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A "breaker boy" was a coal-mining worker whose job was to separate impurities from coal by hand in a coal breaker in the United States and also in the United Kingdom. Breaker boys were primarily children. The use of breaker boys began in the mid-1860s in the United States and the United Kingdom.  Although public disapproval of the employment of children as breaker boys existed by the mid-1880s, the practice did not end until the 1920s.

Lewis Wickes Hine - (1874-1940) was an American sociologist, photographer and humanist.  He used his camera as a tool for social reform. His photographs were instrumental in changing child labor laws in the United States.
Hine began photographing subjects in New York in 1903, including, immigrants at Ellis Island, and immigrants as they settled in America. In 1909, Hine took photographs of child labor practices for the National Child Labor Committee, At the end of World War I, Hine was sent abroad by the American Red Cross to photograph relief activities. After the war, he continued to photograph the workingman and industry, such as the construction of the Empire State Building in 1931. A collection of his industrial photographs were published in 1932 in the book "Men at Work".  Read more about Lewis Wickes Hine

Credit: National Archives


The bill-signing ceremony, took place at the Truman Library in honor of former President Harry S. Truman, who had first proposed national health insurance in 1945. The former President was enrolled as Medicare’s first beneficiary and received the first Medicare card.
For 50 years, these programs have been protecting the health and well-being of millions of American families, saving lives, and improving the economic security of the nation.

A handful of powerful companies control the majority market share of almost 80% of dozens of grocery items bought regularly by ordinary Americans, new analysis reveals.

A joint investigation by the Guardian and Food and Water Watch found that consumer choice is largely an illusion – despite supermarket shelves and fridges brimming with different brands. Read Full Article

AURORA, Colo. — Fatumo Osman, a 65-year-old Somali refugee who speaks limited English, was in a bind. She made too much money at a meal prep service job so she no longer qualified for Medicaid. But knee pain kept her from working, so her income had dropped. She could reapply for Medicaid, get her knee fixed and return to work, at which point she’d lose that safety-net health coverage. Her first step was getting a note from a doctor so she wouldn’t lose her job.

So, Osman came to Mango House, a clinic in this eastern suburb of Denver that caters primarily to refugees and turns no one away, regardless of their ability to pay. Dr. P.J. Parmar designed the clinic to survive on the Medicaid payments that many doctors across the U.S. reject as too low.

The clinic is just one part of a broader refugee ecosystem that Parmar has built. Mango House provides food and clothing assistance, after-school programs, English classes, legal help — and Parmar even leads a Boy Scout troop there. He leases space to nine stores and six restaurants, all owned and run by refugees. Mango House hosts a dozen religious groups, plus community meetings, weddings and other celebrations. When Parmar needs an interpreter for a patient from any of a dozen languages spoken in the building, he can easily grab one of his tenants.

“This is what I call a medical home,” Parmar said.

Although it’s not part of the formal U.S. refugee resettlement program, Mango House is in many ways emblematic of refugee health care in the U.S. It’s a less-than-lucrative field of medicine that often relies on individual physicians willing to eke out a living caring for an underserved and under-resourced population.

Parmar finds creative ways, often flouting norms or skirting rules, to fit his patients’ needs. As a result, Mango House looks nothing like the rest of the U.S. health care system and, at times, draws the ire of the medical establishment.

“How do you deliver the quality of care necessary, and that they deserve, while still keeping the lights on? It’s a struggle for sure,” said Jim Sutton, executive director of the Society of Refugee Healthcare Providers. “It’s these heroes, these champions out there, these cowboys that are taking this on.”

Osman brought her son, Jabarti Yussef, 33, to interpret for her. They have been coming to Mango House for 10 years and said that Parmar opens doors for them when they have trouble accessing care.

“If we ask for an appointment to get Medicaid, P.J. makes the call,” Yussef said. “If we call, we’re on hold for an hour, and then it hangs up. If we go to the ER, it’s a three-hour wait. Here, the majority of people walk in and sit for 30 minutes. It’s good for the community.”

As for Osman’s knee pain, Yussef asked Parmar, could they pay cash to get an MRI at the hospital?

“I can almost guarantee it’s arthritis,” Parmar replied. “You could do an X-ray. That will cost $100. An MRI will cost $500. And if it shows a bigger problem, what are you going to do? It will cost you $100,000.”

Parmar said he would connect them with someone who could help Osman enroll in Medicaid but that it’s an imperfect solution. “Most orthopedists don’t take Medicaid,” Parmar said. Older immigrants need to have worked the equivalent of 10 years in the U.S. to qualify for Medicare.

Medicaid, which covers low-income people, generally pays primary health care providers a third less than Medicare, which covers seniors and the disabled. And both pay even less than commercial insurance plans. Some doctors paint Medicaid patients as more difficult and less likely to follow instructions, show up on time or speak English.

Parmar said he realized back in medical school that few doctors were motivated to treat Medicaid patients. If he limited his practice to just Medicaid, he said dryly, he’d have guaranteed customers and no competition.

So how does he survive on Medicaid rates? By keeping his overhead low. There are no appointments, so no costs for a receptionist or scheduling software.

He said his patients often like that they can drop in anytime and be seen on a first-come, first-served basis, much like an urgent care clinic, and similar to the way things worked in their native countries.

Because he takes only Medicaid, he knows how to bill the program and doesn’t have to hire billing specialists to deal with 10 insurance companies.

It’s also more cost-efficient for the health system. Many of his patients would otherwise go to the emergency room, sometimes avoiding care altogether until their problems get much worse and more expensive to fix.

“Really none of our innovations are new or unique; we just put them together in a unique way to help low-income folks, while making money,” Parmar said. “And then, instead of taking that money home, I put it back into the refugee community.”

The son of Indian immigrants, Parmar, 46, was born in Canada but grew up in Chicago and moved to Colorado after college in 1999, where he did his medical training at the University of Colorado School of Medicine. He opened Mango House 10 years ago, buying a building and renting out space to refugees to cover the cost. Two years ago, he expanded into a vacant J.C. Penney building across the street.

“There’s a good three-, four-year dip in the red here, intentionally, as we move from there to here,” Parmar said. “But that red is going to go away soon.”

The covid pandemic has helped shore up his finances, as federal incentives and payment increases boosted revenue and allowed him to pay down his debt faster.

Parmar must navigate a host of obstacles while working to overcome financial and language barriers. A Muslim Somali woman needs dental care but is uncomfortable seeing a male dentist. A Nepalese woman needs a prescription refill, but she lives in Denver and so has been assigned by Medicaid to the safety-net hospital, Denver Health. Parmar won’t get paid but sees her anyway. Another patient brings paperwork showing he’s being sued by a local health system for a year-old emergency room bill he has no way to pay. A Nepalese man with psoriasis doesn’t want creams or ointments; good medicine, he believes, comes through a needle.

“A lot of this is, basically, geriatrics,” Parmar said. “You have to add 20 years to get their age in refugee years.”

When one patient turns away momentarily, Parmar discreetly throws away her bottle of meloxicam, a strong anti-inflammatory he said she shouldn’t be taking because of her kidney problems. He began stocking over-the-counter medications after realizing his patients got overwhelmed amid 200 varieties of cough and cold medicines at the drugstore. Some couldn’t find what he told them to get, even after he printed flyers showing pictures of the products.

Parmar’s creative solutions, however, often rub many in health care the wrong way. Some balk at his use of family members or others as informal interpreters. Best practices call for the use of trained interpreters who understand medicine and patient privacy rules. But billing for interpretation isn’t possible, so hospitals and clinics must pay interpreters themselves. And that’s beyond the capabilities of most refugee clinics, unless they’re affiliated with a larger health system that can absorb those costs.

“It’s a good thing to have the standards, but it’s another thing altogether to implement them,” said Dr. Pat Walker, an expert on refugee health at the University of Minnesota.

When Mango House began providing covid vaccines, residents of more affluent areas of town started showing up. Parmar tried to limit vaccinations only to those patients living in the immediate area, checking ZIP codes on their IDs. The state stepped in to say he could neither require IDs nor turn away any patients, regardless of his refugee-focused mission.

During a recent lull at the clinic, Parmar took stock of that day’s inventory of patients. Six were assigned to Denver Health, one patient’s Medicaid coverage had expired, and two had high-deductible commercial plans. Chances are he wouldn’t get paid for seeing any of them. Of the 25 patients he had seen that day, 14 had Medicaid coverage that Parmar could bill.

“We see the rest of them anyway,” he said.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

"Owners like Steve Ballmer can take the kinds of deductions on team assets — everything from media deals to player contracts — that industrialists take on factory equipment. That helps them pay lower tax rates than players and even stadium workers"....Read full article

Photo Credit: All-Pro Reels License under https://creativecommons.org/li...

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Long-distance caregivers are more common than you think. Generally speaking, it’s common for seniors to live in one part of the country while their families live and work elsewhere. Regardless of what keeps you apart, caregiving can actually be more than doable by remembering these few tips.

Technology is your friend.

Technology has made the world smaller in many ways. With a plethora of electronic gadgets and internet connectivity available these days, it’s now so much easier to connect with loved ones from afar, making tech an invaluable resource when it comes to long-distance caregiving. Many devices like tablets are senior-friendly with easy-to-use interfaces and features like larger screens. These gadgets can then be leveraged in many ways, such as using video chat to check in on your senior loved ones’ well-being or even attend their medical appointments virtually.

As a bonus, there are countless deals on tablets from trusted brands like Apple, Lenovo, and Samsung (to name a few), making them great investments that won’t put a huge dent on your own household budget.

The Senior List suggests loading your loved one’s phone or tablet with some senior-friendly apps, like Pandora, Zoom, The Weather Channel, and MediSafe Medication Reminder. Thanks to some easily accessible tech, your loved one will have support and entertainment at his or her fingertips.

Help is available for those who ask for it.

Probably the biggest challenge of being a long-distance caregiver is not being physically present to take care of tasks. However, there are, of course, ways around such a hiccup. In fact, the National Institute on Aging points out that there are countless professionals in any given area that provide a plethora of #local">services, ranging from house cleaning to meal deliveries and so much more.

While you may not be around to keep a close eye on them, you can also keep tabs on them through neighbors, friends and even
tracking devices like location tracking or medical alert systems.

It goes without saying that it’s more than prudent to take advantage of these resources. Not only will this ensure that all your loved ones’ needs are taken care of, but alleviate your worries as well.

Your time is the greatest gift.

Last but definitely not least, the best gift you can give your loved ones is a simple one, and that is your time. This can also be a challenge with your own minutiae of daily living. It’s important to check in on your loved ones with a phone or video call to make sure that they are safe, comfortable, and healthy. Even more important is routinely visiting in person, not only to check on current conditions but also to provide the comfort of your presence.

You can give the gift of time in other ways, as well. You already do so when you research services that benefit them and care facilities, as well as when you educate yourself on their conditions and, by extension, repercussions. Ditto when you take care of their bills, sit-in on medical appointments, and the like.

Indeed, caregiving for a senior loved one from afar will be hard. However, the main thing you can do is to improvise and leverage the right resources. So bear these tips in mind to provide the right kind and amount of loving care to your senior wards—without putting an undue burden on yourself, too.

Photo via Pexels.com

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