How Freedomland Became A ‘Health Care’ Center

My parents were in their early 40s in 1969, the year we moved to the massive Co-op City housing development in the Bronx. My brother and I were preteens.

When it was completed a few years later, Co-op City had more than 15,000 apartments, most of them in high-rises scattered across 300 formerly swampy acres that had once been the Freedomland amusement park. Within a few years, the community’s schools and shopping centers appeared. Most of Co-op City’s occupants were working-class laborers and civil servants, drawn mostly from elsewhere in the borough. Direct and indirect subsidies made their new apartments affordable.

My brother and I both left for college within a decade. Our parents stayed until 1990, when they retired, departed for the suburbs of central New Jersey and rebuilt their lives around the activities of the local senior citizens’ center. But many of their peers stayed in Co-op City, and quite a few of the kids my brother and I grew up with ended up staying with their parents, or inheriting apartments when their parents died.

For thousands of people like my parents, Co-op City became a “naturally occurring retirement community,” also known as a NORC. The survivors of their generation who have stayed put, now advanced far into old age, have had the benefit of family, friends, familiar neighborhood institutions and a host of social services to sustain them. The phenomenon of this open-air retirement home that came into being quite by accident has been apparent for more than a decade. The New York Times wrote about it as far back as 2002. (1)

In New York, Medicaid pays for a lot of the services these people need. To the extent that Medicaid is a low-income health care program, this is not necessarily surprising. Yet what makes New York’s situation different is that Medicaid often covers even those services that don’t have much to do with health care as most people understand it. In literature about the “Health Homes” initiative, introduced in 2012, the state’s Medicaid administrators described the function of a “care manager,” an individual who coordinates those seeing to an individual’s medical, behavioral health and social service needs. The theory is that by making sure people can live independently in their own homes, Medicaid saves money on hospital costs, ambulance rides, repetitive doctor visits and, most of all, nursing home care.

The same thing is happening in the mental health arena. Several years ago, New York expanded Medicaid coverage to provide housing for individuals with mental illness. In addition to the Health Homes program, New York also offers “supportive” housing that combines subsidized housing with a host of services, including medical, but also legal, career and educational, among others. Keep people off the streets and make sure they take their meds and get regular meals, the theory goes, and you’ll ultimately save money on emergency room and other acute-care costs.

Brenda Rosen, the director of the organization Common Ground, which runs a supportive housing building called The Brook, told NPR, “You know, we as a society are paying for somebody to be on the streets.” (2) And the outgoing New York State commissioner of health published an article in December 2013 arguing that housing and support services are integral to health, so Medicaid should help support the costs.

The state may be on board, but the arguments in favor of these programs haven’t made much headway with the federal government, which normally shares Medicaid expenses with the states. The feds won’t pay for these housing services, on the grounds that housing is not health care. Bruce Vladeck, who formerly administered the federal Medicaid (and Medicare) programs, said, “Medicaid is supposed to be health insurance, and not every problem somebody has is a health care problem.” (2)

That’s true. Not all care that leads to better health is health care. Good nutrition, having the time and place to get a full night’s sleep, and access to clean air and water are all essential for health, but we do not expect health insurance to pay for these things. Providing housing to people who need it is what we used to call social work, and most people don’t view social workers as health care providers.

But it is easier to gain political support for providing health care – with its image of flashing ambulance lights and skilled professionals dressed in white – than for subsidized housing for the aging or the disabled, especially the mentally disabled. So it is easier for Gov. Andrew Cuomo’s administration to organize these services under the label of Medicaid Health Homes. They are not homes at all in any traditional sense. Care managers are typically not doctors or nurses, but they are trained in social services or health care administration. Health Homes is a potentially worthwhile initiative that comes with clever, voter-ready branding.

The approach itself is not nearly as novel as the marketing. We have known for decades that good community support, including safe housing and close supervision for people who need it, is a lot less expensive than parking people in hospitals, nursing homes and other institutions. As New York State Medicaid Director Jason Helgerson pointed out when arguing in favor of Medicaid-funded housing support, Medicaid (and taxpayers) bear the cost of long, expensive hospital and nursing home stays. Giving people support to stay in their own homes is also a lot more humane in many, if not most, cases.

The challenge is to develop and market these programs in ways that sustain public support in the face of their predictable abuse. People misusing a service does not make it bad, but it does make it harder for politicians to defend. Disability insurance is also a good thing, but the Social Security disability program is just a couple of years away from going broke, in large part because of the wave of malingering that accompanied and followed the recent recession. Offer a benefit and people will want to use it, even if they are not genuinely part of the target population.

Well-supported housing with an effective array of social services for people who need them can do a lot of good, and can save society significant money as long as we are not prepared to make people in need survive on their own. NORCs can make excellent places for the elderly to live out their days, and housing for mentally ill and developmentally disabled people can keep them safely off the streets and out of the ERs.

But the feds are right that efforts to do so are not health care. It’s human care. If we don’t manage it effectively – keeping the malingerers out and holding costs at sustainable levels – some humans are going to be left on their own, no matter what we call it.

Sources:

1) The New York Times, “Haven for Workers in Bronx Evolves for Their Retirement”

2) NPR, “New York Debates Whether Housing Counts As Health Care”

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Article Source: http://EzineArticles.com/expert/Larry_M._Elkin/669166

 

Health and Sanitation Practices and Academic Performance of Grade VI Pupils

The provision of health sanitation is a key development intervention – without it, ill health dominates a life without dignity. Simply having access to sanitation increases health, well-being and economic productivity. Inadequate sanitation impacts individuals, households, communities and countries. Despite its importance, achieving real gains in sanitation coverage has been slow. Achieving the internationally agreed targets for sanitation and hygiene poses a significant challenge to the global community and can only be accomplished if action is taken now. Low-cost, appropriate technologies are available. Effective program management approaches have been developed. Political will and concerted actions by all stakeholders can improve the lives of millions of people in the immediate future.

Nearly 40 percent of the world’s population (2.4 billion) has no access to hygienic means of personal sanitation. World Health Organization (WHO) estimates that 1.8 million people die each year from diarrheal diseases, 200 million people are infected with schistosomiasis and more than 1 billion people suffer from soil-transmitted helminthes infections. A Special Session on Children of the United Nations General Assembly (2002) reported that nearly 5,500 children die every day from diseases caused by contaminated food and water because of health and sanitation malpractice.

Increasing access to sanitation and improving hygienic behaviors are keys to reducing this enormous disease burden. In addition, such changes would increase school attendance, especially for girls, and help school children to learn better. They could also have a major effect on the economies of many countries – both rich and poor – and on the empowerment of women. Most of these benefits would accrue in developing nations.

The global community has set ambitious targets for improving access to sanitation by 2015. Achieving these goals will have a dramatic impact on the lives of hundreds of millions of the world’s poorest people and will open the door to further economic development for tens of thousands of communities. Access to adequate sanitation literally signifies crossing the most critical barrier to a life of dignity and fulfillment of basic needs.

This study determined the health and sanitation practices of the Grade VI pupils in selected public schools in the district of Diadi, Province of Nueva Vizcaya, Philippines. This research undertaking utilized the descriptive correlation method of research to establish the influence of the profile variables on the respondents’ health practices, sanitation practices, and their academic performance, as well as the relationship between health and sanitation practices with academic performance. The following are the significant findings of the study:

Twenty five or 37.31 percent of the respondents are 12 years old; 41 or 61.19 percent are female; 47 or 70.14 percent are Roman Catholics; 22 or 32.84 percent are Ilocano; 20 or 20.89 of the respondents’ fathers reached elementary school level; 21 or 31.34 percent of their mothers are college graduates; 50 or 74.63 percent of their fathers are farmers; 38 or 56.72 percent are housekeepers; 34 or 50.75 percent have family income of 5,000.00 and below; 38 or 56.72 percent have 4 to 6 family members; 36 or 53.73 percent have 2 sanitation facilities; and 42 or 62.69 received 5 immunizations.

Health practices in the school obtained a grand mean of 3.89; 3.90 for health practices in the home; and 3.62 for health practices in the community, all qualitatively described as very satisfactory. The respondents perceived their sanitation practices in the school as very satisfactory with a grand mean of 3.44; also very satisfactory for sanitation practices in the home with 3.55; and again, very satisfactory for sanitation practices in the community, with 3.26 grand mean.

The perceived health practices of the respondents in the home significantly differ when they are grouped according to father’s educational attainment, mother’s educational attainment, father’s occupation, mother’s occupation, family monthly income, type of dwelling, and number of sanitation facilities as evidenced by the computed t-test and F-test results of 2.39, 2.64, 3.19, 3.28, 2.93, 3.18, and 3.19 respectively which are higher than the critical value at 0.05 level of significance. On the other hand, age, gender, mother’s educational attainment, mother’s occupation, type of dwelling, and number of sanitation facilities caused significant differences in the perceived health practices of the respondents in the school as shown by the computed t-test and F-test results of 3.15, 2.03, 2.39, 3.18, 3.16, and 3.74, respectively; all are higher than the critical values at 0.05 level of significance. Significant differences were also noted in the respondents’ health practices in the community when they are grouped according to ethnicity, father’s educational attainment, mother’s educational attainment, father’s occupation, mother’s occupation, family monthly income, number of sanitation facilities, and number of immunization received because the computed t-test and F-test results of 2.76, 2.37, 2.41, 3.148, 3.16, 2.79, 3.26, and 3.17 respectively are higher that the critical values at 0.05 level of significance.

There exists a significant difference in the respondents’ sanitation practices in the home when they are grouped according to gender, ethnicity, father’s educational attainment, mother’s educational attainment, family monthly income, type of dwelling, and number of sanitation facilities because the computed values of t-test and F-test results of 2.05, 2.79, 2.37, 2.51, 2.78, 3.29, and 3.16 respectively are higher than the critical values at 0.05 level of significance. Moreover, gender, ethnicity, father’s educational attainment, mother’s educational attainment, family monthly income and number of sanitation practices caused significant variation in the respondents sanitation practices in the school as evidenced by the computed values of 2.15, 2.81, 2.42, 2.87, 2.83, and 3.79 respectively; all are also higher than the critical values at 0.05 level of significance. On the other hand, the respondents perception of their sanitation practices in the community differs when they are grouped according to gender, father’s educational attainment, mother’s educational attainment, father’s occupation, mother’s occupation, family monthly income and number of sanitation facilities since the computed t-test and F-test results of 2.06, 2.37, 2.41, 3.17, 3.148, 2.78, and 3.25 respectively are higher than the critical values at 0.05 level of significance.

There exists a significant difference in the respondents’ academic achievements when grouped according to gender, as indicated by the computed value of 2.27, which is higher than 1.99 critical values. Father’s and mother’s educational attainment with the computed values of 2.74 and 2.64, respectively, both higher than the critical value of 2.368, and their occupation with 3.17 and 3.27, respectively both higher than the critical value of 3.142 constitute significant variance in the respondents’ academic performance. Family monthly income and number of immunizations received, with the computed values of 2.86 and 3.19, respectively which are higher than the critical values of 2.754 and 3.142, respectively significantly differentiated the respondents’ academic performances. The rest of the variables – age, religion, ethnicity, number of family members, type of dwelling, and number of sanitation facilities do not cause significant differences because the computed values of 2.94, 1.86, 2.71, 2.89, 1.97, and 3.08 respectively were lower than the critical values at 0.05 level of significance.

There is very significant relationship between health practices and sanitation practices as evidenced by the computed r-value of 0.72 which is higher than the critical value of 0.241 for 65 degrees of freedom at 0.05 level of significance, indicating high correlation, with a coefficient of determination of 51.84 percent.

There exists a very small positive correlation between health practices and academic performance, as indicated by the computed r-value of 0.238 with an equivalent computed t-value of 2.198 which is higher than the critical t-value of 1.99 for 65 degrees of freedom at 0.05 level of significance. The said correlation is significant. Moreover, sanitation practices and academic performance have small positive correlation, as evidenced by the computed r-value of 0.226 with an equivalent computed t-value of 2.07 which is higher than the critical t-value of 1.99 for 65 degrees of freedom at 0.05 level of significance. This result is statistically inferred as significant.

Based on the foregoing significant findings, hereunder are the conclusions.

1. The respondents are in their pre-adolescence stage, female, Roman Catholics, Ilocano, have fathers who reached elementary level, mothers who are college graduates, have fathers who are farmers, have mothers who are housekeeper, have low income, belong to medium-sized families, have concrete dwellings, have limited sanitation facilities and adequate immunization received.

2. The respondents also have very satisfactory health practices at home, in the school, and in the community. The same group of respondents has very satisfactory sanitation practices at home, in the school, and satisfactory sanitation practices in the community.

3. The respondents have proficient academic performance.

4. Health and sanitation practices of the respondents differ when they are grouped according to selected profile variables.

5. Academic performance of the respondents differs when they are grouped according to gender, parents’ occupation, family income and number of immunizations received, but not with age, ethnicity, number of family members, type of dwelling and number of sanitation facilities.

6. Very significant relationship exists between health practices and sanitation practices of the respondents.

7. Very significant correlation exists between the respondents’ health and sanitation practices and their academic performance.

Premised on the above-cited findings and conclusions, the following recommendations are offered:

1. Although the respondents demonstrate very satisfactory health and sanitation practices, these should still be enhanced and sustained by implementing various health and sanitation programs.

2. The school, as the lead agency, should orchestrate its efforts with other government agencies, such as the DOH, DSWD, DENR, LGU and non-government sectors for the sustainability of health and sanitation programs.

3. Activities geared towards sustainability of health and sanitation must be designed/conceptualized, such as conduct of search for healthiest pupil, most sanitary classroom/school and should be expanded to the home and community.

4. The scheme of having teacher-coordinators for each purok should be strengthened so that the health and sanitation thereat be improved and maintained.

5. Since there is significant relationship between health and sanitation practices and pupils’ academic performance, schools must spearhead the provision of health and sanitation facilities to keep pupils always reminded of their health and sanitation practices.

Article Source: http://EzineArticles.com/expert/Carlo_Fonbuena_Vadil/1088157

 

Three Steps to Save More Money on Health Care

We all need health care – well, most of us do, anyway. But none of us like to spend much of our hard earned money on that. Health costs are expensive, and we’d much rather spend our cash on our home, on our family, on things we can enjoy. How to save more money on health care? Well, here are three steps.

First, get yourself healthier! I know, this may look too common sense to make it worth writing down here-but it is really the key. If you have an active lifestyle and a good, nutritious diet, you are setting yourself up to pay much, much less on health care than someone who is a couch potato and lives on junk food.

There are two aspects of this. First, you will simply need less health care. If your diet includes plenty of calcium, for example, and you get enough vitamin D to allow your body to make use of it, you can fall down the stairs, get up, and go about your business. If your diet is low in calcium, though-maybe you prefer cola instead of milk as a regular drink-a fall down the stairs is likely to mean a trip to the hospital, a cast on your arm or leg, and a monstrous bill.

The second aspect has to do with your health insurance. Insurance providers look at you and your general health when they give you health insurance quotes. If you want affordable health insurance, you should be as healthy as possible. Pre-existing conditions is a nasty word that makes the price given for health insurance quotes skyrocket and the benefits sink somewhere lower than Mordor. With a healthy lifestyle, you’ll have far fewer pre-exisisting conditions than if you threw your health to the birds and partied your way through life.

So, the first step is to get yourself healthier by choosing a healthier lifestyle. What is the second? Preventative care. Saving a dime to spend a dollar is what many of us do when it comes to medical expenses. If there’s a medical procedure you really should have done, just go get it done. It’s better to pay the fees for this now than to pay the enormous fees you’ll have to pay if you let the problem grow before it’s taken care of.

The third step you can take in order to save money on health care is to do your research before choosing an insurance provider. Get health insurance quotes from a variety of places if you really want affordable health insurance. Make sure you give the insurance provider all relevant information when asking them to generate health insurance quotes, and then, when you’ve got data from quite a few places, compare them. Compare not only the insurance quotes, but also the benefits that each provider is offering-benefits for day to day preventative care as well as benefits in an expensive emergency. A careful analysis of this information will help you get the most affordable health insurance for your personal situation, and affordable health insurance will help you bring your health bills down.

Providing affordable health insurance plans for you and your family to best meet your insurance needs. To learn more about getting savings of up to 75% in just minutes online… Click here! To start you free health insurance quote with us!

Article Source: http://EzineArticles.com/expert/Alec_Alfredo/1738045

 

Workplace Mental Health – A Series – An Overview Of The Issue (This Is Important!)

The mind and the body are inseparable. And you do want to engage the whole employee in your worksite wellness program, right?

Most worksite wellness programs today are not really wellness programs at all – they are employee health status management programs. Why do I say this? Most worksite wellness programs focus solely on employee physical health, to the exclusion of all the other dimensions of wellness.

As conceived by the modern wellness field’s founders, (Robert Allen, Donald Ardell, Halbert Dunn, Bill Hettler and John Travis), wellness is a multi-dimensional concept. The published wellness model of the National Wellness Institute includes the following dimensions: physical, social, emotional, intellectual, occupational and spiritual.

Emotional well-being is associated with numerous benefits to health, family, work, and economic status. Positive emotions and view of life are associated with decreased risk for disease, illness, and injury; better immune functioning; better coping and quicker recovery; and increased longevity. In addition, mental health and mental illness may influence physical health and biologic functioning. Positive mental health is associated with better endocrine function (i.e., lower levels of cortisol, epinephrine, and norepinephrine) and better immune response (i.e., higher antibody production and greater resistance to illness). It has also been shown to be associated with longevity.

Researchers are continuing to learn more and more about the mind – body connection. It has been clearly shown that emotions play a huge role in our physical health. There is also a reciprocal relationship between many chronic diseases and mental health. Self-efficacy, goal-setting, and problem-solving enable self-management behaviors, and these components are dependent on emotional health. On the other hand, self-management behaviors that enhance health, such as physical activity and stress reduction, can improve mental health status and quality of life. In many ways, it makes no sense to address physical health without addressing emotional health at the same time.

The absence of mental illness does not mean the presence of mental health. Growing research supports the view that these are independent, but related dimensions. Mental wellbeing are characterized by the presence of positive affect (e.g., optimism, cheerfulness and interest), absence of negative affect, and satisfaction with life. On the other hand, mental illness is characterized by alterations in thinking, mood, or behavior associated with distress or impaired functioning.

Why Address Mental Wellbeing in the Workplace?

The health of the mind and body cannot be separated. What effects one influences the other. Therefore, a healthy mind supports and contributes to a healthy body and vice versa.

Mental illness costs employers money and mental health can impact productivity and employee performance. Just like physical health, mental health can be viewed as being a continuum. At one end there is mental health and mental illness is located at the opposite end.

Mental health generally refers to the successful performance of mental function, resulting in productive activities, fulfilling relationships, and the ability to adapt to change and adversity. These domains are commonly referred to as wellbeing.

Mental illness includes diseases with classic psychiatric diagnoses, such as depression, bipolar disorder, and schizophrenia. Mental health and mental illness can be influenced by multiple determinants, including genetics and biology and their interactions with social and environmental factors.

Employers approach employee health through a multi-strategy framework. A multi-strategy framework can be applied to an employer approach to mental health as well. A comprehensive approach includes: promotion, prevention, intervention, and follow-up. It is important to recognize that mental health promotion needs to be equal in importance to the prevention and treatment of mental illness.

Today’s worksite wellness programs need to address all dimensions of employee wellness, not just physical health.

Addressing Total Employee Wellness

Employee mental health is a critical component of successful worksite wellness programs. I invite you to let me help you create your own effective, successful and sustainable program. I specialize in mentoring worksite program coordinators and creating Done With You worksite employee health and well-being programs. You can contact me at williammcpeck@gmail.com.

Brought to you by Bill McPeck, Your Worksite Wellness Mentor. Dedicated to helping employers and worksite program coordinators create successful, sustainable employee health and well-being programs, especially in small employer settings.

Article Source: http://EzineArticles.com/expert/William_McPeck/1737577

 

Workplace Mental Health – A Series – Program Integration (Start Today!)

Good mental health is fundamental to maintaining good physical health. And you want your employees to experience total worker health, correct?

The fact that the mind and the body cannot be separated results in an inseparable relationship between physical and mental health. Despite the fact that the connections are striking, integration of the two fields in worksite wellness programming still has not occurred in any meaningful way. Worksite wellness practitioners need to better understand the connections between physical and mental health so they can intervene more effectively with employees to improve the outcomes in both areas.

It is important to address the integration of physical and mental health for the following reasons:

• The individual employee’s mental health status or the presence of a mental illness such as depression or anxiety can affect an individual’s ability to undertake health promoting behaviors that address their physical health status. It is therefore critical that individuals have a better understanding of the integral link between all aspects of their health.

• Chronic diseases such as diabetes, heart disease, or cancer can have a profound impact on an individual’s mental health.

• An individual’s mental health status affects an individual’s ability to participate in their treatment and recovery from a chronic disease.

• Family members and caregivers of people with chronic diseases are also affected psychologically thereby potentially resulting in their neglecting their own health.

Integrating all aspects of health within a worksite wellness program requires partnerships and integration at multiple levels. Integration and partnerships allow the partners to leverage their strengths and resources and to work on common goals. Integration needs to occur at the program level, the policy level, between vendors and potentially between the employer and community based resources.

The elements necessary to support integration include:

• Making the business case through the collection, analysis, and dissemination of data on the interrelationships between all aspects of employee health. The data should also show how integration and partnerships can better advance the employer’s core mission and objectives.

• Developing a champion at every level within the organization. While integration requires leadership and motivation from the top, it is best to have a champion at each level to initiate, implement, and sustain the integration.

• Forming an integration management working team to sustain the integration effort. The integration effort cannot be sustained if it is only the work of just a couple of people.

• Developing integrated interventions that are based on identified needs or gaps where positive outcomes and early wins can be achieved. Early on, look for interventions that are simple, targeted, and within the scope of the missions, resources, infrastructures, processes of the partners’ existing program initiatives.

• Monitor, measure and evaluate integrated initiatives by establishing goals, measures and collecting the appropriate data. Evaluation could include process, output and outcome types of evaluation strategies. They could include assessing improvements in access to and satisfaction with care, services, or programming, determining the effect of policy changes on outcomes or services, and making the case for cost-benefit and/or cost-effectiveness.

Programming is one of the key areas where integration can and should be implemented. The four levels we see for physical health programming can also be applied to other health areas as well. These are: awareness, education, lifestyle change and policy/environmental change.

The traditional core physical health programming topics have included physical activity, nutrition, sleep and stress management. These four core programming areas also have implications for mental health as well. This makes the leap to integrated programming real easy. Prevention and self-care activities are also areas where integration can be applied.

Good mental health is fundamental to maintaining good physical health. Ultimately, there is no health without mental health. A worksite wellness program is a necessary and ideal venue to support program integration.

Creating An Integrated Program Strategy

Since the mind and body cannot be separated, physical and mental health should not be addressed separately either. My unique background qualifies me to provide you the leadership necessary to implement integrated interventions. I invite you to let me help you create your own effective, successful and sustainable program. I specialize in mentoring worksite program coordinators and creating Done With You worksite employee health and well-being programs. You can contact me at williammcpeck@gmail.com.

Brought to you by Bill McPeck, Your Worksite Wellness Mentor. Dedicated to helping employers and worksite program coordinators create successful, sustainable employee health and well-being programs, especially in small employer settings.

Article Source: http://EzineArticles.com/expert/William_McPeck/1737577