DYING, ILLNESS, AND AGING WITH GRACE

Pruritus (proo-RIE-tus) is the medical term for itchiness. The condition causes you to feel the need to scratch your skin to get relief. There are several possible causes for pruritus that include an underlying medical condition, contact with an irritant or a reaction to a medication.

 

•  Itching (MedLine Plus) Itching is an irritating sensation that makes you want to scratch your skin. Sometimes it can feel like pain, but it is different. Often, you feel itchy in one area in your body, but sometimes you may feel itching all over. Along with the itching, you may also have a rash or hives. A succinct guide to resources for various subtopics and possible remedies.

     A mini-encyclopedia on itching and itching-related terms. Among possible remedies listed: Try over-the-counter oral antihistamines such as diphenhydramine (Benadryl), but be aware of possible side effects such as drowsiness.

•  The primary NIH organization for research on Itching is the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)

 

• What Makes Us Itch? (American Academy of Allergy, Asthma, and Immunology)

   "Itching can be caused by many different things including allergies, insect bites, dry skin or illness.
    "While most itches are merely bothersome or uncomfortable, excessive scratching can damage your skin’s protective barrier and expose your body to germs and infection.
    "Itch and pain are closely linked in the brain. The reflex to pain is to withdraw. The reflex to itch is to scratch. This reflex is a protective response developed to help animals remove parasites from their skin. That’s why even a slight movement of hairs is enough to make you want to scratch.
    "Itching is often triggered by histamine, a chemical in the body associated with immune responses. It causes the itch and redness you see with insect bites, rashes and skin dryness or damage.
    "Histamine is released by the body during allergic reactions, such as those to pollen, food, latex and medications." [And more. Worth a read.]

 

• How to relieve itching (Medical News Today, Charlotte Lillis, 12-21-23) Common causes of itchy skin include insect bites, allergies, stress, and skin conditions such as eczema and psoriasis.

   Itchy skin, also known as pruritus, can be uncomfortable and frustrating. Some home remedies may help remedy itchy skin, including applying essential oils, wet wraps, and colloidal oatmeal 

   Applying menthol (an essential oil found in plants of the mint family).

   Cooling the itch. Wet wrap therapy (applying water-soaked fabric wraps made of gauze or surgical netting to areas of itchy skin).

   Colloidal oatmeal ("finely ground oatmeal that a person can dissolve in water. The resulting solution forms a protective barrier on the surface of the skin, which helps to seal in moisture. See Yareli Colloidal Oatmeal Powder for psoriasis

    Apple cider vinegar.

    Moisturizing. (Moisturizers, such as creams and lotions, can help hydrate the outermost layer of the skin. They are essential for managing skin conditions that cause itching and dryness.)

    Baking soda. (The NEA recommends adding one-quarter of a cup of baking soda to a warm bath. An alternative option is to mix the baking soda with a little water to form a paste, which a person can apply directly to itchy areas.)

    Avoiding irritants. Possible irritants include: Hot water. Temperature and humidity changes. Fragranced skin care products. Wool and synthetic fabrics. Stress (try yoga and mindfulness meditation).

    Can apple cider vinegar help with eczema? (Medical News Today) Some people use apple cider vinegar to improve the symptoms of eczema. However, it can irritate the skin and may not be suitable for everyone.

• Atopic Dermatitis (NIAMS)

    "Atopic dermatitis, often referred to as eczema, is a chronic (long-lasting) disease that causes inflammation, redness, and irritation of the skin. It is a common condition that usually begins in childhood; however, anyone can get the disease at any age. Atopic dermatitis is not contagious, so it cannot be spread from person to person.
     "Atopic dermatitis causes the skin to become extremely itchy. Scratching leads to further redness, swelling, cracking, “weeping” clear fluid, crusting, and scaling. In most cases, there are periods of time when the disease is worse, called flares, followed by periods when the skin improves or clears up entirely, called remissions.
     "Researchers do not know what causes atopic dermatitis, but they do know that genes, the immune system, and the environment play a role in the disease. Depending on the severity and location of the symptoms, living with atopic dermatitis can be hard. Treatment can help control symptoms. For many people, atopic dermatitis improves by adulthood, but for some, it can be a lifelong illness."

• Bathing and Eczema (National Aleczema Organization)
    "Establishing a bathing routine that works for your skin is important for daily eczema management and care....

    "People with eczema, especially atopic dermatitis, tend to have very dry skin in general. A skin barrier that is inflamed or dry is vulnerable to bacteria and allergens, which can make eczema symptoms worse.

    Taking a bath or shower is helpful for eczema. Whether you have mild or severe eczema, a regular bathing and skincare routine can strengthen your skin barrier and help you retain moisture."

• Scratching and allergic skin inflammation (NIH Research Matters, 2-25-25) Researchers found how scratching can worsen allergic skin symptoms but also protect from infection. The findings could explain why the instinct to scratch an itch might have evolved in the first place. Targeting mast cells or the neurons that promote their activation could prove to be a promising approach for treating itchy inflammatory diseases like dermatitis and eczema.

• Itchy Skin (pruritis) (Mayo Clinic)

• Neuropathic Itch (NIH) Itching is a tingling or irritation of the skin that makes you want to scratch the area. Itching may occur all over the body or only in one location. (Prose academic.)
• Common neuropathic itch syndromes (Anne Louise Oaklander, PubMed) "Patients with chronic itch are diagnosed and treated by dermatologists. However, itch is a neural sensation and some forms of chronic itch are the presenting symptoms of neurological diseases. Dermatologists need some familiarity with the most common neuropathic itch syndromes to initiate diagnostic testing and to know when to refer to a neurologist. This review summarizes current knowledge, admittedly incomplete, on neuropathic itch caused by diseases of the brain, spinal cord, cranial or spinal nerve-roots, and peripheral nerves."

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• 10 Things to Know About Medicaid (Alice Burns, Elizabeth Hinton, Robin Rudowitz, and Maiss Mohamed, KFF, 2-18-25) Whether subsidies expire at the end of this year or in two or three years, their expiration would result in the steepest increase in out-of-pocket premium payments most enrollees in this market have seen. Because the Inflation Reduction Act extends the enhanced subsidies for three years and not permanently, future Marketplace enrollees may see steep premium increases when the subsidies eventually expire.
    Among potential changes to Medicaid through executive actions (under Trump!), this brief highlights ten key things to know about Medicaid (go to the source for full copy).

1. Nationally, one in five people have Medicaid, but this varies across the states (see map).

2. Medicaid is a key source of coverage for certain populations (see chart).

3. Medicaid is jointly financed by the federal government and states (see map).

4. Medicaid accounts for one fifth of all health care spending, and over half of spending on long-term care (see chart).

5. People who qualify for Medicaid based on age or disability account for more than half of spending I (see chart).

6. Flexibility to administer Medicaid results in variation in per enrollee costs across states (see map).

7. Three-quarters of all Medicaid enrollees receive care through comprehensive, risk-based MCOs. 8. Medicaid coverage facilitates access to care, improves health outcomes, and provides financial protection from medical debt.

9. Section 1115 demonstration waivers reflect changing priorities across presidential administrations.

10. The majority of the public holds favorable views of Medicaid.

    In the most recent KFF tracking poll, more than three-fourths (77%) of Americans held favorable views of Medicaid, including six in ten Republicans (63%), and at least eight in ten independents (81%) and Democrats (87%) (Figure 10). Medicaid is also viewed favorably by a majority of voters who say they voted for President Trump in the 2024 election (62%). Nearly half of the public (46%) say the federal government doesn’t spend enough on the Medicaid program, with another third (33%) saying it spends “about the right amount,” and around one in five (19%) saying it spends “too much.”

    With possible changes to government health programs, seven in ten (72%) say they are worried about the level of benefits that will be available to people covered by Medicaid in the future

Topics Medicaid Uninsured Tags Medicaid's Future Access to Care Maternal and Child Health Children Children's Health Insurance Program (CHIP) Disability Also of Interest Medicaid: What to Watch in 2025 Medicaid Financing: The Basics 10 Things to Know About Medicaid Managed Care
• Medicaid: What to Watch in 2025

• ACA Marketplace Enrollees Will See Steep Increases in Premium Payments in 2026 if Enhanced Subsidies Expire (KFF, 7-6-24) Enrollees in 12 HealthCare.gov states would see their annual payments at least double on average without enhanced subsidies 

• Where ACA Marketplace Enrollment Is Growing the Fastest, and Why (Cynthia Cox and Jared Ortaliza, KFF, 5-16-24) The five states with the fastest growth in Marketplace enrollment since 2020 – Texas (212%), Mississippi (190%), Georgia (181%), Tennessee (177%), and South Carolina (167%) – have certain characteristics in common: They all started off with high uninsured rates before the enhanced subsidies rolled out, they have not expanded Medicaid under the ACA, and they all use the Healthcare.gov enrollment platform.
• What Does the Federal Government Spend on Health Care? (Juliette Cubanski, Alice Burns, and Cynthia Cox, Medicaid, KFF, 2-24-25)
The federal government spent $1.9 trillion on health care programs and services in fiscal year (FY) 2024, 27% of all federal outlays in that year, and collectively the largest category of federal spending.
     Forgone tax revenues to the federal government resulting from tax subsidies for employer sponsored insurance coverage (ESI) and a portion of the Affordable Care Act (ACA) premium tax credits together totaled $398 billion in FY 2024.
     Over 80% of all federal support for health programs and services, including spending and tax subsidies, goes to programs that provide or subsidize health insurance coverage, with

---36% going to Medicare,

---25% going to Medicaid and CHIP,

---17% going to employment-based health coverage, and

---5% going to subsidies for Affordable Care Act (ACA) coverage.
     Discretionary spending is a relatively small component of overall federal support for health programs and services. Over half (52% or $128 billion) of discretionary health spending paid for hospital and medical care for veterans. Discretionary health spending also provides funding for agencies such as the National Institutes of Health (NIH, 19% of discretionary health spending) and the Centers for Disease Control and Prevention (CDC, 4%), as well as global health (4%).

Was UnitedHealthcare CEO Brian Thompson shot and killed for supporting a change in our approach to health care?

 

"At an investor meeting last year, he outlined his company's shift to "value-based care," paying doctors and other caregivers to keep patients healthy rather than focusing on treating them once sick.

 

"Health care should be easier for people," Thompson said at the time. "We are cognizant of the challenges. But navigating a future through value-based care unlocks a situation where the … family doesn't have to make the decisions on their own."

 

Thompson also drew attention in 2021 when the insurer, like its competitors, was widely criticized for a plan to start denying payment for what it deemed non-critical visits to hospital emergency rooms.

 

"The University of Iowa graduate began his career as a certified public accountant at PwC and had little name recognition beyond the health care industry. Even to investors who own its stock, the parent company's face belonged to CEO Andrew Witty, a knighted British triathlete who has testified before Congress.
 

"When Thompson did occasionally draw attention, it was because of his role in shaping the way Americans get health care."

                 ~Excerpt from the story UnitedHealthcare CEO kept a low public profile. Then he was shot to death in New York (Adam Geller and Tom Murphy, AP, 12-4-24)

 

      — — —

 

'The words "deny," "defend" and "depose" were scrawled on the ammunition, Kenny said. The messages mirror the phrase "delay, deny, defend," which is commonly used by lawyers and critics about insurers that delay payments, deny claims and defend their actions.' ~ WTOP

 

        — — —

 

 

As I read about the shooting, wondering what might have made someone angry enough to shoot a CEO.

In a section on Understanding the issues health care reform should address (on my own website), this was the first article I had linked to:

 

How UnitedHealth harnesses its physician empire to squeeze profits out of patients (Bob Herman, Tara Bannow, Casey Ross, and Lizzy Lawrence, Physicians for a National Health Program, PNHP, reprinted from STAT News, Investigation: Health Care’s Colossus, 7-25-24)

 

     "UnitedHealth is a colossus: It’s the country’s largest health insurer and the fourth-largest company of any type by revenue, just behind Apple. A STAT investigation reveals the untold story of how the company has gobbled up multiple pieces of the health care industry and exploited its growing power to milk the system for profit. UnitedHealth’s tactics have transformed medicine in communities across the country into an assembly line that treats millions of patients as products to be monetized."

 

     "Doctors said the company had a fixation with medical coding to generate more revenue — encouraging clinicians through bonuses and performance reviews to identify more health problems in patients, even if those conditions seemed dubious. By controlling doctors, UnitedHealth can lean on them to practice in ways that benefit the insurer, and use its insurance arm to funnel cash back to its clinicians — similar to how Standard Oil amassed power as both the buyer and seller in oil refining.

     "Doctors interviewed by STAT said they were initially seduced by the company's sales pitch that it would be hands-off and help them provide high-quality care, but they quickly became disillusioned. Patients, meanwhile, are wondering why their doctors are rushing through their appointments — if they can get seen at all — and have expressed alarm when concerning diagnoses pop up in their medical records, many of which were never mentioned by their physicians.

 

     "While UnitedHealth expanded in patient care, it also grew its dominance in Medicare Advantage, the alternative to traditional Medicare that is run by private insurers and now covers more than half of all Medicare beneficiaries. Medicare Advantage insurers have gamed the system by excessively coding their members, resulting in massive overpayments to the companies. Overpayments based on coding alone are expected to total $50 billion this year..."

• Killing of UnitedHealthcare CEO brings resentment of the health care system to the fore Anger toward health insurers reflects people’s ‘pent-up pain’ ( Bob Herman and Tara Bannow, STAT, 12-6-24) "Now, Americans are grappling with two heavy subjects at once: the callousness of a slaying, and an undercurrent of deep-seated anger at a health care industry that makes a lot of money by exploiting Americans."

 

 

 

More on:          

What is "value-based care"?
Better health at lower costs: Why we need Value-Based Care now (Aetna, an insurance provider)

     "Value-Based Care (VBC) is a health care delivery model under which providers — hospitals, labs, doctors, nurses and others — are paid based on the health outcomes of their patients and the quality of services rendered. Under some value-based contracts, providers share in financial risk with health insurance companies. In addition to negotiated payments, they can earn incentives for providing high-quality, efficient care. VBC differs from the traditional fee-for-service model where providers are paid separately for each medical service. While quality care can be provided under both models, it’s the difference in how providers are paid, paired with the way patient care is managed, that provides the opportunity for health improvements and savings in a VBC environment."

 

"We spend too much and we get too little."

"The U.S. spends the most on health care, but has the worst outcomes and highest disease burden among developed nations."

• The Gilded Age of Medicine Is Here (Dhruv Khullar, New Yorker, 12-12-24) Health insurers and hospitals increasingly treat patients less as humans in need of care than consumers who generate profit. This year, the health-news site STAT revealed that UnitedHealth, the country’s largest private insurer, had set up dashboards for practices to compete on how many conditions they could diagnose in patients.

Killing of UnitedHealthcare CEO brings resentment of the health care system to the fore Anger toward health insurers reflects people’s ‘pent-up pain’ ( Bob Herman and Tara Bannow, STAT, 12-6-24) "Now, Americans are grappling with two heavy subjects at once: the callousness of a slaying, and an undercurrent of deep-seated anger at a health care industry that makes a lot of money by exploiting Americans." https://www.statnews.com/2024/12/06/unitedhealthcare-ceo-killing-outrage-pain-resentment-reaction-brian-thompson/

....

What are the value-based programs? (Centers for Medicare & Medicaid Services)
       https://www.cms.gov/medicare/quality/value-based-programs
"Our value-based programs are important because they’re helping us move toward paying providers based on the quality, rather than the quantity of care they give patients.

"What are CMS’ original value-based programs?
There are 5 original value-based programs; their goal is to link provider performance of quality measures to provider payment:
    End-Stage Renal Disease Quality Incentive Program (ESRD QIP)
    Hospital Value-Based Purchasing (VBP) Program
    Hospital Readmission Reduction Program (HRRP)
    Value Modifier (VM) Program (also called the Physician Value-Based Modifier or PVBM)
    Hospital Acquired Conditions(HAC) Reduction Program

Other value-based programs:
    Skilled Nursing Facility Value-Based Purchasing (SNFVBP)
    Home Health Value Based Purchasing (HHVBP)"

              

 Here's a link to a 2023 list of recommended changes in health care:
NEWS: Sanders and Marshall Announce Bipartisan Legislation on Primary Care (US Senate Committee on Health, Education, Labor & Pensions, 9-14-23)

https://www.help.senate.gov/chair/newsroom/press/news-sanders-and-marshall-announce-bipartisan-legislation-on-primary-care

"According to the most recent estimates, over the next decade the United States faces a shortage of over 120,000 doctors — including a huge shortage of primary care doctors -- and the nursing shortage may be even worse. Over the next two years alone, it is estimated that we will need between 200,000 and 450,000 more nurses.

    "The Sanders-Marshall agreement answers this crisis by providing over $26 billion in funding to expand primary care in America and address the health care workforce shortage:

 

Provides $5.8 billion a year over the next three years in mandatory funding for community health centers which provide high-quality primary health care to more than 30 million Americans.

Within those funds there is a $245 million per year set aside to expand hours of operation at community health centers and $55 million per year for school-based health services.

Health centers will be newly required to provide nutrition services.

Provides $3 billion in capital funding primarily to enable community health centers to expand dental care and mental health care in their facilities.

Increases funding for the National Health Service Corps from $310 million to $950 million per year over the next three years to provide 2,100 scholarships and debt forgiveness for some 20,000 doctors, nurses, dentists, mental health providers, and other health care professionals who commit to working in our nation's most underserved areas.

Provides $1.5 billion over the next five years in the Teaching Health Center Graduate Medical Education program to create more than 700 new primary care residency slots, which would result in up to 2,800 additional doctors by 2031. This program increases the number of primary care physicians and dental residents trained in community-based settings. In Academic Year 2021-2022, the program funded more than 930 individual primary care medical and dental residents, who provided more than 1.1 million hours of patient care to more than 800,000 patients in medically underserved and rural areas.

Addresses the nursing shortage in America by investing $1.2 billion in grants to community colleges and state universities to increase the number of students enrolled in accredited, two-year registered nursing programs. The schools receiving these awards must use them to expand their class sizes and grow the number of two-year nurses trained across the country. This provision would allow schools to train up to 60,000 additional two-year nurses.

Provides $300 million to produce an additional 2,000 primary care doctors by 2032. The bill will also increase residency programs in rural America through an investment in the Rural Residency Planning and Development program and invests in training and workforce programs for dentists and dental assistants.

 

The legislation will be fully paid for by combatting the enormous waste, fraud and abuse in the health care system, making it easier for patients to access low-cost generic drugs and holding pharmacy benefit managers accountable, among other provisions.

 

 

Sandors Payfors

(Bipartisan Primary Care and Health Workforce Act Bipartisan Offsets)

Possibly for 2011, but clearly about funding, and the ideas listed make sense:

My guess anyone searching for articles and research on these topics would find research gold. Clearly pharmacy benefit managers were a big part of the health care funding problem in 2011 (rather than a solution).

 

Require honest billing by hospitals

Prohibit facility fees for telehealth and evaluation and management services

Prohibit anticompetitive contract clauses in commercial insurance

Pharmacy Benefit Managers/Generic Drug Package --- a suite of bipartisan bills addressing drug prices through reforms to pharmacy benefit managers (PBMs) and the generic drug market

Delinking PBM service fees

Prevention and Public Health Fund (reduce funding)

 

Other funding considerations: Up to $22.2 billion.

Medicaid improvement fund: Use these savings primarily to pay for increased funding for community health centers, the National Health Service Corps, and Teaching Health Centers Graduate Medical Education.

Expand program integrity for unemployment insurance

Extend the Sequester, but exclude Medicare (2011)

This series ran in 2022 but I am linking to stories that many of you won't have read, and should. 

• Patients for Profit: How Private Equity Hijacked Health Care (KFF Health News) Private equity investors are rapidly scooping up thousands of health care businesses, taking over emergency rooms or entire hospitals, and becoming major players in physician practices and patient care, from cradle to grave. But these acquisitions are often invisible to federal regulators. And their profit motives raise concerns about rising prices and the quality of treatment.

 

• Sick Profit: Investigating Private Equity’s Stealthy Takeover of Health Care Across Cities and Specialties (Fred Schulte, KFF Health News, 11-14-22) Private equity firms have shelled out almost $1 trillion to acquire nearly 8000 health care businesses, in deals almost always hidden from federal regulators. The result: higher prices and complaints about care. Government should require 'added scrutiny' of private equity companies whose holdings run afoul of the law.

• Baby, That Bill Is High: Private Equity ‘Gambit’ Squeezes Excessive ER Charges From Routine Births (Rae Ellen Bichell, KFF Health News, 10-13-22) Routine births are turning into moneymaking ‘emergency’ events at hospitals that work with private equity-backed staffing companies. Federal regulators, meanwhile, are almost blind to the incursion, since private equity typically acquires practices and hospitals below the regulatory radar. KHN found that more than 90% of private equity takeovers or investments fall below the $101 million threshold that triggers an antitrust review by the Federal Trade Commission and the U.S. Justice Department. In the health care sphere, private equity has tended to find legal ways to bill more for medical services: trimming services that don’t turn a profit, cutting staff, or employing personnel with less training to perform skilled jobs — actions that may put patients at risk, critics say.

• Sick Profit: Investigating Private Equity’s Stealthy Takeover of Health Care Across Cities and Specialties (Fred Schulte, KFF Health News, 11-14-22) As private equity extends its reach into health care, evidence is mounting that the penetration has led to higher prices and diminished quality of care, a KHN investigation has found. KHN found that companies owned or managed by private equity firms have agreed to pay fines of more than $500 million since 2014 to settle at least 34 lawsuits filed under the False Claims Act, a federal law that punishes false billing submissions to the federal government with fines. Most of the time, the private equity owners have avoided liability.

• Hospices Have Become Big Business for Private Equity Firms, Raising Concerns About End-of-Life Care (Markian Hawryluk, KFF Health News, 7-29-22) With the U.S. population rapidly aging, hospice has become a boom industry. And with limited oversight and generous payment, the industry is at high risk for exploitation. Agencies are paid a daily rate for each patient, which encourages for-profit hospices to limit spending to boost their bottom lines. For-profit hospices had Medicare profit margins of 19% in 2019, compared with 6% for nonprofit hospices. For-profit hospices tend to hire fewer employees than nonprofits and expect them to see more patients. If patients become too costly, requiring expensive care or medicines, hospice providers can discharge them, and take them to a hospital emergency room to get services the agencies don’t want to pay for themselves.

• Infections and falls increased in private equity-owned hospitals (National Institutes of Health, 1-23-24) Local hospitals might be owned by the university next door, by a non-profit organization, or by a for-profit company. Over the last decade, more and more hospitals have been purchased by private equity firms.The private equity model involves using investor money—and additional debt—to purchase an asset like a hospital. The firm typically then cuts operating costs, often sells the real estate portion, and attempts to re-sell the entity for a profit after several years. Hospitals saw a 25% increase in hospital-acquired conditions after acquisition by private equity firms relative to the control group. This increase was mainly driven by a spike in infections after the placement of a central line (a type of IV inserted near the heart to deliver drugs, fluids, or other substances) and an increase in falls. Private equity acquisitions led to higher charges, prices, and societal spending and a decline in the clinical quality of care delivered to hospital patients.

 

The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma by Bessel van der Kolk.

 

“The trauma caused by childhood neglect, sexual or domestic abuse and war wreaks havoc in our bodies, says Bessel van der Kolk in The Body Keeps the Score. . . . Van der Kolk draws on thirty years of experience to argue powerfully that trauma is one of the West’s most urgent public health issues. . . . Packed with science and human stories, the book is an intense read. . . . [T]he struggle and resilience of his patients is very moving.”
—Shaoni Bhattacharya, New Scientist

“War zones may be nearer than you think, as the 25 percent of US citizens raised with alcoholic relatives might attest. Psychiatrist Bessel van der Kolk argues, moreover, that severe trauma is ‘encoded in the viscera’ and demands tailored approaches that enable people to experience deep relief from rage and helplessness. In a narrative packed with decades of findings and case studies, he traces the evolution of treatments from the ‘chemical coshes’ of the 1970s to neurofeedback, mindfulness and other nuanced techniques.”
—Nature

“An astonishing amount of information on almost every aspect of trauma experience, research, interventions, and theories is brought together in this book, which . . . has a distinctly holistic feel to it. The title suggests that what will be explored is how the body retains the imprints of trauma. However, it delivers much more than this, delving into how the brain is impacted by overwhelming traumatic events, and is studded with sections on neuroscience which draw on the author’s own numerous studies as well as that of his peers. In addition, it investigates the effects of adverse childhood attachment patterns, child abuse, and chronic and long-term abuse. . . . [T]his book is a veritable goldmine of information.”
—European Journal of Psychotraumatology

“Dr. van der Kolk . . . has written a fascinating and empowering book about trauma and its effects. He uses modern neuroscience to demonstrate that trauma physically affects the brain and the body, causing anxiety, rage, and the inability to concentrate. Victims have problems remembering, trusting, and forming relationships. They have lost control. Although news reports and discussions tend to focus on war veterans, abused children, domestic violence victims, and victims of violent crime suffer as well. Using a combination of traditional therapy techniques and alternative treatments such as EMDR, yoga, neurofeedback, and theater, patients can regain control of their bodies and rewire their brains so that they can rebuild their lives. The author uses case histories to demonstrate the process. He includes a resource list, bibliography, and extensive notes. This accessible book offers hope and inspiration to those who suffer from trauma and those who care for them. It is an outstanding addition to all library collections.
—Medical Library Association, Consumer Connections

Updated from original entry 10-8-18

Sites geared to helping you prepare for poisoning, pandemics, hurricanes, earthquakes, tornadoes, flood and flash floods, fires, and disasters and emergencies generally. Let me know in comments of additional useful websites and online information. See also Weather and weather-related events (Search engines, Writers and Editors)

 

PREPARING FOR DISASTERS AND EMERGENCIES, GENERALLY
• A preparation & safety awareness guide for travellers (Postcard Travel)

• Disaster Distress Helpline (SAMHSA, Substance Abuse & Mental Health Services Administration) The Disaster Distress Helpline, 1-800-985-5990, is a 24/7, 365-day-a-year, national hotline dedicated to providing immediate crisis counseling for people who are experiencing emotional distress related to any natural or human-caused disaster. Stress, anxiety, and other depression-like symptoms are common reactions after a disaster. Call or text 1-800-985-5990 to connect with a trained crisis counselor. This toll-free, multilingual, and confidential crisis support service is available to all residents in the United States and its territories. SAMHSA’s Disaster Distress Helpline provides 24/7, 365-day-a-year crisis counseling and support to people experiencing emotional distress related to natural or human-caused disasters.
• DisasterAssistance.gov Do you need help after a disaster? We can help you apply for FEMA disaster assistance and guide you to other resources to help you recover. Links for Red Cross and other emergency shelters, state emergency management offices, SBA disaster assistance
• King and Firefighter Syndrome: Disaster Response Goes Beyond the Front Lines (Seth C. Hawkins, Erin R. Eldridge, and Sharon Watson, MedPage Today, 12-23-24) As one Asheville resident explained in a widely shared social media post just days after Helene, "If you are coming to offer help or resources, you need to stay flexible and be ready to be turned away or redirected...We do not need Indiana Jones right now, we need adaptable team players." The same degree of flexibility in interpreting types of disaster response needs to be applied to goods valued as contributions.
• Find Open Shelters and Disaster Relief Services (Red Cross)
• How to prevent drowning: a ground-breaking report that's startling yet hopeful (Melody Schreiber, Goats and Soda, NPR, 12-13-24) More than 300,000 people die from drowning every year – and nearly all of these cases are preventable, according to a new report from the World Health Organization (WHO). The first-ever global report from WHO on how to prevent drownings, drawn from surveying 139 countries.
• How to Pack an Emergency Kit for Any Disaster (Kenneth R. Rosen, NY Times, 7-3-17) The Life Straw "is Mr. Smyth’s choice for purification straws you can drink water through." If you have a container to drink from, iodine water purification tablets are a simpler, nearly weightless alternative."  Read More 

A headings-only version of a helpful document (see links for more info below)

A to-do list for organizing all the essential information and important documents in and of your life.

   

Essentials:

Put these together in one place, for those taking care of your estate after you die.

---***Will ("last will and testament," specifying who will inherit your assets if there is no joint ownership, or beneficiaries whose names are not filed at an institution)

---***Durable financial power-of-attorney form (without which no one can make decisions and act for you if you are incapacitated)

---Revocable trust (in addition to, and privater than, a will; changeable anytime during your lifetime; and harder to dispute in court)
---Letter of instruction (for important final instructions, such as where you want your ashes scattered, who you want notified of your death, or how you want your funeral or memorial service to be performed).
 

Bank accounts:
---List of all bank accounts & online log-in info.

---List of safe deposit boxes (and locations)
  

Health care confidential:

---***Durable health care proxy/power-of-attorney form

     (so your designee can make health-care decisions on your behalf if you are incapacitated)

---***Living will (how you want to be treated in specific medical circumstances)

---Alternative: An Advance Health Care Directive, combining your Living Will and naming a Health Care Proxy/Power of Attorney with authority to make medical decisions for you.

---A personal & family medical history (including your list of medications)

---A HIPAA Authorization that grants permission to release protected health information about you to designated parties
---Do Not Resuscitate Orders (DNR), IF and when you wish to be resuscitated (review regularly)

---Personal & family medical history (including your list of medications)
   

Proof of ownership (and debts), with dates:

---Documentation of housing and land ownership.

---Documentation of cemetery plots (cemetery deeds)

---Documentation of vehicles owned.

---Documentation of stock certificates and savings bonds.

---List of brokerage and escrow mortgage accounts.

---Any partnership or corporate operating agreements.

---List and proof and loans made to others and debts owed to others

    (what has been paid and what is still owed)

---Tax returns--last 3 years (some say 6).

    "Helps your personal representative file a final income-tax and estate return, and if necessary, a revocable-trust return."
   

Retirement and life insurance:

---Copies of life insurance policies (name of carrier, policy number and agent associated with the policy)

     "Be especially careful with life-insurance policies granted by an employer upon your retirement."

---List of (and details about) pensions, annuities, IRA’s, and retirement plans.

    ("An IRA is considered dormant or unclaimed if no withdrawal has been made by age 70.")
   

Marriage and divorce:

---Marriage license.

---Divorce judgment and decree.

---Copies of most recent child support payment order.

---Copies of life-insurance papers benefitting or covering children.

---Qualified domestic relations order.

 
Financial and legal information, a checklist:

[This general list repeats items listed above, in a different order:]

• Names, phone numbers, and email addresses of lawyers and financial advisors
• Names, addresses (especially of your legal residence), phone numbers, email addresses, date and place of birth, and Social Security numbers of everyone named in your will and other documents, and everyone important in your life, for your executors and guardians of minor children.
• Location of all vital and legal documents (including birth and death certificates, adoption records, prenuptial agreements, marriage certificates, divorce decrees, military records, immigration and citizenship documents, property deeds, recent tax returns, wills).
• Location of all vital and legal documents (including birth and death certificates, adoption records, prenuptial agreements, marriage certificates, divorce decrees, military records, immigration and citizenship documents, property (housing, land, and cemetery) deeds, vehicle titles, recent tax returns, do-not-resuscitate orders (DNRs), wills and living wills and related documents).
• List of property you own, with values (include real estate, vehicles, jewelry, furniture, other assets)
• A list of all financial assets and accounts, with bank account numbers and branch locations.
• A master list of all your accounts (savings, checking, credit card, stocks, bonds, mutual fund shares, other investments, escrow mortgage, insurance, frequent flier accounts, etc). List each institution, type of account (checking? savings? money market?), owner or policyholder (you? you and spouse? you and child?), account number, contact information for institution, where certificates are.
• Details about principal income and about your retirement savings accounts and other assets, including names, addresses, phone numbers, and social security numbers of principal beneficiaries.
• Details about your debts (especially to whom and how much). Include mortgages, loans, other debts. And proof on debts paid. For family history:
• List of employers and dates of employment.
• Education and military records.
• List of jointly owned property, and names of co-owners.
• A list of where you keep all pension documents, and folders on IRAs and 401(k) accounts
• Proof of loans made and debts owed (plus details on who and where)
• A list of computer user names, access codes, and passwords, or instructions on how to find them.
• Details on all forms of insurance (life, health, dwelling, car, etc.).
• A list of safe-deposit boxes, with an inventory of the contents. List all irreplaceable valuables (jewelry, heirlooms, photo negatives) and critical documents (marriage license, birth certificate, divorce papers, stock and bond certificates) that are stored under lock and key and photocopy the documents for your home office files.

Also helpful:
• Essential Document Locator Checklist (A Place for Mom)

SOURCES:
• The 25 Documents You Need (CAPTRUST Financial Advisors, 4208 Six Forks Road, Suite 1700, Raleigh, NC 27609.

    CAPSTONE'S list provides helpful explanations.
• The 25 Documents You Need Before You Die (Forge Financial Advisors, Fairport, New York).

"According to the National Association of Unclaimed Property Administrators, state treasurers currently hold $32.9 billion in unclaimed bank accounts and other assets. (You can search for unclaimed assets at MissingMoney.com)."

• The 25 Documents You Need Before You Die (Marc R. Gillespie, Financial Planner)

A similar list, organized by similar categories: Marriage & Divorce, Bank Accounts, Life Insurance and Retirement, Proof of Ownership, Health Care Confidential, The Essentials.
• The 25 Documents You Need Before You Die (Rachel Donnelly, Lantern Co.)

• Gender-affirming surgeries in the US nearly tripled before pandemic dip, study finds (Carla K. Johnson, AP News, 8-23-23) The increase likely reflects expanded insurance coverage for transgender care after the Obama administration and some states actively discouraged discrimination based on gender identity. The dip in 2020 can be attributed to the pandemic.

• What is gender-affirming care? Your questions answered (Patrick Boyle, Association of American Medical Colleges, AAMC, 4-12-22)

    As states move to restrict certain treatments for transgender youth, experts explain the many types of care, the need for them, and their impact.

    "Katherine Imborek, MD, has seen the gender-affirming care provided at UI Health Care’s LGBTQ Clinic in Iowa City change the lives of transgender youths and adults. “It decreases depression, anxiety, and suicide attempts,” says Imborek, co-director of the clinic. To her, that care is “a medical necessity, like providing insulin to a person with diabetes.”

   "But a growing number of lawmakers, including in Iowa, view some gender-affirming care as medically unsound for youths and even a form of child abuse. Iowa is among 15 states that have enacted or are considering laws to prohibit certain gender-affirming treatments for youths and to impose penalties on health care professionals who provide it, according to the Williams Institute at the UCLA School of Law in California.

    "Gender-affirming care, as defined by the World Health Organization, encompasses a range of social, psychological, behavioral, and medical interventions “designed to support and affirm an individual’s gender identity” when it conflicts with the gender they were assigned at birth. The interventions help transgender people align various aspects of their lives — emotional, interpersonal, and biological — with their gender identity. As noted by the American Psychiatric Association (APA), that identity can run anywhere along a continuum that includes man, woman, a combination of those, neither of those, and fluid.

    "The interventions fall along a continuum as well, from counseling to changes in social expression to medications (such as hormone therapy). For children in particular, the timing of the interventions is based on several factors, including cognitive and physical development as well as parental consent. Surgery, including to reduce a person’s Adam’s Apple, or to align their chest or genitalia with their gender identity, is rarely provided to people under 18."

    This long article and explanation is worth reading. It includes several "fictional case vignettes," composite cases written to illustrate certain diagnostic characteristics and to instruct on treatment techniques

• Gender Affirmation Surgery (Cleveland Clinic) A clear explanation of various surgical and other options. "Gender affirmation surgery refers to procedures that help people transition to their gender. Gender-affirming options may include facial surgery, top surgery or bottom surgery. Most people who choose gender affirmation surgeries report satisfaction with results, including the way their body looks and works and improved quality of life." Clear explanations of nonsurgical gender-affirming options and surgical gender-affirming options, as well as what those options involve.

• Gender Affirmation Surgeries (Fan Liang MD, Johns Hopkins Medicine) Surgeries are not required for gender affirmation, but many patients choose to undergo one or more surgical procedures.  Liang presents an excellent overview and explanation of various options for gender affirmation surgery.

• Tim Walz's Policy for Transgender Minors Explained (Mandy Taheri, Newsweek, 8-11-24) Minnesota Governor Tim Walz, named as Vice President Kamala Harris' running mate, has a legislative history of supporting the rights of transgender minors and gender-affirming care, which has come under fire from top Republicans, including former President Donald Trump and his running mate Ohio Senator JD Vance.

• States that protect transgender health care now try to absorb demand (Jeff McMillan and Hannah Schoenbaum, AP News, 8-15-23)

    "States that declared themselves refuges for transgender people have essentially issued an invitation: Get your gender-affirming health care here without fearing prosecution at home.
    "Now that bans on such care for minors are taking effect around the country — Texas could be next, depending on the outcome of a court hearing this week — patients and their families are testing clinics’ capacity. Already-long waiting lists are growing, yet there are only so many providers of gender-affirming care and only so many patients they can see in a day.
    "For those refuge states — so far, California, Connecticut, Colorado, Illinois, Massachusetts, Maryland, Minnesota, New Jersey, New Mexico, New York, Washington and Vermont, plus Washington, D.C. — the question is how to move beyond promises of legal protection and build a network to serve more patients."

---State actions on gender-affirming care for minors (AP News interactive) Several Republican-led states have taken steps to bar access to gender-affirming care for transgender minors, which for people under 18 typically involves puberty blockers or other hormone treatments. Some Democratic-led states are instituting protections. Chart shows the status of gender-affirming care for minors in the states.
    Restricted
    Restrictions not in effect
    Restrictions struck down by court
    Gender-affirming care protected.
Apparently no stand has been taken in states represented in grey.

• Gender-affirming Care for Transgender Patients (Nita Bhatt, Jesse Cannella, and Julie P. Gentile, Innovations in Clinical Neuroscience, NIH, National Library of Medicine, April-June 2022) "It has been well established that gender is a social construct, not an inborn reality of biology, nor is it binary. This is contrasted with sex, which is generally defined as the biological characteristics (i.e., reproductive, chromosomal, hormonal) of a person established at birth, and is in fact also nonbinary, although it is most often characterized as male or female. Even after “checking under the diaper” and with karyotyping, the sex defined at birth may be established as male or female, but it also may be established as intersex or be within other nonbinary variations.Gender, however, is a social construct that may be cisgender male or female, but individuals may alternatively be identified as nonbinary, genderfluid, genderqueer, or transgender male or female, among other identities (Table 1). Indeed, the binary construct of gender is one of Western context and is not absolute.

     "Fundamentally, it must be emphasized that the gender of a person cannot be externally read or assumed. Gender identity is an internal self-identity and may or may not correspond to how a person dresses, how a person grooms their hair or facial hair, what a person calls themselves, or how they speak. How a person externally represents themselves, such as through apparel, hair style, voice, or behavior, is known as their gender expression.4 For various reasons, including but not limited to comfort, safety, self-realization, laws, institutional guidelines, and conformity to social norms, the gender expression of a person may not necessarily correlate to their gender identity. For this reason, the only way to know the gender of a person is by asking them, and even when asked, gender and gender identity is subject to change and is not necessarily a permanent quality. 

 

This lengthy and important article "discusses some of the most significant health disparities faced by transgender patients, common challenges they experience, and how providers, regardless of specialty, can positively intervene to better provide an inclusive environment with gender-affirming care."

• Families with transgender kids are increasingly forced to travel out of state for the care they need (Arleigh Rodgers and MIchael Goldberg, AP News, 7-10-23)   

"At least 20 states have enacted laws restricting or banning gender-affirming care for trans minors, though several are embroiled in legal challenges. For more than a decade prior, such treatments were available to children and teens across the U.S. and have been endorsed by major medical associations.
    "Opponents of gender-affirming care say there’s no solid proof of purported benefits, cite widely discredited research and say children shouldn’t make life-altering decisions they might regret. Advocates and families impacted by the recent laws say such care is vital for trans kids.
    "The perceptions of most parents, Marx said, don’t align neatly with the extremes of full support or rejection of their kids’ identities.
    “Most parents exist in a kind of gray area,” Marx said. “Most parents are going through some kind of developmental process themselves as they come to understand their child’s gender.”

• Indiana lawmakers advance ban on all gender-affirming care (Arleigh Rodgers, AP News, 2-22-234)
     "Krisztina and Ken Inskeep’s son came out as transgender when he was a teenager, a transition they told an Indiana Senate public health committee on Wednesday that offered a remedy to years of his mental health struggles.
     "Still, an Indiana Senate bill that the couple called “cruel and arrogant” — banning gender-affirming transition treatments for those 18 and under, the very care they said kept their son alive — passed the committee 8-3.
     “If it weren’t for the support of doctors and health care professionals, we’re convinced that our child may not have survived,” Krisztina said.

 

• State of Homelessness (map, National Alliance to End Homelessness) Click on your state to view detailed information on homeless statistics, bed inventory, and system capacity. Read the report, including Key Facts. 

 

• Key Findings from the Point-in-Time Counts (Fact Sheet: 2023 Annual Homelessness Assessment Report, U.S. Dept. of Housing and Urban Development, 12-1-23)

   "At a point in time at the end of January 2023, 653,104 people – or about 20 of every 10,000 people in the United States – experienced homelessness across the United States. This is the highest number of people counted and reported as experiencing homelessness on a single night since reporting began in 2007. Unlike in the past where a single population drove the change, this year’s increases were across all populations. While the upward trend in unsheltered homelessness began several years ago, these increases were exacerbated in recent years as the COVID-19 pandemic, an opioid epidemic, and a nationwide affordable housing crisis conspired to make attaining and maintaining housing increasingly difficult for many low-income households. Increases in sheltered homelessness, particularly increases among families, reflect recent contextual issues such as the expiration of pandemic-era eviction moratoria and income protections, expansion of shelter capacity based on new pandemic-related resources and the easing of pandemic-related restrictions on shelter capacity."

• Why it’s so hard to end homelessness in America (Alvin Powell, Harvard Gazette, 1-24-24) Experts cite complexity of problem, which is rooted in poverty, lack of affordable housing but includes medical, psychiatric, substance-use issues.

• Which States Have The Best Homelessness Assistance Programs (Nick VinZant, QuoteWizard, Insurance News)
"Key findings in 2021:
~Colorado ranked the top state in the nation for housing assistance from 2018 to 2019.
~Connecticut saw a 23.6% decline in homelessness from 2018 to 2019.
~In 2019, it was estimated that nearly 568,000 were experiencing homelessness.
~As of November 2020, 10.74 million Americans are unemployed.
~Mississippi, Louisiana and Alabama all had the lowest counts of total homeless per 10K in 2019.
~New York, Hawaii and California have the most homeless per 10K."

• Housing crisis is the 'canary in the coal mine' (Eleanor Black, Newsroom, New Zealand, 4-21-21)New Zealand needs to change its approach to housing completely, and treat it as a public right, like health and education, says property developer Mark Todd. Sitting with a coffee at Mt Albert’s Taco Loco, he gestures towards Ockham’s Modal building across the road – 32 thoughtfully-designed rental apartments on just 680 square metres, with a shared residents’ lounge and balcony, indoor bike storage, easy access to public transport, efficient hot water system and a music room.

 

• Homelessness Statistics (National Alliance to End Homelessness)
• National Coalition for the Homeless
• Healthcare for the Homeless Suitcase Clinic (Facebook page)
---Suitcase Clinic, James Madison University (Harrisonburg, Virginia 22807)
---Homelessness is a Healthcare Issue: New Medical Group Will Treat Southern California Homeless Seniors

• NEXT: Next Generation Military and Veterans Healthcare Systems (America Conference Institute press release, 2023) 

    ‘This is street medicine wrapped in the framework of managed care’     "With the population of unhoused individuals in California soaring to more than 161,000, SCAN Group, whose holdings include SCAN Health Plan, one of the nation’s largest not-for-profit Medicare Advantage plans, is launching Healthcare in Action, a new medical group that will provide healthcare and other services to individuals experiencing homelessness."
• Homeless encampment cleanups do little to change numbers of people on the street, study finds (Doug Smith,LA Times, 7-24-24) Homeless encampment cleanups including Mayor Karen Bass’ Inside Safe program that moves people into motels and hotels have no long-term effect on the number of people living on the streets, a new study by RAND Center on Housing and Homelessness has found
• Supreme Court rules cities may enforce laws against homeless encampments (David G. Savage, LA Times, 6-28-24) The Supreme Court ruled Friday that cities in California and the West may enforce laws restricting homeless encampments on sidewalks and other public property. In a 6-3 decision, the justices disagreed with the 9th Circuit Court in San Francisco and ruled that it is not “cruel and unusual” punishment for city officials to forbid homeless people from sleeping on the streets or in parks.
---Will the Grants Pass ruling on homelessness spur smaller cities to shoo people into L.A.? (David Zahniser and Doug Smith, LA Times, 7-7-24) When the U.S. Supreme Court issued its landmark ruling on anti-camping laws last month, Pasadena Mayor Victor Gordo was one of the local political leaders who welcomed it. The high court concluded that laws penalizing homeless people for sleeping or pitching tents in public spaces do not constitute cruel and unusual punishment. That means cities can clear homeless encampments from parks, sidewalks and other areas even when they lack sufficient shelter beds.
• “Hollywood 2.0” An innovative treatment team approach combining outpatient and intensive field services, in partnership with the community that center around an individual’s needs. "It starts with connection and ends with a neighbor living a safer, more meaningful life.

• A California Medical Group Treats Only Homeless Patients — And Makes Money Doing It (Angela Hart, KFF Health News and Orange County Register, 7-19-24) Doctors, nurses, and social workers are fanning out on the streets of Los Angeles to provide health care and social services to homeless people — foot soldiers of a new business model taking root in communities around California.
   Their strategy: Build trust with homeless people to deliver medicine wherever they are — and make money doing it.
   They distribute GPS devices so they can track their homeless patients. They stock their street kits with glass pipes used to smoke meth, crack, or fentanyl. They keep company credit cards on hand in case a patient needs emergency food or water, or an Uber ride to the doctor.
   Healthcare in Action and SCAN’s Medicare Advantage insurance plan generate revenue by serving homeless patients in multiple ways:
---Both are tapping into billions of dollars in Medicaid money that states and the federal government are spending to treat homeless people in the field and to provide new social services like housing and food assistance.
---For instance, Healthcare in Action has received $3.8 million from Newsom’s $12 billion Medicaid initiative called CalAIM, which allows it to hire social workers, doctors, and providers for street medicine teams, according to the state.
---It also contracts with health insurers, including L.A. Care and Molina Healthcare in Southern California, to identify housing for homeless patients, negotiate with landlords, and provide financial help such as covering security deposits.
---Healthcare in Action collects charitable donations from some hospitals and insurers, including CalOptima in Orange County and its own Medicare Advantage plan, SCAN Health Plan.
---Healthcare in Action partners with cities and hospitals to provide treatment and services. In 2022, it kicked off a contract with Cedars-Sinai to care for patients milling outside the hospital.
---It also enrolls eligible homeless patients into SCAN Health Plan because many low-income, older people qualify for both Medicaid and Medicare coverage. The plan had revenue of $4.9 billion in 2023, up from $3.5 billion in 2021. "#1 in Member Satisfaction among Medicare Advantage Plans in California"

• United States Interagency Council on Homelessness
• Geriatrics and Extended Care (Veterans Administration)
---Community Resources, Geriatrics and Extended Care (Veterans Administration's useful links).

 

More to come, I'm sure. -- Pat McNees