State officials say over 11,000 Georgians die each year from a tobacco-related illness at a cost of $1.8 billion. Although bleak statistics are not enough to get people to stop, one employer in north Georgia is actively helping employees who want to end their addiction to nicotine.
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Company Helps Employees Kick the Habit
by Candice Felice
The number one cause of illness that can be prevented in Georgia is smoking. If current smoking patterns continue, tobacco use will kill about 10 million people every year by the year 2020. State officials say over 11,000 Georgians die each year from a tobacco-related illness at a cost of $1.8 billion. Although bleak statistics are not enough to get people to stop, one employer in north Georgia is actively helping employees who want to end their addiction to nicotine.
Ronnie Anderson lives in Dalton where he has been making carpets at Shaw Industries for over 28 years. He had been smoking for longer than that. Anderson says he started work at the factory when he was 16 years old. He began buying cigarettes and quickly got addicted to nicotine.
"My father started smoking and I picked that up from him. I started smoking roughly at about 15 years old. I smoked for about 32 years, three to three and a half packs a day. I reckoned it relieved the tensions of the day."
The habit got so bad, Anderson says that before getting out of bed he would reach over and pick up a cigarette. By breakfast he had smoked at least eight. "Some people take nerve pills. You know that nicotine fix, it seemed like it just calmed me down. I didn't realize it was doing that much harm."
The dangers of smoking hit home for Anderson two years ago when his father was diagnosed with cancer. "We thought we were going to lose him. He came through the operation and they took a 26-pound tumor from his stomach, and that was a little bit of an incentive to go ahead and lay them down."
Anderson finally quit with the help of his employer. On company time he attended cessation classes at the factory. Each week he would meet with nurse Missy Wright who conducted the classes. "In my class I would buy calendars, and I would ask them to track every day how many cigarettes you smoke. "Let's see when you tend to smoke. What are your triggers?"
Wright uses a program called Fresh Start, which is endorsed by the American Cancer Society. She says of the 90 people who have taken the class, 80 percent have successfully quit. Wright says those employees have become more productive. "I think overall you find people who are smokers do go to the doctor more, they do have more cases of bronchitis and sinus infections, and even more serious conditions of emphysema. And our insurance now is based on if you smoke, you do pay more for your insurance premiums."
Rising healthcare costs for companies are driving cessation programs like Fresh Start. To sweeten the deal for employees who quit, Shaw Industries has added other benefits, such as a $175 gift certificate after a year of smoke-free living, and a party.
These kinds of incentives can make the difference. Michael Eriksen, public health professor at Georgia State University, says for almost all smokers quitting is hard. "Seventy percent of smokers would like to quit, wished they'd never started, and think it's the stupidest thing they've ever done." For those who do succeed, Eriksen says the main health hazards of smoking decrease, even among those who have smoked for 30 years or more.
It has been two years since Ronnie Anderson had his last cigarette. He says he feels better, has more energy, and more cash. "I figured out how much money I was wasting on cigarettes and I couldn't believe it. It was about $3,200 a year. I figured that up for about 30 years and that was over $100,000. I looked at that number and I said, 'Just think what you could do with that money,' and I went and bought me a car with it. And actually what I was saving on smoking, I'm making my car payments."
Anderson is now encouraging other smokers to quit because he says encouragement is the first step. "If you just sit and look at what you are really doing to yourself and look at how much money you're wasting, you'll lay them down."
What You Need to Know About Smoking
The Facts
More than 11,000 Georgians die each year from tobacco-related diseases.
Cigarette smoking is the leading preventable cause of death in Georgia.
Nearly one in four people in Georgia smoke.
Nicotine
Nicotine is the drug that causes addiction and is found in substantial amounts in all forms of tobacco.
Several studies have found nicotine to be as addictive as heroin, cocaine, or alcohol.
Nicotine is absorbed readily from tobacco smoke in the lungs, and from smokeless tobacco in the mouth or nose, and spreads rapidly through the body.
Nicotine is used as an insecticide. Researchers continue to seek other uses for the tobacco plant, such as genetic engineering or growing biomass.
Cigarette Tobacco
From a public health perspective, tobacco has virtually no positive artributes.
Cigarettes account for the largest share of manufactured tobacco products in the world – 96% of total sales.
Tobacco smoke contains over 4,000 chemicals, 60 of which are known or suspected carcinogens and some of which have marked irritant properties. Some of the chemicals are: Acetone (paint stripper), Arsenic (ant poison), Butane (lighter fuel), Cadmium (car batteries), Carbon monoxide (car exhaust fumes), DDT (insecticide), Formaldehyde (embalming fluid), Hydrogen cyanide (capital punishment by gas), Methanol (rocket fuel), Nicotine (cockroach poison), Phenol (toilet bowl disinfectant), Propylene glycol (antifreeze), Toluene (industrial solvent), Vinyl chloride (plastics).
Health Effects of Smoking
Nearly 1 in every 6 deaths is related to smoking in Georgia.
Cigarettes kill more Georgians than alcohol, car accidents, suicide, and AIDS, homicide, and illegal drugs combined.
Smoking causes about 87 percent of all lung cancer cases in Georgia.
Cigarette smoking is a major cause of cancers of the lung, larynx, oral cavity, throat, and esophagus. It is a contributing cause in the development of cancers of the bladder, pancreas, liver, uterine cervix, kidney, stomach, colon, rectum, and some forms of leukemia.
Tobacco has a damaging effect on women's reproductive health; it is associated with increased risk of miscarriage, early delivery, stillbirth, and sudden infant death syndrome (SIDS); and it is a cause of low birth weight in infants.
Smoking is associated with reduced fertility.
Thomas Dubois, Director for Corporate Affairs with Phillip Morris, said in 2002, "Yes, we agree that smoking cigarettes, including our brands, causes lung cancer and other serious diseases in smokers."
Over a million poor Georgians get their medical needs met through Medicaid. This year the state hopes to save $80 million by switching to managed care. That means doctors and hospitals won't be paid directly by the state, but will have to contract with one of three companies the state has selected. In turn, those companies have to build a network of medical professionals that will see their members. Michael Cotton is the CEO of Wellcare, which operates statewide. He says it's been hard to build a network, especially in rural areas.
"I think the issue in some of the regions is that there's not been managed care in any form in the marketplace - managed care in terms of HMOs and what we call 'primary care assignments.' So some of that is part of the challenge. I think once we've had a chance to communicate what the program is, attaching members to providers, making sure that patients have access, and there's an understanding of that as the goal of the program, we think we do a much better job in terms of getting providers to understand and attracting them to the plan."
Cotton says Wellcare is still negotiating with major hospitals in south Georgia, but he hopes that by September 1st they will see the patients that select his plan.
Another struggle for the managed care companies is the fact that some doctors, mainly specialists, have decided to completely quit seeing Medicaid patients because the payout isn't that good. Craig Bass is the CEO of Amerigroup, which will roll out September 1st in southeast, east, and north Georgia. He says he keeps talking with doctors.
"But I do think physicians are taking this opportunity to re-evaluate what they do and don't do relative to their business. They have to pay their bills just as much as everybody else does."
One company that says it has a full network of hospitals and primary care physicians is Peachstate Health Plan which will operate in southwest Georgia around Albany, Tifton, and Valdosta. It's CEO, David McNichols, says their plan is as good as the former state Medicaid system.
"The issue for us is the same issue that the state has faced historically, and that is there simply are not enough specialist providers down there. So our network is as robust as the state had prior to, or today, before going to managed care, we have as good or better coverage. But candidly, there just are not enough docs."
Earlier this month, a group of doctors in Atlanta where all three companies have been operating since June first sued them, saying they were holding back claims and keeping the money as long as possible to earn interest. But Craig Bass of Amerigroup says those allegations are not valid.
"We're off to a very solid start. We are paying 99% of our claims within 15 business days of the claims that we've received, and I think that many providers are working with us to make sure that they get their claims processed. And our intention is that the providers get paid for the services that they provide to our members."
State officials blame a lot of the problems to the massive shift of how medical care will be provided to Georgia's poor from now on.
It's not only doctors who see the change, but patients as well. Michael Cotton with Wellcare says that they will have to educate their new members, that they have to see a doctor or call a nurse as the first step in healthcare.
"This is a population that has routinely used emergency rooms for primary care services, so we believe education, outreach are very critical, very important, and we've made that a cornerstone to our program."
The glitches that still exist in the system changeover have caused at least one lawmaker to ask the state to change the deadline for the statewide rollout of managed care for Medicaid from September 1st to October 1st.
In the debate over immigration, perhaps no question is more politically charged than whether immigrants are a burden on society. A recent study found Latino immigrants use far less health care than other groups.
In the debate over immigration, perhaps no question is more politically-charged than whether immigrants are a burden on society. In health care, the question is even more prickly. A recent study found Latino immigrants use far less health care than other groups.
Walk through Orelia Almanzan's door in downtown Lyons, a small town near Vidalia, and you might think you've entered a pharmacy.
"The something tea is to calm nerves and something at night. The something tea is for babies and some people take it for stomach aches. And we have the something tea and cat claw for kidney problems."
The main street Hispanic grocery has plenty of cures for various ailments, but owner Almanzan is not a doctor. Many immigrants in this onion-growing region come to her extensive herbal section because they use such remedies in Mexico and because they don't want to visit a doctor.
"It sells very well. Since we can't afford to go to the doctor frequently, we try to take care of matters ourselves."
Stores like these are just one small reason why Latino immigrants use less health care than U.S. citizens. A recent Harvard and Columbia University study found they receive 55 percent less the native-born. Report co-author from the University of Southern California, Dr. Sarita Mohanty, says that should lay to rest the myth that immigrants are responsible for the nation's high health costs.
"A lot of the comments made about immigrants burdening the health care system seem to be quite unfounded. There was really no substantial data that supports that the're really overburdening systems on a national level."
Mohanty says some of the reasons immigrants use less health care include cultural differences - like the herbs - but are mostly language and money.
At East Georgia Health Care in Reidsville, money is on the mind of many sitting in the waiting room as the small clinic fills with patients early on the Tuesday after Memorial Day. Among them, Ismael Ruiz complains of stomach pain and fever. He says over the long weekend, his wife urged him to go to the hospital, but he decided to wait it out and come here instead.
"The other time I went to the doctor, it was very, very expensive. I was in a hospital room and it was $500. I had to come to an agreement with the hospital to pay it. I paid it back slowly, but I paid it. I know this clinic is less expensive."
Ruiz says most of the time, he just takes over-the-counter medicine for his ailments. The uninsured construction worker says although he's been sick like this before, this is only his second visit to the doctor in six years. Clinic director Jenny Wren Denmark agrees it's typical for immigrants to delay or do without care.
"They wait until it is debilitating, really. When they can't go in the field anymore, then they come to the doctor. And what we try to encourage is preventative health care."
Denmark says she wants more immigrants to see the doctor and has started programs to go into the fields to make sure they're doing so. She says it costs her organization more to do this, but says it's her job. She gets annoyed at the question, and doesn't want to answer whether immigrants are a burden.
"It costs more to provide a bilingual staff. Sometimes we have to employ someone that their only job is translation. But that's just a mission of serving your population. And that's not something that we hold against anyone. We really avidly look for additional patients, particularly in the migrant population. We need to encourage them that we are not there to report them of their legal status."
At an immigrant health fair in a huge, sweltering gymnasium in Vidalia, many immigrants don't seem as interested in check-ups as they do with getting an identification card from the Mexican consulate. The organizers say they need the IDs to get immigrants near physicians. Josefina, who didn't give her last name, was among those waiting hours in a long line to get official papers.
"I think many people are afraid to go to the doctor and they don't get near them even once a year to get checked. One of the biggest fears is not knowing English and the other is, I don't know, sometimes some of us, Hispanic women, are afraid to go to the doctor, especially if they end up with a male doctor. They get nervous."
Many in the line say it's been years since they've been to the doctor. Others say, they've been told to go, but don't. Still others say, they take over-the-counter medicine until it's really bad, then, they go to the emergency room.
At Meadows Regional Medical Center in Vidalia, the cost of such attitudes falls here, in the ER, where the round-the-clock doctors and state-of-the-art equipment make treatment more expensive. Latino leaders are trying to teach the newly arrived to see the doctor early so they can avoid this place, but ER director Peggy Fountain says the efforts only go so far.
"The bottom line is, it is harder to make those collections. Sometimes people, they don't have a permanent address. If they don't have the funds to pay at the time of service, then you have issues with billing. So, we don't collect a lot of money because of the transition and people moving in and out of the area."
Overall, the study found Latino immigrants have the lowest per-capita use of health care than any other group, a third that of U.S.-born whites. But one immigration critic says the hospital's experience should make anyone doubt whether simply "not seeing the doctor" truly reduces immigrants' impact on the health system. Steven Camarota of the Washington think tank Center for Immigration Studies says, per-capita use doesn't tell the whole story.
"Uninsured immigrants, or uninsured illegal immigrants, use somewhat less in health care at taxpayer expense. However, since the immigrants are many more times likely to be uninsured in the first place, it almost doesn't matter. Or think of it this way: immigrants and their U.S.-born children account for almost three-fifths, or 9,000,000 of the 11,000,000 increase in the number of uninsured people in the United States since 1989."
Camarota supports strict immigration controls. He says illegal immigrants should be sent back to where they came from. Meanwhile, the Reidsville clinic and the Vidalia hospital see more each day. And the physicians and administrators there say unconditionally, "Bring us more. We'll treat them and find the money to do it. That's our job."
Finding a dentist who takes Medicaid can be difficult. Only about one in three Georgia dentists accept payment from the state-run program. Dentists say money, no-shows and paperwork keep them from participating.
Jasmine is doing "so-so" keeping her kids from getting cavities. The mother of three, who didn't want her real name used, is at Dr. Edward Green's office in Albany.
"Excluding a couple of cavities that I'm not too thrilled about, it's been okay. It's getting better because I try to substitute a lot of their sugary sodas with either milk or fruit juices without the sugar in it."
Two of her kids, nine and twelve, were in today for fillings. She says she tries to have them brush twice a day, but struggles. As for paying for today's visit, however, the Medicaid recipient will have no difficulty. She calls the state-issued card she'll take to the front desk "a lifeline" for her and her husband.
"I'm a stay-at-home mom and right now, he's in between jobs. He's leaving one to the next. As with that, you know, you lose company benefits, including dental. So, the Medicaid has really been right there when we needed it."
One million five hundred thousand low-income and disabled Georgians rely on Medicaid. Last year, the program paid for about one million four hundred thousand dental visits, the vast majority of them for children. But in a state with about 4,700 dentists, only about 1,600 take Medicaid, and still many of those aren't taking new Medicaid patients. The problem is most acute outside Metro Atlanta. Dr. Green, a past president of the Georgia Dental Association, is among the minority.
"With the current fee structure, we are probably at a break-even point. But, I feel a responsibility to the community. I attended the Medical College of Georgia, which is a state school. I live in a town where there are needy recipients. And I feel a responsibility to participate."
Green says the state pays only about 70 percent of the costs of treating Medicaid patients, and when Medicaid reimbursements were adjusted up three years ago, the state saw its highest level of dentist participation. The number then dropped and has slowly risen since. Even so, fees are far from Medicaid's only problem. After all, the majority of patients are privately insured, in effect, subsidizing the rest. But...
"When one allocates an appointment time for a Medicaid recipient, it's already at a break-even fee. If that person chooses not to come, or cancels the appointment, then that's a loss for that practitioner who's trying to help."
There are no statistics on how many Medicaid patients are no-shows in Georgia, but the American Dental Association says nationally, it's about 24 percent compared to 14 percent for the privately insured. It's a vexing problem costing doctors hundreds of dollars a week, thousands a year. And that's not all. Georgia Medicaid has been plagued with paperwork problems. Dr. Jay Alderman, Georgia's Medicaid dental director for 22 years ending in 2003, says it got so bad that the state had to stop using one of its private administrators.
"They were double-billing and then they were figuring a mathematical formula based on the past and going back and saying they wanted more proof and they wanted payback. It was just a real mess."
The bureaucratic nightmare cost dentists hundreds of hours in valuable office time. Many now want nothing to do with Medicaid, and that's a problem for state Medicaid director Mark Trail. He's trying to convince dentists the issues with fees, no-shows and paperwork are being addressed.
"Claims are paying extremely well. In fact, many providers tell us that with things like our web-based claims adjudication system, they find that we're actually one of the administratively simplest payees to deal with."
Trail calls claims of paperwork problems "ancient history" and a "temporary glitch" that came with a change of administrators. This year, Medicaid is changing again, this time to a managed care company, something toward which many dentists are taking a wait-and-see approach. Trail believes the HMO will improve service, even for troublesome no-shows.
"We think the managed care organizations are going to help us do that. We actually have some contractual requirements for a certain percentage of the kids in particular to actually get dental care. So they're going to be financially motivated to make sure that the kids get dental care by doing follow-up phone calls and letters."
The importance of getting kids to the dentist is shown in numerous reports linking good oral health to good overall health later in life. Still, dental benefits are optional in Medicaid and many states don't offer them. It's often the first to go when the budget axe falls. States with the strongest commitment to Medicaid dental benefits, however, are clustered in the South, a fact some attribute to the region's poverty. Dr. Alderman, who's now a dental health advocate and a private consultant, says he believes it's also an education issue.
"When I was state dental director, when you talked with teachers, they said that dental problems and vision problems were the most significant problems that they had. This is what kept kids out of school. So obviously, a child in pain cannot learn. Many of the kids that we target in our program had never been to the dentist before."
The Georgia Department of Community Health will roll-out HMOs for Medicaid recipients in Metro Atlanta and Middle Georgia next month and the rest of the state in September. The switch was delayed from last year. DCH says that was to make sure everything was right.
More than 200,000 Georgians have no health insurance. And although they may be working, when they get sick many can't afford to see a doctor. There are about 30 health clinics in Georgia that provide health care to the uninsured; one of them is the Macon Volunteer Clinic.
From a nondescript office building in the Inglewood Section of Macon, the Macon Volunteer Clinic provides free health care to more than 1,000 uninsured adults who live in Bibb County.
Gail Collette is a typical patient. She works as a front desk clerk at a motel on Riverside Drive. "I make just above minimum wage, and I'm just barely able to survive. I had no medical care. If I get a cold I could buy something over the counter but beyond that I did nothing. I just grinned and bared it. I have no health insurance whatsoever, so in order to go to a doctor it costs me almost a week's salary."
Collette was having trouble with pain in her knee. Friends told her about the clinic, and she made an appointment. Doctors there discovered that she also had dangerously high blood pressure. They are treating her high blood pressure as well as her knee.
Some of the patients come in with coughs and colds, but according to Lynn Denny, the clinic's medical director, "A lot of the problems we have are chronic diseases - high blood pressure, diabetes, obesity's a major one, elevated blood cholesterol, elevated blood triglycerides."
Denny says that most of these diseases could have been prevented if the patients had regular medical care, medications, and the knowledge and support to change their diets, stop smoking, and participate in physical activity.
Many of the patients have minimum wage jobs like beauticians, restaurant workers, gardeners, painters and laborers. Health insurance isn't offered by their employers and private insurance is too expensive. And for these working poor, their incomes are too high to qualify for Medicaid. Although their children may qualify for Peachcare, they are without medical resources.
The clinic's director, Valerie Biskey, says that the clinic is filling a gap, a crack in the community's safety net. "They make a choice between living and having a roof over their head and food, and then of course having medicines. We are a primary care clinic."
Volunteer physicians, dentists, nurses, dental assistants and hygienists, optometrists, podiatrists, and physical therapists provide all the health care at the Macon clinic, but money is still needed to pay for drugs, lab tests, and special procedures as well as administrative costs. Most of this comes from foundations and private donations.
Volunteer doctor Jack Menendez practiced surgery in Macon for 35 years. Since 2003, he's been coming into the clinic four days a week. "It's the right thing to do. We can help these people. I don't look at them as anything except as unfortunate in their employment. They don't have money for insurance; others are in low paying jobs that don't have insurance, so we can provide them with health care."
Retired nurse Helen Bridges received financial support to go to nursing school. She feels volunteering is a way to give back to the community. "This way I can help return to the community the help that was given to me."
And the volunteers are not just giving it back to the community; they are providing a vital health service and winning the admiration from patients. Patient Gail Collett says, "They gave me my medication. I saw the doctor, the nurses, and they taught me things about my sodium intake, my blood pressure. This has been a godsend for me. It really has been a blessing for me."
In September, the Georgia Rural Health Association named the Macon Volunteer Clinic as this year's Outstanding Rural Health Clinic.
With a booming population and aging workforce, Georgia is facing a critical physician shortage. Nowhere is it more visible than in rural areas. But some young doctors are bucking the trend. Emily Kopp visited three of them in east central Georgia.
Flipping through the morning paper, you may come across this ad - Wanted: Doctors. With a booming population and aging workforce, Georgia is facing a critical physician shortage. Nowhere is it more visible than in rural areas. But some young doctors are bucking the trend.
The state government gave Heather Naggar a scholarship to the Medical College of Georgia. In return, the Atlanta native is working far from home, in the manufacturing town of Wrens. She opened her practice here just a few months ago. She's still getting to know the locals. On this morning, a couple has brought their feverish granddaughter, who's wary of strangers.
"Hey, Mary Joyce! How are you, sweetheart?" Naggar tries to soothe the toddler, but without success. She has more success in setting the grandparents at ease. She explains everything she does. They seem to listen. Naggar says patients' satisfaction isn't the problem - it's getting them through the front door.
"People really want everyone else to try you out first," Naggar says. "One of my patients works in a hair salon and she says 'People ask me about you all the time and they want to know if you're okay.' I think things are slower to start up here than they would be in a larger area."
But Naggar is optimistic. After all, she's the only full-time pediatrician in town. Pediatricians are especially rare in rural Georgia. Naggar says she almost didn't come here because the state board that awards country doctor scholarships doubted a city girl could make it in a two-stoplight town.
"My response was, 'I've lived in Atlanta my whole life because that's where my parents lived,'" Naggar says, "'but these are the reasons why I think living in a small town would be great.' And I talked about family life and I talked about getting to know my patients."
Naggar says she loves Wrens, but studies have shown that most doctors who succeed in rural areas have grown up there, like Anthony Davis. He graduated from schools in Atlanta and Macon, but Davis says he's always wanted to return home to Swainsboro.
"I enjoy easy access to hunting, fishing," says Davis. Now Davis is raising his children here, and working in nearby Twin City, population 1,777. His wife, Brandy, admits she misses Thai food, upscale coffee shops, and supermarkets.
"It's definitely been an adjustment just going from being able to go to Publix or Harris Teeter-- huge grocery stores--just around the corner to having only two stores to choose from," she says.
Brandy isn't impressed with the job opportunities in Twin City, so she's trying to start her own home-based gift shop. Anthony Davis says the lack of options in tiny towns may be deterring other doctors. "By the time you get done with your training, you've been away 12 to 15 years and you make roots in other places," he says. He knows several physicians who grew up here, but none of them have returned. "Most time, they're either married or almost married and they have to consider what their spouse wants as well."
It's not just the lifestyle that can be tough. The work can be relentless. "Being the only physician in a particular county, you don't have the back up," says Dr. Joel Bray, who runs the health clinic in Soperton, near onion country. "If I need help from a nephrologists or a gastroenterologist, I can't call down the hall and ask a partner, 'Hey, can you come down here and take a look at this?' I've got to find help in far-off places."
People come to Bray with all sorts of problems. On this afternoon, he sees a smoker with allergies and swollen legs, a 500-pound man who had a bad reaction to blood thinners, and 82-year-old Miss Ollie Kate. Her arthritis is so bad, she can barely walk. She points to her left knee. "The first time this one gave out on me, I fell outside. I was going to the mailbox," she says. "The pain hit so hard, I fell on the concrete."
Bray gives Ollie Kate two shots in the knees to ease her pain. He also asks about her family, and offers advice on a personal issue with her grandson. Ollie Kate says Bray is "very nice." Before this clinic opened, she saw a doctor 24 miles away in Dublin. "I wouldn't go if it was further away because I have to get someone to bring me," she says.
Stories like Doc Hollywood, about a country doctor, inspired Joel Bray to seek out a rural practice. He knows he misses out on some things urban physicians receive. "I could make a lot more money working in Augusta, Savannah or Atlanta, but the rewards of being in a community like this and being comfortable, and knowing my family is comfortable, that's what matters," he says. "Knowing I'm providing a resource to these people that otherwise they wouldn't have, that's the rewarding part."
Georgia officials hope other young doctors follow suit. Most of the state's physicians are baby-boomers. But numbers from state medical schools don't look good.
"This state hasn't seen a real increase in graduation rates for medical school in a couple of decades," says Ben Robinson, executive director of the State Medical Education Board. He says a recently-opened medical school will help. But will it be enough? Georgia is the ninth most populous state in the nation and it's growing quickly. But it lags behind two-thirds of the country when it comes to recruiting doctors.
Barrow County in northeast Georgia is one of the top three counties in the area where the senior population is thriving. And many use their local community center to stay healthy and active.
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Barrow Country Seniors Center
by Candice Felice
Georgia's senior population is on the rise. Census figures confirm that the north Georgia mountains are a big draw for retirees. Barrow County in northeast Georgia is one of the top three counties in the area where the senior population is thriving. And many use their local community center to stay healthy and active. Every day more than 130 people over the age of 60 come to the Barrow County Seniors Center. Jerry Friar is one of them.
"You see us in here exercising. We do that most every day. And then on Tuesdays, we have a lady come in with Karaoke and we exercise with her. Pretty much the same exercising but different. And that's nice. That helps you."
There are also bingo games and computer classes. All of those who come live on their own. Elizabeth Moore is the center's director. She says those who come have a new perspective.
"The idea of aging has changed over the years. At one time, say 15 to 20 years ago, being 60 years old was old in people's mind. You turn 60 now, you hit the ground running."
That's what 62-year-old Diane Sams did. She's a retired businesswoman who's been enjoying the center for two years.
"I considered it a blessing when I started coming here. I discovered there was more to life than just being alone. I found friends and love and companionship and discovered that I could go out and have a life again."
Sams says line dancing and day trips to different places around Georgia are some of the things she enjoys doing most with her friends at the center.
Nora Deaton says the seniors center gives her something to look forward to while her husband continues his plumbing business.
"Well, I think a lot of it has to do with state of mind, and being here helps me to keep my mind on something else."
There is no cost to those who come for the activities, which are funded largely by the county. The federal government contributes 15% of the center's money, and 4% comes from the state.
Center director Moore believes it's money well spent, because she says the activities, education, and healthy meals they get cut down on healthcare costs.
"We have one gentleman that is no longer on his blood pressure medicine, just because of the exercise that he does three days a week, and that's a wonderful step. It's just one step of improvement, but any improvement is good. It's not one step backward, but one forward. So it's nutrition education that we give.
It's the actual balanced meal that we serve, and it's the socialization. So it's all together; it all works together."
Experts say ongoing mental and physical activity will put off nursing home care, which costs an average of $66,000 a year. Moore says the popularity of the center shows that the stereotypes attached to seniors to stay at home and grow old gracefully no longer apply.
"If you are at home and you are sitting at home and you are isolated, the only thing you have to think on is what"s hurting."
For Jerry Friar, who was a professional jockey in Kentucky before moving to Barrow, the center has given him a new lease on life.
"I would be laying on the couch and watching TV and that was my life. And I would get bored and I would get to feeling depressed and sorry for myself. So that's when they brought me here. This place saved my life. Basically that's exactly what happened."
Seniors centers like the one in Barrow County can be found in every Georgia county. And if census trends hold true, their use will grow in the coming decade.
America's 78 million baby boomers are putting off retirement and starting new careers, raising grandchildren, becoming more active community members, and changing the face of America.
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Baby Boomer Health Care Revolution
by Philip Graitcer
As America's 78 million baby boomers reach fifty, they are refusing to retire to the rocking chair. Instead, they are starting new careers, raising grandchildren, becoming more active in their communities, and changing the face of America.
According to AARP head Bill Novelli, this new generation of older Americans is leading a revolution that is changing the way those over fifty live their lives, and, according to him, these new "senior" citizens are taking charge by:
Working to transform health care by demanding quality care and lower pharmaceutical prices
Creating secure retirements by personal financial planning
Advocating for causes that will make a difference
Helping to build livable communities with adequate transportation and services
Revolutionizing the workplace, so that those who want or need to continue to work can do so in a way that benefits everyone
Novelli recently visited with Health Desk reporter Philip Graitcer to talk about how the baby boomers are changing health care.
By the year 2025 more than 1.6 million Georgians will be over the age of 64. If eligibility requirements stay the same, Georgia's Medicaid system could be picking up the tab for long term care for more than 250, 000 of those seniors with one or more chronic health conditions. Georgia's home care management system is considered one of the best in the nation.
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Keeping Seniors Healthy – At Home
by Cyd Hoskinson
By the year 2025 more than 1.6 million Georgians will be over the age of 64. If eligibility requirements stay the same, Georgia's Medicaid system could be picking up the tab for long term care for more than 250, 000 of those seniors with one or more chronic health conditions.
With so much money at stake, states are moving away from health care delivery systems centered on hospitalization and long-term nursing home care, and toward care coordination programs designed to keep the frail elderly, the blind and the disabled in their homes and in their communities for as long as possible.Georgia's innovative source care management system is considered one of the best home-and-community-based- services programs in the nation.
A Visit With Miss Carrie
Miss Carrie Tillman is 104 years old. She still lives in her own apartment in Wrightsville. She gets regular visits from Sharon Jones.
"Miss Carrie" is legally blind, and she's outlived practically everyone she once knew, including her two husbands and three of her four children. She's even outlived the battery in her pacemaker. She looks forward to Jones' visits. Jones is a care manager for SOURCE, which is the acronym for Service Options Utilizing Resources in Community Environments.
"Sometimes the case manager and maybe the personal support aide are the only people these people see. They look forward to them coming in - people need a little human touch every now and then. In the frail elderly population, often it's the simple things that allow someone to stay home."
Keeping Seniors Out of the Hospital
SOURCE is a fee-for-service program. It was designed to keep elderly and disabled Medicaid recipients out of hospitals and nursing homes by providing them with a wide range of home and community based services.
Only the very poorest Georgians – those with incomes of 66-hundred dollars or less – financially qualify.
Dr. Jean Sumner is the medical director of SOURCE and a primary care physician in Wrightsville.
"It's the ability to have a bath, 3 meals a day, someone that makes sure to check on you, make sure you're safe or have an emergency number to call."
What makes SOURCE unique is the active role of a physician who as a member of the care team. When Miss Carrie first enrolled in source her team created what they call a carepath for her. It lists specific goals or outcomes that Miss Carrie is expected to meet, and it holds the entire team responsible for her success. That's why she still lives in her apartment.
Miss Carrie: "I just love it here. I told the rent lady I wanted to stay here until I die."
This level of care and physician involvement and medical oversight is costly.
Saving Money At Home
The Federal government and the State of Georgia spend roughly 28,000 dollars a year to keep Miss Carrie healthy and independent. But that still beats the 66,000 dollars a year it would cost to put her in a nursing home.
Those savings are not lost on Georgia's leadership. Governor Purdue recently expanded SOURCE to make it available statewide. That's a good start, says Dr Sumner who'd like to see the SOURCE's enrollment criteria expanded as well.
"Because we feel there's a large number of people that make a little too much money to qualify for the services but may tremendously benefit from our services."
Sumners says she sees people in nursing homes every day who could live independently with the help of SOURCE, but they just aren't poor enough.
For decades, the infant mortality rate in Georgia has ranked among the highest in the nation. Each year, thousands of babies are born prematurely or at a very low weight. Many of them die. While many of the causes are known, health experts are still searching for ways to prevent so many infant deaths. One approach may be to bring a more personal touch to the care of mothers and babies.
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Lowering Georgia's Infant Mortality Rate
by Jill Jordan Sieder
For decades now, the infant mortality rate in Georgia has ranked among the highest in the nation. Each year, thousands of babies are born prematurely or at a very low weight. Many of them die. While many of the causes are known, health experts are still searching for ways to prevent so many infant deaths. One key may be to bring a more personal touch to the care of mothers and babies.
They're Tiny and the Risk is Great
At the neonatal intensive care unit at Memorial Hospital in Savannah, 40 babies lie swaddled in small beds. Their tiny faces and scrawny limbs sprout an array of tubes and wires. Inside a climate-controlled plastic shell, a boy named Demario fights for his life. Born 3 months early, he's now 3 weeks old, and weighs only a pound and a half. He easily fits in the palm of a nurse's hand. As he recovers from a heart infection, a ventilator breathes for him, and an I.V. drips liquid food. He's not yet able to ingest the breast milk of his mother, who is 17.
His doctor, Linda Sacks, predicts what will come next.
"He'll probably have chronic lung disease. He'll have 2 hospitalizations his first year of life, be at risk for pulmonary infections, developmental delay, and neurological problems. He could die. He's very very high risk."
His mother is young, and she had Chlamydia while pregnant, two of several risk factors that often result in early death for infants. Dr. Sacks and her staff have saved many small and sick newborns like Demario. Advances in medical technology have made that possible, and are a major reason that infant mortality rates have decreased steadily statewide, and across the nation, since 1980. Georgia's infant mortality rate is still very high, in fact the 7th highest in the nation.
Dr. Sacks, "The fact is, we spend lots of research money and lots of real money taking care of these tiny little babies. And if we could just not have them, and prevent preterm delivery, we'd be so far ahead of the game."
Low Birth Weight and Prematurity Contribute to Infant Mortality
The two main causes of infant mortality are that babies are born prematurely or they don't weigh enough. Often, it's both. Birth defects, injuries, and Sudden Infant Death Syndrome are also leading causes. Babies born at a low birth weight - that is, five and half pounds or less - account for more than two-thirds of the state's infant deaths. And the percentage of babies born with low birth weight in Georgia has not decreased at all since 1990. On top of that, a disturbing racial disparity persists. African-American babies are twice as likely as white babies to be born at a low weight, and thus to die.
According to Sacks, "Almost any bad thing that can happen to a baby - being born early, being born small, dying before you're born, dying within the first 28 days of life, dying before the first year, is one and a half to three times higher for African-Americans. That's incredible."
The High Costs of Prematurity
What's also incredible is the financial cost of trying to save the lives of babies born too early. The average stay in a neonatal intensive care unit is more than $150,000 per infant, and can easily reach $500,000. Many of the babies die. Those who live often have cerebral palsy, retardation, and other serious conditions that require lifelong, costly care. That's opposed to a normal term birth, which costs a few thousand dollars. So, the primary goal among public health experts is to prevent so many preemies. To do that, they're honing in on minorities, and mothers most at risk.
PHP - A Prevention Strategy
One such program in southeast Georgia is showing some early success. Perinatal Health Partners (PHP) is a team effort by public health experts, doctors and hospitals to care for high-risk pregnant women. That includes women with serious medical conditions, as well as those with a history of preterm labor or miscarriages. Greta O'Steen is the manager of the program.
Says O'Steen, "The goal of this program is to take very good care of this mother, keep her medical issues under control, so that she can deliver at her local birthing hospital, and does not end up in an emergency situation, and everybody wins."
At the center of the program are nurses who make biweekly home visits to these expectant mothers. Whether the risk is diabetes, drug abuse, or a history of fetal death, the nurses come ready to assess their health and dispense advice.
A Perinatal Home Visit
Recently, nurse Julie Rowell and her assistant, Arnita Mooring, paid a visit to a young woman in Waycross who's an insulin-dependent diabetic. Etoya is 21 years old, and in her second trimester. She?s single, poor and lives with her grandmother. She no longer sees the child's father. Rowell is trying to help Etoya to maintain a good diet and to manage her diabetes. So far today, Etoya has eaten only a pop tart.
Etoya tells nurse Rowell, "I don't have an appetite. I feel full after eating popcorn. Everytime I eat something, I get full."
"When you're pregnant and your uterus grows, it makes your stomach seem smaller, so you fill up faster. That's normal. You eat a small amount, and you feel full. You might be full, but what about your baby?" replies Rowell.
As the conversation continues, Etoya discloses that her food stamps have been cut back. Mooring explains how she can reapply, and get more nutritious food. Then they check her vital signs, blood sugar, the proteins in her urine, and listen to the baby's heart.
"It sounds like a soldier."
"Perfect," says Rowell, "You think it sounds like a soldier? I'll have to use that one."
Promising Numbers
This program of intensive in-home case management by nurses has been operating in 10 counties in southeast Georgia for the past four years. Early data indicates that the intervention is helping. According to an analysis by Georgia Southern University, women enrolled in PHP are significantly less likely to give birth to a low weight baby, or to suffer an infant death, than women not receiving such care.
The numbers are especially promising for African-American and Hispanic mothers; the study shows that for the non-white women enrolled in the program, the odds of an infant death are 80 percent less likely. But this kind of care is labor-intensive, and not inexpensive. The PHP program, currently funded by state, federal and private grants, serves about 200 patients a year, at a cost of $350,000.
Program manager Greta O'Steen says that pales in comparison to the cost of caring for premature babies in a neonatal intensive care unit.
"The average stay is 52 days, and costs around $156,000 per infant. If we can just prevent 3 or 4 per year, in these 10 counties, it would more than pay for this program."
Medcaid Changes Threaten PHP
While public health officials are encouraged by the improved outcomes for mothers and babies in the Perinatal Health Program, the funding for it may run out. That's because of the state's move to privatize Medicaid. The new managed care companies are refusing to pay for the kind of in-home case management that the visiting nurses provide, which had been covered by Medicaid. The HMOs are opting instead to monitor high-risk pregnant women by telephone. Doctors say that's not an adequate way to deliver prenatal care, and will do little to reduce infant mortality.
There are also bingo games and computer classes. All of those who come live on their own. Elizabeth Moore is the center's director. She says those who come have a new perspective.
Nora Deaton says the seniors center gives her something to look forward to while her husband continues his plumbing business.
Center director Moore believes it's money well spent, because she says the activities, education, and healthy meals they get cut down on healthcare costs.
Miss Carrie Tillman is 104 years old. She still lives in her own apartment in Wrightsville. She gets regular visits from Sharon Jones.
"Sometimes the case manager and maybe the personal support aide are the only people these people see. They look forward to them coming in - people need a little human touch every now and then. In the frail elderly population, often it's the simple things that allow someone to stay home."
"Because we feel there's a large number of people that make a little too much money to qualify for the services but may tremendously benefit from our services."