Read our Coronavirus Coverage Here

North Carolina Health News

News. Policy. Trends. North Carolina.

Donate Now

Additional Thanks

Today from @CltLedger: Nurse practitioners are replacing neonatologists at this NC hospital in a controversial move. #nchealth #ncnews northcarolinahealthnews.org/2…

Categories

North Carolina General Assembly

shows a coal plant with steam puffing from one of the smokestacks, a concern in the fight against climate change

N.C. environmental groups file petition to join other states in combating climate change

by

N.C. environmental groups file petition to join other states in combating climate change - North Carolina Health News

If approved by the Environmental Management Commission, the petition would force Duke Energy to cap the amount of greenhouse gases it releases. The cap would diminish over time, along with the cost of electricity customers pay.

By Greg Barnes

It no longer takes a meteorologist to realize that North Carolina’s climate is getting hotter, wetter and more turbulent.

Although 2020 didn’t break any state climate records, it came close. The state saw its second-wettest year on record and tied for its third warmest, according to the National Centers for Environmental Information and N.C. State University. Combined, 2020 was the only time since records started being kept in 1895 that the state’s annual temperatures and precipitation ranked in the top five.

What’s even more alarming is that the state recorded its warmest 10-year span on record between 2009 and 2018 and that 2020 broke every North Carolina heat record.

The changing climate has brought more of almost everything. More intense hurricanes. More flooding. More coastal erosion. More sea level changes. More deaths from respiratory diseases. More natural disasters of almost every kind.

And this could be just the beginning. Under a worst-case scenario, climatologists say temperatures could rise globally by as much as 8 degrees by the end of the century unless measures are taken to significantly reduce the greenhouse gases trapped in the earth’s lower atmosphere. An increase of that magnitude would have devastating consequences.

A report released last year titled “North Carolina Climate Risk Assessment and Resilience Plan,” says sea levels will continue to rise in the state and it is likely that summers will get even hotter, rainfall totals will increase, hurricane strengths will intensify, and severe droughts, inland flooding, wildfires and landslides will become more common.

Sea level rises can affect everything from how much bacteria is in coastal waters to critical infrastructures such as sewage treatment plants and roads.

In North Carolina, climate change is already resulting in warmer weather in every season, causing more respiratory problems and other health-related issues, less water in some areas and more stress on crops, according to the state resilience plan.

Fighting back

Only recently has North Carolina made a concerted effort to fight back.

In 2018, Gov. Roy Cooper signed Executive Order 80, which promises to reduce greenhouse gas emissions 40 percent from 2005 levels by 2025.

In 2019, the N.C. Department of Environmental Quality released its Clean Energy Plan, which vows to cut greenhouse gas emissions from power generating plants by 70 percent from 2005 levels and to make the state carbon neutral by 2050.

And now comes a petition from two North Carolina environmental groups that asks the state to join a regional partnership to combat climate change by forcing electrical power plants to reduce heat-trapping carbon dioxide emissions by the same amount specified in the DEQ’s Clean Energy Plan.

The Southern Environmental Law Center (SELC) filed the petition with the N.C. Emergency Management Commission Jan. 11 on behalf of Clean Air Carolina and the North Carolina Coastal Federation.

“With climate change already harming North Carolina, and science telling us we are running out of time to reduce our heat-trapping gas emissions, now is the time to take action,” Gudrun Thompson, a senior attorney at the SELC, said in a statement announcing the petition.

“Whether we act now or delay determines our future as well as the legacy we leave our children and grandchildren,” Thompson said. “This petition outlines a cost-effective solution that is proven to work and ready to go to protect North Carolina’s economy, environment and people.”

If the Environmental Management Commission agrees, North Carolina would join at least 11 other states, from Maine to Virginia, in the Regional Greenhouse Gas Initiative, commonly known as RGGI.

What is RGGI?

The RGGI initiative was approved in 2005 and started fully operating in 2009, Thompson said. A 10-year review in 2019 by the Acadia Center, a nonprofit environmental group, found that:

  • Carbon dioxide emissions from RGGI power plants fell by 47 percent, outpacing the rest of the country by 90 percent.
  • Electricity prices in RGGI states fell by 5.7 percent, while prices increased in the rest of the country by 8.6 percent.
  • Gross domestic product of the RGGI states grew by 47 percent, outpacing growth in the rest of the country by 31 percent.

Thompson explained that the RGGI program puts an annual cap on carbon dioxide emissions from power plants, a cap that diminishes over time.

“They have flexibility in terms of how to comply with the declining cap,” Thompson said. “They can retire coal-fired power plants or they can buy allowances that the state would make available for auction.”

Under RGGI, the power companies are required to buy allowances — or credits — for their share of the pollution. Some of that money is returned to the participating states, Thompson said. The states typically reinvest the bulk of the money into clean energy or energy-efficient projects.

North Carolina won’t have that luxury, Thompson said, because citizens — not the legislature — asked to join RGGI. That means most of the money earned at auction would go toward lowering customers’ electric bills, she said. Electric bills are projected to increase slightly before falling under RGGI.

Duke Energy studying carbon policies

Duke Energy is by far North Carolina’s biggest electric-power provider, and power companies are the biggest emitters of carbon dioxide. Duke Energy has its own plans to reduce greenhouse gases, vowing to reduce carbon emissions by 50 percent by 2030 and to reach “net zero” carbon in its system by 2050.

To do that will require the company to speed up the process of closing coal-fueled power plants. Duke Energy has been replacing coal plants with natural gas plants, which emit 50 percent to 60 percent less carbon dioxide but come with other environmental consequences, such as hydraulic fracturing, or fracking. Fracking is the process of drilling into the earth before a high-pressure water mixture is directed at the rock to release natural gas trapped inside. Environmentalists say toxic chemicals used in the process can lead to air pollution and groundwater contamination.

A spokeswoman for Duke Energy declined to reveal whether the company favors North Carolina’s participation in the RGGI, saying it is awaiting more information.

Over the past year, spokeswoman Grace Rountree said in an email, Duke Energy has participated in the state’s Clean Energy Plan review process, which has examined potential paths for reducing carbon emissions, including RGGI.

“Stakeholders have not yet had the opportunity to see the draft CEP carbon policies report in order to compare the effectiveness, benefits and costs of different policies,” Rountree said. “Duke Energy’s focus as we analyze any policy is to consider how it will affect all of our customers, both in the near-term and long-term. Once we have seen the report, we look forward to continued dialogue with stakeholders and policymakers on a cost-effective path forward for North Carolina’s energy transition.”

Thompson said the Southern Environmental Law Center is among the organizations reviewing the Clean Energy Plan. She said a report from that process is expected to be sent to the governor soon.

“It’s not going to recommend a particular policy, so the reason we filed this petition is because we think it’s time to act,” Thompson said. “Instead of having yet more stakeholder process to pick a policy, we think that the preliminary results of that carbon policy process show that this RGGI option is effective and cost effective.

“It’s a proven approach that is working in other states, and it doesn’t require legislative authorization. So we just filed the petition to basically kickstart this process of actually establishing a rule to limit carbon emissions instead of just continuing to talk about different options.”

Approval not a ‘slam dunk’

Thompson said she doesn’t think approval of RGGI participation will be “a slam dunk.”

“It is certainly possible that the commission could decide to deny the petition or to change the rule significantly before deciding to go forward,” Thompson said. “Based on what has happened in some other states, we anticipate there could be some opposition from the regulated industries and others who might be opposed for political or ideological reasons.”

Thompson blames the North Carolina General Assembly for not pursuing the lead on combating climate change. The RGGI has been operating now for a dozen years in other states.

“To be candid, I think politics is part of it,” Thompson said. “Many of the other states that have joined RGGI have done so at the direction of the legislature.

“Other than politics I don’t really know why North Carolina has been slow and I have to applaud Governor Cooper and his leadership on setting goals for carbon reduction in the state. And it’s just, you know, we think it’s time to actually turn those goals into action and so that’s why we filed the petition.”

Duke reducing carbon emissions

Climate change represents more than just heightened natural disasters. For many, it is a matter of life or death. The World Health Organization estimates that climate change will cause  an estimated 250,000 additional deaths worldwide each year between 2030 and 2050 from malnutrition, malaria, diarrhea and heat stress.

Thompson and others grappling with climate change acknowledge that RGGI is not the cure-all for North Carolina and the rest of the planet.

A report from the Natural Resources Defense Council dated June 2019 says North Carolina will need a combination of policies, programs and technologies — including RGGI and renewable energy — to reach carbon neutrality by 2050.

The Defense Council applauded North Carolina’s continued move into solar energy, noting that it had become the second-leading state in the country for solar power, “representing almost $8 billion in investments and 7,000 permanent local jobs.”

Although North Carolina has since slipped to third in solar energy — behind California and Texas — Duke Energy said in a news release last week that it is committed to increasing the use of the sun to generate electricity.

The company said about 5,500 customers installed private solar systems at their homes and businesses last year, bringing the total of those customers to more than 18,000.

Last year, Duke Energy also connected almost 350 megawatts of solar power capacity, enough to power roughly 60,000 homes. According to the news release, major projects in 2020 included Duke Energy’s 69-megawatt Maiden Creek solar facility in Catawba County and a 25-megawatt facility in Bessemer City in Gaston County. The company owns and operates more than 40 solar facilities in North Carolina.

Almost 60 percent of Duke Energy’s generation in the Carolinas is carbon-free, with nuclear, solar and hydroelectric power being the leading sources of carbon-free generation, the news release says.

shows two adults providing applied behavior analysis, otherwise known as ABA therapy, with two young people.

Lawmakers want to make it easier for children with autism to get therapy

by

Lawmakers want to make it easier for children with autism to get therapy - North Carolina Health News

Two new bills would reduce constraints on the therapists’ practice, but will it produce the desired results?

By Rose Hoban

Samuel Robinson, a 9-year-old with autism spoke into the microphone at the legislative building Tuesday morning, calling out greetings, “Hi Tina,” to good-natured laughter from lawmakers and families in the press conference room at the North Carolina General Assembly building.

His father Kyle Robinson choked up when he talked about the fact that in the past Bobby had been non-verbal.

“From a little boy that, as a dad, you don’t know if he’s ever gonna… if he’s ever going to say ‘Hey Da-da, or give you a hug,’” Kyle Robinson said.

ad reminding readers to support our COVID coverage

He explained that Samuel has been receiving applied behavior analysis therapy since he was 2-years-old. Over recent decades, ABA therapy has emerged as one of the most effective modalities of care for children with autism.

“Now, he talks all the time,” the elder Robinson said to more good-natured laughter as Samuel interrupted him.

What brought the Robinsons and other families to the legislative building this week is the introduction of a bill intended to make it easier for ABA therapists to practice in North Carolina. According to bill sponsor John Bell (R-Goldsboro), the bill will be “hugely beneficial to families across the state.”

“The positive impact [of ABA] has been on families and those with autism cannot be overstated,” he said.

“North Carolina is the only state in the country where behavior analysts who provide highly effective treatment to children with autism are unable to practice independently,” he explained later in the morning to the House Health committee. “Under current state regulations, qualified professionals must operate under the supervision of a licensed psychologist.”

Bell’s bill, House Bill 91 (which has a parallel Senate bill, SB 103) has more than 50 co-sponsors from both sides of the aisle. It would remove that supervision requirement, create a path to independent licensure, establish a licensing board to oversee ABA therapists and allow for the therapists to bill health insurers from commercial plans to government payers, such as Medicaid.

Bell and other co-sponsors say that it will also make the therapy more accessible to families who have children with autism around the state. Whether the bill will make a significant difference, however, is somewhat in doubt.

Intense treatment

Since 2015, ABA therapists have been able to be reimbursed for their treatments by insurers in North Carolina, after a long fight. The original bill allowing for the billing was introduced in several prior legislative sessions, and former House speaker Thom Tillis championed the measure.

ABA treatment can be ”intense,” explained Lorri Unumb, a then-representative of the advocacy group Autism Speaks, who led the charge in North Carolina to get the reimbursement bill passed for several years.

The treatment uses positive reinforcement and repetition – sometimes extreme repetition – to help break through the communication difficulties these children have and help them learn basic skills. Specially trained and certified therapists take each skill – from feeding oneself to bathing and dressing, even waving good-bye – and break it down into component parts.

a boy smiles at his ABA therapy counselor
Applied behavioral analytics (ABA) therapies can help children with autism through one-on-one, repetitive therapies that look to redirect or reduce reactions to otherwise overwhelming situations. (Photo courtesy of Autism Society of North Carolina.)

Unumb told NC Health News in 2013 that the therapy works better the younger the children start, but it is usable for older kids too, and even adults.

“So much of learning that children do is based on imitation, but a lot of severely impacted children don’t have that skill,” Unumb said.

That level of one-on-one interaction doesn’t come cheap. It’s time-consuming – requiring as much as 40 hours in a week – and it must be delivered by a therapist who can interpret incremental progress in the child.

But families like the Robinsons say it’s allowed them to have more interaction with their children and helped Bobby move through the world more easily. Other families say they’re grateful for ABA training their children to do things such as toileting and dressing themselves.

Board-certified behavior analysts, or BCBAs, have to complete graduate-level education, pass a board certifying exam and complete as much as 2,000 hours of supervised practice in order to be licensed. Thirty-one states now license the therapists to practice, but according to Bell, no other state has the supervision requirement that North Carolina does.

“There are a total of 62 psychologists in all of North Carolina that are qualified to provide this type of supervision,” said Matt Filer, who runs Mosaic Pediatric Therapy, the largest company in the state providing ABA services. “That’s 62 supervisors for over 65,000 children with autism.”

“This regulation … strangles job growth by discouraging BCBAs from coming to our state, and dissuading young North Carolina professionals from pursuing careers as BCBAs,” Filer said. “To meet the current needs, North Carolina must add 6,000 new board-certified behavior analysts and that is an impossibility under current regulation.”

Nationwide shortage

Loosening up licensure for BCBAs in North Carolina may not provide the relief that parents are looking for anytime soon.

A review of the landscape published in late 2019 found there are just too few BCBAs in the entire U.S. Researchers used national data from the Behavior Analyst Certification Board and found that only Massachusetts had enough practitioners to meet demand. North Carolina had only about one provider per 100 children who needed services when the study authors found that about six providers would be enough to satisfy the unmet need. Florida had the most ABA providers in the Southeast with less than four practitioners per 100 children with autism spectrum disorder.

“Workforce policies are needed to increase the supply of ABA providers if we want to increase access to these services,” said senior author Janet Cummings, from Emory University in a press release on the study. “If there are not enough ABA providers in a community, then efforts to improve early screening and identification will not necessarily lead to an increase in the receipt of ABA among youth in need of these services.”

An investigation by North Carolina Health News done in 2018 also found there were only a few hundred therapists in the state at the time, resulting in long waits for access to services. That number has ticked up to about 650 therapists in the state, plus about 1850 behavior analysis technicians who carry out the bulk of daily treatment.

The supervision requirement creates an additional hurdle, according to Monique Baker, who runs a small company staffed with BCBAs and technicians who provide services to about 50 children.

“Recently, the licensed psychologist supervising all of our BCBAs had to resign effective the end of this month,” she said during Tuesday’s press conference. “I placed ads in agencies across the state, utilized social media, reached out with personal emails and have not been able to locate one single qualified individual to supervise the services that we provide for children with autism.

“This North Carolina-specific barrier creates huge issues with access to care, causes long waitlists and forces higher cost to businesses. It also serves to create situations such as mine.”

Another scope of practice fight

BCBAs are not the only health care professionals who are looking to be released from similar supervision requirements, all advanced practice nurses such as certified registered nurse anesthetists and certified nurse midwives have long looked to be released from supervision requirements. The state’s medical societies have pushed back against eliminating supervision requirements for years.

Releasing BCBAs would be a first in the state, and it seems more likely to happen given the state’s psychological association has expressed support for the bill.

“We appreciate the opportunity to help craft language for the bill so that it provides the best licensure bill possible and maintains the integrity and scope of practice of other professions,” wrote North Carolina Psychological Association executive director Martha Turner-Quest in a statement sent to NC Health News.

But the Psychological Association has supported the measure before. An almost identical bill, House Bill 671, was filed in the last long legislative work session in 2019. It also would have created a pathway to licensure for the ABA therapists and a governing board to regulate them. It passed the House of Representatives almost unanimously but died after being sent to the Senate without getting a hearing.

“This bill is a step in the right direction,” said Rep. Gale Adcock (D-Cary), who is a nurse practitioner and has long pushed for removing the so-called scope of practice restrictions. “We, as a legislature, should pursue the removal of all unnecessary regulations for all providers, because citizens deserve the care that they need to be able to get the care they need.”

Adcock explained that there’s some support for removing scope of practice restrictions in the state senate, but noted that some in that chamber have resisted adding new licensing boards.

Nonetheless, she noted that there are some powerful senators who she believed would be in support.

“If it gets through the Senate, and it passes, what this says is we have a legislature that understands that too much regulation can prevent people from getting the care they need,” Adcock said. “It shows an enlightened legislature that’s willing to consider where can you do the most good, to lift this regulation and allow people to get the care they need.”

shows rows of headstones in a veterans cemetery

Cooper, national leaders respond to ravaged veterans nursing homes, look ahead for solutions

by

Cooper, national leaders respond to ravaged veterans nursing homes, look ahead for solutions - North Carolina Health News

Gaps in state federal oversight and accountability for privately run veterans homes are now facing scrutiny at all levels of government.

By Thomas Goldsmith and Riley Davis

The 36 deaths of North Carolina veterans in state veterans nursing homes have gotten the attention of Gov. Roy Cooper, whose spokesman says he’s moving to hold accountable the private management company that has run the homes for 22 years.

“The men and women who bravely served our nation deserve the best care in this pandemic,” Cooper spokesman Ford Porter said in an email July 30. “State health officials have taken extensive action to protect residents of nursing homes from COVID-19, including testing, personal protective equipment, and on-site inspections and enforcement if the homes’ infection procedures are deficient.”

ad reminding readers to support our COVID coverage

Then came an apparent stated intention to do something about it in the case of PruittHealth, the Georgia corporation that receives a commission amounting to about $4 million annually to run the homes in Fayetteville, Salisbury and Kinston, where a combined three dozen men died, as well as a fourth facility in Black Mountain.

“The administration is taking action to hold the management company accountable to provide quality care to North Carolina veterans,” Porter said.

A Pruitt spokeswoman declined to comment on the governor’s position.

Cooper’s statement, the first from a high-ranking North Carolina official on the veterans homes, came as the latest development in local and national efforts to investigate the operation of state-owned nursing homes for veterans. On Wednesday, a subcommittee of the U.S. House Committee on Veterans’ Affairs heard a plain message from federal watchdogs to the VA:

“VA Needs to Continue to Strengthen Its Oversight of Quality of State Veterans Homes.”

The testimony and report from the Government Accountability Office were the latest to draw attention to problems with state veterans nursing homes among a growing list of state representatives, U.S. senators and representatives, governors of several states, state legislatures and ad hoc task forces.

On Wednesday the GAO criticized the VA’s failure to present information about the quality of care at state veterans nursing homes on the VA’s website. This contradicted VA’s position that they had no oversight over the state homes even though the agency contributes significant pieces of their funding.

“VA is the only federal agency that conducts regular oversight inspection on the quality of care of all [state veterans homes] and, as a result, is the only agency that could share such quality information on its Website,” Sharon M. Silas, GAO director of health care, said in prepared testimony to Congress.

Nationwide attention to local problems

These are the most recent developments, but far from the only ones, in the examination of the quality of care at the state veterans homes, of which there are more than 130 across the country.

Read the other parts of this series: Thirty-six veterans die of COVID-19 in NC state veterans nursing homes that a private company has run for 22 years
Coronavirus deaths bring attention to privatized state veterans homes

On July 22, the Centers for Medicare and Medicaid Services under the direction of President Donald Trump said it would spend $5 billion on improving testing and other practices at all the nation’s nursing homes, in part to build better models of infection control.

Earlier in July, the North Carolina Department of Health and Human Services cited the State Veterans Nursing Home in Salisbury, managed by the for-profit PruittHealth Services, for lacking a plan for preventing infection at the facility.

In the wake of a catastrophic COVID-19 outbreak at the Soldiers Home in Holyoke, Mass., Gov. Charlie Baker launched an in-depth investigation that resulted in a scathing 174-page report faulting administrators of the center.

In June, North Carolina DHHS inspectors found that the state veterans nursing home in Salisbury, managed by PruittHealth was allowing as many as four or five carloads of visitors each weekday, despite bans of such visits under state and federal guidelines.

More of the nation’s veterans are completing their lives in nursing homes as they age and in some cases deal with intractable ailments caused by their service. The movement on enforcement comes as the nation’s system of state-owned veterans nursing homes deals with an investigation into their practices launched by two U.S. senators.

For-profit long-term-care chains can put concern for profit above residents’ safety, said Suzanne Gordon, a University of California-San Francisco School of Nursing professor and a long-term care authority.

“You can have falls, bedsores, you name it, infection — so it’s the perfect storm when you have a pandemic like COVID-19,” Gordon said. “You have poor staffing, you have poor pay so that nursing home workers have to work in multiple different facilities. And they take the infection from one facility to another. You have an incredibly vulnerable population. And you have low staffing and low training.”

Nationally, hundreds of COVID-19 deaths in state veterans nursing homes have created pushback from elected officials, family members and others who at least want more information about what’s going on.

The NC State Veterans Nursing Home in Fayetteville is managed for a percentage of revenues by PruittHealth, a Georgia-based corporation. State records show that 20 veterans died of COVID-19 here during the pandemic. Photo credit: Greg Barnes

A good bit of buck-passing surfaces along with issues of these nursing homes. After all, they are owned by the state, which can manage the facilities as well, but has chosen to employ PruittHealth care for 22 years under a contract that now pays the company 9.25 percent of overall revenue.

The bills and Pruitt’s commission are paid with a combination of federal Medicare, Medicaid and Veterans Affairs payments, as well as some private payments.

‘VA pays for veterans to receive care’

After more than 70 veterans died in a Massachusetts soldiers home, Sens. Elizabeth Warren and Edward Markey, Democrats from that state, placed the federal Department of Veterans Affairs at the heart of possible reform of SVHs, or state veterans homes. The Soldiers Home in Holyoke, Mass., contained nursing home beds, a dormitory section and hospice care.

“While VA does not supervise or control the administration of State Veterans Homes, VA pays for veterans to receive care at these facilities and is the only entity that inspects every SVH in the nation,” they wrote on May 5.

“As long as VA is utilizing State Veterans Homes to provide care for veterans and pays for all or some of care costs in SVHs across the country, the Department should faithfully and efficiently implement GAO’s recommendations and ensure veterans are receiving quality care.”

Veterans Affairs guidelines certify who is eligible for a bed in these homes, and the agency conducts yearly inspections of the facilities. VA communications staff told NC Health News in a series of emails that the agency does not run these facilities, and that it is up to individual states to decide how they will operate their veterans homes, and whether to contract with private companies.

However, a 2019 Government Accountability Office report found that the VA can cut the purse strings for a state veterans nursing home if the center doesn’t measure up.

“… federal law prohibits payments to SVHs that do not meet standards the VA prescribes and authorizes VA to inspect any SVH at such times as VA deems necessary to ensure that such facility meets those standards,” the auditors said.

In addition to state-owned nursing homes of the sort managed by Pruitt, veterans can choose among community living centers that are owned and operated by the VA and community nursing homes that operate under a VA contract.

‘I’ll continue pressing’

U.S Rep. David Price (D-NC), North Carolina’s only member on the House Appropriations Committee, said he’ll make use of his position to push for the best care for veterans in state nursing homes.

“I’ll continue pressing the Department of Veterans Affairs and Department of Health and Human Services to provide additional resources to these vulnerable residents to ensure a safe environment for all,” Price said in a statement to NCHN.

As a national examination gets underway of nursing home practices regarding COVID-19, PruittHealth CEO Neil Pruitt Jr. has been called on to become part of it. On June 19, Pruitt became one of 25 professionals with long-term care expertise named to the Coronavirus Commission on Safety and Quality in Nursing Homes.

The federal Centers for Medicare and Medicaid Services announced the appointments and said that the panel would conduct “an independent review and comprehensive assessment of the nursing home response to the Coronavirus Disease.” The statement says members will be working under Trump’s leadership.

In May, the North Carolina General Assembly, as part of one of two COVID-19 relief bills, asked the North Carolina Area Health Education Center, or NC AHEC, to include nursing homes in a study of the effects of the pandemic and preparation for public health crises to come.

Anna Amirkhanyan, the American University professor whose studies include public-private relationships in nursing homes, noted that community voices are largely lacking when public resources are privatized.

“We have not observed any major trends in citizens setting the agenda or resolving and participating in larger policy issues like privatization of a major chronic care provider in the community,” she said.

Professor: Society fails to value long-term care

The decision to contract a state’s nursing home operations out to a private company isn’t out of the ordinary, Boucher said.

“The state could certainly see that as a cost-cutting measure, and a human resources efficiency measure,” he said.

Leland resident Jennifer Brigman remains concerned about the way her dad, retired Master Sergeant Harold Lee Brigman, Sr., was treated at the Fayetteville center, and the way that dollars for his care got spent by PruittHealth.

Retired Master Sergeant Harold Lee Brigman, Sr., 85, seen here with daughter Jennifer Brigman, of Leland, died of COVID-19 in May in the NC State Veterans Home in Fayetteville, where 19 of his fellow residents also died after contracting the disease. Harold Brigman served for years as a police detective following his military service. Photo courtesy: Jennifer Brigman

Harold Brigman 85, died May 23 after living in the Fayetteville state veterans nursing home since 2017.

“They were getting money from the Veterans Administration, they were getting money for my dad’s Medicaid, they were getting money from, from, what is it called? Tricare,” she said. “My mother was paying $2,000 a month. Out of pocket, she spent about $80,000 while my dad was there.

“Yeah, and all they did was feed him, change him, and leave him in that wheelchair.”

The pandemic has thrown dysfunctions and societal shortcomings affecting the long-term healthcare system into sharp relief, both in veterans homes and beyond, Boucher said.

“It became that way because, years ago, nobody really wanted to take control over this,” Boucher said. “It wasn’t a huge moneymaker, it wasn’t really valued by society, and still isn’t. Older folks, people with disabilities, ageism, there’s a lot of stuff getting in the way.”

Riley Davis provided assistance via the the NC News Intern Corps, a program of the NC Local News Workshop, funded by the North Carolina Local News Lab Fund and housed at Elon University’s School of Communications.

Shows a woman in a McDonald's takeout window wearing a branded mask against COVID

Pandemic-related job loss nixes health insurance for nearly 200,000

by

Pandemic-related job loss nixes health insurance for nearly 200,000 - North Carolina Health News

Medicaid advocates say expansion now would help rural and urban economies alike and provide health care to aid public health.

By Rose Hoban

North Carolinians interested in the fate of Medicaid expansion certainly are familiar with the characters and well-worn script, by now.

Now, in the middle of a pandemic, when many are losing jobs and health insurance and finding access to health care even more difficult at the precise time it should not be, expansion advocates took to the stage again to try to share their story in a different light.

ad reminding readers to support our COVID coverage

Their performance was a virtual one. On Zoom, a stage that’s become all the more popular as COVID-19 circles the globe.

The N.C. advocates for expansion altered their well-worn script to include new numbers from the pandemic:

  • There could be from 100,000 to 191,500 North Carolinians among the newly uninsured.
  • Expanding Medicaid not only would help them provide care that is important for the public’s health, it also could lead to the creation of jobs in rural areas where hospitals have shuttered.

North Carolina is one of a dwindling number of states that has resisted taking billions of dollars of federal money to cover the Medicaid costs for hundreds of thousands of low-income workers who make too much to be eligible for the state- and federally funded program, but who also make too little to qualify for subsidized health insurance created as part of the 2010 Affordable Care Act.

As in many dramas where the characters are familiar and the script has been all too familiar, it’s difficult to imagine a different outcome.

In North Carolina, this production has been running since early 2013 when the North Carolina General Assembly removed the power of a governor to unilaterally expand Medicaid to cover low-income uninsured people.

No matter how much the audience and many of the actors hang onto their seats for a different outcome, the leadership in the state Senate is unlikely to take leave of its well-rehearsed lines.

No expansion.

“I don’t expect to see movement on any of these based on what we’re seeing from the legislature right now,” said Erica Palmer Smith, head of the Care4Carolina coalition that sponsored the video conference call on Tuesday. “I don’t see a pathway for any of these bills, based on legislative leadership’s statements and their intent not to deal with the coverage gap issue at this time.”

In advocates’ minds, the advent of the coronavirus pandemic has created an even stronger imperative to change the narrative around Medicaid expansion. Hundreds of thousands of North Carolina’s workers have lost their jobs since COVID-19 arrived in the state in early March, and as they lost their jobs, they’ve also lost insurance coverage.

Spotlight on increased need

A flurry of new research is attempting to put numbers behind the job losses.

It can be challenging to calculate rates of uninsurance, with tracking data about the number of uninsured usually lagging real time by more than a year. The U.S. Census currently displays data from 2019, which shows that 12.9 percent of North Carolinians lack coverage. The latest estimate of the rate of insurance from the North Carolina Institute of Medicine dates from fall 2018.

So, researchers have to look to other sources to make their estimates.

“It’s going to take us a year before we fully understand the economic consequences, the health care consequences of the pandemic,” said Jason Gray, an economist with the NC Rural Center during Tuesday’s webinar.

Gray cited recent statistics from the North Carolina Department of Commerce that show about 478,776 working-age adults lost their jobs as a result of COVID-19 in March, April and May.

graph shows an almost vertical drop off in employment statistics starting in march 2020, due to COVID
Employment took a nosedive in 2020 as the COVID-19 pandemic took hold in North Carolina. Graph courtesy: NC Dept of Commerce

He matched these numbers to a survey done by the Commonwealth Fund showing that 21 percent, to as many as 40 percent, of the newly unemployed lost health care coverage. Taken together, Gray estimated that as many as 191,000 could have lost coverage, not to mention their family members, who were covered under their policies.

“These are folks who are unable to afford their health needs, who are going to be economically distressed from, from being able to seek help,” he said. “These are people in dire need, and these are working people.”

Even before the start of the coronavirus pandemic, about 16 percent of North Carolina adults under the age of 65 were uninsured, the sixth-highest rate in the nation.

Gray’s estimates jive with a new report out Tuesday from Families USA estimates that at least 20 percent of working-age adults in North Carolina now lack insurance. Add to that their families’ losses of insurance, Families USA reckoned that at least 238,000 North Carolinians became uninsured this past spring.

Medicaid expansion would cover many, if not all, of these people, picking up 90 percent of the costs.

Economic benefit

According to an analysis done by researchers from the Economic Policy Institute using federal Department of Labor data, about 9 percent of North Carolina’s labor force were receiving unemployment insurance by the end of June, about 432,351 individuals. More than a quarter million (253,496) had also applied for or received pandemic unemployment assistance of $600/ month from the federal government.

Their analysis shows about 476,000 people lost employer-sponsored health insurance.

bar graph showing the number of people losing insurance coverage along with a job loss resulting from the COVID pandemic.
One of five adults who said that they or a spouse or partner had coverage through a job affected by COVID-19 reported that at least one of them
is now uninsured. Data, graph courtesy: Commonwealth Fund

The federal benefits have, in many cases, kept these workers’ lives and families intact. But the benefits are slated to sunset at the end of this month if Congress does not take further action. According to the Economic Policy Institute, a national policy think tank, Congressional inaction on this score could result in a total of 142,496 permanent job losses in this state.

The Rural Center’s Jason Gray talked about how in the most economically distressed counties in North Carolina, expansion would create a billion-dollar economic impact in the form of jobs, revenue to health care providers and all of the ripple effects created by economic activity. In addition, Medicaid expansion could provide up to $14 billion in local tax revenue throughout the state.

He said while most of Medicaid expansion’s additional jobs would take place in urban areas, the policy would also have a dramatic impact on rural coffers.

“Even in, say, in northeastern North Carolina, 1,200 jobs, 2,500 jobs down the far southwest,” he argued. “Even our most rural areas are going to benefit in terms of jobs.”

“It’s really important to realize that the greatest predictor of health is socioeconomic status and that’s comprised of three things: income, occupation and education,” said Karen Winkfield, an oncologist from Wake Forest Baptist Hospital and their director of community outreach. “We know that right now, income is being hammered by COVID-19.

“But someone’s occupation … can oftentimes dictate whether or not someone has access to health care.”

Plot twists

Medicaid is designed to be a safety net program that is counter cyclical, meaning that when the economy tanks, Medicaid rolls increase.

To date, though, North Carolina’s Medicaid enrollment has increased only modestly, by 100,665 beneficiaries (4.4 percent) since February, a smattering compared to the large number of people who lost employer sponsored insurance when they were laid off as a result of COVID-19 closures.

According to state Medicaid Director Dave Richard, Medicaid hasn’t bumped up much because of the federal legislation passed by Congress this spring which included those pandemic unemployment benefits. That’s allowed many people to keep paying their premiums and hold onto their coverage.

Many employers also kept people on insurance in the short term, even as they instituted furloughs.

There’s an even bigger reason recently laid-off workers haven’t swelled Medicaid’s rolls: it is almost impossible for a non-disabled childless adult to qualify for the program in North Carolina. Instead, all of the program expansion is among children.

Richard said he expects that as the supplemental unemployment payments phase out at the end of July more families will feel the hurt.

“We project that we’ll see a significant increase in enrollment as we go throughout this year,” Richard said. “The thing that’s difficult for us and every other state is to actually have a prediction model that works here. Because this, as we’ve all said, this is a totally different type of event. It’s not a typical recession, it’s something that has impacted people in different ways.

“You will continue to see those numbers rise and then depending how long, what happened to our economy, how long the public health emergency is in place … a significant increase.”

Because the General Assembly failed to expand the Medicaid program, many of these newly unemployed will eventually become uninsured, a plot twist not affecting people who lost jobs in expansion states.

According to insurance analysts Health Management Associates, Medicaid enrollment will likely increase dramatically around the country, while a “disproportionate share of the newly uninsured will be in non-expansion states.”

If the state had expanded, many of the newly uninsured would have fallen into the income range that would have the stcare, something of a happy ending.

Instead, HMA’s analysis notes that people in the 14 states that did not expand Medicaid, including North Carolina, comprise 30 percent of the individuals losing employer-sponsored coverage. Tragically, though, they will comprise 70 percent of those who will be newly uninsured by the end of the year.

man in mask opening door

How addiction recovery specialists adapted during COVID-19 pandemic

by

How addiction recovery specialists adapted during COVID-19 pandemic - North Carolina Health News

While some addiction service providers have been forced to cut programs, others have adjusted to the pandemic changes to assist people using drugs and those in early addiction recovery.

By Taylor Knopf

In his 20 years at Healing Transitions, Chris Budnick has never turned away someone seeking help.

But in late March after three false-positive tests for COVID-19 at the residential addiction recovery program in Raleigh, the program director made the tough call to stop all new admissions to the campuses and overnight detox.

ad reminding readers to support our COVID coverage

Soon after, a 71-year-old man came to the door hoping for a bed to sober up. Turned away, he fell asleep on the side of the road and Healing Transitions staff covered him with blankets.

That incident stuck with Budnick, as he and other Wake County partners worked to quickly set up a remote detox center.

Programs for people who use drugs or are in recovery, like Healing Transitions, have been quick to adapt to the changing needs of their clients. However, some providers are cash-starved and waiting for federal and state funding relief.

Meanwhile, the pandemic has created the perfect storm of stressors, putting those who use drugs or are in early addiction recovery at risk for the COVID-19 virus and overdose.

Homelessness and drug use frequently overlap. With program closures and social distancing in effect, people living on the streets are not only more exposed to virus spread, but they lack basic necessities.

Isolation is a common trigger for people to use substances, which is why a lot of recovery programs are built on peer support. That person-to-person contact conflicts with current public health advice for people to keep their distance to stop the spread of the virus.

man wearing mask sits behind desk with naloxone kits in a line in front of him
Healing Transitions staff member Virgil Shelton prepares naloxone kits, the opioid overdose reversal drug, which is readily available throughout the detox center. Photo credit: Taylor Knopf

Stress and anxiety, which are at high levels due to the widespread illness, job losses, isolation and decreased opportunities for recreational activities, can also also be triggers for substance use.

Finally, people in recovery who have given up substances have a lower tolerance for the quantity they may have used in the past. In particular, people who use opioids are at higher risk for overdose if they return to use.

“What we know from past natural disasters is that overdose rates do go up,” said Becca Lilly with NC Harm Reduction Coalition. “We learned from those experiences to give everyone (the opioid overdose reversal drug) Narcan. People do ask for it. But now, everyone gets it. Even if they say they don’t need it, we ask them to take it.”

Quick to adapt

NCHRC workers were quick to adapt to social distancing because many of their needle exchanges are already mobile. Lilly is based in Wilmington, where she said past hurricanes had prepared the organization to have an emergency plan in place.

Harm reduction staff who work the mobile exchanges have met people where they live or gather to deliver supplies and pick up used needles, all while keeping a distance. At the one fixed site exchange in Wilmington, workers are offering curbside pickup of supplies. And the support groups and check-ins have moved online or over the phone.

Never Use Alone 

Because people are isolated and still using drugs, harm reduction workers are encouraging folks to call (800) 484-3731. Someone from the Never Use Alone initiative stays on the line with the person using drugs to make sure they are OK. If there is no response after they use, EMS is called.

The pandemic has created a unique challenge for residential programs where social distancing is nearly impossible. Congregate living settings are prime breeding grounds for the virus, apparent in outbreaks at prisons and nursing homes throughout the country.

Residential programs for people in early recovery, such as TROSA and Healing Transitions in the Triangle, have stopped accepting new participants during COVID-19.

cots and blankets lined up in a room
Wake County provided cots for the men at Healing Transitions’ remote detox center in southeast Raleigh. The Southeastern Health facility already had a couple bedrooms that are being used for the women. Photo credit: Taylor Knopf

At the guidance of local health officials, Budnick made the difficult decision to close the on-campus detox center on March 25.

“We don’t turn anyone away seeking services,” he said. “This is the first time in decades we’ve had to say ‘no’ to someone.”

Remote detox center

By April 6, the temporary remote detox was up and running at a site next to WakeMed Hospital. The hospital provides the meals and the county donated cots.

In the first four weeks, the detox received 91 people, for a total of 134 admissions, with referrals from former participants, as well as Garner, Raleigh and Cary police departments and EMS. Healing Transitions staff responded to one on-site opioid overdose and saved the man’s life using naloxone.

State data shows that overdose-related emergency room visits increased in March and April over the previous months.

Of the admissions to the detox center, 60 percent of men were using more than one substance when they were admitted. Alcohol was involved in more than half the admissions, cocaine was involved in 47 percent, and heroin in 27 percent. Meanwhile, the majority of women were only using one substance, primarily alcohol or heroin.

While the opioid crisis has been at the forefront of the drug conversation in recent years, stimulant use has also been on the rise.

The remote detox uses RelyMD telehealth visits when needed to evaluate patients showing severe signs of substance withdrawal. Doctors cannot prescribe controlled substances through telehealth, but they’ve been able to prescribe drugs such as gabapentin for alcohol withdrawal, which staff can pick up from the local pharmacy.

Alcohol withdrawal symptoms must be monitored closely, as severe conditions can result in serious organ damage or death. At least two admissions to the remote detox center were transferred to the hospital for treatment of severe alcohol withdrawal, including elevated heartbeat.

“Part of the goal with the running off-site detox is to continue to serve the individual with the need, but also to try to serve first responders and to try to serve the emergency departments and hospitals to avoid people ending up there,” Budnick said.

People can stay at the detox center until their withdrawal symptoms are stabilized and they find a place to go. Since Healing Transitions cannot take new participants due to the pandemic, finding housing for people just out of detox has been more challenging.

Oxford Houses, homes for people in recovery, are still accepting people right now. Healing Transitions staff member Amy Brucia lived in an Oxford House for two and a half years and still maintains a lot of her connections to houses in the area. She’s helped several people leaving detox to navigate the application process and join one of the more than 50 Oxford Houses in Wake County.

Brucia is also on the Oxford House alumni board and the organization has adapted to the needs of people during the pandemic. For example, typically Oxford Houses have a 14-day rule that says you cannot live in the house for two weeks if you have a return to substance use. That has been lifted in many cases during the pandemic, she said.

woman wearing mask sitting at a table
Amy Brucia, staff member at Healing Transitions, uses her experience as an Oxford House alumna to help find lodging for people leaving detox during the pandemic when housing is limited. Photo credit: Taylor Knopf

Healthy hotels and stimulus checks

Wake County, as well as other counties across the state, has set up designated “healthy hotels” and “symptom hotels” to get people out of congregate settings or off the streets during the coronavirus pandemic.

Healing Transitions offered older residents and those with underlying health conditions the option of living in “healthy hotels.” So far, 18 participants have taken the offer. Some leaving the remote detox center have also qualified for the hotels.

But hotel living presents unique challenges for those who use drugs and those trying to stay sober. There’s a lot of time alone and now with the stimulus checks, people have extra cash on hand. Budnick said there’s an expression around tax season every year: your rapid tax refund is your “rapid relapse check.”

Related story: During the coronavirus pandemic, recovery support moves online

“I’m a person in recovery, and I know that if I was in addiction while all of this was going on, and I had a lump sum of money go into my account, I can’t imagine that would be the best,” Brucia said.

Money, isolation and being somewhere or with someone associated with getting high can all be triggers for using drugs again, Budnick said.

“Someone can be in a hotel right now for their own safety, and at the same time be dealing with the memories of getting high in hotels,” he said.

Peer support specialists from Healing Transitions have been checking in to support people in recovery living in the healthy hotels both in person and by phone.

white board with a meeting schedule in a common area
People staying at the Healing Transitions’ remote detox center are encouraged to attend virtual recovery meetings held by local groups. Photo credit: Taylor Knopf

Around the state

Some addiction treatment service providers around the state are cash-starved because they’ve been forced to alter or cancel certain services during the pandemic closures.

Addiction Professionals of North Carolina (APNC) surveyed 70 addiction treatment organizations — both inpatient and outpatient — and found that 57 percent had to close at least one program.

More than 40 percent reported to APNC that they can only survive financially for a month or less under current conditions. Nearly 30 percent have laid off or cut staff, and an additional 40 percent are deciding whether to cut people right now.

APNC found that most community-based programs are operating at half their weekly revenue and their emergency funds are almost gone.

There have been certain flexibilities and rule changes to accommodate behavioral health providers during this time, but it’s a lot to keep up with the different schedules and rules from the different payer sources, said APNC Executive Director Sarah Potter. And some have already maxed out their credit just to keep the doors open through this public health crisis.

There’s some money for behavioral health in the HEROES Act, which was passed by the U.S. House last week and is now waiting for the U.S. Senate to act. Though that won’t be enough to address the needs of the whole country, Potter said it will help. But it cannot come soon enough.

She and other recovery advocates are asking the North Carolina General Assembly leaders for help in the meantime.

“We really don’t have the runway to wait for all those things, and so we’re calling on leadership to earmark emergency funding now,” she said.

[email]
[email]
[zip]
[zip]
[listGroups]
[listGroups]
[email]
[email]
[zip]
[zip]
[listGroups]
[listGroups]