“There is no place that I’d rather be. … I love the quiet of living here, the help we get. I thank the Lord every year that I am here,” Stepney, 73, said.

It’s a far cry from a decade ago, when Stepney was homeless and “didn’t care about anything.” His diabetes went unchecked and he had suffered a stroke — a medical event that landed him at the Baltimore Veterans Affairs Medical Center.

After having part of his foot amputated, Stepney moved into long-term nursing home care at a VA medical facility, where he thought he’d remain — until he became a candidate for a small VA effort that puts aging veterans in private homes: the program.

The $20.7 million-per-year program provides housing and care for more than 1,000 veterans in 42 states and Puerto Rico, serving as an alternative to nursing home care for those who cannot live safely on their own. Veterans pay their caregivers $1,500 to $3,000 a month, depending on location, saving the government about $10,000 a month in nursing home care. It has been difficult to scale up, though, because the VA accepts only foster homes that meet strict qualifications.

For the veterans, it’s a chance to live in a home setting with caregivers who treat them like family. For the Department of Veterans Affairs, the program provides an option for meeting its legal obligation to care for ailing, aging patients at significantly reduced costs, since the veterans pay room and board directly to their caregivers.

Cost-effectiveness is but one of the program’s benefits. Stepney and Hundt, 67, are in good hands with West, who previously ran a home health care services company. And they’re in good company, watching television together in the main living room, going to elder care twice a week and sitting on West’s porch chatting with neighbors.

West, who considers caring for older adults “her calling,” also savors the companionship and finds satisfaction in giving back to those who spent their young lives in military service to the U.S.

“I took care of my mother when she got cancer and I found that I really had a passion for it. I took classes and ran an in-home nursing care business for years. But my dream was always to get my own place and do what I am doing now,” West said. “God worked it out.”

The Medical Foster Home program has slightly more than 700 licensed caregivers who live full time with no more than three veterans and provide round-the-clock supervision and care, according to the VA. Akin to a community residential care facility, each foster home must be state-licensed as an assisted living facility and submit to frequent inspections by the VA as well as state inspectors, nutritionists, pharmacists and nurses.

Unlike typical community care facilities, foster home caregivers are required to live on-site and tend to the needs of their patients themselves 24/7 — or supply relief staff.

“It’s a lot of work, but I have support,” West says. “I try to make all my personal appointments on days when Mr. Ralph and Mr. Frank are out, but if I can’t, someone comes in to be here when I’m gone.”

VA medical foster home providers also must pass a federal background check, complete 80 hours of training before they can accept patients, plus 20 hours of additional training each year, and allow the VA to make announced and unannounced home visits. They cannot work outside the home and must maintain certification in first aid, CPR and medicine administration.

But one prerequisite cannot be taught — the ability to make a veteran feel at home. West has grown children serving in the military and takes pride in contributing to the well-being of veterans.

“It’s a lot of joy taking care of them,” she said of Stepney and Hundt. “They deserve it.”

To be considered for the program, veterans must be enrolled in VA health care; have a serious, chronic disabling medical condition that requires a nursing home level of care; and need care coordination and access to VA services. It can take up to a month to place a veteran in a home once they are found eligible, according to the VA.

The veterans also must be able to cover their costs. Because medical foster homes are not considered institutional care, the VA is not allowed to pay for it directly. The average monthly fee, according to the VA, is $2,300, which most veterans cover with their VA compensation, Social Security and savings, said Nicole Trimble, Medical Foster Home coordinator at the Perry Point VA Medical Center in Maryland.

Pilot Program Takes Off

Since 1999, the Department of to provide nursing home services to veterans who qualify for VA health care and have a service-connected disability rating of 70 percent or higher, or are considered unemployable and have a disability rating of 60 percent or higher.

The VA provides this care through short- or long-term nursing home facilities, respite care, community living centers on VA hospital grounds, private assisted living facilities and state veterans homes.

Shortly after, the VA Medical Center in Little Rock, Ark., launched an alternative — a pilot program that placed veterans in individual homes, at an average cost to the VA of roughly $60 a day, including administration and health care expenses, compared with upward of $500 a day for nursing home care.

And because veterans who are enrolled in the Medical Foster Care program must use the VA’s Home-Based Primary Care program, which provides an interdisciplinary team of health professionals for in-home medical treatment, the program saves the VA even more. One that the home-based care has yielded a in VA hospital inpatient days and a 31 percent reduction in admissions among those who participate.

More than 120 VA medical centers now oversee a Medical Foster Home program in their regions, and the VA has actively promoted the program within its health system.

It also has attracted bipartisan congressional support. In 2013, Sen. Bernie Sanders (I-Vt.) introduced a bill to allow the VA to pay for medical foster homes directly.

In 2015, former House Veterans Affairs Committee chairman Rep. Jeff Miller (R-Fla.) introduced similar legislation that would have allowed the VA to pay for up to 900 veterans under the program.

And in May, Rep. Clay Higgins (R-La.) raised the issue again, sponsoring a bill similar to Miller’s. “Allowing veterans to exercise greater flexibility over their benefits ensures that their individual needs are best met,” Higgins said in support of the program.

A Guardian ‘Angel’

Foster care has been a blessing for the family of Hundt, who suffered a stroke shortly after his wife died and was unable to care for himself. Hundt’s daughter, Kimberly Malczewski, lives nearby and often stops in to visit her dad, sometimes with her 2-year-old son.

“I’m not sure where my father would be if he didn’t have this,” she said. “With my life situation — my husband and I both work full time, we have no extra room in our house, and we have a small child — I can’t take care of him the way Miss Joann does.”

Trimble, whose program started in 2012 and has five homes, said she hopes to expand by two to three homes a year. The VA will remain meticulous about selecting homes.

“There is a strict inspection and vetting process to be a medical foster home,” Trimble said. “We only will accept the best.”

It also takes a special person to be an “angel,” as the caregivers are referred to in the program’s motto, ”Where Heroes Meet Angels.”

Stepney and Hundt agree West has earned her wings. On a recent cruise to Bermuda, she brought Stepney and Hundt along.

For Hundt, it was the first time he’d been on a boat. And Stepney said it was nothing like the transport ships he and his fellow troops used in the late 1960s: “Well, I’ve gotten to travel, but it was mainly two years in Vietnam, and there weren’t any women around.”

When asked why she brought the pair along, West said caregiving is “a ministry, something you really have to like to do.”

“And you know how the saying goes,” she said. “When you like what you do, you never work a day in your life.”

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En la National Gallery of Art, en Washington, DC, un grupo de adultos mayores, algunos en sillas de ruedas, con Alzheimer, y sus cuidadores están sentados en semicírculo ante un inquietante retrato de una mujer vestida de blanco.

“Respiren profundamente”, les pidió Lorena Bradford, directora de programas accesibles del museo, de pie frente a la obra “The Repentant Magdalen”, de Georges de La Tour.

“Ahora, dejen que sus ojos vaguen por toda la pintura. ¿Qué sienten?

“Creo que se ve triste”, dijo Marie Fanning, de 75 años, de Alexandria, Virginia, quien tiene Alzheimer.

“Sí, parece triste “, apoyó Bradford.

“Este paseo es un regalo”, dijo Bill Fanning, de 77 años, esposo y cuidador de Marie.

En todo el país, grupos comunitarios, hospitales, agencias del gobierno y organizaciones sin fines de lucro están poniendo más esfuerzos para apoyar al menos a algunos de los aproximadamente 42 millones de personas que son las principales cuidadoras de adultos y niños con discapacidades, que se recuperan de cirugías y enfermedades o están lidiando con el Alzheimer y otras condiciones crónicas. El es parte de esta tendencia que se centra en la salud, el bienestar y la educación de los cuidadores.

“Sabemos que vincularse con el arte mejora el bienestar. En nuestra propia investigación sobre personas con demencia, vemos una reducción en la apatía. En los cuidadores, observamos menos aislamiento y una reducción del estrés”, dijo Carolyn Halpin-Healy, directora ejecutiva del programa Arts & Minds para cuidadores y pacientes en el Museo Metropolitano de Arte de Nueva York.

Junto con James Noble, neurólogo de la Universidad de Columbia, Halpin-Healy cofundó el programa en 2010, en el Harlem Studio Museum de Nueva York. El programa Just Us en Washington, DC, es un derivado del original. Otros museos en Nueva York y Dubuque, Iowa, tienen programas similares.

Una nueva ley bipartidista firmada por el presidente Donald Trump en enero exige una estrategia nacional para atender las necesidades de los cuidadores, que son principalmente mujeres y proporcionan 37 mil millones de horas de cuidados no remunerados a familiares o amigos cercanos valorados en $470 mil millones, según un estudio de AARP.

La ley requerirá que el Departamento de Salud y Servicios Humanos (HHS) establezca un consejo asesor y desarrolle un plan para la acción del gobierno en asuntos financieros, laborales, de cuidado de relevo y otros asuntos relacionados con el cuidador.

Al mismo tiempo, 42 estados han aprobado leyes que requieren que los hospitales y otros centros de enfermería brinden capacitación a los cuidadores que realizan tareas médicas, y que los registren como “cuidadores” cuando los pacientes ingresan o son dados de alta de hospitales o centros.

En estados sin esa ley -Alabama, Florida, Georgia, Idaho, Carolina del Sur, Dakota del Sur, Vermont y Wisconsin-, (la ley de Kansas entra en vigencia en julio), los pacientes pueden ser dados de alta ​​del hospital sin que los miembros de la familia reciban información completa sobre la atención que el ser querido necesita.

La Ley CARE es “más que una simple ley”, dijo Elaine Ryan, vicepresidenta de defensa y estrategia estatal de AARP. “Es un cambio en la práctica del cuidado de la salud”.

Ayudando a los que ayudan

Los cuidadores tienen casi dos veces más probabilidades de sufrir trastornos emocionales y físicos, y tres veces más riesgo de tener problemas de productividad en el trabajo, según un estudio de 2015 de la Universidad Johns Hopkins. Cuanto más intensa es la atención, mayores son los efectos, según este estudio.

El gerontólogo Eric Coleman creó el Care Transitions Intervention Model (CTI). El programa nacional con sede en la Universidad de Colorado, en Denver, capacita a entrenadores para ayudar a los cuidadores a hacer la transición del paciente del hospital a la atención domiciliaria. Los entrenadores suelen ser trabajadores sociales, enfermeras u otras personas contratadas por hospitales y otras instalaciones para trabajar directamente con los cuidadores.

Los entrenadores hablan con el cuidador antes que los pacientes sean dados de alta. Luego tienen una sesión de entrenamiento de una hora en el hogar del paciente y tres llamadas telefónicas de seguimiento. Los estudios han demostrado que tener entrenadores de transición puede bajar la readmisión en los hospitales entre un 20% y un 50%, dijo Coleman.

Los cuidadores hacen más que cocinar; realizan tareas médicas como administrar medicamentos, tomar la presión arterial, cambiar vendas y más. Sin embargo, prácticamente no reciben capacitación, agregó.

Un estudio de AARP encontró que el 46% de los cuidadores familiares realizan tareas médicas o de enfermería, el 78% manejan los medicamentos y el 53% coordinan la atención médica. La mayoría dijo que no recibió capacitación.

Los cuidadores son “la columna vertebral de nuestro sistema de salud”, expresó el doctor Alan Stevens, gerontólogo que entrena a cuidadores en asociación con Baylor Scott White, la mayor compañía hospitalaria sin fines de lucro en Texas.

“Si los cuidadores se van, tenemos un problema. Es importante entender mejor sus necesidades y ayudarlos”.

Entrenamiento con diversión

Por eso, los cuidadores también necesitan un poco de diversión y relajación, dijo Jason Resendez, director ejecutivo de Latinos Against Alzheimer’s Coalition. Alrededor de 8 millones de latinos son cuidadores de sus familiares, y casi 2 millones están cuidando a un pariente con Alzheimer, agregó.

Por ejemplo, en Los Ángeles, grupos latinos realizaron una obra de teatro, una comedia, en español sobre un hijo que es el cuidador de su madre. Y en Chicago, la Alianza Latina de Alzheimer y Trastornos de la Memoria (LAMDA) ofrece capacitación para cuidadores y clases gratuitas de salsa.

“No se trata solo de la traducción; o repartir panfletos”, enfatizó Resendez.

Vinculando hospitales y cuidadores

Dignity Health Systems, la cadena de hospitales sin fines de lucro más grande de California, se ha asociado con la Fundación Santa Barbara para proporcionar entrenadores de cuidadores. Se está entrenando a unos 1,000 cuidadores a la vez, dijo Kathleen Sullivan, vicepresidenta de servicios de atención aguda para Dignity.

“Ahora los cuidadores se identifican como un socio en el equipo de salud del paciente, dijo. “Reciben una placa, tienen una bolsa con información y el hospital sabe a quién contactar”.

En Virginia, el Bay Area Council on Aging y un consorcio de otros cuatro grupos y cinco hospitales están capacitando a entrenadores de cuidadores que usan el programa CTI. La clave para que sea exitoso es hacerlo en la misma casa en donde se cuida al ser querido, dijo Kathy Vesley, miembro del consejo.

“Algunas de estas personas están muy enfermas y están manejando más de 12 medicamentos”, dijo Vesley. “Entras en la casa y dicen: ‘Aquí está mi bolsa de medicamentos.’ Y es literalmente una bolsa de mercado”.

El consorcio ha atendido a 26,000 pacientes y cuidadores durante los últimos 2 años y medio, y la readmisión a los hospitales disminuyó del 23,4% al 9%, apuntó. Los entrenadores ayudan con la capacitación en alimentos, medicamentos y videos sobre cómo hacer procedimientos médicos y cómo resolver problemas relacionados con la manera de llevar a los pacientes a las citas médicas.

Afuera, en la zona rural del sudeste de Virginia, “el transporte adquiere un significado completamente nuevo”, dijo, “cuando el camino de entrada tiene media milla de largo”.

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At the National Gallery of Art in Washington, D.C., a group of older adults — some in wheelchairs, some with Alzheimer’s — and their caregivers sit in a semicircle around a haunting portrait of a woman in white.

“Take a deep breath,” said Lorena Bradford, head of accessible programs at the National Gallery, standing before “The Repentant Magdalen” by Georges de La Tour.

“Now, let your eyes wander all over the painting. Take it all in. What do you think is going on?”

“I think she looks sad,” said Marie Fanning, 75, of Alexandria, Va., an Alzheimer’s patient.

“Yes. Yes, she looks sad,” said Bradford.

“This is such a gift,” Bill Fanning, 77, Marie’s husband and caregiver, said of the outing.

Across the country, community groups, hospitals, government agencies and nonprofits are doing more to support at least some of the estimated 42 million people who are the primary caregivers of adults and children who have disabilities, are recovering from surgeries and illnesses or are coping with Alzheimer’s and other chronic diseases. is part of the trend focusing on the health, well-being and education of caregivers.

“We know that involvement with art improves well-being. In our own research for persons with dementia, we see a reduction in apathy. For caregivers, we see less isolation and a reduction in stress,” said Carolyn Halpin-Healy, executive director of the Arts & Minds program for caregivers and patients at the Metropolitan Museum of Art in New York.

She co-founded the program with Columbia University neurologist James Noble in 2010 at the Harlem Studio Museum in New York. The Just Us program in Washington is a spinoff of that program. Other museums in New York and Dubuque, Iowa, have similar programs.

A new bipartisan law signed by President Donald Trump in January calls for a national strategy to address the needs of caregivers, who are primarily women and provide 37 billion hours in unpaid care to relatives or close friends valued at $470 billion, according to an AARP study. The law will require the Department of Health and Human Services to set up an advisory council and develop a blueprint for government action on financial, workplace, respite care and other caregiver issues.

At the same time, 42 states have passed laws requiring hospitals and other nursing facilities to provide training for caregivers who perform medical tasks, and to record them as the “caregiver” when patients are admitted or released from hospitals or nursing facilities. In states without that law Alabama, Florida, Georgia, Idaho, South Carolina, South Dakota, Vermont and Wisconsin (Kansas’ law takes effect in July) — patients can be dismissed from the hospital without family members being told or briefed fully on what care the patient needs.

The CARE Act is “more than just a law,” said Elaine Ryan, AARP vice president of state advocacy and strategy. “It’s a change in the practice of health care.”

Helping The Helpers

Caregivers are almost two times more likely to have emotional and physical problems, and three times more likely to have productivity problems at work, according to a 2015 study by Johns Hopkins. The more intense the care, the greater the effects, the study said.

Dr. Eric Coleman, a gerontologist who received a MacArthur “genius award” grant in 2012, created the Care Transitions Intervention model (CTI).Ìý The national program based at the University of Colorado in Denver trains coaches to help caregivers transition their patient to home care. The coaches are usually social workers, nurses or others hired by hospitals and other facilities to work directly with caregivers.

Coaches talk to the caregiver before patients are discharged from a hospital. Then they have a one-hour coaching session at the patient’s home, and three follow-up phone calls. Studies have shown that having transition coaches can drop readmission to hospitals by 20 to 50 percent, said Coleman.

Even if a caregiver is with the patient when doctors give instructions, the medical talk can go right over their heads, he said. “We tell people that for the next 24 to 48 hours, here are key things you need to do. Then we follow up at home,” he said.

Caregivers do more than make meals; they perform medical tasks like giving medicine, taking blood pressure, changing bandages and more. Yet they receive virtually no training, Coleman said.

“I’m a physician, and when I take care of my mom, I have an endless loop in my head,” of the to-do list, he said.

A study by AARP found that 46 percent of family caregivers perform medical/nursing tasks, 78 percent of family caregivers manage medications, and 53 percent of family caregivers serve as care coordinators. The majority said they received no training.

Caregivers are “the backbone of our health system,” said Dr. Alan Stevens, a gerontologist who trains caregivers in partnership with Baylor Scott White, the largest nonprofit hospital company in Texas, and a group of aging agencies across the state.

“If caregivers go away, we have a problem. It’s important to better understand their needs — and to help them.”

Linking Hospitals With Caregivers

Dignity Health Systems, the largest nonprofit hospital company in California, is partnering with the nonprofit Santa Barbara Foundation to provide caregiver coaches. At any given time, 1,000 caregivers are being coached, said Kathleen Sullivan, vice president of acute care services for Dignity.

“Now caregivers are identified as a partner in the health team” of the patient, she said. “They’re given a badge, they have a tote bag with information, and the hospital knows who to contact.”

The group works with nonprofit aging agencies to provide in-home coaches, she said. “When people get home from the hospital, they’re just exhausted. They don’t remember what they were told in the hospital.”

In Virginia, the Bay Area Council on Aging and a consortium of four other groups and five hospitals are training caregiver coaches using the CTI program. The key to successful coaching of caregivers is to take training to the homes of caregivers and patients, said Kathy Vesley, of the Bay Area Council on Aging in Fredericksburg, Va.

“Some of these folks are very ill and they’re managing 12-plus medications,” said Vesley. “You get into the home and they say, ‘Here’s my shopping bag of medicines.’ And it’s literally a shopping bag.”

The consortium has seen 26,000 patients and caregivers over the past 2½ years and readmission to the hospitals fell from 23.4 to 9 percent, she said. Coaches help with food, medicine and video training for how to do medical procedures and help solve issues like how to get patients to doctor’s appointments.

Out in rural southeastern Virginia, “transportation takes a whole new meaning,” she said, “when your driveway is half a mile long.”

Having Fun Helps, Too

Caregivers need a little fun and relaxation, said Jason Resendez, executive director of the Latinos Against Alzheimer’s Coalition. About 8 million Latinos are caregivers for their family members, and nearly 2 million are caring for family members with Alzheimer’s, he said.

For instance, in Los Angeles, Latino groups partnered on a play performed in Spanish about a son who is his mother’s caregiver. It was a comedy. And in Chicago, the Latino Alzheimer’s and Memory Disorders Alliance (LAMDA) holds caregiver training — and free salsa dancing classes.

“It’s not just about translation; it’s not just about handing out pamphlets,” he said.

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Hospitals provide observation care for patients who are not well enough to go home but not sick enough to be admitted. The care may seem just like what an admitted patient receives — they are in a hospital room, nurses check on them and doctors Ìýorder treatments.

But surprises can arise over billing because Medicare considers this outpatient care. So instead of Medicare picking up most of the bill, patients usually also have copayments for doctors’ fees and each hospital service, and they have to pay whatever the hospital charges for any routine drugs the hospital provides that they take at home for chronic conditions.

This video by Francis Ying and Thu Nguyen, narrated by Lynne Shallcross, explains what happens. For a transcript of the video, .

For more information, check out Medicare’s Ìý²¹²Ô»å .

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Duke University researchers looked at a program called , which was started in the early 1990s for children who were identified by their teachers and parents to be at high risk for developing aggressive behavioral problems.

The students were randomized into two groups; half took part in the intervention, which included a teacher-led curriculum, parent training groups, academic tutoring and lessons in self-control and social skills. The program, which lasted from first grade through 10th grade, reduced delinquency, arrests and use of health and mental health services as the students aged through adolescence and young adulthood, as researchers explained in a .

“To the extent we can improve those skills, we can improve outcomes in delinquency and juvenile crime,” says Dodge, who is also director of Duke’s Center for Child and Family Policy. The study was published Wednesday in the journal .

To , a psychologist in Washington, D.C., who specializes in child and adolescent behavior disorders, the researchers’ findings seem consistent with what he’s seen on the ground in working with children for more than 30 years. And while he says he agrees with the importance of teaching self-control and social skills, he would add empathy to the list, too.

“Empathy is what makes us aware of the feelings of others, and when you’re empathic, you’re much less likely to hurt someone else’s feelings,” says Bernstein, who serves on the advisory board for the Partnership for Drug-Free Kids and is the author of multiple books, including How to Keep Your Teenager Out of Trouble and What to Do if You Can’t.

Being in tune with how someone else feels might also make adolescents steer clear of bullying and other “behaviors of concern,” Bernstein says.

Empathy was not one of the skills that wasÌýdirectly measured in this study, according to Lucy Sorensen, a Ph.D. student at Duke and lead author of the study. But there were several measures of “prosocial behavior,” Sorensen says, defined as voluntary behavior intended to benefit others.

While Bernstein thinks the study’s findings are meaningful and could potentially serve as a model for schools, he says that collectively getting a school system, teachers, parents and students all motivated enough to take part in an intervention like Fast Track is challenging.

Several parts of the Fast Track study have been picked up successfully in , Sorensen says, such as a social-emotional learning curriculum called Promoting Alternative Thinking Strategies, or PATHS. Programs like Fast Track need buy-in from school systems, teachers and parents, she says, and that can be a tough sell. But she adds that it’s a strength of Fast Track that the students get support both at school and at home.

“There’s a growing and new understanding of what it takes to be successful as an adolescent and an adult,” Dodge says. “It used to be that what we thought all it took was academic skills. Reading and math are very important for tasks that require reading and math. Self-control is important for life tasks that require self-control — that’s what avoiding arrest and violent crime is all about.”

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According to new research, low-income women who lived in a handful of early-adopter states that implemented Medicaid expansion by 2011 were 25 percent more likely to be screened for breast cancer in 2012 than women in non-expansion states. That’s a big change from 2008, when low-income women in both sets of states had similar odds of being screened. The was presented Monday at the annual meeting of the Radiological Society of North America.

The researchers weren’t surprised by the results and had hoped to see an effect from the Medicaid expansion, says lead author Soudabeh Fazeli Dehkordy. “We would expect to see actually greater differences if we redo the analysis today with 2015 [data],” says Fazeli Dehkordy, a first-year resident at St. John Providence Hospital in Southfield, Mich.

Fazeli Dehkordy and her colleagues used data from the 2008 and 2012 Behavioral Risk Factor Surveillance System to look at roughly 31,000 American women ages 40 to 70 who self-reported how often they got mammograms. When the researchers adjusted for age, race, education and income, they found that low-income women in the early-expansion states in 2012 —Ìýwhich included California, Connecticut, Minnesota, New Jersey, Washington and the District of Columbia —Ìýwere 25 percent more likely to get screened than women in non-expansion states.

Several studies have indicated a general decline in mammography rates following from the U.S. Preventive Services Task Force in 2009, Fazeli Dehkordy says. Those recommendations suggested that women could wait until age 50 before beginning regular mammograms and, at that point, begin getting them every other year. “There has been a lot of controversy regarding the importance of screening mammography, especially regarding the best age,” Fazeli Dehkordy says.

Indeed, the guidelines can still be confusing to women: the American Cancer Society updated its in October, pushing back the age at which it recommends women begin annual screenings from 40 to 45.

Yet despite the overall decline in screening rates, the rates among low-income women stayed steady from 2008 to 2012 in states that expanded Medicaid early on, the researchers found.

The next step for research, Fazeli Dehkordy says, is to explore whether expanded coverage and more mammograms translate to better health outcomes with regard to breast cancer. For this study, the researchers did not look into whether low-income women who are now on Medicaid had difficulty finding providers where they could obtain screenings or specialists to follow up with if a screening finds something abnormal.

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Online programs to fight depression are already commercially available, and while they sound efficient and cost-saving, a study out of the U.K. reports that they’re not effective, primarily because depressed patients aren’t likely to engage with them or stick with them.

°Õ³ó±ðÌý, which was published inÌýThe BMJÌýon Wednesday, looked at computer-assisted cognitive behavioral therapyÌýand found that it was no more effective in treating depression than the usual care patients receive from a primary care doctor.

Traditional cognitive behavioral therapy (CBT) is considered an effective form of talk therapy for depression, helping people challenge negative thoughts and change the way they think in order to change their mood and behaviors. Online CBT programs have beenÌý, with the allure of providing low-cost help wherever someone has access to a computer.

The lack of patient engagement in this study means these programs aren’t the panacea that busy doctors and cost-conscious health care officials might be hoping for, Dowrick wrote in the editorial. Yet it’s important to note that the study was conducted in a primary care setting, he says, because many other studies on cCBT that show some benefit have been conducted in psychological settings, where patients might be more motivated to engage with these kinds of online programs.

Despite the unenthusiastic findings of the study, Dowrick says that do-it-yourself treatments like cCBT can still be effective. But they’re more likely to succeed when people have relatively mild symptoms of depression or are in a recovery stage – the participants in this study were mostly in the category of moderate to severe depression, he says.ÌýComputerized CBT is also more likely to succeed, he adds, if the patients are open to seeking help on a computer and when they have a “reasonable amount” of guidance as they go through the program, preferably from a therapist. In this study, he says, participants each totaled roughly six minutes of telephone support and guidance.

Being depressed can mean feeling “lost in your own little small, negative, dark world,” Dowrick says. Having a person, instead of a computer, reach out to you is particularly important in combating that sense of isolation. “When you’re emotionally vulnerable, you’re even more in need of a caring human being,” he says.

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If you’re rooting for smartphones to solve all our health problems, you’re not going to like what the researchers found. The smartphone app didn’t help young adults lose any more weight than if they hadn’t been using the app at all.

The , which was published in the journal Obesity, looked at 365 young adults ages 18 to 35. A third of the participants used an Android app specifically created for the study, which not only tracked their calories, weight and exercise but also offered interactive features like goal setting, games and social support. Another third of the participants received six weekly personal coaching sessions, followed by monthly phone follow-ups. Plus, this personal coaching group was also encouraged to track their weight, calories and exercise via smartphone. The last third of the participants were given three handouts on healthy eating and exercise – nothing else.

Researchers tracked the young adults’ progress after six months, one year and two years. The personal coaching group had lost more weight than the other two groups after six months, but that lead vanished at the one- and two-year follow-ups. As for the group using the smartphone app, their average weight loss was never more than the other two groups.

Lead author said that she and her colleagues were both surprised and disappointed at the results. “Given the seeming power of cell phone apps and frankly the popularity of these health and fitness apps in the commercial world, we thought this might be a really good strategy to provide effective intervention very broadly and potentially at low cost,” said Svetkey, a professor of medicine at Duke University School of Medicine.

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