First national study of homeless people's use of ERs [Aug 7 Morgantown WV]
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The first national study of homeless people’s use of emergency rooms finds that homeless patients are more likely to arrive at the hospital by ambulance and more than twice as likely to be uninsured.
One-third of homeless patients arrived by ambulance – at an estimated cost of almost $67 million, according to the researchers.
Analyzing almost half a million emergency room visits by homeless people, West Virginia University doctors also found that the homeless were more likely to receive more than two diagnostic tests – a higher number compared with other patients.
At the same time, WVU researchers found no difference between the urgency of the medical emergencies in comparing both populations. The study is published in the current issue of the Journal of Health Care for the Poor and Underserved.
“The thing that surprised me the most was that acuity levels – how sick the person was – and hospital admissions rates were similar in comparing the homeless population to people with residences,” said lead author Gary Oates, M.D., a WVU emergency medicine physician. “The sicker you are, the sooner you need to be seen by a doctor when you come to the emergency department. And the homeless patients were no sicker than others, looking at total visits to emergency departments nationwide.”
Despite that, more diagnostic tests were ordered than for other patients. “This may be because emergency physicians needed to do baseline blood work because the homeless patient didn’t have a primary care doctor,” Dr. Oates explained. “Or it could be because the homeless population may be more prone to falls or injuries from assault – injuries that may require x-rays.”
Studying emergency room use is important in the context of the current national healthcare reform effort, Oates said.
“We already know that homeless patients make emergency room visits four times more often than others and are among the most frequent repeat visitors,” he said. “Our study is the first study to look at data nationwide and compare the homeless population in terms of insurance status, use of ambulance transport, hospital admission rate, acuity level and other factors.”
Two-thirds of the homeless patients were white and three-quarters were male.
The study’s data came from the 2005 National Hospital Ambulatory Medical Care Survey, with information on more than 100 million emergency room visits during that year.
Federal hospitals were not represented in the data set, so populations such as homeless veterans were not included in the sample.
The study’s other authors are Allison Tadros, M.D., also a WVU emergency medicine physician, and Stephen M. Davis, research coordinator for the WVU Department of Emergency Medicine.
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National Council on Disability recommends sweeping emergency management changes for people with disabilities
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20090812 USA Washington DC--The National Council on
Disability (NCD) today released its report
Effective Emergency Management:
Making Improvements for Communities and People with Disabilities,
calling on federal, state, and local authorities to make sweeping changes in
emergency management practices for people with disabilities.
According to NCD Chairperson John R.
Vaughn, "NCD's first evaluation of government work in this area was
published in a 2005 report
Saving Lives: Including People with
Disabilities in Emergency Planning.
That report laid out a scenario of a major hurricane striking the Gulf Coast
and outlined steps that the federal government should take to include people
with disabilities in emergency preparedness, disaster relief, and homeland
security. Hurricane Katrina struck four months later."
As a result of NCD's work, the 2006
Homeland Security Appropriations bill's Post-Katrina Emergency Management
Reform Act (H.R. 5441) required Federal Emergency Management Agency (FEMA)
to employ a National Disability Coordinator and to interact, consult, and
coordinate with NCD on a list of eight other activities.
According to NCD Vice Chairperson Pat
Pound, "NCD identified a major gap in the government's homeland security
knowledge base, which involves the availability and use of effective
practices for community preparedness and response to the needs of people
with disabilities in all types of disasters. In 2008, NCD began reviewing
the spectrum of available studies and defined a set of best/promising
practices for emergency management across the life cycle of disasters and
geographic areas. With this new knowledge, it is time to act. The lives of
people with disabilities hang in the balance."
Scientists report a worldwide increase in
the number of natural disasters over the past 25 years. In 1980, only about
100 such disasters were reported per year, but that number has risen to more
than 300 a year since 2000. The increase is expected to continue, and
storm-related disasters are predicted to increase in intensity.
According to NCD Vice Chairperson Chad
Colley, "NCD's report offers information and advice to assist all levels of
government in their work to establish evidence-based policies, programs, and
practices across the life cycle of disasters."
Some of the recommendations and
interventions include:
Federal Recommendations
- Continue strengthening efforts to enforce compliance with Federal
Communications Commission policies regarding emergency broadcasting to
reach people with disabilities.
- Complete the FEMA Comprehensive Planning Guide (CPG) series --
including 301 Special Needs and 302, which includes service animals --
in sync with other CPG series guides.
- Hire disability coordinators at the FEMA regional offices.
State-Level Interventions
- Task a state official with disability and disaster issues.
- Involve disability community organizations and state offices or
agencies in all state efforts regarding natural hazards, terrorism,
technological or hazardous materials concerns, and pandemic planning.
Local-Level Interventions
- Local jurisdictions should create working groups to review and
revise emergency operations plans, mitigation plans, and recovery plans
to address the issues of people with disabilities.
- Cross-training on disability and disaster issues should be conducted
among emergency managers, first responders, voluntary agencies, and
disability agencies.
Individual-Level Interventions
- Accept personal responsibility for preparedness in a disaster
context; where that is challenging, involve caregivers in such efforts.
- Create contingency plans for evacuation and other protective action,
shelter life, medical care, and service animals.
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Juvenile Arthritis Grant named after NEMRC Team Member
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Brooklyn NY July 13--NEMRC is excited and proud to announce that the Arthritis National Research Foundation [ANRF] has named The Kelly Award for Juvenile Arthritis Research after NEMRC Team Member Kelly Rouba. Diagnosed with juvenile rheumatoid arthiritis at the age of two, Kelly has been a strong advocate for those living with the disease for many years. Arthritis is often considered "an old person's disease", however, one may fall victim to the devastating effects of arthritis at any age. "I am committed to finding a cure for the over 300,000 youth in America with juvenile arthritis," says Kelly, who is a national spokesperson for ANRF and a member of the foundation's advisory board. "Research is the key. Arthritis can rob our youth of their childhood -- people need to know that arthritis is not just a disease that afflicts you as you age. It is our goal at ANRF to educate America about the devastating effects of arthritis on young people, too." Kelly is currently being filmed for a documentary on juvenile arthritis called 'Waking Up,' and she recently authored a book 'Juvenile Arthritis: The Ultimate Teen Guide' to help young patients and their families deal with juvenile arthritis. Published by Scarecrow Press, the book is available online through Amazon and Barnes and Noble. The Arthritis National Research Foundation's Grant Guidelines state its intention to fund at least one juvenile arthritis project each year. ANRF hopes that The Kelly Award and Kelly herself will make people aware of juvenile arthritis and its impact on so many young people and their families. For more information or to make a donation, visit http://www.curearthritis.org
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Outreach Toolkit - Article: DTV and People with Disabilities
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The transition from analog to digital television broadcasting will be historic. After June 12, 2009, the country’s full power broadcast television stations will stop broadcasting in analog and broadcast exclusively in digital, as mandated by Congress in the Digital Television and Public Safety Act of 2005. It is very important for consumers to note that local broadcasters may make the transition before June 12th, 2009, so they should be prepared early and act now.
The Federal Communications Commission (FCC) is continuing a multi-faceted approach to informing people with disabilities about the DTV transition. The approach includes DTV workshops dedicated to issues facing people with disabilities, collaboration with disability advocacy groups and outreach organizations, and the publication of educational materials and advisories for people with disabilities.
Consumers who receive their local broadcast stations through a paid provider such as cable or satellite TV are already prepared for the DTV transition. Consumers who rely on free, over-the-air television programming by using rooftop antennas or “rabbit ears” on their sets have two choices to be ready for the DTV transition: (1) they can purchase a digital television (a TV with a built-in digital tuner) or (2) they can purchase a digital-to-analog converter box for each of their analog TVs so they can continue to receive free, over-the-air programming on them.
Closed Captioning
Some consumers have expressed concern about how the digital-to-analog converter boxes will work and whether consumers will continue to receive closed captions after the transition to digital television. FCC rules require digital-to-analog converter boxes to either pass through available analog captions or generate their own digital captions if the programming is captioned. Below is some information about closed captioning and digital broadcasting:
Digital-to-analog converter boxes used with analog TVs:
- If you are able to see closed captions on your analog TV as white text on black background before attaching the digital-to-analog converter box, you will be able to see closed captions the same way after attaching the converter box.
- Analog TVs manufactured after June 1993, with screens 13 inches or larger measured diagonally, will be able to display available analog captions when a digital-to-analog converter box is installed. Smaller or older analog TVs are not required to display closed captions. However, you may be able to see closed captions on these TVs if the digital-to-analog converter box is equipped to generate closed captions.
- Some (not all) digital-to-analog converter boxes can generate and display digital closed captions. To determine whether a converter box is equipped to generate and display digital closed captions, ask the retailer to check the user manual that comes with the converter box.
Digital TVs:
- Digital TVs manufactured after June 2002, with screens 13 inches or larger measured diagonally, must be able to display closed captions. You will not need a digital-to-analog converter box to watch broadcast programming with an antenna for these TV sets.
- Digital TVs allow consumers to change the caption size, font (style), caption color, background color, and opacity.
Paid television services (such as cable or satellite TV):
- Some televisions (such as “cable ready” TVs) are connected directly to a paid TV provider and do not require a set-top box. Follow the instructions that came with the television and turn closed captions on/off through the television or with the remote control that came with the television.
- Some televisions are connected to a paid TV provider through a set-top box. (Note that a set-top box that receives signals from a paid provider is different from the digital-to-analog converter boxes needed for free, over-the-air broadcast television discussed above). To determine whether a paid television service set-top box is equipped to generate digital closed captions, ask your provider or check the user manual for your set-top box. To activate digital closed captions and to control the appearance of these captions, follow the instructions for the set-top box or television.
You can get more information on closed captioning from the following FCC consumer advisories:
Questions about closed captioning also may be sent to the FCC’s dedicated closed captioning email box at closedcaptioning@fcc.gov.
Video Description Services
Some programming has contained video descriptions for a number of years. At present, video descriptions are available through the secondary audio programming (SAP) channel on an analog stereo TV set or VCR.
In July 2000, the FCC adopted rules to make television more accessible to people with vision disabilities by mandating that a certain amount of programming contain video description. These rules took effect in April 2002, but were vacated by a federal court in November 2002. As a result, video description is not required. Nevertheless, some programming providers voluntarily continue to provide video descriptions. Also, the requirement in Section 79.2 of the FCC’s rules that emergency information provided on television be accessible to individuals who have vision disabilities is still in place. This means that broadcasters must orally describe any emergency information that is shown on the screen (e.g., weather map showing tornadoes) during regular or special newscasts, and must accompany any emergency information that is presented in a crawl or scroll with an aural tone which instructs individuals with vision disabilities to turn to a radio or another source for more information.
With digital television, broadcasters have more audio channels on which to provide video description. Because digital television encodes audio in a different manner than the encoding used in analog television, digital television does not utilize a SAP channel to transmit video descriptions. The digital television standards provide for two types of main audio service and six types of associated services, including associated services for people with vision disabilities. The standards also permit the transmission of secondary language programming. So while there was one option under the old analog TV service (i.e., the SAP channel), broadcasters now have more audio channels to provide this voluntary service. However, inserting video descriptions into digital programming that was not created by the distributor may involve additional expense for broadcasters. For this reason, consumers should contact their local broadcasters to determine whether video description is offered.
Televisions with digital tuners should be able to process the audio services associated with the digital TV signals through functions that are built into their systems. Consumers should confirm with the manufacturer, owner’s manual or retailer prior to purchase to determine if this feature is included in the digital TV. For consumers who will be using a digital-to-analog converter box to receive digital over-the-air television signals on an analog television, some of the digital-to-analog converter boxes that have been approved for NTIA coupon eligibility are capable of processing the associated audio services that are broadcast by a digital television station.
Consumers using cable or satellite services should ask for additional information about the availability of video description from their service providers. To the extent that cable systems, satellite systems or other multi-channel video programming distributors receive programming with video description, those video descriptions should be delivered to the consumer.
You can get more information on video descriptions from the following FCC consumer advisory: www.fcc.gov/cgb/consumerfacts/dtvvideodescription.html.
Additional Publications
The FCC website, www.dtv.gov, features a DTV educational video in American Sign Language for individuals who are deaf or hard of hearing. Also, the FCC’s most commonly utilized publications are available in Braille and audio format and all fact sheets and advisories are available in large print.
For more information about the DTV transition, go to www.dtv.gov or contact the FCC by e-mailing dtvinfo@fcc.gov; calling 1-888-CALL-FCC (1-888-225-5322) or by TTY at 1-888-TELL-FCC (1-888-835-5322).
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How does America measure poverty?
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USA: How does the US measure poverty [May 30 New York NY]--How does the U.S. measure poverty?
The U.S. government measures poverty by a narrow income standard that does not include other aspects of economic status, such as material hardship (for example, living in substandard housing) or debt, nor does it consider financial assets (including savings or property). The official poverty measure is a specific dollar amount that varies by family size but is the same across the continental U.S. According to the guidelines, the poverty level in 2009 is $22,050 a year for a family of four and $18,310 for a family of three (see table). The poverty guidelines are used to determine eligibility for public programs. A similar but more complex measure is used for calculating poverty rates.
The current poverty measure was established in the 1960s and is now widely acknowledged to be flawed. It was based on research indicating that families spent about one-third of their incomes on food – the official poverty level was set by multiplying food costs by three. Since then, the figures have been updated annually for inflation but have otherwise remained unchanged.
Why is the current poverty measure inadequate?
The current poverty measure is flawed in two ways.
1.The current poverty level – that is, the specific dollar amount – is based on outdated assumptions about family expenditures.
Food now comprises only one-seventh of an average family’s expenses, while the costs of housing, child care, health care, and transportation have grown disproportionately. Thus, the poverty level does not reflect the true cost of supporting a family. In addition, the current poverty measure is a national standard that does not adjust for the substantial variation in the cost of living from state to state and between urban and rural areas.
More accurate estimates of typical family expenses, and adjustments for local costs, would produce substantially higher dollar amounts.
2.The method used to determine whether a family is poor does not accurately count family resources.
When determining if a family is poor, income sources counted include earnings, interest, dividends, Social Security, and cash assistance. But income is counted before subtracting payroll, income, and other taxes, overstating income for some families. On the other hand, the federal Earned Income Tax Credit isn’t counted either, underestimating income for other families. Also, in-kind government benefits that assist low-income families – food stamps, Medicaid, and housing and child care assistance – are not taken into account. This means that official poverty statistics cannot be used to analyze the effectiveness of these programs.
Are there alternative ways to measure poverty?
Considerable research has been conducted on better methods to measure income poverty. In the early 1990s, Congress asked the National Academy of Sciences (NAS) to investigate alternative measures. The NAS panel of experts issued a report in 1995 that recommended revising the poverty level and the method of determining which families are poor. The panel’s recommendations included the following:
* Create new poverty thresholds that more accurately reflect the cost of food, clothing, and shelter.
* Adjust thresholds by region to account for variation in the cost of living.
* When counting families’ resources to determine whether they fall below the poverty line:
o use families’ post-tax income;
o include earned income tax credits and the value of near-cash benefits (such as food stamps and housing assistance); and
o subtract the cost of work- related expenses (such as child care and transportation) and medical care.
If the NAS recommendations were adopted, millions more people would be considered officially poor. But even these recommendations underestimate the cost of family expenses and thus produce poverty thresholds well below what it takes to make ends meet, for example, increasing the poverty level for a family of four by only about $3,000 annually.
How much does it really take to make ends meet?
Given that the federal poverty level grossly understates how much it takes to support a family, researchers have developed budgets that realistically quantify basic living costs in specific locali- ties. Building on earlier efforts, NCCP has developed Basic Needs Budgets that include only the most basic daily living expenses and are based on modest assumptions about costs. For example, the budgets in the table at right assume that family members have employer-sponsored health coverage, even though the majority of low-wage workers do not have employer coverage. NCCP’s Basic Needs Budgets do not include money to purchase life or disability insurance or to create a rainy-day fund that would help a family withstand a job loss or other financial crisis. Nor do they allow for investments in a family’s future financial success, such as savings to buy a home or for a child’s education. In short, these budgets indicate what it takes for a family to cover their most basic living expenses – enough to get by but not enough to get ahead.
Across the country, families typically need an income of at least twice the official poverty level to meet basic needs. In high-cost cities such as New York, it may take an income of over three times the poverty level to make ends meet, whereas in some rural areas, the figure may be under double the poverty level.
In short, even if the official poverty measure is revised along the lines suggested by the NAS, it would remain a measure of deprivation and severe hardship. In contrast, Basic Needs Budgets provide a way to think about what families need to maintain a minimally decent standard of living.
Basic Needs Budget Calculator
NCCP’s Basic Needs Budget Calculator provides access to budgets for nearly 100 localities across 14 states, with more states coming soon. Users select the number of parents and number and ages of the family’s children. Budgets assume that all families include at least one full- time worker; for two-parent families, users make choices about the employment status of the other parent. Users may also substitute their own numbers for one or more expense estimates, and the Calculator adjusts the family’s tax liability and overall budget totals accordingly.
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Emergency Readiness Wheels
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 This product is designed to help seniors and people with disabilities get better prepared for all kinds of disasters. A complete Train-the-Trainers and Community Readiness program is available as a NEMRC Consultancy package. Visit the NEMRC Shop for more information.
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FEMA National Situation Update
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