More than half the children who attend Munchkin Land Daycare near Billings, Montana, have special needs or compromised immune systems. The kids, who range in age from 4 months to 9 years, have conditions that include fetal alcohol syndrome, cystic fibrosis, and Down syndrome, according to owner Sheryl Hutzenbiler.

“These families came to me knowing we could offer them a safe and healthy environment,” Hutzenbiler said. Part of ensuring that healthy environment is having a strong vaccination policy, she said, especially for those who are immunocompromised or too young to receive the full slate of childhood vaccines.

So, when officials at Montana’s health department revived a proposal that would allow people to claim religious exemptions from immunization requirements at child care facilities, Hutzenbiler was both dismayed and relieved. Dismayed, because allowing more children to claim exemptions could compromise the community immunity levels necessary to defend against highly infectious diseases like measles and pertussis. Relieved, because as she scoured the proposed regulations, she found that her facility, which is licensed to care for up to 15 children, would be in a category of smaller providers that could choose whether to enroll unvaccinated kids.

“If it came down to where I had to, I had no choice, I would stop enrolling children today,” Hutzenbiler said. “In five years, I would be closed.”

Montana, like 44 other states, allows religious exemptions from immunization requirements for school-age children. If the state is successful in expanding its policy to child care facilities, it would become the second this year to add a religious exemption to its immunization requirements for younger kids. Mississippi began allowing such exemptions for schools and child care centers in July following a court ruling that the state’s lack of a religious exemption violated the U.S. Constitution’s free exercise clause.

Until recently, the trend had been going the other way, with four states — California, New York, Connecticut, and Maine — removing religious exemption policies over the past decade. West Virginia has never had a religious exemption.

But religious exemptions, fueled by conservative backlash to covid-19 vaccinations, have become caught up in partisan politics, said Mary Ziegler, a University of California-Davis law professor who specializes in the law, history, and politics of reproduction, health care, and conservatism.

“It tends to be breaking down much more along red state-blue state lines, where progressive states are moving in the direction of mandating vaccines in more situations and conservative states are moving more in the direction of broadening exemptions,” Ziegler said. “So, as much as religious exemptions for vaccines are not a new issue, they’ve become polarized in a new way.”

The proposal in Montana is similar to one the state Department of Public Health and Human Services floated last year, which a legislative committee temporarily blocked after public health advocates and child care providers objected. Afterward, in October 2022, health department officials said they would not enforce a religious exemption ban in child care centers.

“We are committed to ensuring that these families have viable child care options in accordance with state and federal law,” department spokesperson Jon Ebelt told the Montana Free Press at the time.

However, in the state’s latest proposal, 45 pages into a 97-page draft rewrite of child care licensure rules, the health department seeks to extend that exemption to child care facilities, where a family now can claim a vaccine exemption only for medical reasons. (There is an existing religious exemption for the vaccine against Haemophilus influenzae Type B.)

KFF Health News sent the health department a list of questions about its decision to include a religious exemption in the rules proposal. Ebelt emailed a statement that did not address the exemption at all.

“The rules package cuts red tape to increase access to child care for hardworking Montana families, and ensures that related regulations align with statutory changes directed by the Legislature in 2021 and 2023,” his statement said.

The Montana Religious Freedom Restoration Act prohibits the state from infringing on a person’s right to the exercise of religion. Another act bans discrimination based on vaccination status.

A religious exemption under Montana’s proposed rules would require a child’s parent or guardian to submit a form attesting that vaccination is contrary to their religious belief, observance, or practice. With no mechanism to check the validity of such claims, health professionals worry exemptions would spike, reducing community immunity levels.

“Exemptions lead to less people being vaccinated, which can lead to more outbreaks and more sick kids,” said Marian Kummer, a retired pediatrician who practiced in Billings for 36 years.

The risk of disease outbreaks would increase not only in those child care centers but in communities as well, said Sophia Newcomer, an associate professor at the University of Montana School of Public and Community Health Sciences.

A community is protected by herd immunity from measles, for example, if 95% of the population is vaccinated against it, according to the World Health Organization. Montana’s vaccine exemption rate among kindergartners was 3.5% in the 2020-21 school year, according to the most recent data available, putting it within that range of protection.

The health department’s proposed changes also would eliminate a requirement that child care facilities keep out infected and unvaccinated children and staffers when someone becomes sick with a vaccine-preventable disease, said Kiely Lammers, director of the nonprofit advocacy group Montana Families for Vaccines.

Some have questioned the legitimacy of religious exemptions. Most religions, including a majority of Christian denominations, have no theological objection to vaccination, according to a scientific review published in 2013 in the journal Vaccine. And the U.S. Supreme Court has ruled limits do exist on religious and parental rights: “The right to practice religion freely does not include liberty to expose the community or the child to communicable disease or the latter to ill health or death,” says the 1944 ruling in Prince v. Massachusetts.

The American Academy of Pediatrics has called for the elimination of all nonmedical exemptions, including both religious exemptions and personal-belief exemptions, “as inappropriate for individual, public health, and ethical reasons,” according to a 2016 policy statement.

In Connecticut, plaintiffs who challenged the state’s decision to remove religious exemptions said they objected to the use of fetal or animal cell lines in the research and development of vaccines. But a three-judge panel for the 2nd U.S. Circuit Court of Appeals wrote in August that religious exemptions do not serve “to protect the health and safety of Connecticut students and the broader public” when it upheld Connecticut’s decision.

Yet even in California, which eliminated nonmedical exemptions in 2016, efforts are underway to overturn the law. In a lawsuit filed Oct. 31, several parents backed by a conservative law firm are challenging the law’s constitutionality. One plaintiff, Sarah Clark, said she believes vaccines run counter to her interpretation of the Bible “because they are a foreign substance and are harmful to the body.” Attorney General Rob Bonta’s office said Nov. 1 it hadn’t been served with the case yet but will review the complaint and respond as appropriate.

Montana’s proposed rule is scheduled for a public hearing Nov. 13. Some child care providers, like Hutzenbiler, expect it ultimately to take effect. She said she is already drafting language to submit to the state as required under the proposed rules, saying Munchkin Land Daycare will not accept unvaccinated children.

Lammers said state officials should be open to changes and give child care centers with 16 or more kids the same choice as smaller facilities not to enroll unvaccinated children.

“I’m hoping at the very least we can make it equal in all settings,” she said of the rule proposal.

Kummer, the retired pediatrician, said she hopes the proposal prompts enough opposition that the state removes the plans for the religious exemption. But she doubts that will happen, given the anti-vaccination sentiment of Montana policymakers.

“It’s going to take a tragedy in our state or somewhere else where people wake up to the fact that we need vaccinations,” Kummer said.

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California news editor Judy Lin contributed to this report.

(KFF Health News, formerly known as Kaiser Health News (KHN), is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs of KFF — the independent source for health policy research, polling and journalism.)

©2023 KFF Health News. Distributed by Tribune Content Agency, LLC.

The 2.28-acre site, at the southeast corner of Lake Avenue and Villa Street, had sat empty for 10 years before Los Angeles County and city officials joined back in April in an ambitious plan to reimagine it. That plan includes up to 100 housing units and a goal to expand homeless, mental health and community services in an area officials say is “high priority” for such services.

“This project, in partnership with Los Angeles County, is an opportunity to bring much-needed health care and mental health care services to our residents at one location,” said Pasadena Mayor Victor Gordo in a statement accompanying the announcement. “It also is an opportunity to develop quality affordable housing and improve the overall economic vitality of this part of our City.”

Gordo said the work of developing the site will now commence in earnest, adding that he believes the project is a good example of government collaboration.

In April, the City Council approved an agreement with Kaiser for the property. The Board of Supervisors later did the same, in what was said to be a $12 million purchase.

Early on, there was talk about Fuller School of Psychology and Pacific Oaks College coming on to address the lack of mental health staffing. But that is not part of the agreement.

Officials at the county and city envision the site as a model to address homelessness and the mental health crisis across the state, and locally.

While a specific timeline for the project was not announced, City Manager Miguel Marquez said a request for proposals for the site’s development should be released in about 90 days.

Editor’s Note: This story has been updated to reflect that Fuller School of Psychology and Pacific Oaks College, while discussed in early talks about the site, were not part of the agreement.

The blaze that has destroyed the historic structure started early Tuesday morning and smoke was seen rising high into the air throughout the afternoon Tuesday.

Wednesday morning, officials with the South Coast Air Quality Management District issued a smoke advisory because of the fire. It is set to be in effect through the end of the day. Officials with the agency said most of the impacts are localized for now, but stronger Santa Ana winds could push smoke toward the southwest.

“Air quality conditions may reach unhealthy for sensitive groups in nearby neighborhoods,” the advisory said.

Orange County Health Care Agency officials echoed the advisory, saying people who are “being impacted” by windblown smoke, dust or ash, should “try to limit your exposure by remaining indoors, with windows and doors closed or seek alternative shelter to reduce exposure to smoke and ash.”

“Everyone should be aware of the recommended precautions to reduce the health effects of smoke and ash from building fires,” Dr. Regina Chinsio-Kwong, the county’s health officer and director of public health services, said in a statement. “Extra measures may be needed for those with pre-existing medical conditions like heart or lung disease, those with disabilities, older adults, children, and those who may be working outdoors.”

Tustin Mayor Austin Lumbard on Wednesday worried about the impacts on his community’s air quality following the blaze. While the fire still smolders at the base of the burned-out hangar, local agencies are monitoring the air for any health concerns, he said.

“There are concerns about materials used,” Lumbard said. “AQMD’s initial readings were unremarkable, but there is a general concern about materials used 80 years ago.”

NASHVILLE, Tenn. — High school classes start so early around this city that some kids get on buses at 5:30 in the morning.

Just 10% of public schools nationwide start before 7:30 a.m., according to federal statistics. But in Nashville, classes start at 7:05 — a fact the new mayor, Freddie O’Connell, has been criticizing for years.

“It’s not a badge of honor,” he said when he was still a city council member.

Since his election in September, O’Connell has announced that pushing back school start times is a cornerstone of the education policy he is promoting. He and others around the country have been trying to stress that teenagers aren’t lazy or to blame for getting too little sleep. It’s science.

“All teenagers have this shift in their brain that causes them to not feel sleepy until about 10:45 or 11 at night,” said Kyla Wahlstrom, a senior research fellow at the University of Minnesota in the College of Education and Human Development. She studies how education policy affects learning, and she used to be a teacher. “It’s a shift that is biologically determined.”

Sleep deprivation in teenagers is linked to mental health struggles, worse grades, traffic accidents and more. That’s why states including California and Florida have mandated later start times. Individual districts across the country — including some in Tennessee — have made the same change.

But resistance to later starts is less about the science than it is about logistical and financial difficulties, especially with basics like busing.

State Rep. John Ray Clemmons, a Nashville Democrat, tried to pass a bill mandating later start times in 2022.

“I’m starting to experience this with one of my own children,” he said during a committee hearing on the bill. He dug into the biology, including the famous sleep hormone melatonin.

Melatonin makes people feel drowsy. The brain starts producing it when it gets dark outside, and its production peaks in the middle of the night. Adolescents’ brains start releasing melatonin about three hours later than adults’ and younger children’s brains, according to the American Chemical Society. When teens wake up early, their brains are still producing melatonin.

“Because of the way adolescents’ bodies release melatonin, waking a teen at 7 a.m. is akin to waking one of us at 4 a.m.,” Clemmons said.

He brought in a local parent, Anna Thorsen, who testified that later start time legislation could protect vulnerable kids like hers.

“My youngest daughter is a freshman who suffers from a rare genetic epilepsy that killed her older sister last year,” she said. “In fact, last March, my youngest daughter had a life-threatening seizure that was partially induced by sleep deprivation.”

Rep. John Ragan, a Knoxville-area Republican, said almost all the feedback he heard on the bill came from Nashville.

“Go to your school board and tell them to change the rule, change the law, change their start times,” he said. “But to mandate [the rest of the state] do this because of one school board that doesn’t want to listen to their parents?”

Legislative leaders gave the bill one hearing. It didn’t pass into state law.

That leaves Nashville, a city that often calls itself the Silicon Valley of health care, to figure out its own path. O’Connell is now on the case. The mayor has some power over the school budget, which gives him influence in education policy. However, it’s up to the school board to determine start times.

“Early start times, particularly for adolescents, are problematic,” the mayor said. “We also know that making a change — even a 30-minute change — has a lot of logistics.”

A major concern has been busing. Even in normal times, districts use the same buses and drivers for students of all ages. They stagger start times to do that, with high schoolers arriving and leaving school earliest in the day. The idea is that they can handle being alone in the dark at a bus stop more readily than smaller children, and it also lets them get home first to help take care of younger siblings after school.

If high schools started as late as middle and elementary schools, that would likely mean strain on transportation resources. O’Connell said Nashville’s limited mass transit compounds the problem.

“That is one of the biggest issues to resolve,” he said.

Several years ago, Collierville, a district in suburban Memphis, launched a study on school start times. That district serves far fewer students — 9,000, compared with Nashville’s roughly 86,000.

Collierville officials estimated in the study that busing costs associated with delayed start times could be as high as $1.4 million annually. That estimate assumed the district would need more drivers, more fuel and maintenance, more storage facilities, and additional support personnel — for example, an additional dispatcher and mechanic.

Despite that, the district did push back high school start times in 2018.

O’Connell said one of the concerns he has heard from parents is financial, such as that they need help with family-run businesses or they need their students to help generate household income at other jobs after school lets out.

The National Sleep Foundation, a nonprofit that advocates for later start times, conducted a 2022 survey of parents, teachers, and other adults that found that only about one-third of the parents who responded wanted later starts. Adults as a whole and teachers responded slightly more favorably, but less than 40% of each group supported delaying the day.

A National Education Association article from 2022 found that many parents who oppose later start times don’t necessarily doubt the science; they’re concerned about scheduling.

Wahlstrom, the education researcher, said she fears parents underestimate how important sleep is to brain development and academic performance, especially on weeknights.

“Sometimes both parents and teens think that they can just catch up on their sleep on the weekend. That is a total false assumption,” said Wahlstrom, who equated sleep to food for the brain. “It’s like, ‘OK, we’re going to deprive ourselves of adequate food three days out of the week, but then we’re going to gorge on food on the weekend.’ That’s not healthy.”

She explained how a lack of sleep can impede scholastic success: The brain shifts memory into long-term storage during deep sleep, so missing out on that rest means retaining less material.

But — perhaps more importantly — sleep helps teenagers improve their mental health. U.S. Surgeon General Vivek Murthy has been raising alarm bells about youth mental health, noting that a third of teenagers overall and half of teenage girls have reported persistent feelings of hopelessness.

And Wahlstrom said teen sleep deprivation leads to worse mental and behavioral health, which can affect the whole family. She and her team conducted a study funded by the Centers for Disease Control and Prevention on the effects of later start times on ninth to 12th graders by surveying 9,000 students at eight high schools in Minnesota, Colorado, and Wyoming from 2010 to 2013. They found students who got at least eight hours of sleep were less likely to report symptoms of depression.

“We do know that there is greater use of drugs, cigarettes, and alcohol when a teen is getting less than eight hours,” she said. “We also know that there is a significant link between teenage depression and any sleep amount that is less than eight hours.”

More than 92% of parents surveyed in a Minnesota school district as part of one of her earlier studies responded that their teenager was easier to live with after the later start time went into effect.

“Many parents have anecdotally told me that their child is a different child. They are able to speak with them at breakfast. They are chatty in the car. They don’t have moody episodes and fly off the handle,” she said. “The parents are just saying it’s remarkable that this has made such a change in their child’s life and their family dynamics.”

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This article is from a reporting partnership that includes WPLN and KFF Health News.

(KFF Health News, formerly known as Kaiser Health News (KHN), is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs of KFF — the independent source for health policy research, polling and journalism.)

©2023 KFF Health News. Distributed by Tribune Content Agency, LLC.

The share of American consumers with medical debt on their credit reports has declined dramatically over the past year as major credit rating agencies removed small unpaid bills and debts that were less than a year old, according to a new analysis from the nonprofit Urban Institute.

At the same time, millions of Americans have seen their credit scores improve, making it easier for many to get a job, rent an apartment, or get a car.

“This is a very significant change,” said Breno Braga, an economist at the Urban Institute and a co-author of the study. “It affects a lot of people.”

The analysis found that, as of August, just 5% of adults with a credit report had a medical debt on their report, down from almost 14% two years earlier.

Urban Institute researchers also found that Americans with a medical debt on their credit report in August 2022 saw their VantageScore credit score improve over the next year from an average of 585 to an average of 615.

That moved many consumers out of the subprime category. Subprime borrowers typically pay higher interest rates on loans and credit cards, if they can borrow at all.

Consumers’ improved scores don’t mean the medical debts have been eliminated. Hospitals, collectors, and other medical providers still pursue patients for unpaid bills. And many continue to sue patients, place liens on their homes, or sell their debts.

But the credit reporting changes appear to be mitigating one of the more pernicious effects of medical debt that for years has undermined the financial security of tens of millions of patients and their families.

Credit scores depressed by medical debt, for example, can threaten people’s access to housing and fuel homelessness.

A Father Dreamed of a Home for His Family. Medical Debt Nearly Pushed Them Onto the Streets.

As cities like Denver struggle to make homes more affordable, medical debt keeps housing out of reach for millions of Americans.

In total, about 27 million people experienced a significant improvement in their score, the Urban Institute researchers estimated. VantageScore, which uses a slightly different methodology than FICO, in January stopped using any medical debt to calculate scores.

The credit reporting changes have drawn criticism from debt collectors and some medical providers, who warn that hospitals and physicians may require upfront payments from patients before delivering care or may push more patients into credit cards and other kinds of loans.

In August, a California dermatologist sued the three major consumer credit rating agencies, claiming that with fewer medical debts appearing on credit reports, patients would have less of an incentive to pay their bills, costing physicians nationwide potentially billions of dollars. The case is pending in federal court.

But most leading consumer and patient advocates applaud the more restrictive credit reporting rules. Other research, by the federal Consumer Financial Protection Bureau, has found that medical debt — unlike other kinds of debt — does not accurately predict a consumer’s creditworthiness, calling into question how useful it is on a credit report.

In September, the Biden administration announced plans to push broader changes that would eliminate all medical debts from consumers’ credit scores. Federal regulations to implement such a ban will be developed next year by the CFPB, federal officials said.

This would expand current state efforts. In June, Colorado enacted a trailblazing bill that prohibits medical debt from being included on residents’ credit reports or factored into their credit scores. A similar measure was passed by the New York state legislature this year and is pending before the governor.

The Urban Institute researchers predicted that these policies would continue to improve consumer credit scores, though they warned that more systemic changes will be necessary to reduce medical debt, which burdens about 100 million people in the U.S.

“Reducing the burden of medical debt and its wide-ranging consequences would likely require health insurance reforms that build on the Affordable Care Act to further protect consumers from out-of-pocket medical expenses they can’t afford,” the report concludes.

The report by the Urban Institute, which has worked with KFF Health News over the past two years to analyze medical debt data, is based on a sample of credit records from one of the three large credit rating agencies.

About This Project

“Diagnosis: Debt” is a reporting partnership between KFF Health News and NPR exploring the scale, impact, and causes of medical debt in America.

The series draws on original polling by KFF, court records, federal data on hospital finances, contracts obtained through public records requests, data on international health systems, and a yearlong investigation into the financial assistance and collection policies of more than 500 hospitals across the country.

Additional research was conducted by the Urban Institute, which analyzed credit bureau and other demographic data on poverty, race, and health status for KFF Health News to explore where medical debt is concentrated in the U.S. and what factors are associated with high debt levels.

The JPMorgan Chase Institute analyzed records from a sampling of Chase credit card holders to look at how customers’ balances may be affected by major medical expenses. And the CED Project, a Denver nonprofit, worked with KFF Health News on a survey of its clients to explore links between medical debt and housing instability.

KFF Health News journalists worked with KFF public opinion researchers to design and analyze the “KFF Health Care Debt Survey.” The survey was conducted Feb. 25 through March 20, 2022, online and via telephone, in English and Spanish, among a nationally representative sample of 2,375 U.S. adults, including 1,292 adults with current health care debt and 382 adults who had health care debt in the past five years. The margin of sampling error is plus or minus 3 percentage points for the full sample and 3 percentage points for those with current debt. For results based on subgroups, the margin of sampling error may be higher.

Reporters from KFF Health News and NPR also conducted hundreds of interviews with patients across the country; spoke with physicians, health industry leaders, consumer advocates, debt lawyers, and researchers; and reviewed scores of studies and surveys about medical debt.

___

(KFF Health News, formerly known as Kaiser Health News (KHN), is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs of KFF — the independent source for health policy research, polling and journalism.)

©2023 KFF Health News. Distributed by Tribune Content Agency, LLC.

That’s according to a new study from the Centers for Disease Control and Prevention and the Food and Drug Administration, which found that about 50% of students who ever tried e-cigarettes reported currently using them — a sign that many youth who try e-cigarettes remain e-cigarette users.

The CDC and FDA study is based on the results from the 2023 National Youth Tobacco Survey. Students in the survey were asked whether they’ve used tobacco products in the last month.

Among high school students, past 30-day use of any tobacco product declined from last year to this year — from 16.5% to 12.6%. That drop was primarily driven by a decline in e-cigarette use (14.1% to 10.0%).

But middle schooler tobacco use went up significantly, according to the report. Past 30-day use of at least one tobacco product jumped from 4.5% last year to now 6.6% among middle schoolers, and the use of multiple tobacco products climbed from 1.5% to 2.5%.

“The decline in e-cigarette use among high school students shows great progress, but our work is far from over,” said Deirdre Lawrence Kittner, director of CDC’s Office on Smoking and Health.

“Findings from this report underscore the threat that commercial tobacco product use poses to the health of our nation’s youth,” Kittner added. “It is imperative that we prevent youth from starting to use tobacco and help those who use tobacco to quit.”

For the 10th year in a row, e-cigarettes are the most commonly used tobacco product for middle and high school students.

Among e-cigarette student users, about 25% reported using e-cigarettes daily. Also, nearly nine out of 10 students used flavored e-cigarettes.

Among middle and high school students, 2.8 million (10%) reported current use of a tobacco product. Also, 2.13 million (7.7%) students reported current e-cigarette use.

E-cigarettes were followed by cigarettes (1.6%), cigars (1.6%), nicotine pouches (1.5%), smokeless tobacco (1.2%), other oral nicotine products (1.2%), hookah (1.1%), heated tobacco products (1.0%), and pipe tobacco (0.5%).

Disposable products were the most commonly used e-cigarette device type among youth. However, the most popular brands included a variety of both disposable and cartridge-based products.

Among students who currently used e-cigarettes, the most commonly reported brands were Elf Bar (56.7%), Esco Bars (21.6%), Vuse (20.7%), JUUL (16.5%) and Mr. Fog (13.6%).

A “transformational” $50 million gift from Newport Beach philanthropist Richard Pickup is helping establish the center, which will not only work on research and to improve gaps in care for memory and cognitive disorders, but also create programs for patients’ family members who are also impacted by the effects of the often devastating diseases.

Pickup, who turns 90 next month, has directed several donations over the years toward advancing care for those dealing with dementia-related diseases. The Pickup Family Neurosciences Institute, a Hoag program that offers neurologic care and treatment, was established in 2017 after a $15 million donation. This new gift will create the Richard H. Pickup Center for Brain Health.

“We really need to change the model of how we do care for people with dementia and Alzheimer’s disease. Hoag realizes, and our community realizes, that the way we’ve done things is just not going to cut it,” said Aaron Ritter, director of the Memory and Cognitive Disorders Program at the Pickup Family Neurosciences Institute.

“The idea is getting in front of this, doing things now and creating a model and programs that can actually help alleviate the suffering that comes with the disease, and also advancing new therapies and treatments that follow what we’ve done with cardiac care and diabetes care,” Ritter said. “It’s a huge change.”

Along with creating the new space on the hospital grounds, the $50 million gift will also go toward supportive programs for patients and their families with a focus on screenings, early detection and advancing technology, Hoag officials said.

Because care needs to go beyond patient treatment, Ritter said. Family members and loved ones often shoulder the burden and costs of care.

“It’s a family disease, so anybody that’s affected by dementia, you multiply it by two or three, the number of people that it takes to care for those people,” Ritter said.

“Yesterday, I saw somebody whose 21-year-old son has to move to Newport Beach to take care of his dad. He’s like, ‘I don’t know what to do. I won’t be able to make any money.’ Those are the stories we’re hearing,” Ritter said. “So how do we change that? How do we get the support and care for a 21-year-old who has to take care of their 65-year-old father? That’s the challenge that is faced by dementia care right now.”

There are warnings of a “Silver Tsunami” in the United States, as the population older than 65 grows quickly and people live longer.

Orange County’s population of older folks is growing by 15% annually, according to Hoag officials. And with aging comes several health concerns and diseases, including Alzheimer’s and dementia. Alzheimer’s rates in Orange County, Hoag officials noted, doubled between 2014 and 2021 and are projected to double again by 2040, requiring more experts in brain health and aging.

Ritter warned the medical industry hasn’t made as much progress for diseases like dementia and Alzheimer’s as it has in other areas such as cancer, heart disease and diabetes.

“The rates of death from those have gone way down. And for Alzheimer’s, we haven’t seen the same outcome,” he said. “People are living longer, but they’re developing dementia. So the idea of taking care of people that are at risk for dementia, preventing dementia or treating dementia better, that’s a big part of treating the Silver Tsunami.”

The Richard H. Pickup Center for Brain Health will be a place to change that, he said. The center will be designed with a “whole-family” approach to care.

It starts with an accurate, timely diagnosis, Ritter said, and then with the family developing a treatment plan that addresses the areas in a person’s life that illnesses like dementia most impact. A whole-family approach to care covers those things, as well as the ways that the loved ones of a patient may need care as well.

“Right now we have in the United States something we call dementia neurology deserts. There are places where people can’t get a diagnosis, they can’t get answers as to what may be going on,” Ritter said. “Dementia always impacts driving, finances and medications, pragmatic things. Right now, Hoag supports the Alzheimer’s Families Center in Huntington Beach, which is a huge operation. About 100 families use those services every day.”

Pickup understands firsthand the struggles that families face when caring for a person with memory and cognitive disorders.

“I had a close brother of mine that was probably seven or eight years younger than I, and I went through the pain of just seeing him deteriorate so badly,” Pickup said. “I think at this particular point in my life, instead of supporting 75 different (causes), I said, ‘Let’s take this meaningful amount of money – we all have this great big desire to build this particular program up – let’s put it in there and see what these guys can do with it.’”

Pickup said he hopes the new center will help develop better awareness of memory and cognitive diseases, as well as earlier detection.

“There’s got to be some gaps in here that we certainly could cover to come along a little bit faster,” Pickup said. “There’s not a lot of money being spent individually in this particular disease, and maybe this will go for the home run we’re looking for.”

The recall, which was announced Saturday, involves 29-ounce plastic bags of the product, which is called “Fully Cooked Fun Nuggets Breaded Shaped Chicken Patties,” the U.S. Department of Agriculture’s Food Safety and Inspection Service said in a statement.

The recall affects approximately 29,819 pounds of the dinosaur-shaped nuggets, which were produced Sept. 5 by the Arkansas-based food processing company.

The bags affected have a “best if used by” date of Sept. 4, 2024, and lot codes 2483BRV0207, 2483BRV0208, 2483BRV0209 and 2483BRV0210, the statement said. The packaging features cartoon dinosaurs, one green and one red, looking over a plate of the breaded nuggets.

On its website, the company said it was voluntarily recalling the product “out of an abundance of caution.” It added that no other products were affected.

The products were shipped to distributors in Alabama, California, Illinois, Kentucky, Michigan, Ohio, Tennessee, Virginia and Wisconsin, according to the Food Safety and Inspection Service statement.

There was one report of a “minor oral injury” associated with the consumption of the product but no additional reports of injury or illness, officials said.

“Anyone concerned about an injury or illness should contact a health care provider,” the federal statement said.

The Food Safety and Inspection Service urged consumers not to eat the nuggets and advised that any product left in the freezer “should be thrown away or returned to the place of purchase.”

This is not the first recall involving Tyson chicken products. In 2019, the company recalled 69,093 pounds of frozen chicken strips after two people reported finding pieces of metal in the product, the Department of Agriculture said at the time.

The tiny, half-pint cartons of milk served with millions of school lunches nationwide may soon be scarce in some cafeterias, with districts across the country scrambling to find alternatives.

The problem is not a shortage of milk itself, but the cardboard cartons used to package and serve it, according to dairy industry suppliers and state officials.

Also see: 9 diet tips for preparing healthy meals for kids at school

Pactiv Evergreen of Lake Forest, Illinois, which bills itself as “the leading manufacturer of fresh food and beverage packaging in North America” acknowledged in a statement Friday that it “continues to face significantly higher than projected demand” for its milk cartons.

The shortage is affecting the company’s ability to “fully supply some school milk orders,” according to Matt Herrick, spokesperson for the International Dairy Foods Association.

School officials in New York, Pennsylvania, California and Washington state said they were preparing for the shortage, while the U.S. Department of Agriculture acknowledged that the supply chain problem affects “multiple states.”

In California, state education officials told schools to be flexible with how they offer milk to kids, including limiting milk choices; using boxed, shelf-stable milk; and providing milk using bulk dispensers.

The carton shortage — which could also affect milk and juice served in hospitals, nursing homes and prisons — has forced officials across the country to brainstorm backup plans.

In Clarence, New York, local school district officials told parents they plan to provide “small bottles of water or cups of milk with lids” if the cartons run out.

Also see: Soaring chronic absenteeism in California schools is at ‘pivotal moment’

In Lake Stevens, Washington, 40 miles (64 kilometers) from Seattle, chocolate milk was missing from this week’s dairy delivery, said Jayme Taylor, director of communications for the local school district.

“That’s the only complaint we received from students,” she said in an email.

It’s not clear how long the carton shortage could last. In Everett, Washington, school officials told parents to expect a disruption in cafeteria milk supply that could “range up to several months.”

Herrick said U.S. milk processors are working with other package suppliers to resolve the shortage. He said he expected the problem to improve within weeks and to be resolved by early next year. __

The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.

Heidi Emmert describes her 83-year-old mother’s amazement when she brought Saxe to the board-and-care home on a quiet cul-de-sac off La Paz Road. Saxe saw the room designated for her – at the front corner of the house, with a spacious private outdoor patio – and instantly felt at home.

“She said, ‘Is this my bed? Can I get in it right now?’” Emmert recalled seven months after her mother’s passing, unable to hold back tears.

Saxe had been diagnosed with small cell lung cancer on March 1, a terminal disease so aggressive it quickly overwhelmed her family. The retired teacher was suffering so terribly, she had become too scared to leave her house in San Juan Capistrano.

Moving to The Heavenly Home hospice house brought peace to everyone.

Emmert said her mother was able to spend her last days in comfort at The Heavenly Home, a nonprofit residential care facility whose six beds are dedicated exclusively to the elderly who are dying.

It’s among a mere handful of hospice-focused board-and-care homes in California.

Saxe died the morning of March 28 – five days after arriving – in the bed she couldn’t wait to climb into, loved ones at her side.

She was only the second resident at The Heavenly Home, which opened its doors in early February after several years in development.

Emmert, who works full-time, felt relieved to have found such a welcoming place with 24-hour caregivers her mother had come to love.

“Honestly, this is where you want to spend the last days of your life,” Emmert said.

“It is so peaceful.”

‘They are the best’

The Heavenly Home is operated by the nonprofit Southern California Hospice Foundation, an organization fueled by community donations, a dedicated staff and board, and the persistence of Executive Director Michelle Wulfestieg.

The foundation has helped people in need of support since its start in 2002. That outreach has included financial and other basic assistance, from food deliveries to transportation, and granting the wishes of the dying, such as a last-minute wedding ceremony.

But the foundation itself is not a hospice service, which provide end-of-life care to people deemed to have six months or less to live. The six residents of The Heavenly Home are served by six different hospice services.

Government programs, such as Medicare and Medicaid, or private health insurers typically cover most of the cost of hospice service, which largely involves symptom and pain management. It also can include emotional, mental and spiritual support. A social worker may be involved.

It’s been Wulfestieg’s mission for the foundation to open an affordable respite for the dying. Every day, she said, she turns down desperate people calling on behalf of a family member. All six bedrooms have been occupied since June.

“We have seen the dire need for hospice to be a place, to be a home – because a lot of people can’t die at home,” she said.

“They might have difficult living situations, or they don’t have family and friends to care for them.”

Wulfestieg escaped death twice herself after suffering two strokes, at ages 11 and 25. Now in her early 40s, she became executive director of Southern California Hospice Foundation in 2010.

Being placed on hospice does not include a place to stay, nor does it pay for daily caregiving – cooking meals, bathing and attention to other personal needs. Most people eligible for hospice are being served in their homes and those of relatives, at hospitals or in nursing care and assisted-living facilities.

Residents of The Heavenly Home can stay as long as they are certified for hospice care. Under government rules, hospice eligibility is re-evaluated every six months.

Since the arrival of the first resident on Feb. 8, The Heavenly Home has taken in a total of 11 people. Five, including Emmert’s mother Saxe, died at the home.

The décor, furnishings and much of the labor that gives The Heavenly Home its comfy atmosphere – inside and out – was provided by donations and volunteers.

Fall decorations – pumpkins and gourds, faux autumn-colored leaves – accent the foyer and living room, where gentle piano music plays on a TV monitor. A cart with binders for each patient sits unobtrusively off to one side. A large soothing seascape painted by Orange County artist Andrea Moni graces a wall.

Estimated cost for this first year of operation is $500,000.

One of the residents, Archie Cachola, is a pediatrician who once cared for children with cancer at local hospitals, including Children’s Hospital of Orange County and Miller Children’s and Women’s Hospital in Long Beach.

Now Cachola, 71, is dying from thyroid cancer that has spread to his bones.

A once-robust healer who for a time also ran his own catering service, Cachola needs help to move about, is hard of hearing and suffers severe pain in his back.

A native of the Philippines, he never married, never had children of his own. His dream had been to open a hospital to give free care – all volunteer – to sick kids, “my children,” he calls them. He had to retire two years ago, after his diagnosis.

Cachola was living alone in his apartment earlier this year when he had a fall. A home health service contacted The Heavenly Home. He came in May.

“I’m so lucky to be placed in this board and care,” Cachola said on a mild autumn day, resting on an outdoor couch beneath the gazebo in the home’s backyard.

“They are the best.”

He described the home as “comfortable and quiet” and the caregivers “excellent.”

“I’m really happy,” he said, adding with a chuckle, “my standard is very high.”

Wulfestieg stood to one side of him as he chatted and on the other sat his chief caregiver, certified nursing assistant London Hamilton.

Hamilton came to The Heavenly Home as a temporary worker through a registry service. She had worked at Children’s Hospital in the past and recognized Cachola. She knew well his reputation as a physician. Right away, she wanted to honor his lifetime of concern for children by caring for him.

“He set the bar for the other oncologists,” Hamilton said of Cachola. “It brings tears to my eyes because of all the wonderful things he did for so many children.

“I wanted to be there for him in his time of need.”

Hamilton said she initially thought The Heavenly Home would be like any other board-and-care assignment. But she likes it so much she’s asked to become a permanent full-time employee.

“When you step through the door, you just get this positive vibe,” said Hamilton, who was pulling a double shift that day.

“It’s no longer work – it’s like you are taking care of family.”

Low-income patients welcome

The Heavenly Home employs 12 people, including a house manager and caregivers that rotate in and out, two always on site most of the time and one overnight. Some work full-time, some part-time, some per diem.

Wulfestieg says finding and keeping staff remains a challenge, as it has been throughout much of the healthcare industry since the pandemic.

On a sliding scale based on income, residents pay anywhere from $40 a day for their board and care to up to $425 a day. The standard industry cost for 24-hour care is about $500 a day per patient, Wulfestieg said.

“It was really important to us that we were able to meet the needs of lower-income patients,” she said.

The shortest stay at The Heavenly Home was 15 hours; the longest has been that of a bedridden woman who arrived in early April.

One of the residents had been paying as much as $30,000 a month for 24-hour in-home care in a previous residence, Wulfestieg said.

The Heavenly Home’s ability to cover the cost of care is helped by a special status granted by the state to care for low-income hospice patients who have what is known as an Assisted Living Waiver.

The waiver allows The Heavenly Home to bill Medi-Cal, the state’s version of Medicaid health insurance for the poor, for a portion of the care low-income residents receive. This is in addition to elderly residents on Medi-Cal turning over their monthly Social Security benefits – about $1,300 – to pay for their stay.

Half of the residents are there on the waiver, the other half pay privately.

But that is still not enough, Wulfestieg said. An endowment fund established with donations to Southern California Hospice Foundation fills the remaining gap.

So far, the foundation has raised a little more than $2 million for the endowment fund, with a goal of $5 million.

“People have been very generous in Orange County,” Wulfestieg said. “They’ve been very open to this idea.”

‘A sacred place’

Community support helps The Heavenly Home provide the little touches that can make someone’s last days among their best.

Cachola celebrated his birthday the last weekend of October by cooking a meal for the residents and a few invited friends, with “sous chef” Hamilton’s help. They wore matching aprons and chef’s hats.

Family members are encouraged to visit and be themselves.

Emmert said either she or her brother came every night to stay with Saxe. At one point during her mother’s stay, up to 22 family members – some from out of state – came together to celebrate Saxe, Emmert said. They set up a taco bar and barbecued on the backyard patio.

Emmert remains a dedicated supporter and regular visitor to The Heavenly Home. Sometimes she only goes as far as the front porch, to peek at the statue of an angel the family donated in Saxe’s honor for the patio outside her old room.

“This is a sacred place to me,” Emmert said.

On a recent afternoon, Dana Graff sat in a recliner as her mother, Marilyn Rosenlof, 87, dozed nearby. Her mother had been in an assisted living facility in Santa Barbara that was costing $10,000 a month before she became bedridden.

Graff relocated her mother to a little house she and her husband purchased near their own home in Mission Viejo. Then Rosenlof went on hospice care in March.

“We were very naïve,” Graff said, “thinking we could keep Mom at home and help care for her.”

Rosenlof came to The Heavenly Home in mid-June, the last space that’s been available. Graff likes how the staff respects her mother’s own schedule.

“If she doesn’t want to wake up for breakfast, she doesn’t have to,” Graff said. “They’re all so loving, and she loves them.”

Southern California Hospice Foundation hopes to open a second hospice house like The Heavenly Home. The state is reviewing a grant proposal to cover the cost of purchasing another house and funding five years of operating expenses.

“We’re really trying to help fill a huge gap for end-of-life,” Wulfestieg said. “It is caregiving and it is housing.”

Good days to come

The oldest resident, Jean Corcoran, has lived at The Heavenly Home since early May. Her 104th birthday will be Nov. 18. She has bouts of confusion and dementia.

On a warm afternoon last week, Corcoran barely moved in bed, tucked under several blankets. She was not at her sharpest at that time of day but told some of her life story, never lifting her head from her pillows.

Born in West Virginia, she lost her own mother in childbirth and, when she was 3, her father placed her in an orphanage.

She was a Rosie the Riveter welder in a Midwest factory during World War II. She had been a department store model. After coming to California in the post-war boom, she worked as a nurse. Her daughter is in a nursing home. Members of her church are steady visitors.

She is one of the lower-income patients with an Assisted Living Waiver.

Even in her diminished capacity, Corcoran maintains a stylish flair, Wulfestieg said: “This is a woman who still puts on makeup and does her nails. She’s a total fashionista.”

The day after Halloween, Corcoran was the guest of honor at a fundraising event for Southern California Hospice Foundation called “Dolled Up.” The outfit the foundation bought for her to wear included a white faux fur jacket, a shimmering top and sleek black pants, and a princess crown atop her newly coifed white hair.

When she arrived at the event inside the Pacific Club in Newport Beach, Corcoran let out a “Wow.” There was vanilla birthday cake and “Happy Birthday to You.”

At the end, Corcoran expressed her gratitude with tears of joy and repeated over and over, “Thank you, thank you, thank you.”