- Senator Baldwin Introduces HSHS Act to Protect Communities from Hospital Closures
- What to Know about Smoke, Heat and Health
- Tribal Partnership With UW-Madison Combines Ag Research With Indigenous Food Knowledge
- The Rewards of Working as Rural Docs
- Request for Information (RFI): Evolving the Network of the National Library of Medicine
- Dental Therapists, Who Can Fill Cavities and Check Teeth, Get the OK in More States
- Colorectal Cancer Is Rising among Younger Adults. Some States Want to Boost Awareness.
- Rural Hospitals Built During Baby Boom Now Face Baby Bust
- Food Stamps Go Further in Rural Areas — Until You Add Transportation Costs
- CMS Announces Resources and Flexibilities to Assist with the Public Health Emergency in the State of Texas
- CMS Proposes New Payments for Digital Health Under CY2025 PFS Draft Rule
- Improving Public Health by Strengthening Community Infrastructure
- Biden Harris Administration Proposes Policies to Reduce Maternal Mortality, Advance Health Equity, and Support Underserved Communities
- Nearly Half of U.S. Counties Don't Have a Single Cardiologist
- Randolph County, Ill. Turns Unused Part of Nursing Home Into State-Of-The-Art Behavioral Health Center
How to Find Maternity Care in Rural Pennsylvania
Bethany Rodgers, Beaver County Times
Health care representatives and policymakers in Pennsylvania are warning of declining maternity services in rural parts of the commonwealth, a shift that’s making it harder for pregnant women in these communities to access vital care.
But as hospitals continue to close down labor units and obstetricians exit some small towns, an array of organizations are working to help fill the health care gaps left behind.
More: Pregnant women in rural Pa. face expanding ‘maternity deserts.’ Here’s why.
Here are a few of the resources available to rural residents who are or are planning to become pregnant:
Rural Health Clinics
The federal government established a rural health clinic program in the 1970s in response to the lack of physicians in these areas who would treating Medicare patients. By receiving a designation through this program, clinics can benefit from enhanced Medicare and Medicaid reimbursement rates.
Today, there are about 70 of these health clinics scattered across rural parts of the commonwealth, according to the Pennsylvania Office of Rural Health.
While not all of the health system’s clinics have an OB/GYN, Pierce said the primary care providers at these facilities do offer prenatal services and help connect a patient with more specialized care elsewhere.
“They will get the patient started with the prenatal vitamins, get them tested to make sure they’re pregnant, get them started on the right path,” she said.
A list of Pennsylvania’s rural health clinics is accessible at bit.ly/3t67h8V.
More: Erie medical research institute has laid foundation for clinical trials in women’s health
Federally Qualified Health Centers
One of the missions of federally qualified health centers is to provide care in underserved communities, including rural areas. They are also obligated to care for any patient, regardless of the person’s insurance status or ability to pay.
Pennsylvania has about 99 FQHC sites in rural areas, according to the Center for Rural Pennsylvania.
George Garrow, CEO of Primary Health Network, an FQHC that has sites in 16 counties, said that while his health system doesn’t operate any hospitals where someone could give birth, the organization does offer a wide range of primary care services.
Many of its locations deliver behavioral or mental health services, and the network also makes use of case navigators to help patients with their individual needs and to avert any obstacles to care, Garrow said.
Navigators, for instance, might make sure a woman gets started on her prenatal vitamins early in her pregnancy or connect her with obstetricians and other specialists.
Community health workers in the network also assist people who have trouble getting to appointments, using partnerships with transportation programs or by contracting with ridesharing services, Garrow said. And the network also operates a charitable foundation that can aid people who can’t afford the cost of their prescription medicines.
You can search for FQHCs by county and specialty at my.pachc.org/Find-a-Health-Center
Jasmin Martinez Castellanos, M.D.: Pregnancy brings higher risk of cardiovascular disease
Nurse-family partnerships
Through this program, women who are lower income can receive regular home visits from a nurse during their pregnancies and for the first two years of their child’s life.
Elizabeth Cassidy, a nurse who works in the partnership, said she aims to check in on women anywhere from once every several weeks to every week. During these visits, she’ll monitor her clients’ blood pressure, encourage them to establish healthy habits and form a trust-relationship that will continue after their child is born.
“We work with moms to achieve their own goals,” said Cassidy, whose employer, Maternal and Family Health Services, administers the nurse-family partnership program in northeastern Pennsylvania. “It’s not just baby-focused, but also to work on themselves and be the best parent that they can be.”
The nurse-partnership program traditionally is only open to first-time mothers, but Maternal and Family Health Services recently received permission also to serve pregnant women who already have children.
Information on nurse-family partnerships in Pennsylvania is available at nursefamilypartnership.org/locations/pennsylvania/
Paul Speer, M.D.: High blood pressure during pregnancy can lead to later health issues
The USA TODAY Network is covering healthcare access issues in rural parts of the commonwealth. As part of this reporting, we’re interested in hearing from Pennsylvanians in these communities who have struggled to access medical, dental and mental health care.
Fill out the form at bit.ly/pa-maternity and your response will go directly to a USA TODAY Network reporter. You may be contacted for further details about your story.
New Resource Guide Released: Oral Health in Schools
The National Maternal and Child Oral Health Resource Center (OHRC) recently published “Promoting Oral Health in Schools: A Resource Guide.” This guide provides information about materials for promoting oral health in schools and features materials on data and surveillance, policy, professional education, program development, and public education.
New! CMS Releases Sickle Cell Disease Action Plan
The Centers for Medicare & Medicaid Services (CMS) continues to recognize the challenges faced by members of the Sickle Cell Disease (SCD) community and is releasing a new Sickle Cell Disease Action Plan to address and eliminate barriers within CMS programs. The actions in this plan are designed to improve health outcomes and reduce health disparities for individuals living with SCD.
The burden of this disease, particularly for people enrolled in CMS programs, underscores the importance for CMS to use existing levers to take action on opportunities and solutions. The Action Plan builds on the Health Equity pillar of the CMS Strategic Plan and the goals under the CMS Framework for Health Equity. It also aligns with the mission and vision of the CMS National Quality Strategy and the CMS Behavioral Health Strategy’s goal to ensure effective pain treatment and management.
For more information about Sickle Cell Disease and related work that is happening across the agency, check out the resources below and review this recent blog from CMS Administrator Chiquita Brooks-LaSure and Acting CMS OMH Director Dr. Aditi Mallick.
Resources
- NEW! Read CMS’ Sickle Cell Disease Action Plan.
- Infographic on the Action Plan
- Check out these SCD resources from the CMS Office of Minority Health:
- Watch our Sickle Cell Disease video to learn more about common health complications faced by individuals with SCD, in addition to disparities, symptoms, and treatment options.
- Download The Invisible Crisis: Understanding Pain Management in Medicare Beneficiaries with Sickle Cell Disease, which highlights treatment options for pain management in SCD patients.
- Read the Prevalence of Sickle Cell Disease among Medicare Fee-for-Service Beneficiaries Age 18-75 Years, in 2016 data highlight to learn about other common chronic conditions among SCD patients and more.
- Explore our Coverage to Care initiative, which helps patients understand their health coverage and connect to primary care and preventive services, including chronic care management resources for providers and patients.
Learn more about other activities surrounding SCD from agencies across the Department of Health and Human Services (HHS):
- From the National Institutes of Health’s National Heart Lung Blood Institute (NIH/NHLBI) check out “Today’s Faces of SCD“, where NHLBI highlights people living with SCD, their loved ones, researchers, and others, every Friday during the month of September. Also, check out the Sickle Cell Awareness Month tab on their Blood Diseases and Disorders Education Program (BDDEP) webpage. Also view their SCD fact sheets, available in English and in Spanish. Finally, take a look at their Blood Health Network webpage for more information.
- Look at the Cure Sickle Cell Initiative’s webpage to learn more about their patient-focused research effort designed to accelerate promising genetic therapies to cure sickle cell disease. Also review their Sickle Cell Awareness month page for more information about SCD.
- Review the Centers for Disease Control & Prevention’s Sickle Cell Disease Fact Sheet for a collection of resources to increase understanding of the disease.
USDA To Begin Using Most Recent Census Data to Determine Eligibility for Rural Development Programs
The U.S. Department of Agriculture (USDA) Rural Development today announced that USDA, on October 1, 2023, will begin using the most recently released data from the U.S. Census Bureau to determine program eligibility for Rural Development programs.
Beginning in Fiscal Year 2024, the agency will use 2020 Decennial Census population data and 2017-2021 American Community Survey (ACS) income data to determine eligibility. The agency previously used 2010 Decennial Census population data and 2006-2010 ACS data.
Rural Development will also unveil updated online program eligibility maps. The maps will help individuals and organizations applying for Fiscal Year 2024 funding to quickly determine if an area is considered rural and/or eligible for Rural Development programs. The updated maps will be posted to the RD Eligibility Site.
The agency will continue to use 2010 census population data and 2006-2010 ACS income data to process complete applications submitted prior to Sept. 30, 2023, if the:
- Funds are obligated by June 30, 2024; or
- Funds are obligated after June 30, 2024, and the agency administrator has provided concurrence that the
application remains eligible under these metrics; or - Funds are obligated by Sept. 30, 2024, for programs that accept applications on a rolling basis. These programs are the Intermediary Relending Program, Rural Energy for America Program, Rural Economic Development Loan and Grant Program and the Rural Microentrepreneur Assistance Program.
For more information about the transition to the 2020 Decennial Census data and 2017-2021 ACS data, please contact your RD State Office representative at https://www.rd.usda.gov/about-rd/state-offices.
If you’d like to subscribe to USDA Rural Development updates, visit our GovDelivery subscriber page.
HRSA Invests Nearly $90 Million to Address Maternal Health Crisis
The U.S. Department of Health and Human Services’ (HHS), Health Resources and Services Administration (HRSA) announced nearly $90 million in awards to support the White House Blueprint for Addressing the Maternal Health Crisis (PDF – 912 KB), a whole-of-government strategy to combat maternal mortality and improve maternal and infant health, particularly in underserved communities.
In recent decades, the United States’ maternal mortality rate has been among the highest of any developed nation. Disparities in mortality are stark — Black women are more than three times as likely as White women to die from pregnancy-related causes. The Biden-Harris Administration is committed to reversing these trends and making the U.S. the best country in the world to have a baby.
“At the Health Resources and Services Administration, we are laser-focused on reversing this crisis by expanding access to maternal care, growing the maternal care workforce, supporting moms experiencing maternal depression, and addressing the important social supports that are vital to safe pregnancies” said HRSA Administrator Carole Johnson. “We know it will take a sustained approach to reduce and eliminate maternal health disparities and we are committed to this work.”
The Administration’s White House Blueprint for Addressing the Maternal Health Crisis identifies five key goals to realize the vision of the U.S. being the best country in the world to have a baby. Today’s HRSA announcement takes action on each of those goals.
Click here to read more.
What Share of Nursing Facilities Might Meet Proposed New Requirements for Nursing Staff Hours?
On September 1, 2023, the Centers for Medicare and Medicaid Services (CMS) released a proposed rule that would create new requirements for nurse staffing levels in nursing facilities, settings that provide medical and personal care services for nearly 1.2 million Americans. The adequacy of staffing in nursing homes has been a longstanding issue. A recent report issued by the National Academy of Sciences, Engineering, and Medicine (NASEM) raised concerns about low nursing staff levels in nursing facilities across the country and the impact on the quality of care for nursing home residents. The high mortality rate in nursing facilities during the COVID-19 pandemic highlighted and intensified the consequences of inadequate staffing levels.
The new proposed rule includes several provisions to bolster staffing in nursing homes. It proposes a minimum of 0.55 registered nurse (RN) and 2.45 nurse aide hours per resident day; requires facilities to have an RN on staff 24 hours per day, 7 days per week; strengthens staffing assessment and enforcement strategies; creates new reporting requirements regarding Medicaid payments for institutional long-term services and supports (LTSS); and provides $75 million for training for nurse aides. As noted in the proposed rule, CMS aims to balance the goal of establishing stronger staffing requirements against the practicalities of implementation and costs. Comments on the proposed rule are due by November 6, 2023.
This issue brief analyzes the percentage and characteristics of facilities that would meet the rule’s proposed requirements for the minimum number of RN and nurse aide hours to better understand the implications of the rule. The analysis does not evaluate facilities’ ability to comply with other requirements, including the requirement to always have a registered nurse on duty 24/7 or the ability to meet the new reporting and assessment requirements due to data limitations (see methods). The analysis uses Nursing Home Compare data, which include 14,591 nursing facilities (97% of all facilities, serving 1.17 million or 98% of all residents) that reported staffing levels in August 2023.
Click here to read more and to access the brief.
Black Bisexual Women in Rural Areas Are At Highest Risk for Suicidal Behaviors
Penn State College of Medicine-led research study highlights how gender, sexual orientation, race, ethnicity and rurality contribute to suicide ideation, planning and attempts
Non-Hispanic and Hispanic Black bisexual women who live in rural areas have the highest prevalence of experiencing suicidal thoughts and behaviors, according to a Penn State-led study. The researchers said this “first-of-its-kind study,” published in JAMA Psychiatry, revealed how various demographic factors intersect to affect a person’s risk of having suicidal thoughts and behaviors.
An estimated 12 million adults in the United States think about suicide every year, with nearly two million attempting suicide annually. While previous studies have examined how individual demographic factors, like race and gender, individually associate with suicide risk, no studies have demonstrated how different factors combine to influence overall risk. Lauren Forrest, assistant professor of psychiatry and behavioral health at Penn State College of Medicine, analyzed annual National Survey on Drug Use and Health responses from more than 189,000 individuals who provided information on their gender, race, sexual orientation, ethnicity and how rural their environment is, to study how these factors intersect or combine to affect risk of suicidal thoughts and behaviors. The researchers analyzed data from 2015 to 2019.
“We already know that some groups — like LGBTQIA+ individuals or women — are at increased risk for suicidal thoughts and behaviors,” Forrest said. “However, every person possesses multiple identities — including gender, race and sexual orientation, to name a few. Some combinations of identities, for example, Black bisexual women, may be associated with unique suicide risk profiles. But we can’t see these unique risk profiles if we only look at one identity at a time, which is what we’ve been doing thus far in research. It’s important to investigate how prevalence of suicidal thoughts and behaviors varies across intersectional identities, so we can identify populations most at risk and develop interventions specifically for those groups and their unique experiences driving their suicidal thoughts and behaviors.”
The researchers found that the intersectional group with the highest prevalence of suicidal ideation was Hispanic bisexual women living in rural areas — 20% of whom had thought about killing themselves in the last year before they took the survey. By contrast, the intersectional group with the lowest prevalence of suicidal ideation was Hispanic heterosexual men living in large metropolitan counties, where only 3% had contemplated suicide in the year before completing their surveys.
Forrest said the research is based on intersectionality theory, first proposed by Black feminist scholars. Intersectionality theory proposes that health inequities for any group — whether based on gender, sexual orientation, race and ethnicity and/or rurality — arise not due to people’s identities, such as gender, themselves but due to interlocking structural systems of power, privilege and oppression.
According to Forrest, a person can face various types of discrimination based on their gender, race, ethnicity, sexual orientation or simply by where they live. Discrimination can be experienced across levels of influence, which are layered, or nested, within one another. An individual person — the smallest level — is nested within an interpersonal network of peers, family, friends and immediate neighbors. That interpersonal network is nested within a community, and a community is nested within society — the structural systems — at large.
Structural discrimination occurs when there are laws that impose on certain individuals’ rights or welfare, and/or when certain prejudicial attitudes or behaviors are socially acceptable across society, Forrest said. For instance, laws opposing or restricting gay rights is an example of structural discrimination based on sexual orientation. This type of discrimination can set the stage for LGBTQIA+ people to experience more discrimination in their communities, since communities are nested within societies. This discrimination can become more intense on an interpersonal level, too, since interpersonal levels are nested within communities, which are nested within structures.
“When people face multiple types of structural discrimination, such as discrimination based on their sexual orientation and their race, which might be even more heightened in rural areas versus urban areas, it makes sense that the effects of discrimination could compound on one another,” Forrest said. “Discrimination, especially when it’s occurring across identities and levels of influence, is painful. Over time, these repeated and compounding painful discrimination experiences could ultimately contribute to some people contemplating or attempting suicide.”
According to Forrest, her research in this area is just getting started. She plans to continue studying how structural level risk factors, such as structural stigma, interact with individual-level risk factors, such as psychiatric disorders, to jointly impact suicide risk among LGBTQIA+ people living in rural areas. She said her ultimate goal is to collect and analyze data that can ultimately influence policy decisions, especially those relating to health equity.
“I’m passionate about this area of research because it’s important for mental health providers to understand that factors across levels of influence impact suicide risk,” Forrest said. “We often consider, assess and intervene upon individual-level risk factors, like psychiatric disorders. But I’d argue that we rarely, if ever, consider how the structural processes that drive health inequities may be impacting the person sitting in front of us in the therapy or assessment room.”
Forrest noted that better understanding how factors across levels of influence combine to impact suicidal thoughts and behaviors could help mental health professionals better determine the groups most at risk, determine the most potent intervention targets across levels of influence and develop and implement effective interventions for the underlying causes of health disparities and inequities (e.g., structural discrimination). She said that virtual interventions may be useful in rural settings where health care access may be limited and discrimination may be more severe, compared to more urban areas.
This research is part of Forrest’s training as a Penn State Clinical and Translational Science Institute KL2 Scholar. Project collaborators include Forrest’s KL2 mentor and senior author, Emily Ansell, associate professor of biobehavioral health at Penn State College of Health and Human Development and Penn State Social Science Research Institute scholar; Sarah Gehman, College of Medicine medical student; Cara Exten, assistant professor of biobehavioral health at Penn State Ross and Carol Nese College of Nursing; and Ariel Beccia of Harvard Medical School. The researchers declare no conflicts of interest.
This research was supported by the National Center for Advancing Translational Sciences through Penn State Clinical and Translational Science Institute. The views expressed are those of the researchers and do not necessarily represent the views of the National Institutes of Health.
If you or someone you know is experiencing suicidal thoughts or behaviors, help is always available. Call 988; contact the crisis text line by texting PA to 741741; call the Trevor lifeline, for LGBTQIA+ individuals, at 1-866-488-7386; and/or call the Trans Lifeline, for trans and gender diverse individuals, at 1-877-565-8860.
New Fact Sheet Highlights the Importance of Kinship Care
September is National Kinship Care Month, recognizing the countless relatives and caregivers who provide full-time nurturing and protection for children who cannot safely remain in the care of their biological parents. Placement in the foster care system is a traumatizing event, impacting all facets of a child’s life, such as their connection to extended family, school, friends, communities and cultures. If a child must be removed from their home, the best option is placement with kin. Too often, kin are arbitrarily disqualified from becoming licensed foster parents.
Our newly released fact sheet identifies policy solutions that can prioritize and simplify kinship placements, allowing children and youth to be raised by and connected to their families.
One policy solution identified in the fact sheet is passing HB 1058, which would give kin a voice in court proceedings. The bill, sponsored by Rep. Krajewski, would allow kin to be heard by the dependency judge overseeing a foster child’s case. When a kin caregiver is denied placement they are not allowed to present their case and facts to the judge tasked with making placement decisions. Giving kin a voice in court will let the judge hear directly from them about their qualifications and determine if reconsidering placement, ongoing visitation, or contact is appropriate.
HB 1058 passed the House earlier this year and was approved by the Senate Aging and Youth Committee last week. The bill is now in Senate Appropriations and still requires approval on the Senate floor. PPC will continue to advocate for the passage of the bill as one additional step to ensuring that all children can be placed with and connected to their families.
It’s Not All About Wages: What Workers Want In a Job
Enough money to cover the bills and help them get ahead. Fair treatment. Job security. Time to care for their families and themselves. These are things U.S. workers and job seekers without a four-year degree said they want in a job.
The topic of what makes a quality job emerged organically during listening sessions as part of the Worker Voices Project. Led by the Federal Reserve Banks of Atlanta and Philadelphia, Worker Voices looked beyond the numbers to understand the impact of the COVID-19 pandemic on how workers without a four-year degree perceive and navigate employment.
Worker Voices Special Brief: Perspectives on Job Quality takes a deep dive into a major theme that emerged during focus groups with 167 U.S. non-college workers and job seekers across the country — what workers want and expect from a job.
ADA Survey Report on Teledentistry Released
A new survey report was published from the American Dental Association Clinical Evaluators Panel. The report, “Teledentistry Adoption and Applications,” found that the adoption of teledentistry grew in the past three years, in part because of the COVID-19 pandemic, but the technology may be underused. Thirty percent of respondents said they use teledentistry, with 60% of users expressing satisfaction and noting increased access and quality of care, while 60% of those not using teledentistry said there wasn’t a need.