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Yahoo
16-05-2025
- Health
- Yahoo
Barriers to maternity care in rural Kansas leave many moms-to-be miles from services
A graphic from a report on maternity care deserts shows the number of facilities offering inpatient obstetrics care across the state of Kansas. (United Methodist Health Ministry Fund/KU School of Nursing) TOPEKA — Maternity care is becoming out of reach for many in rural Kansas counties, where birth rates are higher than in urban areas, hospitals face closure and obstetrics services are few and far between. The new report from the University of Kansas School of Nursing and Hutchinson-based United Methodist Health Ministry Fund examined Kansas' maternity care deserts, or counties without nearby access to prenatal and obstetrics care. The findings 'paint a stark picture of the current landscape of access to maternal health,' said David Jordan, president and CEO of the health fund, which commissioned and funded the report. The report was based on statewide data from 2022-2024. 'The data also emphasize the critical importance of addressing this challenge before it gets worse, as well as recognizing that the location of services is one piece of the puzzle,' he said. More than 40% of Kansas counties don't have any maternal care services, and most Kansans live 30 miles or more from a high-risk delivery facility, the report found. Plus, most rural counties in the state do not have an obstetrician/gynecologist. In western Kansas, Grant and Wallace counties, which sit on or near the Kansas-Colorado border, have the highest birth rates in the state. Wallace County, home to roughly 1,700 people, has no hospitals, birthing centers or facilities offering prenatal services. The closest facility offering inpatient maternity care is at least 50 miles away. In Grant County, maternity care isn't available at existing facilities, the report found, and the closest maternity care facility is at least 24 miles away. Labor and delivery services and high-risk care are most difficult to access, the report found. About 30% of Kansas ZIP codes are 100 miles or more from high-risk pregnancy services. Medicaid, the joint federal and state public health insurance program, pays for about 40% of all births in Kansas. After delivery, mothers are eligible for continued coverage for a year if they make an annual income less than or equal to 171% of the federal poverty level, which amounts to $47,453 or less for a family of four. The report also revealed the unrecognized costs associated with providing maternity care, which requires the constant presence and attention of teams of nurses and clinicians. Reimbursement rates through public insurance programs can be lacking. Addressing maternal care deserts requires sound data, said Karen Weis, the lead author of the report and dean of KU School of Nursing-Salina. 'Kansas legislators, health care systems, foundations, professional organizations and educational institutions are all working hard to address the concerns of access to care and the health care workforce,' she said. The report highlight four priorities to improve the state's maternal health care. Providers could use telehealth more frequently as a way to expand maternal health options. Rural areas could create regional models of care so providers can more easily collaborate. The Legislature could increase reimbursement rates for maternity care services to ease affordability concerns and retain care providers. 'Eighty-six percent of Kansas hospitals experienced a loss of services in 2023, 63% are at risk of closing and 32% are at risk of immediate closure,' the report said. The report encouraged further engagement and research to maximize scarce resources. Jordan said Kansas needs new, innovative solutions 'to complete the puzzle in order to provide women, children and families across the state with better access to the services they need to thrive.'
Yahoo
09-05-2025
- Health
- Yahoo
KU School of Nursing report highlights dangers of growing ‘maternal care desert' in Kansas
KANSAS CITY, Mo. — The University of Kansas School of Nursing released a report Thursday on the growing 'maternal care desert' in Kansas, highlighting the lack of access to maternal care in the state. The report found that 46% of Kansas women are in a maternal care desert. The state was found to have a higher percentage of counties classified as maternity care deserts than the national average. KC doctors, mothers speak out about maternal deaths in Missouri & Kansas The report, which is based on data from 2022-2024, includes the following key findings: An increasing number of Kansans travel up to 60 miles for low-risk prenatal and postpartum and labor and delivery care, particularly in the central and southwest parts of the state. 59 percent of Kansans do not have local access to inpatient maternity care. The availability of services for women with high-risk pregnancies is extremely limited. Nearly 30% of ZIP codes in Kansas are more than 100 miles away from tertiary, high-risk services. 42 counties in Kansas are without any documented anesthesia providers, and most of those are on the western side of the state. 'Women in the United States who are pregnant, in labor, delivering a baby or recovering from childbirth are twice as likely to be ill or die than they were 20 years ago,' the report says. According to the report, this is directly correlated with the decrease in access to hospitals, doctors, nurses and other maternity care providers in rural areas. Over the past 10 years, many rural hospitals across the country have closed or stopped offering maternity care services altogether. This includes Kansas, which is the second state with the most rural counties. The growing maternal care desert in Kansas is causing more women in the state to drive long distances for care and 59% do not have local access to inpatient maternity services, the report says. Closures of hospitals and cessation of maternity services are correlated with more babies being born early, more infants admitted to neonatal intensive care units and more women dying during pregnancy or in childbirth, according to KU's report. The report also found that the counties with the highest birth rates are the ones losing access to maternity care services, which is even more concerning given that rural counties had higher birth rates than urban ones. Neither Wallace nor Grant counties – two counties in western Kansas with the highest birth rates – have a health care system offering maternity care, the report says. The distance to inpatient maternity care for those residing in Wallace County is approximately 50 miles—and in Grant County, it's 24 miles. 'These statistics indicate that the problem of access to maternity care and the number of hospitals at risk of closing is not new, but worsening,' the report says. 'Decreased access to maternity care harms Kansas communities by threatening the lives of mothers and babies.' The report also highlights that access to quality perinatal care, which includes care during pregnancy and after the birth, is critical to the health of newborn babies and their mothers. A recent FOX4 investigation also highlighted the need for holistic maternal care. The investigation found that a majority of deaths for mothers in Missouri happen between six weeks and one year postpartum. In Kansas, more than half of pregnancy-related deaths happen during this time. Both states fare worse than the national average of 30%, the FOX4 investigation found. You can read KU's full report below: KU-Health-Access-to-Maternity-Care-Report-2025Download This report was produced by the KU School of Nursing in collaboration with the Kansas Center for Rural Health – and with funding from the United Methodist Health Ministry Fund. Copyright 2025 Nexstar Media, Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.
New York Times
03-05-2025
- General
- New York Times
Honey, Sweetie, Dearie: There Are Perils in ‘Elderspeak'
A prime example of elderspeak: Cindy Smith was visiting with her father in his assisted living apartment in Roseville, Calif. An aide who was trying to induce him to do something — Ms. Smith no longer remembers exactly what — said, 'Let me help you, sweetheart.' 'He just gave her The Look — under his bushy eyebrows — and said, 'What, are we getting married?'' recalled Ms. Smith, who had a good laugh, she said. Her father was then 92, a retired county planner and a World War II veteran; macular degeneration had reduced the quality of his vision and he used a walker to get around, but he remained cognitively sharp. 'He wouldn't normally get too frosty with people,' Ms. Smith said. 'But he did have the sense that he was a grown up, and he wasn't always treated like one.' People understand almost intuitively what 'elderspeak' means. 'It's communication to older adults that sounds like baby talk,' said Clarissa Shaw, a dementia care researcher at the University of Iowa College of Nursing and a coauthor of a recent article that helps researchers document its use. 'It arises from an ageist assumption of frailty, incompetence and dependence.' Its elements include inappropriate endearments. 'Elderspeak can be controlling, kind of bossy, so to soften that message there's 'honey,' 'dearie,' 'sweetie,'' said Kristine Williams, a nurse gerontologist at the University of Kansas School of Nursing and another coauthor. 'We have negative stereotypes of older adults, so we change the way we talk.' Or caregivers may resort to plural pronouns: Are we ready to take our bath? There, the implication 'is that the person's not able to act as an individual,' Dr. Williams said. 'Hopefully, I'm not taking the bath with you.' Sometimes, elderspeakers employ a louder volume, shorter sentences or simple words intoned slowly. Or they may adopt an exaggerated, singsong vocal quality more suited to preschoolers, along with words like 'potty' or 'jammies.' With so-called tag questions — It's time for you to eat lunch now, right? — 'You're asking them a question but you're not letting them respond,' Dr. Williams explained. 'You're telling them how to respond.' Studies in nursing homes show how commonplace such speech is. When Dr. Williams, Dr. Shaw and their team analyzed video recordings of 80 interactions between staff and residents with dementia, they found that 84 percent had involved some form of elderspeak. 'Most of elderspeak is well intended. People are trying to show they care,' Dr. Williams said. 'They don't realize the negative messages that come through.' For example, among nursing home residents with dementia, studies have found a relationship between exposure to elderspeak and behaviors collectively known as resistance to care. 'People can turn away or cry or say no,' Dr. Williams explained. 'They may clench their mouths shut when you're trying to feed them.' Sometimes, they push caregivers away or strike them. She and her team developed a training program called CHAT (for Changing Talk), three hourlong sessions that include videos of communication between staff and patients, intended to reduce elderspeak. It worked. Before the training, in 13 nursing homes in Kansas and Missouri, almost 35 percent of the time spent in interactions consisted of elderspeak; that number was only about 20 percent afterward. At the same time, resistant behaviors accounted for almost 36 percent of the time spent in encounters; after training, that proportion fell to about 20 percent. A study conducted in a Midwestern hospital, again among patients with dementia, found the same sort of decline in resistance behavior. What's more, CHAT training in nursing homes was associated with lower use of antipsychotic drugs. Though the results did not reach statistical significance, due in part to the small sample size, the research team deemed them 'clinically significant.' 'Many of these medications have a black box warning from the F.D.A.,' Dr. Williams said of the drugs. 'It's risky to use them in frail, older adults' because of their side effects. Now, Dr. Williams, Dr. Shaw and their colleagues have streamlined the CHAT training and adapted it for online use. They are examining its effects in about 200 nursing homes nationwide. Even without formal training programs, individuals and institutions can combat elderspeak. Kathleen Carmody, owner of Senior Matters Home Care and Consulting in Columbus, Ohio, cautions her aides to address clients as Mr. or Mrs. or Ms., 'unless or until they say, 'Please call me Betty.'' In long-term care, however, families and residents may worry that correcting the way staff members speak could create antagonisms. A few years ago, Carol Fahy was fuming about the way aides at an assisted living facility in suburban Cleveland treated her mother, who was blind and had become increasingly dependent in her 80s. Calling her 'sweetie' and 'honey babe,' the staff 'would hover and coo, and they put her hair up in two pigtails on top of her head, like you would with a toddler,' said Ms. Fahy, 72, a psychologist in Kaneohe, Hawaii. Although she recognized the aides' agreeable intentions, 'there's a falseness about it,' she said. 'It doesn't make someone feel good. It's actually alienating.' Ms. Fahy considered discussing her objections with the aides, but 'I didn't want them to retaliate.' Eventually, for several reasons, she moved her mother to another facility. Yet objecting to elderspeak need not become adversarial, Dr. Shaw said. Residents and patients — and people who encounter elderspeak elsewhere, because it's hardly limited to health care settings — can politely explain how they prefer to be spoken to and what they want to be called. Cultural differences also come into play. Felipe Agudelo, who teaches health communications at Boston University, pointed out that in certain contexts, a diminutive or term of endearment 'doesn't come from underestimating your intellectual ability. It's a term of affection.' He emigrated from Colombia, where his 80-year-old mother takes no offense when a doctor or health care worker asks her to 'tómese la pastillita' (take this little pill) or 'mueva la manito' (move the little hand). That's customary, and 'she feels she's talking to someone who cares,' Dr. Agudelo said. 'Come to a place of negotiation,' he advised. 'It doesn't have to be challenging. The patient has the right to say, 'I don't like your talking to me that way.'' In return, the worker 'should acknowledge that the recipient may not come from the same cultural background,' he said. That person can respond, 'This is the way I usually talk, but I can change it.' Lisa Greim, 65, a retired writer in Arvada, Colo., pushed back against elderspeak recently when she enrolled in Medicare drug coverage. Suddenly, she recounted in an email, a mail-order pharmacy began calling almost daily because she hadn't filled a prescription as expected. These 'gently condescending' callers, apparently reading from a script, all said, 'It's hard to remember to take our meds, isn't it?' — as if they were all swallowing pills together with Ms. Greim. Annoyed by their presumption, and their follow-up question about how frequently she forgot her medications, Ms. Greim informed them that having stocked up earlier, she had a sufficient supply, thanks. She would reorder when she needed more. Then, 'I asked them to stop calling,' she said. 'And they did.' The New Old Age is produced through a partnership with KFF Health News.
