More than 80% of U.S. nursing homes reported staffing shortages in early 2023. SciLine interviewed Dr. Jasmine Travers, a gerontological nurse practitioner and assistant professor of nursing at New York University Rory Meyers College of Nursing, and asked her how the shortage affects health care for nursing home residents, if nursing homes in poorer neighborhoods have been hit harder by the shortages, and what can be done to fix the problem.

Below are some highlights from the discussion. Answers have been edited for brevity and clarity.

Who lives in nursing homes in the United States?

Jasmine Travers: There are 15,000 nursing homes with approximately 1.2 million residents. That population can range in age, although most commonly it’s those 65 years of age or older.

What is the current state of nursing home staffing?

Jasmine Travers: In 2001, the Centers for Medicare & Medicaid Services proposed minimum staffing standards. They indicated that total nursing hours should be 4.1 hours per resident per day. And that’s including the registered nurse, the licensed practical nurse and the certified nursing assistants. Only 25% of nursing homes were found to be meeting those total nursing hours in 2019.

How did the COVID-19 pandemic affect nursing home occupancy and staffing?

Jasmine Travers: Occupancy levels hovered at about 80% prior to the pandemic. During the pandemic, occupancy went down to a low of 67%. By the end of 2022, those levels had gone up to 72%.

Lower occupancy levels can be a significant issue. Higher occupancy brings in more revenue to the nursing homes. With lower occupancy and less revenue coming in, then that’s a decrease in financial support that the nursing home needs to run their day-to-day activities.

How does nursing home staffing affect the quality of care and health outcomes for residents?

Jasmine Travers: A number of studies show that when staffing is low, emergency hospitalization visits increase. Some of these visits could have been addressed by care provided in the nursing home setting. We also see increased instances of pressure ulcers, urinary tract infections, falls and deficiency citations – issued when a nursing home does not meet a certification minimum standard.

When nursing homes are understaffed, that means there might not be a sufficient number of certified nursing assistants to, for example, answer call bells. That might translate to residents sitting in their beds needing help for longer periods of time.

In those instances, if a person doesn’t have someone to get them out of bed, sometimes they might try to get up themselves. And when they do that, they could be at risk of falling. Or if they stay in bed and they’re soiled, they’re at increased risk for urinary tract infections or pressure ulcers.

What can be done to alleviate nursing home staffing challenges?

Jasmine Travers: Areas that are socioeconomically deprived or that lack good transportation, housing and schools are less desirable places to work.

Just recently, the Centers for Medicare & Medicaid Services released an announcement that they are going to allow for those in pediatric specialties to receive loan reimbursements and loan forgiveness for working in underserved areas. A similar program for those working in nursing homes would likely increase staffing.

I’d also like to see improved wages and benefits and more investment in retention efforts to keep the people who are already working in nursing homes working there.

One of the biggest issues when it comes to staffing is turnover. People will stay when the work environment is changed. And when people stay longer, they know their residents more. That consistency translates to better quality of care.

Watch the full interview to hear more.

SciLine is a free service based at the nonprofit American Association for the Advancement of Science that helps journalists include scientific evidence and experts in their news stories.

Jasmine Travers, Assistant Professor of Nursing, New York University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

LAKE COUNTY, Calif. — The final preparations are underway for the annual Lake County Fair, which opens next week.

The fair will take place from Thursday, Aug. 31, through Sunday, Sept. 3.

The gates open on Aug. 31 at 6 p.m., starting with the Blue Ribbon Dinner and the 8 p.m. grand opening.

This year’s grand marshal is the Lake County Tribal Health Consortium.

Volunteer of the Year is Larry Leonard of Leonard’s Hauling & Tractor Service.

Lake County Fair’s nightly grandstand events start at 8 p.m. and are always free with admission.

Kicking off a fun-filled four days of all things fair will be Thursday night’s toughest trucks, Jeeps and more in the Mud Boggs.

On Friday, you have to see the amazing sideways action sponsored by Twin Pine Casino of the drifters and burnouts.

Saturday’s double action night with the destruction derby and the enduring favorite — the boat races.

Sunday, Fiesta Day is Lake County Tribal Health’s Los Campeones Mas Jovenes Del Jaripeo Ranchero Professional and bandas, música and baile.

This year’s fair also will include corn hole, free kids area, Lake County Idol, daily karaoke, Mr. & Miss Lake County Fair and on Sunday during the diaper race a new washing machine will be given away by Pardini Appliance.

The Lake County Fairgrounds are located at 401 Martin St., Lakeport.

For tickets visit the fair website.

MENDOCINO NATIONAL FOREST, Calif. — A fire that lightning caused more than a week ago in the Mendocino National Forest has been fully contained.

The Slide 1 fire, located 1.5 miles north of Mount Linn in the Yolla Bolly Middle Eel Wilderness, was 100% contained at 473 acres as of Tuesday evening, forest officials reported on Wednesday.

The fire began Aug. 14 due to lightning from thunderstorms passing over the forest.

“I want to express my deep appreciation for everyone’s hard work,” said Forest Supervisor Wade McMaster.

Precipitation moved over the fire on Monday and rained on firefighters for several hours during the day shift.

Hotshot crews finished securing the containment line during Tuesday’s shift, officials said.

On Wednesday, crews backhauled supplies and equipment from the fireline using aircraft.

Officials said that over the next several days firefighters will be working with resource advisors on opportunities for suppression repair. Several crews and equipment are being demobilized. A helicopter remains assigned to the incident for reconnaissance.

On Thursday the type-3 incident will transition to a type-4 incident, which means more resources will need to be assigned.

Forest officials remind visitors that a closure is in effect for the Yolla Bolly Middle Eel Wilderness area within the Grindstone Ranger District, Ides Cove Backpacker Trailhead, Ides Cove Horsepacker Trailhead, roads and trails in that area.

Information about the Slide 1 Fire and related closures are available on Inciweb at https://inciweb.wildfire.gov/incident-information/camnf-2023-slide-1.

 

Humans have learned to fear wildfire. It can destroy communities, torch pristine forests and choke even faraway cities with toxic smoke.

Wildfire is scary for good reason, and over a century of fire suppression efforts has conditioned people to expect wildland firefighters to snuff it out. But as journalist Nick Mott and I explore our new book, “This Is Wildfire: How to Protect Your Home, Yourself, and Your Community in the Age of Heat,” and in our podcast “Fireline,” this expectation and the approach to wildfire will have to change.

Over time, extensive fire suppression has set the stage for the increasingly destructive wildfires we see today.

The problem with fighting every fire

The way the U.S. deals with wildfires today dates back to around 1910, when the Great Burn torched some 3 million acres across Washington, Idaho, Montana and British Columbia. After watching the fire’s swift and unstoppable spread, the fledgling Forest Service developed a military-style apparatus built to eradicate wildfire.

The U.S. got really good at putting out fires. So good that citizens grew to accept fire suppression as something the government simply does.

Today, state, federal and private firefighters deploy across the country when fires break out, along with tankers, bulldozers, helicopters and planes. The Forest Service touts a record of snuffing out 98% of wildfires before they reach 100 acres (40 hectares).

As a result, many forest ecosystems that would have periodically burned have become clogged with underbrush, new growth and woody debris that can easily ignite. Efforts by the Forest Service to adopt a more selective policy have run into opposition from Western politicians.

At the same time, people have built more homes and cities in fire-prone areas. And the greenhouse gases released by decades of increasingly burning fossil fuels have caused global temperatures to rise.

Climate change and wildfires

The relationship between climate and wildfire is fairly simple: Higher temperatures lead to more fire. Higher temperatures increase moisture evaporation, drying out plants and soil and making them more likely to burn. When hot, dry winds are blowing, a spark in an already dry area can quickly blow up into dangerous wildfire.

Given the rise in global temperatures that the world has already experienced, much of the Western U.S. is actually in a fire deficit because of the practice of suppressing most fires. That means that, based on historical data, we should expect far more fire than we’re actually seeing.

Fortunately, there are things everyone can do to break this cycle.

What fire managers can do

First, everyone can accept that firefighters can’t and shouldn’t put out every low-risk wildfire.

Remote fires that pose little threat to communities and property can breathe life into ecosystems. Low-level fires that clear out undergrowth but don’t kill the trees create space for trees, plants and wildlife species to thrive, and they return nutrients to the soil. Some tree and plant species depend on fires to open their seeds to reproduce.

Natural fires can also help avoid catastrophic fires that occur when too much underbrush has built up for fuel. And they create fuel breaks on the landscape that could halt the advance of future flames.

Fire managers have advanced mapping technology that can help them decide when and where forests can burn safely. Thoughtful prescribed burning – meaning low-intensity fires intentionally set by professionals – can offer many of the same benefits as the flames that historically burned in forests and grasslands.

The Forest Service is aiming to ramp up its prescribed burning on more acres in more areas across the country. However, the agency struggles to train adequate staff and pay for the projects, and environmental reviews sometimes cause yearslong delays. Other groups offer beacons of hope. Indigenous groups across the country, for example, are returning fire to the landscape.

Adapting homes to fire risk

For decades, scientists have understood the relationship between wildfire and community destruction. However, little has been done to live safely with fire on the ground. More than one-third of U.S. homes are in what’s known as the wildland-urban interface – the zone where houses and other structures intermingle with flammable vegetation.

The biggest risk to homes comes from burning embers blowing on the wind and landing in weak spots that can set a house ablaze. Those embers can travel over a miles to nestle in dry leaves or pine needles clogging a gutter, a wood-shingle roof or shrubs, trees and other flammable vegetation close to a structure.

Some of these vulnerabilities are easy to fix. Cleaning a home’s gutters or trimming back too-close vegetation requires little effort and tools already around the house.

Grant programs exist to help harden homes against wildfire. But enormous investment is needed to get the work done at the scale the fire risk requires. For example, nearly 1 million U.S. homes in wildfire-prone areas have highly combustible wooden roofs. Retrofitting those roofs will cost an estimated US$6 billion, but that investment could both saves lives and property and reduce wildfire management costs in the future.

Homeowners can look to resources like Firewise USA to learn about the “home ignition zone.” It describes the types of vegetation and other flammable objects that become high risks at different distances from a structure and steps to make properties more fire resilient.

For example, homes should not have flammable plants, firewood, dried leaves or needles, or anything burnable, on or under decks and porches within 5 feet (1.5 meters) of the house. Between 5 and 30 feet (9 meters), grasses should be mowed short, tree branches should be pruned to at least 6 feet (2 meters) from the ground, and the tree canopy should be at least 10 feet (3 meters) from the structure.

What communities can do

Many counties and cities have their own wildfire programs to educate homeowners and connect them with resources. Some have started “tool libraries” to help anyone begin the necessary work on their property.

Beyond individual actions, states and communities can enact forward-looking wildfire resilience policies.

These can include developing zoning rules and regulations that require developers to build with fire-resistant materials and designs or might even prohibit building in areas where the risk is too high. The International Wildland-Urban Interface Code, which provides guidance for safeguarding homes and communities from wildfire, has been adopted in jurisdictions in at least 24 states.

Living in a world with wildfire

Prevention and suppression will always be critical pieces of wildfire strategy, but adapting to our fiery future means everyone has a role.

Educate yourself on proposed forest projects in your area. Understand and address risks to your home and community. Help your neighbors. Advocate for better wildfire planning, policy and resources.

Living in a world where more wildfire is inevitable requires that everyone see themselves as part of solving the problem. Wildfire can be terrifying, but also natural and essential. Embracing both isn’t always easy, but I believe it is the only way forward.

Justin Angle, Professor of Marketing, University of Montana

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Scientists from NOAA, NASA and 21 universities from three countries are deploying state-of-the-art instruments in multiple, coordinated research campaigns this month to investigate how air pollution sources have shifted over recent decades.

Since the 1970s, U.S. scientists and environmental regulators made significant strides in reducing air pollution by cleaning up tailpipe and smokestack emissions.

Yet levels of two of the most harmful types of pollution, ground-level ozone and fine particulates, have decreased only modestly in recent years. Both still contribute to the premature deaths of more than 100,000 Americans every year.

“This is an unprecedented scientific investigation — in scope, scale and sophistication — of an ongoing public health threat that kills people every year,” said NOAA Administrator Rick Spinrad, PhD. “No one agency or university could do anything like this alone.”

Using multiple satellites, seven research aircraft, vehicles, dozens of stationary installations — even instrumented backpacks — scientists will measure air pollution from sources that include transportation, industrial facilities, agriculture, wildfires and consumer products such as paint, pesticides and perfumes.

The data will be scrutinized, analyzed and run through sophisticated chemical and weather models by scientists and the U.S. Environmental Protection Agency (EPA) in an effort to improve air pollution forecasts. Findings will be shared with state and local environmental officials to inform decisions about the most effective ways to reduce air pollution.

The data will also be used to evaluate the first observations made by NASA’s groundbreaking TEMPOoffsite link instrument — the first geostationary space-borne sensor to continuously measure air pollution across North America. Lessons learned will aid the development of the new GeoXO satellites being jointly developed by NOAA and NASA.

Probing the causes of persistent pollution

EPA, which sets national air quality regulations, currently lists about 200 U.S. counties as failing to meet the 8-hour ozone standard established in 2015. Sixty-nine counties are failing to meet the standard for fine particulates, or PM2.5, set in 2006. After decades of decline in ground-level ozone and fine particulate matter in the U.S., downward trends have slowed in recent years.

Scientists from four NOAA research labs, led by the Chemical Sciences Laboratory (CSL), along with NOAA satellite scientists and research pilots, are leading three of the research projects. The largest, AEROMMA, has NOAA scientists and collaborators operating 30 specialized instruments aboard NASA’s DC-8 flying laboratory, collecting a myriad of chemical measurements over highly populated cities, including New York City, Chicago, Toronto and Los Angeles.

“In order to make progress on reducing air pollution that negatively affects millions of Americans, we need to have a better understanding of the current sources of pollutants and what happens to these pollutants once they are in the atmosphere,” said CSL scientist Carsten Warneke, one of the AEROMMA project’s mission scientists.

For decades, fossil fuel emissions were the primary source of urban volatile organic compounds or VOCs, which along with nitrogen oxides, or NOx, act as precursors to both ground-level ozone and particulate pollution.

As VOCs from the transportation sector have declined, recent NOAA research shows that consumer products derived from fossil fuels (so-called “volatile chemical products”) may now contribute as much as 50% of total petrochemical VOC emissions in densely populated urban cities.

These may not be properly accounted for in emission inventories or considered in air quality management strategies.

The campaigns may also have an opportunity to investigate another emerging air pollution source: wildfire smoke that has blanketed the Midwest and East Coast states this summer.

Collecting data from the sidewalks to satellites

NASA researchers are also deploying two of their Gulfstream research aircraft with the DC-8, mapping air quality and methane from high altitudes over the five cities while the DC-8 collects measurements at lower altitudes.

Similar to the other projects, data collected by NASA’s STAQS mission will be compared to TEMPO’s high-resolution estimates of trace gas and aerosols, as well as with emission inventories and atmospheric processes.

“NASA is excited to partner with NOAA and EPA during these field campaigns to learn how best to use the TEMPO satellite to observe hourly changes in air quality at the neighborhood scale over North America," said Barry Lefer, NASA's program scientist for tropospheric composition.

A concurrent NOAA research mission, CUPiDS, will use NOAA’s Twin Otter research plane to zero in on the meteorology and dynamics of the atmosphere that creates and transports pollutants from the New York metro area downwind over Southern New England.

Another element pairs a University of Maryland instrumented Cessnaoffsite link aircraft and a NOAA instrumented SUV making simultaneous measurements in the air and at the surface to better understand the vertical distribution of air pollution and greenhouse gas emissions in the Northeast corridor from DC-Baltimore up to New York City and Long Island Sound.

On the ground, researchers from Yale University, Aerodyne Research Inc. and other NOAA-funded collaborators will be taking measurements from a rooftop site at the The City College of New York campus, downwind in Guilford, Connecticut, from a 62-meter research tower on Long Island, in coordination with the DC-8 and Twin Otter flights. NOAA’s Climate Program Office is providing major funding for these and other affiliated studies.

“This regional network of ground sites has enormous potential to help us understand urban and downwind air pollution — not just today but under a continually changing climate,” said Yale Professor Drew Gentner, who is coordinating ground sites in New York and Connecticut.

In Manhattan, scientists will be carrying air pollution sensors in backpacks in a NOAA pilot project to investigate surface ozone and PM2.5 in underserved neighborhoods in New York City, where pollution directly impacts human health, especially during heat wave events.

Tying it all together

“The large number of participants, measurements, the variety of platforms involved, and the way they are working together in a highly choreographed and coordinated way is unique,” said CSL Director David Fahey. “Our goal is a comprehensive view of air pollution spanning the U.S. to improve forecasts of urban and regional air quality and advance the health of our nation.”

LAKE COUNTY, Calif. — After more than a year of Lake County being without a permanent Public Health officer, the Board of Supervisors has hired a doctor who previously led Mendocino County’s health department during the pandemic and now works for Santa Barbara County.

Following a closed session discussion on Aug. 15, the Board of Supervisors emerged to announce that it had appointed Noemi C. Doohan, MD, Ph.D., MPH as Public Health officer, and then voted unanimously in open session to approve a one-year renewable employment agreement contract with her.

The appointment is effective Sept. 1.

Doohan served as Mendocino County’s Public Health officer on a part-time basis from July 2019 to May 2023.

That job overlapped with her position as the chief medical officer for the Santa Barbara County Public Health Department, where she was hired in October.

She also previously was a public health medical officer for the California Department of Public Health.

Medical Board of California records show that she graduated from the Stanford University School of Medicine in 2003.

She holds a bachelor’s degree in biochemistry from Mills College, a Master of Public Health from the University of Massachusetts, Amherst, and a Ph.D. in biochemistry and molecular biology from the University of California, Santa Barbara, according to her LinkedIn profile.

Doohan will provide “Public Health officer services” for a one-year period, with an option to renew.

She will be paid the annually renewable not-to-exceed amount of $290,000, as well as a $20,000 hiring incentive, according to county documents. In addition, Doohan will receive employee benefits through the county.

Deputy County Administrative Officer Matthew Rothstein told Lake County News that the contract amount was negotiated and is annually renewable on completion of a performance evaluation. He said it’s not associated with a particular step for the Public Health officer position.

The county’s job description for the Public Health officer says that the position’s annual salary is $265,000.

Doohan will report directly to the Board of Supervisors, the appointing authority, as the job description says.

Rothstein confirmed that previous Public Health officers also have reported directly to the board, not the Health Services director, noting, “The PHO does work closely and collaboratively with the Health Services/Public Health team.”

California counties are bound by state law to have health officers in place to enforce local health orders and ordinances, and state regulations and statutes relating to public health.

Doohan will be the first Public Health officer not serving on a temporary basis since Dr. Erik McLaughlin resigned in June of 2022, as Lake County News has reported.

McLaughlin’s three-and-a-half-month tenure was the shortest of any permanently appointed Public Health officer in Lake County in 20 years. At the time of his hire, he wasn’t licensed to practice medicine in the state of California.

After McLaughlin’s departure, the county hired Dr. Gary Pace, who had held the Lake County Public Health officer position during the pandemic, to take on the role again for a short period of time.

On Sept. 13, the supervisors appointed Dr. Karl A. Sporer as interim Public Health officer for a six-month term, in an amount not to exceed $6,000 a month. Sporer lives in Sonoma County and works in Alameda County.

The board amended that contract to extend it an additional six months at its Feb. 7 meeting.

Seeking options

This isn’t the first time the county of Lake has contracted with Doohan for health-related services.

At its Nov. 8 meeting, the board unanimously approved a contract with Doohan for a Lake County Public Health officer mentor program in response to having had few, if any, candidates for the position, out of 110 potential candidates identified across the state by a county-hired recruiter.

Some of that reluctance was attributed to the political nature of the job, which also had come under more fire during the COVID-19 pandemic.

At that time, County Administrative Officer Susan Parker said Doohan wasn’t interested in the Public Health officer job.

That mentor program contract called for Doohan to be paid a consulting rate of $250 per hour for three to six months, with a not-to-exceed amount of $25,000.

In her report to the board for the Aug. 15 meeting, Parker said that the county has not been able to find a permanent full-time Public Health officer since Pace left the position in April of 2021, “despite an aggressive nationwide search,” and outreach to professional associations, the California Department of Public Health and California Conference of Local Health Officers.

“None of these efforts attracted an enduring and permanent Public Health Officer. Describing this position as, ‘Difficult to Fill,’ is an understatement; the reasons are numerous,” Parker wrote in her memo to the board.

“Strains of the COVID-19 pandemic caused unprecedented turnover in the Public Health professions. What had been crucial and largely behind-the-scenes roles were suddenly thrust into the spotlight. With the overwhelming workload that came in initial pandemic response, long hours in the face of ever-changing information, many long-time practitioners understandably burned out; late career professionals also retired in significant numbers,” Parker wrote.

Following the departure of Dr. Karen Tait, who served from April 2008 to December 2017, no Lake County Public Health officer has served for longer than 20 months. The longest tenure has been that of Pace, who filled the role from Aug. 2019 to April 2021, Parker said.

Parker said there have been more than 10 changes in staffing of the Public Health officer role over a period of five and a half years.

Sporer advised the county that he couldn’t continue in the job past Sept. 30 and hoped to end the job sooner than that if possible, according to Parker’s report.

Referring to the contract with Doohan, Parker said, “Providing stability in the Public Health Officer role for a period of one year, with the option to renew, will provide critical support to the Health Services Department and broader community.”

There had been concerns over McLaughlin — who lived in Nevada — not being in Lake County for some key inspections and work that requires an on-site presence.

Doohan, who lives in Solvang, will be required to be in-person full-time for four of her first six weeks on the job. For the following month, she must be in-person for two weeks and can be remote for two weeks.

That will be followed by one week full-time in person and three weeks remote per month for the remainder of the contract.

Doohan will be responsible for developing a two-year Public Health officer workplan for the board’s approval and can perform other “current contractual obligations” if they don’t conflict with Lake County employment policies.

Email Elizabeth Larson at This email address is being protected from spambots. You need JavaScript enabled to view it.. Follow her on Twitter, @ERLarson, or Lake County News, @LakeCoNews.