Friday, October 20, 2023

Many rural counties are poorly equipped to deal with rising gun homicides; some of the worst rates are in the South

From 2016 to 2020, Phillips County had the country’s highest per capita
rate of gun homicides. (Photo by Renuka Rayasam, KFF Health News)
Homicides involving guns are often considered an urban problem, but rural America has its own firearm traumas that few communities have the resources to address effectively. "Nationwide, rural gun homicides have risen, and, in some areas, outpaced their urban counterparts. From 2016 to 2020, 13 of the 20 counties with the highest gun homicide rates were in the rural South, according to the Center for American Progress, a policy research institute, reports Renuka Rayasam for The Daily Yonder.

Elaine, Arkansas, pop. 500, is a dramatic example, "Phillips County, where Elaine is located, is home to about 15,000 people spread across 690 square miles. Data shows they're at high risk of gun violence. From 2016 to 2020, the Phillips County had the country's highest per capita rate of gun homicides, according to an analysis last year by the CAP," Rayasam writes. "During three days in July, police responded to reports of four homicides in Helena-West Helena, the Phillips County seat. That might be a small number for a major city, but it has an outsize impact in a rural town," said Nick Wilson, senior director for gun violence prevention at the Center for American Progress. The sheer number of deaths can devastate communities that often lack resources to stem gun violence or mental health services to help traumatized residents. Also, the nearest medical centers to treat victims are often miles away.

Segregated communities, racism and poverty add to social tensions that can lead to violent outcomes. Phillips County has "a harrowing history of racism," Rayasam reports. "In 1919, Elaine was the site of one of the worst racial massacres in U.S. history. At least 200 Black residents were murdered by white residents and soldiers over a couple of days after a group of Black farmers met one late September evening to demand better payments for their cotton crops." Daniel Webster, a distinguished scholar at the Johns Hopkins Center for Gun Violence Solutions, told Rayasam: "These disadvantages are structural and driven by policy rather than naturally occurring. The conditions that lead to structural racism also lead to higher rates of gun violence. . . . These places have lacked investment, where poverty is rampant, unemployment is high, schools are failing, and buildings are crumbling."

"Under those conditions, even small stressors, like a fight over a cigarette, can lead to a shooting, researchers say. Most homicides in Phillips County, as in urban areas, stem from interpersonal or domestic disputes," Rayasam adds. "A few years ago, a man in Helena shot a man who allegedly stole butter beans from his garden."

Hicks Gilbert, who became Elaine's first Black and female mayor, is working on changing "'the mindset of what is possible,'" Rayasam reports. "She is requiring public housing operators to keep properties up to code, bringing in dumpsters to encourage residents to clean up trash, tearing down dilapidated houses, hiring young people to work in city government and at the community center, and starting a tutoring program." But progress can be slow and "persistent poverty and violence take an emotional toll, said Steven Cannon, a pastor who also runs an after-school community center in West Helena." Cannon told Rayasam, "What you see can be depressing at times, especially on a young generation."

Iowa farmer still owns two of the first John Deere plows ever made; the plows 'forever changed agriculture and America'

The plows are almost 200 years old.
(Photo by Sam Shaff via The Daily Scoop)
A tale of two plows begins in Germany, travels to Wisconsin territory, and ends in Sam Shaff's "unassuming garage" in rural Iowa," reports Chris Bennett for The Daily Scoop. "Twin grails that changed U.S. history — a pair of steel, moldboard plows crafted in the flesh by the hands of John Deere and bought directly from the American titan’s Illinois shop in 1839 and 1840 . . . . Purchased by Shaff’s great-great grandfather, Heman Shaff, the 1839 specimen was the first Deere plow on Iowa farmland, and possibly the first to break dirt on the far side of the Mississippi River during America’s westward expansion."

Shaff told Bennett, “My family bought the plows directly from John Deere, and the accounts I was told all said that Deere was an extremely busy, but very nice gentleman. The first plow cost $24, and all the neighbors wanted a turn to use it.”

Bennett writes, "On 1,000 acres of corn and soybeans in eastern Iowa’s Clinton County, a stone’s throw from the Mississippi River outside Camanche, the oldest continuous farm in Iowa is overseen by seventh-generation producer Sam Shaff. Shaff told him, “Like with a lot of people, my family history gets richer the older I get.” 

The "intrepid" Sam Shaff and his wife, Mary
(Shaff Family Farm photo via Daily Scoop)
"In 1732, the year of George Washington’s birth, the Shaff family departed Germany for colonial shores. . . beckoned by westward opportunity, 19-year-old Heman Shaff loaded his widowed mother, two sisters, and a younger brother into two covered wagons — generally bound for the vast, five-state expanse of Wisconsin Territory, but specifically zeroed on what would become the state of Iowa," Bennett writes. "In 1838, Heman moved the Shaff family across the Mississippi River and broke virgin soil on 240 acres of Camanche dirt. . . . Heman heard accounts of a plow wonder made by an innovative blacksmith — Mr. John Deere."

In 1836, financially strapped Deere moved from Vermont to Illinois and set up a blacksmith business in northwest Illinois’ Grand Detour. Bennett reports, "In 1837, inside a 26’-by-31’ shop on the Rock River, Deere solved the plow riddle. His solution? Sleek, polished steel. . . . Deere built a self-scouring steel plow — an answer to the drag of cast iron and sticky prairie soils of the Midwest. . . .In 1837, he produced a single steel plow. In 1838, he made two plows. . . . In 1839, he quintupled production to 10 plows. And that same year — 1839 — Heman Shaff crossed the Mississippi River, rode 60 miles, and knocked on Deere’s door, anxious to buy one of 10 magical moldboards."

Sam Shaff is a seventh-generation producer.
(Shaff Family Farm photo via Daily Scoop)
“Heman went all the way to Grand Detour and bought the plow personally from Deere," Shaff told Bennett. "Loaded onto his wagon, Heman returned to Camanche with the first Deere steel moldboard used on Iowa farmland—and possibly the first Deere steel plow used west of the Mississippi River. . . . The neighbors couldn’t get over how well it worked, and they borrowed it at night, literally plowing by lantern light. It worked so well that Heman went back to Deere’s shop in Grand Detour in 1840 and bought another. . . I have the oldest farm in Iowa. . . . I’m protecting two of Deere’s plows—personally made by him and personally sold by him almost 200 years ago.” Bennett adds, "Simply, Shaff owns steel that forever changed agriculture and America."

Project offers multi-faceted help for ethical addiction reporting

Reporting on Addiction is a collaborative project staffed by media professionals with a shared goal of decreasing addiction stigmas by providing best practices for covering all types of addiction. The project touts an array of options for newsrooms of all sizes, including professional and student newsroom training, research-based reporting resources, and an active expert database for question-and-answer volleys with an actual human.

Their website just added a visual guide for journalists to use for photo portrayals of addiction that keep ethical journalism's first principle of do no harm at its heart. "Visual journalism has the power to create deep and lasting connections beyond the written word; therefore, visual journalists must be highly intentional to reduce harm and honor their sources' full experiences while also educating their audiences." Access their one-page visual style guide here.

If your community is receiving opioid lawsuit materials, the project has an introductory newsletter series that "will bring you up-to-speed about the settlement money and how you can cover it in your city, county, or state. It also offers a Slack channel to "share resources, your work, and get questions answered." Everything from "Fireside chats" to style guides to sensitivity reads are also available. Their database is searchable and vetted

Reporting on Addiction offers training that is for journalists and people working in addiction spaces who want to improve media coverage but may not know where to start. Their training helps reporters and professionals by providing:
  • Newsroom-level trainings that discuss the latest in addiction science, how stigma can unintentionally appear in reporting, and how to use resources to improve stories. 
  • Group trainings to prepare participants to translate their message to a broader audience. 
  • Group training that focuses on empowering people in their interactions with local, regional and national journalists. The goal is for participants to come away with a basic understanding of how journalists find them and make decisions about reporting, best practices for interacting with the media, and how to cultivate relationships with journalists to improve coverage today.
Journalists, educators and experts can complete an online request for training. Custom training is also available.

Opinion: Growing old includes the good, the bad and the unexpected

Illustration by Lauren Martin, The New York Times
Aging can be filled with experiences you never wanted to have, often failing to live up to past expectations, muses 83-year-old Roger Rosenblatt in his opinion piece for The New York Times. Humorous highlights are condensed below.

"Old age isn’t what the books promised it would be. Literature is littered with old people for whom the years have brought some combination of wisdom, serenity, authority and power — King Lear, the ageless priest in Shangri-La, Miss Marple, Mr. Chips, Mrs. Chips (I made that up), Dickens’s Aged P, crazy Mrs. Danvers. In fiction, old folks are usually impressive and in control. In life, something less.

"I can’t think of anyone who has come to me for wisdom, serenity, authority or power. People do come to sell me life insurance for $9 a month and medicines such as Prevagen, which is advertised on TV as making one sharper and improving one’s memory. Of course, that is beneficial only to those who have more things they wish to remember than to forget.

"One thing I need to remember is which day for which doctor. . . . On one day last week, I had a vascular sonogram in the morning, consulted my ophthalmologist in the afternoon, made an appointment with a retina specialist, spoke to my primary care physician about test results and put off my dentist. As a result of such activities, my vocabulary has increased. I now can say 'occlusion' — and mean it.

"I wrote a book called Rules for Aging 25 years ago. . . .The rules were less about aging than about living generally, one of the first being 'Nobody’s thinking about you.' . . . In old age that’s true in spades. . . . You disappear from the culture, or rather, it disappears from you.

"To be sure, old age has compensations. Grandchildren. Their company is delightful, partly because they think you have something useful to impart, if you could remember to impart it. Waitresses tend to treat you sweetly. Doormen and maintenance crews show respect. And there are positive or harmless activities for the over the hill. Women take up watercolors and form book clubs. Men find loud, if pointless, camaraderie in diners and on village benches all over the country. Hey, old-timer.

"My point is: Who ever expected to spend time wondering if Madison Beer is a beverage honoring a founding father? Who ever expected that one’s social circle would consist of Marie, who does blood work, and an M.R.I. technician named Lou? Who ever expected old age?"

Thursday, October 19, 2023

Berkshire Eagle, Seven Days, Vermont Standard, Nantucket paper big rural winners in New England newspaper awards

Slide from awards presentation

The Berkshire Eagle
scored big in the New England Newspaper and Press Association awards, which were announced Thursday during the group's semiannual online conference.

The Eagle, of Pittsfield, Mass., was judged the best small daily (less than 9,000 print circulation), with The Keene Sentinel of New Hampshire and the Record Journal of Meriden, Conn., as runners-up. 

The Eagle was judged to have the best editorial, "chastising the Catholic diocese in western Massachusetts for trying to subpoena a reporter's notes which would reveal confidential sources" and calling on legislators to pass a shield law like most other states have to protect reporters. 

And the Eagle won two of NENPA's Publick Occurrences awards, named for America's first newspaper and honoring 13 pieces that were judged to be the best in New England journalism in the past year. The rural or rural-impact winners included the Eagle's reports on nursing homes and hazardous-materials shipments on trains that go through its region; projects by Seven Days of Burlington, Vermont, on child care and the pandemic's impact on housing in the largely rural state; the Lewiston Sun Journal's "Homeless in Maine" series; the Concord Monitor's series on police spending and policies all over New Hampshire; and CT Mirror's "Elder Care Reckoning" series that prompted reforms in Connecticut.

The best small weekly newspaper in New England was judged to be the Vermont Standard of Woodstock, with runners-up the Milton Times of Massachusetts and the St. Albans Messenger of Vermont. The best large weekly (over 4,000 circ.) was the Inquirer and Mirror of Nantucket, Mass.; runners-up were the Martha's Vineyard Times and sister papers in Maine, the Mt. Desert Islander of Bar Harbor the Ellsworth American. The best mid-size daily (circ. 9,000-20,000) was The Day of New London, Conn., with Massachusetts' Daily Hampshire Gazette of Northampton and the Greenfield Recorder runners-up. The Concord Monitor was judged best small Sunday paper.

American farmers are getting old, and there aren't enough younger farmers to replace them

Lack of younger farms means aging farmers have to work
  harder. (Photo by KT Kanazawich, The Washington Post)
American farming has a problem -- its labor force is aging, and there's no clear pipeline to fill the eventual need. "The average American farmer is 57 and a half years old, according to the most recent data from the Department of Agriculture. That's up sharply from 1978, when the figure was just a smidge over 50, report David R. Buys, John J. Green and Mary Nelson Robertson for The Conversation, a platform for journalism by academics. "As researchers who study well-being in rural areas, we wanted to understand this trend and its implications. So we dug into the data."

"We found that the average age of farmers was fairly consistent across the country, even though the general population's age varies quite a bit from place to place," the researchers write. "For example, the average Maine farmer is just a few months older than the average farmer in Utah, even though the average Maine resident is more than a decade older than the average Utahn." Their data also showed a countrywide trend of "amber waves of gray" and noted that if farmer recruitment or industry adaptations aren't implemented, America's food supply could be at risk.

Buys, Green and Robertson asked, "Why is this happening?" They cite several barriers younger would-be farmers face, including how much money it takes to start a farm, agricultural consolidation, and the profession's overall stresses from weather to politics.

The lack of younger farmers increases workloads for current farmers. Researchers explain, "Without younger people to leave the work to, farmers are left with intense labor — physically and mentally – to accomplish, on top of the ordinary challenges of aging. . . . The U.S. needs to increase opportunities for younger farmers while also supporting farmers as they age."

The good news is that the USDA already has some programs within the Farm Bill designed to "aid new farmers, as well as farmers of color and female farmers, and those who operate small farms," Buys, Green and Robertson explain. The upcoming Farm Bill could expand those programs to "help bring new talent into the field. . . . The farm bill also includes nutrition aid and funds for telehealth training and educational outreach for farmers, all of which could help meet the needs of young and aging farmers alike. Notably, the Cooperative Extension Service offers programs that range from 4-H and youth development, including introduction to agriculture, to providing on-site technical help."

Researchers point to the 2024 Census of Agriculture, which will provide "new insight into America's farming workforce. We expect it will show that the average age of U.S. farmers has reached a new all-time high." 

Government officials have 'unqualified access to private land;' hunters sue to change Open Fields doctrine

The Open Fields doctrine has allowed government officials access
to private land. (Photo by Institute for Justice via Farm Journal)

Sometimes private land isn't private, and in states such as Pennsylvania, the question, "How much power does the government claim on private land?" is answered by a court ruling, reports Chris Bennett of Farm Journal. On Sept. 29, a "court ruled against two hunting clubs in their lawsuit accusing the Pennsylvania Game Commission of private property rights violations. . . . In its ruling, the Commonwealth Court of Pennsylvania noted the government's absolute power to 'roam private land without consent, warrants, or probable cause.'"

The hunting clubs, Pitch Pine and Punxsutawney sued PGC "after game wardens consistently entered club lands without permission or warrant, and secretly monitored club members, including photo collection via installation of a hidden game camera," Bennett writes. "The wardens' behavior, the lawsuit asserted, was a direct violation of Pennsylvania's state constitution, which explicitly protects 'persons, houses, papers, and possessions.'"

The Open Fields doctrine allows state and federal officials "unqualified access to private land" without requiring a warrant to "enter or surveil private land," Bennett reports. "The Commonwealth Court detailed the alarming powers and 'unfettered discretion' assumed by the government via Open Fields: To ensure their members' privacy, the Hunting Clubs have posted their properties with no trespassing signs and have installed gates at all entrances to exclude nonmembers and intruders. However, the Entry Statutes empower game wardens with unfettered discretion to enter upon and roam private land without consent, warrants, or probable cause."

"Six states place state constitutional authority above the Open Fields doctrine: Mississippi, Montana, New York, Oregon, Vermont, and Washington," Bennett writes. The Institute for Justice represents Pitch Pine and Punxsutawney is appealing the decision. "Arguments before the Pennsylvania Supreme Court should take place in 2024, with a decision likely in 2025. IJ is litigating similar Open Fields cases in Virginia and Tennessee about warrantless intrusions on private land."

(For more on Open Fields, see How Much Ag Property Is Protected From a Warrantless Search?)

90% of U.S. iron ore travels through the Soo Locks, and the system needs expensive upgrades

Map by Marine Cadastre, Army Corps of Engineers via 
The Wall Street Journal

It isn't just the mighty Mississippi River that moves U.S. commerce. A system of locks, known as the Soo Locks is also vital to trade, but the neglected system needs ongoing, long-term repairs.

"About 10,000 ships pass through the Soo Locks each year to bring iron ore, grain, limestone and other staples across the Great Lakes and Canada into the Midwest and beyond," reports Ken Thomas of The Wall Street Journal. "The navigational system allows large ships to bypass rapids below Lake Superior. . . . Every few decades, the locks were upgraded — until recently."

The pandemic gave Americans a first-hand look at the havoc supply chain disruptions can cause, helping projects like the Soo Locks repairs become a national priority. "Now, construction crews are working to complete a modernization of the locks," Thomas writes. "The question is whether the upgrades can get the funds they need in time." And while the Biden administration has increased funding, more will be needed through 2030 when the upgrades are slated for completion.

In 2015, a Department of Homeland Security study "found that the aging network serves shipping vessels carrying nearly 90% of the nation's iron ore, a critical component of the steel used to make cars and refrigerators," Thomas explains. "The study estimated that if it closed for an extended period, it would also disrupt steel production, cost millions of jobs, and reduce U.S. gross domestic product by $1.1 trillion. . . . John Walsh, the chief executive of the Michigan Manufacturers Association, said trade associations as well as congressional delegations from the Great Lakes states are working to keep the funding a priority.

"The locks are the only effective way to transport the raw materials because distributing iron ore and other supplies by trucks or trains would be cost-prohibitive. Supporters noted that 13 of 14 North American integrated steel mills are dependent upon the Soo Locks to transport iron ore from Minnesota and Michigan," Thomas adds. "The system is nearly as old as the U.S.: The first lock, about 40 feet long to handle canoes, was built on the St. Marys River in 1798 by the Northwest Fur Co. to enhance the fur trade."

Flora and Fauna: Reconsider rats; farm-to-school lunches; spawning salmon; a 7,000 mile migration; give up raking

Illustration by Sarah Gilman, Hakai
Many people describe rats as dirty, disease-carrying rodents. But do they deserve the bad rap? "Rats are less pestilent and more lovable than we think," writes J.B. MacKinnon of Hakai magazine. "Can we learn to live with them?"

Hey, kids! What's for lunch? Farm fresh potatoes? How does that work? Some states have launched "Farm-to-school programs that prioritize getting locally produced, minimally processed products onto students’ plates in states like Maine, Minnesota, and New York," reports Shea Swenson of Ambrook Research. "Now, Oklahoma has launched its own Local Food for Schools program — but with a twist." Link here to find out more.

A trip to Salmon River offers a breathtaking experience: "I visited Salmon River in Mount Hood National Forest hoping to see my favorite Pacific Northwest inhabitants, Coho and Chinook salmon, on their way home to spawn, Claire Carlson of The Daily Yonder writes. "This is a long, difficult, and always deadly undertaking – a hero’s journey, through and through, and it’s absolutely worth seeing if you can."

A male humpback whale swims off Maui, Hawaii.
(Photo by Ralph Pace, Whale Trust)
His name is Frodo, but he's not trekking through Middle-earth to Mordor. "He's a battle-scarred male humpback whale who completed the longest-known movement for his species," reports Ralph Pace of National Geographic. "Between 2017 and 2018, the animal swam nearly 7,000 miles from Saipan, in the Mariana Islands, to Sayulita, Mexico, according to a new study published in Endangered Species Research. . . . It shows that whale migration patterns are more complex than we thought."

Hikers and animal lovers alike take heed -- it's flea-borne typhus season. FBT still lives in humid pockets of the South, California, Texas and Hawaii, reports Claire Panosian Dunavan for MedPage Today. "In fact, just last month, a letter to local physicians cited Los Angeles County's record-high count of 171 verified cases and three deaths in 2022."

Photo by Matt McClain, The Washington Post
Dread raking leaves? Don't. This year, leave the leaves, advises Allyson Chiu of The Washington Post. David Mizejewski, a naturalist with the National Wildlife Federation, told Chieu: "The fallen leaf layer is actually really important wildlife habitat. All sorts of creatures rely on that for their survival as a place where they can find food and cover. . . and even complete their life cycle.”

In a county with glaring wealth disparities, one reporter looks at how rural is defined and where higher education fits

The Grand Teton Mountains separate Teton County, Wyoming
from Teton County, Idaho. (Photo by Leslie Cross/Unsplash)

About 30 miles and a mountain pass separate Teton County, Wyoming, from Teton County, Idaho, but the county is divided by more than geography: Teton County, Wyoming, has a whopping average $318,297 per-capita income, and Teton County, Idaho, claims a $35,000 average. Higher education reporter Nick Fouriezos of The Daily Yonder discusses three things he learned while visiting the Teton Counties.

Fouriezos writes, "I encourage you to read the piece, which deals with a number of issues being felt across rural America, from how educational institutions and state governments are trying to address workforce gaps to deepening concerns about affordable housing."

When making choices about rural areas, go where the people go. "Earlier this year, the College of Eastern Idaho teamed up with the nonprofit Education Design Lab. . . to design, test, and scale rural postsecondary programs. The college wanted to get feedback from residents of Driggs, a mostly working-class rural town in Teton County, Idaho, which is quickly seeing its own costs rise as people move there while leaving behind its neighboring counterpart in Wyoming.

"To start, the education nonprofit and the college conducted interviews at the local farmer's market. . . . But after spending more time talking to educators in the area, they realized that anybody who could afford to be buying fresh veggies at 2 p.m. on a Thursday probably wasn't their target demographic.

"They shifted gears, doing their next round of interviews while handing out gift cards at the Broulim's grocery store, a popular lunch haunt for construction and service workers in the Driggs area. . . . That moment was a good reminder: If you really want to hear from rural America, don't rely on outliers of the rural experience.

Amid shifting costs, rural communities are feeling pressure to change. Almost every year, Powell Symons says she gets approached by the Jackson Hole Chamber of Commerce to bring the Teton Valley Balloon Rally from Idaho over to the Wyoming side. Even though the offer has become more tempting as the region's disparities deepen, she has resisted so far. . . .To Powell Symons, it would end a four-decade tradition here in Driggs, one that draws Idahoans from all over the state each year. And having had the chance to share their love for those balloons personally, that would be a tragedy."

Higher ed can't attract students who don't feel like they have choices. "For a time, Luna dreamed of going to cosmetology school. Then she could work at a salon, doing the face masks and other lux cleansing rituals people in Jackson are willing to pay so much more money for than in Driggs. . . . Now, those plans seem far off. She has to make payments on the truck and to fix its transmission. She has to pay her share of rent on the mobile home she shares with her uncle and her grandma, who is now 82 and needs just as much help as ever.

"These are the types of decisions many rural students face across the country. It's not just whether a degree will pay off four years from now, or over a lifetime. . . It's more often about whether they can get by today. Not just for themselves, but for those who rely upon them."

Wednesday, October 18, 2023

As pandemic-era funding runs dry, many rural nursing homes are closing -- a loss for families and local economies

Bloomberg map, from CMS and Census Bureau data
Amid increasing medical costs, depopulation and a national nursing shortage, hundreds of rural nursing homes are closing, leaving economic losses and care deserts behind, reports Lauren Coleman-Lochner and Martin Z. Braun of Bloomberg. "Across the country, almost 690 nursing homes have shut their doors since 2020, according to the Centers for Medicare & Medicaid Services. The American Health Care Association, an industry trade group, expects the number to keep ticking up in the coming years because of a combination of rising labor costs, falling enrollments and government reimbursements that fall far short of paying the bills."

Many rural places already face depopulation and staffing shortages across several sectors, so the struggles for a small long-term care facility are amplified. "America's elder-care deficit is particularly acute in the Midwest and parts of the South, where a larger portion of the population age 65 and older resides in rural counties; in North Dakota, it's 46%, double the average nationwide, according to Census Bureau data," Coleman-Lochner and Braun write. Residents in these regions face further stress because finding a new nursing home, which may be hundreds of miles away, "causes families to splinter and can become yet another contributor to depopulation."

In smaller towns, a care facility is often the largest employer, so when it closes, the economic domino effect begins with job losses and trickles down. When a long-term care facility closed in Mott, North Dakota, pop. 700, "Business at the town's drugstore dropped 40% . . . , according to owner Chuck Oien. His wife's grocery store also saw a decline," Bloomberg reports, "as did restaurants and hotels that catered to out-of-town family members when they visited."

The pandemic "didn't cause the troubles at hundreds of U.S. nursing homes, but it sure didn't help," Bloomberg reports. "The number of workers in nursing homes and residential-care facilities dropped by 210,000 between February 2020 and June 2023, according to the Bureau of Labor Statistics, as nurses and caretakers sickened or quit, feeling burned out. CMS estimates that nursing homes lose more than half their workers each year. . . .The federal aid directed at hospitals and nursing homes during the early part of the pandemic temporarily covered up the fundamental problems with the industry's economics, says Kelly Arduino, head of the healthcare practice at advisory firm Wipfli. With government assistance winding down, there will be more financial distress and closures." Arduino told Bloomberg: "It's only going to get worse. We all see it coming. We don't see a mechanism for how to fix it."

Medicare Advantage plans are growing in popularity, but their payment tactics hurt smaller hospitals

Photo via Mesa View Regional Hospital
Medicare Advantage plans have become increasingly popular with seniors, but for small, rural hospitals, the plans are too risky, which can leave local plan participants unable to go to their town's hospital. "Medicare Advantage insurers are private companies that contract with the federal government to provide Medicare benefits to seniors in place of traditional Medicare," reports Sarah Jane Tribble of KFF News. "The plans have become dubious payers for many large and small hospitals, which report that the insurers are often slow to pay or don't pay."

Enrollment in private Medicare plans "has increased fourfold in rural areas since 2010. Meanwhile, more than 150 rural hospitals have closed since 2010, according to the Cecil G. Sheps Center for Health Services Research at the University of North Carolina. States such as Texas, Tennessee and Georgia have had the most closures."

The slow or no-payment tactics of Advantage plans disproportionately hurt "small, rural hospitals that Medicare has designated as 'critical access," Tribble explains. "Under the designation, government-administered Medicare pays extra to those hospitals to compensate for low patient volumes. Medicare Advantage plans, on the other hand, offer negotiated rates that hospital operators say often don't match those of traditional Medicare." 

Medical providers can face a no-win situation when rural residents enroll in Advantage plans. For example, Mesa View Regional Hospital, a rural hospital about 80 miles east of Las Vegas, has "a high percentage of patients enrolled in Medicare Advantage plans," Tribble reports. The hospital has "21 Medicare Advantage contracts with multiple insurance companies. . . . Mesa View's CEO, Kelly Adams, says he has trouble getting the plans to pay for care the hospital has provided. They are either 'slow pay or no pay, he said. . . . It would be a 'tough deal' to be forced to reject patients because they didn't have traditional Medicare."

"At Mesa View, patients must drive to Utah to find nursing homes and rehabilitation facilities covered by their Medicare Advantage plans," Tribble reports. Adams told her: "Our local nursing homes are not taking Medicare Advantage patients because they don't get paid. But if you're straight Medicare, they'd be happy to take that patient."

What is being done? "In June, a bipartisan group of Congress members, led by Sen. Sherrod Brown, D-Ohio, sent a letter urging federal agencies to do more to force Medicare Advantage insurers to pay health systems what they owe for patient care. . . . In an August response, CMS Administrator Chiquita Brooks-LaSure wrote that a final rule issued in April made 'impactful changes' to speed up care and address concerns about prior authorization — when a hospital and patient must get advance permission for care to ensure it will be covered by an insurer," Tribble reports. Brooks-LaSure noted another proposed rule that, once finalized, "could mandate that insurers provide specific reasons for denying care within seven days."

The Washington Post's first Freedom of Information Act director explains how to find important information

Image by Marissa Vonesh, The Washington Post

Nate Jones of The Washington Post reveals how he finds the materials others don't want found in his "Revealing Records" series. Below is an excerpted version of his first installment.

"Few things make a journalist happier than receiving a manila envelope full of internal government records. These days, a large email attachment is pretty good, too.

"As the Post's first Freedom of Information Act director, I work to ensure that our entire newsroom receives as many of those envelopes and email attachments as possible. Those documents have helped us publish stories that have exposed government waste and wrongdoing, and led to congressional hearings and new laws. Successful requests take strategy, creativity and a tenacity for overcoming bureaucratic resistance. Now, I'm writing a periodic column about how I do it.

"The federal Freedom of Information Act is one of a reporter's most powerful tools. Commonly known as FOIA, this law requires federal agencies to release records to the public upon request — unless the records are exempt for privacy, national security or other reasons. Each state also has its own version of the federal law that applies to state and local governments. When agencies refuse to produce the records, the laws allow those making the requests to sue.

"Unfortunately, the Post has had to turn to the courts to force state and federal agencies to follow FOIA laws. As a newly barred attorney, I research the chances of succeeding in a lawsuit, then work with The Post's legal counsel and outside lawyers to file a suit.

"Generally, the Post only sues when we believe we can make a strong case. When we do prevail, the agencies often have to pay our attorneys' fees. That is a cherry on top of any records the agencies are ordered to produce. 

"More often, we are able to use public records laws to obtain documents without going to court. After Osama bin Laden was killed in 2011, many people saw the famous photo of President Barack Obama and his aides tensely watching the raid on bin Laden's compound, one of just nine photos taken by the White House photographer that day and released on the official Flickr page. But I wanted to see what else was photographed that day, including pictures that might counter the official White House narrative.

"The Freedom of Information Act doesn't apply to records of presidents still in office. . . . At the time of the bin Laden raid, Obama was running for reelection. If he won, I would have to wait until 2017 to start the five-year clock to request his presidential records. So I marked my calendar. . . . On Jan. 20, 2022, five years to the day after Obama left office, I filed a slew of requests — including one for all official White House photographs taken the day bin Laden was killed. . . .After a year, the National Archives processed the request and provided a 161-page PDF of thumbnails and file names for all White House photographs taken between May 1 and 3, 2011. . . . These photographs — like all internal government records — are powerful because they help reveal what actually happened within our government, not just the view officials want to present.

"These manila envelopes and email attachments do not always come easily. Post reporters are constantly thinking and inquiring about the government documents behind public statements and official actions. I've helped them file requests for records in the federal government and every U.S. state, district and territory. Without public records laws, they would not be able to tear open the envelopes, download the attachments and share the stories of the documents within."

Rural haunts: Halloween's origins; spooky season humor; dark doll decor; creepy AI; a most satisfying scary tale

Snap-Apple Night, painted by Irish artist Daniel Maclise in 1833, based on an
Irish Halloween party. (Wikimedia Commons photo via Modern Farmer)
Who started Halloween anyway? Farmers. "It’s believed the Halloween’s origins lie in the ancient Celtic festival of Samhain (pronounced sow-in), which was celebrated from Oct. 31 into Nov. 1, marking the end of the harvest season and the beginning of winter," reports Andrew Amelinckx of Modern Farmer. "It all began with the celebration of agriculture. . . . Maybe this year you should get back to basics and dress up as the goddess Pomona or perhaps a zombie farmer to give a nod to Halloween’s real roots."

How do you know "spooky season" is here? Kerry Elson of The New Yorker casts a spell with her quirky brew of signs. "A spider will descend from the ceiling on a single thread. His eyes are red, but they are kind. Could he be your friend? (The answer is yes! During spooky season, spiders will be excited to make plans.) . . . The spooky-season warbler will emerge. This bird is known for its orange, brown, and yellow coloring and its distinct call, which typically sounds like bones clattering around, in a fun way. . . . Nothing says spooky season quite like a scarecrow holding an origami snake that it made all by itself."
Dolls can be creepy.
(Photo by Rose Maura Lorre, Wirecutter)

This summer Propstore sold the clown from 1982s Poltergeist movie for $650,000. That's a lot of loot for something freakishly terrifying. Wirecutter has a cheaper solution that will still give your friends chills -- Creepy Doll Decor. "I started turning dolls into haunting Halloween decor because the dolls started haunting me first," writes Rose Maura Lorre. "It all began about 10 years ago when my husband randomly texted me a photo of a discarded doll he’d walked past that was clearly refusing its fate as refuse."

Speaking of creepy, AI can scare. "What does it mean to be human? When a robot asks that question, it might elicit feelings of unease — indeed, when artificial beings start acting or looking a little too human, you might experience the uncanny valley phenomenon," reports Natalia Mesa of National Geographic. "Although the concept of the uncanny valley has existed for half a century, scientists still debate why fabricated people cause us so much discomfort."

There's so much to love about fall, but one of the season's most iconic candies can lead to arguments. "Halloween is a time for all things spooky, but it can also be quite divisive," reports Michael Beausoleil for Medium. "On one side, we have the group of people who love candy corn. On the other side, we have people who hate the stuff."

Illustration via The History Reader
With rural breadth and depth, Washington Irving gives Americans one of the best "haunted" rural stories of all time in "The Legend of Sleepy Hollow." The "Rosie Posie Reads" website muses: "Is it the dreamy pastoral town of Sleepy Hollow, with its quaint residents, candlelit parties, and bone-chilling ghost stories? Is it the mystery of what really happened to Ichabod Crane on the covered bridge? Is it the faint possibility that the ghost of a Hessian soldier scours the land in search of a head?"

Efforts to help rural communities obtain grants for climate change didn't help much; awards skewed urban and coastal

Despite the Biden administration's focus on grant access for rural communities, many areas still struggled to apply for or win government funding, according to a new analysis, reports Claire Carlson of The Daily Yonder. "Most of the funding in a recent round of climate-change grantmaking went to high-capacity communities located in coastal states, according to a report by the nonprofit Headwaters Economics. Less than a fifth of the grants went to 'low-capacity' communities, which tend to be rural, according to Kristin Smith, author of the study."

Smaller community governments often have staff members doing multiple roles, and funding additional people to apply for grants isn't financially doable, so their capacity to find, research and apply for federal money can be severely hampered. Looking at the most recent round of grants made through FEMA's Building Resilient Infrastructure and Communities program, "Smith said low-capacity communities that did not fare well in the competition lack the staff and expertise necessary to create competitive proposals for federal grant programs," Carlson writes. "Match requirements, which is money awardees must contribute themselves to a grant-funded project, can also be a barrier for rural communities with small budgets or less access to philanthropic funding, according to Smith."

A  rural-urban disparity "played out in this year's BRIC funding, which is paid through an apportionment of the Federal Emergency Management Agency's disaster relief fund: Only 3% of the counties that received grants are low-capacity, as defined by Headwaters Economics' Rural Capacity Index," Carlson reports. "High-capacity counties – which have the staff, resources, and expertise to apply for and win federal grants – were chosen 83% of the time. . . . FEMA is aware of these findings. A FEMA spokesperson said that the agency is 'currently in the process of reviewing the findings in the Headwaters Economics article and is open to engaging.'"

BRIC funding differs from many other federal programs, which could be particularly important for rural areas. Carlson adds, "There is no expiration date for the BRIC program. It's funded through an earmarked 6% of estimated disaster expenses every year through FEMA's Disaster Relief Fund, so even for the communities rejected funds, there is time to reapply. . . . Whether rural communities are prioritized in future funding awards remains to be seen." Smith told Carlson: "I do think FEMA is taking the issue seriously, and I also think there's a lot of work to do."

Tuesday, October 17, 2023

Newly released data reveals a 'virtual opioid belt' developed over about 15 years in West Virginia, Virginia and Kentucky

Average number of pills distributed per person per year, ranked by county from 2006 to 2019. White is equal to zero pills and scarlet is 120+ pills; shades of pink are ranges between those two. (Post via Openmap, with DEA Automation report data)

America's battle with pain-pill prescriptions might be tapering off, but deaths spawned by its spin-offs, heroin and fentanyl, have increased, and deeply affected regions are still clawing toward a recovery.

A database maintained by the Drug Enforcement Administration shows how the use of pain pills increased dramatically, particularly in Appalachian counties. The database "tracks every single pain pill sold in the United States, tracing the path from manufacturers and distributors to pharmacies in every town and city," reports Steven Rich, Paige Moody and Kevin Schaul of The Washington Post. "These records provide an unprecedented look at the surge of legal pain pills. . . which resulted in more than 210,000 overdose deaths during the 14-year time frame ending in 2019. It also sparked waves of an ongoing and raging opioid crisis first fueled by heroin and then illicit fentanyl."

The information can help people "understand the impact of years of prescription pill shipments on their communities," the Post reports. "A county-level analysis shows where the most oxycodone and hydrocodone pills were distributed across the country over that time — more than 145 billion in all."

The DEA's database, known as ARCHOs, was not willingly shared with the public. The Post and HD Media, which publishes the Charleston Gazette-Mail in West Virginia, "waged a year-long legal battle for access to the database, which the government and the drug industry had sought to keep secret," Rich, Moody and Shaw add. "The initial release of data covered 2006 to 2012, and was later updated through 2014. . . . The Post analysis shows that the volumes of the pills handled by the companies climbed as the epidemic surged, increasing by 52 percent from 8.4 billion in 2006 to 12.8 billion in 2011."

Appalachian counties have maintained that their regions were targeted by pharmaceutical companies' greed. The maps show how those areas suffered more than other areas of the country. The Post reports, "Comparing county-level maps of prescription opioid overdose deaths and pill shipments reveal a virtual opioid belt of more than 90 counties stretching southwest from Webster County, W.Va., through southern Virginia and ending in Monroe County, Ky. This swath includes 18 of the top 20 counties ranked by per-capita prescription opioid deaths nationwide and 15 of the top 20 counties for opioid pills distributed per capita."

The maps show a 'virtual opioid belt' through Appalachia. (Post map, from DEA and CDC data)

Veterinarians face pet owners who reject vaccinations; research shows fewer vaccinations could be dangerous

Forty percent of dog owners distrust vaccines, new research
shows. (Photo by Karsten Winegeart, Unsplash)

New research shows that more pet owners are resisting traditional vaccines, which could cause disease outbreaks in animals and people. "Researchers who have studied vaccine hesitancy since the onset of the Covid-19 pandemic say a growing body of evidence shows a surprisingly high level of mistrust among pet owners over vaccines for cats and dogs," reports Stephanie Armour of The Wall Street Journal. "Almost 40% of dog owners believe that canine vaccines are unsafe, more than 20% believe these vaccines are ineffective and 30% consider them to be medically unnecessary, according to a new study published in the journal Vaccine."

Commenting on the study's anti-vax skew, its lead author, Matthew Motta, an assistant professor of health law, policy and management at Boston University, told Armour, "We were shocked. In a world where mandates are being dialed back, and more pets go unvaccinated. . . .That’s a threat to our pets but also a public health threat to you and me.”

If fewer animals are vaccinated, the chance for previously controlled diseases such as rabies to return dramatically increases. Rena Carlson, a veterinarian and president of the American Veterinary Medical Association, told Armour, "We’re going to see more and more disease as we see vaccine compliance drop. . . . Vaccines can really prevent severe disease.” Armour reports, "Seventy percent of dogs in a population should be vaccinated against rabies to prevent outbreaks, according to the World Health Organization."

Social media postings about the potential harm vaccines "could do" has contributed to the anti-vaccine movement. Armour writes, "A pet owner in California with a Chihuahua said she always takes her dogs 'off the system' because she said vaccines can cause cancer, seizures or death. . . . Misinformation and misperceptions are driving a lot of the skepticism, veterinarians say. Thirty-seven percent of dog owners believe vaccines could cause cognitive problems such as autism, according to the study in Vaccine. No scientific data exists that validates the risk for people or animals."

Monarch migration has begun. They're 'marathon runners.'

Monarch butterflies fly thousands of miles, often starting in
Canada, to overwinter in Mexico. (Photo by Ron Holmes, FWS)

As summer tips into fall, much of nature shifts with it. Alongside breathtaking leaf foliage and the harvest, autumn includes the monarch butterfly migration from the Northern United States to Mexico.

"Sometime in August, the monarchs from Wisconsin and the upper Midwest start to migrate south. Traveling as far as 50 miles each day, it will take them a month or more," reports Julie Belschner for AgriView. "They often roost at night on trees or bushes. The generation floating on the Midwest winds – as much as a quarter-mile or more high – are those that will overwinter in Mexico for the next six to eight months."

Explaining how monarchs know when to migrate and how they endure the long journey, P.J. Liesch, with the University of Wisconsin Department of Entomology, told Belschner, "It turns out that monarchs have a way to read the earth's magnetic field; essentially metals interact with the earth's magnetic fields, and they use those clues. . . . .Compare the butterflies to a marathon runner. They need carbs. Those butterflies are going from nectar source to nectar source – pit stops, if you will. Have a pit stop ready for them, so if they're passing through, they can pick up what they need." Belschner adds, "Farmers can make a difference by limiting use of pesticides, creating windbreaks and planting nectar plants."

The Fish & Wildlife Service has marked five monarch "super stops" along their journey, reports Julie Morse of the National Wildlife Refuge System.

Neal Smith National Wildlife Refuge held its first Monarch Madness Day in 2006. Ninety people caught and tagged 250 monarchs during the day; almost 500 were tagged over the season.

The butterflies tend to come in waves based on weather patterns. Migrating monarchs feed on asters goldenrods and other wildflowers that bloom throughout the refuge in the central Kansas wetlands. If winds frustrate butterfly hunters, visitors can catch monarchs inside an enclosed butterfly pavilion.
During the day, look for monarchs in wildflower areas. Toward evening, the best viewing areas are sheltered places that are cool and damp. Monarchs typically visit Kansas in mid-to late September. Check out Quivira National Wildlife Refuge.

In late September/early October, when conditions are favorable, thousands of monarchs a day may flutter through the prairies and oak savannas of Balcones Canyonlands National Wildlife Refuge in the Hill Country of central Texas.

Each year during monarch season (from early September to late October), the Coastal Virginia Wildlife Observatory counts and tags monarchs at the Eastern Shore of Virginia National Wildlife Refuge, at the tip of the Delmarva Peninsula between the Atlantic Ocean and Chesapeake Bay. Visitors are welcome to watch. Taggers record monarch size, condition and gender.

People start calling St. Marks National Wildlife Refuge as early as August to ask when the monarch butterflies are coming. The refuge is the last refueling stop for thousands of migrating monarchs before they fly over the open water of the Gulf of Mexico.

Help your community 'know their risk and protect their money' by raising public awareness with this media kit

To increase the public's awareness of deposit insurance and how it can protect people's money in the event of a bank's failure, the Federal Deposit Insurance Corporation developed a national consumer campaign, "Know Your Risk. Protect Your Money."

The campaign reaches people who may have lower confidence in the U.S. banking system or do not use a bank, as well as those who use mobile payment systems, alternative banking services and financial products that may appear to be FDIC-insured but are not.

The FDIC is asking financial institutions, community organizations, government agencies, and others who serve the public to help raise awareness of deposit insurance protections.

Tips on how to spread the word:
To make the topic less daunting, FDIC offers several "Saving Pigs" in English and Spanish to get the conversation going.

Should I stay or should I go? One author's deep struggle to decide if she should move back to rural Appalachia

"The reason for my indecision is not clear to me."
(Photo by Ricardo Alfaro, Unsplash)
When home and holler beckon, author Kathleen M. Jacobs struggles to decide if she will move back to rural Appalachia. In her commentary for The Daily Yonder. Jacobs presents her emotional yearning for home alongside the practical worries of leaving the city.

"Thinking of returning to live once again in a rural area of West Virginia where I grew up tugs at my heart repeatedly, as if to remind me of a possibility that never leaves — has not left me since I considered it a number of years ago. The reason for my indecision is not clear to me. Perhaps that’s part of the problem.

"Certainly, the people I know in the area — have known for many years — play a vital role in my consideration to return, but in the end, it is not so much about them as it is about how I might find a way to bring something of value to the table. Because unless I can identify that crucial element, I would only be in the way, and if you know anything about rural Americans, you know there’s little appetite for that. They would wish me well and then get on with the important work to be done, and there is plenty: health care, education, jobs, housing, infrastructure, addiction treatment, the list goes on.

"Part of the calculus I am doing revolves around the housing piece, in particular. Affordable, yes, until you factor in the costs of renovations: plumbing, electrical, and structural. The beauty of the area remains untarnished, but the ever-growing number of folks leaving for more equitable employment landscapes, better health care and a stronger educational system are often not in a financial position to make these necessary repairs to their property. If they could, they might not be leaving in the first place. It’s a catch-22 for certain and a heart-wrenching one as well.

"The lack of certain access to high-speed internet service also gives me pause. It’s not an impossible situation to live with, but its challenges are pervasive and prevent so many who want to return to their rural roots from actually returning. It’s this ever-present struggle between the heart and the head. 

". . . . I retrieve from my bookcase a work that reminds me time and again why I need to take a deep breath and jump into the far end of the pool, knowing that passion for a place that struggles against all odds for a rebirth just might be enough for me to take the leap. And as I turn to read each page from Cynthia Rylant’s Appalachia: The Voice of Sleeping Birds, knowing the clock is always ticking, I am reminded of why those hills keep beckoning: a reverence for the natural world, a certain endurance in the face of adversity, a dedication to family and an unquenchable belief in a Being greater than ourselves, a reveling in the ups and downs of seasonal challenges, a people continuing to live with 'no sourness about them.' That’s when one question rises to the top: 'What are you waiting for?'”