• Feds Move to Rein In Prior Authorization, a System That Harms and Frustrates Patients (Lauren Sausser, KHN, 3-13-23) Few things about the American health care system infuriate patients and doctors more than prior authorization, a common tool whose use by insurers has exploded in recent years. Prior authorization, or pre-certification, was designed decades ago to prevent doctors from ordering expensive tests or procedures that are not indicated or needed, with the aim of delivering cost-effective care. Originally focused on the costliest types of care, such as cancer treatment, insurers now commonly require prior authorization for many mundane medical encounters, including basic imaging and prescription refills.
      So today, instead of providing a guardrail against useless, expensive treatment, pre-authorization prevents patients from getting the vital care they need, researchers and doctors say. It’s not just patients who are confused and frustrated by the process. Doctors said they find the system convoluted and time-consuming, and feel as if their expertise is being challenged.

• I Write About America’s Absurd Health Care System. Then I Got Caught Up in It. (Bram Sable-Smith, KHN, 1-25-22) The insurance industry defends "prior authorization" as protecting patient safety and saving money. It feels like a lot of paperwork to confirm something we already know: Without insulin, I will die. The time wasted by me, the pharmacists, the nurses and probably some insurance functionaries is astounding and likely both a cause and a symptom of the high cost of medical care. The problem is also much bigger than that.

• What are the downsides to Medicare Advantage? (Explainer NY Times, 11-20-22) One big downside [to Medicare Advantage alternatives to Medicare] is that these insurers require "prior authorization," or approval in advance, for many procedures, drugs or facilities. Advantage participants who are denied care can appeal, and those who do so see the denials reversed 75 percent of the time, but only about 1 percent of beneficiaries or providers file appeals. Before signing up for a Medicare Advantage plan, understand that anytime you want care other than an emergency, the plan has to approve it. So "think very carefully before you switch out of traditional Medicare, which lets you see just about any doctor or go to any hospital." One topic under Which to Choose: Medicare or Medicare Advantage?

• Why So Slow? Legislators Take on Insurers’ Delays in Approving Prescribed Treatments (Michelle Andrews, KHN,5-17-22) Insurers say prior authorization requirements are intended to reduce wasteful and inappropriate health care spending. But getting that approval can take as many as three weeks, and patients sometimes run out of insulin before it comes through. Doctors say that insurers have yet to follow through on commitments to improve the process.
      Prior authorizations take up on average almost two business days—14.9 hours—each week to complete. This leads to hiring staff who are dedicated solely to processing prior authorizations.

 
• Pros and Cons of Prior Authorization for Value-Based Contracting (Kelsey Waddill, Health Payer Intelligence) Prior authorizations seem to also enforce the evidence-based care goals of value-based care. One of the major goals of value-based contracts and systems is to reduce unnecessary paperwork so that providers can dedicate more time to high-quality patient care. However, providers have found that prior authorizations often stand in the way of this aim.

       Also, recent research demonstrated that in some cases prior authorizations may be weaponized as tools for discrimination. instead of serving the patient population as designed. In the South, some qualified health plans on the Affordable Care Act have been shown to place prior authorizations on PrEP therapy for HIV patients.
       Plans in the South were 16 times more likely to place a prior authorization on the HIV therapy than plans in the Northeast where prior authorizations for these therapies were lowest. Yet prior authorizations are typically only applied when there are multiple drugs to choose from for a particular condition, and until recently there was only one medication option for HIV patients.

• The Shocking Truth about Prior Authorization Process in Healthcare (GetReferralMD, 4-18) Around 66% of prescriptions that get rejected at the pharmacy require prior authorization. When a PA requirement is imposed, only 29% of patients end up with the originally prescribed product—and 40% end up abandoning therapy altogether! Prior authorization is designed to control costs, but in practice it requires a lot of administrative time, phone calls, and recurring paperwork by both pharmacies and doctors. In 2009, one study estimated that on average, prior authorization requests consumed about 20 hours a week per medical practice: one hour of the doctor’s time, nearly six hours of clerical time, plus 13 hours of nurses’ time. No authorization means no payment. PA problems can create a huge interruption for patients, who have to figure out whether the process is stalled out by the doctor, the insurance company, or the pharmacy.
Insurance companies can deny a request for prior authorization for reasons such as:
---The doctor or pharmacist didn’t complete the steps necessary
---Filling in the wrong paperwork or missing information such as service code or date of birth
---The physician’s office neglected to contact the insurance company due to a lack of time
---The pharmacy didn’t bill the insurance company properly
---Outdated information – claims can be denied due to outdated insurance information, such as sending the claim to the wrong insurance company
---The insurer failed to notify the pharmacy
---The approval expired after a limited time (normally 30 days)

 

A different kind of prior authorization:
 • Can health care providers invite or arrange for members of the media, including film crews, to enter treatment areas of their facilities without prior written authorization? (HHS.gov) Answer: Health care providers cannot invite or allow media personnel, including film crews, into treatment or other areas of their facilities where patients’ protected health information (PHI) will be accessible in written, electronic, oral, or other visual or audio form, or otherwise make PHI accessible to the media, without prior written authorization from each individual who is or will be in the area or whose PHI otherwise will be accessible to the media. Only in very limited circumstances, as set forth on this website page, does the HIPAA Privacy Rule permit health care providers to disclose protected health information to members of the media without a prior authorization signed by the individual.

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For your information (and your next argument on the topic):

Meanwhile: Ventilate!

• Worried About Your Gas Stove? Here’s What to Do instead of panicking.

(Rachel Wharton, Wirecutter, NY Times, 1-24-23) You can usually eliminate most of the risks—even if your household includes kids with asthma—by getting more fresh air into your kitchen while you cook.

1) Turn on your range hood every single time you cook.

2) Open a window, add a fan.

3) Use countertop appliances, including a portable induction cooktop (Duxtop 9600LS).

4) Consider an air quality monitor that detects carbon dioxide (SAF Aranet 4 ("reliable CO2 monitoring"). Don't invest in an air purifier (they"aren’t designed to efficiently capture and remove gaseous pollutants like methane or nitrogen dioxide").

5) Consider switching to a radiant-electric or induction stove.
• Gas Stoves Are Tied to Health Concerns. Here’s How to Lower Your Risk. (Dani Blum, NY Times, 1-11-23) Emissions from gas stoves have been connected to an increased risk for childhood asthma, among other things. You can mitigate the effects with a few simple steps.

1) Ventilate, Ventilate, Ventilate!

2) Use the exhaust hood every time you use your stove.

3) Try to use the stove less often.

A study published last year found that families who use gas stoves in homes with poor ventilation, or without range hoods, can blow past the national standard for safe hourly outdoor exposure to nitrogen oxides within just a few minutes; there are no agreed upon standards for nitrogen oxides in indoor air.

• Is the Era of Gas Stoves Burning Out? (Spencer Bokat-Lindell, Opinion, Debatable, NY Times, 1-25-23) The main component of natural gas is methane, which many readers may know primarily as a potent greenhouse gas, responsible for about 30 percent of global warming since the Industrial Revolution. The combustion of methane also produces toxic nitrogen oxides, including nitrogen dioxide. Indoor air pollution is largely unregulated. Since at least the 1970s, researchers have been studying the negative health effects of gas stoves, which are the only major indoor gas appliance that isn’t required to be vented outside.
• The Best Air Purifier (Wirecutter, NY Times, 11-8-22) Their selection: Coway Airmega AP-1512HH(W) Warning: It's big!
• What to Know About the Risks of Gas Stoves and Appliances (Lisa Song, ProPublica, 1-23-22) Homeowners who can afford it should switch to an induction or electric stove. Or you could try an induction hot plate, which costs a lot less. The article also recommends improving ventilation, such as by opening a window, to lower health risks when cooking with gas.
• Gas stoves, freedom, and the politics of distraction (Doug Muder,The Weekly Sift, 1-30-23) Don’t worry about your Social Security, medical care, or bodily autonomy.Instead, focus your attention on gas stoves, light bulbs, X-boxes, M&Ms, and the Democrats’ quest to achieve “Soviet America”. This month’s shiniest object has been: Democrats are coming for your gas stove! Article is about what's really happening.
• Gas stoves became part of the culture war in less than a week. Here's why (Lisa Hagen and Jeff Brady, WBUR, 1-21-23) A growing body of research shows children and others with breathing problems such as asthma can experience short and even long-term health effects from gas cooking stoves. The issue has triggered a debate between people concerned about the health and climate impacts of gas — and those who fear the government is coming for their stoves. The "culture war," according to NPR, is playing out on television and social media.
• How Politics Are Determining What Stove You Use (Brad Plumer and Hiroko Tabuchi, NY Times, 12-16-21) New York is the latest Democratic city aiming to fight climate change by ushering out stoves and furnaces that run on gas in favor of electric alternatives. But Republican states and the gas industry are fighting back.
• Why Are Gas Stoves Under Fire? (Rebecca Leber, Science Friday, 1-20-23)
• 5 myths about gas stoves, the latest culture war clash (Rebecca Lever, Vox, 1-20-23) Myth 1: Biden — or federal regulators — want to take your gas stove away

Myth 2: Gas stove hazards are “newfound”

Myth 3: No type of cooking can compare to the gas stove

Myth 4: Most of America uses gas stoves

Myth 5: As long as you use ventilation, the risks don’t matter
• Gas stoves can harm your health — and scientists have known that for decades (Grid News, 1-17-23) You may need a subscription to read this.
• The New Soldiers in Propane’s Fight Against Climate Action: Television Stars (Hiroko Tabuchi, NY Times, 1-11-23) An industry group is spending millions of dollars to push back against efforts to move heating away from oil and gas.
• Ban Gas Stoves? Just the Idea Gets Some in Washington Boiling. (Elena Shao and Lisa Friedman, NY Times, 1-11-23) The nation’s top consumer watchdog agency raised concerns about indoor air pollution from gas stoves. A political firestorm ensued. A stream of Republican lawmakers attacked Mr. Trumka and the Biden administration on Twitter for even contemplating restrictions on gas stoves.
• Gas stoves and the problematic politics of sacrifice (Kelsey Piper, Vox, 1-25-23)To reach sustainable progress on climate and health issues, we need to focus on what’s easy — not what’s hard.
• Did I Turn Off the Stove? Yes, but Maybe Not the Gas (Raymond Zhong, NY Times, 1-27-22) New research finds that gas stoves emit methane, a potent greenhouse gas, even when turned off and adds to the debate over electrifying homes.
• I Bought a CO2 Monitor, and It Broke Me Katherine J. Wu, The Atlantic, 2-3-23) I thought I could fix the air quality in my apartment. I was wrong.
• N.Y.C.’s Gas Ban Takes Fight Against Climate Change to the Kitchen (Anne Barnard, NY Times, 12-15-21) New York will become the nation’s largest city to enact a ban on gas heat and stoves in new buildings. It’s a major step away from fossil fuels that is expected to influence wider markets.
• U.S. Greenhouse Gas Emissions Bounced Back Sharply in 2021 (Brad Plumer, NYTimes, 1-10-22) Emissions rose 6 percent last year after a record 10 percent decline in 2020, fueled by a rise in coal power and truck traffic as the U.S. economy rebounded from the pandemic.
• Clean Air Act Requirements and History (EPA)
• Why Is Indoor Air Pollution Largely Unregulated? (Christian Roselund, RMI, 5-13-20) RMI is a green energy nonprofit (Decarbonizing Energy Systems) Much of the most serious air pollution that threatens our health comes not from giant power plants or freeways, but from inside our homes.
• Gas Stoves: Health and Air Quality Impacts and Solutions (Brady Seals, Andee Krasner, RMI, 2020) The charts tell a story.

Anything to add?

The following links to devices are adapted from p. 12 chart of Devices for fighting social isolation among older adults (GreatCall) . Clearly this is for seniors in elder-residential facilities, but they might also be helpful for seniors living at home with the family.

If you've had experience with any of these, good or bad, or if there are other devices you recommend, feel free to leave a comment (with a link to a page where the device is shown or described).

• Amazon Echo Show A cloud-based voice hub. Make video calls with a 13 MP camera that uses auto-framing to keep you centered.
• Bose Hearing Aid Self-fitting hearing aids ("hearables")
• Breezie Tablet An open platform that enables senior care providers to deliver care and services through a simple and personalized tablet interface.
• Embodied Labs A modified pair of glasses simulates a senior's impairment so caregivers can imagine the experience. Check out the Immersive Experiences Library Virtual reality for caregiver training.
• Eversound Wireless headphones "give residents the power of sound")
• Google Home Pixel cellphones and more.
• GrandPad An encrypted private network of approved contacts uploaded by a family member. Securely share photos, emails and make video calls without scams.
• ElliQ Companion (Intuition Robotics) A robotic tabletop companion.
• iN2L A touchscreen tablet to facilitate interactions between elder and caregivers and family.
• Jitterbug Phones (GreatCall) An android smartphone with simplified keypads to connect to Call Center.
• JoyforAll Pets Cheery, artfully crafted animatronic birds like Waler Squawker.
• Livio AI (Starkey hearing aids)
• MyndVR Virtual reality headset
• OneClick.Chat Connect on video over computers, tablets, and smartphones
• Oticon In-the-ear hearing aid that learns through experience
• Nuheara Hearing aid integrated with Siri, Google
• Rendever Virtual reality tool helps elders stroll down memory lane. Networked for staff to control, residents to enjoy.

Robots rise to meet the challenge of caring for old people (Nature Outlook, 1-19-22)

‘It’s Becoming Too Expensive to Live’: Anxious Older Adults Try to Cope With Limited Budgets

Economic insecurity is upending the lives of millions of older adults as soaring housing costs and inflation diminish the value of fixed incomes.

Across the country, seniors who until recently successfully managed limited budgets are growing more anxious and distressed. Some lost work during the covid-19 pandemic. Others are encountering unaffordable rent increases and the prospect of losing their homes. Still others are suffering significant sticker shock at grocery stores.

Dozens of older adults struggling with these challenges — none poor by government standards — wrote to me after I featured the Elder Index, a measure of the cost of aging, in a recent column. That tool, developed by researchers at the Gerontology Institute at the University of Massachusetts-Boston, suggests that 54% of older women who live alone have incomes below what’s needed to pay for essential expenses. For single men, the figure is 45%.

To learn more, I spoke at length to three women who reached out to me and were willing to share highly personal details of their lives. Their stories illustrate how unexpected circumstances — the pandemic and its economic aftereffects, natural disasters, and domestic abuse — can result in unanticipated precarity in later life, even for people who worked hard for decades.

Bettye Cohen

“After 33 years living in my apartment, I will have to move since the new owners of the building are renovating all apartments and charging rents of over $1,800 to 2,500/month which I cannot afford.”

Cohen, 79, has been distraught since learning that the owners of her Towson, Maryland, apartment complex are raising rents precipitously as they upgrade units. She pays $989 monthly for a one-bedroom apartment with a terrace. A similar apartment that has been redone recently went on the market for $1,900.

This is a national trend affecting all age groups: As landlords respond to high demand, rent hikes this year have reached 9.2%.

Cohen has been told that her lease will be canceled at the end of January and that she’ll be charged $1,200 a month until it’s time for her apartment to be refurbished and for her to vacate the premises.

“The devastation, I cannot tell you,” she said during a phone conversation. “Thirty-three years of living in one place lets you know I’m a very boring person, but I’m also a very practical, stable person. I never in a million years would have thought something like this would happen to me.”

During a long career, Cohen worked as a risk manager for department stores and as an insurance agent. She retired in 2007. Today, her monthly income is $2,426: $1,851 from Social Security after payments for Medicare Part B coverage are taken out, $308 from an individual retirement account, and $267 from a small pension.

In addition to rent, Cohen estimates she spends $200 to $240 a month on food, $165 on phone and internet, $25 on Medicare Advantage premiums, $20 on dental care, $22 for gas, and $100 or more for incidentals such as cleaning products and toiletries.

That doesn’t include non-routine expenses, such as new partial dentures that Cohen needs (she guesses they’ll cost $1,200) or hearing aids that she purchased several years ago for $3,400, drawing on a small savings account. If forced to relocate, Cohen estimates moving costs will top $1,000.

Cohen has looked for apartments in her area, but many are in smaller buildings, without elevators, and not readily accessible to someone with severe arthritis, which she has. One-bedroom units are renting for $1,200 and up, not including utilities, which might be an additional $200 or more. Waiting lists for senior housing top two years.

“I’m miserable,” Cohen told me. “I’m waking up in the middle of the night a lot of times because my brain won’t shut off. Everything is so overwhelming.”

Carrie England

“It’s becoming too expensive to be alive. I’ve lost everything and break down on a daily basis because I do not know how I can continue to survive with the cost of living.”

England, 61, thought she’d grow old in a three-bedroom home in Winchester, Virginia, that she said she purchased with her partner in 1999. But that dream exploded in January 2021.

Around that time, England learned to her surprise that her name was not on the deed of the house she’d been living in. She had thought that had been arranged, and she contacted a legal aid lawyer, hoping to recover money she’d put into the property. Without proof of ownership, the lawyer told her, she didn’t have a leg to stand on.

“My nest was the house. It’s gone. It was my investment. My peace of mind,” England told me.

England’s story is complicated. She and her partner ended their longtime romantic relationship in 2009 but continued living together as friends, she told me. That changed during the pandemic, when he stopped working and England’s work as a caterer and hospitality specialist abruptly ended.

“His personality changed a lot,” she said, and “I started encountering emotional abuse.”

Trying to cope, England enrolled in Medicaid and arranged for eight sessions with a therapist specializing in domestic abuse. Those ended in November 2021, and she hasn’t been able to find another therapist since. “If I wasn’t so worried about my housing situation, I think I could process and work through all the things that have happened,” she told me.

After moving out of her home early in 2021, England relocated to Ashburn, Virginia, where she rents an apartment for $1,511 a month. (She thought, wrongly, that she would qualify for assistance from Loudoun County.) With utilities and trash removal included, the monthly total exceeds $1,700.

On an income of about $2,000 a month, which she scrambles to maintain by picking up gig work whenever she can, England has less than $300 available for everything else. She has no savings. “I do not have a life. I don’t do anything other than try to find work, go to work, and go home,” she said.

England knows her housing costs are unsustainable, and she has put her name on more than a dozen waiting lists for affordable housing or public housing. But there’s little chance she’ll see progress on that front anytime soon.

“If I were a younger person, I think I would be able to rebound from all the difficulties I’m having,” she told me. “I just never foresaw myself being in this situation at the age I am now.”

Elaine Ross

“Please help! I just turned 65 and [am] disabled on disability. My husband is on Social Security and we cannot even afford to buy groceries. This is not what I had in mind for the golden years.”

When asked about her troubles, Ross, 65, talks about a tornado that swept through central Florida on Groundhog Day in 2007, destroying her home. Too late, she learned her insurance coverage wasn’t adequate and wouldn’t replace most of her belongings.

To make ends meet, Ross started working two jobs: as a hairdresser and a customer service representative at a convenience store. With her new husband, Douglas Ross, a machinist, she purchased a new home. Recovery seemed possible.

Then, Elaine Ross fell twice over several years, breaking her leg, and ended up having three hip replacements. Trying to manage diabetes and beset by pain, Ross quit working in 2016 and applied for Social Security Disability Insurance, which now pays her $919 a month.

She doesn’t have a pension. Douglas stopped working in 2019, no longer able to handle the demands of his job because of a bad back. He, too, doesn’t have a pension. With Douglas’ Social Security payment of $1,051 a month, the couple live on just over $23,600 annually. Their meager savings evaporated with various emergency expenditures, and they sold their home.

Their rent in Empire, Alabama, where they now live, is $540 a month. Other regular expenses include $200 a month for their truck and gas, $340 for Medicare Part B premiums, $200 for electricity, $100 for medications, $70 for phone, and hundreds of dollars — Ross didn’t offer a precise estimate — for food.

“All this inflation, it’s just killing us,” she said. Nationally, the price of food consumed at home is expected to rise 10% to 11% this year, according to the U.S. Department of Agriculture.

To cut costs, Ross has been turning off her air conditioning during peak hours for electricity rates, 1 p.m. to 7 p.m., despite summer temperatures in the 90s or higher. “I sweat like a bullet and try to wear the least amount of clothes possible,” she said.

“It’s awful,” she continued. “I know I’m not the only old person in this situation, but it pains me that I lived my whole life doing all the right things to be in the situation I’m in.”

We’re eager to hear from readers about questions you’d like answered, problems you’ve been having with your care, and advice you need in dealing with the health care system. Visit khn.org/columnists to submit your requests or tips.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

Subscribe to KHN's free Morning Briefing.

by Pat McNees (updated 9-7-22)

Gathered here are links to helpful articles about the many kinds of abuse elders may be subject to (including physical, sexual, and financial abuse) and steps they can take to avoid fraud and scams. Sadly, their abusers may be friends, family, caregivers, and professional advisors. Do your homework and protect yourself and those you care about. Click on:

Elder fraud and abuse, generally  (how to avoid being taken in)

Housing and financial fraud 

Home improvement and other types of scams 

Telemarketing and phone fraud, including IRS scams 

How scammers and fraudsters operate

ATM and tax fraud and identity theft 

Elder abuse 

Fraud, abuse, neglect in elder guardianship system 

Where to monitor credit reports, check a charity's status 

Where to file a complaint if you've been scammed, defrauded, hacked, abused, cheated, etc.  Read More 

by Pat McNees (updated 9-5-22). Original publication 5-29-16.

aka Life Hacks for the Home and Office.

Final section, "Shopping Smartly"

 

See also

Cleaning and other management tips

Cleaning in the presence of allergies
Organizing and dealing with things and information

 

Preferring books to housecleaning, I live in a messy apartment. But now I'm ready to act on tips I've been gathering (posted below) on how to upgrade my home, make my clothes last longer, detox my life, find a better credit card, tidy up the spaces guests are most likely to judge me on, handle a tax audit, clean the bottom of my iron, sanitize a sponge in the microwave, and so on. For example, thanks to Buzzfeed (61 Little Tips and Tweaks to Improve the Appearance of your Home), I've discovered dozens of practical tips, including How to
3. Hide my television wires in a shower curtain rod.
6. Add cheap framed mirrors to closet doors, painted to match.
19. Get the right-size rugs and learn how to place them.  Read More 

Updated 12-16-22

 Read More 

Updated 5-12-22.

When friends report being crippled by pain from sciatica, I pull out my "notes for friends with sciatica." This is not medical advice; I am not a doctor. I do not have medical training. But these links may provide some relief until you get to a doctor. They're culled from years of hearing what worked from friends who've been  Read More 

Let me know in Comments if additional resources are missing here.

 

• The Homeless Get Sick; ‘Street Medicine’ Is There for Them (David Montgomery, Stateline, Pew Charitable Trust, 9-18-18) “Street medicine,” which had only a few resolute practitioners when it got its start in the mid-1980s, has surged within the past decade, growing into a network of programs in over 85 cities and in 15 countries. In the United States, street medicine programs are operating in more than 20 states and at least 45 cities, including New York, Chicago, Atlanta, Los Angeles, Minneapolis, Detroit and Washington, D.C.So-called point-in-time estimates by the U.S. Department of Housing and Urban Development placed the number of homeless people at 553,742 in 2017. Two-thirds, or 360,867, were in emergency shelters or transitional housing. The remaining third, or 192,875, were in unsheltered locations — making them most vulnerable to threatening diseases and physical abuse.
• The Street Medicine Movement (YouTube video, Jim Withers, TEDxPittsburgh, 7-20-15) Withers is the internal medicine physician who began providing medical care to Pittsburgh’s unsheltered homeless population in 1992. He is also the founder of Operation Safety Net, a street medicine program in Pittsburgh, Pennsylvania. For the past 23 years, Dr. Withers has been working with the homeless population to provide free medical care by going from one bridge to the next to assist homeless individuals in need. As a 2014 Huffington Post article on Dr. Withers stated, “What started off as two people offering free medical treatment has since grown into a national network of medical students and volunteers who go out to treat the homeless four nights a week.”

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• Street Medicine: Medical Outreach for Unsheltered People (Ad, National Health Care for the Homeless Council) “Street medicine” is the practice of providing medical care to unsheltered people experiencing homelessness in locations like encampments, parks, and under bridges.Dr. Jim Withers first coined the concept of “street medicine” in the 1980s and founded the Street Medicine Institute, an international organization that aims to advance street medicine as a distinct health care discipline. Soon after, Dr. Philip Brickner in New York City used the street medicine approach to create the Health Care for the Homeless (HCH) model of care in the mid-1980s. Today, the Street Medicine Institute estimates 50 independent street medicine programs operate across the country, funded in a variety of ways.
• Narrative Medicine: A Way Out (Corinne T. Feldman, Clinical Advisor, 2-25-22) In the practice of street medicine, which is the direct delivery of primary care to people experiencing homelessness living in parks, underpasses, and abandoned buildings, we have the privilege of witnessing those lives lived as society casually passes by, seemingly blinded to the suffering happening at their feet.
• Safeguarding Our Communities: Get to Know Your Lifeguards (Corinne T. Feldman, Clinical Advisor, 2-25-22)
• Street Medics Battle Bureaucracy to Bring Health Care to the Homeless (Jack Ross, Capital and Main, 6-28-21) Street medicine originated on the East Coast in the early 1990s; today, street teams treat the homeless from Brazil to Russia. In California the programs are now widespread, but current state health care law is preventing teams from treating their patients, street medics say, even as California’s homeless population grows past 160,000.
The Street Medicine Act (AB-369), a new bill under debate in the California State Senate, tries to remove those barriers. It seeks recognition of the street as a legitimate place to deliver medical care, a place where patients can bill Medi-Cal and access benefits like X-rays, lab work and specialized treatment just as they would in a doctor’s office. It will make it easier to take life-saving treatment to the people who need it most.
“We create laws and systems with an expectation that people meet the government where the government is,” says state Sen. Sydney Kamlager. “This is an opportunity to meet people where they are,” says Kamlager. “We have a system that creates all kinds of barriers of access to folks who are homeless.”

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• Street Medicine—The Challenge of Earning Homeless Patients' Trust (YouTube video, JAMA Network, 2-5-20)
• Finding patients where they live: Street medicine grows, along with homeless population (Soumya Karlamangla, LA Times, 2-16-20) Brett Feldman leads a four-person medical team that offers care to some of the sickest people in Los Angeles by meeting them where they live, on the street. The patients don’t have to schedule appointments, find transportation to the clinic, pick up prescriptions or pay for their treatment — barriers that make homeless people much sicker and more likely to die. This team is one of several providing medical care on the street for L.A. County’s growing homeless population. These so-called street medicine teams are multiplying nationwide, with more than 90 across the country and some doctors weighing whether the practice should be taught in medical schools. The shift acknowledges not just the humanity of homeless people but also a nationwide failure to house them and provide healthcare to everyone who needs it.
• What You Need to Know about Street Medicine Movement and Homeless Healthcare (Rohit Varma, 11-13-18)
• Street Medicine: Bringing Healthcare to the Homeless Community (Ad, Cynthia Griffith, Invisible People, 8-20-21)
• Million-Dollar Murray (Malcolm Gladwell, New Yorker, 2-13-06) Why problems like homelessness may be easier to solve than to manage

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Watch Julie Nolke's TED Talk

 

  The 6 Year Overnight Success (10-8-21)

and then watch the series:

• Explaining the Pandemic to My Past Self, part 1 (January 2020)  This went viral: 28 million views.

• Explaining the Pandemic to My Past Self Part 2 (June 2020) This also went viral, 11 million views.

• Explaining the Pandemic to My Past Self Part 3 (October 2020)  And so on.

• Explaining the Pandemic to My Past Self Part 4 (December 2020)

• Explaining the Pandemic to My Past Self - 1 Year Later (April 2021)

• Explaining the Pandemic to My Past Self Part 5 (August 2021)