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Boris faces Union crisis as SNP vow to ‘speed up’ desperate Scottish independence bid

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NICOLA Sturgeon is going head to head with Boris Johnson as the SNP ramp up their independence referendum plans ahead of an intense six week campaign period for the Holyrood elections.

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Gov. Cuomo says New York couldn’t report nursing home deaths in hospitals. But other states did.

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When New York Gov. Andrew Cuomo was first accused of undercounting nursing home deaths from Covid-19, his administration offered a simple explanation:

The state did not include nursing home residents who died in the hospital in the publicly posted tally of coronavirus deaths linked to long-term care facilities, officials said, because it wanted to avoid a “double count” of those deaths in the statewide total.

But New York stands apart from other states in taking this approach to counting nursing home deaths, research experts said — a decision that made New York’s tally of nursing home deaths appear lower than it was, and that is now under federal investigation.

“It’s tricky to compare state-level data, but New York is the only state that explicitly stated that they were excluding hospital-based deaths,” said Priya Chidambaram, a senior policy analyst at the Kaiser Family Foundation, a nonprofit research organization.

By contrast, officials in other states, including Minnesota, Connecticut, Massachusetts and Vermont, said in recent interviews that they found ways to total all nursing home deaths, including residents who died at hospitals, without counting them twice, by cross-referencing the reports from nursing homes with other data sources. Research experts, including Chidambaram, said they were not aware of any other state that counted nursing home deaths as New York did.

That has left both policymakers and researchers wondering why New York didn’t find a similar workaround to avoid leaving out thousands of nursing home deaths from its reported total.

“New York is an outlier of sorts when it comes to this issue,” said David Grabowski, a long-term care expert and policy professor at Harvard Medical School.

Every state has developed its own method for counting Covid-19 deaths in nursing homes, as well as the general population. And New York said explicitly from the early months of the pandemic that its publicly posted count of nursing home deaths only included those that occurred on the premises, as opposed to at a hospital or elsewhere.

The state took this approach to avoid including those deaths twice in its total of all New York residents who had died from Covid-19, the state’s health commissioner, Dr. Howard Zucker, told state lawmakers during an August hearing on the administration’s handling of nursing homes during the pandemic.

“We don’t want to double count — this person died here, and also died there,” Zucker said, describing the Cuomo administration as being “incredibly transparent on information.”

New York officials also said it was important to verify reports of residents who died at hospitals before making those numbers public, as the information provided by nursing homes was not always accurate, especially during the chaotic early days of the pandemic.

“It’s natural to assume they might not have as much information as what happened inside their walls,” said Gary Holmes, a spokesman for the state health department.

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That approach, however, led New York to omit a huge number of deaths from its publicly reported nursing home total until recently. The state had said that about 8,500 nursing home residents had died from Covid-19. But when New York finally included residents who died in hospitals, the total shot up to about 15,000 — more than any other state as of late January, according to a state-by-state count of long-term deaths compiled by the Kaiser Family Foundation. And the state only released the new total after its own attorney general issued a report last month accusing the Cuomo administration of undercounting the deaths.

The New York health department said the delay in releasing the number of hospital-based deaths was due to a time-consuming verification process. The Covid-19 reports that nursing homes and hospitals submit daily only include the initials and age of residents who died “to protect patient privacy,” Holmes said.

While more detailed data on hospital deaths is available, the information is entered into a separate system that often lags and does not include the name of a patient’s nursing home, he added. “Great lengths have been taken to ensure accuracy in data reporting from multiple sources.”

Holmes also said the newly released numbers did not change the overall death toll in New York from the virus, since all nursing home deaths had been included in the statewide count, regardless of the place where they occurred.

Officials in other states in the Northeast and elsewhere told NBC News that they took a different approach to compile a comprehensive count of resident deaths — regardless of whether they occurred at a hospital or at the facility — to avoid the double-counting problem that New York officials were concerned about.

In Minnesota, for example, “deaths are categorized by place of residence,” said Scott Smith, a spokesman for the state’s public health department.

The state relies on self-reported data from nursing homes, which are asked to provide demographic information, date and place of death, and other information. Minnesota also collects data from hospitals, laboratories, medical examiners and death certificates to match reports and exclude duplicate entries to avoid double-counting, Smith said.

Similarly, Connecticut uses self-reported data from nursing homes, which are required to report all resident deaths “whether they occur in their facilities or after transfer to a hospital,” said David Dearborn, a spokesman for the state health department.

The state also relies on reports from the state medical examiner to prevent double-counting in the overall death toll, Dearborn said. “This process ensures an accurate statewide total.”

Massachusetts uses a similar approach, cross-referencing nursing home reports with death certificates to avoid duplicate entries to capture total Covid-19 deaths in the state, a state health spokesman said.

While the pandemic was unprecedented in many ways, the data challenges associated with it are not new, said Grabowski, the Harvard Medical School professor.

“Historically, public health officials have often had to distinguish between site of death and immediate residence prior to death,” he said. “I don’t see any reason why other states were able to classify prior residence and New York was not.”

The basic data should have been readily available to New York officials, said Bill Hammond, senior fellow for health policy at the Empire Center, a right-leaning think tank that sued the state for failing to release its data on nursing home deaths. According to New York’s data collection form, obtained through the lawsuit, nursing homes are specifically asked for “the total number of Covid-19 residents who have died outside your facility,” as well as the total number who died in the facility itself.

“This is not a complicated thing to do,” said Hammond, who believes New York officials should have released both hospital and nonhospital death counts immediately, then cross-checked the information later if they thought it was necessary.

“They’re using the need for maximum accuracy and the difficulty of reconciling the two data sets as a rationale for postponing” the release of public information, he said.

There are other differences between the states, as well as broader inconsistencies in the data. New York and Minnesota, for instance, are among the states that include probable Covid-19 cases in death counts, but some only count lab-confirmed cases.

Some states included staff members in the total number of deaths associated with long-term care facilities, while others did not include them, or separated them out. Some states took months before releasing detailed information on nursing home deaths. And facilities themselves may not always report accurate information.

The long-term care industry itself is skeptical that more data would have made a big difference in the overall response to the pandemic.

“It’s just another piece of data that may show something or may not,” said James Clyne, CEO and president of LeadingAge New York, which represents nonprofit long-term care facilities. “Has anybody looked at it and come to any conclusions? It’s not like anybody had this epiphany because this information was given out.”

But researchers say that complete information from the states is important to understanding the full impact of the pandemic on nursing homes. During the worst months of the pandemic, such data could help public health officials decide where to send resources first, advocates said. It could also help researchers identify which factors left facilities most vulnerable to Covid-19 cases and deaths, and which policy decisions seem to help protect residents and staff members.

In the early months of the pandemic, for instance, the Cuomo administration came under fire for requiring nursing homes to accept recovering Covid-19 patients discharged from hospitals — a decision intended to clear much-needed space in hospitals. The guidance was effectively reversed by May, and state officials released an analysis stating it was not a driver of nursing home outbreaks. But more comprehensive data on resident deaths could help provide more definitive answers, experts and advocates said.

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New York state Sen. Gustavo Rivera, a Democrat from the Bronx who chairs the health committee, recently introduced a bill requiring the state to disclose the deaths of residents who died after being transferred to the hospital, criticizing the state’s decision to exclude them.

“Families and residents alike have suffered not knowing what is going on in the facilities during the Covid pandemic,” the bill said.

The federal government did not start collecting national data on Covid-19 cases and deaths in nursing homes until the first week of May, and facilities were not required to provide information about the previous months. So the state and local governments were the only ones keeping track since the beginning of the pandemic — which is another reason why New York’s nursing home numbers are so important, researchers said.

“Accurate data is the foundation of policy that addresses actual needs — what policies were the most helpful? What policies were the least helpful?” said Chidambaram, of the Kaiser Family Foundation. “The lack of accurate numbers did do a disservice.”

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Abolishing the police and prisons is a lot more practical than critics claim

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Skeptics often argue that abolishing the police and our prison system is impractical. How will you stop people from murdering if there aren’t any police? How will you punish sexual offenders or robbers if there’s no prison? Abolition, at least until recently in the public conversation, has generally been treated as a movement for utopian fantasists, rather than for serious policy wonks concerned with hammering out the gritty iron realities of justice.

Abolition, at least until recently in the public conversation, has generally been treated as a movement for utopian fantasists.

Mariame Kaba’s new book “We Do This ‘Til We Free Us: Abolitionist Organizing and Transforming Justice” refutes this caricature. Flipping such criticism on its head, she writes that prison and police abolitionists are the realists here, and their critics are the ones wandering around with their heads in strategically placed clouds.

Kaba is an organizer and educator who founded Project NIA to work against youth incarceration. She’s been doing abolitionist work for more than two decades in Chicago and New York. Her hatred of the spotlight means she’s not a household name. But she’s inspired a generation and more of Black activism. Her new volume collects interviews, essays and blog posts she wrote alone or with her numerous collaborators between 2014 — the year of the uprisings in Ferguson, Missouri — and today.

Abolitionists are accused of imagining a world without conflict, or in which no one does anything wrong. Reading Kaba’s book, though, it’s clear that she is very aware of brutality and inequity — more so than her critics. Her opposition to police and prison starts with the experiences of marginalized people, who have to deal with police and carceral violence every day. “Abolition is rooted in the experiences of incarcerated people and criminalized people who were some of the first people who called for the end of these systems,” Kaba told me by phone. “And they call for the end of these systems because they’re in them and directly impacted by them and understand their harms.”

Reformers, or people who defend current police systems, tend to talk as if most police work is beneficial. Officers in this view are friendly, as in the police fictionalized in the comedy “Brooklyn Nine-Nine,” or are at least engaged in vital work, as portrayed dramatically in “Law & Order.” But Kaba doesn’t get her view of policing from television. She gets it from talking to Black people and people of color — especially youth, queer people and sex workers — who deal with the police every day.

Among the most devastating essays in the collection is one of the first; a short 2015 piece titled “The System Isn’t Broken.” Here Kaba details what she calls Chicago’s “urban summer criminalization merry-go-round — a kind of demented child’s play.” Every summer, Kaba says, she watches police stop, frisk, harass, bully, intimidate and arrest young people she knows and cares about over and over again. Black people, 32 percent of the population in Chicago, account for 72 percent of police stops, according to ACLU of Illinois data.

Kaba emphasizes that the police violence that makes the news — the Black people choked to death, or shot in the back, or killed when police invade the wrong home by mistake — are “just the tip of the spear.” Police killings can capture national attention, and rightly so. But, she told me, “it’s the routine and mundane violence that shapes our lives on a real systemic basis, and a structural basis.” Abolitionists believe the current system is so thoroughly intolerable that it can’t be tweaked into tolerability. Institutions that are built, day to day, on terrorizing and harming Black people can’t be reformed. They have to be abolished.

Police and prisons are so entrenched that it can seem unrealistic or impossible to change them. But again, Kaba provides practical perspective and pragmatic advice. The current prison system, she notes, is a historical artifact. It was itself the result of reforms. Quakers in the 1600s and 1700s advocated to replace capital punishment or physical punishment with penitentiaries, which they believed were more humane. “People built these systems, you know,” she told me. “They came from somewhere.” And what people can build, they can also unbuild.

The process of unbuilding is difficult, but Kaba provides a good deal of concrete guidance on how to proceed. In a 2014 piece titled “Police ‘Reforms’ You Should Always Oppose” she provides a brief, simple, insightful rubric for determining whether proposed policies are beneficial or not.

Giving more money to the police, or expanding the number of police, should be opposed, she says, because such actions allow police to harass and incarcerate marginalized people with greater efficiency. Instead, she suggests advocating for reparations for victims of police violence (Kaba was involved in a successful campaign for reparations in Chicago). She also recommends moving resources from police to social programs — mental health resources, schools, health care. Arguments like these helped inspire demands for defunding the police that were a major feature of the protests over the police killing of George Floyd this summer.

Body cameras are a popular reform with politicians. But Kaba argues that from an abolitionist perspective, body cameras are worse than useless.

As an example of how these principles work in action, Kaba pointed to body cameras. Body cameras are a popular reform with politicians because they seem like a technological fix. But Kaba argues that from an abolitionist perspective, body cameras are worse than useless. Paying for body cameras, she says, “is giving money into the very system you want to actually shrink. The cameras are turned on you, the citizen, not on the cop. The cops will have control over all the footage.” If you assume cops are basically good and just need help doing their job better, then body cameras make sense. But if you have a realistic view of how police actually treat marginalized people, giving the cops the ability to do more sophisticated surveillance is just going to give them more tools to harass people.

Of course, there is a utopian aspect to abolitionist thinking. Kaba includes one speculative fiction piece in the book that imagines a world without police or prisons, in which justice means care for victims and the society has systems that encourage perpetrators to acknowledge harm. But even this vision is tentative. “I see abolition as a process and a practice more than I do a destination,” Kaba told me.

Part of that process is acknowledging that police are in our heads as well as in our streets. What we think is realistic is limited by what we’re allowed to say or debate. “We Do This ‘Til We Free Us” is dedicated to a dream of a world without walls. But it takes the very pragmatic position that you can’t get out of a cage until you teach yourself to see the bars.

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