynecology," stating that without such training, "residents will compromise the future of OB/GYN health care and failure to incorporate abortion training in the resident curriculum will lead to a generation of physicians ill-equipped to fulfill their duty to care for patients." 

The other resolution calls for "revisions to relevant state statutes that restrict access to abortion-inducing medications for women who experience underlying medical conditions concurrently with life-threatening pregnancies."

That is aimed at 2022 House Bill 3, which "prohibits doctors from providing abortion-inducing medication to patients with certain medical histories, including if they have a history of ectopic pregnancies, are taking steroid hormones for rheumatoid arthritis, or are on a blood thinner medication for a heart condition, for example," Acquisto writes.  

The resolution says “The unintended consequences of HB 3 could adversely impact women and risk their lives during a life-threatening pregnancy.” 

A resolution to support comprehensive reproductive health care for women, including the opportunity to choose a medical or surgical abortion, was not adopted. 

Transgender health care and sex education 

Acquisto reports that last year, before most Republican-controlled states "began outlawing gender-affirming care for transgender youth, KMA adopted a policy supporting access to hormones and puberty blockers, and the preservation of the doctor-patient relationship in such settings, devoid of political tampering. According to the current policy handbook, KMA 'advocates against any prohibition of physicians or other health care providers (from) socially affirming gender identity or discussing evidence-based therapies for management of gender dysphoria with their patients and their parents.' The association also supports behavioral-health options and "non-surgical treatment provided to youth by appropriately trained and experienced health-care providers."

This year, the General Assembly passed Senate Bill 150, outlawing all forms of gender-affirming medical care for trans youth, contradicting the advice of the KMA and all oyther major U.S. medical associations.

None of this year's KMA resolutions addressed gender-affirming care, but two dealt with sex and health education in direct response to SB 150. One says "KMA supports legislation to remove age limits for health education in schools."

The other says "SB 150 . . . has raised the question of whether teaching students human health-related curriculum, including puberty and menstrual health education, is permitted in Kentucky before 6th grade." It amended KMA policy to say the group opposes the sole use of "abstinence-only education by providing information about condoms, birth control, and other means of preventing pregnancy and sexually transmitted diseases," and "supports age-appropriate anticipatory education related to menstruation and puberty for elementary school students," as well as "age-appropriate sexual education in schools to include information on sexual assault, consent communication, and dating violence prevention" and "age-appropriate sexual education in schools to include reference to non-traditional (LGBTQIA) practices for safe sex, in the interests of equality and prevention of sexually transmitted disease."

The resolution says KMA "will work with appropriate agencies, including but not limited to the public-school system, to ensure that sex education is age-appropriate, evidence-based, led by well- trained individuals, and subject to periodic evaluation and improvement." 

Other resolutions 

The House of Delegates also adopted resolutions to :

• Encourage swimming lessons for children, promotion of fences around swimming pools and direct supervision of children around water by a responsible individual, amid increased focus on an increased drowning risk of children with autism.
• Encourage caution in pediatric melatonin consumption and to promote physician-led education to caregivers regarding pediatric use of melatonin. 
• Increase skin cancer prevention, noting that "from 2016 to 2020, Kentucky was in the top 10 states with incidence rates of melanoma." 
• Support efforts to educate health care professionals and the public about the frequency and severity of eating disorders and weight stigma, and stated that it supports evidence-based treatment for eating disorders and the removal of insurance barriers designed to deny or restrict such treatment. 
• Promote efforts to decrease the rate of physicians' moral injury in Kentucky, defined as “the challenge of simultaneously knowing what care patients need but being unable to provide it due to a variety of constraints that are beyond a physician’s control.”
• Support improvements in mental health care services for the postpartum period to improve maternal and infant health outcomes; and supports advocating for funding of programs that aid postpartum depression research.
• Support use of anti-obesity medications if they are safe, effective and have a sustained impact with lifestyle modifications; and to advocate for better access to anti-obesity medications for all patients appropriately prescribed those medications.
• Urge an increase research on the safety and efficacy of Kratom and to support increased regulation on the sale and purchase of Kratom. The resolution states that while Kratom is legal to buy, sell and own in Kentucky, "The opioid and stimulant properties of Kratom make it an option for treating opioid withdrawal, but subsequently comes with risk for abuse, addiction, and overdose." It also supported a resolution to ban over-the-counter sales of Kratom in Kentucky and that it supports increased education regarding its misuse and negative health effects.
• Encourages and support expanding representation of darker skin tones in medical education, especially in printed texts and textbooks. 

Click here for a list of the adopted resolutions and for the "Kentucky Medical Association Gun Violence and Firearm Safety Work Group Report to the 2023 KMA House of Delegates."

The pandemic is over; now Covid-19 is endemic, but is still a leading cause of death. When we will stop treating it differently?

Many resist wearing masks, but they work. (CBC photo)

As new coronavirus variants make the headlines and Covid-19 hospitalizations are are on the rise, experts told Carolyn Y. Johnson of The Washington Post that this is the new normal in a world where Covid is now considered an endemic disease. 

This, Johnson writes, is prompting people to ask when we can stop treating the novel coronavirus differently from other common respiratory diseases. 

Experts in Kentucky and elsewhere say the answer will vary, "depending on people’s individual tolerance for risk and the changing landscape of variants and boosters," Johnson reports. 

"Doctors have little to offer people who are stricken by the constellation of lingering symptoms known as long covid. Vigilance is still required to protect high-risk people, including those who are older or who have compromised immune systems." 

Covid-19 was the No. 4 cause of death in the U.S. in 2022, behind heart disease, cancer and unintentional injury. And many Americans and Kentuckians continue to suffer from "long Covid," lingering effects of the disease.

“The newer people [just diagnosed] with long Covid are really angry,” Hannah Davis, a co-founder of the Patient-Led Research Collaborative, who has long Covid, told Johnson. “Everyone’s been told the pandemic is basically over, the risk is basically over if you are vaccinated.”

All that said, public-health experts told Johnson that there is a middle ground between living in fear of the virus and ignoring its existence. And, she writes, this is especially true since we have widespread immunity, and tools such as masks, testing, treatments, updated boosters and improved ventilation. 

Also, she writes, "Many public-health experts also hope that our concept of normalcy will shift, and that habits people learned to guard against Covid — such as staying home when sick and putting on a mask in high-risk situations — will become muscle memory," done with little thinking. 

One challenge is that with the end of the public-health emergency in May, federal policies that had made Covid markedly different from other diseases — such as the government footing the bill to buy vaccines, tests and treatments for everyone — ended, Johnson notes. And with reporting requirements fading away, cases have become harder to track. Instead, experts look to other metrics, like wastewater sampling and hospitalizations, which have been rising since July. 

Scott Lockard

Johnson spoke with Scott Lockard, health director for the Kentucky River District Health Department, which serves seven counties, about the increase of Covid in Eastern Kentucky. 

Lockard said he’s seen a jump in employers calling for guidance when a worker tests positive for Covid, and noted thatg Lee County schools shut down for a few days in August because they were seeing so many absences due to respiratory illness. And the disease is even hitting Lockard's staff.

“Pretty much, my message is: If you’re in a mass gathering, you’re likely to come in contact with someone who has Covid right now in our area,” he said. “So protect yourself accordingly.”

Lockard went on to encourage eligible people get a booster shot, and he advised people to stay home when sick, and test when they have symptoms. He also acknowledged "a great reluctance" to use masks, but reminded people that they work, generally preventing severe Covid and hospitalzation.

Johnson writes, "Even as health experts urge people to stay calm but alert, many argue that we need to continue to treat Covid differently from seasonal flu or the common cold for a few reasons." But others told her that we still don't know what to expect from the virus so it's important to remain cautions. Added to that concern, one expert told Johnson that as we become more complacent about Covid-19, we may have lost "our barometer" for knowing when to worry.

At the time Johnson wrote the article, the White House had not announced that it was relaunching its free Covid-19 test program, allowing every household to order up to four free tests through the mail. Orders can be placed at COVIDTests.gov starting Sept. 25. The tests will be delivered without charge.

Federal government relaunches free, at-home Covid-19 tests, to be available Monday, Sept. 25, for up to 4 tests per household

CDC photo

Kentucky Health News

The Biden administration announced Wednesday that it is providing $600 million to make new at-home tests for Covid-19 and relaunch the program that allows Americans to order up to four free tests per household through the mail.  

The Department of Health and Human Services says in a news release that orders can be placed at COVIDTests.gov starting Sept. 25. The tests will be delivered for free by mail.

"These tests will detect the currently circulating COVID-19 variants, are intended for use through the end of 2023, and will include clear instructions on how to verify extended expiration dates," says the release.

The funding will go to 12 manufacturers in seven states that will produce 200 million new over-the-counter Covid-19 tests. 

“Manufacturing Covid-19 tests in the United States strengthens our preparedness for the upcoming fall and winter seasons, reduces our reliance on other countries, and provides good jobs to hardworking Americans,” Assistant Secretary for Preparedness and Response Dawn O’Connell said in the release. The Administration for Strategic Preparedness and Response's "investments in these domestic manufacturers will increase availability of tests in the future.”

HHS Secretary Xavier Becerra added that this investment will address "vulnerabilities in the U.S. supply chain by reducing our reliance on overseas manufacturing" and will "help mitigate the spread of the virus." 

The initiative follows four previous rounds of free tests where federal officials and the U.S. Postal Service provided more than 755 million tests for free to homes nationwide.

Covid-19 cases and hospitalizations have been on the rise in Kentucky and the U.S. since July, though the numbers are far below where they were during the peak of the pandemic.

Kentucky had 54 Covid hospital admissions per 100,000 residents in the last seven days and 10 reported deaths during the week of Sept. 3 to Sept. 9, according to The New York Times Covid-19 tracker, which uses Centers for Disease Control and Prevention data. 

O'Connell told Will Weissert of The Associated Press that home testing remains a key way to slow the spread of new cases. 

“Whether or not people are done with it, we know the virus is there, we know that it’s circulating. We know, if past is prologue, it’ll circulate to a higher degree and spread, and cases will go up in the fall and winter seasons,” O’Connell said. “Anticipating that that would be true again, or something similar, we want to make sure the American people have these tools.”

O’Connell told Weissert that the website is scheduled to receive orders through the holidays, but could stay open longer if there is an increase in cases. "At this point, our focus is getting through the holidays and making sure folks can take a test if they’re going to see Grandma for Thanksgiving," she said. 

Weissert reports, "It is also meant to complement ongoing federal efforts to provide free Covid tests to long-term care facilities, schools, low-income senior housing, uninsured individuals and underserved communities which are already distributing 4 million per week and have distributed 500 million tests to date, the department said."

WellCare of Kentucky, a manager of Medicaid, honors nine Kentucky health heroes with Community Health Champion awards

Front row, from left: Matt and Jennifer Westwood, Chelsea Ryann’s Festival of Hope; Christy Hinton, River Valley Behavioral Health; Faith Fountain, Ramey-Estep/Re-group; Sonja Grey, Exploited Children’s Help Organization; Stacy Kuhn, Farmstead, Inc. Back row, from left: Katina Hayden (overall winner), Catholic Charities of Owensboro; Dustin Bowman, Frankfort Police Department; Tiffany Riley, Kentucky Care; Corey Ewing, WellCare plan president; Dr. Key Douthitt, Breathitt County Long-Term Recovery.

Kentucky Health News

WellCare of Kentucky, one of the companies that manages Medicaid coverage for the state, honored nine people as "community health champions" for their efforts to improve the physical and mental well-being of Kentuckians.

 

Gov. Andy Beshear spoke at the Wednesday event, recognizing the health-care professionals who work to improve the quality of life in Kentucky’s communities through service, volunteerism and advocacy.

"All of this year’s nominees are integral partners in supporting the well-being of Kentuckians, and I am proud to be a part of this ceremony honoring their efforts," said Beshear. "Thank you to WellCare of Kentucky for continuing to recognize those who go above and beyond in helping their neighbors."

The statewide award was presented to Katina Hayden, director of case management of Catholic Charities of Owensboro.

Hayden's nomination by her peers said she played a crucial role in managing recovery efforts from the tornados that ripped across Western Kentucky in July, and helped the most marginalized Kentuckians recover from the natural disaster, a nws relese said. Hayden provided assistance to more than 4,000 survivors through her tireless work, helping to provide hope to 14 counties.

“Katina represents exactly the type of service, commitment, and passion that we want to support in Kentucky,” WellCare Plan President Corey Ewing said. “We know that people like her help make Kentucky communities healthier.”

The 2023 Regional Community Health Champions, by Medicaid region, are: 

Region 1: Tiffany Riley, Kentucky Care community health worker, for her "remarkable" impact on the lives of homeless individuals with physical and mental health problems. She was also recognized for her work as a lead facilitator at Western Kentucky Situation Table, connecting people at risk with essential resources. "Thanks to her valiant efforts, countless individuals who often slip through the cracks have been provided medical, dental, vision, and behavioral health services," says the release.

Region 2: Christy Hinton, River Valley Behavioral Health 988 mental-health first responder, for putting in up to 70 hours a week, and her volunteering for New Beginnings and her local church. "But her commitment does not stop there. Hinton goes above and beyond for everyone she meets, always having a smile on her face," says the release. 

Region 3: Sonja Grey, Exploited Children’s Help Organization, for her dedication to preventing and reducing child abuse through education, advocacy and support services in Louisville. It also says she actively partners with non-profit organizations, schools, and youth-serving organizations while serving in multiple leadership roles, with more than 15 years of experience in leading nonprofit organizations and for-profit businesses "Grey is extensively involved in the community, serving on multiple task forces and advisory councils for organizations like Kosair for Kids-FaceIt Movement campaign and Jefferson County Public Schools," says the release.

Region 4: Stacy Kuhn, Farmstead Inc., for her work as a volunteer providing pro bono equine-assisted psychotherapy to veterans. "Kuhn, a trauma survivor, holds multiple licenses in counseling. Her unique qualifications and personal journey make her the perfect advocate for our veterans," says the release.

Region 5: Dustin Bowman, Frankfort Police Department, for his work in addressing substance abuse treatment and prevention, and understanding that arresting people is not a long-term solution. "Bowman is involved in school activities, substance abuse prevention initiatives, and organizations addressing homelessness and affordable housing. Chief Bowman has secured grants for collaborative efforts between law enforcement and service organizations," says the release.

Region 6: Matt and Jennifer Westwood, Chelsea Ryan Festival of Hope, for their efforts to spread awareness about mental health, having "turned their pain into purpose," the release says. "After their daughter's tragic suicide, they dedicated themselves to helping the students at Lloyd Memorial High School. Through their fall festival, Chelsea Ryann Festival of Hope, they not only raised funds but also spread awareness about mental health. It is a joyful event where the community comes together, and mental health resources are readily available. Every year, they raise an average of $10,000, which helps the counselors bring in outside help for students in need." 

Region 7: Faith Fountain, Ramey-Estep/Re-group, for her work to better people's lives. She joined the organization as a youth support specialist in 2012 and has worked with more than 200 young people. "Faith is a passionate advocate for diversity and inclusion within the community. She serves on several community action boards, working to ensure equitable representation and opportunities for all. Faith initiated programs such as free ordainment ceremonies, fostering inclusivity and supporting individuals from various backgrounds," says the release.

Region 8: Dr. Key Douthitt, Breathitt County Long-Term Recovery Team, for his work as the medical director of the North Fork Valley Community Health Center, where he played a pivotal role in in helping rural communities during the flood of 2022. According to the release, "He organized door-to-door medical teams to hit the hardest affected areas across Breathitt, Knott, Perry and Letcher counties. He coordinated 13 teams and administered over 2,500 tetanus vaccines. Dr. Douthitt also established a hotline for flood-related medical needs. Furthermore, he also helped replace lost medications for those in shelters at Wolfe and Perry counties."

Now is the time to get vaccinated or re-vaccinated for Covid-19, as the weather cools and people spend more time indoors

University of Kentucky photo

By Vince Venditto
University of Kentucky

As the weather gets colder and gatherings move indoors, vaccines remain the safest and most effective way to protect ourselves from Covid-19.

On Sept. 11, the Food and Drug Administration approved the updated mRNA Covid-19 booster vaccines to align with the currently circulating variants. The vaccines are recommended for everyone six months and older to protect against the serious outcomes of Covid-19.

Vaccines are free to most people in the U.S. who have health insurance, and available for free to everyone through local health centers, or participating pharmacies. Here are questions and answers :

Is COVID-19 still with us? The virus that causes Covid-19 is still circulating, causing increased rates of hospitalization in several counties in our region. Nationally, there was about an 8% increase in hospitalizations and 5% increase in deaths last week. As the weather gets colder and more people gather indoors, it is likely that the infection rate and hospitalizations will continue to increase. It is important to remain mindful of yourself and others for the potential risk of infection with SARS-CoV-2, flu, and RSV (respiratory synctial virus).

Isn’t the virus getting weaker and not making us as sick? It is true that there are lower rates of hospitalization and death from the virus, compared to the peak of the pandemic, but this is due mostly to the immune response after vaccination and infection. New variants of the virus continue to emerge with changes that sometimes lead to increased risk of infection, increased severity, or ability to avoid our immune system. Vaccination remains the safest method to protect ourselves from severe disease.

Do we still need vaccines? Vaccination is the second most important public-health intervention, only behind clean drinking water. The vaccines are designed to improve our immune response to fight a potential infection, and the new vaccines are designed to provide improved immunity against the virus that is currently circulating, which aligns with how the flu vaccines are developed each year. As the virus continues to change, new vaccines become necessary to target the virus that we are most likely going to be exposed to.

What’s different with the new vaccine? The new mRNA vaccines are based on the XBB.1.5 variant and closely related to other currently circulating variants. While previous vaccines and boosters were effective at inducing robust immunity, the new vaccines align better with the variants that are currently circulating to provide an additional boost to our immune system. The other change to this vaccine is that it is monovalent – meaning there is only one variant included. The prior booster consisted of two variants and the new vaccines provide a more focused immune response on what is currently circulating. Currently, only the updated mRNA vaccines from Pfizer and Moderna have been approved and an alternative vaccine from Novavax is currently under review by the FDA.

When should I get the vaccine? It is recommended that Covid-19, flu, and RSV vaccines be obtained in the fall, around late September and early October. All three vaccines can be given during the same visit or spaced out over three different visits. The biggest benefit of getting all three at the same time is convenience.

Vince Venditto, Ph.D., is an assistant professor of pharmaceutical sciences in the University of Kentucky College of Pharmacy.

90% of for-profit nursing homes would need more staff to meet proposed rules; 60% of others would, KFF Health News estimates

KFF Health News graph; individual estimates for staffing by RNs and aides are in the story.

Kentucky Health News

For-profit nursing homes would have to hire more staff to meet proposed federal rules than other nursing homes would, according to an analysis by KFF Health News, a service of the Kaiser Family Foundation.

"90% of for-profit facilities would need to hire additional nursing staff, compared with 60% of non-profit and government facilities," says the analysis by Alice Burns, Priya Chidambaram, Tricia Neuman and Robin Rudowitz.

In Kentucky, about two-thirds of nursing homes are for profit, and only 21% of all homes meet the proposed standard, which is about the same as the national figure of 19%, KFF Health News estimates.

The Centers for Medicare and Medicaid Services has proposed that nursing homes employ registared nurses for at least 0.55 hours per resident per day, and nurses' aides for at least 2.45 hours per resident per day. The rule would also require facilities to have an RN working at all times.

"CMS is seeking comment on several alternatives to the proposed rule, one of which would require facilities to comply with requirements that were adjusted to reflect the health and frailty of nursing facility residents," KFF Health News notes. "Assuming this alternative was implemented using CMS’ existing approach for adjusting staff hours for resident health and frailty, virtually all facilities would need to hire new staff to meet the requirements."

Nursing homes say some of them might have to go out of business because they already have big problems finding enough nurses and nurses' aides. To address that concern, the rules would be phased in, with some differences for rural and urban nursing facilities.

The first phase, starting 60 days after publication of the final rule, would require facilities to "assess the needs of each resident, include input from nursing facility staff and residents’ families or legal representatives, and develop a plan to meet required staffing levels given residents’ needs," KFF notes.

Two years after publication, urban nursing homes would need round-the-clock RNs. For rural nursing homes, that would occur three years after publication. After that, the rules for number of nursing hours per resident day would kick in.

The proposed rule would allow nursing hoems to have less staffing if they are "at least 20 miles from the nearest nursing facility, or in an area with workforce unavailability (defined as having a provider to population ratio that is at least 20% lower than the national average)," KFF notes. "Nursing facilities would also have to demonstrate good faith efforts to hire and retain staff and a financial commitment to staffing by reporting the total amount of money spent on direct care staff." They could not get such exemptions "if they had any staffing-related violations" or had been designated as a Special Focus Facility "with a history of serious quality issues."

KFF explains, "Nearly half of facilities meet the RN requirement (52%) but only 28% meet the nurse aide requirement. . . . When looking at ownership of facilities that meet the RN requirement, a larger share of non-profit facilities would meet the 0.55 standard than for-profit and government facilities (75%, 44%, and 61%, respectively). When looking at nurse aides, about half of non-profit and government facilities meet the minimum staffing levels, compared with only 20% of for-profit facilities."

However, "If the proposed staffing levels were enforced after accounting for resident health and frailty, virtually no nursing facilities would meet the requirements in the proposed rule," KFF estimates.

And what about the workforce shortage? "As of June 2023, employment levels were still more than 11% below pre-pandemic levels for workers in skilled nursing care facilities and 3% below pre-pandemic levels for workers in elderly care facilities," KFF reports. "Although fewer facilities would need to hire new RNs, those that do may find it difficult to compete with hospitals, many of which are also trying to increase the number of RNs they employ. To the extent that many nursing facilities receive hardship exemptions on account of workforce shortages, the effects of the proposed rule on minimum staffing levels will be muted."

CMS estimates that the proposed rules would cost nursing homes $40 billion in the first 10 years after the final rule takes effect. "Such costs are likely to be passed on to public and private payers for nursing facility services, including residents and their family members who paid $45 billion in out-of-pocket costs for care in nursing homes" and other long-term care in 2020. "Medicaid spent nearly $53 billion in that year, about twice the amount ($26 billion) that traditional Medicare spent on skilled nursing facilities in 2020, and although Medicaid financing is shared by the state and federal governments, all states except for Vermont must meet balanced budget requirements."