In Connecticut, Saving Lives Comes With an Unexpected Perk: Saving Money

Across much of the U.S., a person who’s poor, overweight and a candidate for obesity-related diseases might not visit a doctor until they’ve already contracted diabetes — that is, if they can even find a physician who will accept Medicaid, the federal health insurance program aimed at the neediest Americans.
But in Connecticut, they’re doing things differently. There, state employees actually reach out to those at the greatest risk before they’ve exhibited any noticeable symptoms, then work diligently to connect them with the right care. Doctors are paid a bonus for getting a patient to see the appropriate specialists, and out-of-the-box arrangements are made when other solutions prove necessary; a low-income senior facing eviction, for example, might be given a “prescription” of a rental voucher so that she can remain in her own neighborhood.
In treating poverty as an ailment in and of itself, Connecticut has adopted a proactive approach to improving the health of its poorest residents — and it’s saving money in the process. After switching to a rarely used Medicaid payment model, known as fee-for-service (FFS), the state faced a daunting challenge: Keep those unable to pay out of the emergency room, or see its budget eaten up by soaring medical costs.
Here’s how it works: Using the extensive data collected from all Medicaid patients, the state’s predictive modeling identifies those most in danger of expensive, chronic ailments like diabetes. Then, says Dr. Robert Zavoski, a former pediatrician who now serves as the state’s medical director, “We make sure they’re getting preventive care so that, 10 years from now, we’re not paying for dialysis for renal dysfunction and amputations for limbs that would have been better left where they were.”
After Connecticut dropped three private companies who administered its Medicaid program and decided to run the massive entitlement on its own, other states practically took bets on when the system would implode.
“They patted us on the head and said, ‘Good luck with that,’” Kate McEvoy, who oversees all of Connecticut’s public health services, recalls of the 2010 decision.
In booting private insurance companies off the job (in Hartford, a city that’s known as the insurance capital of the world, no less), Connecticut was bucking a trend. Thirty-nine other states, representing nearly three-quarters of the nation’s enrollees, have hired managed-care organizations, or MCOs, to oversee Medicaid, with even more governors pondering following suit. Of the rest, only Alaska and Wyoming have a system like Connecticut’s.
Without relying on MCOs to set standards and manage the process, Connecticut’s been on the hook for whatever care its Medicaid population requires, which can include check-ups, specialist visits and hospital drop-ins. The looming receipts have created an incentive for Connecticut to keep its poor healthy.
The tactic has already paid off in the short term and promises to deliver even bigger dividends in the future.
According to a recent analysis of federal payment data published in the journal Health Affairs, Connecticut led the nation in reducing Medicaid costs. The state’s per-patient spending on Medicaid dropped by an average of 5.7 percent each year between 2010 and 2014. One explanation is simple. “We got rid of [the MCOs’] profit and overhead,” says Ellen Andrews, the head of Connecticut Health Policy Project, a nonpartisan analyst. But officials also believe, financially and morally, they’ll do better by paying upfront.
“The old adage went, ‘If you can predict something, you can prevent it.’ And yet as a practitioner, when we look at the population of inner-city children, a lot of stuff was happening that you could predict but nobody was preventing anything,” Zavoski says. “Standing in the capital city in the richest state in the richest country in the world, that’s not acceptable.”
Under Connecticut’s FFS system, primary care doctors are given bonuses for coordinating their Medicaid patients’ care. “They don’t just say, ‘You have a heart problem.’ They’ll make an appointment with a cardiologist and follow-up,” Andrews says.
Paying out doctor bonuses won’t break the bank, but other preventive measures do involve five-figure decisions. Previously, under managed care, insurers denied coverage of top-dollar treatments — exclusions the state has now reversed. For example, Connecticut will pay $94,500 for a prescription that cures Hepatitis C, with the confidence that it will lower costs in the long run. Zavoski reasons that a one-time course of drugs, paired with education about reinfection, might be cheaper than a lifetime supply of the older pills, which put the patient at risk of severe liver and kidney damage.
Of course, the resources might not always be there. As Connecticut’s legislature faces a massive budget deficit that could slash health programs and congressional Republicans attempt to dismantle Obamacare’s expansion, Medicaid is under constant assault. But if the Nutmeg State has one lesson for the rest of the country, it’s that deferring treatment will cost us later — in dollars and in lives.
Homepage photo courtesy of Joe Raedle/Getty Images.
Continue reading “In Connecticut, Saving Lives Comes With an Unexpected Perk: Saving Money”

Bike-Sharing Systems Cost Money, But Make Money Too

In the past decade, several midsize cities have launched campaigns to attract young professionals, and as millennials move in, they’re embracing more and varied ways to get around town. Ride-share companies like Uber and Lyft are making having your own wheels less important, even in car-reliant cities like Los Angeles, where more alternatives to public transit have been a focus for legislators and public transit advocates. And the same is true for bike-sharing programs, which have skyrocketed since the first one was introduced in Washington, D.C., nearly a decade ago. Today, there is an estimated 119 systems nationwide.
As Bill Dossett, executive director of the Twin Cities’ bike share program, Nice Ride Minnesota, said last year, “It’s no longer a novelty. To be a world-class city, you need to have a bike-share program.”
For cities still debating their benefits, here’s what to know — both the good and the bad — about building out a bike-share program.

You Have to Spend Money to Make Money

Bikes cost money, but they also bring it in. The University of Iowa found that bike commuters in 37 of the state’s counties contributed $41.5 million to the local economy through jobs and spending. Fort Worth, Texas, spent $598,000 last year on its first bike share program, and immediately made it back and then some when ridership surged 34 percent more than expected.
But reaping those benefits can come with a hefty price tag.
In New York, for example, the city council requested $12 million this year to fund an additional 2,000 more bikes for its Citi Bike program, the nation’s largest. That comes on top of the bike-share’s rocky — and expensive — start, which was delayed after flooding from 2012’s Superstorm Sandy resulted in $10 million in damages to bike equipment.
And with more bikes comes the need for more bike lanes. To fund them, some cities have turned to tax increases, like in Portland, Ore., where voters recently agreed to a temporary 10-cent gas tax that would raise $64 million over four years, 44 percent of which is earmarked for more bike lanes and safety improvements.

Different Cities Require Different Approaches

There’s no debating that bike shares have been a smash, with the number of bike-share rides exploding from 2.3 million in 2011 to 28 million last year, according to the National Association of City Transportation Officials.
But not every system has been successful. Just this year, Pronto in Seattle shut down operations in March after posting poor ridership numbers. The culprits: Hilly terrain, inclement weather, a mandatory helmet law and few bike lanes in the congested downtown area. (The city is giving bike shares another whirl, however, recently announcing it will see two new companies launch operations later this year.)
L.A., too, is similarly struggling with low ridership compared to other cities, according to an analysis by the Los Angeles Times. In that instance, city officials limited the bike-share system to downtown blocks, making the program out of reach for many who live in L.A.’s sprawling outskirts. Still, officials defend the nascent program. “We’re not New York, we’re not Chicago,” Laura Cornejo, a Metro deputy executive officer told the newspaper. “For every city, you need to look at what the culture is, what the infrastructure is, and what the political and community dynamic is.”

Address Gentrification Controversies Head-On

But not everyone loves the bike-share craze. In some neighborhoods, activists and legislators worry that the bike racks add to congestion and help usher in gentrification.
After New York’s CitiBike program proposed an expansion of bike stations last year in Harlem, a historically black and Latino neighborhood, community leaders called the initiative a “gateway to gentrification” and harmful to local businesses and food trucks.
But research has shown that investing in bike infrastructure and bike shares are actually good for neighborhoods and property value.
In 2013, officials in Indianapolis invested $63 million in grants and private funding to build the Cultural Trail, eight miles of interconnected bike and pedestrian pathways. Two years later, Indiana University’s Public Policy Institute found that properties within 500 feet of the trail increased in value 148 percent, to $1 billion.
“As with anything, some of the pushback is within the community itself, and a lot of it is due to misunderstanding or misinformation,” Jolie Lemoine, president of the board of directors for New Orleans’s Bike Easy program, tells NationSwell. “People think that it will put small businesses out of business, but it’s just not true.”
For Bike Easy, which is currently in the testing phase in parts of New Orleans’s popular tourism areas, such as the French Quarter, the message has been to include the community in deciding where bike docks will go and how they will be used.
“We want people to have the opportunity to get bikes without owning one, so that they can see this is an effective system,” Lemoine says. “It can make areas of town more valuable to residents. I think [the challenge is] changing sentiments, attitudes and desires of what we want our city to offer us.”

Want more? Check out these reads on the challenges and rewards of bike shares:

“Bikes Aren’t Just Good for You, They’re Good for the Economy, Too,” Fast Company
“Have You Heard About That Awesome New Bike-Share Diet?” Next City
“What Keeps Bike Share White,” CityLab

Homepage photo courtesy of Los Angeles Metro Bike Share

There’s Always Something to Do in Brownsville

“There’s nothing to do in Brownsville.” It was a constant refrain when Eva Garcia was growing up in the midsize Texas city, situated just across the border from Mexico. After college, most of her friends moved away to Austin or other cities perceived as more dynamic and interesting. But Garcia stayed, got a job in city government, and is now part of an initiative to transform her community and neighboring cities. “I want to make Brownsville a place where people want to stay,” she says.
As an employee of the city’s department of planning and development, Garcia is taking an active role in doing just that, helping to organize programs and funding for a network of 17 miles of new multiuse trails in and around Brownsville. She’s also been lobbying to attract new businesses to open alongside these new biking, hiking and paddling trails. She recently attended the Kauffman Foundation’s inaugural ESHIP Summit to connect with other people working to build thriving small business communities and get new ideas for how to improve her own.
The goals of Brownsville’s recent outdoorsy development are nothing less than ambitious: Boost the local economy, improve health outcomes, rescue precious natural resources and encourage the growth of a robust entrepreneurial ecosystem. Those are big problems to solve, and Brownsville is trying to tackle them all at once. But the city is aiming to prove that all at once is the best way to take on big issues.
“There’s never enough money to do what you want,” Garcia says. “We’re leveraging resources to attack multiple problems.” For Garcia, the ESHIP Summit was a chance to better understand and imagine the end goal of the development happening in Brownsville. “What I’ve learned is the characteristics of highly functioning systems,” she says, “and how collaboration is essential.”
Turning around an entire community’s idea of itself isn’t exactly easy. Brownsville is behind the curve in developing as a tourist destination, Garcia says. “Right now the challenge seems to be changing the perception of what’s successful, or what could be successful.” Some people believe that in a relatively poor community, building nature trails is a waste of taxpayer money that could be better spent improving public transportation or other services.
But Garcia sees the potential to make her community much stronger — and healthier too. The progress happening today is a steep departure from her experience growing up in Brownsville, which as recently as 2012 was the poorest city in America, with a median income of less than $30,000 a year. The majority of residents are Hispanic, and a CDC study found that the rates of obesity and diabetes were among the highest in the country. Almost 40 percent of residents lack health insurance, according to the most recent census data available. Growing up, Garcia says she had no idea that the health disparities and poverty levels were so severe.
After graduating from the University of Texas at Brownsville (now the University of Texas Rio Grande) with a degree in environmental science, Garcia got an internship with the city and started to learn more about her own community. “I felt like my eyes were opened,” she says. “I started becoming aware of what the issues really were here, and why there were challenges to development.” The city had already started to work on some initiatives to reduce poverty and improve health outcomes, and Garcia decided she wanted to be involved.
Today, Garcia’s department is partnering with Rails to Trails Conservancy to connect 10 local communities with new pathways. The UT School of Public Health in Brownsville has provided grant funding to help promote the new trails and healthy living in general. And the city is taking advantage of a local utility program to dredge and restore tributaries of the Rio Grande that have filled with sediment, organizing new trails around these resacas. The university’s architecture program is designing birding blinds (small shelters that help observers watch birds without startling them) to line the new trails. “Everyone has a role to play,” Garcia says.
That includes entrepreneurs, who are key to making the “active tourism” initiative a success. The city is looking for ways to incentivize small businesses to take advantage of the new walking and biking pathways. “You cannot be active without the [proper] gear,” Garcia says. “Even to go fishing, you need poles and lines, and people to take you out on boats to show you where things are.”
More businesses are needed, she says, to showcase the city’s assets — new companies like outdoor tour operators or kayak and paddleboard rental shops will help market the community as a fun, dynamic place.
“There are constantly things to do now,” Garcia says.

_______

This content was produced in partnership with the Ewing Marion Kauffman Foundation, which works in entrepreneurship and education to create opportunities and connect people to the tools they need to achieve success, change their futures and give back to their communities. In June 2017, the foundation hosted its inaugural ESHIP Sumit, convening 435 leaders fighting to help break down barriers for entrepreneurs across the country.
 

In Atlanta, This Group Fights Hunger With Tech and Found Fruit

Off the Atlanta BeltLine, about 20 feet from the Freedom Parkway bridge, as teenagers skateboarded, joggers pushed strollers and couples walked hand-in-hand, Logan Pool looks up.
“Do you think this tree can hold my weight?” he asks Katherine Kennedy, executive director of Concrete Jungle, the nonprofit that organized the day’s fruit pick.
Kennedy chuckles. “I’ll let you make that call,” she says.
The branches above him hang heavy with reddening plums the size of golfballs. Farther up the hill, six volunteers pull plums from other trees, filling quart-sized containers with the sticky-sweet fruit.
Concrete Jungle aims to address two connected issues. On the one hand, thousands of fruit trees grow unattended — their ripened fruits drop and rot, contributing to the 40 percent of agricultural products in the U.S. that go to waste, according to the Natural Resources Defense Council. And alongside that food waste, people are going hungry. In Atlanta 19 percent of adults and 28 percent of kids are food insecure — a phrase that, in practical terms, means skipping one meal a day based on necessity. Although food pantries and soup kitchens alleviate some of that need, it’s often with donated pantry staples and processed foods, rather than fresh, vitamin- and mineral-rich ones.
Since 2009, the organization has mapped 4,700 neglected trees to create Atlanta’s only fruit-tree map. It’s allowed the small group — which has just one employee and 10 board members — and their volunteers to maximize the harvest and minimize wasted fruit. To date, more than 33,000 pounds of produce have been donated to those in need.
For most of the 10 hunger-relief organizations that partner with Concrete Jungle, this is the only fresh produce they can provide to the families they serve. Subsequently, in places where Concrete Jungle drops off contributions, the fresh produce is used immediately, whether it’s set out for people to grab or set aside for volunteers to prepare as part of a meal.
“Concrete Jungle was the first and remains the most consistent donor of fresh-picked and farm-grown fruits and vegetables for our community,” Chad Hyatt, pastor at Atlanta’s Mercy Community Church, says. “Getting food donations isn’t hard; getting healthy, nutritious, fresh food is.”

Growing Roots

Concrete Jungle started with two friends and some apples. Craig Durkin and Aubrey Daniels had a cider press but, as broke students at the Georgia Institute of Technology, they didn’t have the money for the abundance of fruit required to use it. So they scouted out apple trees in the area and started picking. Before long, they realized the scope of the fruit available in Atlanta — a metro area with so much lush green space it’s widely known as “the city in the forest.”
Sometimes referred to as “gleaning,” this age-old practice gathers whatever crops remain on a farmer’s land after it was harvested. And Concrete Jungle isn’t alone in gleaning food donations. “Urban fruit foraging” organizations — a more modern term for the practice — have popped up in cities such as Seattle; Louisville, Ky.; Philadelphia; Boulder, Colo.; and Los Angeles.
For volunteers, these organizations provide a novel experience that harkens back to childhood tree-climbing or family trips to orchards. “They can now see Atlanta in a new light,” Kennedy says. “They can see fruit trees all over the place.”
That was one of the main draws for Erin Croom, who came out to the plum pick with her two sons, five-year-old Thomas and four-year-old Henry.
“I love showing them that there is magic in ordinary and familiar spaces,” says Croom. “They are so proud to gain new knowledge — like being able to identify new trees — and do something that helps others.”
Back by the parkway bridge, Pool has successfully climbed the plum tree and is diligently harvesting from halfway up its branches, although a few plums have ended up in his mouth.
“I’m only eating the bruised ones!” he calls down, laughing.

A Better Bounty

Beyond a growing volunteer base, Concrete Jungle has technology on its side. Because it’s difficult to keep an eye on the thousands of trees the group has mapped all across Atlanta, they’ve partnered with the Georgia Institute of Technology’s Public Design Workshop to better monitor their potential crops.
First, to reduce the amount of time spent driving to a picking site, the team deployed drones to take photos and videos of the trees. (The drone is currently grounded due to FAA regulations and licensing requirements.) Now they’re creating sensors that will be directly placed in trees to monitor fruit growth. Cameras take weekly pictures of tree branches, and a bend sensor measures a branch’s angle (as fruit grows bigger and heavier, it weighs the branch down). And an electronic nose, still very much in the development phase, aims to “smell” gases as they’re released from growing fruit. Once the gases reach a certain level, the fruit is ready to pick.
Last year Concrete Jungle donated 16,000 pounds of produce, a harvest record they’re hoping to double this year.
On this afternoon, eight volunteers collect 98 pounds of plums, some of which end up at Mercy Community Church, hand-delivered, like most donations, by Kennedy.
A group of predominantly homeless men is gathered for breakfast and prayer. Pastor Hyatt loads some of the plums into a bowl and passes it around. “Concrete Jungle is an example of fundamental justice,” he says, “of seeing a resource and a need and doing the right thing by rolling up your sleeves and dirtying your hands to get the resource to those who need it.”
Correction: This article originally referred to Atlanta’s BeltLine as the Beltway. NationSwell regrets the error.
MORE: Can This Ambitious Plan Both Preserve History and Revitalize a City?

Fighting Food Waste, One Sector at a Time

America is one of the largest offenders of food waste in the world, according to a recent survey. Every year, roughly 1.3 billion tons of food is thrown out worldwide, a considerable problem given that agriculture contributes about 22 percent of the planet’s greenhouse gas emissions and 12.7 million people go hungry in America alone. Entrepreneurs across several sectors have created ways to repurpose food. Their efforts are admirable and economical, but the biggest difference will be if you make food waste reduction a daily habit.

Recovered food from the University of Denver Food Recovery Network chapter.

On College Campuses

On average, a student who lives in university housing throws out 141 pounds of food per year. Multiply that by the number of residential colleges around the country, and it becomes a huge problem, says Regina Northouse, executive director for the Food Recovery Network, the only nonprofit dealing specifically with campus food waste.
WATCH: How Much Food Could Be Rescued If College Dining Halls Saved Their Leftovers?
Northouse’s group reduces waste by enlisting the help of student volunteers at 226 universities. This manpower shuttles still-edible food from dining halls that would otherwise be thrown out to local nonprofits fighting hunger. Northouse estimates that since 2011, Food Recovery Network has fed 150,000 food-insecure people.

Through the box-subscription company Hungry Harvest, farmers sell “ugly food” to consumers instead of tossing the unsightly produce out.

On Farms

If a carrot isn’t quite orange enough, odds are it’ll be tossed. Blemishes and unattractive produce make up nearly 40 percent of discarded food, according to a 2012 study by the Natural Resources Defense Council. Though some unused fruits and veggies can be sent to food manufacturers, farmers lose profits from about a quarter of their crops because of cosmetic imperfections. To put money back into their pockets, box subscriptions services, such as Hungry Harvest, have found their way into the ugly food market.
“We started out with 10 customers at a stand,” says Stacy Carroll, director of partnerships for Hungry Harvest. “We now have thousands of customers every week buying thousands of pounds of food that would, in the past, have been thrown away.”
Roughly 10,000 subscribers along the East Coast receive weekly boxes of recovered produce from the Baltimore-based company (which was started by the founders of Food Recovery Network). In addition, food insecure families who use SNAP benefits can purchase boxes at 10 Hungry Harvest sites. All in all, the organization redistributes between 60,000 and 80,000 pounds of food through its subscription service each week.

MealConnect provides a platform for retailers to redistribute unsold produce to those in need.

At Food Retailers

For merchants, food wasted is also money wasted. Across the U.S., the cost of tossing food runs upward of $165 billion annually.
MealConnect, a tech platform launched in April by Feeding America (a nationwide network of food banks), allows retailers to post surplus meals and unused produce on its app, which then notifies local food banks workers to pick it up and redistribute it to those in need. The company has recovered 333 million pounds of food by working with large retailers like Walmart and Starbucks. MealConnect also allows merchants to recoup some of their outlays (via tax deductions).

Chef Dan Barber’s wastED pop-ups challenged chefs to create innovate dishes using produce that otherwise would have been thrown out.

In Restaurants

In 2015, the aptly named food popup wastED found itself in the heart of a media frenzy because of what was on the menu: trashed food. 
Since then, a handful of other restaurants in urban areas across the world have used recovered produce in their meals.
“We’re offering our cooks the opportunity to be creative and come up with menus instead,” says Brooklyn, N.Y., chef Przemek Adolf, owner of Saucy By Nature, which uses leftovers from previous catering events to create daily lunch and dinner specials.

The USDA’s FoodKeeper app educates consumers on how to extend the shelf life of stored foods.

In Your Own Kitchen

Individual families throw away nearly $1,600 worth of food per year, according to the EPA, which has spurred the federal government to step in and help.
The U.S. Department of Agriculture created the app FoodKeeper, which informs consumers on how long an apple can last in the fridge, for example, and proper food storage techniques to extend shelf life. It also sends out reminder alerts to use up food that’s in danger of spoiling. The desired outcome? People changing their behaviors, ultimately buying less and consuming what they do purchase.
 

Teen Caregivers

A 62-year-old recovering from a broken neck and a 17-year-old who wore the reddest dress in the world to prom are an unlikely pair. But they’re mentor and mentee, and now friends, as part of a program that aims to solve two troubling challenges: the “silver tsunami” of millions living longer and needing care, and the challenges of at-risk urban youth trying to find meaningful careers that offer the chance for advancement into the middle class.
Olga Cruz lives in The New Jewish Home, a nursing home in New York City’s Upper West Side. She fights feelings of isolation and depression with the help of Wenetta Celestine, who shares stories about life during weekly visits. Celestine, like 225 other high school students from the Bronx and Manhattan, spends six to eight hours a week training to work in geriatric care.
Cruz helps her understand what it is like to grow old and what elders in a long-term care facility need.  
“She’s wonderful and loving; I want to hug and squeeze her like a grandma,” Celestine says of Cruz. “If I can’t tell my mom something, I can tell her.”

Many of the teens who are part of the Geriatric Career Development program develop mutually supportive relationships with residents.

With 10,000 Baby Boomers turning 65 every day, and the population of elderly people expected to more than double by 2050, well-trained caregivers are already scarce. And they’re becoming even harder to find, with growth slowing in the primary pool of such workers: women ages 25 to 64.
Back in 2006, The New Jewish Home had trouble hiring certified nursing assistants (CNAs) for residents in its facilities in Manhattan and Westchester County, N.Y. Meanwhile, the graduation rates of many high schools in the Bronx and Manhattan was 40 to 60 percent; few students went on to college.
With the help of private, city and federal grants and a curriculum from nearby Columbia University Teachers College, the Geriatric Career Development (GCD) program introduced 20 students to eldercare.
As part of a summer certification course, Tania Hueston (left) and Jaileen Morales (right) performed clinical tasks at a local hospital. The teens do similar work all year long at The New Jewish Home.

GCD isn’t just about finding people to take vital signs, empty bedpans and bathe the elderly. Its larger aim is to provide struggling teens with the skills and jobs that make it possible for them to earn money, pursue higher education and escape from poverty (almost three quarters live below the poverty line; many reside in violent neighborhoods).
Without this program, Celestine says, “I wouldn’t be working to be a CNA, and I’d probably not know CPR. I learned that there’s always an open door, no matter where you go.”
Eleven years in, it’s found success. Ninety-nine percent of GCD’s 517 graduates have finished high school and 28 currently work at The New Jewish Home. Of this year’s 62 graduates, all are going on to attend college.
In return, the Home gets more than simply a larger hiring pool. Students spend 8,000 hours a year with its elders.
“It makes the residents feel less lonely, and they feel a sense of satisfaction, especially those who do not have family around,” says John Cruz, director of the program. “It makes them feel young again, alive again.”
GCD participants Hinelsey Quezada (left) and Jose Moncada (right) study for their Certified Nursing Assistant certification exam.

Research shows that both young people and the elderly gain when participating in programs like GCD. A recent Stanford University report called for “intergenerational engagement,” citing particular benefits for underprivileged youth.
Today, similar programs exist in Maryland, through the High School Health Education Foundation, and via the Pathways in Technology Early College High School (P-TECH) model, where students can enroll in a six-year-long program that includes job training, a no-cost associate degree and employment that’s all but guaranteed.
Demand for the GCD program is high — each year about 200 students (mostly African American or Latino) apply for 100 spots. Most start as sophomores and spend the next three years learning how to care for elderly patients. Students can earn $11 an hour during a nine-week-long internship at the Home when they are seniors.
Participants receive tutoring help and assistance on how to study for the SAT and how to write resumes and cover letters, among other topics. They also receive counseling on college selection and are taken on campus visits.
About 80 percent continue their medical education by receiving nursing assistant certification via Lehman College (The New Jewish Home covers the cost for each student’s certification course), and some become certified phlebotomists, EKG technicians, medical coders or patient care technicians.
Kayla Rivas, 17, and Joanne Langer, 91, chose each other because they both like to sing.
Joanne Langer, 91, and Kayla Rivas, 17, at The New Jewish Home in New York City.

“It was like love at first sight,” Rivas says. Langer explains that they enjoy “anything except rock and roll,” before she croons her rendition of Irving Berlin’s “What’ll I Do?”
“I feel like she’s like a grandma for me. I always come to her for advice and comfort. When I told her about wanting to go to college she always motivates me, and gives me hugs and kisses,” Rivas says.
Other pairs share similar sentiments. Jaileen Morales, 18, says that without Mizue Fujimoto, 67, she’d likely be struggling more and planning to stay local after high school, instead of going to the State University of New York in Old Westbury, where she plans to study biology.
Just as important, Fujimoto helps Morales, who was raised by her grandmother, have a better relationship with the elderly.
The New Jewish Home has extended its program to people ages 18 to 24, who have dropped out of school or are not currently working. After three months’ of training, participants become certified home health aides, a position that does not require a high school diploma and pays a median hourly wage of $10.87.
Half of all home aides live in households that receive welfare or food stamps and other public benefits. Because of this, the program encourages graduates to earn more credentials.
Certified nursing assistants fare slightly better, earning a national median of $11.68 per hour, compared to $12.81 for patient care technicians and $16.92 for medical coders. While some of these jobs may not boost a worker into the middle class, they can further his or her healthcare career path or provide useful income during college.
Some GCD students are aiming higher. In all, 40 percent of GCD graduates became or are studying to become doctors, nurses, physical or occupational therapists, administrators or other healthcare professionals.
Rivas wants to be a physician’s assistant, a position that has a median salary of more than $90,000. And Morales hopes to become a plastic surgeon.
What started out as a desire to fill entry-level jobs has turned into a program that’s creating a chance to fulfill big dreams. Celestine, Cruz’s mentee, says that without GCD, she wouldn’t be heading off to SUNY Cobleskill in the fall.
“I like to keep to myself, so I’d stay home and get a job,” Celestine says. “I learned that there’s always an open door, no matter where you go. When I see kids on the street, I feel like saying, ‘If you all just knew what GCD could do for you, even if you’ve not finished high school. This is like a change.’”
Correction: A previous version of this article stated that 530 GCD students have finished high school and 75 of this year’s class is going to college. NationSwell apologizes for these errors.

Perspective on Poverty: A Systematized Approach to Improving Healthcare

“When you work in global health, it never feels like you’re doing enough — it’s never big enough, it’s never fast enough. People are dying for reasons they shouldn’t be for reasons that should’ve disappeared from the world 90 years ago,” says Mark Arnoldy, CEO at Possible.
As healthcare continues to be a hot topic of debate here in the United States, Arnoldy is providing an integrative system that delivers care to the poor across the globe.
Nepal is a rich environment… To try and prove that a healthcare system involving government hospitals, clinics and community health works can be successful. The country has enormous demand: 30 million people, of which 80 percent live in rural areas. After enduring a decade-long civil war [from 1996 to 2006], there’s a fair amount of political will and a lot of interest in building a system of universal health care.
Digital connectivity… Is one of the most exciting, new developments in healthcare. Five years ago, in some of these really rural, isolated areas, you couldn’t use a cell phone. Now, we’re running an integrated, electronic health system between our hospital and community health workers using an Android device.
A major, global challenge that people don’t really hear about … In a place like Nepal, there is no registration system for births or deaths. If you’re trying to understand whether some sort of intervention is effective, you don’t know who is living or who is dying. Complicating matters further is that there’s often no national identification system either.
Previously, for instance, a person would go to India for a serious operation. They would be given pamphlets and an x-ray and be expected to keep them and take them to other medical facilities as needed. When people are responsible for paper records, it’s very hard to provide quality healthcare; you can do harm to patients when you don’t have the proper history. Advancements in biometric devices — essentially machines that turn a fingerprint into a secure, digital code — enable us to rethink how we design a healthcare system. With them, we can track patients longitudinally.
It’s almost cliché at this point… But the book “Mountains Beyond Mountains” by Tracy Kidder had a profound effect on me. It’s about Dr. Paul Farmer, the cofounder of Partners In Health. It presents a very compelling narrative and challenges people around the question, What does it mean to live a moral life in the 21st century?
Reporting by Chris Peak

Bridging the Language Barrier Between Patient and Doctor

Lina Guerra used to spend her nights pouring drinks for passengers at Boston’s Logan Airport. The menial job left the 36-year-old single mother of a newborn feeling like she hadn’t realized the economic potential her parents gifted her when they left Colombia in the late 1980s.
During her prolonged hunt for a salaried position, Guerra came across an ad that seemed too perfect. “There’s no way I’ll get it,” she thought. Despite possessing the required language skills, she hesitated, right up to the deadline, before applying. A few weeks later, Guerra received a call to come in for an interview.
The position? A medical interpreter fellowship with Found in Translation, a nonprofit that trains low-income, bilingual immigrant women and places them in jobs at prestigious hospitals in the Boston area. Launched by Maria Vertkin (a Russian immigrant herself) in 2011, the organization has recruited 158 participants that collectively speak about a dozen languages, including Spanish, Haitian Creole, Arabic and Portuguese.
During more than 100 hours of training, fellows learn the rigors of medical interpreting. “You have to be very accurate,” Guerra says. A loose, informal translation could lead to the wrong diagnosis. When a patient describes a stomachache, for example, the interpreter must possess the vocabulary, in both languages, to translate “tummy,” “belly,” “stomach” or “abdomen” to convey the right connotation. On top of that, Guerra adds, interpreters must know the slang for each culture.
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Interpreters act as cultural brokers. During one prep class, for instance, trainees debated the appropriate gender for a gynecologist or urologist. (Arabic speakers believed patients should see a physician of the same gender; those of Spanish heritage believed doing so would imply homosexuality.)
They also learn to advocate, and in a few rare instances, interrupt on the patient’s behalf. “There’s implicit bias and prejudice,” Vertkin says. “It’s the interpreter’s job to say, ‘Wait a minute, are there other options? You’re only offering the cheapest metal filling.’ That might be because of who the patient is and the assumption that they’re poor. The interpreter has the obligation then to intervene.”
With the new commander-in-chief calling for a border wall, mass deportations and an unprecedented Muslim travel ban, times are tough for immigrants like Guerra, who arrived in this country at age 8. She has a message for President Trump: “Please know in your heart that the majority of non-English speaking people have an even greater desire to be American than some people that were born in this country. They are so proud to be in America, regardless of the struggles that they are currently facing,” Guerra says, pleading, “Give them a chance.”
Employed by a translation agency, Guerra makes her living speaking for foreigners. Perhaps it’s time we all starting listening to what she has to say.
MORE: What to Do During ICE Stops
 

The Surprising Story Behind One School’s Healthy Lunch Program, The Best Way to Reach Your Reps and More

 
Revenge of the Lunch Lady, The Huffington Post Highline
In a country where cheap mass-produced food is king and pizza counts as a vegetable, healthy lunches for kids can be hard to come by. But a recent revamp of school fare in Huntington, W.V., previously designated as the nation’s unhealthiest city, provides a hopeful model. There, an enterprising employee managed to implement a healthy lunch program, starring locally grown produce, while maintaining the district’s minuscule $1.50-per-meal budget.
Getting a Busy Signal When You Call Congress? Here’s How to Get Through, The Christian Science Monitor
Since President Trump’s inauguration last month, there’s been a surge in citizens reaching out to Congress, but not all forms of communication are equally effective. If you really want your voice heard, say experts, try meeting with your representative in person, writing a personal letter and focusing on policy rather than cabinet picks.
The Compost King of New York, The New York Times
New York City alone generates 1 million tons of organic waste per year, but a new plant on Long Island will process this waste into both fertilizer and clean energy, generating significant returns. This new large-scale industrial waste processing is both more environmentally friendly and more profitable than traditional composting, and could revolutionize American energy.
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Erecting Skyscrapers With Climate Change in Mind, Coping With Pain Through Virtual Reality and More

 
Building to the Sky, With a Plan for Rising Waters, The New York Times
As climate change becomes impossible to ignore, real estate developers are adjusting their plans for rising storms and sea levels. A new waterfront property in New York City features generators with the ability to power tenants’ refrigerators and power outlets for a week, because “if you have your phone and your refrigerator, you can survive,” as one designer put it. After devastating hurricanes Katrina and Sandy, “resilient design” has become the buzzword in architecture.
Virtually Painless — How VR Is Making Surgery Simpler, Science Focus
Could VR headsets replace painkillers? That’s what a handful of surgeons are betting on in regions where sedatives are expensive and hard to come by. Once a high-tech luxury, virtual reality is becoming ever more mainstream and affordable, and has proven to reduce patient pain by up to 50 percent.
First Class Meal: Could the Declining U.S. Postal Service Deliver Food to the Needy? The Guardian
A creative proposal from students at Washington University in St. Louis aims to turn the stagnant U.S. Postal Service into a thriving food delivery service for underserved communities. A number of organizations are working to curb food waste in a nation where, despite its wealth, one in seven residents experiences food insecurity. But most lack a sustainable transport system to get surplus food to those in need. With vehicles, routes and workers already in place, the declining postal service could be an invaluable resource in the fight against hunger.
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