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She's formerly the host of \u003ca href=\"http://ww2.kqed.org/pop/category/the-cooler/\" rel=\"noopener noreferrer\">The Cooler\u003c/a> podcast.","avatar":"https://secure.gravatar.com/avatar/2d8d6765f186e64c798cf7f0c8088a41?s=600&d=blank&r=g","twitter":"teacupinthebay","facebook":null,"instagram":null,"linkedin":null,"sites":[{"site":"","roles":["editor"]},{"site":"arts","roles":["editor"]},{"site":"news","roles":["administrator"]},{"site":"pop","roles":["editor"]},{"site":"futureofyou","roles":["editor"]},{"site":"about","roles":["administrator"]},{"site":"mindshift","roles":["editor"]},{"site":"bayareabites","roles":["editor"]},{"site":"stateofhealth","roles":["editor"]},{"site":"science","roles":["editor"]},{"site":"food","roles":["contributor"]},{"site":"forum","roles":["editor"]},{"site":"perspectives","roles":["administrator"]}],"headData":{"title":"Carly Severn | KQED","description":"Senior Editor, Audience News ","ogImgSrc":"https://secure.gravatar.com/avatar/2d8d6765f186e64c798cf7f0c8088a41?s=600&d=blank&r=g","twImgSrc":"https://secure.gravatar.com/avatar/2d8d6765f186e64c798cf7f0c8088a41?s=600&d=blank&r=g"},"isLoading":false,"link":"/author/carlysevern"},"ebaldassari":{"type":"authors","id":"11652","meta":{"index":"authors_1591205172","id":"11652","found":true},"name":"Erin Baldassari","firstName":"Erin","lastName":"Baldassari","slug":"ebaldassari","email":"ebaldassari@KQED.org","display_author_email":true,"staff_mastheads":["news"],"title":"Staff Writer","bio":"Erin Baldassari covers housing for KQED. She's a former print journalist and most recently worked as the transportation reporter for the \u003cem>Mercury News\u003c/em> and \u003cem>East Bay Times. \u003c/em>There, she focused on how the Bay Area’s housing shortage has changed the way people move around the region. She also served on the \u003cem>East Bay Times\u003c/em>’ 2017 Pulitzer Prize-winning team for coverage of the Ghost Ship Fire in Oakland. Prior to that, Erin worked as a breaking news and general assignment reporter for a variety of outlets in the Bay Area and the greater Boston area. A Tufts University alumna, Erin grew up in the foothills of the Sierra Nevada mountains and in Sonoma County. She is a life-long KQED listener.","avatar":"https://secure.gravatar.com/avatar/660ce35d088ca54ad606d7e941abc652?s=600&d=blank&r=g","twitter":"e_baldi","facebook":null,"instagram":null,"linkedin":null,"sites":[{"site":"news","roles":["author","edit_others_posts"]},{"site":"science","roles":["editor"]}],"headData":{"title":"Erin Baldassari | KQED","description":"Staff Writer","ogImgSrc":"https://secure.gravatar.com/avatar/660ce35d088ca54ad606d7e941abc652?s=600&d=blank&r=g","twImgSrc":"https://secure.gravatar.com/avatar/660ce35d088ca54ad606d7e941abc652?s=600&d=blank&r=g"},"isLoading":false,"link":"/author/ebaldassari"}},"breakingNewsReducer":{},"campaignFinanceReducer":{},"firebase":{"requesting":{},"requested":{},"timestamps":{},"data":{},"ordered":{},"auth":{"isLoaded":false,"isEmpty":true},"authError":null,"profile":{"isLoaded":false,"isEmpty":true},"listeners":{"byId":{},"allIds":[]},"isInitializing":false,"errors":[]},"navBarReducer":{"navBarId":"news","fullView":true,"showPlayer":false},"navMenuReducer":{"menus":[{"key":"menu1","items":[{"name":"News","link":"/","type":"title"},{"name":"Politics","link":"/politics"},{"name":"Science","link":"/science"},{"name":"Education","link":"/educationnews"},{"name":"Housing","link":"/housing"},{"name":"Immigration","link":"/immigration"},{"name":"Criminal Justice","link":"/criminaljustice"},{"name":"Silicon Valley","link":"/siliconvalley"},{"name":"Forum","link":"/forum"},{"name":"The California Report","link":"/californiareport"}]},{"key":"menu2","items":[{"name":"Arts & Culture","link":"/arts","type":"title"},{"name":"Critics’ Picks","link":"/thedolist"},{"name":"Cultural Commentary","link":"/artscommentary"},{"name":"Food & Drink","link":"/food"},{"name":"Bay Area Hip-Hop","link":"/bayareahiphop"},{"name":"Rebel Girls","link":"/rebelgirls"},{"name":"Arts Video","link":"/artsvideos"}]},{"key":"menu3","items":[{"name":"Podcasts","link":"/podcasts","type":"title"},{"name":"Bay Curious","link":"/podcasts/baycurious"},{"name":"Rightnowish","link":"/podcasts/rightnowish"},{"name":"The Bay","link":"/podcasts/thebay"},{"name":"On Our Watch","link":"/podcasts/onourwatch"},{"name":"Mindshift","link":"/podcasts/mindshift"},{"name":"Consider This","link":"/podcasts/considerthis"},{"name":"Political Breakdown","link":"/podcasts/politicalbreakdown"}]},{"key":"menu4","items":[{"name":"Live Radio","link":"/radio","type":"title"},{"name":"TV","link":"/tv","type":"title"},{"name":"Events","link":"/events","type":"title"},{"name":"For Educators","link":"/education","type":"title"},{"name":"Support KQED","link":"/support","type":"title"},{"name":"About","link":"/about","type":"title"},{"name":"Help Center","link":"https://kqed-helpcenter.kqed.org/s","type":"title"}]}]},"pagesReducer":{},"postsReducer":{"stream_live":{"type":"live","id":"stream_live","audioUrl":"https://streams.kqed.org/kqedradio","title":"Live Stream","excerpt":"Live Stream information currently unavailable.","link":"/radio","featImg":"","label":{"name":"KQED Live","link":"/"}},"stream_kqedNewscast":{"type":"posts","id":"stream_kqedNewscast","audioUrl":"https://www.kqed.org/.stream/anon/radio/RDnews/newscast.mp3?_=1","title":"KQED Newscast","featImg":"","label":{"name":"88.5 FM","link":"/"}},"news_11961649":{"type":"posts","id":"news_11961649","meta":{"index":"posts_1591205157","site":"news","id":"11961649","score":null,"sort":[1695407414000]},"guestAuthors":[],"slug":"when-should-i-get-2023-flu-shot-safe-with-new-covid-vaccine-rsv","title":"When Should You Get Your 2023 Flu Shot?","publishDate":1695407414,"format":"image","headTitle":"When Should You Get Your 2023 Flu Shot? | KQED","labelTerm":{"site":"news"},"content":"\u003cp>We’re over three years into the COVID pandemic. And \u003ca href=\"https://www.kqed.org/news/11957790/the-new-covid-eris-variant-and-rising-cases-what-you-need-to-know\">as we’ve seen this summer, with the new Eris variant\u003c/a>, COVID continues to infect folks of all ages and still results in severe disease and hospitalization for some.\u003c/p>\n\u003cp>But please don’t forget: The flu remains a potentially serious threat to your health too.\u003c/p>\n\u003cp>Jump straight to:\u003c/p>\n\u003cul>\n\u003cli>\u003cstrong>\u003ca href=\"#whenflushot\">When should I get my flu shot?\u003c/a>\u003c/strong>\u003c/li>\n\u003cli>\u003cstrong>\u003ca href=\"#boosterflushot\">Can I get my new COVID vaccine and my flu shot at the same time? What about the RSV vaccine?\u003c/a>\u003c/strong>\u003c/li>\n\u003cli>\u003cstrong>\u003ca href=\"#flushotnearme\">Where can I get a flu shot, with or without insurance?\u003c/a>\u003c/strong>\u003c/li>\n\u003c/ul>\n\u003ch2>Why is the flu so serious?\u003c/h2>\n\u003cp>Back in \u003ca href=\"https://www.cdc.gov/flu/season/faq-flu-season-2020-2021.htm\">2020, the U.S. saw a record-low number of flu cases\u003c/a> — most likely due to widespread mask-wearing, increased hygiene, social distancing and remote work and school. And \u003ca href=\"https://www.cdc.gov/flu/about/burden/preliminary-in-season-estimates.htm\">the Centers for Disease Control and Prevention says that flu activity has overall “been lower\u003c/a> than observed before the pandemic.”\u003c/p>\n\u003cp>Nonetheless, the CDC estimates that\u003ca href=\"https://www.cdc.gov/flu/about/burden/preliminary-in-season-estimates.htm\"> last year’s flu season resulted in 19,000–58,000 deaths from flu\u003c/a> and 300,000–650,000 flu hospitalizations. The agency says that the 2022–2023 flu season caused up to 54 million illnesses.\u003c/p>\n\u003cp>But the organization says that \u003ca href=\"https://www.cdc.gov/flu/fluvaxview/coverage-2022estimates.htm\">in the 2021–2022 flu season, just under half of adults got a flu shot\u003c/a> — a slight decrease from the previous season.\u003c/p>\n\u003ch2>Why should I get a flu shot?\u003c/h2>\n\u003cp>Getting a flu vaccine can prevent you from getting sick with the flu, which is a draining, unpleasant experience even if your symptoms are not severe. And if you \u003cem>do\u003c/em> get the flu, having a flu shot can also stop you from getting sick enough to have to visit the hospital (and be exposed to all the COVID risks hospital settings can still bring).\u003c/p>\n\u003cp>The CDC says the flu vaccine also offers other potential health impacts, such as being associated with \u003ca class=\"tp-link-policy\" href=\"https://pubmed.ncbi.nlm.nih.gov/24150467/\" data-domain-ext=\"gov\">lower rates of certain cardiac events\u003c/a> for people who have heart disease. It’s also the best, safest way not only to protect \u003cem>yourself\u003c/em> against the influenza virus, but also to minimize the chance you will spread it to others — folks who could be at far higher risk for serious complications or even death if they were to become infected. \u003ca href=\"https://www.cdc.gov/flu/vaccines-work/vaccineeffect.htm\">Read more from the CDC about what the flu shot can do for you.\u003c/a>\u003c/p>\n\u003cp>Keep reading to find out whether you should be getting your flu shot right now, and where to find free or low-cost flu shot options near you.\u003c/p>\n\u003ch2>\u003ca id=\"whenflushot\">\u003c/a>Should I get a flu shot now, or wait?\u003c/h2>\n\u003cp>The recommendations medical professionals make about when to get a flu shot are based on the fact that it takes about two weeks after you get vaccinated for antibodies to develop and provide protection against the flu.\u003c/p>\n\u003cp>This 2023–2024 season, as with previous seasons, \u003ca href=\"https://www.cdc.gov/flu/spotlights/2022-2023/flu-vaccination-recommendations-adopted.htm\">the CDC says that September and October are “the best times for most people to get vaccinated.”\u003c/a> These recommendations are based on traditional predictions of flu season starting in November and peaking around January or February.\u003c/p>\n\u003cfigure id=\"attachment_11838737\" class=\"wp-caption alignnone\" style=\"max-width: 1900px\">\u003cimg decoding=\"async\" loading=\"lazy\" class=\"size-full wp-image-11838737\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2020/09/shots2.png\" alt=\"\" width=\"1900\" height=\"1267\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2020/09/shots2.png 1900w, https://ww2.kqed.org/app/uploads/sites/10/2020/09/shots2-800x533.png 800w, https://ww2.kqed.org/app/uploads/sites/10/2020/09/shots2-1020x680.png 1020w, https://ww2.kqed.org/app/uploads/sites/10/2020/09/shots2-160x107.png 160w, https://ww2.kqed.org/app/uploads/sites/10/2020/09/shots2-1536x1024.png 1536w\" sizes=\"(max-width: 1900px) 100vw, 1900px\">\u003cfigcaption class=\"wp-caption-text\">It takes 2 weeks after your flu shot for your body to develop the antibodies it needs to protect you from the flu virus. \u003ccite>(Queen's University/Flickr)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Dr. Peter Chin-Hong, an infectious disease expert at UCSF says that yes, there’s evidence that \u003ca href=\"https://pubmed.ncbi.nlm.nih.gov/28039340/\">your risk of getting the flu increases every month after your flu shot, due to the antibodies waning over time\u003c/a>.\u003c/p>\n\u003cp>But when medical professionals talk about strategically “waiting” to get a flu shot, they’re aiming that advice at those who are at particularly high risk for more serious complications related to the flu. That includes:\u003c/p>\n\u003cul>\n\u003cli>People over 65.\u003c/li>\n\u003cli>Folks with chronic medical conditions.\u003c/li>\n\u003cli>Pregnant people (or those who are planning to become pregnant).\u003c/li>\n\u003cli>Kids under 5.\u003c/li>\n\u003c/ul>\n\u003cp>Delaying inoculations for these populations is based on the idea of getting the shot at a time Chin-Hong calls “the sweet spot,” around mid-to-late October. Two weeks later, right around early November, the antibodies should have developed, just as flu season is (usually) getting serious. Think of it as getting the “biggest bang for your buck,” he said.\u003c/p>\n\u003cp>So, if you’re in one of those vulnerable categories, yes, you can think about waiting, says Chin-Hong. People over 65 might also consider requesting special flu vaccines for this age group — read more about this below. As with all health matters, if you’re looking for advice, it’s best to consult your health care provider or someone you see regularly for your medical needs.\u003c/p>\n\u003cp>And what if you’re under 65, not pregnant and don’t have other risk factors for severe flu? If you can truly trust yourself to plan ahead and not forget to make the appointment, getting it by Halloween (i.e., before October is up) is best, Chin-Hong said. But remember: Not only are you human, and it might slip your mind, but predictions about how the flu season might behave are just that — predictions.\u003c/p>\n\u003cp>Flu cases might start to rise earlier than anticipated, throwing previous notions of a “best time” to get the vaccine into disarray. So, take that “October rule” with “a grain of salt,” Chin-Hong advised, and “get [your flu shot] when you get it.”\u003c/p>\n\u003cp>What if you plan to get your flu shot in October with the best of intentions, but you still forget? If Nov. 1 comes and goes, and you realize you haven’t been vaccinated, all is not lost — since the CDC says that “vaccination after October can still provide protection during the peak of flu season,” which is usually February.\u003c/p>\n\u003cp>In other words, just go get the shot already — whenever that may be.\u003c/p>\n\u003cp>\u003cimg decoding=\"async\" loading=\"lazy\" class=\"alignnone size-full wp-image-11838740\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2020/09/shots3.png\" alt=\"\" width=\"1900\" height=\"1267\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2020/09/shots3.png 1900w, https://ww2.kqed.org/app/uploads/sites/10/2020/09/shots3-800x533.png 800w, https://ww2.kqed.org/app/uploads/sites/10/2020/09/shots3-1020x680.png 1020w, https://ww2.kqed.org/app/uploads/sites/10/2020/09/shots3-160x107.png 160w, https://ww2.kqed.org/app/uploads/sites/10/2020/09/shots3-1536x1024.png 1536w\" sizes=\"(max-width: 1900px) 100vw, 1900px\">\u003c/p>\n\u003ch2>\u003ca id=\"boosterflushot\">\u003c/a>Can I get my new COVID vaccine and my flu shot at the same time?\u003c/h2>\n\u003cp>\u003ca href=\"https://www.kqed.org/news/11960630/free-new-covid-vaccine-near-me-2023#shouldigetfluandcovidvaccine\">It’s totally fine, and safe, to get your flu shot at the same time\u003c/a> as your new COVID vaccine, and you’ll find that COVID vaccine appointments will often prompt you to “add on” a flu shot at the same session — especially at pharmacies. Although, if you’re trying to schedule your kid’s vaccinations, \u003ca href=\"https://www.npr.org/sections/health-shots/2023/09/13/1198803134/covid-boosters-updated-vaccines-fda-cdc\">the CDC advises that you first talk to your pediatrician\u003c/a> about the best schedule for the COVID and flu vaccines (and now the RSV — respiratory syncytial virus — preventive treatment too).\u003c/p>\n\u003cp>But if that optimal time to get your flu shot is “sometime before Halloween” according to Chin-Hong — as long as flu season behaves as expected and doesn’t start in earnest before November — should you get your new COVID shot \u003cem>first\u003c/em>, and follow up with a flu shot later?\u003c/p>\n\u003cp>If you can trust yourself to remember to seek out your flu shot by the end of October (or schedule an appointment for October in advance), yes: You might consider getting your new COVID vaccine earlier, separately from your flu shot. And if not — or if life is getting hectic, and a two-for-one vaccination appointment ensures that you actually \u003ci>will \u003c/i>get your shots rather than forgetting — just go ahead and get your COVID and flu shots at the same time, when you can.\u003c/p>\n\u003cp>There’s also the fact that \u003ca href=\"https://www.kqed.org/news/11960630/free-new-covid-vaccine-near-me-2023\">you might \u003cem>have\u003c/em> to wait a little longer for your COVID shot anyway\u003c/a>. Public health officials are urging people to first seek out the new vaccine via their health care provider, but supplies haven’t yet reached many providers. Kaiser Permanente, for example, is telling patients that \u003ca href=\"https://mydoctor.kaiserpermanente.org/covid-19/covid-19-vaccine\">shots of the new COVID vaccine won’t become available through Kaiser until early October\u003c/a>. All this to say: You might not have a choice about waiting to get your new COVID shot — by which time, you might be approaching that optimal October flu shot time anyway, and can choose a double vaccination appointment at that time.\u003c/p>\n\u003cp>Chin-Hong reiterated that “if you really wanted to optimize” the timing of your flu shot, yes, “sometime in October \u003cem>is\u003c/em> probably the best.” But ultimately, he says that just \u003cem>getting\u003c/em> the shots is better than not getting them at all.\u003c/p>\n\u003cp>\u003ca href=\"https://www.kqed.org/news/11960630/free-new-covid-vaccine-near-me-2023\">Read more about where to find the new COVID vaccine near you.\u003c/a>\u003c/p>\n\u003ch2>What about the RSV vaccine?\u003c/h2>\n\u003cp>The CDC says that the respiratory syncytial virus — RSV — is “a common cause of respiratory illness in infants and young children, as well as older adults.” The disease results in up to 160,000 hospitalizations and \u003ca href=\"https://www.cdc.gov/vaccines/vpd/rsv/hcp/older-adults-faqs.html\">up to 10,000 deaths annually among adults ages 65 years and older\u003c/a>, says the agency.\u003c/p>\n\u003cp>\u003ca href=\"https://www.cdc.gov/vaccines/vpd/rsv/index.html\">The vaccine against the respiratory syncytial virus — RSV — is accordingly recommended by the CDC\u003c/a> for infants, young children and adults ages 60 and older.\u003c/p>\n\u003cp>Most \u003ca href=\"https://www.npr.org/sections/health-shots/2023/09/13/1198803134/covid-boosters-updated-vaccines-fda-cdc\">experts NPR talked to for their fall booster guide\u003c/a> recommended getting the RSV vaccine separately from the COVID and flu vaccines.\u003c/p>\n\u003cp>“I think the recommendation would be if you’re going in, get your flu and COVID shot. If you’re eligible for RSV, maybe space that out by a week or two,” Dr. \u003ca href=\"https://www.bcm.edu/people-search/peter-hotez-23229\">Peter Hotez\u003c/a>, who leads the National School of Tropical Medicine at Baylor College of Medicine, told NPR.\u003c/p>\n\u003cp>Again, if you’re trying to schedule your kid’s vaccinations, \u003ca href=\"https://www.npr.org/sections/health-shots/2023/09/13/1198803134/covid-boosters-updated-vaccines-fda-cdc\">the CDC advises that you first talk to your pediatrician\u003c/a> about the best schedule for the COVID, flu and RSV vaccines.\u003c/p>\n\u003ch2>\u003ca id=\"highrisk\">\u003c/a>If I have risk factors for severe flu, what kind of flu shot should I get?\u003c/h2>\n\u003cp>If you’re age 65 or older, there are now three types of flu vaccines it’s recommended you get — because they’ll be even more effective for you than a regular flu shot.\u003c/p>\n\u003cp>Chin-Hong said folks in this age group should seek out these three types of vaccines because you’ll be getting “essentially a high-dose shot” or a vaccine that contains an “adjuvant” — which, in simple terms, “makes the flu shot more powerful in terms of waking up the immune system,” he said. \u003ca href=\"https://www.cdc.gov/flu/prevent/keyfacts.htm\">Read more about the three kinds of flu shots available to people ages 65 and older.\u003c/a>\u003c/p>\n\u003cp>Pregnant people can get a regular flu shot, although some types of flu vaccines are off-limits to pregnant people. The CDC says that getting vaccinated when you’re pregnant will not only help protect you from the flu, but also — if your baby is born during the immunity period — protect your infant in the first few months of their life when they’re too young to get vaccinated themselves.\u003c/p>\n\u003cp>This benefit to the baby is also the reason that pregnant people are one of the few groups who might want to consider getting a flu shot \u003cem>early\u003c/em>, instead of waiting — to ensure their baby isn’t left completely unprotected for those first six months after birth when they can’t get a vaccine. \u003ca href=\"https://www.cdc.gov/flu/prevent/keyfacts.htm\">Read more about the benefits of getting a flu shot if you’re pregnant.\u003c/a>\u003c/p>\n\u003cp>Children ages 6 months and older can get a regular dose of the flu shot. \u003ca href=\"https://www.cdc.gov/flu/highrisk/children-high-risk.htm\">Flu can be particularly dangerous for kids\u003c/a>, and the CDC says that a 2022 study showed that flu vaccination reduced children’s risk of severe, life-threatening influenza by 75%.\u003c/p>\n\u003ch2>\u003ca id=\"flushotnearme\">\u003c/a>Where can I get a flu shot if I have insurance?\u003c/h2>\n\u003cp>If you have health insurance, a flu shot is available without extra cost as a preventive service from your usual health care provider, or at most pharmacies (see below).\u003c/p>\n\u003cp>It’s a good idea to wear a mask, maintain social distancing wherever possible while waiting for your shot, and dress in a top with sleeves you can easily pull up to your shoulder, to make receiving the injection even easier (and quicker).\u003c/p>\n\u003cp>\u003cstrong>Common places to find a flu shot appointment, walk-in site or drive-thru flu shot:\u003c/strong>\u003c/p>\n\u003cul>\n\u003cli>\u003ca href=\"https://www.vaccines.gov/find-vaccines/\">CDC’s Find Flu Vaccines tool.\u003c/a>\u003c/li>\n\u003cli>\u003ca href=\"https://mydoctor.kaiserpermanente.org/ncal/cold-and-flu/prevention#/prevention\">Kaiser Permanente flu shots (Northern California)\u003c/a>.\u003c/li>\n\u003cli>\u003ca href=\"https://www.cvs.com/immunizations/flu\">CVS flu shots.\u003c/a>\u003c/li>\n\u003cli>\u003ca href=\"https://www.walgreens.com/topic/pharmacy/seasonal-flu.jsp?ban=flu_fy21_influenzapage\">Walgreens flu shots.\u003c/a>\u003c/li>\n\u003cli>\u003ca href=\"https://www.riteaid.com/pharmacy/scheduler\">Rite Aid flu shots.\u003c/a>\u003c/li>\n\u003cli>\u003ca href=\"https://www.costco.com/Pharmacy/adult-immunization-program.html\">Costco Pharmacy flu shots.\u003c/a>\u003c/li>\n\u003cli>\u003ca href=\"https://www.albertsons.com/pharmacy/pharmacy-services/immunizations.html\">Albertsons (Safeway) flu shots.\u003c/a>\u003c/li>\n\u003c/ul>\n\u003ch2>Where can I get a flu shot if I \u003cem>don’t\u003c/em> have health insurance?\u003c/h2>\n\u003cp>If you want a flu shot but don’t have health insurance, you can get the vaccine free of charge from several providers and community clinics around the Bay Area. (You can also technically use these free services even if you do have insurance, but you may consider choosing to free up these particular resources for those who are not covered.)\u003c/p>\n\u003cp>Your county’s public health department may also be offering flu shots.\u003c/p>\n\u003cp>\u003cstrong>Places to get a free or low-cost flu shot in the Bay Area include:\u003c/strong>\u003c/p>\n\u003cul>\n\u003cli>\u003ca href=\"https://www.sfcdcp.org/aitc/aitc-regular-prices-low-cost-or-free-vaccines/\">San Francisco Department of Public Health’s AITC clinic\u003c/a> (offers a pay-what-you-can option).\u003c/li>\n\u003cli>\u003ca href=\"https://cchealth.org/immunization/clinics.php#Uninsured\">Contra Costa Public Health Immunization Clinic\u003c/a> (flu shots are $15 for adults over 19, but fees may be waived if you’re unable to pay).\u003c/li>\n\u003cli>\u003ca href=\"https://acphd.org/clinics/\">Alameda County Immunization Clinics.\u003c/a>\u003c/li>\n\u003c/ul>\n\u003cp>\u003cspan style=\"font-weight: 400\">[ad fullwidth]\u003c/span>\u003c/p>\n\u003ch2>And a reminder … the flu vaccine can’t give you the flu\u003c/h2>\n\u003cp>The virus that the flu shot contains has been inactivated or severely weakened, so \u003ca href=\"https://www.cdc.gov/flu/prevent/misconceptions.htm#:~:text=Can%20a%20flu%20vaccine%20give,protein%20from%20the%20flu%20virus.\">you just aren’t physically able to get the flu from your flu shot\u003c/a>, confirms the CDC.\u003c/p>\n\u003cp>\u003ca href=\"https://www.cdc.gov/flu/prevent/general.htm#side-effects\">The flu vaccine can cause side effects\u003c/a> like any medical product, but they’re “\u003ca href=\"https://www.cdc.gov/flu/prevent/general.htm\">generally mild and go away on their own within a few days\u003c/a>,” the agency says.\u003c/p>\n\u003cp>Common flu shot side effects can include soreness or swelling at the injection site, headache, fever, nausea and muscle aches. (But not the flu.)\u003c/p>\n\u003cp>\u003cem>This story contains reporting by KQED’s Alexander Gonzalez.\u003c/em>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n","blocks":[],"excerpt":"Should you be getting your 2023 flu shot right now? Plus: Where to find free and low-cost flu shots near you.","status":"publish","parent":0,"modified":1695411793,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":48,"wordCount":2333},"headData":{"title":"When Should You Get Your 2023 Flu Shot? | KQED","description":"Should you be getting your flu shot right now? Plus: where to find free and low-cost flu shots near you in the Bay Area, without an apppointment.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","socialDescription":"Should you be getting your flu shot right now? Plus: where to find free and low-cost flu shots near you in the Bay Area, without an apppointment."},"excludeFromSiteSearch":"Include","articleAge":"0","path":"/news/11961649/when-should-i-get-2023-flu-shot-safe-with-new-covid-vaccine-rsv","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>We’re over three years into the COVID pandemic. And \u003ca href=\"https://www.kqed.org/news/11957790/the-new-covid-eris-variant-and-rising-cases-what-you-need-to-know\">as we’ve seen this summer, with the new Eris variant\u003c/a>, COVID continues to infect folks of all ages and still results in severe disease and hospitalization for some.\u003c/p>\n\u003cp>But please don’t forget: The flu remains a potentially serious threat to your health too.\u003c/p>\n\u003cp>Jump straight to:\u003c/p>\n\u003cul>\n\u003cli>\u003cstrong>\u003ca href=\"#whenflushot\">When should I get my flu shot?\u003c/a>\u003c/strong>\u003c/li>\n\u003cli>\u003cstrong>\u003ca href=\"#boosterflushot\">Can I get my new COVID vaccine and my flu shot at the same time? What about the RSV vaccine?\u003c/a>\u003c/strong>\u003c/li>\n\u003cli>\u003cstrong>\u003ca href=\"#flushotnearme\">Where can I get a flu shot, with or without insurance?\u003c/a>\u003c/strong>\u003c/li>\n\u003c/ul>\n\u003ch2>Why is the flu so serious?\u003c/h2>\n\u003cp>Back in \u003ca href=\"https://www.cdc.gov/flu/season/faq-flu-season-2020-2021.htm\">2020, the U.S. saw a record-low number of flu cases\u003c/a> — most likely due to widespread mask-wearing, increased hygiene, social distancing and remote work and school. And \u003ca href=\"https://www.cdc.gov/flu/about/burden/preliminary-in-season-estimates.htm\">the Centers for Disease Control and Prevention says that flu activity has overall “been lower\u003c/a> than observed before the pandemic.”\u003c/p>\n\u003cp>Nonetheless, the CDC estimates that\u003ca href=\"https://www.cdc.gov/flu/about/burden/preliminary-in-season-estimates.htm\"> last year’s flu season resulted in 19,000–58,000 deaths from flu\u003c/a> and 300,000–650,000 flu hospitalizations. The agency says that the 2022–2023 flu season caused up to 54 million illnesses.\u003c/p>\n\u003cp>But the organization says that \u003ca href=\"https://www.cdc.gov/flu/fluvaxview/coverage-2022estimates.htm\">in the 2021–2022 flu season, just under half of adults got a flu shot\u003c/a> — a slight decrease from the previous season.\u003c/p>\n\u003ch2>Why should I get a flu shot?\u003c/h2>\n\u003cp>Getting a flu vaccine can prevent you from getting sick with the flu, which is a draining, unpleasant experience even if your symptoms are not severe. And if you \u003cem>do\u003c/em> get the flu, having a flu shot can also stop you from getting sick enough to have to visit the hospital (and be exposed to all the COVID risks hospital settings can still bring).\u003c/p>\n\u003cp>The CDC says the flu vaccine also offers other potential health impacts, such as being associated with \u003ca class=\"tp-link-policy\" href=\"https://pubmed.ncbi.nlm.nih.gov/24150467/\" data-domain-ext=\"gov\">lower rates of certain cardiac events\u003c/a> for people who have heart disease. It’s also the best, safest way not only to protect \u003cem>yourself\u003c/em> against the influenza virus, but also to minimize the chance you will spread it to others — folks who could be at far higher risk for serious complications or even death if they were to become infected. \u003ca href=\"https://www.cdc.gov/flu/vaccines-work/vaccineeffect.htm\">Read more from the CDC about what the flu shot can do for you.\u003c/a>\u003c/p>\n\u003cp>Keep reading to find out whether you should be getting your flu shot right now, and where to find free or low-cost flu shot options near you.\u003c/p>\n\u003ch2>\u003ca id=\"whenflushot\">\u003c/a>Should I get a flu shot now, or wait?\u003c/h2>\n\u003cp>The recommendations medical professionals make about when to get a flu shot are based on the fact that it takes about two weeks after you get vaccinated for antibodies to develop and provide protection against the flu.\u003c/p>\n\u003cp>This 2023–2024 season, as with previous seasons, \u003ca href=\"https://www.cdc.gov/flu/spotlights/2022-2023/flu-vaccination-recommendations-adopted.htm\">the CDC says that September and October are “the best times for most people to get vaccinated.”\u003c/a> These recommendations are based on traditional predictions of flu season starting in November and peaking around January or February.\u003c/p>\n\u003cfigure id=\"attachment_11838737\" class=\"wp-caption alignnone\" style=\"max-width: 1900px\">\u003cimg decoding=\"async\" loading=\"lazy\" class=\"size-full wp-image-11838737\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2020/09/shots2.png\" alt=\"\" width=\"1900\" height=\"1267\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2020/09/shots2.png 1900w, https://ww2.kqed.org/app/uploads/sites/10/2020/09/shots2-800x533.png 800w, https://ww2.kqed.org/app/uploads/sites/10/2020/09/shots2-1020x680.png 1020w, https://ww2.kqed.org/app/uploads/sites/10/2020/09/shots2-160x107.png 160w, https://ww2.kqed.org/app/uploads/sites/10/2020/09/shots2-1536x1024.png 1536w\" sizes=\"(max-width: 1900px) 100vw, 1900px\">\u003cfigcaption class=\"wp-caption-text\">It takes 2 weeks after your flu shot for your body to develop the antibodies it needs to protect you from the flu virus. \u003ccite>(Queen's University/Flickr)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Dr. Peter Chin-Hong, an infectious disease expert at UCSF says that yes, there’s evidence that \u003ca href=\"https://pubmed.ncbi.nlm.nih.gov/28039340/\">your risk of getting the flu increases every month after your flu shot, due to the antibodies waning over time\u003c/a>.\u003c/p>\n\u003cp>But when medical professionals talk about strategically “waiting” to get a flu shot, they’re aiming that advice at those who are at particularly high risk for more serious complications related to the flu. That includes:\u003c/p>\n\u003cul>\n\u003cli>People over 65.\u003c/li>\n\u003cli>Folks with chronic medical conditions.\u003c/li>\n\u003cli>Pregnant people (or those who are planning to become pregnant).\u003c/li>\n\u003cli>Kids under 5.\u003c/li>\n\u003c/ul>\n\u003cp>Delaying inoculations for these populations is based on the idea of getting the shot at a time Chin-Hong calls “the sweet spot,” around mid-to-late October. Two weeks later, right around early November, the antibodies should have developed, just as flu season is (usually) getting serious. Think of it as getting the “biggest bang for your buck,” he said.\u003c/p>\n\u003cp>So, if you’re in one of those vulnerable categories, yes, you can think about waiting, says Chin-Hong. People over 65 might also consider requesting special flu vaccines for this age group — read more about this below. As with all health matters, if you’re looking for advice, it’s best to consult your health care provider or someone you see regularly for your medical needs.\u003c/p>\n\u003cp>And what if you’re under 65, not pregnant and don’t have other risk factors for severe flu? If you can truly trust yourself to plan ahead and not forget to make the appointment, getting it by Halloween (i.e., before October is up) is best, Chin-Hong said. But remember: Not only are you human, and it might slip your mind, but predictions about how the flu season might behave are just that — predictions.\u003c/p>\n\u003cp>Flu cases might start to rise earlier than anticipated, throwing previous notions of a “best time” to get the vaccine into disarray. So, take that “October rule” with “a grain of salt,” Chin-Hong advised, and “get [your flu shot] when you get it.”\u003c/p>\n\u003cp>What if you plan to get your flu shot in October with the best of intentions, but you still forget? If Nov. 1 comes and goes, and you realize you haven’t been vaccinated, all is not lost — since the CDC says that “vaccination after October can still provide protection during the peak of flu season,” which is usually February.\u003c/p>\n\u003cp>In other words, just go get the shot already — whenever that may be.\u003c/p>\n\u003cp>\u003cimg decoding=\"async\" loading=\"lazy\" class=\"alignnone size-full wp-image-11838740\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2020/09/shots3.png\" alt=\"\" width=\"1900\" height=\"1267\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2020/09/shots3.png 1900w, https://ww2.kqed.org/app/uploads/sites/10/2020/09/shots3-800x533.png 800w, https://ww2.kqed.org/app/uploads/sites/10/2020/09/shots3-1020x680.png 1020w, https://ww2.kqed.org/app/uploads/sites/10/2020/09/shots3-160x107.png 160w, https://ww2.kqed.org/app/uploads/sites/10/2020/09/shots3-1536x1024.png 1536w\" sizes=\"(max-width: 1900px) 100vw, 1900px\">\u003c/p>\n\u003ch2>\u003ca id=\"boosterflushot\">\u003c/a>Can I get my new COVID vaccine and my flu shot at the same time?\u003c/h2>\n\u003cp>\u003ca href=\"https://www.kqed.org/news/11960630/free-new-covid-vaccine-near-me-2023#shouldigetfluandcovidvaccine\">It’s totally fine, and safe, to get your flu shot at the same time\u003c/a> as your new COVID vaccine, and you’ll find that COVID vaccine appointments will often prompt you to “add on” a flu shot at the same session — especially at pharmacies. Although, if you’re trying to schedule your kid’s vaccinations, \u003ca href=\"https://www.npr.org/sections/health-shots/2023/09/13/1198803134/covid-boosters-updated-vaccines-fda-cdc\">the CDC advises that you first talk to your pediatrician\u003c/a> about the best schedule for the COVID and flu vaccines (and now the RSV — respiratory syncytial virus — preventive treatment too).\u003c/p>\n\u003cp>But if that optimal time to get your flu shot is “sometime before Halloween” according to Chin-Hong — as long as flu season behaves as expected and doesn’t start in earnest before November — should you get your new COVID shot \u003cem>first\u003c/em>, and follow up with a flu shot later?\u003c/p>\n\u003cp>If you can trust yourself to remember to seek out your flu shot by the end of October (or schedule an appointment for October in advance), yes: You might consider getting your new COVID vaccine earlier, separately from your flu shot. And if not — or if life is getting hectic, and a two-for-one vaccination appointment ensures that you actually \u003ci>will \u003c/i>get your shots rather than forgetting — just go ahead and get your COVID and flu shots at the same time, when you can.\u003c/p>\n\u003cp>There’s also the fact that \u003ca href=\"https://www.kqed.org/news/11960630/free-new-covid-vaccine-near-me-2023\">you might \u003cem>have\u003c/em> to wait a little longer for your COVID shot anyway\u003c/a>. Public health officials are urging people to first seek out the new vaccine via their health care provider, but supplies haven’t yet reached many providers. Kaiser Permanente, for example, is telling patients that \u003ca href=\"https://mydoctor.kaiserpermanente.org/covid-19/covid-19-vaccine\">shots of the new COVID vaccine won’t become available through Kaiser until early October\u003c/a>. All this to say: You might not have a choice about waiting to get your new COVID shot — by which time, you might be approaching that optimal October flu shot time anyway, and can choose a double vaccination appointment at that time.\u003c/p>\n\u003cp>Chin-Hong reiterated that “if you really wanted to optimize” the timing of your flu shot, yes, “sometime in October \u003cem>is\u003c/em> probably the best.” But ultimately, he says that just \u003cem>getting\u003c/em> the shots is better than not getting them at all.\u003c/p>\n\u003cp>\u003ca href=\"https://www.kqed.org/news/11960630/free-new-covid-vaccine-near-me-2023\">Read more about where to find the new COVID vaccine near you.\u003c/a>\u003c/p>\n\u003ch2>What about the RSV vaccine?\u003c/h2>\n\u003cp>The CDC says that the respiratory syncytial virus — RSV — is “a common cause of respiratory illness in infants and young children, as well as older adults.” The disease results in up to 160,000 hospitalizations and \u003ca href=\"https://www.cdc.gov/vaccines/vpd/rsv/hcp/older-adults-faqs.html\">up to 10,000 deaths annually among adults ages 65 years and older\u003c/a>, says the agency.\u003c/p>\n\u003cp>\u003ca href=\"https://www.cdc.gov/vaccines/vpd/rsv/index.html\">The vaccine against the respiratory syncytial virus — RSV — is accordingly recommended by the CDC\u003c/a> for infants, young children and adults ages 60 and older.\u003c/p>\n\u003cp>Most \u003ca href=\"https://www.npr.org/sections/health-shots/2023/09/13/1198803134/covid-boosters-updated-vaccines-fda-cdc\">experts NPR talked to for their fall booster guide\u003c/a> recommended getting the RSV vaccine separately from the COVID and flu vaccines.\u003c/p>\n\u003cp>“I think the recommendation would be if you’re going in, get your flu and COVID shot. If you’re eligible for RSV, maybe space that out by a week or two,” Dr. \u003ca href=\"https://www.bcm.edu/people-search/peter-hotez-23229\">Peter Hotez\u003c/a>, who leads the National School of Tropical Medicine at Baylor College of Medicine, told NPR.\u003c/p>\n\u003cp>Again, if you’re trying to schedule your kid’s vaccinations, \u003ca href=\"https://www.npr.org/sections/health-shots/2023/09/13/1198803134/covid-boosters-updated-vaccines-fda-cdc\">the CDC advises that you first talk to your pediatrician\u003c/a> about the best schedule for the COVID, flu and RSV vaccines.\u003c/p>\n\u003ch2>\u003ca id=\"highrisk\">\u003c/a>If I have risk factors for severe flu, what kind of flu shot should I get?\u003c/h2>\n\u003cp>If you’re age 65 or older, there are now three types of flu vaccines it’s recommended you get — because they’ll be even more effective for you than a regular flu shot.\u003c/p>\n\u003cp>Chin-Hong said folks in this age group should seek out these three types of vaccines because you’ll be getting “essentially a high-dose shot” or a vaccine that contains an “adjuvant” — which, in simple terms, “makes the flu shot more powerful in terms of waking up the immune system,” he said. \u003ca href=\"https://www.cdc.gov/flu/prevent/keyfacts.htm\">Read more about the three kinds of flu shots available to people ages 65 and older.\u003c/a>\u003c/p>\n\u003cp>Pregnant people can get a regular flu shot, although some types of flu vaccines are off-limits to pregnant people. The CDC says that getting vaccinated when you’re pregnant will not only help protect you from the flu, but also — if your baby is born during the immunity period — protect your infant in the first few months of their life when they’re too young to get vaccinated themselves.\u003c/p>\n\u003cp>This benefit to the baby is also the reason that pregnant people are one of the few groups who might want to consider getting a flu shot \u003cem>early\u003c/em>, instead of waiting — to ensure their baby isn’t left completely unprotected for those first six months after birth when they can’t get a vaccine. \u003ca href=\"https://www.cdc.gov/flu/prevent/keyfacts.htm\">Read more about the benefits of getting a flu shot if you’re pregnant.\u003c/a>\u003c/p>\n\u003cp>Children ages 6 months and older can get a regular dose of the flu shot. \u003ca href=\"https://www.cdc.gov/flu/highrisk/children-high-risk.htm\">Flu can be particularly dangerous for kids\u003c/a>, and the CDC says that a 2022 study showed that flu vaccination reduced children’s risk of severe, life-threatening influenza by 75%.\u003c/p>\n\u003ch2>\u003ca id=\"flushotnearme\">\u003c/a>Where can I get a flu shot if I have insurance?\u003c/h2>\n\u003cp>If you have health insurance, a flu shot is available without extra cost as a preventive service from your usual health care provider, or at most pharmacies (see below).\u003c/p>\n\u003cp>It’s a good idea to wear a mask, maintain social distancing wherever possible while waiting for your shot, and dress in a top with sleeves you can easily pull up to your shoulder, to make receiving the injection even easier (and quicker).\u003c/p>\n\u003cp>\u003cstrong>Common places to find a flu shot appointment, walk-in site or drive-thru flu shot:\u003c/strong>\u003c/p>\n\u003cul>\n\u003cli>\u003ca href=\"https://www.vaccines.gov/find-vaccines/\">CDC’s Find Flu Vaccines tool.\u003c/a>\u003c/li>\n\u003cli>\u003ca href=\"https://mydoctor.kaiserpermanente.org/ncal/cold-and-flu/prevention#/prevention\">Kaiser Permanente flu shots (Northern California)\u003c/a>.\u003c/li>\n\u003cli>\u003ca href=\"https://www.cvs.com/immunizations/flu\">CVS flu shots.\u003c/a>\u003c/li>\n\u003cli>\u003ca href=\"https://www.walgreens.com/topic/pharmacy/seasonal-flu.jsp?ban=flu_fy21_influenzapage\">Walgreens flu shots.\u003c/a>\u003c/li>\n\u003cli>\u003ca href=\"https://www.riteaid.com/pharmacy/scheduler\">Rite Aid flu shots.\u003c/a>\u003c/li>\n\u003cli>\u003ca href=\"https://www.costco.com/Pharmacy/adult-immunization-program.html\">Costco Pharmacy flu shots.\u003c/a>\u003c/li>\n\u003cli>\u003ca href=\"https://www.albertsons.com/pharmacy/pharmacy-services/immunizations.html\">Albertsons (Safeway) flu shots.\u003c/a>\u003c/li>\n\u003c/ul>\n\u003ch2>Where can I get a flu shot if I \u003cem>don’t\u003c/em> have health insurance?\u003c/h2>\n\u003cp>If you want a flu shot but don’t have health insurance, you can get the vaccine free of charge from several providers and community clinics around the Bay Area. (You can also technically use these free services even if you do have insurance, but you may consider choosing to free up these particular resources for those who are not covered.)\u003c/p>\n\u003cp>Your county’s public health department may also be offering flu shots.\u003c/p>\n\u003cp>\u003cstrong>Places to get a free or low-cost flu shot in the Bay Area include:\u003c/strong>\u003c/p>\n\u003cul>\n\u003cli>\u003ca href=\"https://www.sfcdcp.org/aitc/aitc-regular-prices-low-cost-or-free-vaccines/\">San Francisco Department of Public Health’s AITC clinic\u003c/a> (offers a pay-what-you-can option).\u003c/li>\n\u003cli>\u003ca href=\"https://cchealth.org/immunization/clinics.php#Uninsured\">Contra Costa Public Health Immunization Clinic\u003c/a> (flu shots are $15 for adults over 19, but fees may be waived if you’re unable to pay).\u003c/li>\n\u003cli>\u003ca href=\"https://acphd.org/clinics/\">Alameda County Immunization Clinics.\u003c/a>\u003c/li>\n\u003c/ul>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/span>\u003c/p>\n\u003ch2>And a reminder … the flu vaccine can’t give you the flu\u003c/h2>\n\u003cp>The virus that the flu shot contains has been inactivated or severely weakened, so \u003ca href=\"https://www.cdc.gov/flu/prevent/misconceptions.htm#:~:text=Can%20a%20flu%20vaccine%20give,protein%20from%20the%20flu%20virus.\">you just aren’t physically able to get the flu from your flu shot\u003c/a>, confirms the CDC.\u003c/p>\n\u003cp>\u003ca href=\"https://www.cdc.gov/flu/prevent/general.htm#side-effects\">The flu vaccine can cause side effects\u003c/a> like any medical product, but they’re “\u003ca href=\"https://www.cdc.gov/flu/prevent/general.htm\">generally mild and go away on their own within a few days\u003c/a>,” the agency says.\u003c/p>\n\u003cp>Common flu shot side effects can include soreness or swelling at the injection site, headache, fever, nausea and muscle aches. (But not the flu.)\u003c/p>\n\u003cp>\u003cem>This story contains reporting by KQED’s Alexander Gonzalez.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/news/11961649/when-should-i-get-2023-flu-shot-safe-with-new-covid-vaccine-rsv","authors":["3243"],"categories":["news_457","news_8"],"tags":["news_32707","news_29029","news_27504","news_22326","news_28567","news_18543","news_20277","news_22327","news_981"],"featImg":"news_11962138","label":"news"},"news_11943288":{"type":"posts","id":"news_11943288","meta":{"index":"posts_1591205157","site":"news","id":"11943288","score":null,"sort":[1678490769000]},"guestAuthors":[],"slug":"post-roe-calepa-secretary-yana-garcia","title":"Post-Roe | CalEPA Secretary Yana Garcia","publishDate":1678490769,"format":"video","headTitle":"KQED Newsroom | KQED News","labelTerm":{"term":7052,"site":"news"},"content":"\u003cp>\u003cb>Post-Roe\u003cbr>\n\u003c/b>\u003cspan style=\"font-weight: 400\">A move to stop selling abortion pills by Walgreens has led California to cut ties with the pharmaceutical giant. We check in with\u003c/span>\u003cspan style=\"font-weight: 400\"> Katherine Tangalakis-Lippert, reporter for Insider, on the latest fight surrounding reproductive rights.\u003c/span>\u003c/p>\n\u003cp>\u003cb>CalEPA Secretary Yana Garcia\u003cbr>\n\u003c/b>\u003cspan style=\"font-weight: 400\">Plus, the California Environmental Protection Agency often leads policies that are ahead of the nation in the fight against climate change. We sit down with the newest Cal EPA secretary, Yana Garcia, to discuss what she plans to accomplish.\u003c/span>\u003c/p>\n\u003cp>\u003cb>Something Beautiful: Chinese Culture Center of SF\u003cbr>\n\u003c/b>\u003cspan style=\"font-weight: 400\">In 1965, one year after the passage of the Civil Rights Act, the Chinese Culture Center of San Francisco was founded to combat racism and inequity. Fifty years later, the center is still elevating underserved communities, and it's this week's look at Something Beautiful.\u003c/span>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\u003cp>\u003c/p>\n","blocks":[],"excerpt":null,"status":"publish","parent":0,"modified":1678491899,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":5,"wordCount":137},"headData":{"title":"Post-Roe | CalEPA Secretary Yana Garcia | KQED","description":"Post-Roe A move to stop selling abortion pills by Walgreens has led California to cut ties with the pharmaceutical giant. We check in with Katherine Tangalakis-Lippert, reporter for Insider, on the latest fight surrounding reproductive rights. CalEPA Secretary Yana Garcia Plus, the California Environmental Protection Agency often leads policies that are ahead of the nation in","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"videoEmbed":"https://youtu.be/viMJw41C_fM","excludeFromSiteSearch":"Include","articleAge":"0","path":"/news/11943288/post-roe-calepa-secretary-yana-garcia","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cb>Post-Roe\u003cbr>\n\u003c/b>\u003cspan style=\"font-weight: 400\">A move to stop selling abortion pills by Walgreens has led California to cut ties with the pharmaceutical giant. We check in with\u003c/span>\u003cspan style=\"font-weight: 400\"> Katherine Tangalakis-Lippert, reporter for Insider, on the latest fight surrounding reproductive rights.\u003c/span>\u003c/p>\n\u003cp>\u003cb>CalEPA Secretary Yana Garcia\u003cbr>\n\u003c/b>\u003cspan style=\"font-weight: 400\">Plus, the California Environmental Protection Agency often leads policies that are ahead of the nation in the fight against climate change. We sit down with the newest Cal EPA secretary, Yana Garcia, to discuss what she plans to accomplish.\u003c/span>\u003c/p>\n\u003cp>\u003cb>Something Beautiful: Chinese Culture Center of SF\u003cbr>\n\u003c/b>\u003cspan style=\"font-weight: 400\">In 1965, one year after the passage of the Civil Rights Act, the Chinese Culture Center of San Francisco was founded to combat racism and inequity. Fifty years later, the center is still elevating underserved communities, and it's this week's look at Something Beautiful.\u003c/span>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/news/11943288/post-roe-calepa-secretary-yana-garcia","authors":["236"],"programs":["news_7052"],"categories":["news_223","news_31795","news_19906","news_457","news_8"],"tags":["news_866","news_28321","news_32516","news_32515","news_20023","news_20277","news_32514","news_2211","news_32513"],"featImg":"news_11943289","label":"news_7052"},"news_11925585":{"type":"posts","id":"news_11925585","meta":{"index":"posts_1591205157","site":"news","id":"11925585","score":null,"sort":[1663285046000]},"guestAuthors":[],"slug":"when-should-you-get-your-2022-flu-shot","title":"When Should You Get Your 2022 Flu Shot?","publishDate":1663285046,"format":"image","headTitle":"KQED News","labelTerm":{"site":"news"},"content":"\u003cp>\u003cem>Updated 11 a.m. Wednesday, September 21\u003c/em>\u003c/p>\n\u003cp>Even as the COVID-19 pandemic continues to claim lives across the country, the flu remains a potentially serious threat to your health.\u003c/p>\n\u003cp>Jump straight to:\u003c/p>\n\u003cul>\n\u003cli>\u003cstrong>\u003ca href=\"#whenflushot\">When should I get my flu shot?\u003c/a>\u003c/strong>\u003c/li>\n\u003cli>\u003cstrong>\u003ca href=\"#boosterflushot\">Can I get a COVID booster and my flu shot at the same time?\u003c/a>\u003c/strong>\u003c/li>\n\u003cli>\u003cstrong>\u003ca href=\"#highrisk\">Which flu shot should I get if I'm 65 and older, I'm pregnant, or I need a shot for my kids?\u003c/a>\u003c/strong>\u003c/li>\n\u003cli>\u003cstrong>\u003ca href=\"#flushotnearme\">Where can I get a flu shot, with or without insurance?\u003c/a>\u003c/strong>\u003c/li>\n\u003c/ul>\n\u003cp>The Centers for Disease Control and Prevention estimates that, annually, the flu caused 140,000-710,000 hospitalizations and 12,000-52,000 deaths between 2010 and 2020. But the organization says that \u003ca href=\"https://www.cdc.gov/flu/fluvaxview/coverage-2021estimates.htm\">in the 2020-2021 flu season, only around half of adults got a flu shot\u003c/a>.\u003c/p>\n\u003cp>Getting a flu vaccine can prevent you from getting sick with the flu, which is a draining, unpleasant experience even if your symptoms are not severe. And if you \u003cem>do\u003c/em> get the flu, having a flu shot can also stop you from getting sick enough to have to go to the hospital (and be exposed to all the COVID risks hospital settings can bring).\u003c/p>\n\u003cp>The CDC says the flu vaccine also offers other potential health impacts, such as being associated with \u003ca class=\"tp-link-policy\" href=\"https://pubmed.ncbi.nlm.nih.gov/24150467/\" data-domain-ext=\"gov\">lower rates of certain cardiac events\u003c/a> for people who have heart disease. It's also the best, safest way not only to protect \u003cem>yourself\u003c/em> against the influenza virus, but also to minimize the chance you will spread it to others — folks who could be at far higher risk for serious complications or even death if they were to become infected. \u003ca href=\"https://www.cdc.gov/flu/vaccines-work/vaccineeffect.htm\">Read more from the CDC about what the flu shot can do for you.\u003c/a>\u003c/p>\n\u003cp>And read on to find out whether you should be getting your flu shot right now, and where to find free or low-cost flu shot options near you.\u003c/p>\n\u003ch2>Will this flu season be bad?\u003c/h2>\n\u003cp>It's true that \u003ca href=\"https://www.cdc.gov/flu/season/faq-flu-season-2020-2021.htm\">2020 saw a record-low number of flu cases\u003c/a> — most likely due to widespread mask-wearing, increased hygiene, social distancing and remote work and school.\u003c/p>\n\u003cp>Last year's flu season also \"didn't surge in the numbers that people expected,\" said UCSF professor of medicine Dr. Peter Chin-Hong — but \"it did drag on for much longer.\" Whereas a typical flu season peaks in February, Chin-Hong said that last year's \"went from October of 2021 to June of 2022 — so, a much longer tail than usually we would expect.\"\u003c/p>\n\u003cp>So what about this winter's flu risks? Chin-Hong said he and other medical professionals are \"worried for several reasons.\"\u003c/p>\n\u003cp>Along with the lifting of COVID restrictions, there's the fact that \u003ca href=\"https://www.nbcnews.com/health/health-news/australia-flu-season-warning-sign-us-this-year-rcna40123\">Australia has just had its worst flu season in five years\u003c/a>. Because the continent's winter happens during the United States' summer, Australia's flu season is traditionally an indicator of how bad ours might be — and, of concern, it was as \"robust as any of the pre-pandemic flu seasons,\" said Chin-Hong.\u003c/p>\n\u003cp>Dr. Michael Kim, vice president of medical affairs for MarinHealth, echoes these particular worries in the context of the lifting of COVID safety measures.\u003c/p>\n\u003cp>\"I think we're all concerned that flu season this year might be particularly severe, especially since people are not masking as much, as well as people haven't been exposed to flu as much in the last couple of years,” said Kim.\u003c/p>\n\u003ch2>\u003ca id=\"whenflushot\">\u003c/a>Should I get a flu shot now, or wait?\u003c/h2>\n\u003cp>The recommendations medical professionals make about when to get a flu shot are based on the fact that it takes about two weeks after you get vaccinated for antibodies to develop and provide protection against the flu.\u003c/p>\n\u003cp>This flu season, the CDC says that September and October are \"generally good times to be vaccinated against flu,\" and that \"\u003ca href=\"https://www.cdc.gov/flu/season/faq-flu-season-2022-2023.htm\">ideally, everyone should be vaccinated by the end of October\u003c/a>.\"\u003c/p>\n\u003cfigure id=\"attachment_11838737\" class=\"wp-caption alignnone\" style=\"max-width: 1900px\">\u003cimg class=\"size-full wp-image-11838737\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2020/09/shots2.png\" alt=\"\" width=\"1900\" height=\"1267\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2020/09/shots2.png 1900w, https://ww2.kqed.org/app/uploads/sites/10/2020/09/shots2-800x533.png 800w, https://ww2.kqed.org/app/uploads/sites/10/2020/09/shots2-1020x680.png 1020w, https://ww2.kqed.org/app/uploads/sites/10/2020/09/shots2-160x107.png 160w, https://ww2.kqed.org/app/uploads/sites/10/2020/09/shots2-1536x1024.png 1536w\" sizes=\"(max-width: 1900px) 100vw, 1900px\">\u003cfigcaption class=\"wp-caption-text\">It takes two weeks after your flu shot for your body to develop the antibodies it needs to protect you from the flu virus. \u003ccite>(Queen's University/Flickr)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Yes, there's evidence, says Chin-Hong, that \u003ca href=\"https://pubmed.ncbi.nlm.nih.gov/28039340/\">your risk of getting the flu increases every month after your flu shot, due to the antibodies waning over time\u003c/a>.\u003c/p>\n\u003cp>But when medical professionals talk about strategically \"waiting\" to get a flu shot, they're aiming that advice at those who are at particularly high risk for more serious complications related to the flu. That includes people over 65, those with chronic medical conditions, people who are pregnant or planning a pregnancy, and kids under 5.\u003c/p>\n\u003cp>Delaying inoculations for these populations is based on the idea of getting the shot at a time Chin-Hong calls \"the sweet spot,\" around mid-to-late October. Two weeks later, right around early November, the antibodies should have developed, just as flu season is getting serious. Think of it as getting the \"biggest bang for your buck,\" he said.\u003c/p>\n\u003cp>So if you're in one of those vulnerable categories? Yes, you can think about waiting, says Chin-Hong. People over 65 might also consider requesting the special flu vaccines for this age group — read more about this below. As with all health matters, if you're looking for advice, it's best to consult your health care provider or someone you see regularly for your medical needs.\u003c/p>\n\u003cp>And what if you're under 65, not pregnant and don't have other risk factors for severe flu? If you can truly trust yourself to plan ahead and not forget to make the appointment, \"getting it before the end of October is probably the best,\" said Chin-Hong. But remember: Not only are you human and it might slip your mind, but predictions about how the flu season might behave are just that — predictions. The timing of this year's flu season might surprise us, and throw previous notions of a \"best time\" to get the vaccine into disarray.\u003c/p>\n\u003cp>\"Just like we can't predict the next COVID surge, we don't know if influenza will have a different pattern this year,\" said Chin-Hong, noting how Australia's particularly bad flu season started earlier than expected. So take that \"October rule\" with \"a grain of salt,\" he advised, and \"get it [your flu shot] when you get it.\"\u003c/p>\n\u003cp>What if you plan to get your flu shot in October with the best of intentions, but you still forget? If November 1 comes and goes and you realize you haven't been vaccinated, all is not lost — since the CDC says that \"vaccination after October can still provide protection during the peak of flu season,\" which is usually February.\u003c/p>\n\u003cp>In other words, just go get the shot already — whenever that may be.\u003c/p>\n\u003cp>\u003cimg class=\"alignnone size-full wp-image-11838740\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2020/09/shots3.png\" alt=\"\" width=\"1900\" height=\"1267\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2020/09/shots3.png 1900w, https://ww2.kqed.org/app/uploads/sites/10/2020/09/shots3-800x533.png 800w, https://ww2.kqed.org/app/uploads/sites/10/2020/09/shots3-1020x680.png 1020w, https://ww2.kqed.org/app/uploads/sites/10/2020/09/shots3-160x107.png 160w, https://ww2.kqed.org/app/uploads/sites/10/2020/09/shots3-1536x1024.png 1536w\" sizes=\"(max-width: 1900px) 100vw, 1900px\">\u003c/p>\n\u003ch2>\u003ca id=\"boosterflushot\">\u003c/a>Can I get my COVID booster and my flu shot at the same time?\u003c/h2>\n\u003cp>Yes, you can. Ashish Jha, White House COVID response coordinator, went so far in a September 6 briefing as to tell the audience \"\u003ca href=\"https://www.whitehouse.gov/briefing-room/press-briefings/2022/09/06/press-briefing-by-white-house-covid-19-response-team-and-public-health-officials-88/\">I really believe this is why God gave us two arms\u003c/a> — one for the flu shot and the other one for the COVID shot.\"\u003c/p>\n\u003cp>That \"COVID shot\" is the newly available COVID booster — that is, the \u003ca href=\"https://www.cdc.gov/media/releases/2022/s0901-covid-19-booster.html\">new Moderna and Pfizer booster shots of the reformulated COVID-19 vaccine\u003c/a>. The updated shots, called bivalent vaccines, target both the original strain of the coronavirus and the widespread BA.4/BA.5 omicron subvariants that have largely evaded previous boosters.\u003c/p>\n\u003cp>Anyone age 12 and up who got their last COVID vaccine shot at least two months ago — whether that was their primary vaccination series or their last booster shot — can now get an updated COVID booster. \u003ca href=\"https://www.kqed.org/news/11924327/where-can-i-find-a-new-omicron-covid-booster-shot-near-me\">Read more about how to find an updated COVID booster near you.\u003c/a>\u003c/p>\n\u003cp>\u003ca href=\"https://www.cdc.gov/flu/season/faq-flu-season-2022-2023.htm#Flu-Vaccine-and-COVID-19-Vaccine-Coadministration\">The CDC confirms that it's safe to get both the flu shot and the bivalent COVID booster at the same time\u003c/a> \"if you are eligible and the timing coincides.\" Several pharmacy chains are prompting those making an online appointment for a bivalent COVID booster to also \"add on\" a flu shot at the same time.\u003c/p>\n\u003cp>Getting both shots simultaneously certainly offers you convenience, said Chin-Hong: \"It's one-stop shopping and again: out of sight, out of mind.\"\u003c/p>\n\u003cp>The only thing that might give you pause about getting your COVID bivalent booster and your flu shot: If you want to get your booster ASAP, some experts believe that \u003ca href=\"https://www.statnews.com/2022/09/09/doubling-up-on-covid-booster-flu-shot-may-have-downside/\">it might be slightly too early right now to get your flu shot\u003c/a>, considering how immunity from the vaccine wanes. That said, other medical professionals say that \u003ca href=\"https://www.statnews.com/2022/09/09/doubling-up-on-covid-booster-flu-shot-may-have-downside/\">the benefits of folks remembering to actually \u003cem>get\u003c/em> both their booster and their flu shot probably outweigh the downsides\u003c/a>, even if it means the timing of their flu vaccine is a little early.\u003c/p>\n\u003cp>Chin-Hong reiterated that \"if you really wanted to optimize\" the timing of your flu shot, yes, \"sometime in October \u003cem>is\u003c/em> probably the best.\" But ultimately, he says that just \u003cem>getting\u003c/em> the shots is better than not getting them at all.\u003c/p>\n\u003ch2>\u003ca id=\"highrisk\">\u003c/a>If I have risk factors for severe flu, what kind of flu shot should I get?\u003c/h2>\n\u003cp>If you're age 65 or older, there's something new for you to know this flu season: There are now three types of flu vaccines it's recommended you get, because they'll be even more effective for you than a regular flu shot.\u003c/p>\n\u003cp>Chin-Hong said folks in this age group should seek out these three types of vaccines because you'll be getting \"essentially a high-dose shot\" or a vaccine that contains an \"adjuvant\" — which, in simple terms, \"makes the flu shot more powerful in terms of waking up the immune system,\" he said. \u003ca href=\"https://www.cdc.gov/flu/prevent/keyfacts.htm\">Read more about the three kinds of flu shots available to people age 65 and older.\u003c/a>\u003c/p>\n\u003cp>Pregnant people can get a regular flu shot, although there are some types of flu vaccine that are off-limits to pregnant people. The CDC says that getting vaccinated when you're pregnant will not only help protect you from the flu, but also — if your baby is born during the immunity period — protect your infant in the first few months of their life, when they're too young to get vaccinated themselves.\u003c/p>\n\u003cp>This benefit to the baby is also the reason that pregnant people are one of the few groups who might want to consider getting a flu shot \u003cem>early\u003c/em>, instead of waiting — to ensure their baby isn't left completely unprotected for those first six months after birth, when they can't get a vaccine. \u003ca href=\"https://www.cdc.gov/flu/prevent/keyfacts.htm\">Read more about the benefits of getting a flu shot if you're pregnant.\u003c/a>\u003c/p>\n\u003cp>Children age 6 months and older can get a regular dose of the flu shot. \u003ca href=\"https://www.cdc.gov/flu/highrisk/children-high-risk.htm\">Flu can be particularly dangerous for kids\u003c/a>, and the CDC says that a 2022 study showed that flu vaccination reduced children’s risk of severe, life-threatening influenza by 75%.\u003c/p>\n\u003ch2>\u003ca id=\"flushotnearme\">\u003c/a>Where can I get a flu shot if I have insurance?\u003c/h2>\n\u003cp>If you have health insurance, a flu shot is available without extra cost as a preventive service from your usual health care provider, or at most pharmacies (see below).\u003c/p>\n\u003cp>It's a good idea to wear a mask, maintain social distancing wherever possible while waiting for your shot, and dress in a top with sleeves you can easily pull up to your shoulder, to make receiving the injection even easier (and quicker).\u003c/p>\n\u003cp>\u003cstrong>Common places to find a flu shot appointment, walk-in site or drive-thru flu shot:\u003c/strong>\u003c/p>\n\u003cul>\n\u003cli>\u003ca href=\"https://www.vaccines.gov/find-vaccines/\">CDC's Find Flu Vaccines tool\u003c/a>\u003c/li>\n\u003cli>\u003ca href=\"https://mydoctor.kaiserpermanente.org/ncal/cold-and-flu/prevention#/prevention\">Kaiser Permanente flu shots (Northern California) \u003c/a>\u003c/li>\n\u003cli>\u003ca href=\"https://www.cvs.com/immunizations/flu\">CVS flu shots\u003c/a>\u003c/li>\n\u003cli>\u003ca href=\"https://www.walgreens.com/topic/pharmacy/seasonal-flu.jsp?ban=flu_fy21_influenzapage\">Walgreens flu shots \u003c/a>\u003c/li>\n\u003cli>\u003ca href=\"https://www.riteaid.com/pharmacy/scheduler\">Rite Aid flu shots\u003c/a>\u003c/li>\n\u003cli>\u003ca href=\"https://www.costco.com/Pharmacy/adult-immunization-program.html\">Costco Pharmacy flu shots\u003c/a>\u003c/li>\n\u003cli>\u003ca href=\"https://www.albertsons.com/pharmacy/pharmacy-services/immunizations.html\">Albertsons (Safeway) flu shots\u003c/a>\u003c/li>\n\u003c/ul>\n\u003ch2>Where can I get a flu shot if I \u003cem>don't\u003c/em> have health insurance?\u003c/h2>\n\u003cp>If you want a flu shot but don't have health insurance, you can get the vaccine free of charge from several providers and community clinics around the Bay Area. (You can also technically use these free services even if you do have insurance, but you may consider choosing to free up these particular resources for those who are not covered.)\u003c/p>\n\u003cp>Your county's own public health department may also be offering flu shots.\u003c/p>\n\u003cp>\u003cstrong>Places to get a free or low-cost flu shot in the Bay Area include:\u003c/strong>\u003c/p>\n\u003cul>\n\u003cli>\u003ca href=\"https://www.sfcdcp.org/aitc/aitc-regular-prices-low-cost-or-free-vaccines/\">San Francisco Department of Public Health's AITC clinic\u003c/a> (offers a pay-what-you-can option, and says nobody will be refused for inability to pay)\u003c/li>\n\u003cli>\u003ca href=\"https://cchealth.org/immunization/clinics.php#Uninsured\">Contra Costa Public Health Immunization Clinic\u003c/a> (flu shots are $15 for adults over 19, but fees may be waived if you're unable to pay)\u003c/li>\n\u003cli>\u003ca href=\"https://acphd.org/clinics/\">Alameda County Immunization Clinics\u003c/a>\u003c/li>\n\u003c/ul>\n\u003cp>\u003cspan style=\"font-weight: 400\">[ad fullwidth]\u003c/span>\u003c/p>\n\u003ch2>And a reminder ... the flu vaccine can't give you the flu\u003c/h2>\n\u003cp>The virus that the flu shot contains has been inactivated or severely weakened, so \u003ca href=\"https://www.cdc.gov/flu/prevent/misconceptions.htm#:~:text=Can%20a%20flu%20vaccine%20give,protein%20from%20the%20flu%20virus.\">you just aren't physically able to get the flu from your flu shot\u003c/a>, confirms the CDC.\u003c/p>\n\u003cp>\u003ca href=\"https://www.cdc.gov/flu/prevent/general.htm#side-effects\">The flu vaccine can cause side effects\u003c/a> like any medical product, but they're \"\u003ca href=\"https://www.cdc.gov/flu/prevent/general.htm\">generally mild and go away on their own within a few days\u003c/a>,\" the agency says.\u003c/p>\n\u003cp>Common flu shot side effects can include soreness or swelling at the injection site, headache, fever, nausea and muscle aches. (But not the flu.)\u003c/p>\n\u003cp>\u003cem>This story contains reporting by KQED's Alexander Gonzalez.\u003c/em>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n","blocks":[],"excerpt":"Should you be getting your 2022 flu shot right now? Plus: Where to find free and low-cost flu shots near you.","status":"publish","parent":0,"modified":1663784365,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":48,"wordCount":2231},"headData":{"title":"When Should You Get Your 2022 Flu Shot? | KQED","description":"Should you be getting your flu shot right now? Plus: where to find free and low-cost flu shots near you in the Bay Area, without an apppointment.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"11925585 https://ww2.kqed.org/news/?p=11925585","disqusUrl":"https://ww2.kqed.org/news/2022/09/15/when-should-you-get-your-2022-flu-shot/","disqusTitle":"When Should You Get Your 2022 Flu Shot?","excludeFromSiteSearch":"Include","path":"/news/11925585/when-should-you-get-your-2022-flu-shot","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cem>Updated 11 a.m. Wednesday, September 21\u003c/em>\u003c/p>\n\u003cp>Even as the COVID-19 pandemic continues to claim lives across the country, the flu remains a potentially serious threat to your health.\u003c/p>\n\u003cp>Jump straight to:\u003c/p>\n\u003cul>\n\u003cli>\u003cstrong>\u003ca href=\"#whenflushot\">When should I get my flu shot?\u003c/a>\u003c/strong>\u003c/li>\n\u003cli>\u003cstrong>\u003ca href=\"#boosterflushot\">Can I get a COVID booster and my flu shot at the same time?\u003c/a>\u003c/strong>\u003c/li>\n\u003cli>\u003cstrong>\u003ca href=\"#highrisk\">Which flu shot should I get if I'm 65 and older, I'm pregnant, or I need a shot for my kids?\u003c/a>\u003c/strong>\u003c/li>\n\u003cli>\u003cstrong>\u003ca href=\"#flushotnearme\">Where can I get a flu shot, with or without insurance?\u003c/a>\u003c/strong>\u003c/li>\n\u003c/ul>\n\u003cp>The Centers for Disease Control and Prevention estimates that, annually, the flu caused 140,000-710,000 hospitalizations and 12,000-52,000 deaths between 2010 and 2020. But the organization says that \u003ca href=\"https://www.cdc.gov/flu/fluvaxview/coverage-2021estimates.htm\">in the 2020-2021 flu season, only around half of adults got a flu shot\u003c/a>.\u003c/p>\n\u003cp>Getting a flu vaccine can prevent you from getting sick with the flu, which is a draining, unpleasant experience even if your symptoms are not severe. And if you \u003cem>do\u003c/em> get the flu, having a flu shot can also stop you from getting sick enough to have to go to the hospital (and be exposed to all the COVID risks hospital settings can bring).\u003c/p>\n\u003cp>The CDC says the flu vaccine also offers other potential health impacts, such as being associated with \u003ca class=\"tp-link-policy\" href=\"https://pubmed.ncbi.nlm.nih.gov/24150467/\" data-domain-ext=\"gov\">lower rates of certain cardiac events\u003c/a> for people who have heart disease. It's also the best, safest way not only to protect \u003cem>yourself\u003c/em> against the influenza virus, but also to minimize the chance you will spread it to others — folks who could be at far higher risk for serious complications or even death if they were to become infected. \u003ca href=\"https://www.cdc.gov/flu/vaccines-work/vaccineeffect.htm\">Read more from the CDC about what the flu shot can do for you.\u003c/a>\u003c/p>\n\u003cp>And read on to find out whether you should be getting your flu shot right now, and where to find free or low-cost flu shot options near you.\u003c/p>\n\u003ch2>Will this flu season be bad?\u003c/h2>\n\u003cp>It's true that \u003ca href=\"https://www.cdc.gov/flu/season/faq-flu-season-2020-2021.htm\">2020 saw a record-low number of flu cases\u003c/a> — most likely due to widespread mask-wearing, increased hygiene, social distancing and remote work and school.\u003c/p>\n\u003cp>Last year's flu season also \"didn't surge in the numbers that people expected,\" said UCSF professor of medicine Dr. Peter Chin-Hong — but \"it did drag on for much longer.\" Whereas a typical flu season peaks in February, Chin-Hong said that last year's \"went from October of 2021 to June of 2022 — so, a much longer tail than usually we would expect.\"\u003c/p>\n\u003cp>So what about this winter's flu risks? Chin-Hong said he and other medical professionals are \"worried for several reasons.\"\u003c/p>\n\u003cp>Along with the lifting of COVID restrictions, there's the fact that \u003ca href=\"https://www.nbcnews.com/health/health-news/australia-flu-season-warning-sign-us-this-year-rcna40123\">Australia has just had its worst flu season in five years\u003c/a>. Because the continent's winter happens during the United States' summer, Australia's flu season is traditionally an indicator of how bad ours might be — and, of concern, it was as \"robust as any of the pre-pandemic flu seasons,\" said Chin-Hong.\u003c/p>\n\u003cp>Dr. Michael Kim, vice president of medical affairs for MarinHealth, echoes these particular worries in the context of the lifting of COVID safety measures.\u003c/p>\n\u003cp>\"I think we're all concerned that flu season this year might be particularly severe, especially since people are not masking as much, as well as people haven't been exposed to flu as much in the last couple of years,” said Kim.\u003c/p>\n\u003ch2>\u003ca id=\"whenflushot\">\u003c/a>Should I get a flu shot now, or wait?\u003c/h2>\n\u003cp>The recommendations medical professionals make about when to get a flu shot are based on the fact that it takes about two weeks after you get vaccinated for antibodies to develop and provide protection against the flu.\u003c/p>\n\u003cp>This flu season, the CDC says that September and October are \"generally good times to be vaccinated against flu,\" and that \"\u003ca href=\"https://www.cdc.gov/flu/season/faq-flu-season-2022-2023.htm\">ideally, everyone should be vaccinated by the end of October\u003c/a>.\"\u003c/p>\n\u003cfigure id=\"attachment_11838737\" class=\"wp-caption alignnone\" style=\"max-width: 1900px\">\u003cimg class=\"size-full wp-image-11838737\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2020/09/shots2.png\" alt=\"\" width=\"1900\" height=\"1267\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2020/09/shots2.png 1900w, https://ww2.kqed.org/app/uploads/sites/10/2020/09/shots2-800x533.png 800w, https://ww2.kqed.org/app/uploads/sites/10/2020/09/shots2-1020x680.png 1020w, https://ww2.kqed.org/app/uploads/sites/10/2020/09/shots2-160x107.png 160w, https://ww2.kqed.org/app/uploads/sites/10/2020/09/shots2-1536x1024.png 1536w\" sizes=\"(max-width: 1900px) 100vw, 1900px\">\u003cfigcaption class=\"wp-caption-text\">It takes two weeks after your flu shot for your body to develop the antibodies it needs to protect you from the flu virus. \u003ccite>(Queen's University/Flickr)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Yes, there's evidence, says Chin-Hong, that \u003ca href=\"https://pubmed.ncbi.nlm.nih.gov/28039340/\">your risk of getting the flu increases every month after your flu shot, due to the antibodies waning over time\u003c/a>.\u003c/p>\n\u003cp>But when medical professionals talk about strategically \"waiting\" to get a flu shot, they're aiming that advice at those who are at particularly high risk for more serious complications related to the flu. That includes people over 65, those with chronic medical conditions, people who are pregnant or planning a pregnancy, and kids under 5.\u003c/p>\n\u003cp>Delaying inoculations for these populations is based on the idea of getting the shot at a time Chin-Hong calls \"the sweet spot,\" around mid-to-late October. Two weeks later, right around early November, the antibodies should have developed, just as flu season is getting serious. Think of it as getting the \"biggest bang for your buck,\" he said.\u003c/p>\n\u003cp>So if you're in one of those vulnerable categories? Yes, you can think about waiting, says Chin-Hong. People over 65 might also consider requesting the special flu vaccines for this age group — read more about this below. As with all health matters, if you're looking for advice, it's best to consult your health care provider or someone you see regularly for your medical needs.\u003c/p>\n\u003cp>And what if you're under 65, not pregnant and don't have other risk factors for severe flu? If you can truly trust yourself to plan ahead and not forget to make the appointment, \"getting it before the end of October is probably the best,\" said Chin-Hong. But remember: Not only are you human and it might slip your mind, but predictions about how the flu season might behave are just that — predictions. The timing of this year's flu season might surprise us, and throw previous notions of a \"best time\" to get the vaccine into disarray.\u003c/p>\n\u003cp>\"Just like we can't predict the next COVID surge, we don't know if influenza will have a different pattern this year,\" said Chin-Hong, noting how Australia's particularly bad flu season started earlier than expected. So take that \"October rule\" with \"a grain of salt,\" he advised, and \"get it [your flu shot] when you get it.\"\u003c/p>\n\u003cp>What if you plan to get your flu shot in October with the best of intentions, but you still forget? If November 1 comes and goes and you realize you haven't been vaccinated, all is not lost — since the CDC says that \"vaccination after October can still provide protection during the peak of flu season,\" which is usually February.\u003c/p>\n\u003cp>In other words, just go get the shot already — whenever that may be.\u003c/p>\n\u003cp>\u003cimg class=\"alignnone size-full wp-image-11838740\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2020/09/shots3.png\" alt=\"\" width=\"1900\" height=\"1267\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2020/09/shots3.png 1900w, https://ww2.kqed.org/app/uploads/sites/10/2020/09/shots3-800x533.png 800w, https://ww2.kqed.org/app/uploads/sites/10/2020/09/shots3-1020x680.png 1020w, https://ww2.kqed.org/app/uploads/sites/10/2020/09/shots3-160x107.png 160w, https://ww2.kqed.org/app/uploads/sites/10/2020/09/shots3-1536x1024.png 1536w\" sizes=\"(max-width: 1900px) 100vw, 1900px\">\u003c/p>\n\u003ch2>\u003ca id=\"boosterflushot\">\u003c/a>Can I get my COVID booster and my flu shot at the same time?\u003c/h2>\n\u003cp>Yes, you can. Ashish Jha, White House COVID response coordinator, went so far in a September 6 briefing as to tell the audience \"\u003ca href=\"https://www.whitehouse.gov/briefing-room/press-briefings/2022/09/06/press-briefing-by-white-house-covid-19-response-team-and-public-health-officials-88/\">I really believe this is why God gave us two arms\u003c/a> — one for the flu shot and the other one for the COVID shot.\"\u003c/p>\n\u003cp>That \"COVID shot\" is the newly available COVID booster — that is, the \u003ca href=\"https://www.cdc.gov/media/releases/2022/s0901-covid-19-booster.html\">new Moderna and Pfizer booster shots of the reformulated COVID-19 vaccine\u003c/a>. The updated shots, called bivalent vaccines, target both the original strain of the coronavirus and the widespread BA.4/BA.5 omicron subvariants that have largely evaded previous boosters.\u003c/p>\n\u003cp>Anyone age 12 and up who got their last COVID vaccine shot at least two months ago — whether that was their primary vaccination series or their last booster shot — can now get an updated COVID booster. \u003ca href=\"https://www.kqed.org/news/11924327/where-can-i-find-a-new-omicron-covid-booster-shot-near-me\">Read more about how to find an updated COVID booster near you.\u003c/a>\u003c/p>\n\u003cp>\u003ca href=\"https://www.cdc.gov/flu/season/faq-flu-season-2022-2023.htm#Flu-Vaccine-and-COVID-19-Vaccine-Coadministration\">The CDC confirms that it's safe to get both the flu shot and the bivalent COVID booster at the same time\u003c/a> \"if you are eligible and the timing coincides.\" Several pharmacy chains are prompting those making an online appointment for a bivalent COVID booster to also \"add on\" a flu shot at the same time.\u003c/p>\n\u003cp>Getting both shots simultaneously certainly offers you convenience, said Chin-Hong: \"It's one-stop shopping and again: out of sight, out of mind.\"\u003c/p>\n\u003cp>The only thing that might give you pause about getting your COVID bivalent booster and your flu shot: If you want to get your booster ASAP, some experts believe that \u003ca href=\"https://www.statnews.com/2022/09/09/doubling-up-on-covid-booster-flu-shot-may-have-downside/\">it might be slightly too early right now to get your flu shot\u003c/a>, considering how immunity from the vaccine wanes. That said, other medical professionals say that \u003ca href=\"https://www.statnews.com/2022/09/09/doubling-up-on-covid-booster-flu-shot-may-have-downside/\">the benefits of folks remembering to actually \u003cem>get\u003c/em> both their booster and their flu shot probably outweigh the downsides\u003c/a>, even if it means the timing of their flu vaccine is a little early.\u003c/p>\n\u003cp>Chin-Hong reiterated that \"if you really wanted to optimize\" the timing of your flu shot, yes, \"sometime in October \u003cem>is\u003c/em> probably the best.\" But ultimately, he says that just \u003cem>getting\u003c/em> the shots is better than not getting them at all.\u003c/p>\n\u003ch2>\u003ca id=\"highrisk\">\u003c/a>If I have risk factors for severe flu, what kind of flu shot should I get?\u003c/h2>\n\u003cp>If you're age 65 or older, there's something new for you to know this flu season: There are now three types of flu vaccines it's recommended you get, because they'll be even more effective for you than a regular flu shot.\u003c/p>\n\u003cp>Chin-Hong said folks in this age group should seek out these three types of vaccines because you'll be getting \"essentially a high-dose shot\" or a vaccine that contains an \"adjuvant\" — which, in simple terms, \"makes the flu shot more powerful in terms of waking up the immune system,\" he said. \u003ca href=\"https://www.cdc.gov/flu/prevent/keyfacts.htm\">Read more about the three kinds of flu shots available to people age 65 and older.\u003c/a>\u003c/p>\n\u003cp>Pregnant people can get a regular flu shot, although there are some types of flu vaccine that are off-limits to pregnant people. The CDC says that getting vaccinated when you're pregnant will not only help protect you from the flu, but also — if your baby is born during the immunity period — protect your infant in the first few months of their life, when they're too young to get vaccinated themselves.\u003c/p>\n\u003cp>This benefit to the baby is also the reason that pregnant people are one of the few groups who might want to consider getting a flu shot \u003cem>early\u003c/em>, instead of waiting — to ensure their baby isn't left completely unprotected for those first six months after birth, when they can't get a vaccine. \u003ca href=\"https://www.cdc.gov/flu/prevent/keyfacts.htm\">Read more about the benefits of getting a flu shot if you're pregnant.\u003c/a>\u003c/p>\n\u003cp>Children age 6 months and older can get a regular dose of the flu shot. \u003ca href=\"https://www.cdc.gov/flu/highrisk/children-high-risk.htm\">Flu can be particularly dangerous for kids\u003c/a>, and the CDC says that a 2022 study showed that flu vaccination reduced children’s risk of severe, life-threatening influenza by 75%.\u003c/p>\n\u003ch2>\u003ca id=\"flushotnearme\">\u003c/a>Where can I get a flu shot if I have insurance?\u003c/h2>\n\u003cp>If you have health insurance, a flu shot is available without extra cost as a preventive service from your usual health care provider, or at most pharmacies (see below).\u003c/p>\n\u003cp>It's a good idea to wear a mask, maintain social distancing wherever possible while waiting for your shot, and dress in a top with sleeves you can easily pull up to your shoulder, to make receiving the injection even easier (and quicker).\u003c/p>\n\u003cp>\u003cstrong>Common places to find a flu shot appointment, walk-in site or drive-thru flu shot:\u003c/strong>\u003c/p>\n\u003cul>\n\u003cli>\u003ca href=\"https://www.vaccines.gov/find-vaccines/\">CDC's Find Flu Vaccines tool\u003c/a>\u003c/li>\n\u003cli>\u003ca href=\"https://mydoctor.kaiserpermanente.org/ncal/cold-and-flu/prevention#/prevention\">Kaiser Permanente flu shots (Northern California) \u003c/a>\u003c/li>\n\u003cli>\u003ca href=\"https://www.cvs.com/immunizations/flu\">CVS flu shots\u003c/a>\u003c/li>\n\u003cli>\u003ca href=\"https://www.walgreens.com/topic/pharmacy/seasonal-flu.jsp?ban=flu_fy21_influenzapage\">Walgreens flu shots \u003c/a>\u003c/li>\n\u003cli>\u003ca href=\"https://www.riteaid.com/pharmacy/scheduler\">Rite Aid flu shots\u003c/a>\u003c/li>\n\u003cli>\u003ca href=\"https://www.costco.com/Pharmacy/adult-immunization-program.html\">Costco Pharmacy flu shots\u003c/a>\u003c/li>\n\u003cli>\u003ca href=\"https://www.albertsons.com/pharmacy/pharmacy-services/immunizations.html\">Albertsons (Safeway) flu shots\u003c/a>\u003c/li>\n\u003c/ul>\n\u003ch2>Where can I get a flu shot if I \u003cem>don't\u003c/em> have health insurance?\u003c/h2>\n\u003cp>If you want a flu shot but don't have health insurance, you can get the vaccine free of charge from several providers and community clinics around the Bay Area. (You can also technically use these free services even if you do have insurance, but you may consider choosing to free up these particular resources for those who are not covered.)\u003c/p>\n\u003cp>Your county's own public health department may also be offering flu shots.\u003c/p>\n\u003cp>\u003cstrong>Places to get a free or low-cost flu shot in the Bay Area include:\u003c/strong>\u003c/p>\n\u003cul>\n\u003cli>\u003ca href=\"https://www.sfcdcp.org/aitc/aitc-regular-prices-low-cost-or-free-vaccines/\">San Francisco Department of Public Health's AITC clinic\u003c/a> (offers a pay-what-you-can option, and says nobody will be refused for inability to pay)\u003c/li>\n\u003cli>\u003ca href=\"https://cchealth.org/immunization/clinics.php#Uninsured\">Contra Costa Public Health Immunization Clinic\u003c/a> (flu shots are $15 for adults over 19, but fees may be waived if you're unable to pay)\u003c/li>\n\u003cli>\u003ca href=\"https://acphd.org/clinics/\">Alameda County Immunization Clinics\u003c/a>\u003c/li>\n\u003c/ul>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/span>\u003c/p>\n\u003ch2>And a reminder ... the flu vaccine can't give you the flu\u003c/h2>\n\u003cp>The virus that the flu shot contains has been inactivated or severely weakened, so \u003ca href=\"https://www.cdc.gov/flu/prevent/misconceptions.htm#:~:text=Can%20a%20flu%20vaccine%20give,protein%20from%20the%20flu%20virus.\">you just aren't physically able to get the flu from your flu shot\u003c/a>, confirms the CDC.\u003c/p>\n\u003cp>\u003ca href=\"https://www.cdc.gov/flu/prevent/general.htm#side-effects\">The flu vaccine can cause side effects\u003c/a> like any medical product, but they're \"\u003ca href=\"https://www.cdc.gov/flu/prevent/general.htm\">generally mild and go away on their own within a few days\u003c/a>,\" the agency says.\u003c/p>\n\u003cp>Common flu shot side effects can include soreness or swelling at the injection site, headache, fever, nausea and muscle aches. (But not the flu.)\u003c/p>\n\u003cp>\u003cem>This story contains reporting by KQED's Alexander Gonzalez.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/news/11925585/when-should-you-get-your-2022-flu-shot","authors":["3243"],"categories":["news_8"],"tags":["news_27504","news_22326","news_28567","news_18543","news_20277","news_22327","news_981"],"featImg":"news_11925828","label":"news"},"news_11916950":{"type":"posts","id":"news_11916950","meta":{"index":"posts_1591205157","site":"news","id":"11916950","score":null,"sort":[1656094634000]},"guestAuthors":[],"slug":"roe-v-wade-overturned-your-questions","title":"What Do You Need to Know About the End of Roe v. Wade?","publishDate":1656094634,"format":"standard","headTitle":"KQED News","labelTerm":{"site":"news"},"content":"\u003cp>As many across the U.S. feared since \u003ca href=\"https://www.kqed.org/news/11913033/heres-what-could-happen-if-roe-v-wade-is-overturned\">a Supreme Court draft opinion was leaked in May\u003c/a>, \u003ca href=\"https://www.kqed.org/news/11917776/supreme-court-overturns-roe-v-wade\">Friday's decision in Dobbs v. Jackson Women's Health Organization has struck down Roe v. Wade\u003c/a>.\u003c/p>\n\u003cp>Now, without the constitutionally protected right to abortion access, \u003ca href=\"https://www.kqed.org/news/11913033/heres-what-could-happen-if-roe-v-wade-is-overturned\">individual states have the power to ban any and all abortion procedures\u003c/a>. California guarantees the right to abortion in statute and the state constitution, which remains unchanged, and \u003ca href=\"https://www.kqed.org/news/11912134/we-fill-the-gaps-california-preps-to-be-a-haven-for-abortion-rights\">the state already has been preparing to be a haven for abortion access\u003c/a> for people elsewhere in the U.S.\u003c/p>\n\u003ch2>What do you need to know right now?\u003c/h2>\n\u003cp>We know this news is affecting many of you greatly — perhaps sparking anger, fear and confusion. And we want to be able to provide you with the information you need.\u003c/p>\n\u003cp>If you have a question about Roe v. Wade being overturned — whether it's what losing Roe means for the United States, how you can personally take action in support of abortion access or what this ruling means for California — \u003cstrong>send us your question below, via this comment box:\u003c/strong>\u003c/p>\n\u003cp>[hearken id=\"9626\" src=\"https://modules.wearehearken.com/kqed/embed/9626.js\"]\u003c/p>\n\u003cp>We may not be able to reach out directly to everyone who asks a question. But what you submit will make our reporting on abortion access stronger, and help us decide what to cover here on our site, and on KQED Public Radio.\u003c/p>\n\u003ch2>Abortion access resources for right now\u003c/h2>\n\u003cp>How to act:\u003c/p>\n\u003cul>\n\u003cli>\u003cstrong>\u003ca href=\"https://www.kqed.org/arts/13912860/roe-v-wade-where-to-donate-abortion-reproductive-rights-supreme-court\">Concerned About Access to Abortion? Here's How to Help\u003c/a>\u003c/strong>\u003c/li>\n\u003cli>\u003cstrong>\u003ca href=\"https://www.kqed.org/news/11821950/how-to-safely-attend-a-protest-in-the-bay-area\">How to Attend a Rally Safely in the Bay Area\u003c/a>\u003c/strong>\u003c/li>\n\u003c/ul>\n\u003cp>Abortion access in California:\u003c/p>\n\u003cul>\n\u003cli>\u003cstrong>\u003ca href=\"https://www.kqed.org/news/11917111/even-without-roe-v-wade-abortion-is-still-legal-in-california-heres-what-you-need-to-know\">Even Without Roe v. Wade, Abortion is Still Legal in California. Here's What You Need to Know\u003c/a>\u003c/strong>\u003c/li>\n\u003cli>\u003cstrong>\u003ca href=\"https://www.kqed.org/news/11912134/we-fill-the-gaps-california-preps-to-be-a-haven-for-abortion-rights\">'We Fill the Gaps': California Preps to Be a Haven for Abortion Rights\u003c/a>\u003c/strong>\u003c/li>\n\u003cli>\u003ca href=\"https://www.kqed.org/news/11913011/california-will-fight-like-hell-to-protect-abortion-rights-if-roe-v-wade-overturned-newsom-says\">\u003cstrong>California Will 'Fight Like Hell' to Protect Abortion Rights If Roe V. Wade Overturned, Newsom Says\u003c/strong>\u003c/a>\u003c/li>\n\u003c/ul>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003ch2>How to share your longer thoughts with us\u003c/h2>\n\u003cp>If you're looking for a wider space to share your thoughts, or tell your own story about abortion, KQED Public Radio's \u003ca href=\"https://www.kqed.org/perspectives\">Perspectives\u003c/a> series — our morning series that lets listeners have their say in their own words — also wants to hear from you:\u003c/p>\n\u003cp>\u003cstrong>How do you feel about living in a nation without Roe v. Wade?\u003c/strong>\u003c/p>\n\u003cp>Share your thoughts in the form below, and we may be in touch to talk about featuring your story, told by you in your own voice, on air. You can also email \u003ca href=\"mailto:mtrautwein@kqed.org\" rel=\"noopener noreferrer\">mtrautwein@kqed.org\u003c/a> or call (415) 553-2108 and leave us a message.\u003c/p>\n\u003cp>https://docs.google.com/forms/d/e/1FAIpQLScCV-FMA3W1019BmzePKn_0BQkcSy8Bfluu3ZP_ZcOt-oDHAA/viewform?embedded=true\u003c/p>\n\u003cp>\u003c/p>\n","blocks":[],"excerpt":"If you have questions about the end of Roe v. Wade in the United States, we want to get you the information you need. Here's how to send us your questions.","status":"publish","parent":0,"modified":1656094634,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":true,"hasGallery":false,"hasHearkenModule":true,"hasPolis":false,"paragraphCount":13,"wordCount":443},"headData":{"title":"What Do You Need to Know About the End of Roe v. Wade? | KQED","description":"If you have questions about the end of Roe v. Wade in the United States, we want to get you the information you need. Here's how to send us your questions.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"11916950 https://ww2.kqed.org/news/?p=11916950","disqusUrl":"https://ww2.kqed.org/news/2022/06/24/roe-v-wade-overturned-your-questions/","disqusTitle":"What Do You Need to Know About the End of Roe v. Wade?","excludeFromSiteSearch":"Include","path":"/news/11916950/roe-v-wade-overturned-your-questions","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>As many across the U.S. feared since \u003ca href=\"https://www.kqed.org/news/11913033/heres-what-could-happen-if-roe-v-wade-is-overturned\">a Supreme Court draft opinion was leaked in May\u003c/a>, \u003ca href=\"https://www.kqed.org/news/11917776/supreme-court-overturns-roe-v-wade\">Friday's decision in Dobbs v. Jackson Women's Health Organization has struck down Roe v. Wade\u003c/a>.\u003c/p>\n\u003cp>Now, without the constitutionally protected right to abortion access, \u003ca href=\"https://www.kqed.org/news/11913033/heres-what-could-happen-if-roe-v-wade-is-overturned\">individual states have the power to ban any and all abortion procedures\u003c/a>. California guarantees the right to abortion in statute and the state constitution, which remains unchanged, and \u003ca href=\"https://www.kqed.org/news/11912134/we-fill-the-gaps-california-preps-to-be-a-haven-for-abortion-rights\">the state already has been preparing to be a haven for abortion access\u003c/a> for people elsewhere in the U.S.\u003c/p>\n\u003ch2>What do you need to know right now?\u003c/h2>\n\u003cp>We know this news is affecting many of you greatly — perhaps sparking anger, fear and confusion. And we want to be able to provide you with the information you need.\u003c/p>\n\u003cp>If you have a question about Roe v. Wade being overturned — whether it's what losing Roe means for the United States, how you can personally take action in support of abortion access or what this ruling means for California — \u003cstrong>send us your question below, via this comment box:\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"hearken","attributes":{"named":{"id":"9626","src":"https://modules.wearehearken.com/kqed/embed/9626.js","label":""},"numeric":[]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>We may not be able to reach out directly to everyone who asks a question. But what you submit will make our reporting on abortion access stronger, and help us decide what to cover here on our site, and on KQED Public Radio.\u003c/p>\n\u003ch2>Abortion access resources for right now\u003c/h2>\n\u003cp>How to act:\u003c/p>\n\u003cul>\n\u003cli>\u003cstrong>\u003ca href=\"https://www.kqed.org/arts/13912860/roe-v-wade-where-to-donate-abortion-reproductive-rights-supreme-court\">Concerned About Access to Abortion? Here's How to Help\u003c/a>\u003c/strong>\u003c/li>\n\u003cli>\u003cstrong>\u003ca href=\"https://www.kqed.org/news/11821950/how-to-safely-attend-a-protest-in-the-bay-area\">How to Attend a Rally Safely in the Bay Area\u003c/a>\u003c/strong>\u003c/li>\n\u003c/ul>\n\u003cp>Abortion access in California:\u003c/p>\n\u003cul>\n\u003cli>\u003cstrong>\u003ca href=\"https://www.kqed.org/news/11917111/even-without-roe-v-wade-abortion-is-still-legal-in-california-heres-what-you-need-to-know\">Even Without Roe v. Wade, Abortion is Still Legal in California. Here's What You Need to Know\u003c/a>\u003c/strong>\u003c/li>\n\u003cli>\u003cstrong>\u003ca href=\"https://www.kqed.org/news/11912134/we-fill-the-gaps-california-preps-to-be-a-haven-for-abortion-rights\">'We Fill the Gaps': California Preps to Be a Haven for Abortion Rights\u003c/a>\u003c/strong>\u003c/li>\n\u003cli>\u003ca href=\"https://www.kqed.org/news/11913011/california-will-fight-like-hell-to-protect-abortion-rights-if-roe-v-wade-overturned-newsom-says\">\u003cstrong>California Will 'Fight Like Hell' to Protect Abortion Rights If Roe V. Wade Overturned, Newsom Says\u003c/strong>\u003c/a>\u003c/li>\n\u003c/ul>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003ch2>How to share your longer thoughts with us\u003c/h2>\n\u003cp>If you're looking for a wider space to share your thoughts, or tell your own story about abortion, KQED Public Radio's \u003ca href=\"https://www.kqed.org/perspectives\">Perspectives\u003c/a> series — our morning series that lets listeners have their say in their own words — also wants to hear from you:\u003c/p>\n\u003cp>\u003cstrong>How do you feel about living in a nation without Roe v. Wade?\u003c/strong>\u003c/p>\n\u003cp>Share your thoughts in the form below, and we may be in touch to talk about featuring your story, told by you in your own voice, on air. You can also email \u003ca href=\"mailto:mtrautwein@kqed.org\" rel=\"noopener noreferrer\">mtrautwein@kqed.org\u003c/a> or call (415) 553-2108 and leave us a message.\u003c/p>\u003c/p>\u003cp>\u003cdiv class='utils-parseShortcode-shortcodes-__shortcodes__shortcodeWrapper'>\n \u003ciframe\n src='https://docs.google.com/forms/d/e/1FAIpQLScCV-FMA3W1019BmzePKn_0BQkcSy8Bfluu3ZP_ZcOt-oDHAA/viewform?embedded=true?embedded=true'\n title='https://docs.google.com/forms/d/e/1FAIpQLScCV-FMA3W1019BmzePKn_0BQkcSy8Bfluu3ZP_ZcOt-oDHAA/viewform?embedded=true'\n width='760' height='500'\n frameborder='0'\n marginheight='0' marginwidth='0'>\u003c/iframe>\u003c/div>\u003c/p>\u003cp>\u003cp>\u003c/p>\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/news/11916950/roe-v-wade-overturned-your-questions","authors":["236"],"categories":["news_8"],"tags":["news_866","news_30251","news_20277","news_23688","news_932"],"featImg":"news_11917846","label":"news"},"news_11914873":{"type":"posts","id":"news_11914873","meta":{"index":"posts_1591205157","site":"news","id":"11914873","score":null,"sort":[1653404451000]},"guestAuthors":[],"slug":"newsoms-care-court-faces-foe-shortage-of-treatment-beds-housing","title":"Newsom's 'Care Court' Passes Senate but Still Faces Shortage of Treatment Beds, Housing","publishDate":1653404451,"format":"standard","headTitle":"KQED News","labelTerm":{"site":"news"},"content":"\u003cp>On a cold day in March, Shahada Hull admitted herself to the hospital.\u003c/p>\n\u003cp>She had been sleeping outside in San Francisco’s Tenderloin neighborhood for months, ever since she was evicted in December from the affordable studio apartment she'd rented near the Presidio. Her feet felt numb, her back sore from the concrete sidewalk.[pullquote size=\"medium\" align=\"right\" citation=\"Shahada Hull, San Francisco resident\"]'Wanting to force people that are homeless and on drugs into treatment and to housing, that's just forcing. That's still not giving them a chance to talk.'[/pullquote]\u003c/p>\n\u003cp>“After a while, I was like, look, I’m going to 5150 myself,” Hull said, referring to the civic code to place someone on an emergency, 72-hour psychiatric hold. Hull has been diagnosed with obsessive-compulsive disorder, anxiety, PTSD and depression.\u003c/p>\n\u003cp>But on that particular day, it wasn’t the intrusive thoughts that sometimes cloud her mind that brought her to Sutter Health’s Street Care Center. She was just looking to get off the street.\u003c/p>\n\u003cp>“I was praying, like, please just let them help me today,” Hull said. “Please let there be resources open today, just anything.”\u003c/p>\n\u003cp>After she spent a week in the psychiatric ward, the on-site social worker produced a sheet of paper. On it was a list of shelters.\u003c/p>\n\u003cp>“They were going to take me back out into the streets because they felt that I didn't need any further help,” Hull said. She was upset. “Like, really? You can clearly see that I’m not really in the right state of mind right now.”\u003c/p>\n\u003cfigure id=\"attachment_11914876\" class=\"wp-caption alignright\" style=\"max-width: 160px\">\u003ca href=\"https://ww2.kqed.org/app/uploads/sites/10/2022/05/Shahada-Hull_selfie-1.jpg\">\u003cimg class=\"wp-image-11914876 size-thumbnail\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2022/05/Shahada-Hull_selfie-1-160x213.jpg\" alt=\"A young Black woman with long Black hair, tossed over her right shoulder, smiles at the camera. She has sculpted eyebrows and wears a red or pink sleeveless top. The image has a filter on it so that her skin and the wall behind her appear yellow.\" width=\"160\" height=\"213\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2022/05/Shahada-Hull_selfie-1-160x213.jpg 160w, https://ww2.kqed.org/app/uploads/sites/10/2022/05/Shahada-Hull_selfie-1.jpg 480w\" sizes=\"(max-width: 160px) 100vw, 160px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Shahada Hull, 30, poses for a portrait in this undated photo. She has a dual diagnosis of substance use disorder and mental illness and might qualify for court-ordered treatment under Gov. Gavin Newsom's CARE Court proposal, which is currently making its way through the Legislature. \u003ccite>(Courtesy Shahada Hull)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Throughout her life, Hull, 30, has had around 160 mental health episodes, documented in a thick case file. At 13 months old, the San Francisco resident was placed in foster care. And she’s been in “the system” ever since — cycling in and out of affordable housing placements, the courts and county behavioral health services.\u003c/p>\n\u003cp>In many ways, she’s the archetypal candidate for CARE Court, part of a sweeping new proposal to address mental health care in California. The state Senate voted Wednesday to approve the legislation, \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=202120220SB1338\" target=\"_blank\" rel=\"noopener noreferrer\">SB 1338\u003c/a>. It now heads to the Assembly for a vote.\u003c/p>\n\u003cp>When Gov. Gavin Newsom unveiled CARE Court in March, he said it’s designed to help people like Hull, who move between emergency psychiatric treatment and homelessness.\u003c/p>\n\u003cp>“This approach with the courts allows … a pathway to actually develop a strategy and a plan with oversight and accountability, with housing supports, that are a component of this, to achieve some more permanency and success as opposed to episodic experiences through the 5150,” Newsom said.\u003c/p>\n\u003cp>Under the governor’s Community Assistance, Recovery, and Empowerment Court, Hull would be able to enter into a civil process with a judge to oversee her mental health treatment.\u003c/p>\n\u003cp>She’d have a public defender and a supporter to help her make decisions about what sorts of treatment programs she would like, with a care plan lasting up to two years. In turn, the county behavioral health department would be compelled to provide her with treatment or face fines if they do not.\u003c/p>\n\u003cp>Ideally, the program would enable Hull to reach her goals, all the things she had wanted to achieve by the time she turned 30: her GED, a job, stable housing, a car.\u003c/p>\n\u003cp>But Hull is skeptical the program really would help. She sat at a café in San Francisco’s Civic Center on a recent afternoon and looked toward City Hall.\u003c/p>\n\u003cp>“Wanting to force people that are homeless and on drugs into treatment and to housing, that’s just forcing,” she said. “That’s still not giving them a chance to talk.”\u003c/p>\n\u003cp>Newsom and officials in his administration say the treatment is voluntary. But the legislation also comes with a threat: Continued refusal to participate in CARE Court could be used as justification for conservatorship, where people could be forced into care against their will.\u003c/p>\n\u003cp>That has provoked harsh criticism from civil rights advocates who say compelling people into care is not only less effective, it undermines the kind of trust-building needed to actually bring people into treatment successfully.[pullquote size=\"medium\" align=\"right\" citation=\"Dr. Le Ondra Clark Harvey, CEO, California Council of Community Behavioral Health Agencies\"]'We need to be able to have dependable, well-trained workers within this CARE Court system to make it successful.'[/pullquote]\u003c/p>\n\u003cp>“It seems to just undercut a lot of the principles of disability rights, the right to self-determination, the need for services to accommodate people with disabilities,” said Lili Graham, a lawyer with Disability Rights California. “And there is this coercive component to it because it's under the court's mandate.”\u003c/p>\n\u003cp>But Hull is also optimistic. If there’s a chance that CARE Court could help, she’d welcome the change.\u003c/p>\n\u003cp>“Sometimes there's a lot of things that you don't like and you have to do it,” Hull said. “So, yeah, if it’s a chance for somebody to be housed and get their word out, I'm all for it.”\u003c/p>\n\u003cp>Newsom’s administration poured $12 billion into homelessness and mental health programs last year — with another $2 billion proposed this year. But the state still faces serious shortages in behavioral health care workers, treatment programs and housing. And Hull’s most recent experience seeking help illustrates the hurdles CARE Court will have to clear to ensure that Hull, and others with a similar experience, can break the cycle of homelessness and succeed in treatment.\u003c/p>\n\u003ch2>A slow process\u003c/h2>\n\u003cp>When Hull realized the hospital staff were going to discharge her to the streets, she called her godfather in a panic. He called the Coalition on Homelessness in San Francisco.\u003c/p>\n\u003cp>That’s how Hull first met Christin Evans, who owns the Booksmith, an independent bookstore in San Francisco, and also volunteers with the coalition. Evans stepped in as an advocate to help Hull find someplace to stay.\u003c/p>\n\u003cp>Hull has a paid social worker, appointed by the city. But with a heavy caseload, Evans said, the city social worker isn’t always able to give Hull as much time as she needs.\u003c/p>\n\u003cp>Across California, the behavioral health care industry faces a worker shortage, and it's expected to grow. A 2018 University of California San Francisco study found that \u003ca href=\"https://healthforce.ucsf.edu/sites/healthforce.ucsf.edu/files/publication-pdf/California%E2%80%99s%20Current%20and%20Future%20Behavioral%20Health%20Workforce.pdf\">by 2028, California will have 50% fewer psychiatrists and 28% fewer psychologists, licensed therapists and social workers than needed\u003c/a>, due to retirement and attrition.\u003c/p>\n\u003cp>The pandemic only exacerbated that shortage, said Dr. Le Ondra Clark Harvey, CEO of the California Council of Community Behavioral Health Agencies. And Newsom’s administration estimates that 7,000 to 12,000 people will qualify for CARE Court each year, adding to that caseload. All of these people will be, by definition, high-needs cases.\u003c/p>\n\u003cp>“As the system currently stands, we're already struggling,” Harvey said. “We need to be able to have dependable, well-trained workers within this CARE Court system to make it successful.”\u003c/p>\n\u003cp>Without Evans volunteering support, Hull said she would have been lost.\u003c/p>\n\u003cp>“I would be downtown, going to see case manager after case manager, praying that there's an opening somewhere, praying that I'll be safe, sleeping in doorways,” Hull said.\u003c/p>\n\u003cp>Evans was able to spring into action. She started by convincing the hospital to keep Hull for a few more days — days that Evans spent trying to find housing.\u003c/p>\n\u003cp>She couldn’t place Hull at an emergency shelter in the Tenderloin, where Hull knew the heroin dealers. Sober for a week, Hull didn’t want to be tempted to use again.\u003c/p>\n\u003cp>“The options for her for emergency shelter were really limited,” Evans said.\u003c/p>\n\u003cp>She found a substance use treatment program that agreed to do an intake assessment, but not right away.\u003c/p>\n\u003cp>In the meantime, the hospital did discharge Hull, who was able to stay with her godparents over the weekend. That wasn’t a long-term option, though, because they only let Hull stay with them when she’s sober and getting into treatment.\u003c/p>\n\u003cp>When it came time for the program to do the intake assessment, however, the staff determined Hull needed more care than they could provide. She wouldn’t be getting a bed there. So, Evans started over, searching for a place that could provide both substance use and mental health treatment for Hull’s dual diagnoses.\u003c/p>\n\u003cp>“We started cold-calling, basically,” Evans said. “We were informed that there really weren't dual-diagnosis beds readily available that she could go into that night.”\u003c/p>\n\u003cp>To get into dual-diagnosis programs, Hull needed to fill out a five-page application, get a TB test and get a referral from a primary care physician, all of which took several days. Hull spent those nights with her godparents and at an overnight urgent care facility.\u003c/p>\n\u003cp>Finally, she got into The Avenues Transitional Care Center. But it was only temporary.\u003c/p>\n\u003cp>She had to wait another couple weeks until a bed opened at Baker Places Inc., which operates a 90-day treatment program in San Francisco. The whole process took about a month.\u003c/p>\n\u003cp>“I really do believe that in her case, she's not service-resistant,” Evans said. “The system is resistant to serving her.”\u003c/p>\n\u003cfigure id=\"attachment_11914879\" class=\"wp-caption aligncenter\" style=\"max-width: 1440px\">\u003ca href=\"https://ww2.kqed.org/app/uploads/sites/10/2022/05/RS13773_20141218_homeless_jt_001.JPG-qut.jpg\">\u003cimg class=\"wp-image-11914879 size-full\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2022/05/RS13773_20141218_homeless_jt_001.JPG-qut.jpg\" alt=\"A line of six people, all presenting as white or Asian, hold a long, white, lit candle in one hand and what seems to be a paper program in the other. Some look down at the program, and others look up at a focal point beyond and to the left of the camera. Behind them is the south half of the facade of San Francisco City Hall (facing what would be the plaza), the rotunda lit up in red, and the wall beneath it lighted in alternating columns of red and green. The sky, which takes up most of the top half of the photo, is a deep blue, as after sunset.\" width=\"1440\" height=\"961\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2022/05/RS13773_20141218_homeless_jt_001.JPG-qut.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/10/2022/05/RS13773_20141218_homeless_jt_001.JPG-qut-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/10/2022/05/RS13773_20141218_homeless_jt_001.JPG-qut-1020x681.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/10/2022/05/RS13773_20141218_homeless_jt_001.JPG-qut-160x107.jpg 160w\" sizes=\"(max-width: 1440px) 100vw, 1440px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Mourners gather in Civic Center Plaza to commemorate unhoused people who died in San Francisco, on Dec. 18, 2014. Supporters of CARE Court say it's about preventing deaths for people who are living on the street with untreated mental illness. \u003ccite>(James Tensuan/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>California faces \u003ca href=\"https://www.rand.org/pubs/research_reports/RRA1824-1-v2.html\">a shortfall of nearly 5,000 psychiatric beds\u003c/a> for short- and medium-term care, according to the RAND Institute, as well as nearly 3,000 long-term care beds.\u003c/p>\n\u003cp>Last year, the \u003ca href=\"https://www.chhs.ca.gov/wp-content/uploads/2022/04/Public-Community-Behavioral-Health-Funding-4.20.22.pdf\">state budget included $2.2 billion to create or acquire residential treatment facilities\u003c/a>, including board and care homes for people with mental health issues. This year’s proposed budget includes another $1.5 billion for short-term housing for people exiting homelessness and entering behavioral health treatment programs.\u003c/p>\n\u003cp>But Michelle Doty Cabrera, executive director of the County Behavioral Health Directors Association of California, said all those facilities will need ongoing funding.\u003c/p>\n\u003cp>“Those are buildings. They're not the people to work in the buildings,” Cabrera said. “We still have not expanded funding at the state level to support the expanded services that would be needed to go along with those buildings.”\u003c/p>\n\u003cp>\u003ca href=\"https://www.ebudget.ca.gov/budget/2022-23MR/#/Home\">The governor’s proposed budget includes $65 million to implement CARE Court\u003c/a>, including $39 million to facilitate proceedings in county courts, $10 million to finance a supporter program through the state’s Department of Aging and $15 million to provide county governments with training and technical assistance.\u003c/p>\n\u003cp>It doesn’t specify any additional funds to increase services for new CARE Court enrollees. But it does include \u003ca href=\"https://www.chhs.ca.gov/wp-content/uploads/2022/04/Public-Community-Behavioral-Health-Funding-4.20.22.pdf\">a projected $11.6 billion for county behavioral health departments\u003c/a>, which are charged with providing services to people on Medi-Cal. That would be a nearly 50% increase from the prior year’s budget, if actual revenues match the projections.\u003c/p>\n\u003cp>Health and Human Services Secretary Dr. Mark Ghaly said in an interview it’s about prioritization.\u003c/p>\n\u003cp>“Our focus [is] on prioritizing this population,” Ghaly said, “not just making sure that they are no longer out of the line, but that they are towards the front of the line and getting these services in a prioritized way.”\u003c/p>\n\u003ch2>Housing shortage\u003c/h2>\n\u003cp>Hull isn’t sure where she will go when her treatment program ends in early July. Evans is worried that all the work done to get Hull sober and stabilized will be undone if she goes back to homelessness.\u003c/p>\n\u003cp>The shortage of affordable housing remains a huge problem in California, particularly for people who often need on-site services to help them remain stably housed. Nearly 14,000 people experiencing homelessness voluntarily sought mental health services last year, but only half were placed into housing, according to a survey conducted earlier this year by the County Behavioral Health Directors Association of California.\u003c/p>\n\u003cp>For the other half, there simply weren’t enough affordable options that could accommodate people with complex behavioral health needs.\u003c/p>\n\u003cp>“We've sort of been casualties of the hot housing market in California,” Cabrera said, noting the state has lost many residential treatment facilities in recent years. “We have very limited resources ourselves to support our clients’ housing needs.”\u003c/p>\n\u003cp>An early draft of the CARE Court legislation didn't guarantee housing as part of the plan. But recent amendments to the bill now require county staff to identify an available housing placement for CARE Court enrollees. And courts could order other government agencies to provide that housing.\u003c/p>\n\u003cp>Hull tries not to think about what will happen to her in July, “because I don't want to get into a depression,” she said.\u003c/p>\n\u003cp>She’ll be 31 in September, and she’s still a long way from her goals. Sitting at the café in San Francisco's Civic Center, she said she knows that, ultimately, getting there is up to her.\u003c/p>\n\u003cp>“At the end of the day, the government has this and they have that,” she said. “It’s really up to you to fight for that.”\u003c/p>\n\u003cp>She turned her face toward the gilded dome on top of City Hall.\u003c/p>\n\u003cp>\"But the fight shouldn’t be this hard,” she said.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n","blocks":[],"excerpt":"As Gov. Gavin Newsom's CARE Court proposal nears a crucial Senate vote, questions remain about whether the state's mental health care industry has the workforce, treatment beds and housing needed to sustain the effort.","status":"publish","parent":0,"modified":1653589534,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":61,"wordCount":2370},"headData":{"title":"Newsom's 'Care Court' Passes Senate but Still Faces Shortage of Treatment Beds, Housing | KQED","description":"As Gov. Gavin Newsom's CARE Court proposal nears a crucial Senate vote, questions remain about whether the state's mental health care industry has the workforce, treatment beds and housing needed to sustain the effort.","ogTitle":"Newsom's 'Care Court' Passes Senate but Still Faces Shortage of Treatment Beds, Housing","ogDescription":"","ogImgId":"","twTitle":"Newsom's 'Care Court' Passes Senate but Still Faces Shortage of Treatment Beds, Housing","twDescription":"","twImgId":""},"disqusIdentifier":"11914873 https://ww2.kqed.org/news/?p=11914873","disqusUrl":"https://ww2.kqed.org/news/2022/05/24/newsoms-care-court-faces-foe-shortage-of-treatment-beds-housing/","disqusTitle":"Newsom's 'Care Court' Passes Senate but Still Faces Shortage of Treatment Beds, Housing","excludeFromSiteSearch":"Include","path":"/news/11914873/newsoms-care-court-faces-foe-shortage-of-treatment-beds-housing","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>On a cold day in March, Shahada Hull admitted herself to the hospital.\u003c/p>\n\u003cp>She had been sleeping outside in San Francisco’s Tenderloin neighborhood for months, ever since she was evicted in December from the affordable studio apartment she'd rented near the Presidio. Her feet felt numb, her back sore from the concrete sidewalk.\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"'Wanting to force people that are homeless and on drugs into treatment and to housing, that's just forcing. That's still not giving them a chance to talk.'","name":"pullquote","attributes":{"named":{"size":"medium","align":"right","citation":"Shahada Hull, San Francisco resident","label":""},"numeric":[]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“After a while, I was like, look, I’m going to 5150 myself,” Hull said, referring to the civic code to place someone on an emergency, 72-hour psychiatric hold. Hull has been diagnosed with obsessive-compulsive disorder, anxiety, PTSD and depression.\u003c/p>\n\u003cp>But on that particular day, it wasn’t the intrusive thoughts that sometimes cloud her mind that brought her to Sutter Health’s Street Care Center. She was just looking to get off the street.\u003c/p>\n\u003cp>“I was praying, like, please just let them help me today,” Hull said. “Please let there be resources open today, just anything.”\u003c/p>\n\u003cp>After she spent a week in the psychiatric ward, the on-site social worker produced a sheet of paper. On it was a list of shelters.\u003c/p>\n\u003cp>“They were going to take me back out into the streets because they felt that I didn't need any further help,” Hull said. She was upset. “Like, really? You can clearly see that I’m not really in the right state of mind right now.”\u003c/p>\n\u003cfigure id=\"attachment_11914876\" class=\"wp-caption alignright\" style=\"max-width: 160px\">\u003ca href=\"https://ww2.kqed.org/app/uploads/sites/10/2022/05/Shahada-Hull_selfie-1.jpg\">\u003cimg class=\"wp-image-11914876 size-thumbnail\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2022/05/Shahada-Hull_selfie-1-160x213.jpg\" alt=\"A young Black woman with long Black hair, tossed over her right shoulder, smiles at the camera. She has sculpted eyebrows and wears a red or pink sleeveless top. The image has a filter on it so that her skin and the wall behind her appear yellow.\" width=\"160\" height=\"213\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2022/05/Shahada-Hull_selfie-1-160x213.jpg 160w, https://ww2.kqed.org/app/uploads/sites/10/2022/05/Shahada-Hull_selfie-1.jpg 480w\" sizes=\"(max-width: 160px) 100vw, 160px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Shahada Hull, 30, poses for a portrait in this undated photo. She has a dual diagnosis of substance use disorder and mental illness and might qualify for court-ordered treatment under Gov. Gavin Newsom's CARE Court proposal, which is currently making its way through the Legislature. \u003ccite>(Courtesy Shahada Hull)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Throughout her life, Hull, 30, has had around 160 mental health episodes, documented in a thick case file. At 13 months old, the San Francisco resident was placed in foster care. And she’s been in “the system” ever since — cycling in and out of affordable housing placements, the courts and county behavioral health services.\u003c/p>\n\u003cp>In many ways, she’s the archetypal candidate for CARE Court, part of a sweeping new proposal to address mental health care in California. The state Senate voted Wednesday to approve the legislation, \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=202120220SB1338\" target=\"_blank\" rel=\"noopener noreferrer\">SB 1338\u003c/a>. It now heads to the Assembly for a vote.\u003c/p>\n\u003cp>When Gov. Gavin Newsom unveiled CARE Court in March, he said it’s designed to help people like Hull, who move between emergency psychiatric treatment and homelessness.\u003c/p>\n\u003cp>“This approach with the courts allows … a pathway to actually develop a strategy and a plan with oversight and accountability, with housing supports, that are a component of this, to achieve some more permanency and success as opposed to episodic experiences through the 5150,” Newsom said.\u003c/p>\n\u003cp>Under the governor’s Community Assistance, Recovery, and Empowerment Court, Hull would be able to enter into a civil process with a judge to oversee her mental health treatment.\u003c/p>\n\u003cp>She’d have a public defender and a supporter to help her make decisions about what sorts of treatment programs she would like, with a care plan lasting up to two years. In turn, the county behavioral health department would be compelled to provide her with treatment or face fines if they do not.\u003c/p>\n\u003cp>Ideally, the program would enable Hull to reach her goals, all the things she had wanted to achieve by the time she turned 30: her GED, a job, stable housing, a car.\u003c/p>\n\u003cp>But Hull is skeptical the program really would help. She sat at a café in San Francisco’s Civic Center on a recent afternoon and looked toward City Hall.\u003c/p>\n\u003cp>“Wanting to force people that are homeless and on drugs into treatment and to housing, that’s just forcing,” she said. “That’s still not giving them a chance to talk.”\u003c/p>\n\u003cp>Newsom and officials in his administration say the treatment is voluntary. But the legislation also comes with a threat: Continued refusal to participate in CARE Court could be used as justification for conservatorship, where people could be forced into care against their will.\u003c/p>\n\u003cp>That has provoked harsh criticism from civil rights advocates who say compelling people into care is not only less effective, it undermines the kind of trust-building needed to actually bring people into treatment successfully.\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"'We need to be able to have dependable, well-trained workers within this CARE Court system to make it successful.'","name":"pullquote","attributes":{"named":{"size":"medium","align":"right","citation":"Dr. Le Ondra Clark Harvey, CEO, California Council of Community Behavioral Health Agencies","label":""},"numeric":[]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“It seems to just undercut a lot of the principles of disability rights, the right to self-determination, the need for services to accommodate people with disabilities,” said Lili Graham, a lawyer with Disability Rights California. “And there is this coercive component to it because it's under the court's mandate.”\u003c/p>\n\u003cp>But Hull is also optimistic. If there’s a chance that CARE Court could help, she’d welcome the change.\u003c/p>\n\u003cp>“Sometimes there's a lot of things that you don't like and you have to do it,” Hull said. “So, yeah, if it’s a chance for somebody to be housed and get their word out, I'm all for it.”\u003c/p>\n\u003cp>Newsom’s administration poured $12 billion into homelessness and mental health programs last year — with another $2 billion proposed this year. But the state still faces serious shortages in behavioral health care workers, treatment programs and housing. And Hull’s most recent experience seeking help illustrates the hurdles CARE Court will have to clear to ensure that Hull, and others with a similar experience, can break the cycle of homelessness and succeed in treatment.\u003c/p>\n\u003ch2>A slow process\u003c/h2>\n\u003cp>When Hull realized the hospital staff were going to discharge her to the streets, she called her godfather in a panic. He called the Coalition on Homelessness in San Francisco.\u003c/p>\n\u003cp>That’s how Hull first met Christin Evans, who owns the Booksmith, an independent bookstore in San Francisco, and also volunteers with the coalition. Evans stepped in as an advocate to help Hull find someplace to stay.\u003c/p>\n\u003cp>Hull has a paid social worker, appointed by the city. But with a heavy caseload, Evans said, the city social worker isn’t always able to give Hull as much time as she needs.\u003c/p>\n\u003cp>Across California, the behavioral health care industry faces a worker shortage, and it's expected to grow. A 2018 University of California San Francisco study found that \u003ca href=\"https://healthforce.ucsf.edu/sites/healthforce.ucsf.edu/files/publication-pdf/California%E2%80%99s%20Current%20and%20Future%20Behavioral%20Health%20Workforce.pdf\">by 2028, California will have 50% fewer psychiatrists and 28% fewer psychologists, licensed therapists and social workers than needed\u003c/a>, due to retirement and attrition.\u003c/p>\n\u003cp>The pandemic only exacerbated that shortage, said Dr. Le Ondra Clark Harvey, CEO of the California Council of Community Behavioral Health Agencies. And Newsom’s administration estimates that 7,000 to 12,000 people will qualify for CARE Court each year, adding to that caseload. All of these people will be, by definition, high-needs cases.\u003c/p>\n\u003cp>“As the system currently stands, we're already struggling,” Harvey said. “We need to be able to have dependable, well-trained workers within this CARE Court system to make it successful.”\u003c/p>\n\u003cp>Without Evans volunteering support, Hull said she would have been lost.\u003c/p>\n\u003cp>“I would be downtown, going to see case manager after case manager, praying that there's an opening somewhere, praying that I'll be safe, sleeping in doorways,” Hull said.\u003c/p>\n\u003cp>Evans was able to spring into action. She started by convincing the hospital to keep Hull for a few more days — days that Evans spent trying to find housing.\u003c/p>\n\u003cp>She couldn’t place Hull at an emergency shelter in the Tenderloin, where Hull knew the heroin dealers. Sober for a week, Hull didn’t want to be tempted to use again.\u003c/p>\n\u003cp>“The options for her for emergency shelter were really limited,” Evans said.\u003c/p>\n\u003cp>She found a substance use treatment program that agreed to do an intake assessment, but not right away.\u003c/p>\n\u003cp>In the meantime, the hospital did discharge Hull, who was able to stay with her godparents over the weekend. That wasn’t a long-term option, though, because they only let Hull stay with them when she’s sober and getting into treatment.\u003c/p>\n\u003cp>When it came time for the program to do the intake assessment, however, the staff determined Hull needed more care than they could provide. She wouldn’t be getting a bed there. So, Evans started over, searching for a place that could provide both substance use and mental health treatment for Hull’s dual diagnoses.\u003c/p>\n\u003cp>“We started cold-calling, basically,” Evans said. “We were informed that there really weren't dual-diagnosis beds readily available that she could go into that night.”\u003c/p>\n\u003cp>To get into dual-diagnosis programs, Hull needed to fill out a five-page application, get a TB test and get a referral from a primary care physician, all of which took several days. Hull spent those nights with her godparents and at an overnight urgent care facility.\u003c/p>\n\u003cp>Finally, she got into The Avenues Transitional Care Center. But it was only temporary.\u003c/p>\n\u003cp>She had to wait another couple weeks until a bed opened at Baker Places Inc., which operates a 90-day treatment program in San Francisco. The whole process took about a month.\u003c/p>\n\u003cp>“I really do believe that in her case, she's not service-resistant,” Evans said. “The system is resistant to serving her.”\u003c/p>\n\u003cfigure id=\"attachment_11914879\" class=\"wp-caption aligncenter\" style=\"max-width: 1440px\">\u003ca href=\"https://ww2.kqed.org/app/uploads/sites/10/2022/05/RS13773_20141218_homeless_jt_001.JPG-qut.jpg\">\u003cimg class=\"wp-image-11914879 size-full\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2022/05/RS13773_20141218_homeless_jt_001.JPG-qut.jpg\" alt=\"A line of six people, all presenting as white or Asian, hold a long, white, lit candle in one hand and what seems to be a paper program in the other. Some look down at the program, and others look up at a focal point beyond and to the left of the camera. Behind them is the south half of the facade of San Francisco City Hall (facing what would be the plaza), the rotunda lit up in red, and the wall beneath it lighted in alternating columns of red and green. The sky, which takes up most of the top half of the photo, is a deep blue, as after sunset.\" width=\"1440\" height=\"961\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2022/05/RS13773_20141218_homeless_jt_001.JPG-qut.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/10/2022/05/RS13773_20141218_homeless_jt_001.JPG-qut-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/10/2022/05/RS13773_20141218_homeless_jt_001.JPG-qut-1020x681.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/10/2022/05/RS13773_20141218_homeless_jt_001.JPG-qut-160x107.jpg 160w\" sizes=\"(max-width: 1440px) 100vw, 1440px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Mourners gather in Civic Center Plaza to commemorate unhoused people who died in San Francisco, on Dec. 18, 2014. Supporters of CARE Court say it's about preventing deaths for people who are living on the street with untreated mental illness. \u003ccite>(James Tensuan/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>California faces \u003ca href=\"https://www.rand.org/pubs/research_reports/RRA1824-1-v2.html\">a shortfall of nearly 5,000 psychiatric beds\u003c/a> for short- and medium-term care, according to the RAND Institute, as well as nearly 3,000 long-term care beds.\u003c/p>\n\u003cp>Last year, the \u003ca href=\"https://www.chhs.ca.gov/wp-content/uploads/2022/04/Public-Community-Behavioral-Health-Funding-4.20.22.pdf\">state budget included $2.2 billion to create or acquire residential treatment facilities\u003c/a>, including board and care homes for people with mental health issues. This year’s proposed budget includes another $1.5 billion for short-term housing for people exiting homelessness and entering behavioral health treatment programs.\u003c/p>\n\u003cp>But Michelle Doty Cabrera, executive director of the County Behavioral Health Directors Association of California, said all those facilities will need ongoing funding.\u003c/p>\n\u003cp>“Those are buildings. They're not the people to work in the buildings,” Cabrera said. “We still have not expanded funding at the state level to support the expanded services that would be needed to go along with those buildings.”\u003c/p>\n\u003cp>\u003ca href=\"https://www.ebudget.ca.gov/budget/2022-23MR/#/Home\">The governor’s proposed budget includes $65 million to implement CARE Court\u003c/a>, including $39 million to facilitate proceedings in county courts, $10 million to finance a supporter program through the state’s Department of Aging and $15 million to provide county governments with training and technical assistance.\u003c/p>\n\u003cp>It doesn’t specify any additional funds to increase services for new CARE Court enrollees. But it does include \u003ca href=\"https://www.chhs.ca.gov/wp-content/uploads/2022/04/Public-Community-Behavioral-Health-Funding-4.20.22.pdf\">a projected $11.6 billion for county behavioral health departments\u003c/a>, which are charged with providing services to people on Medi-Cal. That would be a nearly 50% increase from the prior year’s budget, if actual revenues match the projections.\u003c/p>\n\u003cp>Health and Human Services Secretary Dr. Mark Ghaly said in an interview it’s about prioritization.\u003c/p>\n\u003cp>“Our focus [is] on prioritizing this population,” Ghaly said, “not just making sure that they are no longer out of the line, but that they are towards the front of the line and getting these services in a prioritized way.”\u003c/p>\n\u003ch2>Housing shortage\u003c/h2>\n\u003cp>Hull isn’t sure where she will go when her treatment program ends in early July. Evans is worried that all the work done to get Hull sober and stabilized will be undone if she goes back to homelessness.\u003c/p>\n\u003cp>The shortage of affordable housing remains a huge problem in California, particularly for people who often need on-site services to help them remain stably housed. Nearly 14,000 people experiencing homelessness voluntarily sought mental health services last year, but only half were placed into housing, according to a survey conducted earlier this year by the County Behavioral Health Directors Association of California.\u003c/p>\n\u003cp>For the other half, there simply weren’t enough affordable options that could accommodate people with complex behavioral health needs.\u003c/p>\n\u003cp>“We've sort of been casualties of the hot housing market in California,” Cabrera said, noting the state has lost many residential treatment facilities in recent years. “We have very limited resources ourselves to support our clients’ housing needs.”\u003c/p>\n\u003cp>An early draft of the CARE Court legislation didn't guarantee housing as part of the plan. But recent amendments to the bill now require county staff to identify an available housing placement for CARE Court enrollees. And courts could order other government agencies to provide that housing.\u003c/p>\n\u003cp>Hull tries not to think about what will happen to her in July, “because I don't want to get into a depression,” she said.\u003c/p>\n\u003cp>She’ll be 31 in September, and she’s still a long way from her goals. Sitting at the café in San Francisco's Civic Center, she said she knows that, ultimately, getting there is up to her.\u003c/p>\n\u003cp>“At the end of the day, the government has this and they have that,” she said. “It’s really up to you to fight for that.”\u003c/p>\n\u003cp>She turned her face toward the gilded dome on top of City Hall.\u003c/p>\n\u003cp>\"But the fight shouldn’t be this hard,” she said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/news/11914873/newsoms-care-court-faces-foe-shortage-of-treatment-beds-housing","authors":["11652"],"categories":["news_457","news_6266","news_8"],"tags":["news_3921","news_25676","news_27626","news_28872","news_20277","news_20305","news_4020","news_1775","news_27208","news_2109"],"featImg":"news_11914875","label":"news"},"news_11905181":{"type":"posts","id":"news_11905181","meta":{"index":"posts_1591205157","site":"news","id":"11905181","score":null,"sort":[1644955258000]},"guestAuthors":[],"slug":"california-reformed-medi-cal-to-include-whole-person-care-is-it-working","title":"California Reformed Medi-Cal to Include 'Whole Person Care' — Is It Working?","publishDate":1644955258,"format":"standard","headTitle":"CALmatters | KQED News","labelTerm":{"term":18481,"site":"news"},"content":"\u003cp>At 66, Edward El has a new lease on life — literally. In two weeks, he’ll move into his own apartment in Berkeley after spending the better part of the past 16 years unhoused.\u003c/p>\n\u003cp>Years ago, a back injury and pinched nerves in his legs made standing and walking painful, and he was laid off from his construction job. He ended up in “shelter after shelter after shelter.”\u003c/p>\n\u003cp>But nine months ago, El moved into one of 12 Project Roomkey shelters in Alameda County designed to reduce COVID-19 among the unhoused population. He was connected with a housing navigator, a counselor and medical staff. They helped El apply for affordable housing and rental assistance vouchers, and coordinated with landlords who would give unhoused renters a chance.\u003c/p>\n\u003cfigure id=\"attachment_11905186\" class=\"wp-caption alignnone\" style=\"max-width: 1536px\">\u003cimg class=\"size-full wp-image-11905186\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2022/02/020922-CALAIM-MHN-14-CM.jpg\" alt=\"A man, wearing a hoodie, beanie and a face mask, sits on a chair in an indoor space. He looks to the side, a bit away from the camera.\" width=\"1536\" height=\"1025\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2022/02/020922-CALAIM-MHN-14-CM.jpg 1536w, https://ww2.kqed.org/app/uploads/sites/10/2022/02/020922-CALAIM-MHN-14-CM-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/10/2022/02/020922-CALAIM-MHN-14-CM-1020x681.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/10/2022/02/020922-CALAIM-MHN-14-CM-160x107.jpg 160w\" sizes=\"(max-width: 1536px) 100vw, 1536px\">\u003cfigcaption class=\"wp-caption-text\">As Edward El prepares to move to a permanent home, he has enrolled in Medi-Cal. He said he couldn't have navigated the array of complex systems if it weren't for his new case management team. 'I'm happy. They knew about programs that I didn't know about that allowed me to get a place,' he said. \u003ccite>(Martin do Nascimento/CalMatters)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Now El will pay a fraction of the cost to live in an area where one-bedroom apartments often exceed $3,000 per month.\u003c/p>\n\u003cp>The team also made sure that El was enrolled in Medi-Cal and had transportation to his doctor’s appointments. He said he couldn’t have navigated the array of complex systems if it weren’t for his new case management team. “I’m happy. They knew about programs that I didn’t know about that allowed me to get a place,” he said.\u003c/p>\n\u003cp>Intensive case management like this is an example of the ambitious, sweeping changes California made to Medi-Cal beginning in January under an initiative it’s calling CalAIM, or California Advancing and Innovating Medi-Cal.\u003c/p>\n\u003cp>Medi-Cal \u003ca href=\"https://www.chcf.org/publication/2021-edition-medi-cal-facts-figures/\">offers medical insurance to lower-income Californians\u003c/a>, serving as a lifeline for nearly half the state’s children, 1 in 5 adults and 2 million seniors and people with disabilities. But the program is inefficient: More than half of Medi-Cal’s \u003ca href=\"https://calmatters.org/health/coronavirus/2021/07/medi-cal-covid-vaccinations/\">roughly $133 billion annual budget is spent on just 5% of the program’s highest-needs individuals\u003c/a> — people with multiple complex health problems compounded by homelessness, poverty, substance abuse, mental illness or incarceration, \u003ca href=\"https://www.dhcs.ca.gov/CalAIM/Documents/CalAIM-ECM-a11y.pdf\">according the Department of Health Care Services\u003c/a>.\u003c/p>\n\u003cp>[pullquote align=\"right\" size=\"medium\" citation=\"Edward El, CalAIM beneficiary\"]'I'm happy. They knew about programs that I didn't know about that allowed me to get a place.'[/pullquote]Over the next five years, CalAIM will seek to address the upstream drivers of deteriorating health — things like food insecurity and housing instability — in an effort to reduce costly emergency department visits, hospitalizations and nursing home stays. The program redesign is based on “whole person care” principles, which help people avoid situations that worsen their physical and mental health.\u003c/p>\n\u003cp>“This was designed at the county level to identify very high-risk populations — oftentimes people who were coming to the emergency room five to 10 times a month.” said Erica Murray, president and CEO of the California Association of Public Hospitals and Health Systems.\u003c/p>\n\u003cp>In his January budget, \u003ca href=\"https://www.ebudget.ca.gov/2022-23/pdf/GovernorsBudget/4000.pdf\">Gov. Gavin Newsom proposed $8 billion over five years to implement the program\u003c/a>, about 6% of Medi-Cal’s total budget. Included are temporary payments to managed care plans to offer enhanced case management and other services.\u003c/p>\n\u003cp>These so-called social determinants of health have not been historically covered by health insurance like Medi-Cal. Yet they have an outsized impact on people who often struggle with economic instability, poor nutrition, discrimination, violence and disproportionate exposure to polluted air and water.\u003c/p>\n\u003cp>“One of my patients calls it social deterrents to health,” said Alameda County Medical Director Dr. Kathleen Clanon.\u003c/p>\n\u003cp>No other state has mounted such a comprehensive program that wraps in so many elements. The scale is unprecedented, too: Medi-Cal provides health insurance for more than 13 million people.\u003c/p>\n\u003cp>[aside postID=\"news_11887815\" hero=\"https://ww2.kqed.org/app/uploads/sites/10/2021/09/GettyImages-1233456190-1020x680.jpg\"]“This is a big deal. Not only is California taking the lead but also setting a precedent for potentially other states to follow it,” said Anthony Wright, executive director of Health Access California, a consumer advocate group.\u003c/p>\n\u003cp>Pilot programs in 25 counties helped get CalAIM off the ground. Roughly \u003ca href=\"https://healthpolicy.ucla.edu/publications/Documents/PDF/2020/wholepersoncare-report-jan2020.pdf\">108,000 Medi-Cal patients were enrolled in county pilots\u003c/a> and \u003ca href=\"https://healthpolicy.ucla.edu/publications/Documents/PDF/2020/First-Interim-Evaluation-CA-HHP-Report-sep2020.pdf\">15,000 in managed care pilots during a two-year period\u003c/a>, according to an early analysis by UCLA researchers. As a result of the success, federal officials granted a waiver allowing CalAIM to move forward for the next five years.\u003c/p>\n\u003cp>In Placer County, David Norris, 67, was one of the patients who benefited from the experimental programs.\u003c/p>\n\u003cp>Norris ended up in a homeless shelter after his mother, for whom he was a long-term caregiver, died. He earns $900 a month in Social Security and retirement, but it’s not enough for rent and living expenses. In April, an infected foot wound spread to the bone and cost Norris his left leg. Another infection resulted in more trips to the ER and subsequent surgeries. Several months later, a fight at the shelter ended in a shove, a fall and a broken right leg.\u003c/p>\n\u003cp>His caseworker, Todd Perbetsky, helped him enroll in Medi-Cal, find a nursing home where he could recuperate and apply for a housing voucher. He’s now helping Norris find permanent housing after leaving the nursing home.\u003c/p>\n\u003cp>“These are definitely people that are falling through the cracks,” Perbetsky said. “They may not meet the criteria of some programs. They may need linkage to services. They can have tons of barriers to even getting their CalFresh turned on or other benefits they qualify for.”\u003c/p>\n\u003cp>Norris called Perbetsky a “hell of a godsend. If you don’t know the ins and outs, you just get spit out. You get absolutely no help at all. That’s where Todd … helps me and people like me navigate the waters and get all squared away.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003ch2>\u003cstrong>Creating a one-stop shop\u003c/strong>\u003c/h2>\n\u003cp>Wraparound services aren’t new, but they haven’t always been easy to access, nor have they been directly connected to medical care. Walk through the wrong door and you might not get any help at all.\u003c/p>\n\u003cp>An unhoused patient who suffers from addiction and mental health issues and has diabetes would have to approach three different county departments and a doctor to get all their needs addressed, and even then they’re likely to get lost in the system.\u003c/p>\n\u003cp>“It’s a little bit like if you needed to get ingredients for a meal and instead of just going to the supermarket, you had to go to different stores to get your proteins and your fruits and your grains and your vegetables. And at those stores, you had to pay with different cards and navigate different rules about what you could buy,” said Melora Simon, a senior strategist at the California Health Care Foundation.\u003c/p>\n\u003cp>[aside postID=\"news_11894981\" hero=\"https://ww2.kqed.org/app/uploads/sites/10/2021/11/NPR-fentanyl-1-1020x766.jpg\"]This fragmentation frequently causes barriers to health care and is one of the primary reasons the Department of Health Care Services is focused on reforming Medi-Cal under CalAIM.\u003c/p>\n\u003cp>One such barrier is making sure patients don’t get lost between systems that don’t traditionally talk to one another.\u003c/p>\n\u003cp>Clanon, who also works as a physician in Alameda County, said a few years ago a pregnant, HIV-positive patient needed to begin HIV treatment but had left the usual encampment she stayed in and couldn’t be found. A nurse spent more than an hour calling local emergency departments, homeless shelters and case managers to see whether anyone had seen the patient, with no luck.\u003c/p>\n\u003cp>Had the system been integrated, Clanon’s patient would have been flagged as needing critical medical care any time she entered a homeless shelter, emergency department, substance abuse center or mental health facility.\u003c/p>\n\u003cp>“CalAIM is trying to fix the problem of disparate systems of care both among and between different counties and among and between different parts of the health care system,” said Diana Douglas, a health policy expert with Health Access California.\u003c/p>\n\u003ch2>\u003cstrong>Accountability and missing pieces\u003c/strong>\u003c/h2>\n\u003cp>Since 2016, California has dedicated more than $3 billion in state and federal funds to experiment with doing just that.\u003c/p>\n\u003cp>Four years after launch, the pilots demonstrated “substantial evidence” of improved follow-up after hospitalization for mental illness, increased participation in substance abuse treatment and decreased use of emergency services, among other metrics, \u003ca href=\"https://healthpolicy.ucla.edu/publications/Documents/PDF/2020/First-Interim-Evaluation-CA-HHP-Report-sep2020.pdf\">according to the UCLA analysis\u003c/a>.\u003c/p>\n\u003cp>In Contra Costa County, more than 12,000 patients were enrolled in the pilot annually, and the county health department hired more than 100 public health nurses, mental health specialists, community health workers, homeless service specialists, substance abuse specialists and social workers to provide coordinated case management.\u003c/p>\n\u003cp>“Most of them were types of positions that existed in the county before, but they were very siloed,” said Emily Parmenter, the pilot’s program manager at Contra Costa County Health Services. “So we brought them all together in these multidisciplinary teams where they had a wealth of experience … and were able to provide case consultations across divisions.”\u003c/p>\n\u003cp>Medi-Cal patients who enrolled in the Contra Costa pilot experienced medical emergencies less frequently than nonenrolled patients.\u003c/p>\n\u003cp>“We found that after being involved in the program for a year, our hospital admission rates decreased by 25% … and our [emergency department] rates were 14% lower compared to the control group,” Parmenter said.\u003c/p>\n\u003cp>[pullquote align=\"right\" size=\"medium\" citation=\"Emily Parmenter, Contra Costa Health Services\"]'We found that after being involved in the program for a year, our hospital admission rates decreased by 25%.'[/pullquote]UCLA researcher Nadereh Pourat, who conducted the pilot evaluation, said her team has just begun to analyze the impact on specific health conditions, such as blood pressure and congestive heart failure, as well as cost-effectiveness.\u003c/p>\n\u003cp>Despite their promise — or perhaps because of it — advocates say the transition from pilot programs to CalAIM will need to be watched carefully.\u003c/p>\n\u003cp>Responsibility has now shifted from county health departments to health care plans, which don’t always meet quality benchmarks. And health care plans in the 33 counties that did not have pilots are starting from scratch.\u003c/p>\n\u003cp>“There are serious concerns about Medi-Cal [health care] plans on the ground being able to implement some of the work necessary for CalAIM to really be effective and live up to its potential,” health policy expert Douglas said.\u003c/p>\n\u003cp>“In some cases, plans struggle to deliver quality care across what we think of as very basic measures: childhood immunizations, are people getting mammograms on time, just very basic preventive care and chronic disease management,” she said.\u003c/p>\n\u003cfigure id=\"attachment_11905185\" class=\"wp-caption alignnone\" style=\"max-width: 1024px\">\u003cimg class=\"size-full wp-image-11905185\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2022/02/020922-CALAIM-MHN-10-CM_11.jpg\" alt=\"Two people sit at a table, handling paperwork. One person has their backed to the camera, the other one sits across from them.\" width=\"1024\" height=\"682\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2022/02/020922-CALAIM-MHN-10-CM_11.jpg 1024w, https://ww2.kqed.org/app/uploads/sites/10/2022/02/020922-CALAIM-MHN-10-CM_11-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/10/2022/02/020922-CALAIM-MHN-10-CM_11-1020x679.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/10/2022/02/020922-CALAIM-MHN-10-CM_11-160x107.jpg 160w\" sizes=\"(max-width: 1024px) 100vw, 1024px\">\u003cfigcaption class=\"wp-caption-text\">Alameda County intake specialist Annie Wyley meets with a Medi-Cal patient in the repurposed dining room at the Radisson Hotel in Oakland. \u003ccite>(Martin do Nascimento/CalMatters)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Accountability is especially important for improving equity among communities of color, advocates say.\u003c/p>\n\u003cp>“Communities of color are disproportionately impacted by these same factors: lack of housing, lack of income, lack of food security,” said Cary Sanders, senior policy director for the California Pan-Ethnic Health Network.\u003c/p>\n\u003cp>Health plans need to provide services that are “linguistically and culturally appropriate,” Sanders said.\u003c/p>\n\u003cp>One critical piece of the pilot programs that was left out of CalAIM is legal aid. In counties that funded legal aid during the pilot programs, lawyers and paralegals were stationed in medical clinics to assist patients who needed help with benefit denials, eviction notices, immigration issues or domestic abuse cases.\u003c/p>\n\u003cp>Frequently patients and even their doctors don’t realize that their issue could use the help of a lawyer, said Daniel Nesbit, managing attorney for medical legal partnerships with California Rural Legal Assistance. Nesbit said that during the pilot program in Monterey County his team helped 700 clients with more than 1,000 cases.\u003c/p>\n\u003cp>“A really good example is someone struggling with some sort of medical condition, and it’s making it hard for them to go to work every day and do their job to the full extent,” Nesbit said. “They might not know, for example, that they have a possible right to a reasonable accommodation under the Americans with Disabilities Act.”\u003c/p>\n\u003cp>Alameda and Contra Costa counties, which contracted with Bay Area Legal Aid to participate in the pilot, hired five additional attorneys dedicated to assisting Medi-Cal patients. The partnership helped reach people who ordinarily wouldn’t be able to access legal aid because their disability prevented them from attending an appointment or they didn’t have a phone number or an address. Case managers were able to link people to the attorneys, accounting for 300 referrals a year.\u003c/p>\n\u003cp>But when the pilot ended in December and state funding dried up, attorneys were reassigned and are no longer able to focus on Medi-Cal patients.\u003c/p>\n\u003cp>[pullquote align=\"right\" size=\"medium\" citation=\"Diana Douglas, Health Access California\"]'There are serious concerns about Medi-Cal [health care] … being able to implement some of the work necessary for CalAIM to really be effective.'[/pullquote]“I’m still getting emails and phone calls from the case managers I worked with who I think are now kind of scrambling to figure out how to help,” said Abby Khodayari, an attorney who worked in Contra Costa County’s program. “Case managers are hoping to get help analyzing eviction notices and figuring out the validity of them. It’s hard not having dedicated time to be able to spend working on those issues.”\u003c/p>\n\u003cp>While legal services aren’t explicitly named as one of 14 preapproved services under CalAIM, the Department of Health Care Services said health care plans could integrate them as part of supportive housing services, which are covered.\u003c/p>\n\u003cp>But attorneys say it’s unlikely to happen unless plans get specific guarantees that CalAIM will cover the cost. They hope that subsequent phases of CalAIM will include legal aid.\u003c/p>\n\u003cp>“There hasn’t been a health plan here in LA who’s come forward and said we want to offer these legal services,” said Gerson Sorto, a managing attorney with Neighborhood Legal Services of Los Angeles County.\u003c/p>\n\u003cp>Los Angeles County has continued funding their partnership through the summer, but there’s no permanent money in sight. “As of today, there is no funding secured or confirmed beyond June 30,” Sorto said.\u003c/p>\n\u003ch2>\u003cstrong>Life under 'whole person care'\u003c/strong>\u003c/h2>\n\u003cp>Back at the Radisson Hotel in Oakland, the shelter where El is waiting patiently to move into his new apartment, he watches a home renovation show on the television. He likes to see how the hosts redesign the interior and gets ideas for his own future home.\u003c/p>\n\u003cp>Before losing his job, El lived in an apartment near Lake Merritt but hasn’t had a place to call his own in years. After he enrolled in Alameda County’s pilot program, things started turning around for him.\u003c/p>\n\u003cp>“These people really respect you and help if you ask for it,” El said.\u003c/p>\n\u003cp>Part of the program is connecting Medi-Cal patients to peers with similar backgrounds.\u003c/p>\n\u003cp>[aside label='More Housing Coverage' tag='housing']“You can’t tell them ‘do this and do that.’ You walk alongside someone and support whatever they’ve got going on,” said Michael Webb, a CalAIM peer support navigator who experienced addiction and homelessness. “Most importantly,” he said, “[is] someone to listen. I might not have any answer at all but there’s power in listening.”\u003c/p>\n\u003cp>Down the hall from El’s room, shelter monitors are delivering lunch to residents who can’t make it to the dining room. Lunch is a chicken sandwich, banana, salad and a soda, but those with dietary restrictions or certain medical conditions like diabetes get tailored meals.\u003c/p>\n\u003cp>As part of the CalAIM program, caretakers perform wellness checks on shelter residents with disabilities, helping them clean, bathe and use the restroom.\u003c/p>\n\u003cp>In the lobby, an intake worker asks a new guest about his seizure disorder and works to link him to his CalAIM team of health care providers, case workers and housing navigators. As the program grows, millions more Californians may benefit. On this day alone, the Oakland team expects to sign up eight new people.\u003cbr>\n[ad fullwidth]\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n","blocks":[],"excerpt":"California's first-of-its-kind Medi-Cal reform aims to help lower-income patients navigate problems like homelessness, poverty and substance abuse that can harm health.","status":"publish","parent":0,"modified":1644967044,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":62,"wordCount":2840},"headData":{"title":"California Reformed Medi-Cal to Include 'Whole Person Care' — Is It Working? | KQED","description":"California's first-of-its-kind Medi-Cal reform aims to help lower-income patients navigate problems like homelessness, poverty and substance abuse that can harm health.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"11905181 https://ww2.kqed.org/news/?p=11905181","disqusUrl":"https://ww2.kqed.org/news/2022/02/15/california-reformed-medi-cal-to-include-whole-person-care-is-it-working/","disqusTitle":"California Reformed Medi-Cal to Include 'Whole Person Care' — Is It Working?","nprByline":"\u003ca href=\"https://calmatters.org/author/kristen-hwang/\">Kristen Hwang\u003c/a>","excludeFromSiteSearch":"Include","showOnAuthorArchivePages":"No","path":"/news/11905181/california-reformed-medi-cal-to-include-whole-person-care-is-it-working","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>At 66, Edward El has a new lease on life — literally. In two weeks, he’ll move into his own apartment in Berkeley after spending the better part of the past 16 years unhoused.\u003c/p>\n\u003cp>Years ago, a back injury and pinched nerves in his legs made standing and walking painful, and he was laid off from his construction job. He ended up in “shelter after shelter after shelter.”\u003c/p>\n\u003cp>But nine months ago, El moved into one of 12 Project Roomkey shelters in Alameda County designed to reduce COVID-19 among the unhoused population. He was connected with a housing navigator, a counselor and medical staff. They helped El apply for affordable housing and rental assistance vouchers, and coordinated with landlords who would give unhoused renters a chance.\u003c/p>\n\u003cfigure id=\"attachment_11905186\" class=\"wp-caption alignnone\" style=\"max-width: 1536px\">\u003cimg class=\"size-full wp-image-11905186\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2022/02/020922-CALAIM-MHN-14-CM.jpg\" alt=\"A man, wearing a hoodie, beanie and a face mask, sits on a chair in an indoor space. He looks to the side, a bit away from the camera.\" width=\"1536\" height=\"1025\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2022/02/020922-CALAIM-MHN-14-CM.jpg 1536w, https://ww2.kqed.org/app/uploads/sites/10/2022/02/020922-CALAIM-MHN-14-CM-800x534.jpg 800w, https://ww2.kqed.org/app/uploads/sites/10/2022/02/020922-CALAIM-MHN-14-CM-1020x681.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/10/2022/02/020922-CALAIM-MHN-14-CM-160x107.jpg 160w\" sizes=\"(max-width: 1536px) 100vw, 1536px\">\u003cfigcaption class=\"wp-caption-text\">As Edward El prepares to move to a permanent home, he has enrolled in Medi-Cal. He said he couldn't have navigated the array of complex systems if it weren't for his new case management team. 'I'm happy. They knew about programs that I didn't know about that allowed me to get a place,' he said. \u003ccite>(Martin do Nascimento/CalMatters)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Now El will pay a fraction of the cost to live in an area where one-bedroom apartments often exceed $3,000 per month.\u003c/p>\n\u003cp>The team also made sure that El was enrolled in Medi-Cal and had transportation to his doctor’s appointments. He said he couldn’t have navigated the array of complex systems if it weren’t for his new case management team. “I’m happy. They knew about programs that I didn’t know about that allowed me to get a place,” he said.\u003c/p>\n\u003cp>Intensive case management like this is an example of the ambitious, sweeping changes California made to Medi-Cal beginning in January under an initiative it’s calling CalAIM, or California Advancing and Innovating Medi-Cal.\u003c/p>\n\u003cp>Medi-Cal \u003ca href=\"https://www.chcf.org/publication/2021-edition-medi-cal-facts-figures/\">offers medical insurance to lower-income Californians\u003c/a>, serving as a lifeline for nearly half the state’s children, 1 in 5 adults and 2 million seniors and people with disabilities. But the program is inefficient: More than half of Medi-Cal’s \u003ca href=\"https://calmatters.org/health/coronavirus/2021/07/medi-cal-covid-vaccinations/\">roughly $133 billion annual budget is spent on just 5% of the program’s highest-needs individuals\u003c/a> — people with multiple complex health problems compounded by homelessness, poverty, substance abuse, mental illness or incarceration, \u003ca href=\"https://www.dhcs.ca.gov/CalAIM/Documents/CalAIM-ECM-a11y.pdf\">according the Department of Health Care Services\u003c/a>.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"'I'm happy. They knew about programs that I didn't know about that allowed me to get a place.'","name":"pullquote","attributes":{"named":{"align":"right","size":"medium","citation":"Edward El, CalAIM beneficiary","label":""},"numeric":[]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>Over the next five years, CalAIM will seek to address the upstream drivers of deteriorating health — things like food insecurity and housing instability — in an effort to reduce costly emergency department visits, hospitalizations and nursing home stays. The program redesign is based on “whole person care” principles, which help people avoid situations that worsen their physical and mental health.\u003c/p>\n\u003cp>“This was designed at the county level to identify very high-risk populations — oftentimes people who were coming to the emergency room five to 10 times a month.” said Erica Murray, president and CEO of the California Association of Public Hospitals and Health Systems.\u003c/p>\n\u003cp>In his January budget, \u003ca href=\"https://www.ebudget.ca.gov/2022-23/pdf/GovernorsBudget/4000.pdf\">Gov. Gavin Newsom proposed $8 billion over five years to implement the program\u003c/a>, about 6% of Medi-Cal’s total budget. Included are temporary payments to managed care plans to offer enhanced case management and other services.\u003c/p>\n\u003cp>These so-called social determinants of health have not been historically covered by health insurance like Medi-Cal. Yet they have an outsized impact on people who often struggle with economic instability, poor nutrition, discrimination, violence and disproportionate exposure to polluted air and water.\u003c/p>\n\u003cp>“One of my patients calls it social deterrents to health,” said Alameda County Medical Director Dr. Kathleen Clanon.\u003c/p>\n\u003cp>No other state has mounted such a comprehensive program that wraps in so many elements. The scale is unprecedented, too: Medi-Cal provides health insurance for more than 13 million people.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"aside","attributes":{"named":{"postid":"news_11887815","hero":"https://ww2.kqed.org/app/uploads/sites/10/2021/09/GettyImages-1233456190-1020x680.jpg","label":""},"numeric":[]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>“This is a big deal. Not only is California taking the lead but also setting a precedent for potentially other states to follow it,” said Anthony Wright, executive director of Health Access California, a consumer advocate group.\u003c/p>\n\u003cp>Pilot programs in 25 counties helped get CalAIM off the ground. Roughly \u003ca href=\"https://healthpolicy.ucla.edu/publications/Documents/PDF/2020/wholepersoncare-report-jan2020.pdf\">108,000 Medi-Cal patients were enrolled in county pilots\u003c/a> and \u003ca href=\"https://healthpolicy.ucla.edu/publications/Documents/PDF/2020/First-Interim-Evaluation-CA-HHP-Report-sep2020.pdf\">15,000 in managed care pilots during a two-year period\u003c/a>, according to an early analysis by UCLA researchers. As a result of the success, federal officials granted a waiver allowing CalAIM to move forward for the next five years.\u003c/p>\n\u003cp>In Placer County, David Norris, 67, was one of the patients who benefited from the experimental programs.\u003c/p>\n\u003cp>Norris ended up in a homeless shelter after his mother, for whom he was a long-term caregiver, died. He earns $900 a month in Social Security and retirement, but it’s not enough for rent and living expenses. In April, an infected foot wound spread to the bone and cost Norris his left leg. Another infection resulted in more trips to the ER and subsequent surgeries. Several months later, a fight at the shelter ended in a shove, a fall and a broken right leg.\u003c/p>\n\u003cp>His caseworker, Todd Perbetsky, helped him enroll in Medi-Cal, find a nursing home where he could recuperate and apply for a housing voucher. He’s now helping Norris find permanent housing after leaving the nursing home.\u003c/p>\n\u003cp>“These are definitely people that are falling through the cracks,” Perbetsky said. “They may not meet the criteria of some programs. They may need linkage to services. They can have tons of barriers to even getting their CalFresh turned on or other benefits they qualify for.”\u003c/p>\n\u003cp>Norris called Perbetsky a “hell of a godsend. If you don’t know the ins and outs, you just get spit out. You get absolutely no help at all. That’s where Todd … helps me and people like me navigate the waters and get all squared away.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003ch2>\u003cstrong>Creating a one-stop shop\u003c/strong>\u003c/h2>\n\u003cp>Wraparound services aren’t new, but they haven’t always been easy to access, nor have they been directly connected to medical care. Walk through the wrong door and you might not get any help at all.\u003c/p>\n\u003cp>An unhoused patient who suffers from addiction and mental health issues and has diabetes would have to approach three different county departments and a doctor to get all their needs addressed, and even then they’re likely to get lost in the system.\u003c/p>\n\u003cp>“It’s a little bit like if you needed to get ingredients for a meal and instead of just going to the supermarket, you had to go to different stores to get your proteins and your fruits and your grains and your vegetables. And at those stores, you had to pay with different cards and navigate different rules about what you could buy,” said Melora Simon, a senior strategist at the California Health Care Foundation.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"aside","attributes":{"named":{"postid":"news_11894981","hero":"https://ww2.kqed.org/app/uploads/sites/10/2021/11/NPR-fentanyl-1-1020x766.jpg","label":""},"numeric":[]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>This fragmentation frequently causes barriers to health care and is one of the primary reasons the Department of Health Care Services is focused on reforming Medi-Cal under CalAIM.\u003c/p>\n\u003cp>One such barrier is making sure patients don’t get lost between systems that don’t traditionally talk to one another.\u003c/p>\n\u003cp>Clanon, who also works as a physician in Alameda County, said a few years ago a pregnant, HIV-positive patient needed to begin HIV treatment but had left the usual encampment she stayed in and couldn’t be found. A nurse spent more than an hour calling local emergency departments, homeless shelters and case managers to see whether anyone had seen the patient, with no luck.\u003c/p>\n\u003cp>Had the system been integrated, Clanon’s patient would have been flagged as needing critical medical care any time she entered a homeless shelter, emergency department, substance abuse center or mental health facility.\u003c/p>\n\u003cp>“CalAIM is trying to fix the problem of disparate systems of care both among and between different counties and among and between different parts of the health care system,” said Diana Douglas, a health policy expert with Health Access California.\u003c/p>\n\u003ch2>\u003cstrong>Accountability and missing pieces\u003c/strong>\u003c/h2>\n\u003cp>Since 2016, California has dedicated more than $3 billion in state and federal funds to experiment with doing just that.\u003c/p>\n\u003cp>Four years after launch, the pilots demonstrated “substantial evidence” of improved follow-up after hospitalization for mental illness, increased participation in substance abuse treatment and decreased use of emergency services, among other metrics, \u003ca href=\"https://healthpolicy.ucla.edu/publications/Documents/PDF/2020/First-Interim-Evaluation-CA-HHP-Report-sep2020.pdf\">according to the UCLA analysis\u003c/a>.\u003c/p>\n\u003cp>In Contra Costa County, more than 12,000 patients were enrolled in the pilot annually, and the county health department hired more than 100 public health nurses, mental health specialists, community health workers, homeless service specialists, substance abuse specialists and social workers to provide coordinated case management.\u003c/p>\n\u003cp>“Most of them were types of positions that existed in the county before, but they were very siloed,” said Emily Parmenter, the pilot’s program manager at Contra Costa County Health Services. “So we brought them all together in these multidisciplinary teams where they had a wealth of experience … and were able to provide case consultations across divisions.”\u003c/p>\n\u003cp>Medi-Cal patients who enrolled in the Contra Costa pilot experienced medical emergencies less frequently than nonenrolled patients.\u003c/p>\n\u003cp>“We found that after being involved in the program for a year, our hospital admission rates decreased by 25% … and our [emergency department] rates were 14% lower compared to the control group,” Parmenter said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"'We found that after being involved in the program for a year, our hospital admission rates decreased by 25%.'","name":"pullquote","attributes":{"named":{"align":"right","size":"medium","citation":"Emily Parmenter, Contra Costa Health Services","label":""},"numeric":[]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>UCLA researcher Nadereh Pourat, who conducted the pilot evaluation, said her team has just begun to analyze the impact on specific health conditions, such as blood pressure and congestive heart failure, as well as cost-effectiveness.\u003c/p>\n\u003cp>Despite their promise — or perhaps because of it — advocates say the transition from pilot programs to CalAIM will need to be watched carefully.\u003c/p>\n\u003cp>Responsibility has now shifted from county health departments to health care plans, which don’t always meet quality benchmarks. And health care plans in the 33 counties that did not have pilots are starting from scratch.\u003c/p>\n\u003cp>“There are serious concerns about Medi-Cal [health care] plans on the ground being able to implement some of the work necessary for CalAIM to really be effective and live up to its potential,” health policy expert Douglas said.\u003c/p>\n\u003cp>“In some cases, plans struggle to deliver quality care across what we think of as very basic measures: childhood immunizations, are people getting mammograms on time, just very basic preventive care and chronic disease management,” she said.\u003c/p>\n\u003cfigure id=\"attachment_11905185\" class=\"wp-caption alignnone\" style=\"max-width: 1024px\">\u003cimg class=\"size-full wp-image-11905185\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2022/02/020922-CALAIM-MHN-10-CM_11.jpg\" alt=\"Two people sit at a table, handling paperwork. One person has their backed to the camera, the other one sits across from them.\" width=\"1024\" height=\"682\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2022/02/020922-CALAIM-MHN-10-CM_11.jpg 1024w, https://ww2.kqed.org/app/uploads/sites/10/2022/02/020922-CALAIM-MHN-10-CM_11-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/10/2022/02/020922-CALAIM-MHN-10-CM_11-1020x679.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/10/2022/02/020922-CALAIM-MHN-10-CM_11-160x107.jpg 160w\" sizes=\"(max-width: 1024px) 100vw, 1024px\">\u003cfigcaption class=\"wp-caption-text\">Alameda County intake specialist Annie Wyley meets with a Medi-Cal patient in the repurposed dining room at the Radisson Hotel in Oakland. \u003ccite>(Martin do Nascimento/CalMatters)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Accountability is especially important for improving equity among communities of color, advocates say.\u003c/p>\n\u003cp>“Communities of color are disproportionately impacted by these same factors: lack of housing, lack of income, lack of food security,” said Cary Sanders, senior policy director for the California Pan-Ethnic Health Network.\u003c/p>\n\u003cp>Health plans need to provide services that are “linguistically and culturally appropriate,” Sanders said.\u003c/p>\n\u003cp>One critical piece of the pilot programs that was left out of CalAIM is legal aid. In counties that funded legal aid during the pilot programs, lawyers and paralegals were stationed in medical clinics to assist patients who needed help with benefit denials, eviction notices, immigration issues or domestic abuse cases.\u003c/p>\n\u003cp>Frequently patients and even their doctors don’t realize that their issue could use the help of a lawyer, said Daniel Nesbit, managing attorney for medical legal partnerships with California Rural Legal Assistance. Nesbit said that during the pilot program in Monterey County his team helped 700 clients with more than 1,000 cases.\u003c/p>\n\u003cp>“A really good example is someone struggling with some sort of medical condition, and it’s making it hard for them to go to work every day and do their job to the full extent,” Nesbit said. “They might not know, for example, that they have a possible right to a reasonable accommodation under the Americans with Disabilities Act.”\u003c/p>\n\u003cp>Alameda and Contra Costa counties, which contracted with Bay Area Legal Aid to participate in the pilot, hired five additional attorneys dedicated to assisting Medi-Cal patients. The partnership helped reach people who ordinarily wouldn’t be able to access legal aid because their disability prevented them from attending an appointment or they didn’t have a phone number or an address. Case managers were able to link people to the attorneys, accounting for 300 referrals a year.\u003c/p>\n\u003cp>But when the pilot ended in December and state funding dried up, attorneys were reassigned and are no longer able to focus on Medi-Cal patients.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"'There are serious concerns about Medi-Cal [health care] … being able to implement some of the work necessary for CalAIM to really be effective.'","name":"pullquote","attributes":{"named":{"align":"right","size":"medium","citation":"Diana Douglas, Health Access California","label":""},"numeric":[]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>“I’m still getting emails and phone calls from the case managers I worked with who I think are now kind of scrambling to figure out how to help,” said Abby Khodayari, an attorney who worked in Contra Costa County’s program. “Case managers are hoping to get help analyzing eviction notices and figuring out the validity of them. It’s hard not having dedicated time to be able to spend working on those issues.”\u003c/p>\n\u003cp>While legal services aren’t explicitly named as one of 14 preapproved services under CalAIM, the Department of Health Care Services said health care plans could integrate them as part of supportive housing services, which are covered.\u003c/p>\n\u003cp>But attorneys say it’s unlikely to happen unless plans get specific guarantees that CalAIM will cover the cost. They hope that subsequent phases of CalAIM will include legal aid.\u003c/p>\n\u003cp>“There hasn’t been a health plan here in LA who’s come forward and said we want to offer these legal services,” said Gerson Sorto, a managing attorney with Neighborhood Legal Services of Los Angeles County.\u003c/p>\n\u003cp>Los Angeles County has continued funding their partnership through the summer, but there’s no permanent money in sight. “As of today, there is no funding secured or confirmed beyond June 30,” Sorto said.\u003c/p>\n\u003ch2>\u003cstrong>Life under 'whole person care'\u003c/strong>\u003c/h2>\n\u003cp>Back at the Radisson Hotel in Oakland, the shelter where El is waiting patiently to move into his new apartment, he watches a home renovation show on the television. He likes to see how the hosts redesign the interior and gets ideas for his own future home.\u003c/p>\n\u003cp>Before losing his job, El lived in an apartment near Lake Merritt but hasn’t had a place to call his own in years. After he enrolled in Alameda County’s pilot program, things started turning around for him.\u003c/p>\n\u003cp>“These people really respect you and help if you ask for it,” El said.\u003c/p>\n\u003cp>Part of the program is connecting Medi-Cal patients to peers with similar backgrounds.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"aside","attributes":{"named":{"label":"More Housing Coverage ","tag":"housing"},"numeric":[]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>“You can’t tell them ‘do this and do that.’ You walk alongside someone and support whatever they’ve got going on,” said Michael Webb, a CalAIM peer support navigator who experienced addiction and homelessness. “Most importantly,” he said, “[is] someone to listen. I might not have any answer at all but there’s power in listening.”\u003c/p>\n\u003cp>Down the hall from El’s room, shelter monitors are delivering lunch to residents who can’t make it to the dining room. Lunch is a chicken sandwich, banana, salad and a soda, but those with dietary restrictions or certain medical conditions like diabetes get tailored meals.\u003c/p>\n\u003cp>As part of the CalAIM program, caretakers perform wellness checks on shelter residents with disabilities, helping them clean, bathe and use the restroom.\u003c/p>\n\u003cp>In the lobby, an intake worker asks a new guest about his seizure disorder and works to link him to his CalAIM team of health care providers, case workers and housing navigators. As the program grows, millions more Californians may benefit. On this day alone, the Oakland team expects to sign up eight new people.\u003cbr>\n\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/news/11905181/california-reformed-medi-cal-to-include-whole-person-care-is-it-working","authors":["byline_news_11905181"],"categories":["news_457","news_6266","news_8"],"tags":["news_260","news_30670","news_25676","news_1467","news_16","news_20277","news_20305","news_22903","news_5259","news_4020","news_1775","news_2605","news_28146","news_30671"],"affiliates":["news_18481"],"featImg":"news_11905187","label":"news_18481"},"news_11904155":{"type":"posts","id":"news_11904155","meta":{"index":"posts_1591205157","site":"news","id":"11904155","score":null,"sort":[1644021044000]},"guestAuthors":[],"slug":"california-inks-sweetheart-deal-with-kaiser-permanente-jeopardizing-medicaid-reforms","title":"California Inks Sweetheart Deal With Kaiser Permanente, Jeopardizing Medicaid Reforms","publishDate":1644021044,"format":"standard","headTitle":"KQED News","labelTerm":{},"content":"\u003cp>\u003cem>Editor's note: KHN is not affiliated with Kaiser Permanente.\u003c/em>\u003c/p>\n\u003cp>Gov. Gavin Newsom’s administration has negotiated a secret deal to give Kaiser Permanente a special Medicaid contract that would allow the health care behemoth to expand its reach in California and largely continue selecting the enrollees it wants, which other health care plans say leaves them with a disproportionate share of the program’s sickest and costliest patients.\u003c/p>\n\u003cp>The deal, hammered out behind closed doors between Kaiser Permanente and senior officials in Newsom’s office, could complicate a long-planned and expensive transformation of Medi-Cal, the state’s Medicaid program, which covers roughly 14 million lower-income Californians.\u003c/p>\n\u003cp>It has infuriated executives of other managed-care insurance plans in Medi-Cal, who say they stand to lose hundreds of thousands of patients and millions of dollars a year. The deal allows KP to limit enrollment primarily to its previous enrollees, except in the case of kids in foster care and people who are eligible for both Medicare and Medi-Cal.\u003c/p>\n\u003cp>[pullquote size=\"medium\" align=\"right\" citation=\"Jarrod McNaughton, CEO, Inland Empire Health Plan\"]'[This deal] has caused a massive amount of frenzy.'[/pullquote]\u003c/p>\n\u003cp>“It has caused a massive amount of frenzy,” said Jarrod McNaughton, CEO of the Inland Empire Health Plan, which covers about 1.5 million Medi-Cal enrollees in Riverside and San Bernardino counties. “All of us are doing our best to implement the most transformational Medi-Cal initiative in state history, and to put all this together without a public process is very disconcerting.”\u003c/p>\n\u003cp>Linnea Koopmans, CEO of the Local Health Plans of California, echoed McNaughton’s concerns.\u003c/p>\n\u003cp>Insurance plans got wind of the backroom talks when broad outlines of the deal were leaked days before the state briefed their executives Thursday.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Dr. Bechara Choucair, Kaiser Permanente’s chief health officer, argued \u003ca href=\"https://khn.org/wp-content/uploads/sites/2/2022/02/Kaiser-Permanente-response-to-KHN-inquiry.pdf\">in a prepared written response\u003c/a> on behalf of KP that because it operates both as a health insurer and a health care provider, KP should be treated differently from other commercial health care plans that participate in Medi-Cal. Doing business directly with the state will eliminate complexity and improve the quality of care for the Medi-Cal patients it serves, he said.\u003c/p>\n\u003cp>“We are not seeking to turn a profit off Medi-Cal enrollment,” Choucair said. “Kaiser Permanente participates in Medi-Cal because it is part of our mission to improve the health of the communities we serve. We participate in Medi-Cal despite incurring losses every year.”\u003c/p>\n\u003cp>His statement cited nearly $1.8 billion in losses in the program in 2020 and said KP had donated $402 million to help care for uninsured people that year.\u003c/p>\n\u003cp>Kaiser Permanente, the state’s largest managed-care organization, is one of Newsom’s most generous supporters and close political allies.\u003c/p>\n\u003cp>The new, five-year contract, confirmed to KHN by administration officials and expected to be announced publicly Friday, will take effect in 2024 pending approval from the Legislature — and will make KP the only insurer with a statewide Medi-Cal contract. It allows KP to solidify its position before California’s other commercial Medi-Cal plans participate in a \u003ca href=\"https://californiahealthline.org/news/article/californias-reboot-of-troubled-medi-cal-puts-pressure-on-health-plans/\">statewide bidding process\u003c/a> — and after those plans have spent many months and considerable resources developing their bidding strategies.\u003c/p>\n\u003cp>[aside postID=news_11902149 hero='https://ww2.kqed.org/app/uploads/sites/10/2022/01/RS53217_034_Richmond_LifelongCOVIDClinic_01192022-qut-1020x680.jpg']Other health care plans fear the contract could also muddle a massive and expensive initiative called \u003ca href=\"https://californiahealthline.org/news/article/california-medicaid-makeover-calaim-homeless-whole-body-care/\">CalAIM\u003c/a> that seeks to provide social services to the state’s most vulnerable patients, including home-delivered meals, housing aid for unhoused people, and \u003ca href=\"https://californiahealthline.org/news/article/mattresses-and-mold-removal-medi-cal-to-offer-unconventional-treatments-to-asthma-patients/\">mold removal\u003c/a> from homes. Under its new contract, KP must provide some of those services. But some executives at other health care plans say KP will not have to enroll a large number of sick patients who need such services because of how it limits enrollment.\u003c/p>\n\u003cp>Critics of the deal noted Newsom’s close relationship with KP, which has given nearly $100 million in charitable funding and grant money to boost Newsom’s efforts against homelessness, COVID response and wildfire relief since 2019, according to state records and KP news releases. The health care giant was also one of two hospital systems awarded a no-bid contract from the state to run a \u003ca href=\"https://about.kaiserpermanente.org/our-story/news/announcements/innovative-partnership-creates-los-angeles-surge-hospital\">field hospital in Los Angeles\u003c/a> during the early days of the COVID pandemic, and it got \u003ca href=\"https://khn.org/news/article/blue-shield-spent-years-cultivating-a-relationship-with-newsom-it-got-the-state-vaccine-contract/\">a special agreement\u003c/a> from the Newsom administration to help vaccinate Californians last year.\u003c/p>\n\u003cp>Jim DeBoo, Newsom’s executive secretary, \u003ca href=\"https://cal-access.sos.ca.gov/Lobbying/Firms/Detail.aspx?id=1364764&session=2019\">used to lobby for KP\u003c/a> before joining the administration. Toby Douglas, a former director of the state Department of Health Care Services, which runs Medi-Cal, is now Kaiser Permanente’s vice president for national Medicaid.\u003c/p>\n\u003cp>https://twitter.com/Paul_Erskine/status/1218294697593933825?s=20&t=VHrby3saI4V4EOHIQJNoWg\u003c/p>\n\u003cp>Still, many critics agree that Kaiser Permanente is a linchpin of the state’s health care system, with its strong focus on preventive care and high marks for quality of care. Many of the public insurance plans upset by the deal subcontract with KP for patient care and acknowledge that their overall quality scores will likely decline when KP goes its own way.\u003c/p>\n\u003cp>Michelle Baass, director of the state Department of Health Care Services, said Medi-Cal had risked losing KP’s “high quality” and “clinical expertise” altogether had it been required to accept all enrollees, as the other health plans must. But she said KP will have to comply with all other conditions that other plans must meet, including tightened requirements on access, quality, consumer satisfaction and health equity.\u003c/p>\n\u003cp>The state will also have greater oversight over patient care, she said.\u003c/p>\n\u003cp>“This proposal is a way to help ensure Kaiser treats more low-income patients, and that more low-income patients have access to Kaiser’s high-quality services,” Baass said.\u003c/p>\n\u003cp>Though Kaiser Permanente has 9 million enrollees, close to a quarter of all Californians, only about 900,000 of them are Medi-Cal members.\u003c/p>\n\u003cp>Under the current system, 12 of the 24 other managed care insurance plans that participate in Medi-Cal subcontract with KP to care for a subset of their patients, keeping a small slice of the Medi-Cal dollars earmarked for those patients. Under the new contract, KP can take those patients away and keep all the money.\u003c/p>\n\u003cp>In its subcontracts, and in counties where it enrolls patients directly, KP accepts only people who are recent Kaiser Permanente members and, in some cases, their family members. It is the only health plan that can limit its Medi-Cal enrollment in this way.\u003c/p>\n\u003cp>The new contract allows KP to continue this practice, but it also requires Kaiser Permanente to take on more children in foster care and complex, expensive patients who are eligible for both Medi-Cal and Medicare. It allows KP to expand its geographic reach in Medi-Cal to do so.\u003c/p>\n\u003cp>Baass said the state expects KP’s Medi-Cal enrollment to increase 25% over the life of the contract.\u003c/p>\n\u003cp>KP defended the practice of limiting enrollment primarily to its previous members, arguing that it provides “continuity of care when members transition into and out of Medi-Cal.”\u003c/p>\n\u003cp>[aside label='More Health Coverage' tag='health']The state has long pushed for a larger KP footprint in Medi-Cal, citing its high quality ratings, its strong integrated network, and its huge role on the broader health care landscape.\u003c/p>\n\u003cp>“Kaiser Permanente historically has not played a very big role in Medi-Cal, and the state has long recognized that we would benefit from having them more engaged because they get better health outcomes and focus on prevention,” said Daniel Zingale, a former Newsom administration official and health insurance regulator who now advises a lobbying firm that has Kaiser Permanente as a client.\u003c/p>\n\u003cp>But by accepting primarily people who have been KP members in the recent past, the health care system has been able to limit its share of high-need, expensive patients, say rival health plan executives and former state health officials.\u003c/p>\n\u003cp>The executives fear the deal could saddle them with even more of these patients in the future, including unhoused people and those with mental illnesses — and make it harder to provide adequate care for them. Many of those patients will join Medi-Cal for the first time under the CalAIM initiative, and KP will not be required to accept many of them.\u003c/p>\n\u003cp>“Awarding a no-bid Medi-Cal contract to a statewide commercial plan with a track record of ‘cherry picking’ members and offering only limited behavioral health and community support benefits not only conflicts with the intent and goals of CalAIM but undermines publicly organized health care,” according to an internal document prepared by the Inland Empire Health Plan.\u003c/p>\n\u003cp>The plan said it stands to lose the roughly 144,000 Medi-Cal members it delegates to KP and about $10 million in annual revenue. LA Care, the nation’s largest Medicaid health plan, with 2.4 million enrollees in Los Angeles County, will lose its 244,000 KP members, based on data shared by the plan.\u003c/p>\n\u003cp>The state had been scheduled on Wednesday to release final details and instructions for the commercial plans that are submitting bids for new contracts starting in 2024. But it delayed the release a week to make the KP deal public beforehand.\u003c/p>\n\u003cp>Baass said the state agreed to exempt KP from the bidding process because the standardized contract expected to result from it would have required the insurer to accept all enrollees, which Kaiser Permanente does not have the capacity to do.\u003c/p>\n\u003cp>“It’s not surprising to me that the state will go to extraordinary means to make sure that Kaiser is in the mix, given it has been in the vanguard of our health care delivery system,” Zingale said.\u003c/p>\n\u003cp>Having a direct statewide Medi-Cal contract will greatly reduce the administrative workload for KP, which will now deal with only one agency on reporting and oversight, rather than the 12 public plans it currently subcontracts with.\u003c/p>\n\u003cp>And the new contract will give it an even closer relationship with Newsom and state health officials.\u003c/p>\n\u003cp>In 2020, \u003ca href=\"https://about.kaiserpermanente.org/community-health/news/25m-pledge-to-california-governors-housing-fund\">KP gave $25 million to one of Newsom’s key initiatives\u003c/a>, a state homelessness fund to move people off the streets and into hotel rooms, according to a KHN analysis of charitable payments filed with the California \u003ca href=\"https://www.fppc.ca.gov/transparency/behested-payments.html\">Fair Political Practices Commission\u003c/a>. The same year, it donated $9.75 million to a state COVID relief fund.\u003c/p>\n\u003cp>In summer 2020, when local and state public health departments struggled to contain COVID spread, the health care giant pledged \u003ca href=\"https://about.kaiserpermanente.org/community-health/news/kaiser-permanente-commits-63m-to-support-contact-tracing-in-california\">$63 million in grant funding to help contract-tracing efforts\u003c/a>.\u003c/p>\n\u003cp>KP’s influence extends beyond its massive charitable giving. Its CEO, Greg Adams, landed an appointment on the governor’s economic recovery task force early in the pandemic, and Newsom has showcased KP hospitals at vaccine media events throughout the state.\u003c/p>\n\u003cp>https://twitter.com/KPSCALnews/status/1338603794062438400?s=20&t=4dpVkiilzowe4ESRlCyPOg\u003c/p>\n\u003cp>“In California and across the U.S., the campaign contributions and the organizing, the lobbying, all of that stuff is important,” said Andrew Kelly, an assistant professor of health policy at California State University, East Bay. “But there’s a different type of power that comes from your ability to have this privileged position within public programs.”\u003c/p>\n\u003cp>\u003cem>This story was produced by \u003ca href=\"https://khn.org/\">KHN\u003c/a>, which publishes \u003ca href=\"http://www.californiahealthline.org/\">California Healthline\u003c/a>, an editorially independent service of the \u003ca href=\"http://www.chcf.org/\">California Health Care Foundation\u003c/a>.\u003c/em>\u003c/p>\n\u003cp>\u003cem>KHN is not affiliated with Kaiser Permanente.\u003c/em>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n","blocks":[],"excerpt":"The deal, hammered out behind closed doors between Kaiser Permanente and senior officials in Gov. Newsom's office, could complicate a long-planned transformation of Medi-Cal, which covers roughly 14 million lower-income Californians.","status":"publish","parent":0,"modified":1644261481,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":45,"wordCount":1964},"headData":{"title":"California Inks Sweetheart Deal With Kaiser Permanente, Jeopardizing Medicaid Reforms | KQED","description":"The deal, hammered out behind closed doors between Kaiser Permanente and senior officials in Gov. Newsom's office, could complicate a long-planned transformation of Medi-Cal, which covers roughly 14 million lower-income Californians.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"11904155 https://ww2.kqed.org/news/?p=11904155","disqusUrl":"https://ww2.kqed.org/news/2022/02/04/california-inks-sweetheart-deal-with-kaiser-permanente-jeopardizing-medicaid-reforms/","disqusTitle":"California Inks Sweetheart Deal With Kaiser Permanente, Jeopardizing Medicaid Reforms","source":"KHN","sourceUrl":"https://khn.org/","nprByline":"\u003ca href=\"https://khn.org/news/author/bernard-j-wolfson/\">Bernard J. Wolfson\u003c/a>, \u003ca href=\"https://khn.org/news/author/angela-hart/\">Angela Hart\u003c/a> and \u003ca href=\"https://khn.org/news/author/samantha-young/\">Samantha Young\u003c/a>","subhead":"The backroom deal with politically connected Kaiser Permanente, which infuriated executives of other Medi-Cal health plans, allows the health care giant to continue selecting the enrollees it wants.","excludeFromSiteSearch":"Include","showOnAuthorArchivePages":"No","path":"/news/11904155/california-inks-sweetheart-deal-with-kaiser-permanente-jeopardizing-medicaid-reforms","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cem>Editor's note: KHN is not affiliated with Kaiser Permanente.\u003c/em>\u003c/p>\n\u003cp>Gov. Gavin Newsom’s administration has negotiated a secret deal to give Kaiser Permanente a special Medicaid contract that would allow the health care behemoth to expand its reach in California and largely continue selecting the enrollees it wants, which other health care plans say leaves them with a disproportionate share of the program’s sickest and costliest patients.\u003c/p>\n\u003cp>The deal, hammered out behind closed doors between Kaiser Permanente and senior officials in Newsom’s office, could complicate a long-planned and expensive transformation of Medi-Cal, the state’s Medicaid program, which covers roughly 14 million lower-income Californians.\u003c/p>\n\u003cp>It has infuriated executives of other managed-care insurance plans in Medi-Cal, who say they stand to lose hundreds of thousands of patients and millions of dollars a year. The deal allows KP to limit enrollment primarily to its previous enrollees, except in the case of kids in foster care and people who are eligible for both Medicare and Medi-Cal.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"'[This deal] has caused a massive amount of frenzy.'","name":"pullquote","attributes":{"named":{"size":"medium","align":"right","citation":"Jarrod McNaughton, CEO, Inland Empire Health Plan","label":""},"numeric":[]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“It has caused a massive amount of frenzy,” said Jarrod McNaughton, CEO of the Inland Empire Health Plan, which covers about 1.5 million Medi-Cal enrollees in Riverside and San Bernardino counties. “All of us are doing our best to implement the most transformational Medi-Cal initiative in state history, and to put all this together without a public process is very disconcerting.”\u003c/p>\n\u003cp>Linnea Koopmans, CEO of the Local Health Plans of California, echoed McNaughton’s concerns.\u003c/p>\n\u003cp>Insurance plans got wind of the backroom talks when broad outlines of the deal were leaked days before the state briefed their executives Thursday.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Dr. Bechara Choucair, Kaiser Permanente’s chief health officer, argued \u003ca href=\"https://khn.org/wp-content/uploads/sites/2/2022/02/Kaiser-Permanente-response-to-KHN-inquiry.pdf\">in a prepared written response\u003c/a> on behalf of KP that because it operates both as a health insurer and a health care provider, KP should be treated differently from other commercial health care plans that participate in Medi-Cal. Doing business directly with the state will eliminate complexity and improve the quality of care for the Medi-Cal patients it serves, he said.\u003c/p>\n\u003cp>“We are not seeking to turn a profit off Medi-Cal enrollment,” Choucair said. “Kaiser Permanente participates in Medi-Cal because it is part of our mission to improve the health of the communities we serve. We participate in Medi-Cal despite incurring losses every year.”\u003c/p>\n\u003cp>His statement cited nearly $1.8 billion in losses in the program in 2020 and said KP had donated $402 million to help care for uninsured people that year.\u003c/p>\n\u003cp>Kaiser Permanente, the state’s largest managed-care organization, is one of Newsom’s most generous supporters and close political allies.\u003c/p>\n\u003cp>The new, five-year contract, confirmed to KHN by administration officials and expected to be announced publicly Friday, will take effect in 2024 pending approval from the Legislature — and will make KP the only insurer with a statewide Medi-Cal contract. It allows KP to solidify its position before California’s other commercial Medi-Cal plans participate in a \u003ca href=\"https://californiahealthline.org/news/article/californias-reboot-of-troubled-medi-cal-puts-pressure-on-health-plans/\">statewide bidding process\u003c/a> — and after those plans have spent many months and considerable resources developing their bidding strategies.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"aside","attributes":{"named":{"postid":"news_11902149","hero":"https://ww2.kqed.org/app/uploads/sites/10/2022/01/RS53217_034_Richmond_LifelongCOVIDClinic_01192022-qut-1020x680.jpg","label":""},"numeric":[]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>Other health care plans fear the contract could also muddle a massive and expensive initiative called \u003ca href=\"https://californiahealthline.org/news/article/california-medicaid-makeover-calaim-homeless-whole-body-care/\">CalAIM\u003c/a> that seeks to provide social services to the state’s most vulnerable patients, including home-delivered meals, housing aid for unhoused people, and \u003ca href=\"https://californiahealthline.org/news/article/mattresses-and-mold-removal-medi-cal-to-offer-unconventional-treatments-to-asthma-patients/\">mold removal\u003c/a> from homes. Under its new contract, KP must provide some of those services. But some executives at other health care plans say KP will not have to enroll a large number of sick patients who need such services because of how it limits enrollment.\u003c/p>\n\u003cp>Critics of the deal noted Newsom’s close relationship with KP, which has given nearly $100 million in charitable funding and grant money to boost Newsom’s efforts against homelessness, COVID response and wildfire relief since 2019, according to state records and KP news releases. The health care giant was also one of two hospital systems awarded a no-bid contract from the state to run a \u003ca href=\"https://about.kaiserpermanente.org/our-story/news/announcements/innovative-partnership-creates-los-angeles-surge-hospital\">field hospital in Los Angeles\u003c/a> during the early days of the COVID pandemic, and it got \u003ca href=\"https://khn.org/news/article/blue-shield-spent-years-cultivating-a-relationship-with-newsom-it-got-the-state-vaccine-contract/\">a special agreement\u003c/a> from the Newsom administration to help vaccinate Californians last year.\u003c/p>\n\u003cp>Jim DeBoo, Newsom’s executive secretary, \u003ca href=\"https://cal-access.sos.ca.gov/Lobbying/Firms/Detail.aspx?id=1364764&session=2019\">used to lobby for KP\u003c/a> before joining the administration. Toby Douglas, a former director of the state Department of Health Care Services, which runs Medi-Cal, is now Kaiser Permanente’s vice president for national Medicaid.\u003c/p>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"singleTwitterStatus","attributes":{"named":{"id":"1218294697593933825"},"numeric":[]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\n\u003cp>Still, many critics agree that Kaiser Permanente is a linchpin of the state’s health care system, with its strong focus on preventive care and high marks for quality of care. Many of the public insurance plans upset by the deal subcontract with KP for patient care and acknowledge that their overall quality scores will likely decline when KP goes its own way.\u003c/p>\n\u003cp>Michelle Baass, director of the state Department of Health Care Services, said Medi-Cal had risked losing KP’s “high quality” and “clinical expertise” altogether had it been required to accept all enrollees, as the other health plans must. But she said KP will have to comply with all other conditions that other plans must meet, including tightened requirements on access, quality, consumer satisfaction and health equity.\u003c/p>\n\u003cp>The state will also have greater oversight over patient care, she said.\u003c/p>\n\u003cp>“This proposal is a way to help ensure Kaiser treats more low-income patients, and that more low-income patients have access to Kaiser’s high-quality services,” Baass said.\u003c/p>\n\u003cp>Though Kaiser Permanente has 9 million enrollees, close to a quarter of all Californians, only about 900,000 of them are Medi-Cal members.\u003c/p>\n\u003cp>Under the current system, 12 of the 24 other managed care insurance plans that participate in Medi-Cal subcontract with KP to care for a subset of their patients, keeping a small slice of the Medi-Cal dollars earmarked for those patients. Under the new contract, KP can take those patients away and keep all the money.\u003c/p>\n\u003cp>In its subcontracts, and in counties where it enrolls patients directly, KP accepts only people who are recent Kaiser Permanente members and, in some cases, their family members. It is the only health plan that can limit its Medi-Cal enrollment in this way.\u003c/p>\n\u003cp>The new contract allows KP to continue this practice, but it also requires Kaiser Permanente to take on more children in foster care and complex, expensive patients who are eligible for both Medi-Cal and Medicare. It allows KP to expand its geographic reach in Medi-Cal to do so.\u003c/p>\n\u003cp>Baass said the state expects KP’s Medi-Cal enrollment to increase 25% over the life of the contract.\u003c/p>\n\u003cp>KP defended the practice of limiting enrollment primarily to its previous members, arguing that it provides “continuity of care when members transition into and out of Medi-Cal.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"aside","attributes":{"named":{"label":"More Health Coverage ","tag":"health"},"numeric":[]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>The state has long pushed for a larger KP footprint in Medi-Cal, citing its high quality ratings, its strong integrated network, and its huge role on the broader health care landscape.\u003c/p>\n\u003cp>“Kaiser Permanente historically has not played a very big role in Medi-Cal, and the state has long recognized that we would benefit from having them more engaged because they get better health outcomes and focus on prevention,” said Daniel Zingale, a former Newsom administration official and health insurance regulator who now advises a lobbying firm that has Kaiser Permanente as a client.\u003c/p>\n\u003cp>But by accepting primarily people who have been KP members in the recent past, the health care system has been able to limit its share of high-need, expensive patients, say rival health plan executives and former state health officials.\u003c/p>\n\u003cp>The executives fear the deal could saddle them with even more of these patients in the future, including unhoused people and those with mental illnesses — and make it harder to provide adequate care for them. Many of those patients will join Medi-Cal for the first time under the CalAIM initiative, and KP will not be required to accept many of them.\u003c/p>\n\u003cp>“Awarding a no-bid Medi-Cal contract to a statewide commercial plan with a track record of ‘cherry picking’ members and offering only limited behavioral health and community support benefits not only conflicts with the intent and goals of CalAIM but undermines publicly organized health care,” according to an internal document prepared by the Inland Empire Health Plan.\u003c/p>\n\u003cp>The plan said it stands to lose the roughly 144,000 Medi-Cal members it delegates to KP and about $10 million in annual revenue. LA Care, the nation’s largest Medicaid health plan, with 2.4 million enrollees in Los Angeles County, will lose its 244,000 KP members, based on data shared by the plan.\u003c/p>\n\u003cp>The state had been scheduled on Wednesday to release final details and instructions for the commercial plans that are submitting bids for new contracts starting in 2024. But it delayed the release a week to make the KP deal public beforehand.\u003c/p>\n\u003cp>Baass said the state agreed to exempt KP from the bidding process because the standardized contract expected to result from it would have required the insurer to accept all enrollees, which Kaiser Permanente does not have the capacity to do.\u003c/p>\n\u003cp>“It’s not surprising to me that the state will go to extraordinary means to make sure that Kaiser is in the mix, given it has been in the vanguard of our health care delivery system,” Zingale said.\u003c/p>\n\u003cp>Having a direct statewide Medi-Cal contract will greatly reduce the administrative workload for KP, which will now deal with only one agency on reporting and oversight, rather than the 12 public plans it currently subcontracts with.\u003c/p>\n\u003cp>And the new contract will give it an even closer relationship with Newsom and state health officials.\u003c/p>\n\u003cp>In 2020, \u003ca href=\"https://about.kaiserpermanente.org/community-health/news/25m-pledge-to-california-governors-housing-fund\">KP gave $25 million to one of Newsom’s key initiatives\u003c/a>, a state homelessness fund to move people off the streets and into hotel rooms, according to a KHN analysis of charitable payments filed with the California \u003ca href=\"https://www.fppc.ca.gov/transparency/behested-payments.html\">Fair Political Practices Commission\u003c/a>. The same year, it donated $9.75 million to a state COVID relief fund.\u003c/p>\n\u003cp>In summer 2020, when local and state public health departments struggled to contain COVID spread, the health care giant pledged \u003ca href=\"https://about.kaiserpermanente.org/community-health/news/kaiser-permanente-commits-63m-to-support-contact-tracing-in-california\">$63 million in grant funding to help contract-tracing efforts\u003c/a>.\u003c/p>\n\u003cp>KP’s influence extends beyond its massive charitable giving. Its CEO, Greg Adams, landed an appointment on the governor’s economic recovery task force early in the pandemic, and Newsom has showcased KP hospitals at vaccine media events throughout the state.\u003c/p>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"singleTwitterStatus","attributes":{"named":{"id":"1338603794062438400"},"numeric":[]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\n\u003cp>“In California and across the U.S., the campaign contributions and the organizing, the lobbying, all of that stuff is important,” said Andrew Kelly, an assistant professor of health policy at California State University, East Bay. “But there’s a different type of power that comes from your ability to have this privileged position within public programs.”\u003c/p>\n\u003cp>\u003cem>This story was produced by \u003ca href=\"https://khn.org/\">KHN\u003c/a>, which publishes \u003ca href=\"http://www.californiahealthline.org/\">California Healthline\u003c/a>, an editorially independent service of the \u003ca href=\"http://www.chcf.org/\">California Health Care Foundation\u003c/a>.\u003c/em>\u003c/p>\n\u003cp>\u003cem>KHN is not affiliated with Kaiser Permanente.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/news/11904155/california-inks-sweetheart-deal-with-kaiser-permanente-jeopardizing-medicaid-reforms","authors":["byline_news_11904155"],"categories":["news_457","news_8"],"tags":["news_18538","news_16","news_18543","news_20277","news_29652","news_421","news_2605","news_20666"],"featImg":"news_11904185","label":"source_news_11904155"},"news_11897208":{"type":"posts","id":"news_11897208","meta":{"index":"posts_1591205157","site":"news","id":"11897208","score":null,"sort":[1637708856000]},"guestAuthors":[],"slug":"supply-chain-woes-trigger-shortages-of-critical-medical-devices-may-drive-up-health-care-costs","title":"Supply Chain Woes Trigger Shortages of Critical Medical Devices, May Drive Up Health Care Costs","publishDate":1637708856,"format":"standard","headTitle":"CALmatters | KQED News","labelTerm":{},"content":"\u003cp>When Henry Genung was 4 months old, doctors cut a hole in his windpipe and inserted a tube to help him breathe. Born with a rare genetic mutation that blocked his upper airway, Henry, who is now 18 months old, will need the tube for several more years.\u003c/p>\n\u003cp>For three months, Henry hasn’t had a new rubber tracheostomy tube even though doctors recommend that they be replaced weekly to reduce the risk of infection. Instead, Henry’s parents have resorted to soaking his used tubes in hydrogen peroxide and boiling them for five minutes. Their medical supplier and doctor’s office told them they don’t know how soon new supplies will be available.\u003c/p>\n\u003cp>“It’s an ongoing saga of delayed shipments,” said Myah Genung, Henry’s mother, who lives in Los Angeles with her husband Dillon and son.\u003c/p>\n\u003cfigure id=\"attachment_11897227\" class=\"wp-caption alignnone\" style=\"max-width: 1000px\">\u003cimg class=\"size-full wp-image-11897227\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2021/11/111621-Henry-Genung-CM-02.jpg\" alt=\"A baby sitting on a couch smiling, wearing a T-shirt. \" width=\"1000\" height=\"1250\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2021/11/111621-Henry-Genung-CM-02.jpg 1000w, https://ww2.kqed.org/app/uploads/sites/10/2021/11/111621-Henry-Genung-CM-02-800x1000.jpg 800w, https://ww2.kqed.org/app/uploads/sites/10/2021/11/111621-Henry-Genung-CM-02-160x200.jpg 160w\" sizes=\"(max-width: 1000px) 100vw, 1000px\">\u003cfigcaption class=\"wp-caption-text\">Henry Genung was born with CLAPO syndrome, which causes malformations of the lymph nodes and obstructs his breathing. He had a tracheostomy put in at 4 months and the tube is supposed to be replaced weekly, but the Genung family has been unable to get new tracheostomy tubes since September because of the port logjam and supply chain backlogs. \u003ccite>(Photo courtesy of Maya Genung)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>With upwards of 80 container ships languishing off the coast of Southern California, patients and medical suppliers are worried that stories like Genung’s will become increasingly common.\u003c/p>\n\u003cp>The \u003ca href=\"https://calmatters.org/economy/2021/11/california-ports/\">logjam at the ports of Los Angeles and Long Beach\u003c/a> — which handle \u003ca href=\"https://www.portoflosangeles.org/business/statistics/facts-and-figures\">40% of all waterbound imports\u003c/a> to the U.S. — has triggered shortages of everything from computer chips to paper products to kitchen appliances, and drawn the \u003ca href=\"https://www.washingtonpost.com/business/2021/10/13/biden-port-los-angeles-supply-chain/\">attention of President Joe Biden\u003c/a>. But, while many people are worrying about delayed Christmas gifts, many Californians are grappling with shortages of lifesaving medical supplies.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>California hospitals say medical supplies are more difficult to acquire now or are taking much longer to be delivered. Although the Hospital Association of Southern California says no one has reported any acute shortages yet, administrators are concerned about the delayed shipments that are anchored off the coast.\u003c/p>\n\u003cp>Experts say the shortages and inflation will drive health care costs up, increasing insurance premiums. In addition, some medical device suppliers are considering cutting off sales to patients on Medi-Cal, the state’s insurance for low-income people, as they look for ways to reduce costs.\u003c/p>\n\u003ch3 id=\"h-where-are-the-medical-supplies\">Where are the medical supplies?\u003c/h3>\n\u003cp>Port gridlock is the latest chapter in a long saga of medical supply chain disruptions during the pandemic. Demand for personal protective equipment and respirators skyrocketed globally at the same time that overseas manufacturers temporarily closed to reduce the spread of COVID-19 among workers.\u003c/p>\n\u003cp>Last winter, hospitals desperate for bed space were sending less-severe COVID-19 patients home on supplemental oxygen. “We couldn’t keep oxygen concentrators on the wall, couldn’t keep them in inventory,” said Terry Racciato, who owns a durable medical equipment supply company in San Diego. “The shipping backlog prevented them from getting into the country, much less getting to patients that need them.”\u003c/p>\n\u003cp>Now, specialized equipment like walkers, canes, wheelchairs, crutches, syringes, needles, catheters, surgical gloves, feeding tubes and suction canisters are increasingly hard to come by.\u003c/p>\n\u003cfigure id=\"attachment_11852807\" class=\"wp-caption alignnone\" style=\"max-width: 1000px\">\u003cimg class=\"size-full wp-image-11852807\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2020/12/1000.jpeg\" alt=\"Phlebotomist lab assistant Jennifer Cukati, right, and Registered Nurse Carina Klescewski, left, care for a COVID-19 patient inside the Sutter Roseville Medical Center ICU in Roseville, Calif.\" width=\"1000\" height=\"665\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2020/12/1000.jpeg 1000w, https://ww2.kqed.org/app/uploads/sites/10/2020/12/1000-800x532.jpeg 800w, https://ww2.kqed.org/app/uploads/sites/10/2020/12/1000-160x106.jpeg 160w\" sizes=\"(max-width: 1000px) 100vw, 1000px\">\u003cfigcaption class=\"wp-caption-text\">Phlebotomist lab assistant Jennifer Cukati, right, and Registered Nurse Carina Klescewski, left, care for a COVID-19 patient inside the Sutter Roseville Medical Center ICU in Roseville, Calif. \u003ccite>(Renee C. Byer/The Sacramento Bee via AP)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>In September, the \u003ca href=\"https://www.fda.gov/medical-devices/coronavirus-covid-19-and-medical-devices/medical-device-shortages-during-covid-19-public-health-emergency#shortage\">FDA announced\u003c/a> nationwide shortages of ventilators. Specimen collection tubes also have been in short supply since the summer.\u003c/p>\n\u003cp>Compounding the issue, hospitals, which are admitting above-average numbers of patients who delayed care during the pandemic, are trying to stay ahead of any potential winter COVID-19 surge.\u003c/p>\n\u003cp>\"A key concern for hospital directors right now is that they're trying to schedule an enormous backlog of patients that weren't able to get into facilities in the last year due to COVID patients that might have needed a scheduled surgery in 2019 or 2020 or 2021,\" said Dr. William Padula, an assistant professor of pharmaceutical & health economics at the USC Leonard D. Schaeffer Center for Health Policy and Economics. \"With the backlog of supplies in the medical sector, they might not be able to get the procedure that they were anticipating, or they might not be able to get the materials that they need to follow up from a procedure for rehabilitative care. So it really creates a concern that those who have already delayed or foregone certain procedures now have to wait more so until the supplies catch up.\"\u003c/p>\n\u003cp>Prime Healthcare, which operates hospitals throughout the state, has been able to shift supplies as needed between its hospitals, but has joined other health systems and the California Chamber of Commerce in \u003ca href=\"https://calchamberalert.com/2021/11/05/calchamber-practical-steps-to-ease-supply-chain-crisis/\">requesting help\u003c/a> from Gov. Gavin Newsom and the Legislature to speed up the movement of medical goods.\u003c/p>\n\u003cp>“We have a number of hospitals and health care suppliers saying ‘Hey we’ve got products sitting out there.’ So they’re pretty concerned about that issue in particular,” said Leah Silverthorn, policy advocate for CalChamber, which sent the letter to Newsom and the Legislature.\u003c/p>\n\u003cp>Increased purchasing of all consumer goods coupled with labor shortages, outdated port infrastructure\u003cem>, \u003c/em>and prior disruptions to shipping and manufacturing early in the pandemic have culminated in the \u003ca href=\"https://calmatters.org/economy/2021/11/california-ports/\">offshore traffic jam\u003c/a>.\u003c/p>\n\u003cp>While the two ports have \u003ca href=\"https://www.portoflosangeles.org/references/2021-news-releases/news_111521_dwelpostpone\">reduced the backlog of idling containers by 26%\u003c/a> in the past three weeks by threatening steep fines, more than 40,000 containers have sat at the terminals for at least nine days. Before the pandemic, the average wait was less than four days, according to port operations reports in Los Angeles and Long Beach. Some ships have been anchored off the coast for more than 30 days while they await a spot to dock.\u003c/p>\n\u003cp>“There’s some concern about a winter surge of COVID and having access to those containers,” Silverthorn said.\u003c/p>\n\u003cp>CalChamber is working with its nearly 1,000 health care members to track down the container numbers for delayed shipments and identify the ships.\u003c/p>\n\u003cp>“It’s kind of a bottleneck of data right now,” Silverthorn said. “The data lies with each link of the shipping supply chain, and so trying to aggregate it in a convenient way is challenging.”\u003c/p>\n\u003cp>Currently, no one knows how many containers may be carrying medical supplies or the quantity of goods waiting offshore. Experts say the lack of data is a systemic problem in the supply chain that makes it nearly impossible to prioritize critical health care devices. No information system connects the manufacturers, shipping companies, port terminal operators, suppliers and buyers.\u003c/p>\n\u003cp>“This is already 2021, but shipping companies cannot give an accurate hour-by-hour estimation about when goods will arrive or where they are,” said Tinglong Dai, a professor of operations management and business analytics at Johns Hopkins University who specializes in health care operations.\u003c/p>\n\u003cp>Dai has spent the 20 months of the pandemic advocating for supply chain transparency, particularly when it comes to medical supplies.\u003c/p>\n\u003cp>“What they are producing is very important to public health,” he said, “and public health authorities have no idea exactly how much inventory we’re going to have if and when similar crises will arise in the future.”\u003c/p>\n\u003cp>In response to the letter to Newsom and an earlier \u003ca href=\"https://www.gov.ca.gov/2021/10/20/governor-newsom-signs-executive-order-to-help-tackle-supply-chain-issues/\">executive order\u003c/a>, GO-Biz, the governor’s Office of Business and Economic Development, and other state agencies have been working to identify sites that can be used to store empty, abandoned and slow-moving containers that are exacerbating the backlog, said GO-Biz spokesperson Heather Purcell.\u003c/p>\n\u003cfigure id=\"attachment_11892157\" class=\"wp-caption alignnone\" style=\"max-width: 2560px\">\u003cimg class=\"size-full wp-image-11892157\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2021/10/GettyImages-1344305961-scaled.jpg\" alt=\"Gavin Newsom, wearing a black mask and standing beyond a podium with the Seal of California, scribbles in a tiny notepad.\" width=\"2560\" height=\"1706\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2021/10/GettyImages-1344305961-scaled.jpg 2560w, https://ww2.kqed.org/app/uploads/sites/10/2021/10/GettyImages-1344305961-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/10/2021/10/GettyImages-1344305961-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/10/2021/10/GettyImages-1344305961-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/10/2021/10/GettyImages-1344305961-1536x1024.jpg 1536w, https://ww2.kqed.org/app/uploads/sites/10/2021/10/GettyImages-1344305961-2048x1365.jpg 2048w, https://ww2.kqed.org/app/uploads/sites/10/2021/10/GettyImages-1344305961-1920x1280.jpg 1920w\" sizes=\"(max-width: 2560px) 100vw, 2560px\">\u003cfigcaption class=\"wp-caption-text\">Gov. Gavin Newsom takes notes before speaking at a news conference on Oct. 1, 2021, in San Francisco. \u003ccite>(Justin Sullivan/Getty Images)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“This will free up crowded dock space to move integral medical supplies. Additionally, GO-Biz is directly in coordination with a terminal operator to speed up the movement of medical supplies,” Purcell said.\u003c/p>\n\u003cp>However, Purcell said the state has no way to identify medical supplies other than consulting with individual buyers. Even then, the contents of specific containers are frequently unknown.\u003c/p>\n\u003ch3 id=\"h-shortages-and-delays\">Shortages and delays\u003c/h3>\n\u003cp>Cedars Sinai in Los Angeles has experienced supply chain problems acquiring catheters, syringes and blood collection tubes, communications director Duke Helfand said. However, the hospital has been able to rely on pre-existing reserves and alternate suppliers to avoid any impact on patients.\u003c/p>\n\u003cp>Similarly, Community Medical Centers in the Central Valley have experienced periodic shortages of computers, suction canisters and masks during the pandemic, according to Lucky Malhi, vice president of supply chain management. His team has worked round-the-clock to secure supplies through alternate distributors.\u003c/p>\n\u003cp>But patients requiring supplies for home use, like the Genungs’ son Henry, typically don’t have the option to find alternate suppliers, so they have felt the scarcity much more sharply.\u003c/p>\n\u003cp>Myah Genung said she has turned to Facebook groups where parents of “trach babies” share extra supplies. She has snagged humidifying filters for Henry’s breathing tube through social media, but more often than not, there are more people seeking supplies than there are extras.\u003c/p>\n\u003cp>“We’re just having to make do the best we can,” she said.\u003c/p>\n\u003cp>More than \u003ca href=\"http://rc.rcjournal.com/content/59/6/895#ref-20\">100,000 tracheostomy\u003c/a> procedures are performed annually across the country. Racchiato, whose supply company, SpecialCare, primarily distributes directly to patients, said replacement tubes are one of the most difficult things to acquire right now.\u003c/p>\n\u003cp>“There are people who are trying to sterilize (the tubes) themselves and reuse them. They’re risking serious infection because new supplies aren’t available,” Racciato said.\u003c/p>\n\u003cp>Most tracheostomy tubes are only supposed to be used once, said Dr. Maggie Kuhn, associate professor of otolaryngology at UC Davis Health. Reusing the tubes can cause serious problems, including increased risk of infection and device malfunctioning.\u003c/p>\n\u003cp>“We have observed complications from this practice which can be life-threatening, including mucous plugging and airway trauma,” Kuhn said.\u003c/p>\n\u003cp>Other devices like oxygen concentrators face months-long delays compared to typical delivery times of one to two weeks.\u003c/p>\n\u003cp>Complicating matters, one of the largest manufacturers of continuous positive airway pressure, or CPAP, machines \u003ca href=\"https://www.nytimes.com/2021/08/17/health/cpap-breathing-devices-recall.html\">recalled millions of devices\u003c/a> in June and is reserving its inventory for patients that need replacement machines. As a result, Racciato said she has at least 1,000 patients diagnosed with sleep apnea who have been on a waiting list without treatment for five months.\u003c/p>\n\u003ch3 id=\"h-prices-increase-while-access-decreases\">Prices increase while access decreases\u003c/h3>\n\u003cp>\u003ca href=\"https://www.newyorker.com/news/our-columnists/inflation-and-the-great-global-logjam\">Inflationary pressure\u003c/a> on the medical supply market also has some suppliers concerned about how long they can stay in business. Scarcity of raw materials and logistical challenges along with the port backlogs have steeply driven up the cost of manufacturing and shipping, creating a volatile market.\u003c/p>\n\u003cp>“(Shipping) containers have gone from $2,000 for rental to anywhere from $15,000 to $20,000 for the same container,” said Steve Yaeger, a Los Angeles-based medical supplier who specializes in respiratory equipment.\u003c/p>\n\u003cp>Since the beginning of the pandemic, Yaeger said his overhead has increased 25%.\u003c/p>\n\u003cp>“When you see the cost of goods go up like that, all of a sudden you’re figuring out, ‘OK are we even going to make any money this year?’”\u003c/p>\n\u003cp>Experts say inflation among medical supplies will result in higher health care costs for patients as hospitals and other providers struggle to maintain adequate profit margins.\u003c/p>\n\u003cp>William Padula, a senior fellow at the USC Schaeffer Center for Health Policy & Economics, said the “supply chain disaster” will result in hospitals negotiating for higher reimbursement rates with insurers and patients paying higher premiums.\u003c/p>\n\u003cp>“The natural consequence on the consumer side is … premiums will go up,” Padula said. [aside tag=\"politics\" label=\"More political coverage\"]\u003c/p>\n\u003cp>Already, the Centers for Medicare and Medicaid Services announced the \u003ca href=\"https://www.cms.gov/newsroom/fact-sheets/2022-medicare-parts-b-premiums-and-deductibles2022-medicare-part-d-income-related-monthly-adjustment\">highest premium increase\u003c/a> in the program’s history for Medicare Part B and higher deductibles for other aspects of the program, in part due to increased utilization in the past year.\u003c/p>\n\u003cp>“In their statement, Medicare blamed the increase of premiums on COVID and the cost of that new drug for Alzheimers, which is expected to take off, but COVID is very broad. It really is about the supply chain,” Padula said.\u003c/p>\n\u003cp>Although it’s too soon to tell how much premiums will increase across the board, historically commercial insurers have followed Medicare’s lead.\u003c/p>\n\u003cp>“That gives a lot of commercial payers a pass to increase by a similar amount at a minimum,” Padula said.\u003c/p>\n\u003cp>The resultant cost hikes have also forced small and mid-sized suppliers to rethink which patients they can afford to serve, potentially leading to decreased access for those with Medi-Cal or Medicare, which have fixed reimbursement rates.\u003c/p>\n\u003cp>California has temporarily increased these reimbursement rates for the duration of the \u003ca href=\"https://calmatters.org/newsletters/whatmatters/2021/11/california-covid-state-of-emergency/\">COVID-19 public health emergency\u003c/a>, which is set to expire at the end of March. Beyond that, providers aren’t sure how long they can hold on.\u003c/p>\n\u003cp>Ron Biasca, a medical supplier based in Eureka, said increased costs are forcing his company to reassess what services it provides to Medicare and Medi-Cal patients.\u003c/p>\n\u003cp>“We are evaluating all entitlements right now to look at what we’re making money on. We are going to have to make some hard decisions and just not accept the insurance payment,” Biasca said.\u003c/p>\n\u003cp>Roughly \u003ca href=\"https://calmatters.org/economy/poverty/2017/08/paying-doctors-now-will-treat-poor-californians/\">one-third of all Californians rely on Medi-Cal\u003c/a> for health care and frequently face long wait times and \u003ca href=\"https://www.chcf.org/publication/measuring-up-access-care-medi-cal-compared-other-types-health-insurance-2018/\">difficulty finding doctors\u003c/a> and other providers who will accept their insurance. And the out-of-pocket costs are inaccessible even for people with private health insurance.\u003c/p>\n\u003cfigure id=\"attachment_11897232\" class=\"wp-caption alignnone\" style=\"max-width: 1000px\">\u003cimg class=\"size-full wp-image-11897232\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2021/11/111621-Genung-Family-Portrait-CM-01.jpg\" alt=\"The family, mother father and child, are well-dressed. \" width=\"1000\" height=\"1250\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2021/11/111621-Genung-Family-Portrait-CM-01.jpg 1000w, https://ww2.kqed.org/app/uploads/sites/10/2021/11/111621-Genung-Family-Portrait-CM-01-800x1000.jpg 800w, https://ww2.kqed.org/app/uploads/sites/10/2021/11/111621-Genung-Family-Portrait-CM-01-160x200.jpg 160w\" sizes=\"(max-width: 1000px) 100vw, 1000px\">\u003cfigcaption class=\"wp-caption-text\">Maya and Dillon Genung hold their son Henry in a family portrait. \u003ccite>( Image courtesy of Maya Genung)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Genung said she has tried to purchase the tracheostomy tubes her son needs online but they cost between $300 to $600 each. “You would be spending thousands and thousands of dollars a month just to purchase it yourself,” she said.\u003c/p>\n\u003cp>Reusing the tubes fills her with worry. Henry’s condition requires him to be immunosuppressed, and reusing tubes increases the risk of infection or breakage as the equipment wears down.\u003c/p>\n\u003cp>“It’s not foolproof because you’re not in a sterile environment. You’re at home, you’re in your kitchen, doing your best to make it work,” Genung said.\u003c/p>\n\u003cp>A week ago, Henry was admitted to Children’s Hospital Los Angeles with pneumonia. Doctors told his parents there’s no way of knowing if the infection was caused by the reuse of tubes.\u003c/p>\n\u003cp>The only small silver lining is that the hospital gave Genung two new tracheostomy tubes, enough to get Henry through another month.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This article was originally published by \u003ca href=\"https://calmatters.org/health/2021/11/medical-supplies-shortage-california/\">CalMatters\u003c/a>. KQED producer Keith Mizuguchi contributed to this report.\u003c/em>\u003c/p>\n\n","blocks":[],"excerpt":"Industry experts say the supply chain issues could drive up the cost of health care for those who need it most. ","status":"publish","parent":0,"modified":1637710133,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":62,"wordCount":2548},"headData":{"title":"Supply Chain Woes Trigger Shortages of Critical Medical Devices, May Drive Up Health Care Costs | KQED","description":"Industry experts say the supply chain issues could drive up the cost of health care for those who need it most. ","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"11897208 https://ww2.kqed.org/news/?p=11897208","disqusUrl":"https://ww2.kqed.org/news/2021/11/23/supply-chain-woes-trigger-shortages-of-critical-medical-devices-may-drive-up-health-care-costs/","disqusTitle":"Supply Chain Woes Trigger Shortages of Critical Medical Devices, May Drive Up Health Care Costs","source":"CalMatters","sourceUrl":"www.calmatters.org","nprByline":"Kristen Hwang","excludeFromSiteSearch":"Include","showOnAuthorArchivePages":"No","path":"/news/11897208/supply-chain-woes-trigger-shortages-of-critical-medical-devices-may-drive-up-health-care-costs","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>When Henry Genung was 4 months old, doctors cut a hole in his windpipe and inserted a tube to help him breathe. Born with a rare genetic mutation that blocked his upper airway, Henry, who is now 18 months old, will need the tube for several more years.\u003c/p>\n\u003cp>For three months, Henry hasn’t had a new rubber tracheostomy tube even though doctors recommend that they be replaced weekly to reduce the risk of infection. Instead, Henry’s parents have resorted to soaking his used tubes in hydrogen peroxide and boiling them for five minutes. Their medical supplier and doctor’s office told them they don’t know how soon new supplies will be available.\u003c/p>\n\u003cp>“It’s an ongoing saga of delayed shipments,” said Myah Genung, Henry’s mother, who lives in Los Angeles with her husband Dillon and son.\u003c/p>\n\u003cfigure id=\"attachment_11897227\" class=\"wp-caption alignnone\" style=\"max-width: 1000px\">\u003cimg class=\"size-full wp-image-11897227\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2021/11/111621-Henry-Genung-CM-02.jpg\" alt=\"A baby sitting on a couch smiling, wearing a T-shirt. \" width=\"1000\" height=\"1250\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2021/11/111621-Henry-Genung-CM-02.jpg 1000w, https://ww2.kqed.org/app/uploads/sites/10/2021/11/111621-Henry-Genung-CM-02-800x1000.jpg 800w, https://ww2.kqed.org/app/uploads/sites/10/2021/11/111621-Henry-Genung-CM-02-160x200.jpg 160w\" sizes=\"(max-width: 1000px) 100vw, 1000px\">\u003cfigcaption class=\"wp-caption-text\">Henry Genung was born with CLAPO syndrome, which causes malformations of the lymph nodes and obstructs his breathing. He had a tracheostomy put in at 4 months and the tube is supposed to be replaced weekly, but the Genung family has been unable to get new tracheostomy tubes since September because of the port logjam and supply chain backlogs. \u003ccite>(Photo courtesy of Maya Genung)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>With upwards of 80 container ships languishing off the coast of Southern California, patients and medical suppliers are worried that stories like Genung’s will become increasingly common.\u003c/p>\n\u003cp>The \u003ca href=\"https://calmatters.org/economy/2021/11/california-ports/\">logjam at the ports of Los Angeles and Long Beach\u003c/a> — which handle \u003ca href=\"https://www.portoflosangeles.org/business/statistics/facts-and-figures\">40% of all waterbound imports\u003c/a> to the U.S. — has triggered shortages of everything from computer chips to paper products to kitchen appliances, and drawn the \u003ca href=\"https://www.washingtonpost.com/business/2021/10/13/biden-port-los-angeles-supply-chain/\">attention of President Joe Biden\u003c/a>. But, while many people are worrying about delayed Christmas gifts, many Californians are grappling with shortages of lifesaving medical supplies.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>California hospitals say medical supplies are more difficult to acquire now or are taking much longer to be delivered. Although the Hospital Association of Southern California says no one has reported any acute shortages yet, administrators are concerned about the delayed shipments that are anchored off the coast.\u003c/p>\n\u003cp>Experts say the shortages and inflation will drive health care costs up, increasing insurance premiums. In addition, some medical device suppliers are considering cutting off sales to patients on Medi-Cal, the state’s insurance for low-income people, as they look for ways to reduce costs.\u003c/p>\n\u003ch3 id=\"h-where-are-the-medical-supplies\">Where are the medical supplies?\u003c/h3>\n\u003cp>Port gridlock is the latest chapter in a long saga of medical supply chain disruptions during the pandemic. Demand for personal protective equipment and respirators skyrocketed globally at the same time that overseas manufacturers temporarily closed to reduce the spread of COVID-19 among workers.\u003c/p>\n\u003cp>Last winter, hospitals desperate for bed space were sending less-severe COVID-19 patients home on supplemental oxygen. “We couldn’t keep oxygen concentrators on the wall, couldn’t keep them in inventory,” said Terry Racciato, who owns a durable medical equipment supply company in San Diego. “The shipping backlog prevented them from getting into the country, much less getting to patients that need them.”\u003c/p>\n\u003cp>Now, specialized equipment like walkers, canes, wheelchairs, crutches, syringes, needles, catheters, surgical gloves, feeding tubes and suction canisters are increasingly hard to come by.\u003c/p>\n\u003cfigure id=\"attachment_11852807\" class=\"wp-caption alignnone\" style=\"max-width: 1000px\">\u003cimg class=\"size-full wp-image-11852807\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2020/12/1000.jpeg\" alt=\"Phlebotomist lab assistant Jennifer Cukati, right, and Registered Nurse Carina Klescewski, left, care for a COVID-19 patient inside the Sutter Roseville Medical Center ICU in Roseville, Calif.\" width=\"1000\" height=\"665\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2020/12/1000.jpeg 1000w, https://ww2.kqed.org/app/uploads/sites/10/2020/12/1000-800x532.jpeg 800w, https://ww2.kqed.org/app/uploads/sites/10/2020/12/1000-160x106.jpeg 160w\" sizes=\"(max-width: 1000px) 100vw, 1000px\">\u003cfigcaption class=\"wp-caption-text\">Phlebotomist lab assistant Jennifer Cukati, right, and Registered Nurse Carina Klescewski, left, care for a COVID-19 patient inside the Sutter Roseville Medical Center ICU in Roseville, Calif. \u003ccite>(Renee C. Byer/The Sacramento Bee via AP)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>In September, the \u003ca href=\"https://www.fda.gov/medical-devices/coronavirus-covid-19-and-medical-devices/medical-device-shortages-during-covid-19-public-health-emergency#shortage\">FDA announced\u003c/a> nationwide shortages of ventilators. Specimen collection tubes also have been in short supply since the summer.\u003c/p>\n\u003cp>Compounding the issue, hospitals, which are admitting above-average numbers of patients who delayed care during the pandemic, are trying to stay ahead of any potential winter COVID-19 surge.\u003c/p>\n\u003cp>\"A key concern for hospital directors right now is that they're trying to schedule an enormous backlog of patients that weren't able to get into facilities in the last year due to COVID patients that might have needed a scheduled surgery in 2019 or 2020 or 2021,\" said Dr. William Padula, an assistant professor of pharmaceutical & health economics at the USC Leonard D. Schaeffer Center for Health Policy and Economics. \"With the backlog of supplies in the medical sector, they might not be able to get the procedure that they were anticipating, or they might not be able to get the materials that they need to follow up from a procedure for rehabilitative care. So it really creates a concern that those who have already delayed or foregone certain procedures now have to wait more so until the supplies catch up.\"\u003c/p>\n\u003cp>Prime Healthcare, which operates hospitals throughout the state, has been able to shift supplies as needed between its hospitals, but has joined other health systems and the California Chamber of Commerce in \u003ca href=\"https://calchamberalert.com/2021/11/05/calchamber-practical-steps-to-ease-supply-chain-crisis/\">requesting help\u003c/a> from Gov. Gavin Newsom and the Legislature to speed up the movement of medical goods.\u003c/p>\n\u003cp>“We have a number of hospitals and health care suppliers saying ‘Hey we’ve got products sitting out there.’ So they’re pretty concerned about that issue in particular,” said Leah Silverthorn, policy advocate for CalChamber, which sent the letter to Newsom and the Legislature.\u003c/p>\n\u003cp>Increased purchasing of all consumer goods coupled with labor shortages, outdated port infrastructure\u003cem>, \u003c/em>and prior disruptions to shipping and manufacturing early in the pandemic have culminated in the \u003ca href=\"https://calmatters.org/economy/2021/11/california-ports/\">offshore traffic jam\u003c/a>.\u003c/p>\n\u003cp>While the two ports have \u003ca href=\"https://www.portoflosangeles.org/references/2021-news-releases/news_111521_dwelpostpone\">reduced the backlog of idling containers by 26%\u003c/a> in the past three weeks by threatening steep fines, more than 40,000 containers have sat at the terminals for at least nine days. Before the pandemic, the average wait was less than four days, according to port operations reports in Los Angeles and Long Beach. Some ships have been anchored off the coast for more than 30 days while they await a spot to dock.\u003c/p>\n\u003cp>“There’s some concern about a winter surge of COVID and having access to those containers,” Silverthorn said.\u003c/p>\n\u003cp>CalChamber is working with its nearly 1,000 health care members to track down the container numbers for delayed shipments and identify the ships.\u003c/p>\n\u003cp>“It’s kind of a bottleneck of data right now,” Silverthorn said. “The data lies with each link of the shipping supply chain, and so trying to aggregate it in a convenient way is challenging.”\u003c/p>\n\u003cp>Currently, no one knows how many containers may be carrying medical supplies or the quantity of goods waiting offshore. Experts say the lack of data is a systemic problem in the supply chain that makes it nearly impossible to prioritize critical health care devices. No information system connects the manufacturers, shipping companies, port terminal operators, suppliers and buyers.\u003c/p>\n\u003cp>“This is already 2021, but shipping companies cannot give an accurate hour-by-hour estimation about when goods will arrive or where they are,” said Tinglong Dai, a professor of operations management and business analytics at Johns Hopkins University who specializes in health care operations.\u003c/p>\n\u003cp>Dai has spent the 20 months of the pandemic advocating for supply chain transparency, particularly when it comes to medical supplies.\u003c/p>\n\u003cp>“What they are producing is very important to public health,” he said, “and public health authorities have no idea exactly how much inventory we’re going to have if and when similar crises will arise in the future.”\u003c/p>\n\u003cp>In response to the letter to Newsom and an earlier \u003ca href=\"https://www.gov.ca.gov/2021/10/20/governor-newsom-signs-executive-order-to-help-tackle-supply-chain-issues/\">executive order\u003c/a>, GO-Biz, the governor’s Office of Business and Economic Development, and other state agencies have been working to identify sites that can be used to store empty, abandoned and slow-moving containers that are exacerbating the backlog, said GO-Biz spokesperson Heather Purcell.\u003c/p>\n\u003cfigure id=\"attachment_11892157\" class=\"wp-caption alignnone\" style=\"max-width: 2560px\">\u003cimg class=\"size-full wp-image-11892157\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2021/10/GettyImages-1344305961-scaled.jpg\" alt=\"Gavin Newsom, wearing a black mask and standing beyond a podium with the Seal of California, scribbles in a tiny notepad.\" width=\"2560\" height=\"1706\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2021/10/GettyImages-1344305961-scaled.jpg 2560w, https://ww2.kqed.org/app/uploads/sites/10/2021/10/GettyImages-1344305961-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/10/2021/10/GettyImages-1344305961-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/10/2021/10/GettyImages-1344305961-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/10/2021/10/GettyImages-1344305961-1536x1024.jpg 1536w, https://ww2.kqed.org/app/uploads/sites/10/2021/10/GettyImages-1344305961-2048x1365.jpg 2048w, https://ww2.kqed.org/app/uploads/sites/10/2021/10/GettyImages-1344305961-1920x1280.jpg 1920w\" sizes=\"(max-width: 2560px) 100vw, 2560px\">\u003cfigcaption class=\"wp-caption-text\">Gov. Gavin Newsom takes notes before speaking at a news conference on Oct. 1, 2021, in San Francisco. \u003ccite>(Justin Sullivan/Getty Images)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“This will free up crowded dock space to move integral medical supplies. Additionally, GO-Biz is directly in coordination with a terminal operator to speed up the movement of medical supplies,” Purcell said.\u003c/p>\n\u003cp>However, Purcell said the state has no way to identify medical supplies other than consulting with individual buyers. Even then, the contents of specific containers are frequently unknown.\u003c/p>\n\u003ch3 id=\"h-shortages-and-delays\">Shortages and delays\u003c/h3>\n\u003cp>Cedars Sinai in Los Angeles has experienced supply chain problems acquiring catheters, syringes and blood collection tubes, communications director Duke Helfand said. However, the hospital has been able to rely on pre-existing reserves and alternate suppliers to avoid any impact on patients.\u003c/p>\n\u003cp>Similarly, Community Medical Centers in the Central Valley have experienced periodic shortages of computers, suction canisters and masks during the pandemic, according to Lucky Malhi, vice president of supply chain management. His team has worked round-the-clock to secure supplies through alternate distributors.\u003c/p>\n\u003cp>But patients requiring supplies for home use, like the Genungs’ son Henry, typically don’t have the option to find alternate suppliers, so they have felt the scarcity much more sharply.\u003c/p>\n\u003cp>Myah Genung said she has turned to Facebook groups where parents of “trach babies” share extra supplies. She has snagged humidifying filters for Henry’s breathing tube through social media, but more often than not, there are more people seeking supplies than there are extras.\u003c/p>\n\u003cp>“We’re just having to make do the best we can,” she said.\u003c/p>\n\u003cp>More than \u003ca href=\"http://rc.rcjournal.com/content/59/6/895#ref-20\">100,000 tracheostomy\u003c/a> procedures are performed annually across the country. Racchiato, whose supply company, SpecialCare, primarily distributes directly to patients, said replacement tubes are one of the most difficult things to acquire right now.\u003c/p>\n\u003cp>“There are people who are trying to sterilize (the tubes) themselves and reuse them. They’re risking serious infection because new supplies aren’t available,” Racciato said.\u003c/p>\n\u003cp>Most tracheostomy tubes are only supposed to be used once, said Dr. Maggie Kuhn, associate professor of otolaryngology at UC Davis Health. Reusing the tubes can cause serious problems, including increased risk of infection and device malfunctioning.\u003c/p>\n\u003cp>“We have observed complications from this practice which can be life-threatening, including mucous plugging and airway trauma,” Kuhn said.\u003c/p>\n\u003cp>Other devices like oxygen concentrators face months-long delays compared to typical delivery times of one to two weeks.\u003c/p>\n\u003cp>Complicating matters, one of the largest manufacturers of continuous positive airway pressure, or CPAP, machines \u003ca href=\"https://www.nytimes.com/2021/08/17/health/cpap-breathing-devices-recall.html\">recalled millions of devices\u003c/a> in June and is reserving its inventory for patients that need replacement machines. As a result, Racciato said she has at least 1,000 patients diagnosed with sleep apnea who have been on a waiting list without treatment for five months.\u003c/p>\n\u003ch3 id=\"h-prices-increase-while-access-decreases\">Prices increase while access decreases\u003c/h3>\n\u003cp>\u003ca href=\"https://www.newyorker.com/news/our-columnists/inflation-and-the-great-global-logjam\">Inflationary pressure\u003c/a> on the medical supply market also has some suppliers concerned about how long they can stay in business. Scarcity of raw materials and logistical challenges along with the port backlogs have steeply driven up the cost of manufacturing and shipping, creating a volatile market.\u003c/p>\n\u003cp>“(Shipping) containers have gone from $2,000 for rental to anywhere from $15,000 to $20,000 for the same container,” said Steve Yaeger, a Los Angeles-based medical supplier who specializes in respiratory equipment.\u003c/p>\n\u003cp>Since the beginning of the pandemic, Yaeger said his overhead has increased 25%.\u003c/p>\n\u003cp>“When you see the cost of goods go up like that, all of a sudden you’re figuring out, ‘OK are we even going to make any money this year?’”\u003c/p>\n\u003cp>Experts say inflation among medical supplies will result in higher health care costs for patients as hospitals and other providers struggle to maintain adequate profit margins.\u003c/p>\n\u003cp>William Padula, a senior fellow at the USC Schaeffer Center for Health Policy & Economics, said the “supply chain disaster” will result in hospitals negotiating for higher reimbursement rates with insurers and patients paying higher premiums.\u003c/p>\n\u003cp>“The natural consequence on the consumer side is … premiums will go up,” Padula said. \u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"aside","attributes":{"named":{"tag":"politics","label":"More political coverage "},"numeric":[]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Already, the Centers for Medicare and Medicaid Services announced the \u003ca href=\"https://www.cms.gov/newsroom/fact-sheets/2022-medicare-parts-b-premiums-and-deductibles2022-medicare-part-d-income-related-monthly-adjustment\">highest premium increase\u003c/a> in the program’s history for Medicare Part B and higher deductibles for other aspects of the program, in part due to increased utilization in the past year.\u003c/p>\n\u003cp>“In their statement, Medicare blamed the increase of premiums on COVID and the cost of that new drug for Alzheimers, which is expected to take off, but COVID is very broad. It really is about the supply chain,” Padula said.\u003c/p>\n\u003cp>Although it’s too soon to tell how much premiums will increase across the board, historically commercial insurers have followed Medicare’s lead.\u003c/p>\n\u003cp>“That gives a lot of commercial payers a pass to increase by a similar amount at a minimum,” Padula said.\u003c/p>\n\u003cp>The resultant cost hikes have also forced small and mid-sized suppliers to rethink which patients they can afford to serve, potentially leading to decreased access for those with Medi-Cal or Medicare, which have fixed reimbursement rates.\u003c/p>\n\u003cp>California has temporarily increased these reimbursement rates for the duration of the \u003ca href=\"https://calmatters.org/newsletters/whatmatters/2021/11/california-covid-state-of-emergency/\">COVID-19 public health emergency\u003c/a>, which is set to expire at the end of March. Beyond that, providers aren’t sure how long they can hold on.\u003c/p>\n\u003cp>Ron Biasca, a medical supplier based in Eureka, said increased costs are forcing his company to reassess what services it provides to Medicare and Medi-Cal patients.\u003c/p>\n\u003cp>“We are evaluating all entitlements right now to look at what we’re making money on. We are going to have to make some hard decisions and just not accept the insurance payment,” Biasca said.\u003c/p>\n\u003cp>Roughly \u003ca href=\"https://calmatters.org/economy/poverty/2017/08/paying-doctors-now-will-treat-poor-californians/\">one-third of all Californians rely on Medi-Cal\u003c/a> for health care and frequently face long wait times and \u003ca href=\"https://www.chcf.org/publication/measuring-up-access-care-medi-cal-compared-other-types-health-insurance-2018/\">difficulty finding doctors\u003c/a> and other providers who will accept their insurance. And the out-of-pocket costs are inaccessible even for people with private health insurance.\u003c/p>\n\u003cfigure id=\"attachment_11897232\" class=\"wp-caption alignnone\" style=\"max-width: 1000px\">\u003cimg class=\"size-full wp-image-11897232\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2021/11/111621-Genung-Family-Portrait-CM-01.jpg\" alt=\"The family, mother father and child, are well-dressed. \" width=\"1000\" height=\"1250\" srcset=\"https://ww2.kqed.org/app/uploads/sites/10/2021/11/111621-Genung-Family-Portrait-CM-01.jpg 1000w, https://ww2.kqed.org/app/uploads/sites/10/2021/11/111621-Genung-Family-Portrait-CM-01-800x1000.jpg 800w, https://ww2.kqed.org/app/uploads/sites/10/2021/11/111621-Genung-Family-Portrait-CM-01-160x200.jpg 160w\" sizes=\"(max-width: 1000px) 100vw, 1000px\">\u003cfigcaption class=\"wp-caption-text\">Maya and Dillon Genung hold their son Henry in a family portrait. \u003ccite>( Image courtesy of Maya Genung)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Genung said she has tried to purchase the tracheostomy tubes her son needs online but they cost between $300 to $600 each. “You would be spending thousands and thousands of dollars a month just to purchase it yourself,” she said.\u003c/p>\n\u003cp>Reusing the tubes fills her with worry. Henry’s condition requires him to be immunosuppressed, and reusing tubes increases the risk of infection or breakage as the equipment wears down.\u003c/p>\n\u003cp>“It’s not foolproof because you’re not in a sterile environment. You’re at home, you’re in your kitchen, doing your best to make it work,” Genung said.\u003c/p>\n\u003cp>A week ago, Henry was admitted to Children’s Hospital Los Angeles with pneumonia. Doctors told his parents there’s no way of knowing if the infection was caused by the reuse of tubes.\u003c/p>\n\u003cp>The only small silver lining is that the hospital gave Genung two new tracheostomy tubes, enough to get Henry through another month.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>This article was originally published by \u003ca href=\"https://calmatters.org/health/2021/11/medical-supplies-shortage-california/\">CalMatters\u003c/a>. KQED producer Keith Mizuguchi contributed to this report.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/news/11897208/supply-chain-woes-trigger-shortages-of-critical-medical-devices-may-drive-up-health-care-costs","authors":["byline_news_11897208"],"categories":["news_8"],"tags":["news_22772","news_20277","news_30219"],"affiliates":["news_18481"],"featImg":"news_11897228","label":"source_news_11897208"},"news_11886407":{"type":"posts","id":"news_11886407","meta":{"index":"posts_1591205157","site":"news","id":"11886407","score":null,"sort":[1630022546000]},"guestAuthors":[],"slug":"nurse-shortages-in-california-reaching-crisis-point","title":"Nurse Shortages in California Reaching Crisis Point","publishDate":1630022546,"format":"standard","headTitle":"KQED News","labelTerm":{},"content":"\u003cp>In the past month, four emergency room nurses — exhausted by the onslaught of patients and emotional turmoil wrought by COVID-19 — have quit at the Eureka hospital where Matt Miele works.\u003c/p>\n\u003cp>Miele, who has been a trauma nurse for four years, is actively looking for a less stressful nursing position and has colleagues who are, too.\u003c/p>\n\u003cp>\"On the bad days, I think, 'What am I doing and is this what I want to be doing?'\" Miele said. \"It’s shifting me to my core.\"\u003c/p>\n\u003cp>Around California — and the nation — nurses are trading in high-pressure jobs for a career change, early retirement or less demanding assignments, leading to staffing shortages in many hospitals.\u003c/p>\n\u003cp>Hospitals are struggling to comply with the state’s nurse staffing requirements as pandemic-induced burnout has exacerbated an already chronic nursing shortage nationwide.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>But burnout isn’t the only thing compounding California’s nursing shortage: The state’s \u003ca href=\"https://calmatters.org/health/coronavirus/2021/08/california-healthcare-vaccinations-mandate/\">new vaccine mandate for health care workers\u003c/a> is already causing headaches for understaffed hospitals before it is even implemented. Some traveling nurses — who are in high demand nationwide — are turning down California assignments because they don’t want to get vaccinated.\u003c/p>\n\u003cp>Hospitals say they are reaching a crisis point, straining under the dual forces of more people seeking routine care and \u003ca href=\"https://calmatters.org/health/coronavirus/2020/04/california-coronavirus-covid-patient-hospitalization-data-icu/\">surging COVID-19 hospitalizations\u003c/a> driven by the delta variant.\u003c/p>\n\u003cp>[pullquote size='medium' align='right' citation=\"Dr. Tom Sugarman, Emergency Physician\"]'There’s not enough staff to keep beds open, and patients can languish waiting.'[/pullquote]\u003c/p>\n\u003cp>\"Oftentimes at hospitals there are long waits and long delays,\" said Dr. Tom Sugarman, an emergency physician in the East Bay and senior director of government affairs at Vituity, a physicians’ group. \"There’s not enough staff to keep beds open, and patients can languish waiting.\"\u003c/p>\n\u003cp>In March 2020, the California Department of Public Health \u003ca href=\"https://files.covid19.ca.gov/pdf/Aya-healthcare-inc-CDPH.pdf\">contracted with Aya Healthcare\u003c/a> — one of the nation’s largest traveling nurse providers — to pay up to $1 billion over six months to help hospitals meet nursing and other clinical staff shortages.\u003c/p>\n\u003cp>Department officials did not respond to multiple requests about the number of hospitals now seeking emergency staffing, and would not release the updated contract.\u003c/p>\n\u003cp>Last week, Gov. Gavin Newsom \u003ca href=\"https://www.gov.ca.gov/wp-content/uploads/2021/08/8.16.21-EO-N-12-21.pdf\">signed an executive order\u003c/a> reinstating emergency provisions aimed at ensuring adequate staffing. In part, the order allows health care workers from out of state to work in California.\u003c/p>\n\u003ch2>Unprecedented staff shortages\u003c/h2>\n\u003cp>Before the pandemic, nursing shortages were common in most areas of the state, according to the \u003ca href=\"https://oshpd.ca.gov/wp-content/uploads/2020/10/Registered-Nurse-Shortage-Areas-Report.pdf\">Office of Statewide Health Planning and Development\u003c/a>.\u003c/p>\n\u003cp>Now the pandemic has stretched resources to a breaking point.\u003c/p>\n\u003cp>Hospitals, some with \u003ca href=\"https://calmatters.org/health/coronavirus/2021/08/california-covid/\">more COVID-19 patients now than during the winter surge\u003c/a>, say they are confronting unprecedented staffing shortages, particularly among nurses.\u003c/p>\n\u003cp>\"All of our hospitals are saying staffing is a big problem,\" said Lois Richardson, attorney for the California Hospital Association. \"We have fewer personnel than at the beginning of the pandemic and more patients.\"\u003c/p>\n\u003cp>[pullquote size='medium' align='right' citation=\"Lois Richardson, California Hospital Association\"]'We have fewer personnel than at the beginning of the pandemic and more patients.'[/pullquote]\u003c/p>\n\u003cp>The staffing shortage is so severe that Scripps Health is considering temporarily consolidating some of its outpatient centers. Scripps, which has five hospitals and 28 outpatient clinics in the San Diego area, told CalMatters that it is serving nearly 20% more patients on average than before the pandemic. At the same time, job openings at the hospitals have increased 57% since August 2019. For nursing jobs alone, vacancies have increased 96%.\u003c/p>\n\u003cp>\"We’ve had some staff leave the organization or leave the industry as a whole because they’re burned out,\" said Eric Cole, corporate senior vice president of human resources for Scripps. \"They’ll wake up in the morning and call off the shift. They’ve done as much as they can do.\"\u003c/p>\n\u003cp>Emotional and physical exhaustion is the primary reason nurses are fleeing the bedside, experts say. It has been a long and brutal 18 months.\u003c/p>\n\u003cp>\"We thought the pandemic would be over soon and could take time later to deal with our emotions,\" said Zenei Triunfo-Cortez, president of National Nurses United, the largest nursing union in the country, which has more than 100,000 members in its California association. \"Then the \u003ca href=\"https://calmatters.org/health/coronavirus/2021/01/california-hospitals-covid-cases/\">second surge\u003c/a> hit, and the third and now it’s the fourth.\"\u003c/p>\n\u003cp>Mary Lynn Briggs, an ICU nurse in Bakersfield, said that of the dozens of COVID-19 patients she has treated since the pandemic began, only three have survived.\u003c/p>\n\u003cp>\"Some days coming home from the hospital I yell at God, I yell at myself, I yell at COVID and cry. And that’s all before I pull into my driveway,\" Briggs said.\u003c/p>\n\u003cp>Her workplace has lost more staff than they can hire, and that means the ones who are left have to pick up the slack.\u003c/p>\n\u003cp>[pullquote size='medium' align='right' citation=\"Mary Lynn Briggs, ICU Nurse\"]'Some days coming home from the hospital I yell at God, I yell at myself, I yell at COVID and cry. And that’s all before I pull into my driveway.'[/pullquote]\u003c/p>\n\u003cp>\"There have been multiple nights where I swear I am tired and I need a night off, and then I get a call from somebody saying we’re going to give the nurse three patients, so I go in because I don’t want anyone to work out of ratio,\" Briggs said.\u003c/p>\n\u003cp>\"Out of ratio\" means that a nurse is assigned too many patients. California is the only state that caps the \u003ca href=\"https://www.nationalnursesunited.org/what-does-california-ratios-law-actually-require\">number of patients that can be assigned to a single nurse\u003c/a>. Under state requirements, for instance, an ICU nurse can have no more than two patients and an emergency room nurse, no more than four.\u003c/p>\n\u003cp>In December, during the winter surge, emergency waivers for the ratios were granted to hospitals throughout the state, allowing ICU nurses to see three patients, for instance. Critics say the conditions threatened patient safety.\u003c/p>\n\u003cp>Newsom’s order last week did not reinstate the waivers of the nurse-patient ratios, which expired on Feb. 8. Individual facilities, however, can still apply for them.\u003c/p>\n\u003cp>\"I would not be surprised if they reapply for waivers,\" union president Triunfo-Cortez said.\u003c/p>\n\u003cp>The state health department did not respond to requests seeking information on whether hospitals have applied for staffing waivers in response to the shortages.\u003c/p>\n\u003ch2>Vaccine mandate complicates staffing\u003c/h2>\n\u003cp>Hospital administrators worry that the state’s \u003ca href=\"https://calmatters.org/health/coronavirus/2021/08/california-healthcare-vaccinations-mandate/\">vaccine mandate\u003c/a> for health care workers, which goes into effect Sept. 30, could drive some of their workers out. Already, some report resistance among employees.\u003c/p>\n\u003cp>\"One hospital told us they had 474 unvaccinated employees. They did a big education and incentive push. Only 12 people signed up,\" said Richardson, the hospital association’s attorney.\u003c/p>\n\u003cp>[aside label=\"Related Stories\" postID=news_11883989,news_11882632,news_11885623]\u003c/p>\n\u003cp>Administrators are particularly concerned about low vaccination rates among support staff like janitors and food service workers. However, some nurses also are wary of the COVID-19 vaccine. Some nurses with large social media followings have participated in \u003ca href=\"https://www.nbcnews.com/tech/social-media/vaccine-mandates-spread-protests-follow-spurred-nurses-rcna1654\">protests in Southern California\u003c/a>, arguing that the mandates violate their personal freedom.\u003c/p>\n\u003cp>The vaccine order allows only for narrow religious and medical exemptions. Until Sept. 30, unvaccinated workers must undergo weekly COVID-19 testing. The state nursing association issued a statement saying \"all eligible people should be vaccinated.\"\u003c/p>\n\u003cp>While California was first in the nation to impose a vaccine mandate for health care workers, other states have since joined in, but their mandates aren’t as broad.\u003c/p>\n\u003cp>Cole of Scripps Health said the state’s \u003ca href=\"https://calmatters.org/health/2021/07/california-vaccine-requirements-workers/\">testing requirement\u003c/a>, imposed this week, already has discouraged some out-of-state, traveling nurses from taking temporary jobs at California hospitals.\u003c/p>\n\u003cp>\"If they don’t want to get vaccinated, they are turning down California assignments,\" he said.\u003c/p>\n\u003ch2>Traveling nurses in high demand\u003c/h2>\n\u003cp>To contend with local shortages, hospitals are increasingly turning to hiring temporary, traveling nurses from around the country.\u003c/p>\n\u003cp>During the past 18 months, Janet Stovall, a traveling ICU nurse for more than 20 years, has worked in hospitals in the Imperial Valley town of Brawley; Visalia; Wichita, Kan.; and now Folsom and Alameda — and all of them have been running on \"very lean staffing.\"\u003c/p>\n\u003cp>\"Last night there were ambulances waiting just to get into the ER to be evaluated … They pulled a nurse from the ICU to help with the ER, and we worked without a charge nurse or a break nurse,\" Stovall said.\u003c/p>\n\u003cp>Stovall said traveling nurses like her are in high demand. At one hospital, \"we hadn’t even finished orientation when the VP of patient services called and said, 'You need to leave right now, test out of orientation, and be at work by 11 p.m.,'\" Stovall said. \"That’s how desperate they are.\"\u003c/p>\n\u003cp>[pullquote size='medium' align='right' citation=\"Sophia Morris, Vice President of Account Management at Aya Healthcare\"]'In the 16 years I’ve been in this space, I have never seen this high a need.'[/pullquote]\u003c/p>\n\u003cp>Sophia Morris, vice president of account management at \u003ca href=\"https://www.ayahealthcare.com/\">Aya Healthcare\u003c/a>, said California has the second highest number of positions posted for nurses, exceeded only by Texas.\u003c/p>\n\u003cp>Nationwide more than 52,000 temporary health care jobs are posted, and Aya is only able to fill about 3,000 per week, she said.\u003c/p>\n\u003cp>\"In the 16 years I’ve been in this space, I have never seen this high a need,\" Morris said.\u003c/p>\n\u003cp>That need is creating intense competition for a limited pool of nurses nationwide.\u003c/p>\n\u003cp>\"Nurses are getting paid premiums to work in Texas and Florida where it’s surging right now,\" Sugarman said. \"Those nurses have to come from somewhere, and I wouldn’t be surprised if some are coming from California.\"\u003c/p>\n\u003cp>Hospitals have been paying twice as much as pre-pandemic times for travelers, Morris said.\u003c/p>\n\u003cp>To entice nurses to come to California, the state Department of Public Health agreed to pay up to $145 per hour for Aya's ICU nurses and more if a facility had a \"critical need.\" Stovall, who works for Aya, said between October and December 2020, she was paid $10,000 per week with an additional $2,000 if she picked up an extra shift.\u003c/p>\n\u003cp>It’s working — but not without consequences.\u003c/p>\n\u003cp>The money is pulling full-time staff nurses into traveling positions, further aggravating the staffing shortage nationwide. Stovall, who is based in North Carolina, said her sister-in-law took a week’s vacation from a full-time nursing gig to pick up an $8,000 traveling contract. She also convinced a longtime friend, Candace Brim, to leave her staff position and travel during the height of the pandemic in December.\u003c/p>\n\u003cp>\"Everywhere we go people ask, 'Can we get your recruiter’s number? We’ve given it out 20 times,'\" she said.\u003c/p>\n\u003cp>[aside label=\"More Coronavirus Coverage\" tag=\"coronavirus\"]\u003c/p>\n\u003cp>Traveling has been key to helping them avoid burnout, Brim and Stovall said. It’s rewarding to be able to come in and \"save the situation\" at hospitals in dire need of extra hands, Brim said, and the money is good enough that they can afford to take weeks off at a time after difficult assignments. Their contracts in Folsom and Alameda last until Thanksgiving.\u003c/p>\n\u003cp>\"By the time we finish our contract in November, we will have enough money to sit home the rest of November and December all through the holidays,\" Stovall said.\u003c/p>\n\u003cp>Time off has helped them cope with the somber realities of treating COVID-19 patients in the ICU: In the past seven months, every COVID patient Brim and Stovall treated has died.\u003c/p>\n\u003cp>\"We took care of about 65 COVID patients in Brawley and not a single one made it,\" Stovall said. \"We coded one every night. Before [COVID-19], you could make a difference in someone’s life. Now I will do anything for a patient, and it does not make a difference …Three days later they don’t make it.\"\u003c/p>\n\u003cp>Will so many nurses burn out and leave the profession that California will face long-term shortages? It’s possible. Pre-pandemic, one projection said California will be \u003ca href=\"https://bhw.hrsa.gov/sites/default/files/bureau-health-workforce/data-research/nchwa-hrsa-nursing-report.pdf\">short more than 44,000 nurses\u003c/a> by 2030, while other studies suggested that there will be an \u003ca href=\"https://www.rn.ca.gov/pdfs/forms/forecast2019.pdf\">adequate supply of new graduates\u003c/a>.\u003c/p>\n\u003cfigure id=\"attachment_11886461\" class=\"wp-caption aligncenter\" style=\"max-width: 1092px\">\u003cimg class=\"size-full wp-image-11886461\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2021/08/082421_travelingnurses_AW_sized_02-e1630013055384.jpeg\" alt=\"Nurses in scrubs stand in front of a hospital gurney\" width=\"1092\" height=\"728\">\u003cfigcaption class=\"wp-caption-text\">In the past seven months, every COVID patient that Janet Stovall (left) and Candace Brim treated has died. “We took care of about 65 COVID patients in Brawley and not a single one made it,” Stovall said. “We coded one every night ... Before [COVID], you could make a difference in someone’s life. Now I will do anything for a patient, and it does not make a difference.” \u003ccite>(Anne Wernikoff/CalMatters)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003ch2>Low staffing stresses out ER nurses\u003c/h2>\n\u003cp>In Humboldt County, all floors are at full capacity at the hospital where ER nurse Miele works. Humboldt is one of the areas experiencing record-setting COVID-19 hospitalizations.\u003c/p>\n\u003cp>Miele has had patients who waited 10 to 12 hours in the emergency room. Sometimes, the patients he checks on at 9:30 p.m. before he leaves are still in the waiting room the next morning when he returns to work.\u003c/p>\n\u003cp>\"To me it seems like the lowest staffing levels that I’ve seen at the time we need it the most,\" he said, adding that he frequently works at a patient-to-emergency-room-nurse ratio that exceeds the four-to-one required by the state.\u003c/p>\n\u003cp>People are triaged in the waiting room \"like a mass casualty patient event,\" getting their initial assessments and tests ordered before ever seeing the inside of an examination room. He said he worries because staff are unable to routinely monitor the patients in the waiting rooms.\u003c/p>\n\u003cp>His hospital hasn’t yet rationed care by prioritizing who gets treated based on who is most likely to survive, but it is being discussed, Miele said.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\"Stress is part of the game when you sign up to be an emergency medicine RN,\" he said, \"but this is another level.\"\u003c/p>\n\n","blocks":[],"excerpt":"COVID-19 burnout is driving many nurses to quit, and hospital administrators say the state’s new vaccine mandate is compounding the shortage.","status":"publish","parent":0,"modified":1630079896,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":68,"wordCount":2381},"headData":{"title":"Nurse Shortages in California Reaching Crisis Point | KQED","description":"COVID-19 burnout is driving many nurses to quit, and hospital administrators say the state’s new vaccine mandate is compounding the shortage.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"11886407 https://ww2.kqed.org/news/?p=11886407","disqusUrl":"https://ww2.kqed.org/news/2021/08/26/nurse-shortages-in-california-reaching-crisis-point/","disqusTitle":"Nurse Shortages in California Reaching Crisis Point","source":"CalMatters","sourceUrl":"https://calmatters.org/health/coronavirus/2021/08/california-nurses-shortage/","nprByline":"Kristen Hwang","path":"/news/11886407/nurse-shortages-in-california-reaching-crisis-point","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>In the past month, four emergency room nurses — exhausted by the onslaught of patients and emotional turmoil wrought by COVID-19 — have quit at the Eureka hospital where Matt Miele works.\u003c/p>\n\u003cp>Miele, who has been a trauma nurse for four years, is actively looking for a less stressful nursing position and has colleagues who are, too.\u003c/p>\n\u003cp>\"On the bad days, I think, 'What am I doing and is this what I want to be doing?'\" Miele said. \"It’s shifting me to my core.\"\u003c/p>\n\u003cp>Around California — and the nation — nurses are trading in high-pressure jobs for a career change, early retirement or less demanding assignments, leading to staffing shortages in many hospitals.\u003c/p>\n\u003cp>Hospitals are struggling to comply with the state’s nurse staffing requirements as pandemic-induced burnout has exacerbated an already chronic nursing shortage nationwide.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>But burnout isn’t the only thing compounding California’s nursing shortage: The state’s \u003ca href=\"https://calmatters.org/health/coronavirus/2021/08/california-healthcare-vaccinations-mandate/\">new vaccine mandate for health care workers\u003c/a> is already causing headaches for understaffed hospitals before it is even implemented. Some traveling nurses — who are in high demand nationwide — are turning down California assignments because they don’t want to get vaccinated.\u003c/p>\n\u003cp>Hospitals say they are reaching a crisis point, straining under the dual forces of more people seeking routine care and \u003ca href=\"https://calmatters.org/health/coronavirus/2020/04/california-coronavirus-covid-patient-hospitalization-data-icu/\">surging COVID-19 hospitalizations\u003c/a> driven by the delta variant.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"'There’s not enough staff to keep beds open, and patients can languish waiting.'","name":"pullquote","attributes":{"named":{"size":"medium","align":"right","citation":"Dr. Tom Sugarman, Emergency Physician","label":""},"numeric":[]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"Oftentimes at hospitals there are long waits and long delays,\" said Dr. Tom Sugarman, an emergency physician in the East Bay and senior director of government affairs at Vituity, a physicians’ group. \"There’s not enough staff to keep beds open, and patients can languish waiting.\"\u003c/p>\n\u003cp>In March 2020, the California Department of Public Health \u003ca href=\"https://files.covid19.ca.gov/pdf/Aya-healthcare-inc-CDPH.pdf\">contracted with Aya Healthcare\u003c/a> — one of the nation’s largest traveling nurse providers — to pay up to $1 billion over six months to help hospitals meet nursing and other clinical staff shortages.\u003c/p>\n\u003cp>Department officials did not respond to multiple requests about the number of hospitals now seeking emergency staffing, and would not release the updated contract.\u003c/p>\n\u003cp>Last week, Gov. Gavin Newsom \u003ca href=\"https://www.gov.ca.gov/wp-content/uploads/2021/08/8.16.21-EO-N-12-21.pdf\">signed an executive order\u003c/a> reinstating emergency provisions aimed at ensuring adequate staffing. In part, the order allows health care workers from out of state to work in California.\u003c/p>\n\u003ch2>Unprecedented staff shortages\u003c/h2>\n\u003cp>Before the pandemic, nursing shortages were common in most areas of the state, according to the \u003ca href=\"https://oshpd.ca.gov/wp-content/uploads/2020/10/Registered-Nurse-Shortage-Areas-Report.pdf\">Office of Statewide Health Planning and Development\u003c/a>.\u003c/p>\n\u003cp>Now the pandemic has stretched resources to a breaking point.\u003c/p>\n\u003cp>Hospitals, some with \u003ca href=\"https://calmatters.org/health/coronavirus/2021/08/california-covid/\">more COVID-19 patients now than during the winter surge\u003c/a>, say they are confronting unprecedented staffing shortages, particularly among nurses.\u003c/p>\n\u003cp>\"All of our hospitals are saying staffing is a big problem,\" said Lois Richardson, attorney for the California Hospital Association. \"We have fewer personnel than at the beginning of the pandemic and more patients.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"'We have fewer personnel than at the beginning of the pandemic and more patients.'","name":"pullquote","attributes":{"named":{"size":"medium","align":"right","citation":"Lois Richardson, California Hospital Association","label":""},"numeric":[]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The staffing shortage is so severe that Scripps Health is considering temporarily consolidating some of its outpatient centers. Scripps, which has five hospitals and 28 outpatient clinics in the San Diego area, told CalMatters that it is serving nearly 20% more patients on average than before the pandemic. At the same time, job openings at the hospitals have increased 57% since August 2019. For nursing jobs alone, vacancies have increased 96%.\u003c/p>\n\u003cp>\"We’ve had some staff leave the organization or leave the industry as a whole because they’re burned out,\" said Eric Cole, corporate senior vice president of human resources for Scripps. \"They’ll wake up in the morning and call off the shift. They’ve done as much as they can do.\"\u003c/p>\n\u003cp>Emotional and physical exhaustion is the primary reason nurses are fleeing the bedside, experts say. It has been a long and brutal 18 months.\u003c/p>\n\u003cp>\"We thought the pandemic would be over soon and could take time later to deal with our emotions,\" said Zenei Triunfo-Cortez, president of National Nurses United, the largest nursing union in the country, which has more than 100,000 members in its California association. \"Then the \u003ca href=\"https://calmatters.org/health/coronavirus/2021/01/california-hospitals-covid-cases/\">second surge\u003c/a> hit, and the third and now it’s the fourth.\"\u003c/p>\n\u003cp>Mary Lynn Briggs, an ICU nurse in Bakersfield, said that of the dozens of COVID-19 patients she has treated since the pandemic began, only three have survived.\u003c/p>\n\u003cp>\"Some days coming home from the hospital I yell at God, I yell at myself, I yell at COVID and cry. And that’s all before I pull into my driveway,\" Briggs said.\u003c/p>\n\u003cp>Her workplace has lost more staff than they can hire, and that means the ones who are left have to pick up the slack.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"'Some days coming home from the hospital I yell at God, I yell at myself, I yell at COVID and cry. And that’s all before I pull into my driveway.'","name":"pullquote","attributes":{"named":{"size":"medium","align":"right","citation":"Mary Lynn Briggs, ICU Nurse","label":""},"numeric":[]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"There have been multiple nights where I swear I am tired and I need a night off, and then I get a call from somebody saying we’re going to give the nurse three patients, so I go in because I don’t want anyone to work out of ratio,\" Briggs said.\u003c/p>\n\u003cp>\"Out of ratio\" means that a nurse is assigned too many patients. California is the only state that caps the \u003ca href=\"https://www.nationalnursesunited.org/what-does-california-ratios-law-actually-require\">number of patients that can be assigned to a single nurse\u003c/a>. Under state requirements, for instance, an ICU nurse can have no more than two patients and an emergency room nurse, no more than four.\u003c/p>\n\u003cp>In December, during the winter surge, emergency waivers for the ratios were granted to hospitals throughout the state, allowing ICU nurses to see three patients, for instance. Critics say the conditions threatened patient safety.\u003c/p>\n\u003cp>Newsom’s order last week did not reinstate the waivers of the nurse-patient ratios, which expired on Feb. 8. Individual facilities, however, can still apply for them.\u003c/p>\n\u003cp>\"I would not be surprised if they reapply for waivers,\" union president Triunfo-Cortez said.\u003c/p>\n\u003cp>The state health department did not respond to requests seeking information on whether hospitals have applied for staffing waivers in response to the shortages.\u003c/p>\n\u003ch2>Vaccine mandate complicates staffing\u003c/h2>\n\u003cp>Hospital administrators worry that the state’s \u003ca href=\"https://calmatters.org/health/coronavirus/2021/08/california-healthcare-vaccinations-mandate/\">vaccine mandate\u003c/a> for health care workers, which goes into effect Sept. 30, could drive some of their workers out. Already, some report resistance among employees.\u003c/p>\n\u003cp>\"One hospital told us they had 474 unvaccinated employees. They did a big education and incentive push. Only 12 people signed up,\" said Richardson, the hospital association’s attorney.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"aside","attributes":{"named":{"label":"Related Stories ","postid":"news_11883989,news_11882632,news_11885623"},"numeric":[]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Administrators are particularly concerned about low vaccination rates among support staff like janitors and food service workers. However, some nurses also are wary of the COVID-19 vaccine. Some nurses with large social media followings have participated in \u003ca href=\"https://www.nbcnews.com/tech/social-media/vaccine-mandates-spread-protests-follow-spurred-nurses-rcna1654\">protests in Southern California\u003c/a>, arguing that the mandates violate their personal freedom.\u003c/p>\n\u003cp>The vaccine order allows only for narrow religious and medical exemptions. Until Sept. 30, unvaccinated workers must undergo weekly COVID-19 testing. The state nursing association issued a statement saying \"all eligible people should be vaccinated.\"\u003c/p>\n\u003cp>While California was first in the nation to impose a vaccine mandate for health care workers, other states have since joined in, but their mandates aren’t as broad.\u003c/p>\n\u003cp>Cole of Scripps Health said the state’s \u003ca href=\"https://calmatters.org/health/2021/07/california-vaccine-requirements-workers/\">testing requirement\u003c/a>, imposed this week, already has discouraged some out-of-state, traveling nurses from taking temporary jobs at California hospitals.\u003c/p>\n\u003cp>\"If they don’t want to get vaccinated, they are turning down California assignments,\" he said.\u003c/p>\n\u003ch2>Traveling nurses in high demand\u003c/h2>\n\u003cp>To contend with local shortages, hospitals are increasingly turning to hiring temporary, traveling nurses from around the country.\u003c/p>\n\u003cp>During the past 18 months, Janet Stovall, a traveling ICU nurse for more than 20 years, has worked in hospitals in the Imperial Valley town of Brawley; Visalia; Wichita, Kan.; and now Folsom and Alameda — and all of them have been running on \"very lean staffing.\"\u003c/p>\n\u003cp>\"Last night there were ambulances waiting just to get into the ER to be evaluated … They pulled a nurse from the ICU to help with the ER, and we worked without a charge nurse or a break nurse,\" Stovall said.\u003c/p>\n\u003cp>Stovall said traveling nurses like her are in high demand. At one hospital, \"we hadn’t even finished orientation when the VP of patient services called and said, 'You need to leave right now, test out of orientation, and be at work by 11 p.m.,'\" Stovall said. \"That’s how desperate they are.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"'In the 16 years I’ve been in this space, I have never seen this high a need.'","name":"pullquote","attributes":{"named":{"size":"medium","align":"right","citation":"Sophia Morris, Vice President of Account Management at Aya Healthcare","label":""},"numeric":[]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Sophia Morris, vice president of account management at \u003ca href=\"https://www.ayahealthcare.com/\">Aya Healthcare\u003c/a>, said California has the second highest number of positions posted for nurses, exceeded only by Texas.\u003c/p>\n\u003cp>Nationwide more than 52,000 temporary health care jobs are posted, and Aya is only able to fill about 3,000 per week, she said.\u003c/p>\n\u003cp>\"In the 16 years I’ve been in this space, I have never seen this high a need,\" Morris said.\u003c/p>\n\u003cp>That need is creating intense competition for a limited pool of nurses nationwide.\u003c/p>\n\u003cp>\"Nurses are getting paid premiums to work in Texas and Florida where it’s surging right now,\" Sugarman said. \"Those nurses have to come from somewhere, and I wouldn’t be surprised if some are coming from California.\"\u003c/p>\n\u003cp>Hospitals have been paying twice as much as pre-pandemic times for travelers, Morris said.\u003c/p>\n\u003cp>To entice nurses to come to California, the state Department of Public Health agreed to pay up to $145 per hour for Aya's ICU nurses and more if a facility had a \"critical need.\" Stovall, who works for Aya, said between October and December 2020, she was paid $10,000 per week with an additional $2,000 if she picked up an extra shift.\u003c/p>\n\u003cp>It’s working — but not without consequences.\u003c/p>\n\u003cp>The money is pulling full-time staff nurses into traveling positions, further aggravating the staffing shortage nationwide. Stovall, who is based in North Carolina, said her sister-in-law took a week’s vacation from a full-time nursing gig to pick up an $8,000 traveling contract. She also convinced a longtime friend, Candace Brim, to leave her staff position and travel during the height of the pandemic in December.\u003c/p>\n\u003cp>\"Everywhere we go people ask, 'Can we get your recruiter’s number? We’ve given it out 20 times,'\" she said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"aside","attributes":{"named":{"label":"More Coronavirus Coverage ","tag":"coronavirus"},"numeric":[]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Traveling has been key to helping them avoid burnout, Brim and Stovall said. It’s rewarding to be able to come in and \"save the situation\" at hospitals in dire need of extra hands, Brim said, and the money is good enough that they can afford to take weeks off at a time after difficult assignments. Their contracts in Folsom and Alameda last until Thanksgiving.\u003c/p>\n\u003cp>\"By the time we finish our contract in November, we will have enough money to sit home the rest of November and December all through the holidays,\" Stovall said.\u003c/p>\n\u003cp>Time off has helped them cope with the somber realities of treating COVID-19 patients in the ICU: In the past seven months, every COVID patient Brim and Stovall treated has died.\u003c/p>\n\u003cp>\"We took care of about 65 COVID patients in Brawley and not a single one made it,\" Stovall said. \"We coded one every night. Before [COVID-19], you could make a difference in someone’s life. Now I will do anything for a patient, and it does not make a difference …Three days later they don’t make it.\"\u003c/p>\n\u003cp>Will so many nurses burn out and leave the profession that California will face long-term shortages? It’s possible. Pre-pandemic, one projection said California will be \u003ca href=\"https://bhw.hrsa.gov/sites/default/files/bureau-health-workforce/data-research/nchwa-hrsa-nursing-report.pdf\">short more than 44,000 nurses\u003c/a> by 2030, while other studies suggested that there will be an \u003ca href=\"https://www.rn.ca.gov/pdfs/forms/forecast2019.pdf\">adequate supply of new graduates\u003c/a>.\u003c/p>\n\u003cfigure id=\"attachment_11886461\" class=\"wp-caption aligncenter\" style=\"max-width: 1092px\">\u003cimg class=\"size-full wp-image-11886461\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2021/08/082421_travelingnurses_AW_sized_02-e1630013055384.jpeg\" alt=\"Nurses in scrubs stand in front of a hospital gurney\" width=\"1092\" height=\"728\">\u003cfigcaption class=\"wp-caption-text\">In the past seven months, every COVID patient that Janet Stovall (left) and Candace Brim treated has died. “We took care of about 65 COVID patients in Brawley and not a single one made it,” Stovall said. “We coded one every night ... Before [COVID], you could make a difference in someone’s life. Now I will do anything for a patient, and it does not make a difference.” \u003ccite>(Anne Wernikoff/CalMatters)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003ch2>Low staffing stresses out ER nurses\u003c/h2>\n\u003cp>In Humboldt County, all floors are at full capacity at the hospital where ER nurse Miele works. Humboldt is one of the areas experiencing record-setting COVID-19 hospitalizations.\u003c/p>\n\u003cp>Miele has had patients who waited 10 to 12 hours in the emergency room. Sometimes, the patients he checks on at 9:30 p.m. before he leaves are still in the waiting room the next morning when he returns to work.\u003c/p>\n\u003cp>\"To me it seems like the lowest staffing levels that I’ve seen at the time we need it the most,\" he said, adding that he frequently works at a patient-to-emergency-room-nurse ratio that exceeds the four-to-one required by the state.\u003c/p>\n\u003cp>People are triaged in the waiting room \"like a mass casualty patient event,\" getting their initial assessments and tests ordered before ever seeing the inside of an examination room. He said he worries because staff are unable to routinely monitor the patients in the waiting rooms.\u003c/p>\n\u003cp>His hospital hasn’t yet rationed care by prioritizing who gets treated based on who is most likely to survive, but it is being discussed, Miele said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"Stress is part of the game when you sign up to be an emergency medicine RN,\" he said, \"but this is another level.\"\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/news/11886407/nurse-shortages-in-california-reaching-crisis-point","authors":["byline_news_11886407"],"categories":["news_457","news_8"],"tags":["news_27350","news_29058","news_29546","news_28801","news_27504","news_27626","news_20277","news_29193","news_29841"],"featImg":"news_11886462","label":"source_news_11886407"}},"programsReducer":{"possible":{"id":"possible","title":"Possible","info":"Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. 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But is this once sleepy suburb ready for them?","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/American-Suburb-Podcast-Tile-703x703-1.jpg","officialWebsiteLink":"/news/series/american-suburb-podcast","meta":{"site":"news","source":"kqed","order":"13"},"link":"/news/series/american-suburb-podcast/","subscribe":{"npr":"https://rpb3r.app.goo.gl/RBrW","apple":"https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?mt=2&id=1287748328","tuneIn":"https://tunein.com/radio/American-Suburb-p1086805/","rss":"https://ww2.kqed.org/news/series/american-suburb-podcast/feed/podcast","google":"https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkMzMDExODgxNjA5"}},"baycurious":{"id":"baycurious","title":"Bay Curious","tagline":"Exploring the Bay Area, one question at a time","info":"KQED’s new podcast, Bay Curious, gets to the bottom of the mysteries — both profound and peculiar — that give the Bay Area its unique identity. And we’ll do it with your help! You ask the questions. You decide what Bay Curious investigates. And you join us on the journey to find the answers.","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Bay-Curious-Podcast-Tile-703x703-1.jpg","imageAlt":"\"KQED Bay Curious","officialWebsiteLink":"/news/series/baycurious","meta":{"site":"news","source":"kqed","order":"4"},"link":"/podcasts/baycurious","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/bay-curious/id1172473406","npr":"https://www.npr.org/podcasts/500557090/bay-curious","rss":"https://ww2.kqed.org/news/category/bay-curious-podcast/feed/podcast","google":"https://podcasts.google.com/feed/aHR0cHM6Ly93dzIua3FlZC5vcmcvbmV3cy9jYXRlZ29yeS9iYXktY3VyaW91cy1wb2RjYXN0L2ZlZWQvcG9kY2FzdA","stitcher":"https://www.stitcher.com/podcast/kqed/bay-curious","spotify":"https://open.spotify.com/show/6O76IdmhixfijmhTZLIJ8k"}},"bbc-world-service":{"id":"bbc-world-service","title":"BBC World Service","info":"The day's top stories from BBC News compiled twice daily in the week, once at weekends.","airtime":"MON-FRI 9pm-10pm, TUE-FRI 1am-2am","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/BBC-World-Service-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://www.bbc.co.uk/sounds/play/live:bbc_world_service","meta":{"site":"news","source":"BBC World Service"},"link":"/radio/program/bbc-world-service","subscribe":{"apple":"https://itunes.apple.com/us/podcast/global-news-podcast/id135067274?mt=2","tuneIn":"https://tunein.com/radio/BBC-World-Service-p455581/","rss":"https://podcasts.files.bbci.co.uk/p02nq0gn.rss"}},"code-switch-life-kit":{"id":"code-switch-life-kit","title":"Code Switch / Life Kit","info":"\u003cem>Code Switch\u003c/em>, which listeners will hear in the first part of the hour, has fearless and much-needed conversations about race. Hosted by journalists of color, the show tackles the subject of race head-on, exploring how it impacts every part of society — from politics and pop culture to history, sports and more.\u003cbr />\u003cbr />\u003cem>Life Kit\u003c/em>, which will be in the second part of the hour, guides you through spaces and feelings no one prepares you for — from finances to mental health, from workplace microaggressions to imposter syndrome, from relationships to parenting. The show features experts with real world experience and shares their knowledge. Because everyone needs a little help being human.\u003cbr />\u003cbr />\u003ca href=\"https://www.npr.org/podcasts/510312/codeswitch\">\u003cem>Code Switch\u003c/em> offical site and podcast\u003c/a>\u003cbr />\u003ca href=\"https://www.npr.org/lifekit\">\u003cem>Life Kit\u003c/em> offical site and podcast\u003c/a>\u003cbr />","airtime":"SUN 9pm-10pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Code-Switch-Life-Kit-Podcast-Tile-360x360-1.jpg","meta":{"site":"radio","source":"npr"},"link":"/radio/program/code-switch-life-kit","subscribe":{"apple":"https://podcasts.apple.com/podcast/1112190608?mt=2&at=11l79Y&ct=nprdirectory","google":"https://podcasts.google.com/feed/aHR0cHM6Ly93d3cubnByLm9yZy9yc3MvcG9kY2FzdC5waHA_aWQ9NTEwMzEy","spotify":"https://open.spotify.com/show/3bExJ9JQpkwNhoHvaIIuyV","rss":"https://feeds.npr.org/510312/podcast.xml"}},"commonwealth-club":{"id":"commonwealth-club","title":"Commonwealth Club of California Podcast","info":"The Commonwealth Club of California is the nation's oldest and largest public affairs forum. As a non-partisan forum, The Club brings to the public airwaves diverse viewpoints on important topics. The Club's weekly radio broadcast - the oldest in the U.S., dating back to 1924 - is carried across the nation on public radio stations and is now podcasting. Our website archive features audio of our recent programs, as well as selected speeches from our long and distinguished history. This podcast feed is usually updated twice a week and is always un-edited.","airtime":"THU 10pm, FRI 1am","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Commonwealth-Club-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://www.commonwealthclub.org/podcasts","meta":{"site":"news","source":"Commonwealth Club of California"},"link":"/radio/program/commonwealth-club","subscribe":{"apple":"https://itunes.apple.com/us/podcast/commonwealth-club-of-california-podcast/id976334034?mt=2","google":"https://podcasts.google.com/feed/aHR0cDovL3d3dy5jb21tb253ZWFsdGhjbHViLm9yZy9hdWRpby9wb2RjYXN0L3dlZWtseS54bWw","tuneIn":"https://tunein.com/radio/Commonwealth-Club-of-California-p1060/"}},"considerthis":{"id":"considerthis","title":"Consider This","tagline":"Make sense of the day","info":"Make sense of the day. Every weekday afternoon, Consider This helps you consider the major stories of the day in less than 15 minutes, featuring the reporting and storytelling resources of NPR. Plus, KQED’s Bianca Taylor brings you the local KQED news you need to know.","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Consider-This-Podcast-Tile-703x703-1.jpg","imageAlt":"Consider This from NPR and KQED","officialWebsiteLink":"/podcasts/considerthis","meta":{"site":"news","source":"kqed","order":"7"},"link":"/podcasts/considerthis","subscribe":{"apple":"https://podcasts.apple.com/podcast/id1503226625?mt=2&at=11l79Y&ct=nprdirectory","npr":"https://rpb3r.app.goo.gl/coronavirusdaily","google":"https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5ucHIub3JnLzUxMDM1NS9wb2RjYXN0LnhtbA","spotify":"https://open.spotify.com/show/3Z6JdCS2d0eFEpXHKI6WqH"}},"forum":{"id":"forum","title":"Forum","tagline":"The conversation starts here","info":"KQED’s live call-in program discussing local, state, national and international issues, as well as in-depth interviews.","airtime":"MON-FRI 9am-11am, 10pm-11pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Forum-Podcast-Tile-703x703-1.jpg","imageAlt":"KQED Forum with Mina Kim and Alexis Madrigal","officialWebsiteLink":"/forum","meta":{"site":"news","source":"kqed","order":"8"},"link":"/forum","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/kqeds-forum/id73329719","google":"https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM5NTU3MzgxNjMz","npr":"https://www.npr.org/podcasts/432307980/forum","stitcher":"https://www.stitcher.com/podcast/kqedfm-kqeds-forum-podcast","rss":"https://feeds.megaphone.fm/KQINC9557381633"}},"freakonomics-radio":{"id":"freakonomics-radio","title":"Freakonomics Radio","info":"Freakonomics Radio is a one-hour award-winning podcast and public-radio project hosted by Stephen Dubner, with co-author Steve Levitt as a regular guest. It is produced in partnership with WNYC.","imageSrc":"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/05/freakonomicsRadio.png","officialWebsiteLink":"http://freakonomics.com/","airtime":"SUN 1am-2am, SAT 3pm-4pm","meta":{"site":"radio","source":"WNYC"},"link":"/radio/program/freakonomics-radio","subscribe":{"npr":"https://rpb3r.app.goo.gl/4s8b","apple":"https://itunes.apple.com/us/podcast/freakonomics-radio/id354668519","tuneIn":"https://tunein.com/podcasts/WNYC-Podcasts/Freakonomics-Radio-p272293/","rss":"https://feeds.feedburner.com/freakonomicsradio"}},"fresh-air":{"id":"fresh-air","title":"Fresh Air","info":"Hosted by Terry Gross, \u003cem>Fresh Air from WHYY\u003c/em> is the Peabody Award-winning weekday magazine of contemporary arts and issues. One of public radio's most popular programs, Fresh Air features intimate conversations with today's biggest luminaries.","airtime":"MON-FRI 7pm-8pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Fresh-Air-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://www.npr.org/programs/fresh-air/","meta":{"site":"radio","source":"npr"},"link":"/radio/program/fresh-air","subscribe":{"npr":"https://rpb3r.app.goo.gl/4s8b","apple":"https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=214089682&at=11l79Y&ct=nprdirectory","tuneIn":"https://tunein.com/radio/Fresh-Air-p17/","rss":"https://feeds.npr.org/381444908/podcast.xml"}},"here-and-now":{"id":"here-and-now","title":"Here & Now","info":"A live production of NPR and WBUR Boston, in collaboration with stations across the country, Here & Now reflects the fluid world of news as it's happening in the middle of the day, with timely, in-depth news, interviews and conversation. Hosted by Robin Young, Jeremy Hobson and Tonya Mosley.","airtime":"MON-THU 11am-12pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Here-And-Now-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"http://www.wbur.org/hereandnow","meta":{"site":"news","source":"npr"},"link":"/radio/program/here-and-now","subsdcribe":{"apple":"https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?mt=2&id=426698661","tuneIn":"https://tunein.com/radio/Here--Now-p211/","rss":"https://feeds.npr.org/510051/podcast.xml"}},"how-i-built-this":{"id":"how-i-built-this","title":"How I Built This with Guy Raz","info":"Guy Raz dives into the stories behind some of the world's best known companies. 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