Trouble Coping? How the Emotional PPE Project Can Help

It’s been six months since the start of the coronavirus pandemic here in the U.S., and nurses all over the country are still fighting the effects. New hotspots are popping up around the Great Lakes, near the Rocky Mountains, and throughout the Midwest. As the layout of the pandemic changes, some nurses are coming to terms with the reality of the moment, while others are reliving the drama they experienced last spring when the virus was ravaging New York, California, and Michigan.

Mental healthcare providers say all this stress and ongoing trauma can be a recipe for disaster if left untreated, especially as the pandemic lingers on.

Kimberly Johnson, a therapist in Long Beach, NY, has been seeing healthcare providers remotely since the start of the crisis. She recently started volunteering with the Emotional PPE Project, which offers free counseling and therapy to healthcare workers who have been impacted by the pandemic. The network currently has over 450 licensed therapists across all 50 states. If you’re having a hard time coping with the new normal, help is nearby.

Waves of Grief and Anxiety

During her work, Johnson has been hearing from providers all over the country. She says this current juncture point in the pandemic is critical.

“In the beginning, a lot of them were in that high-stress, high-response mode. And during that time, they may not be as active and processing what’s going on or what they’ve been through. And now, months later, we’re starting to see the kind of the quieting come in and [their experiences] coming back up for them.”

She will often hear from nurses that spend their days sitting in bed with patients helping them coordinate Zoom calls with family and friends. Many providers are still processing the grief and losses they faced earlier in the year. As the work continues, nurses often don’t have the means or time to come to terms with their experiences as they juggle life, work, and their own health concerns.

Instead of nurses telling her they want to leave the profession, Johnson says many of them are looking for ways to keep going as they continue to combat the pandemic.

She recalls, “The people that come to me are not necessarily talking about, ‘I want out.’ It’s, ‘Is what I’m experiencing normal? When will it get better? How can I help myself and my family?’ It’s really people looking at how I can continue to do the work I’m doing and doing the quality of work I’m doing with this situation as it is.”

While the pandemic is anything but normal for many people, Johnsons says what these providers are going through is similar to trauma we’ve seen in the past. 

She compares it to what happened after 9/11. “Difficulty sleeping, problems with eating, problems with, you know, ruminations about what happened, issues with frustration and anger, depression. It’s a lot of similarity there.”

Free Help on Demand

The Emotional PPE Project, which launched over the summer, is looking to help providers who have been affected by the pandemic, including nurses, EMTs, physicians, and home living aides, as well as licensed therapists that want to donate their services to those in need.

If you’re looking for help, just open the website, select your state, and you’ll see a number of experienced mental health providers along with their training and specialties, such as depression, PTSD, and couples and family therapy. No bills or insurance required. All the providers are volunteers, which creates a network of goodwill.

The project originally started as a pilot program at Massachusetts General Hospital. It soon branched out across the country as more therapists were conducting sessions online.

Ariel Brown, PhD, founder of The Emotional PPE Project, says it’s all about increasing access to care. Talking about the initiative, she says:

“Many healthcare professionals are uninsured or underinsured and are concerned there may be personal and professional consequences if they use employee-based services like employee assistance programs (EAPs). Because the Emotional PPE Project is independent from any other institution, and all services are free, key barriers that may stop people from getting support have been removed.”

The project is just a directory of providers, so nurses don’t have to worry about sharing confidential information with a third-party.

Those who want to support their fellow nurses can also donate to the project online to make sure other providers can get the support they need.

If you are struggling to cope, don’t be afraid to ask for help. 

Ever Heard of “Trumpcare”? Dubious Ads for “Garbage” Insurance Spread Online

In the lead up to the November 3rd election, Facebook and Google both agreed to ban misleading information regarding politics, but that doesn’t apply to health insurance. 

President Trump and the GOP have long promised to replace the Affordable Care Act, also known as “Obamacare”, with a more conservative approach to healthcare that would strip protections for those with pre-existing conditions. The plan, which has yet to be unveiled, is often referred to as “Trumpcare”, but details remain scant.

Now, Facebook and Google are running ads for health insurance with the “Trumpcare” label. These ads aren’t political in nature, but instead encourage people to sign up for health insurance policies that could put consumers at risk. Those looking for insurance will get bombarded with calls from unlicensed brokers selling policies with gaps in coverage that exclude certain conditions or contain misleading information, all of which could lead to higher costs, less access to care, and more surprise bills.

Getting Rid of the ACA

The ACA requires traditional health insurance plans to provide “minimal essential coverage,” which includes services such as preventive care, mental health care, substance abuse, maternity care, and more. The law also protects individuals with pre-existing conditions, so insurance companies can’t deny them service due to their health status.

President Trump has made dismantling the ACA a key part of his re-election campaign. The GOP has tried to undo the law several times over the last few years. The law is currently being challenged in court. The case, California v. Texas, is set to go before the U.S. Supreme Court later this year.

Getting rid of the ACA would likely strip health insurance plans of these “essential benefits,” which would leave more people without health insurance.

Since 2010 when the ACA was enacted, the number of uninsured nonelderly Americans decreased from over 46.5 million to just below 27 million in 2016. However, recent attempts to undermine the ACA have reversed this trend. Since President Trump took office, the number of uninsured Americans rose by 2.3 million from 2016 to 2019, including 726,000 children, according to the U.S. Census Bureau.

Is “Trumpcare” Real?

Repealing the ACA has long been the goal of the Republican Party, but it’s still not clear what they would put in its stead. President Trump maintains that his plan for replacing the law, or “Trumpcare”, is just around the corner, but the election is just two weeks away.

However, some consumers are already signing up for non-traditional health insurance plans, even though the ACA has yet to be repealed. According to Facebook data, ads touting health insurance policies with the “Trumpcare” banner have already been viewed more than 22 million times since the beginning of 2020. The ads appear to target voters in swing states, such as North Carolina, Texas, Wisconsin, Florida, Ohio, and Pennsylvania.

Instead of encouraging the person to vote for either President Trump or Vice-President Joe Biden, the ads contain misleading information regarding health insurance policies with temporary or limited coverage. If users click on the link in the ad, they are often redirected to a website with logos from major insurance companies, such as UnitedHealthcare. The user is then asked to enter their contact information, as well as details regarding their health status.

Those who report they are healthy will get flooded with calls from unlicensed insurance brokers. Some consumers report getting harassed over 50 times a day after entering their information. If the person picks up the phone, the broker, who is not employed by the insurance provider, will use aggressive sales tactics to get the person to sign up for policies with limited or temporary coverage.

According to Sabrina Corlette, a research professor at Georgetown University’s Center on Health Insurance Reforms, “The marketing is extremely deceptive. Both the advertising and the brokers use terms that to the average consumer will make them think they are buying a comprehensive insurance plan that provides coverage if they get injured or sick. But quite often nothing could be further from the truth.”

Evasive Tactics

Many of these non-traditional policies exclude certain types of care, such as mental health, maternity, and preventative care for those with pre-existing conditions. However, the brokers rarely share these exclusions and restrictions with customers. When consumers ask questions over the phone or request additional information about the policy in question, the broker will either avoid the question or the line cuts out.

If you ask licensed insurance brokers about these “Trumpcare” policies, they will tell you it’s “fake news.” That’s according to recent reporting from ProPublica, which reached out to several professionals in the insurance industry. Some said the label was just a new way of referring to “Obamacare”, but others said, “‘Trumpcare’ is not even in existence yet.”

Thanks to Facebook’s user analytics, marketers have been targeting consumers with unprecedented precision. Brokers use these tools to identify “leads,” or those most likely to buy the health policy in question. This includes those with an expressed interest in President Trump as well as those looking for health insurance. That’s a lot of people, considering 14 million Americans have already lost their employer-sponsored insurance since the start of the COVID-19 pandemic.

A company called Apollo Interactive has been collecting data on those looking for health insurance. These consumers then become leads for companies and unlicensed brokers looking to sell dubious policies. Google and Facebook will charge marketers anywhere from $20 to $80 for these “leads,” based on how likely they are to make a purchase.

Looking at the Fine Print

While some of these health insurance plans say they can help consumers save money in the short term by covering at least part of the cost of medical care, it’s not the same as buying traditional health insurance. For example, some ads say they offer fixed payments for a doctor’s visit, but when you read the fine print, this only applies if the person suffers from a certain type of accident. Other plans will only cover people for a limited period. Some sales reps will even outright lie about the details of the policy.

Justin Brain, a USHEALTH benefits specialist who’s been pitching these policies online, said sales agents can make tens of thousands of dollars for every policy they sell to consumers.

One of those is the Freedom Life plan, which comes from the Freedom Life Insurance Company of America, a UnitedHealthcare company. Jeffrey Hogan, the Northeast regional manager for Rogers Benefit Group, a national benefits marketing firm, examined the policy and deemed it, “a “cascading mess” of coverage for specific conditions. “I wouldn’t sell this stuff if it was the last piece of garbage on earth,” Hogan said. He says these policies are highly profitable for insurance companies. In the end, “they pay very little out on the dollar,” he said.

Looking at the fine print, many of these policies are meant to supplement traditional health insurance plans, like those offered under the ACA. This means they are not a good choice for those who are currently uninsured, but you wouldn’t know that by scrolling through Google or Facebook. As more people lose their health insurance, be on the lookout for dubious policies that could put your patients at risk.

State Governors Line Up to Review Potential COVID-19 Vaccines

The idea of getting vaccinated for the coronavirus has become a divisive issue in recent months. According to the Pew Research Center, the number of Americans that say they would definitely or probably get a COVID-19 vaccine recently dropped from 72% back in May to 51% in September.

With President Trump hoping to get a vaccine before the Nov. 3rd election, many people on all sides of the political aisle have become increasingly worried that the federal government may rush the process for political reasons. The U.S. also has a significant population that’s generally opposed to the idea of getting vaccinated against anything from measles to chickenpox, especially if these drugs are coming from the government.

With six major possible vaccines moving through the clinical trial phase, we should know whether these drugs work in just a few weeks or months. That’s according to Dr. Anthony Fauci, from the National Institute of Infectious Diseases. He recently told CBS News that he hopes to have more concrete information on the efficacy of these drugs by the end of the year. He also said he has “strong confidence” in the safety of any drug that gets approved by the Food and Drug Administration. If they are approved, Fauci says they will likely be available by April of 2021.

Now, several state governors, including Gov. Newsom from California, have said that they will independently review these vaccinations before releasing them to the public, adding another layer of protection for patients and consumers. While experts say this could encourage more people to get the vaccine, it could also add another layer of bureaucracy that could slow down the process.

State Governors Speak Up

The coronavirus pandemic has been uneven across the country. Coastal states like New York and California have been ravaged by the deadly disease for months, while more rural states have imposed little to no safety restrictions. NY and CA are also the two largest states in the union with liberal constituents that have little faith in the U.S. President, especially after months of touting unproven treatment techniques.

This has undermined confidence in the American medical system, including the FDA and CDC, which could make it harder to vaccinate the general population. The latest statistics from the Pew Research Center and other news outlets that show declining support for a COVID-19 has experts worried.

That’s why both New York and California have decided to set up their own independent review boards for testing any COVID-19 vaccine that’s been approved by the FDA. These boards will include public health experts from each respective state.

During a recent press conference, Newsom said, “Of course, we don’t take anyone’s word for it. We will do our own independently reviewed process with our world-class experts that just happen to live here in the state of California.”

NY Gov. Andrew Cuomo, along with the National Governors Association, recently published a list of questions for the federal government on the effective implementation of a potential COVID-19 vaccine. This comes just a week after the federal government imposed a strict deadline for every state in the union to submit a framework for how they plan on distributing the vaccine to the local population. While this is just a template for vaccination, many states have said they still need more information from the federal government before they can start planning effectively. For example, the list of questions includes:

  • How will the vaccine be allocated to states? What formula will be used? 
  • How will the vaccine be distributed? What mechanism will the federal government use?  
  • How will funding/reimbursement for vaccines be handled? 
  • How will vaccine administration costs be covered for people who are uninsured?  

Additional Safety Measure or Bureaucratic Mess?

Public policy experts are divided over the idea of having each state independently review a possible vaccine for COVID-19. 

LaVonna B. Lewis, a professor of public policy with an emphasis on healthcare at the USC Sol Price School, says she’s still on the fence. “To assume that people will just automatically shake off all of the misinformation that has been part of this process and all the viciousness that has been part of this process and just stand in line and take the vaccine, I think is unrealistic.”

Lewis says we all need to work together to restore faith in the American medical system. The issue often comes down to who’s delivering the message.

“Trusted agents make a difference,” Lewis said. “If I don’t trust the messenger, then it’s very difficult for me to believe the message.” That means politics could come into play, whether we like it or not.

Now that we’re in the middle of a contentious election, we need both Democrats and Republicans to get on board with a plan to distribute a vaccine for COVID-19, but the parties can’t seem to agree on pretty much anything.

To Each Their Own

Throughout the pandemic, the Trump Administration has largely left the states to their own devices as they impose their own safety guidelines. The government may use a similar approach for distributing the vaccine, which means each state will need to find a way to make sure the drug first gets to those who need it most.

Every state is different, which could add confusion to the process. Getting the drug to low-income patients, first-responders, and those with pre-existing health conditions continues to be the chief priority when formulating these plans.

Having each state independently review any drug for COVID-19 that gets approved by the FDA could slow down the vaccination process, but states haven’t received a lot of support from the federal government thus far, so they are planning to go it alone.

Stolen Patient Records and Hoarded Pills: TN Nurse Faces Criminal Charges

Margaret Grimsley, a long-time registered nurse, is at the center of a crime scene in Chattanooga, Tennessee. The woman had been living in a small house outside of the city for twenty years when her landlord decided to file for eviction after Grimsley stopped paying her bills.

When the local authorities finally got inside the home, it was full of stolen patient records, prescription medications, and unused medical supplies. It’s one of the strangest examples of hoarding in recent memory. Now Grimsley is facing criminal charges.

The Warning Signs Pile Up

Kari Matthews, the owner of the property in question, became concerned when Grimsley stopped paying rent and piles of trash started collecting outside the home. For Matthews, it was a clear case of hoarding, a condition in which the person has difficulty discarding or parting with possessions because of a perceived psychological need to save them, regardless of their apparent value.

“We had an eviction. The person residing here was a hoarder, wasn’t paying bills as they should,” she told a local news outlet.

71-year-old Margaret Grimsley had been living in the house for 20 years when Matthews filed for an eviction. Several local deputies soon arrived at the house to investigate, but it was unlike anything they had ever seen.

The entire interior was full of trash, dirty clothes, and even human feces. “We found where she had been defecating on the floor…she was using clothes to wipe,” Matthews remembered.

But that wasn’t the most disturbing part. “We knew what we were getting into as far as a hoarding situation when we came in… then we started uncovering patient records, pill bottles, extra identities,” Matthews said.

Authorities also say they found a range of syringes and even blood vials from patients Grimsley must’ve treated in the past.

“We’ve pulled out entire original files on patients from the facility they were at,” Matthews said. Apparently, there were enough files on hand to fill an entire investigator’s van.

Police also found hundreds of grams of prescription pills including Xanax, Oxycodone, and Fentanyl, according to court documents.

Now, Grimsley is facing several criminal charges, including identity theft and possession of a number of prescription drugs for resale.

But Why (and How)?

It’s not clear exactly why Grimsley was holding onto these materials or how she got her hands on them in the first place. A local news outlet reached out to her after the charges came down. Grimsley says she meant to destroy the patient records but forget they were there. “To be perfectly honest I thought they were gone…but anyway that’s how those got there,” she said. Court documents show that she said the same thing to the local police upon her arrest.

However, medical facilities rarely ask their employees to destroy protected health information. HIPAA details specific instructions for deleting this information. By no means should a provider be able to take these records home, let alone store them in their house for several years. These records contain private, personal information that could be used to steal a person’s identity.

According to federal law, “medical offices must ensure paper and electronic records are destroyed by a method that provides for no possibility that the protected health information can be reconstructed.” Common methods including shredding, burning, and pulverizing documents.

As for the pills in her possession, Grimsley says she had nothing to do with it. She told reporters that she believes she’s being set up. “Some of those…I don’t know how they got there.”

She is still licensed by the Tennessee Board of Nursing and has been since 1969. However, that license is expected to expire next month. When asked if they were aware of the charges against Grimsley, the group said it hadn’t taken disciplinary action against the RN, considering, “Everyone is entitled to due process.” There is no state law that requires automatic action against a health professional’s license if he or she is charged with a crime.

However, according to state law, “If an applicant or a registered nurse already licensed by the Board is convicted of any crime, it is grounds for denial of licensure or disciplinary action.”

Grimsley is due in court on October 28th.

The Facts on Hoarding

Current estimates suggest that hoarding effects around 6% of the U.S. population, or 19 million Americans. It’s usually common among people who live alone, those who are considered obese, those suffering from OCD, and those with at least one family member that’s considered a hoarder. It can also be a risk factor for addiction. 

Studies also show that adults between the ages of 55 and 94 are three times more likely to have a diagnosable hoarding disorder than adults between 34 and 44 years old.

It’s not clear what sets off the condition, however researchers believe it’s often linked to trauma and genetics. Over time, hoarding can lead to poor hygiene, unsanitary living conditions, the spread of disease and bacteria, and poor air quality.

If a person seems like they have a hard time letting go of things that most people would throw away, it may be a sign of hoarding. Experts say those suffering from hoarding should seek professional help. Treatment usually involves counselling and support groups. Cognitive behavioral therapy tends to be the most effective, with 70% of patients experiencing positive results, according to the latest recovery statistics.

Grimsley may need counselling more than a stay behind bars. Keep this information as your patients spend more time at home and less time in public.

Pfizer Readies First COVID-19 Vaccine for Possible November Approval

A safe, effective vaccine for COVID-19 can’t come soon enough. The pharmaceutical giant Pfizer made headlines over the weekend when it announced it has manufactured several hundred thousand doses of a potential vaccine. The company expects to send the finished product to the FDA for emergency use authorization by the third week of November.

The company hopes the vaccine will provide a sort of stopgap against a possible additional wave of the virus. Cases and hospitalizations are rising in several new hotspots across the U.S., including Colorado, Montana, Wisconsin, Iowa, and Utah. Europe is also struggling to contain recent outbreaks after lifting safety restrictions over the summer.

So, could we have a working vaccine by the end of November?

Ready and Waiting

Producing the world’s first COVID-19 vaccine is no easy feat. Dozens of drug makers have entered the race to produce a working vaccine, and Pfizer appears to be nearing the finish line, but there’s still more work to be done.

The news first broke when Pfizer’s U.K. production head Ben Osborn told the U.K.’s Daily Mail that the company hopes to submit the drug for review by the FDA by the third week of November. Osborne told reporters that the company is stockpiling hundreds of thousands of doses in a storage facility in Belgium so they can quickly distribute the drug to scale if it receives emergency use authorization from federal regulators, which means providers would be able to administer the drug on a limited basis. If approved, the company says it would start distributing the drug immediately.

Many drug manufacturers, including the U.S. government, have started producing doses of these drugs before they’ve been approved by regulators as a way of expediting the vaccination process. 

For the employees working on the Pfizer factory floor, it was a tremendous feeling of accomplishment.

“It was great to see the first vial coming off the manufacturing line. It just brought a tremendous smile to my face to see all of this work actually result in a product,” Osborne recalled. However, he cautioned that “we can only go as fast as the science allows us to.”

If all goes well, Pfizer says it plans to produce around 100 million doses of the vaccine by the end of the year with the goal of manufacturing 1.2 billion doses in 2021. Every patient would need to receive two doses, according to the company.

In collaboration with the firm BioNTech, Pfizer also announced that it’s working on distributing 200 million potential doses to the European Union.

While Pfizer is touting its latest achievements, it’s not clear how effective the drug will be. When speaking with Osborne, the Daily Mail showed a video detailing the company’s manufacturing process, but it was later revealed that the drug being manufactured in the video wasn’t the COVID-19 vaccine, which left some in the industry scratching their heads.

Checking in on Other Candidates

Pfizer isn’t the only company in the race. Currently, the Trump Administration is hedging their bets on six possible vaccines as part of its Operation Warp Speed.

Many of these candidates will try to trick the body into thinking that it has been exposed to the virus, so the immune system can quickly fight off an infection if the person were to get infected.

The vaccines from Moderna and Pfizer use a snippet of the coronavirus’ genome to encourage antibody production, while those from AstraZeneca and Johnson & Johnson supposedly introduce a coronavirus gene to the body using a genetically engineered common-cold virus.

Any one of these companies could emerge as the winner of the race as we get closer to 2021. It’s also important to remember that we will likely have more than one working vaccine. Some may be more effective than others, while some may contain side effects that others don’t.

Johnson & Johnson halted its clinical trials last week after a participant came down with an unexplained illness, which is fairly common during the clinical trial phase. However, neither Johnson & Johnson nor the FDA have stated publicly what went wrong or where the trial goes from here. It’s not clear whether the patient in question fell ill after receiving the drug that’s being studied or a placebo drug.

Other firms and organizations like UNICEF recently announced they are stockpiling equipment and medical resources to administer a potential vaccine, including basic supplies like syringes.  

Regardless of when these drugs get approved by the FDA, experts maintain that a working vaccine probably won’t be widely available until mid-2021. Some frontline workers may get a dose of one of these drugs by the end of the year, but don’t hold your breath.

$52,112 for a Helicopter Ride? Surprise Medical Bills Amid the Pandemic

U.S. lawmakers have been working on protecting consumers and patients from surprise medical bills for years. Earlier this year, both parties were close to passing legislation that would mandate protections for patients, but the effort was stalled after private-equity firms started flooding the country with ads opposing the policy. As the bill got held up in deliberation, the coronavirus pandemic hit, further stalling the process.

With no law in the books, patients have become more vulnerable to surprise medical bills than ever. Congress set aside $175 billion for hospitals, doctors, and providers working on the front lines of the pandemic, but to receive this money, they had to agree not to send surprise medical bills to their patients. However, the protections are littered with gaps that can put patients at risk.

Short Rides and Steep Bills

Around 450,000 Americans have been hospitalized with coronavirus thus far, with more being admitted every day. Having a robust health insurance plan may not be enough to shield patients from surprise medical bills, which usually stem from ambulance rides, out-of-network providers, and medical laboratories. In many cases, the patient didn’t choose the provider(s) or the care they received. It was after they left the hospital when they realized how much they were being charged.

That’s what happened to a 60-year-old woman from Pennsylvania who wishes to remain anonymous for personal reasons. She was being treated at a hospital in Philadelphia for COVID-19 when the medical team decided to take her off her ventilator, so they could move her by helicopter to another local hospital with better care equipment nearly 20 miles away. After spending six weeks in the hospital, she later recovered from her illness, but she continues to suffer from symptoms to this day.

Now house-bound, she’s gotten hit with a bill for $52,112 from the air ambulance company. “How am I going to pay this all off?” she worries. 

She was unconscious when providers decided to move her to another hospital, so she didn’t have any control over the process. Both hospitals are also in-network. It was the air ambulance company that wasn’t covered by her insurance. Blue Cross initially offered to cover $7,539, but the company later reneged its offer.

She isn’t alone.

Studies show around 71% of ambulance rides result in surprise medical bills. Around 20% of emergency room patients are also at risk of getting hit with these charges.

Dealing with all this financial stress can be overwhelming when these patients are still recovering from the illness that put them in the hospital in the first place. Around a third of hospitalized coronavirus patients say they’ve experienced an altered state of mind after contracting the disease. This often includes fatigue, confusion, and mental fog.

For the woman from Pennsylvania, she’s still having trouble completing basic tasks like cooking, bathing, and eating.

Filling the Gaps

While Congress tried to get providers and health networks on board with these protections, many companies have the freedom to charge however they please. Emergency relief funds distributed by Congress didn’t go to ambulance firms and medical laboratories when they were released to providers and hospitals.

Many states are hesitant to regulate ambulance fees, considering service providers are often run by state or local governments. States and districts depend on ambulance rides as a source of revenue, but this usually puts older and less healthy residents at a disadvantage.

Some health plans offered by insurance companies do not cover follow-up care or ambulance rides, and the government doesn’t have the authority to restrict or regulate air ambulance fees. To do so, lawmakers would have to amend the Airline Deregulation Act.

Several air ambulance firms have been hit with multiple lawsuits from patients, giving them a chance to fight these charges in court. One firm, Air Methods, is currently facing six separate class-action lawsuits in federal court where patients describe expensive charges and aggressive debt collection tactics. 

In one case, the company tried to garnish over $53,000 from a patient’s bank account. Air Methods says these bills are several years old and the company has since updated its billing practices. However, records show Air Methods has already transported 3,300 coronavirus patients over the course of the pandemic. The company says it had a “special process” for handling their billing. 

It’s often up to facility administrators to contract with third-parties that use more sound billing tactics. 

Unable to pay the exorbitant bill, the Pennsylvania woman ended up calling her state’s insurance commissioner, Jessica Altman. While Altman doesn’t have the authority to force the air ambulance firm to cancel the bill, she was able to talk to someone from the woman’s insurance company, Independence Blue Cross. She got the company to reprocess the claim, and now the woman doesn’t have to pay $52,000 for an ambulance ride that she never asked for in the first place.  

Do your best to help your patients make sense of these fees. Getting treated for the coronavirus can result in a range of medical expenses, but we can try to work together to limit the number of surprise medical bills. 

Meet the Patients and Providers Battling Misinformation Online

The internet is fraught with medical misinformation, from conspiracy theories to unproven – if not dangerous – treatment methods. Experts say all this false reporting can undermine trust in science and medicine. However, the internet is also one of the best tools for finding accurate information. Chances are your patients are looking for health information online, whether it’s from a reputable news organization or Facebook. 

This trend of increasing misinformation has worsened over the last few years as apps become integral to everyday life. A recent study from the research firm Pew Internet & American Life Project shows that 80% of internet users, or about 93 million Americans, have searched for a health-related topic online. That’s a considerable jump from 2001, when the firm found that just 62% of internet users were searching for health information online.

As we gear up for winter and the eventual COVID-19 vaccine, battling medical misinformation has taken on a whole new meaning.

Coronavirus Patients Go Online

COVID-19 is still a new disease, and doctors don’t always have the answers patients are looking for. Many of those who have been infected report experiencing symptoms long after the worst of the disease has gone away. For lack of a better name, this group has become known as the “COVID long-haulers.” Doctors are still studying the long-term effects of the disease, so these patients often go online to share and learn about other people’s experiences with the disease.

That was true for 36-year-old Matthew Long-Middleton, who got sick with the virus on March 12th. After recurring bouts of fatigue, discomfort in his chest, muscle weakness, and fever, he started using the Slack messaging channel Body Politic to learn more about the long-term effects of the disease.

“I had no idea where this road leads, and so I was looking for support and other theories and some places where people were going through a similar thing, including the uncertainty, and also the thing of like, we have to figure this out for ourselves,” he recalled.

However, these groups can sometimes do more harm than good. “You want to find hope, but you don’t want the hope to lead you down a path that hurts you,” Long-Middleton said.

Vanessa Cruz, a mother of two, has also been experiencing symptoms, including fatigue, fever, and confusion, since March. She turned to the Facebook group “have it/had it” to get in touch with other people who have had the disease. For her, it wasn’t just about learning the facts on COVID-19, it was about connecting with other people who understand where she’s coming from. Without traditional support groups, suffering from a new disease can be isolating.

She said, “It’s really become like a second family to me and being able to help everybody is a positive thing that comes out of all this negativity we’re experiencing right now.”

Unfortunately, the group, which now has over 30,000 members, has also become a magnet for misinformation in recent months, so Cruz volunteered to start fact-checking the page. Some posts have advocated for the use of a common tapeworm medication used in India, but it’s not FDA-approved. Others are calling for the use of hydroxychloroquine, which has not been proven effective in treating COVID-19.

Cruz is doing her best to keep the group factual. “It’s like you really don’t know what to question, what to ask for, how to reach for help. Instead of doing that, they just, they write up their story, basically, and they share it with everybody,” she commented.

Fighting Back Against Misinformation

As the Facebook group gets larger, moderators have appointed a 17-person team of fact-checkers to rid the website of any false information, including two nurses and a biologist. They examine every post that goes up on the group’s page to make sure it is medically accurate.

However, simply removing these posts may not be enough. Some images and shares may get thousands of views before moderators eventually delete them.

As Elizabeth Glowacki, a health communication researcher at Northeastern University, puts it, “Even if we’re not actively seeking information, we encounter these kinds of messages on social media, and because of this repeated exposure, there’s more likelihood that it’s going to seep into our thinking and perhaps even change the way that we view certain issues, even if there’s no real merit or credibility.”

Recent statistics show that posts on Facebook containing false or misleading information have received four times as many views as posts from official organizations such as the World Health Organization.

Fadi Quran, campaign director of Avaaz, a human rights group that studies disinformation campaigns, says that’s because Facebook uses algorithms that are inherently flawed. The social media company says it’s doing more to track and prevent the spread of misinformation, but Quran says moderators tend to focus on the most sensationalized posts that tend to get the most clicks. That means less-popular health-related posts that contain misinformation can easily fly under the radar.

Until Facebook changes its policies, the most we can do is keep an eye out for medical misinformation and delete it before it spreads. Keep these ideas in mind as you talk to your patients about the latest healthcare information.

“Vote Like Our Health Depends on It” | Inside the Push to Register Voters at Hospitals

As the pandemic rages on, the doctor’s office or local hospital is one of the few places where people still meet in-person. Patients worried about food, housing, the virus, and other pressing issues can always find comfort and solace in their local healthcare facility. As it turns out, it’s also a great place to register to vote.

A new bipartisan project known as VotER wants to see more hospitals and doctors’ offices helping people register to vote. We’re less than three weeks from election day, and every vote counts. Providers and staff aren’t there to tell people how to vote. They’re just encouraging people to register, so they are all set for Election Day on November 3rd.  

County fairs, community get-togethers, and other local events designed to register potential voters have largely been canceled in the wake of COVID-19. With few alternatives in communities, many people might have to rely on their local doctor’s office instead.

Democracy on Demand

The pandemic has upended traditional life in America. This year’s election will be unlike anything in recent memory as millions of people cast their ballots by mail. Others will do so carefully in person, donned in all kinds of PPE.

The virus has also intensified the debate around politics in many communities. We’ve seen nasty disputes over lockdowns and other safety measures on the state and local levels. Many people do not have enough access to affordable healthcare, even as infection rates rise around the country. Many households are worried about paying rent, keeping their kids in school, and making ends meet.

In short, this year’s election feels more personal than ever.

That’s why Dr. Alister Martin, an ER physician, founded the organization VotER, which is already being used by more than 300 hospitals nationwide. The group has adopted the phrase, “Vote like your life depends on it” because for many Americans, it does.

Hospitals and doctors’ offices interested in signing up can do so online. The group will send the facility what’s known as a democracy kit, which contains everything the staff will need to help register patients to vote.

In many cases, the facility will use patient contact information to send out automatic alerts reminding people to register to vote. The message will contain a link containing information on how to do it and where. Every state has different voting laws in the books, and registering can be a challenge for some individuals, especially if they have more urgent issues on their plate, such as finding a place to live, securing food, and getting a job.

Spanish speakers and low-income residents may also have trouble navigating the registration process. Some states require different forms of ID and documentation, while others aren’t as strict.

Signing Up Patients

Marshae Love, a medical assistant in Wisconsin, says registering patients to vote is just another part of her day. She’s happy to answer questions about voting in between other topics, such as weight loss, COVID-19, and high blood pressure.

She says, “So, when I go in the rooms, just having conversation once I’m checking in the patients, they’ll ask, like, hey, what’s that around your neck? So, I’ll let them know it’s just a way for them to register to vote.”

Love is wearing a badge around her neck that has a QR code. Patients can scan the code with their cell phones and it will bring them to a website where they can register in just a few minutes, usually while they’re waiting to see the doctor. If they have any questions or get lost along the way, the website will direct them to a help line where they can talk to a live person.

Working in a doctor’s office, Love knows that most of her patients are already on their phones, so why not give them something to do while they wait? She adds, “It’s just something quick they can do, and it’s one more thing they can knock off of their to-do list.”

Why It Matters

Wisconsin is one of many areas where minority Americans are less likely to register to vote than white residents, especially amid a pandemic when many people are focused on other issues.

Love works at Progressive Community Health Centers in Milwaukee, where 80% of her patients are black and 90% are considered low-income. The center sends out monthly text messages asking 9,500 patients to register. So far, about 40,000 patients have gotten help registering or requesting ballots.

As Dr. Madelaine Tully puts it, “With people having to move in with family members, people having real issues with their financial security, their food security and all that – so you can imagine that registering to vote is not high on that list when you have, you know, issues of basic shelter, safety and food.”

However, these are the issues that are on the ballot in November. From expanding access to healthcare to affordable quality housing and increasing employment opportunities, everyone should be able to make their voices heard.

The hospital or doctor’s office is also a great place to get the conversation going. Many people may be turned off when it comes to politics, but nurses and doctors usually have the power to cut through this noise. They are among the most trusted professionals in the country. With so much misinformation and derision in today’s politics, this is one of the best ways for people to learn how to register to vote and why it matters.

If you’re interested in signing up, visit VotER today to learn more.  

Nurses Scare Up More Scary Stories for Halloween

Haunted nurses, sneaky pranks, and phantom children, oh my! It’s almost Halloween, and we can’t get enough of these scary stories from the nurses that follow our Facebook page Funny Nurses. Providers from all over the world have been sharing spine-tingling encounters from their time on the job. It’s just a reminder of how scary healthcare can be. And we’re not talking about staff shortages or working without PPE.

Instead of going to a costume party this year, use these stories to forget about your troubles as we gear up a Halloween unlike any other.

Blast from the Past

Gary Baron appears to have come in close contact with nurses from generations past.

“I worked a bank night shift on a cystic fibrosis unit. The majority of the patients there died young. The patients weren’t allowed in the day room at night. I walked past the day room and all the lights were off and I heard what sounded like a young voice say, ‘Shhhhhh, he’s coming.’

I turned the lights on and there was nobody there. Just after midnight I saw the silhouette of two nurses in old-fashioned uniforms with the waist belt and hats walk up the ward talking to each other whilst I was sat at the nurses’ station. I was obviously terrified at this point, but the regular night nurses laughed at me and said, ‘Yes, we see them all the time.’ I didn’t do any bank shifts on there again but every time I walked past the unit I went cold.”

Are we all doomed to roam the halls of the hospital for eternity? Sounds like a nightmare.

First Day Jitters

Jane Hand, a healthcare assistant, recalls one of her first days on the job:

“When I was working in the care home to gain some care experience, I went in on my first night and my colleague who was supposed to be looking after me asked me to go and strip the bed in one of the rooms as the lady had sadly passed away, stating, “You’ll find fresh bedding in the wardrobe.”

Someone new was moving into that room in the morning, so I wanted to make it nice for them. I stood at the window trying to open it as the room was stuffy, and I heard this creaking coming from what I thought was the wardrobe. I went about doing my business, opened what I thought was the wardrobe and low and behold one of my colleagues was hiding in there dressed up as a skeleton, and she leapt out saying “Hello.” I’ve never felt my heart skip so many beats ever.”

They say it’s good to keep nurses on their toes, but this is a little extreme.

Touched by a Ghost

Spirits from the beyond need a little love and attention just like the rest of us. At least that was true for Carmel Walker, a practical nurse in Ireland.

“I used to work in a nursing home a few years ago… I was on a night shift once and around 2 or 3 AM I was helping a lady to the bathroom, I heard footsteps in the corridor, so I went to the door to see who was up but there was no one there… I returned to the room and could still hear footsteps walking up the corridor… as I was putting on the lady’s shoes I felt something lightly ruffle my hair. I swiped my hair with my hand… then it happened again😳. Weird things happen on night shift!!”

Sounds like a friendly greeting to us. At least they weren’t pushing the call button.

Seeing is Believing

Working in healthcare means learning to live with life and death, and that could include working alongside ghosts from beyond the grave.

Carol Nielson shares this story from her time at a behavioral health facility:

“We were sitting around telling ghost stories about the place when a sceptic scoffed and insulted the spirits. A chart on top of the rack flipped over onto his head. There was no way it just slid, and no one touched it. He freaked out and told us to tell it to go away 😂 Dude, apologize and make nice.”

They should really teach us this stuff in medical school.

The Face of Death

Some patients never go away, but what if they linger to help dying patients cross over to the other side?

This story from Patti Hunter still gives us chills:

“[Several] years ago, a little boy was hit by a car on a bike across from a facility that I worked in. He died. Patients often taking a turn for the worst would say that there was a little boy in their room visiting when no visitors had been present. When he visited, they would pass away shortly after. It was always on the same unit but different rooms.”

A huge thanks to everyone who shared their story on Facebook. We’re looking forward to reading more spooky tales as we get closer to the end of the month. 

As Californians Get Older and Less Mobile, Fires Get Hotter and Faster

PETALUMA, Calif. — Late on the night of Sept. 27, a bumper-to-bumper caravan of fleeing cars, horse trailers, RVs and overstuffed pickup trucks snaked east on Highway 12, the flames of the Glass Fire glowing orange in their rearview mirrors.

With her cat, Bodhi, in his carrier in the back seat, 80-year-old Diana Dimas, who doesn’t see well at night, kept her eyes glued to the rear lights of her neighbor’s Toyota. She and Magdalena Mulay had met a few years before at a bingo night in their sprawling retirement community on the outskirts of Santa Rosa. Both Libras, each with two marriages behind her, the two women soon became the sort of friends who finish each other’s sentences.

Now, for the second time in three years, they heard the alarms and fled together as fire consumed the golden hills of Northern California’s wine country.

“I thought, where on earth are we going to go?” recalled Dimas. She remembered that when the catastrophic Tubbs Fire hit back in 2017, people had sought refuge outside well-lit supermarkets, which had water and bathrooms. Which is how Dimas and Mulay and dozens of other seniors ended up spending the night of the most recent evacuation in the parking lot of the Sonoma Safeway.

At midnight, Mulay was trying to get comfortable enough to catch a few winks in her driver’s seat when her phone began to chirp. A friend was calling to wish her a happy 74th birthday.

The stories of that Sunday night — as a 20-acre fire started that morning merged with two other fires to become an 11,000-acre conflagration forcing tens of thousands from their homes in two counties — spotlight the challenges of evacuating elderly and infirm residents from the deadly wildfires that have become an annual occurrence in California. This year, the coronavirus, which is especially dangerous to the elderly, has further complicated the problem.

While the 2020 fire season will go down as the state’s biggest on record, rescuers have so far managed to avoid horrors on the scale of three years ago, when the firestorm that raced through California’s wine country killed 45 people. Almost all were over 65 — found in wheelchairs, trapped in their garages, isolated and hard of hearing, or simply too stubborn to leave. The same grim pattern emerged from the Camp Fire, which leveled the Northern California town of Paradise in 2018.

Assisted care homes in particular came under scrutiny after the 2017 fire, when ill-equipped and untrained workers at two Santa Rosa facilities abandoned two dozen frail, elderly residents as the flames closed in, according to state investigators. They concluded the seniors would have died in the flames had emergency workers and relatives not arrived at the last minute to rescue them.

“The problem is we don’t value elders as a society,” said Debbie Toth, CEO of Choice in Aging, an advocacy group. “If children needed to be evacuated, we’d have a freaking Romper Room stood up overnight to entertain them so they wouldn’t be damaged by the experience.”

The destructive effects of climate change in California have dovetailed with a rapidly graying population — which in a decade is projected to include 8.6 million senior citizens. That has fueled a growing demand for senior housing, from assisted care homes to swanky “active adult” facilities complete with golf courses and pools.

Proximity to nature is a major selling point of Oakmont Village, Dimas and Mulay’s upscale community of nearly 5,000 over-55s, which has everything from bridge games to cannabis clubs. But the woodlands and vineyards surrounding this suburban sprawl have put thousands of elderly citizens in hazardous wildfire zones.

“With seniors, there’s mobility issues, hearing issues — even the sense of smell is often gone in the later years,” said Marrianne McBride, who heads Sonoma County’s Council on Aging. Getting out fast in an emergency is especially challenging for those who no longer drive. In Sunday’s evacuation, some residents who followed official advice to call ride services had to wait hours, until 3 or 4 a.m., for the overtaxed vans.

Dimas and Mulay managed to scramble into their cars and get on the road shortly after 10 p.m., when a mandatory evacuation order went out for the thousands of seniors in Oakmont Village. But it was after midnight when residents of two Santa Rosa assisted care homes in the evacuation zone were shuffled onto city buses in their bathrobes, some with the aid of walkers. Off-duty drivers braved thick smoke and falling embers to ferry some of them to safety, only to spend hours being sent from one shelter to another as evacuation sites filled up fast because of social distancing rules designed to prevent the spread of COVID-19.

Other precautions, including masks and temperature checks, were followed. But health officials nonetheless voiced concerns that vulnerable people in their 80s and 90s — especially residents of skilled nursing homes, the source of most of Sonoma County’s coronavirus deaths so far — had been moved among multiple locations, upping their chance for exposure.

In the following days, shelters were fielding frantic calls from out-of-town relatives searching for their loved ones. “We were getting phone calls from Michigan, other places across the country, saying, ‘I’m trying to find my mother!’” said Allison Keaney, CEO of the Sonoma-Marin Fairgrounds, which sheltered several hundred horses, chickens, goats and llamas as well as displaced people.

By Wednesday afternoon, a few dozen evacuees remained at the shelters, mostly seniors without relatives or friends nearby to take them in, like Dimas and Mulay. The two women had left the Safeway lot and were sleeping on folding cots in a gym at the Veterans Memorial Building in Petaluma, an old poultry industry town dotted with upscale subdivisions.

This was their first time out and around other people since March, when the two friends had been planning a big night out to see Il Volo, an Italian pop group. Seven months later, the new outfits they bought for the concert still hang unworn in their closets.

“All we do since the shutdown is stay home and talk on the phone,” said Mulay, who spoke to a reporter while sitting next to her friend on a folding chair outside the shelter. “Now, with all these crowds — it’s terrifying.”

Dimas likened the pandemic followed by the fires to “a ball rolling downhill, getting bigger and bigger. And then there we were, with the flashing lights all around us and the cops shouting, ‘Go this way!’ ‘Keep moving!’”

Listos California — an outreach program, for seniors and other vulnerable people, run out of the Governor’s Office of Emergency Services — allotted $50 million to engage dozens of nonprofits and community groups around the state to help warn and locate people during disasters. (Listos means “Ready” in Spanish.)

In Sonoma and Napa counties, where the Glass Fire had destroyed at least 630 structures by late last week, the bolstered threat of wildfires in recent years has promoted new alert systems — including a weather radio that has strobe lights for the deaf or can shake the bed to awaken you.

But while counties are legally responsible for alerting people and providing shelter for them once they’re out, no public agency is responsible for overseeing the evacuation. Practices differ widely from county to county, said Listos co-director Karen Baker.

If Sonoma County has learned anything from the disasters of the past few years, it’s not to depend too much on any system in an emergency. “You’ve got to have a neighborhood network,” McBride said. “As community members, we have to rely on each other when these things happen.”

Early last week, word filtered through the shelters that the fire had consumed a triplex and two single-family homes in the Oakmont neighborhood, but firefighters had battled the blaze through the night with hoses, shovels and chainsaws and miraculously managed to save the rest of the community.

A week later, to their relief, Oakmont’s senior residents were allowed to return home. By then, Mulay had developed severe back pain. Dimas missed her TV.

Back in her apartment with Bodhi, Dimas noted with horror that the blaze had come close enough to her building to incinerate several juniper bushes and scorch a redwood just 2 feet away.

“The whole thing feels surreal, like ‘Oh, my God, did that really happen, or did I dream it?’” she said.

This KHN story first published on California Healthline, a service of the California Health Care Foundation.