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Couple says 'hello and goodbye' to baby born without brain

The Oklahoma couple who decided to carry their baby without a brain to term in hopes of helping others has said "hello and goodbye" to their newborn girl.According to the Facebook posts of Keri and Royce Young, baby Eva Grace was born April 17, and died the same day. 

>> Read more trending news


In February, Royce Young's Facebook post about his wife's reaction to learning their baby would be born without a brain went viral. Keri Young asked the doctor if she carried the baby to term, if she could donate the baby's organs to help others.It was unclear from the new Facebook posts if the Youngs were able to donate Eva's organs, but Keri Young said that she would share more about Eva's incredible story at a later date.

25 Dinners With No Added Sugar That Help You Stick to Your #Goals

Think about it: That tablespoon of maple syrup in your salad dressing, the honey in your Asian-inspired stir-fry sauce, the generous drizzle of ketchup on your burger. Despite many people’s best efforts, that sugar still manages to creep into so many healthy dinner dishes. But meals can be just as tasty and easy to make without the slightest hint of added sweetener. We’ve rounded up 25 added-sugar-free dinners proving just that. 

Poultry 1. Healthy Orange Peel Chicken Photo: Lively Table In a welcome contrast to the honey-soaked restaurant version, this dish uses the actual peel and fresh juice of the orange for its fruity flavor and sweetness. It’s also all done in one pan, so it’s really only marginally harder than ordering in.  2. Creamy Buffalo Chicken Pasta Photo: Living Loving Paleo Instead of sugary ranch dressing for the “creamy” portion of this pasta, this recipe’s secret weapon is blended cashews, which make the dish incredibly rich in a much healthier way. If you use the coconut oil option instead of ghee, the dish also becomes entirely dairy-free. 3. Yogurt Chicken Curry Photo: Chef de Home Along with tang, plain yogurt adds some mild sweetness to this otherwise spicy curry. It’s so much better for you than the butter chicken you’d find in a traditional Indian restaurant, but just as tasty, especially paired with naan or rice.  4. Taco Stuffed Sweet Potato Photo: Spinach 4 Breakfast Get your taco the gluten-free way by stuffing your turkey mixture into a sweet potato. You get an extra serving of fiber and a touch of natural sweetness; plus, it’s a lot more fun to eat this way.   5. Chicken, Sweet Potato, and Coconut Stew Photo: Chew Out Loud There’s a lot that’s sweet about this recipe, but none of it has anything to do with sugar. It’s all from the sweet potatoes, the creamy coconut milk, and the freshly squeezed orange juice. Clean eating really doesn’t have to be hard or bland. 6. Easy 30-Minute Turkey Chili You’ll notice that the teaspoon of sugar in this chili is entirely optional—and it’s for good reason, since you won’t miss it at all if you omit it. With sweet bell peppers, mild turkey, cumin, and chili powder to spice things up, there’s already plenty of flavor going on.  Beef/Pork 7. Weeknight Sesame Steak Salad Photo: PDX Food Love A good steak salad shouldn’t just be a meal you order at a restaurant. It’s just as easy to re-create at home. As a bonus, you control everything that goes on to this plate, from the quality of the meat to the homemade dressing to the fun add-ins such as avocado and peanuts. 8. Peanut Broccoli and Pork Stir-Fry Photo: Nutritionist Reviews Asian-inspired food is delicious, but unfortunately, tends to use alarming amounts of added sugar, such as honey or sweetened sauces. This one gets its not-too-sweet flavor from a blend of rice vinegar and peanut powder (use peanut butter as an alternative)—it’s so good and so easy, you may want to bottle some of it for future stir-fries and salads. 9. One-Pot Beef and Tomato Macaroni Soup Photo: The Recipe Rebel Even canned soup can come loaded with sweeteners and additives. Ditch the store-bought stuff and whip up your own take on the classic beef and macaroni soup with a recipe that comes together in fewer than 30 minutes and uses all real food, including whole-wheat pasta. 10. Grandma's One-Pan Hamburger Helper Photo: The Seasoned Mom Packaged Hamburger Helper may save you a few minutes in the kitchen, but it isn’t doing a whole lot for your health with ingredients such as corn syrup, sugar, and MSG. This stovetop version packs in lean ground beef, whole-grain macaroni, and plenty of actual tomato sauce, and is hardly time-consuming to put together.  11. Spring Pea Risotto Photo: Kiwi and Carrot Who needs sugar when you have rich, creamy carbs that involve bacon? Not only is this recipe the ultimate savory comfort food, it also comes together in just 35 minutes—pretty much record timing for a risotto. 12. Yellow Rice Pork Chop Bake Photo: Food Done Light This foolproof rice recipe requires no stovetop stirring—the oven-baked method gets it just right. Plus the combination of saffron, paprika, and garlic powder will have your kitchen smelling heavenly.  Seafood 13. 20-Minute Baked Pesto Salmon Photo: Skinny Fitalicious With an avocado-based pesto slathered over salmon, this recipe is all about the “s” word—that is, superfoods, not sugar. Pair the fish with asparagus for a filling—not to mention, incredibly good-looking—plate.  14. Avocado Tuna Cakes Photo: Well Plated Get your protein and healthy fats in these neat little patties. Held together with egg and breadcrumbs then baked, they’re tasty and versatile. Serve them on a salad or with roasted veggies.   15. Pineapple Chipotle Salmon Tostadas Photo: Joyful Healthy Eats Fruit is a fantastic way to give a dish some all-natural sweetness, and a little goes a long way. These tostadas, piled high with spiced salmon and cooled off with a pineapple salsa, are a perfect example. 16. Cajun Shrimp and Rice Photo: Everyday Easy Eats No room for sugar in this spicy rice dish; Cajun seasonings, a squirt of lemon, and protein-packed shrimp do more than enough to make it tasty without the need for sweeteners, all-natural or otherwise.  17. Shrimp, Orzo, Spinach, and Feta Casserole Photo: The Straight Dish Next time anyone declares that seafood and cheese don’t mix, plate them up a big ol’ portion of this. The salty feta and shrimp go so perfectly with the garlicky pasta and sauce, you’ll no doubt be serving seconds. 18. Panfried Halibut With Grapefruit and Mango Salsa Photo: Cooks With Cocktails This dish packs in so many different flavors, you won’t even feel like you’re eating “light.” Simply seasoned halibut is pan-seared until flaky and topped with an herbed and slightly spicy fruit salsa. It’s refreshing and satisfying all at once. 19. Easy Tilapia Pomodoro Photo: My Life Cookbook Crusted in bread crumbs and Parmesan, and lightly browned—not fried—in a pan, this tilapia dish looks fancy, but requires just six ingredients. The easy tomato sauce makes for a tangy complement to the mild fish.  Meatless 20. Garlic Asparagus Artichoke Pasta Photo: Pumpkin and Peanut Butter While there’s no sugar in this recipe, it does use funky store-bought cubes of garlic, herbs, and ginger. If you can’t find them, just use regular garlic cloves and spices. This super-simple pasta will be just as delicious either way. 21. Pad Thai Zucchini Noodle Quinoa Salad Photo: Simply Quinoa Sugar is almost always included in an authentic pad Thai. This recipe departs from tradition, going for a loosely inspired version that not only skips sugar, but also uses zucchini “noodles” and adds quinoa for extra protein.  22. Quinoa Fried Rice Photo: Everyday Easy Eats Everyone needs a fried rice recipe in their arsenal, but give yours a superfood upgrade by using quinoa as a base instead. The fluffy kernels are chewy enough to hold up to the veggies and do a great job of absorbing the soy and Sriracha sauce. 23. Vegetable Samosa Bowl Photo: Kristin's Kitchen Who doesn’t love going to an Indian restaurant and starting off with a plate of crispy, deep-fried samosas? While that’s all well and good once in a while, try a healthier version at home. The veggie filling is piled on top of rice instead of wrapped in dough, and a spicy, cilantro sauce replaces the sugary tamarind one on the outside. 24. Easy Tempeh Fajitas Photo: B Brtinell Like tofu, tempeh soaks up whatever flavors you put on it. Here, it’s marinating in lime juice, garlic, and classic Mexican spices, then quickly sautéed with veggies for a fantastic weeknight fajita dinner.  25. Lentil Sloppy Joes Photo: Modern Little Victories Using lentils instead of meat for sloppy joes is a common vegetarian fix, but lots of recipes use brown sugar to sweeten the tomato sauce. This one nixes the sweetness, letting the tomato sauce and spices speak for themselves.  


15 Things Yogis Can’t Live Without

Sure, you have a yoga mat (you’re not doing your flow on a hard floor, right?), but if you really want to embrace your inner yogi, a mat is just the tip of the iceberg. We found more than a dozen irresistible products that all yoga lovers will be obsessed with. They range from the useful (yoga blocks and yoga bags) to the silly (namaste puns, anyone?). Having them around has been making us feel all sorts of zen.

1. Pinch Provisions Fitness Kit How many times have you walked into yoga class only to realize you don’t have a hair tie? This cute kit has you covered. You'll find the hair tie you were looking for, plus bobby pins, extra socks, ear buds, sample-size dry shampoo, deodorant towelettes, a foldable brush, a headband, a tampon, lip balm, blister balm, Band-Aids, safety pins, and breath mints. It's the definition of a lifesaver. ($22; 2. Namast’ay in Bed Mug We all have that chipper friend who’s an unapologetic morning person and thinks it’s OK to say, “You sure you don’t want to sign up for a 7 a.m. flow this Sunday?” Just send them a selfie while sipping on some coffee (or booze—we’re not here to judge) from this cheeky mug. Problem solved. ($16.75; 3. ClassPass We’re all about at-home yoga, but doing the same flow again and again gets boring. Classes are our favorite way to spice things up (Bikram, aerial, and beer yoga are all amazing), and ClassPass makes it so easy to sign up for the coolest yoga classes in your area. Bonus: They’re giving Greatist readers 70 percent off their first month.  (Price varies depending on location; 4. Yoga Joes G.I. Joe must be stiff from standing at attention for so long. You know what he needs? Yoga. These Yoga Joes flawlessly demonstrate nine moves, from child’s pose to warrior I (appropriate, right?). They'll be an awesome addition to any shelf or desk.  ($25; 5. Sweaty Betty Yoga Block Unless you’re uber flexible, you’re going to need a yoga block at some point in your flow. Maybe you use it for support during triangle pose, or you grab two blocks to deepen your stretch in downward dog. You could purchase any old block, or you could get this one from Sweaty Betty. It might be made from the same foam, but it looks so much better. ($16; 6. Quiver of Arrows Yoga Bag Embrace your inner Katniss Everdeen with this sweet yoga bag from Brogamats. It’s functional (a full-length zipper means you can fit all standard-size mats) and a great conversation starter. Next time you head to a new studio, bring this bag, and you’re pretty much guaranteed to make some new friends.  ($40;   7. Namast’op I Can’t Even T-Shirt You know those moments when you’re in a hot yoga class and you slip while easing into warrior II because you’re basically a puddle of sweat? The little voice in our head says what's printed on this t-shirt (plus an expletive or two). So obviously we need to be wearing it. ($35; 8. Bed of Nails Acupressure Mat and Pillow Twisting yourself into a pretzel in yoga class might work wonders to relieve muscle tension, but this mat takes it to the next level. Don’t let the name “bed of nails” scare you—there isn't anything you would find in a hardware store attached to this mat. Instead, the pointy acupressure plates stimulate blood flow to ease any lingering muscle soreness or pain.  ($39.95; 9. Athleta Get to Work Gym Bag Finding a fashionable gym bag that actually holds your yoga mat? We thought that was impossible until we came across this beauty from Athleta. The straps along the side of the bag are specially designed to hold your mat. And, on top of that, both the interior and the exterior have lots of pockets so this doesn't become the giant black hole that most gym bags are.  ($79; 10. Yogitoes Yoga Mat Towel Call us skeptical, but every no-slip yoga mat we’ve tried hasn’t worked as advertised. At the beginning of class it appears to be doing its job, but the second we start sweating, our mat turns into a slip 'n slide. OK, fine. We're being a *little* dramatic, but you get the point. And that’s why these towels come in handy. They’re pricey, but washable. Put one over your yoga mat and never slip again—seriously.  ($59.01; 11. Every Body Yoga We wish we had someone like Jessamyn Stanley by our side when we started practicing yoga—someone to tell us to stop comparing ourselves to everyone else in class, someone to tell us how yoga can help us love our bodies. Her how-to book has 50 basic poses and 10 sequences, but it’s not just for beginners. We can all learn something from the way Stanley thinks (and talks) about yoga.  ($11.56; 12. Yummi Yogi Cutting Board Your charcuterie board has never looked so balanced! This adorable handmade cutting board is shaped like someone in tree pose, making it super Instagrammable when you’re using it to cut fruit or serve cheese and crackers.  ($50;  13. Pug Yoga Poster We’ll spare you the downward dog puns and just say this poster of pug poses is perfect for anyone who loves dogs or yoga—or both! And doesn’t that cover pretty much everyone out there?   ($24.88; 14. The Mindfulness Coloring Book Feeling stressed? Chakras out of whack? Keep this mini coloring book in your bag or your back pocket—it really is small enough to fit. Its 70 designs range from flowers to butterflies to rolling waves, making them all a quick way to zen out on those days when you're too busy to take an hour-long yoga class.  ($6.45; 15. Hey What’s Up Let’s Flow T-Shirt We’re not sure if Fetty Wap does yoga, but it doesn't matter. This twist on the opening line in his song “Trap Queen” makes us laugh every time anyway. We know, we know—$50 is pricey for a tank top. But can you really put a price on telling the world, “Hey, I’m zen and on trend?” Didn't think so. ($50;


Couple married almost 70 years dies minutes apart

An Illinois couple married for 69 years died minutes apart, according to their daughter.Isaac and Teresa Vatkin died last weekend, their daughter, Clara, told WGN.

>> Read more trending news The couple immigrated to the U.S. in the 1960s, according to Clara, and had a loving marriage until the very end.The couple's health had declined in recent years and they were both taken to the hospital last weekend. When doctors determined that the couple did not have much time left, they were placed side by side so they could hold hands. Teresa died first, and Isaac died not more than 20 minutes later, according to Clara.

Girl almost turned away from prom because of dress length

A Florida woman is calling on school leaders to clarify guidelines for what students can wear to prom after confusion and controversy arose over the dress that her daughter wore to the dance.

>> Read more trending news 

Leaders at Sandalwood High School in Jacksonville, Florida, told  Action News Jax that the teenager's dress was too short in the front.

“She’s crying, she’s like, ‘Mom, just come and get me.’ I said, ‘No, you’re going to the prom.’ We spent all of this money, and it doesn’t make any sense for them to say it’s inappropriate,” Nydia Allen said.

>> Related: Florida student wears Black Lives Matter-inspired prom dress

Allen said her daughter called her an hour after she took a picture of her in her dress before prom. Most of the dress touches the ground. The skirt touches her knees in the front.

“She was saying that they said her skirt was too short,” Allen said.

Allen said she bought the dress based on the guidelines outlined in a letter that she said the school sent home.

>> Related: Teen takes 93-year-old grandmother to prom

The letter said dresses must be an appropriate length, but Allen said that when her daughter got to the prom, school leaders told her a different story.

“I asked them to show me what’s inappropriate, and they continued to say, ‘It says it here, it has to be to the ankle,’ and I said, ‘That’s not the paperwork you guys sent home.’ They need to change the way they’re writing these contracts for the students let it be known and make it clear, on what you expect at the prom. She can wear the skirt to school, but she can’t wear it to prom? What’s the difference?” Allen said.

A spokesperson for Duval County Public Schools sent Action News Jax this statement: “For Sandalwood High School, students were made aware in advance that prom dresses must be floor length. To resolve the issue, additional fabric was added to the front of the dress.”

Allen said they tried to add more material to the dress to make it longer, but eventually allowed her daughter in after she put on black tights. 

>> Related: Jacksonville high school apologizes for 'good girl' prom dress flyers posted in hallways

Giant 3-foot rabbit found dead on United Airlines flight

While still dealing with legal action and negative public relations after a man was forcibly dragged from a flight, United Airlines is now investigating an incident in which a giant rabbit was found dead aboard one of the airline’s international flights.  

>> Read more trending news 

According to the BBC, a nearly 3-foot-long giant rabbit named Simon was traveling from London’s Heathrow airport to Chicago’s O'Hare airport in the cargo space of a United plane on April 19.

The rabbit was being shipped to a new owner in the U.S.

Simon’s breeder, Annette Edwards, from Worcestershire, England, said the rabbit had been seen by a veterinarian hours before the flight. 

“Simon had a vet’s checkup three hours before the flight and was fit as a fiddle,” Edwards told The Sun. “I’ve sent rabbits all around the world and nothing like this has happened before.”

Edwards said the unidentified American buyer is upset.

“I haven’t got a clue who’s to blame, but it’s certainly very weird when Simon was so healthy,” Edwards told CNN.

Simon, a 10-month-old Continental Giant rabbit, was poised to grow to be the world’s largest rabbit, according to NBC News. The largest rabbit on record, as noted by the Guinness World Records, is Simon’s father, a 4-foot-4-inch and 50-pound animal named Darius.

“We were saddened to hear this news. The safety and well-being of all the animals that travel with us is of the utmost importance to United Airlines and our PetSafe team,” the airline said in a statement. “We have been in contact with our customer and have offered assistance. We are reviewing this matter.”

Earlier this month, United Airlines made headlines when a passenger, David Dao, was forcibly removed from a flight after refusing to give up his seat for a United employee on a fully booked flight. United CEO Oscar Munoz said no one would be fired for the incident.

Dry conditions could mean more venomous snake sightings, experts say

The ongoing drought could bring danger slithering right into Floridians' yards.

The dry conditions mean the most venomous snakes in Central Florida are on the move.

>> Watch the news report here

Herpetologist Bob Cross said low water levels in many lakes and swamps means snake sightings are more likely to happen in neighborhoods.

“It’s very frightening to think that they’re that they’re that close to a house,” said Longwood resident Candy Bauer. "I don't feel the same about my backyard."

>> Snakes dumped in Walmart parking lot

She found a cottonmouth in her backyard this week and called Cross to relocate the animal.

“Usually when people saw that, it’s a harmless water snake," Cross said. "But in this case, the lady was right."

>> Read more trending news

He said the dry weather is forcing the cottonmouths and other snakes to seek water elsewhere.

"He’s going to be traveling like the gators,” Cross said.

>> 'Firefighters saved my life,' rattlesnake victim says

He said a bite from a cottonmouth would cause severe pain and swelling.

"We'd be calling 911 and a helicopter for you," Cross said.

The snake found in Bauer’s yard will be sent to a facility in DeLand which will use it to produce anti-venom.

12 Boxing-Inspired Core Exercises for Rock-Solid Abs

You might find it surprising that boxing is one of the most complete, full-body workouts you can do. Your aerobic, anaerobic, and nervous system have to work together, and as a result, your musculature and mental sharpness, or reaction time, improves, explains Noah Neiman, cofounder and head trainer at Rumble Boxing in New York City. 

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“A common misconception most people have is that launch power for a punch comes from strong arms,” he says. “But it’s actually the ability to generate power from your legs, from the speed and power of rotation through your hips and core, and then ultimately the extension of your arms that creates a strong punch.” 

Translation: Core strength is integral to generating the force necessary for boxing (whether you're a casual kickboxer or a serious competitor). And a strong core isn’t just beneficial in the ring; it's important outside of it too. “Poor core strength can lead to back, lower back, neck, and even knee pain,” Neiman says. So to keep you in top shape on and off the ropes, we collected 12 abs exercises borrowed from boxers that'll help you build serious core strength. How to use this list: Start by performing each exercise below for 30 seconds. Use the modifications or progressions listed, if applicable, to better suit your personal strength. Build up to 60 seconds each. Perform each move with no rest in between for a killer 12-minute workout or scroll down to try our 12-minute, 4-move sample workout below. You can substitute any exercise in this list for another in the workout. Grab an exercise mat to get started.

Inchworm Push-Up Stand with feet shoulder-width apart. Hinge at hips to bend over and touch floor with hands, then walk hands out to high plank position. Keeping elbows close to sides, bend elbows and lower chest to floor. Push back up, then walk hands back toward feet. Repeat. Make it easier: Drop to knees for the push-up then return to plank.  Sit-Up With One-Two Punch Lie faceup on mat, knees bent, feet flat on the floor in front of you. Keeping feet planted, engage core and use abdominal muscles to sit up while keeping hands in fists in guard in front of face. At the top, throw a right and left punch, then slowly lower back down one vertebrae at a time to return to starting position. Repeat. Make it harder: Add 16-ounce gloves or a light set of hand weights.   Walking Plank Start in high plank position, hands directly under shoulders, legs extended out behind you, core engaged to keep body in straight line from head to toe. Lift up right hand and lower right forearm to the floor. Do the same with left hand and forearm. Then lift right forearm and place right hand back on ground, followed by the left hand. Continue repeating. Make it harder: Place a BOSU ball underneath your forearms to challenge your stability.  V-Up Lie faceup on mat, legs extended straight, arms extended overhead. Keeping core engaged, sit up, lifting arms and legs simultaneously toward each other, so body forms a V shape. Slowly lower back down until arms and legs are two inches above ground. Repeat. Plank Jack Start in a forearm plank, elbows directly under shoulders, core engaged so body forms a straight line from head to toe. Without moving upper body, jump feet apart, then back together. Continue jumping.Make it harder: Increase your speed.  Sprinter Crunch Lie faceup on mat, legs extended out in front of you, hands up in guard. Keeping core tight, sit up and twist toward left while simultaneously bringing left knee to right elbow. Lower back down to starting position. Repeat on other side. Continue alternating.  Straight Leg Scissor Sit on mat, legs extended straight out in front of you. Lean torso back and place fingertips on floor next to hips for support. Keeping legs straight NS core engaged, lift right leg toward ceiling. Lower, then lift left leg toward ceiling. Continue alternating. Make it harder: Add ankle weights.  Push-Up to Superman Start in high plank position, hands slightly wider than shoulder-width apart, body in straight line from head to toe. Bend at elbows to lower chest to floor to perform a push-up. Release hands, pull shoulder blades together, and lift chest, arms, and legs off mat. Lower down, place hands on ground, and push back up to plank position. Repeat. Russian Twist  Sit on mat with knees bent, feet on floor in front of you about hip-width apart. Engage core, lean back about 45 degrees, and bring fists up to chest with elbows out. Twist at waist to tap right elbow to the mat on right side, then left elbow to mat on left side. Continue alternating. Make it harder: Grab a medicine ball or kettlebell in the weight of your choice and hold at chest.  Shoulder Tap Start in high plank position, hands directly under shoulders, body in straight line from head to toe. Without shifting weight and keeping body still, lift right hand and tap left shoulder, then lift left hand and tap right shoulder. Continue alternating as fast as possible.   Reverse Oblique Crunch  Start sitting on mat, legs extended out in front of you, hands on mat behind you. Lean back slightly onto fingertips for balance and lift legs two inches off floor. Keeping core tight, twist at the waist and bring bent knees toward chest, then extend back out (don't drop legs to mat). Twist to the other side and repeat. Continue alternating. Sit-Up to Stand Up  You might also like {{displayTitle}} READ This is a classic Mayweather move that'll challenge your entire body. Grab a partner (or just use the base of a couch, dresser, or heavy object to lock down your feet). Start lying faceup on mat, knees bent, feet flat on the floor in front of you with partner anchoring feet. Engage core, perform a sit-up, and continue to come all the way up to standing, reaching arms overhead. Slowly reverse the movement back down to return to starting position. Repeat. Make it harder: Add a set of dumbbells. 

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Photography: Julia Hembree Special thanks to Gotham Gym NYC and our model, Tatiana Firpo, Gotham group fitness manager and trainer. 

Severe Shortage Of Home Health Workers Robs Thousands Of Proper Care

Acute shortages of home health aides and nursing assistants are cropping up across the country, threatening care for people with serious disabilities and vulnerable older adults.

In Minnesota and Wisconsin, nursing homes have denied admission to thousands of patients over the past year because they lack essential staff, according to local long-term care associations.

In New York, patients living in rural areas have been injured, soiled themselves and gone without meals because paid caregivers aren’t available, according to testimony provided to the state Assembly’s health committee in February.

In Illinois, the independence of people with severe developmental disabilities is being compromised, as agencies experience staff shortages of up to 30 percent, according to a court monitor overseeing a federal consent decree.

[caption id="attachment_723078" align="alignright" width="370"] Renzo Viscardi (center), pictured with his parents Anthony Viscardi and Cheryl Dougan, relies on round-the-clock care from home health aides. (Courtesy of Cheryl Dougan)[/caption]

The emerging crisis is driven by low wages — around $10 an hour, mostly funded by state Medicaid programs — and a shrinking pool of workers willing to perform this physically and emotionally demanding work: helping people get in and out of bed, go to the bathroom, shower, eat, participate in activities, and often dealing with challenging behaviors.

It portends even worse difficulties to come, as America’s senior citizen population swells to 88 million people in 2050, up from 48 million currently, and requires more assistance with chronic health conditions and disabilities, experts warn.

“If we don’t turn this around, things are only going to get worse” said Dr. David Gifford, senior vice president of quality and regulatory affairs for the American Health Care Association, which represents nursing homes across the U.S.

“For me, as a parent, the instability of this system is terrifying,” said Cheryl Dougan of Bethlehem, Pa., whose profoundly disabled son, Renzo, suffered cardiac arrest nearly 19 years ago at age 14 and receives round-the-clock care from paid caregivers.

Rising Demand, Stagnant Wages

For years, experts have predicted that demand for services from a rapidly aging population would outstrip the capacity of the “direct care” workforce: personal care aides, home health aides and nursing assistants.

The U.S. Bureau of Labor Statistics estimates an additional 1.1 million workers of this kind will be needed by 2024 — a 26 percent increase over 2014. Yet, the population of potential workers who tend to fill these jobs, overwhelmingly women ages 25 to 64, will increase at a much slower rate.

After the recession of 2008-09, positions in Medicaid-funded home health agencies, nursing homes and community service agencies were relatively easy to fill for several years. But the improving economy has led workers to pursue other higher-paying alternatives, in retail services for example, and turnover rates have soared.

At the same time, wages for nursing assistants, home health aides and personal care aides have stagnated, making recruitment difficult. The average hourly rate nationally is $10.11 — a few cents lower than a decade ago, according to PHI, an organization that studies the direct-care workforce. There is a push on now in a handful of states to raise the minimum to $15 an hour.

Even for-profit franchises that offer services such as light housekeeping and companionship to seniors who pay out-of-pocket are having problems with staffing.

“All the experienced workers are already placed with families. They’re off the market,” said Carrie Bianco, owner of Always Best Care Senior Services, which is based in Torrance, Calif., with franchises in 30 states.

Finding new employees was so difficult that Bianco started her own 14-week training program for caregivers nine months ago. To attract recruits, she ran ads targeting women who had left the workforce or been close to their grandparents. In exchange for free tuition, graduates must agree to start working for her agency.

“There’s much more competition now — a lot of franchises have opened and people will approach our workers outside our building or in the lobby and ask if they want to come work for them,” said Karen Kulp, president of Home Care Associates of Philadelphia.

Hardest to cover in Kulp’s area are people with disabilities or older adults who live at some distance from the city center and need only one to two hours of help a day.  Workers prefer longer shifts and less time traveling between clients, so they gravitate to other opportunities and “these people are not necessarily getting service,” she said.

It isn’t possible to document exactly how common these problems are nationally. Neither states nor the federal government routinely collect information about staff vacancy rates in home care agencies or nursing homes, turnover rates or people going without services.

“If we really want to understand what’s needed to address workforce shortages, we need better data,” said Robert Espinoza, vice president of policy at PHI.

Hard Times In Wisconsin

Some of the best data available come from Wisconsin, where long-term care facilities and agencies serving seniors and people with disabilities have surveyed their members over the past year.

The findings are startling. One of seven caregiving positions in Wisconsin nursing homes and group homes remained unfilled, one survey discovered; 70 percent of administrators reported a lack of qualified job applicants. As a result, 18 percent of long-term facilities in Wisconsin have had to limit resident admissions, declining care for more than 5,300 vulnerable residents.

“The words ‘unprecedented’ and ‘desperate’ come to mind,” said John Sauer, president and chief executive of LeadingAge Wisconsin, which represents not-for-profit long-term care institutions. “In my 28 years in the business, this is the most challenging workforce situation I’ve seen.”

Sauer and others blame inadequate payments from Medicaid — which funds about two-thirds of nursing homes’ business — for the bind. In rural areas, especially, operators are at the breaking point.

“We are very seriously considering closing our nursing facility so it doesn’t drive the whole corporation out of business,” said Greg Loeser, chief executive of Iola Living Assistance, which offers skilled nursing, assisted living and independent living services in a rural area about 70 miles west of Green Bay.

Like other short-staffed operators, he’s had to ask employees to work overtime and use agency staff, increasing labor costs substantially. A nearby state veterans home, the largest in Wisconsin, pays higher wages, making it hard for him to find employees. Last year, Iola’s losses on Medicaid-funded residents skyrocketed to $631,000 — an “unsustainable amount,” Loeser said.

Wisconsin Gov. Scott Walker has proposed a 2 percent Medicaid increase for long-term care facilities and personal care agencies for each of the next two years, but that won’t be enough to make a substantial difference, Loeser and other experts say.

The situation is equally grim for Wisconsin agencies that send personal care workers into people’s homes. According to a separate survey in 2016, 85 percent of agencies said they didn’t have enough staff to cover all shifts, and 43 percent reported not filling shifts at least seven times a month.

Barbara Vedder, 67, of Madison, paralyzed from her chest down since a spinal cord injury in 1981, has witnessed the impact firsthand. Currently, she qualifies for 8.75 hours of help a day, while her husband tends to her in the evening.

“It’s getting much, much, much more difficult to find willing, capable people to help me,” she said. “It’s a revolving door: People come for a couple of months, maybe, then they find a better job or they get pregnant or they move out of state. It’s an endless state of not knowing what’s going to happen next — will somebody be around to help me tomorrow? Next month?”

When caregivers don’t show up or shifts are cut back or canceled, “I don’t get proper cleaning around my catheter or in my groin area,” Vedder continued. “I’ll skip a meal or wait later several hours to take a pill. I won’t get my range-of-motion exercises, or my wheelchair cushion might slip out of place and I’ll start getting sore. Basically, I start losing my health.”

[caption id="attachment_723079" align="alignright" width="370"] Debra Ramacher is executive director of Wisconsin Family Ties, an organization for families of children with emotional, behavioral and mental disorders. Her daughter Maya, 20, pictured in 2015, has cerebral palsy, epilepsy and other significant disabilities. (Courtesy of the Ramacher family)[/caption]

Debra Ramacher and her husband have been unable to find paid caregivers since June 2015 for daughter Maya, 20, and son Michael, 19, both of whom have cerebral palsy, epilepsy and other significant disabilities. The family lives in New Richmond in western Wisconsin, about 45 minutes from the Minneapolis-St. Paul metropolitan area.

“At least three agencies told me they’ve stopped trying to hire personal care aides. They can’t find anybody and it costs them money to advertise,” said Ramacher, executive director of Wisconsin Family Ties, an organization for families with children with emotional, behavioral and mental disorders.

“It’s incredibly stressful on all of us, living with this kind of uncertainty,” she said.

Every few months, Ramacher tries to find caregivers on her own by putting ads up on Craigslist, in local newspapers and on job boards.

“We get a few bites,” she said. “Most recently, two people came and interviewed. One never got back to us; the other got a better job that paid more.”

In the meantime, she and her husband are being paid by Medicaid to look after Maya and Michael.

“We don’t want to be the caregivers; we want to have our own life,” Ramacher said. “But we don’t have any option.”

KHN’s coverage related to aging & improving care of older adults is supported by The John A. Hartford Foundation.

Pre-Obamacare, Preexisting Conditions Long Vexed States And Insurers

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For most of his life, Carl Goulden had near-perfect health. He and his wife, Wanda, say that changed 10 years ago. Carl remembered feeling “a lot of pain in the back, tired, fatigue, yellow eyes — a lot of jaundice.”

“Gray-like skin,” Wanda added. His liver wasn’t working, she explained. “It wasn’t filtering.”

Carl was diagnosed with hepatitis B. He is now 65 and on Medicare, but back then he had a flower shop in Littlestown, Pa., so he had been buying health insurance for his family on the market for small businesses and the self-employed.

The medications to manage Carl’s hepatitis cost more than $10,000 a year — and if he ever needed a liver transplant, as some people with hepatitis eventually do, the costs could be formidable. Thank goodness they had health insurance, the couple thought.

But then, Carl said, “the insurance renewals went way up.”

After a few years, he could no longer afford to buy the coverage — more than $1,000 a month — and maintain his business. So he dropped the insurance.

“I was devastated,” he said, “because I didn’t know when my liver might fail.”

Teresa Miller, Pennsylvania’s insurance commissioner, said that steep increase in insurance rates was legal. And before the Affordable Care Act became law, a patient like Goulden might have had a hard time buying another policy. He likely would have been turned down by private insurers because he had a “preexisting” medical condition.

A family like the Gouldens would “just have been out of luck,” Miller said.

Pennsylvania: The Wild, Wild West 

Before the ACA, states had differing approaches to handling preexisting conditions.

Pennsylvania was typical. Until the ACA mandated that insurers treat sick and healthy people equally, buying insurance seemed as lawless as the Wild West.

Insurers couldn’t overtly kick people off a plan if they got sick, but they could find ways to charge them much more, even those whose chronic condition wasn’t that serious — such as acne. For individuals looking to sign up in the first place, “an insurance company could simply decline to offer you insurance at all because of your preexisting condition,” Miller said.

Insurers who did offer a policy to someone with a preexisting condition might have done so with a catch — the plan could require a waiting period or might exclude treatment for that condition.

“So, let’s say you had diabetes, for example,” Miller said. “You might have been able to get coverage for an unexpected health care need that arose, but you’d still be on your own for any treatment and management of your diabetes.”

From the perspective of an insurance company, these practices were intended to prevent the sick from signing up for a health plan only when they needed costly care.

Pennsylvania tried to partially solve this problem by creating a scaled-back health plan, called adultBasic, for those with incomes too high to qualify for Medicaid who didn’t have any coverage. Household incomes had to be less than 200 percent of the federal poverty level, which at that time would have been $21,660 for an individual. More than 40,000 people were signed up in 2011, and nearly half a million were on the waiting list,  but the plans didn’t include coverage for mental health care, prescription drugs or more than two nights in a hospital. Even so, Miller said, the strategy proved too expensive for the state.

“That program was spending $13 million to $14 million a month when it was shut down,” she said.

High-Risk Pools

More than 30 other states dealt with preexisting conditions by setting up what are called high-risk pools, a separate insurance plan for individuals who couldn’t get health coverage in the private market.

These plans could be lifesavers for some people with conditions like cancer — which can cost tens if not hundreds of thousands of dollars to treat.

The experiences with high-risk pools varied, but states faced challenges, said John Bertko, an insurance actuary with the state of California. And the main problem was the high cost.

“The one in California, which I was associated with, limited annual services to no more than $75,000, and they had a waiting list. There was not enough money,” Bertko said. “The 20,000 people who got into it were the lucky ones. At one point in time, there were another 10,000 people on a waiting list.”

The pools also had catches: Premiums were expensive, as were out-of-pocket costs. And plans often excluded the coverage of preexisting conditions for six months to a year after the patient bought the policy.

New Jersey: Preexisting Conditions Covered, With A Catch

Around that same time, across the Delaware River, the state of New Jersey was trying something different.

“Insurers could not take health status into account,” said Joel Cantor, director of Rutgers’ Center for State Health Policy who has been analyzing the New Jersey experience.

Before the ACA, New Jersey was one of just a handful of states that prohibited insurers from denying coverage to people with preexisting conditions. Insurers also weren’t allowed to charge people significantly more for having a health issue, and the plans had to offer robust coverage of services.

There was a one-year waiting period for coverage of a preexisting condition, but a larger issue became cost. The entire individual market in New Jersey became expensive for everyone, regardless of their health status, Cantor said. Because there was no mandate to have health insurance coverage, those who signed up tended to need it, and healthy people did not enroll.

And so, “the prices went up and up,” he said. And the premiums and enrollment “went down and down.”

The state tried to address this in the early 2000s by introducing a “skinny” health plan, Cantor said.

“By that I mean very few benefits,” he explains. “It covered very, very limited services.”

The plan was affordable and really popular, especially among the young and healthy people, and about 100,000 people signed up. But if a person had a health need, many costs shifted to the individual.

“It left people with huge financial exposure,” he said.

That’s, in part, why the ACA included a rule that insurance plans now must offer good benefits and be available to everybody. In exchange, insurers have the mandate and subsidies — so that everybody will buy in.

Cantor said these experiences point to an ongoing quandary: A small portion of people consume a big chunk of health care costs. It’s hard to predict who will cost a lot — or when.

This story is part of a partnership that includes The Pulse, NPR and Kaiser Health News.

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