By Sarah Hijaz, Health Policy Intern Sarah is a recent graduate of The George Washington University Trachtenberg of Public Policy and Public Administration, where she received a Master of Public Policy (MPP). Her main background is in public health, having worked in clinical trial protocol development and cancer health disparity research and outreach efforts. Sarah plans to pursue a Doctor of Public Health (DrPH) degree, concentrating on health policy. During the interim period before starting a DrPH program, an internship at NCL is a great opportunity to gain exposure to the advocacy side of public health and health policy.

November is Family Caregivers Month, and as President Obama describes it’s meant to “recognize and thank the humble heroes who do so much to keep our families and communities strong.” Family caregivers are individuals, including friends or neighbors that dedicate unpaid time and resources towards caring for the physical and/or mental health of a loved one. The Caregiver Action Network, a non-profit organization that provides support, education, and resources to family caregivers across the United States, has identified the theme for this year’s Family Caregivers Month as “Now More Than Ever.”

Family caregiver advocates are increasingly calling for a shift in the focus of national conversation away from the concept that family caregivers are simply providers of care to a more relationship in which these caregivers are also integral members of loved ones’ healthcare teams. There are 90 million family caregivers in this country; that’s two out of every five adults who care for one or more family members. Certain patient populations that depend heavily on family caregiving support are rising, such as those suffering from Alzheimer’s, children with special needs, as well as wounded veterans. The overall population of adult caregivers has correspondingly risen from 30% to 39% in the past 3 years. Often, many caregivers find themselves in this challenging and complex role suddenly and with little warning or time for preparation.

Patient health issues can be purely physical, emphasizing family care activities that focus on duties such as administration of medications or household help. However, other loved ones may suffer from psychological ailments that leave them unable to take part in their care planning, transforming the family caregiver into a healthcare decision maker. Because of the many different roles that a family caregiver can play, there are rising calls for a more formal recognition of family caregivers as key members of patient-centered teams.

This past Friday, I attended a conference at The Kaiser Permanente Center for Total Health in Washington, DC. The focus of the event was “Identifying Family Caregivers in Electronic Health Records (EHRs).” Technology is beginning to play a larger role in healthcare, especially technology aimed at compiling and organizing patient information. Proponents of EHRs claim that computerizing patient health records can have many benefits, such as reducing unnecessary testing and prescribing. The push towards expanding EHRs to all healthcare settings is gaining traction; the Patient Protection and Affordable Care Act even includes elements to support this drive. While EHRs can expand patient-provider communication and improve health care, there are concerns that family caregivers might not have equal access to electronic records. Especially since family caregivers have so far been under-recognized as valid healthcare team members.

There was no doubt in the room that supporting patients/loved ones requires expanding the healthcare team to include family caregivers. However, while this concept may seem straightforward, there are plenty of questions that need to be addressed in order to incorporate this goal into EHRs. For example, are family caregivers’ formally identified in the EHR? Does the patient identify family caregivers? If so, what if the patient is suffering from dementia? At what point do caregiver demands and the seriousness of a patient’s conditions warrant the designation of someone who is “helping out” to be an official family caregiver?  There is a great deal that needs to be clarified as the healthcare system in this country continues it push towards expanded EHR systems. Family caregiving is not only an evolving role, but also is an evolving concept.

The nature of what constitutes a family caregiver is being discussed and debated. The increasing conversation on this topic can only improve our understanding and will hopefully improve care for patients under the attention of family caregivers as well as ease the burden associated with caring for a loved one. For more than 90 million Americans, Family Caregivers Month is not the only time of the year that family caregiving is recognized and reflected upon. Patients and their professional healthcare providers have long asserted the important nature of family caregiving.

The Large Retailer Accountability Act (LRAA) was vetoed by DC Mayor Vincent Gray and then the veto was sustained by the DC City Council earlier this month. This was a defeat for DC’s low wage workers and a missed opportunity for Washington to set an example for the rest of the country that workers deserve a living wage.

This is a compelling letter from Daniel Solomon, a DC resident, to the Mayor urging him to sign the LRAA in the days leading up to his decision. Dear Mayor Gray, I have been following the progress of the Large Retailer Accountability Act since it first attracted public attention last year.  I find the arguments of its proponents compelling and the arguments of its opponents weak at best.  I urge you to act on your best instincts and sign the bill.

My grandfather, N. M. Cohen, founded Giant Food in Washington, DC in 1936.  From the beginning, he regarded his workers as his most important asset.  He would say, “This company is built on three things: people, people, people.” He paid his people well.  He dealt fairly with the union that represented them, even ordering coffee for strikers in the rare instance when his workers went on strike in winter.  He built Giant on the shoulders of his workers, not on their backs.

He made a lot of money as a high-road employer.  He plowed that money back into the community in a variety of ways, not the least of which is through the Naomi and Nehemiah Cohen Foundation, which continues to give back to the District of Columbia. N. M. would be appalled to watch WalMart’s hijinks.  Threatening to leave D.C. or cut back on its planned investments here if we don’t keep their workers’ wages down.  Using the needs of our poorest communities as leverage, rather than as a reason to build new stores and pay workers living wages.

Refusing to testify publicly on the Large Retailer Accountability Act, but seeking to kill the legislation  behind the scenes through highly-paid lobbyists and using other businesses and business associations as its surrogates.  Pursuing a low road to growth rather than the high road pursued by Giant Food and such other companies as Costco and Trader Joe’s and Quick Chek. Your campaign theme of One City meant a great deal to me, both as a member of the Giant family and as a prosperous resident on the prosperous side of town.

I believe DC will be One City and a thriving city only when the least fortunate residents have good jobs, excellent schools and the opportunities now available almost exclusively to those West of the River.  Good jobs are not retail jobs at or near minimum wages.  Those jobs will only perpetuate poverty.  Of course, not every retailer can afford to provide living wage jobs.  Those that can should.  Surely big box retailers whose parent companies earn $1 billion or more a year can afford far more than many of them choose to provide. You and some of the Council opponents of LRAA say that the residents of Ward 7 want the jobs WalMart may bring, no matter what they pay.  Elissa Silverman of the DC Fiscal Policy Institute has found otherwise.

Here is a link to her article: https://www.dcfpi.org/all/one-thousand-dc-residents-have-signed-on-for-a-living-wage-and-counting/ Your Administration has done much to raise the prospects and hopes of those East of the River.  I urge you to harness the wealth of the large retailers who want to do business here to provide the next boost. Please sign the LRAA. Sincerely, Daniel Solomon

Do you text when you drive? Sure, you can stay in constant contact with your friends, instantly “like” a picture on Facebook, or tweet what you just passed on the road, but it’s not worth it? More than 100,000 car crashes every year involve drivers who are texting. It can wait.

Over 75 percent of teens say texting and driving is common among their friends. This habit is widespread and deadly. AT&T’s “It Can Wait” campaign encourages teens to put down the phone when driving and focus on the road. Today, September 19, is the Drive 4 Pledges Day. Americans around the country are encouraged to sign a pledge that they will not drive and text. Texting isn’t the only distraction while driving.

In 2011, accidents resulting from drivers texting, calling, eating, reading maps, using navigation systems, and performing other distracting activities, resulted in 3,331 deaths and an additional 387,000 injuries. For teen drivers, over 20 percent of fatal crashes involved a distracted driver on a cellphone. Need a reason to sign the pledge? Watch these videos of family members telling stories of how they lost loved ones in car accidents involving distracted drivers. 

A driver who sends a text will be distracted for five seconds. Anything can happen in five seconds. Play this game to see just how dangerous it is to text and drive. In a survey of teen drivers, 97 percent of teens say texting while driving is dangerous, and yet 43 percent admit they do it. It’s time this changes. Become an advocate for the cause and pledge that you will not text and drive. This is a public health and safety epidemic; no text is worth the risk. It’s not worth it. Put the phone down. It can wait.

 

This week, in honor of Labor Day, let’s take some time to acknowledge the growing disparity between CEOs and the workers who make their companies succeed. Workers are the backbone of our nation. Thank you to America’s workforce, and this year let’s think about spreading the wealth.