Monthly Archive for November, 2012

The ‘With Model’ of Patient and Family Engagement

Published on November 27, 2012 in Debra Ness and Health Care. 1 Comment

Debra Ness, President, National Partnership

Cross-posted from NAPH’s “SafetyNet Matters” Blog.

As our national debate over health care reform continues, with its future, at least in part, likely to be shaped by the election, one thing is clear: There is consensus that we need to move to a more patient- and family-centered health care system. But the key question is how to do it and make it work.

As a leading advocate for health care consumers and families, the National Partnership for Women & Families is, of course, pleased to see health leaders commit themselves and their institutions to putting patients first. We worked hard to make that a central tenet of the historic Affordable Care Act, which is helping to reform the care delivery system to make it more efficient, effective and patient-centered.

But a lot of work to make that happen lies ahead because true collaborative consumer engagement, implemented broadly, would amount to nothing less than culture change for our health care system—and culture change is never quick or easy.
There are two models of patient-centered care. I like to call them the “To Model” and the “With Model.”

The “To Model” of patient-centered care is familiar to most of us. To keep patients healthy or restore their health, well-meaning doctors, hospitals, insurers, and others decide what a patient needs and then find ways to do those things “to” or “for” them. And then we try to figure out how to get patients to comply.

The “With Model,” on the other hand, is more difficult to create but much more meaningful. In this model, providers and patients jointly set care goals and work together to determine the approaches that will yield the best possible results. Patients are involved in decision-making and in the design of their treatment plans. In other words, it’s about getting patients to tell providers and others what they need us to do.

In both models, the training, skills and experience of caring health care professionals is essential to success. But the “With Model” involves the patient from the beginning and is much more likely to lead to better outcomes. To make it work, we need the involvement of patients, families, and consumer representatives in reshaping the way we deliver care. We can’t design patient-centered care without the patient. Patients and families need to be part of a collaborative engagement that drives genuine transformation in attitudes, behavior, and practice. They need to be partners in defining, designing and assessing the care practices and systems that serve them. This model engages patients and families at all levels—from policy to governance, to redesign of care practices, to individual/family engagement, to community involvement.

Many hospitals and other care institutions are working to redesign their care delivery systems. The National Partnership for Women & Families is leading the “Campaign for Better Care,” which encourages consumers, patients and families to partner with health care providers across the country to create the kind of change we all want. But for this to happen, providers have to embrace such a partnership, and move beyond the mindset that they always know best what patients want and need.

We talk with patients, families, and consumer advocates every day to get a first-hand understanding of what they want from a redesigned health care system. Time and again we hear four key concepts:

“Whole-person”care.
Better coordination and communication.
Information and support to help them manage their health.
Ready access to their providers.

The foundation for whole-person care is a strong patient-clinician relationship built on trust. But today, too many patients are viewed as a collection of body parts. We need care systems that take into account all the factors affecting a patient’s ability to get and stay well. And we need treatment recommendations that align with a patient’s values, preferences, and life circumstances.

The biggest complaint we hear from patients and their families is the lack of consistent communication and coordination of care. This is particularly—but not only—true for older women and men, because many of them are living with multiple chronic conditions. Older adults with five or more chronic health conditions have an average of 37 physician visits a year, see 14 different physicians, and fill an average of 50 separate prescriptions each year. These patients urgently need their providers to talk to each other and they urgently need better-coordinated care.

There is overwhelming data that the failure to coordinate care causes harm and costs all of us more. That’s why patients and their families want and need a “go-to” person who is available to answer questions, help navigate the system, and help them understand their conditions and how best to take care of themselves. They want help choosing specialists and getting timely appointments. They need their providers to have complete information at the point of care and a system that tracks referrals and results. They want their providers to work as a team, ensuring smooth transitions across settings and providers.

To truly feel like a partner in their care, patients and their families need tools and services that help them manage their conditions. They need to know they will be treated with trust and respect for their preferences, comfort and privacy. And they need to be able to communicate in a system where language, culture, and literacy barriers, as well as physical limitations and cognitive impairment, are taken into account and addressed.

Finally, patients and their families want to be able to get the right care, at the right time, and in the right place—the kind of care that keeps people from getting sicker and prevents medication errors, trips to the emergency department, and unnecessary hospitalizations. That means 24/7 access to care team members. It also means prompt appointments and short waiting times, and access beyond traditional office visits, including e-visits, secure messaging and, when appropriate, telemedicine.

When we truly ask and listen to what patients and families want, we realize they want the very things that will help us achieve better care, better health, and lower costs. It’s also time to realize that redesigning care together is the best way to create a system that meets the goals we all share.

Debra Ness is president of the National Partnership for Women & Families, which leads the Campaign for Better Care.

Supreme Court to Take Up Supervisor Harassment Case

Published on November 26, 2012 in Judges & Supreme Court, Sarah Crawford and Workplace Fairness. 0 Comments

Director of Workplace Fairness

Cross-posted from the American Constitution Society.

Later this term, the Supreme Court will decide the case of Vance v. Ball State, a case that will have critical implications for the ability of our nation’s civil rights laws to root out unlawful workplace harassment. At issue in the case is the meaning of “supervisor” and whether employers may be held vicariously liable for harassment committed by supervisors who have the authority to direct and oversee employees’ work, as compared to those who have the authority to hire or fire. The Court’s decision will have important ramifications for the ability of victims of supervisor harassment to hold their employers accountable.

With so much at stake, the National Partnership for Women & Families led a group of ten top civil and workers’ rights organizations in filing a friend-of-the-court brief in Vance that calls on the Court to reject an overly restrictive definition of supervisor that is limited to those with the authority to make “tangible” employment decisions like hiring and firing. Quite simply, this definition does not reflect the realities of the workplace or the Court’s previously demonstrated understanding of what it means to be a supervisor.

Petitioner Maetta Vance worked at Ball State University as a catering assistant for the university’s dining services department when she was harassed by an employee that she considered to be a supervisor with the authority to direct and oversee her work. Vance alleges that, as a result of the harassment and physical intimidation she suffered, she lived and worked in a constant state of fear. Despite her complaints to the university, the harassment persisted.

Ultimately, Vance filed claims for harassment and retaliation under Title VII of the Civil Rights Act of 1964. The district court granted the employer’s motion for summary judgment, ruling in pertinent part that the supervisor in question lacked the power to hire, fire, demote, transfer, or discipline Vance. As such, the court applied a mere negligence standard of liability applicable to co-worker harassment, rather than the vicarious liability standard applicable to supervisor harassment. Under established precedent, if the harasser is deemed to be a supervisor, vicarious liability is imputed to the employer. However, if the harasser is deemed to be a co-worker, under a negligence standard, the employer is liable only if the target of the harassment can prove that the employer knew or should have known of the harassment.

On appeal, the Seventh Circuit affirmed, approving a narrow definition of “supervisor” for purposes of imposing vicarious liability by including only those supervisors with the formal authority to make tangible employment decisions. The Seventh Circuit noted that it “ha[d] not joined other circuits in holding that the authority to direct an employee’s daily activities establishes supervisory status under Title VII.” The Seventh Circuit joins the First and Eighth Circuits in concluding that only those supervisors with the power to fire, hire, promote, etc. should be treated as supervisors under Title VII.

By contrast, the Second, Fourth, and Ninth Circuits have affirmed a rule consistent with Equal Employment Opportunity Commission (EEOC) guidance stating that:

An individual qualifies as an employee’s “supervisor” if:

the individual has authority to undertake or recommend tangible employment decisions affecting the employee; or

the individual has authority to direct the employee’s daily work activities.

An amicus brief filed by the Solicitor General affirms this well-reasoned interpretation as well, concluding that “an employee who directs another employee’s daily work activities but cannot take tangible employment actions is a supervisor for purposes of vicarious liability under Title VII.”

The Supreme Court did not distinguish between various types of supervisors when it considered the issue of supervisor harassment in Faragher v. City of Boca Raton and Burlington Industries, Inc. v. Ellerth in 1998. In those cases, the Court drew distinctions between supervisors and co-workers, rather than drawing arbitrary distinctions between different types of supervisors. The same common sense approach should be applied in Vance.

The Court should also recognize that even though high-level supervisors are undoubtedly responsible for maintaining a workplace free from discrimination, it is the supervisors who direct and control workers’ daily activities who are delegated the most immediate control over their subordinates’ working conditions and the greatest opportunity to inflict harm on employees.

Vance v. Ball State offers the Supreme Court an opportunity to set a standard that comports with the realities of the workplace, established precedent and well-reasoned EEOC guidance. The case is a chance for the Court to affirm a standard that furthers the purposes of Title VII – to root out harassment and make clear that employers will be held accountable when supervisors violate the law. A contrary ruling will have grave consequences for victims of harassment and the rights guaranteed by our nation’s equal employment opportunity laws.

The case will be argued November 26.

My Abortion, My Activism: The Impact of Stigma

Published on November 20, 2012 in Melinda McKew, Repro Health Watch and Reproductive Health. 19 Comments

MelindaMcKew, Board Member, Georgia Reproductive Justice Access Network

This blog post was published in conjunction with Repro Health Watch, an exciting new edition of the Women’s Health Policy Report, which compiles and distributes media coverage of proposed and enacted state laws, ballot initiatives and litigation affecting women’s access to comprehensive reproductive health care.

Like all of our clients at the Georgia Reproductive Justice Access Network (GRJAN), Jane* called us in desperation. She had become pregnant after her birth control failed, and she simply couldn’t afford another child. She and her husband already had two children, and they were barely making ends meet, requiring government assistance to feed themselves and their children.

Jane never had an abortion before, and she was floored at the costs of the procedure—nearly $1,500! So she contacted us at GRJAN for help in funding her abortion as well as transporting her back and forth from the clinic to her friend’s home.

I volunteered to be one of Jane’s drivers. After picking Jane up from the clinic when it was over, we stopped at a nearby restaurant for dinner. I figured she’d be hungry because she had to fast for her procedure. And as we talked, Jane became pensive. She was clearly ambivalent about her abortion. She knew she made the right decision for herself, her family, and her community, but she couldn’t shake the feeling that she’d done something wrong. Eventually, she lowered her eyes and said, “I know this is stupid, but… do you think God will take away any of my children because I’m getting rid of this one? I’m just so worried that I’m going to lose one of my children now as punishment for my abortion.” My heart sank. I looked at her and responded, “No, I don’t think God works like that.”

I share this story because it highlights the impact abortion stigma has upon individuals having abortions as well as persons who are in any way associated with abortion—clinic workers, abortion doctors, abortion rights advocates, among many others. And it is without a doubt the stigmatization of abortion that plays the most detrimental role in organizing around abortion access initiatives in the Southeast, the so-called “Bible Belt,” where the religious and ideological imperative toward “protecting the sanctity of life” dominates.

For our clients and us, such an imperative is insidious, burrowing itself into our psyches and producing feelings of shame, guilt, and humiliation. Not only do our clients live in perpetual fear of being “found out” about their abortions, but we, too, find ourselves being always “on guard” concerning our work. After all, we’ve begun to receive anti-abortion mail, and we know that doing this type of work isn’t without its dangers. We struggle to find volunteers and raise the money necessary to provide the practical support (transportation, lodging, and childcare) and funding for our clients because so few people want to be linked to abortion.

And I should know. I was 14 when I became pregnant and part of a poor family, living in rural Georgia. At the time of my abortion, my family lived at approximately 154% of the federal poverty line—the highest income level my family had ever achieved. We could barely afford the money necessary for basic living expenses, let alone the funds for a costly procedure like an abortion. And my mother was forced to cover the costs of my abortion by credit card, a notable risk to my family as we were already in thousands of dollars of debt.

Understandably, my mother was disappointed and stressed. Not only was her teenage daughter pregnant, but now she had to cover the costs of her daughter’s abortion procedure when she could barely put food on the table! But sadly, her stress manifested as anger—an anger that left me to face my abortion alone in a conservative and rural area. My last memory before the procedure is of tears rolling down my cheeks as I was placed under anesthesia, and the nurse wiping away my tears, whispering, “It’ll be alright… It’ll be alright.”

After the procedure, my mother made me vow to never speak of my abortion to anyone—not my father, not my family, not even my close friends—lest they discover my shame. I returned to school the next day as if nothing had ever happened.

And it is with these experiences that I joined and continue to work with GRJAN toward enacting a world of reproductive justice, where all people can make the reproductive decisions so vital to their well-being without shame or stigma. I personally know how difficult the decision to terminate a pregnancy can be even after the procedure has occurred. By working with GRJAN, even while working part-time and going to school full-time, I hope to help others, like Jane, from having to go through an abortion all alone and in secrecy.

*Names and details have been changed to protect the confidentiality of our client.

Melinda McKew, Board Member of Georgia Reproductive Justice Access Network (GRJAN) and a Women’s Studies Graduate Student at Georgia State University

Election 2012: Moving Forward on Fairness for Women in the Workplace

Published on November 9, 2012 in Sarah Crawford. 0 Comments

Director of Workplace Fairness

Women made a difference this election. Issues like fair pay received attention nationally and at the state level like never before. Women at all levels broke barriers. And a record number of women were elected to Congress. The results of this historic election represent great progress for women, and they have also created a great opportunity: a chance to move forward with real, concrete solutions to the challenges women and their families grapple with every day.

Challenges like unfair pay. Women who are employed full time in the United States are still being paid just 77 cents for every dollar paid to men, amounting to more than $11,000 in lost income each year. During many campaigns this election, elected officials and candidates talked about what this wage gap means for women and families. Now, it’s time to act.

The Lilly Ledbetter Fair Pay Act was the first piece of legislation signed by President Obama in 2009. It helps women fight back when they are paid less than men, restoring the law and its protections after a damaging U.S. Supreme Court decision. But it’s not enough. The Paycheck Fairness Act is a much-needed next step that offers real solutions for closing the punishing wage gap that costs women and families so much.

The Department of Labor can also take concrete steps to promote fair pay. It can finalize a rule that would prohibit employers that contract with the federal government from engaging in discriminatory compensation practices – or using pay secrecy policies that perpetuate them. It can also finalize a rule that would help to ensure that home care workers get the same minimum wage and overtime protections that other workers enjoy. The department can – and should – prioritize these rules without delay.

Another all-too-common and increasing challenge for employed women is discrimination based on pregnancy. In fact, over the past decade, charges of pregnancy discrimination have risen by 35 percent. This election shined a light on the importance of women’s income to the financial security of families and our nation. It is simply appalling that women are being fired or forced out of the jobs simply because they are pregnant. Here, too, it’s time for action.

The Pregnant Workers Fairness Act is critical legislation that would help ensure that pregnant workers are not forced out of their jobs unnecessarily or denied reasonable job modifications that would allow them to continue working and supporting their families. It would promote the health and economic security of pregnant women, their babies and their families. And it should be a priority for any elected official who claims to value families and a strong economy.

So, as we celebrate a historic election for women, let’s also remember the urgent need to translate this energy and momentum into real progress. It’s time to move forward in promoting fairness for women in the workplace.

Election 2012: Women and Families Need Full Implementation of Health Reform

Published on November 9, 2012 in Kirsten Sloan. 1 Comment

Kirsten Sloan, Vice President, National Partnership

One of the certainties coming out of this week’s election is that health care reform is moving forward. And it’s about time. With millions of women and families counting on the Affordable Care Act’s promise of access to quality health care, we can’t afford any more delays or roadblocks.

Women fought hard for passage of the legislation. We held our collective breath until the Supreme Court ruled the new law constitutional. And a vast number of women cast their votes to ensure that there would be an Administration and Congress that would continue to move health reform forward.

With the election behind us, it’s time to turn back to the task of making sure the elements of health reform so critical for women are implemented fully and soon. These include provisions that ensure women don’t have to pay more for insurance simply because of gender, protect women from being denied health coverage if we get sick or have pre-existing conditions, and make coverage more affordable through subsidies for women who lack employer-sponsored health insurance.

Unfortunately, we know there will be further attempts to de-rail implementation by opponents in Congress. Some members remain determined to repeal the law. We have a clear message from voters now that they don’t want that. Efforts to repeal or undermine the law should be swiftly and decisively rebuffed.

Women sent a clear message in this election – health care matters to us and there is no going back. The Affordable Care Act must move forward.

For more information on how the Affordable Care Act helps women, take a look at our factsheet.

Election 2012: A Good Day for Women, A Good Day for the Country

Published on November 8, 2012 in Debra Ness. 0 Comments

Debra Ness, President, National Partnership

Cross-posted from the Huffington Post.

In reelecting President Obama and significantly increasing the numbers of women and progressives in the United States Senate, Americans have said ‘yes’ to fair pay for women, ‘yes’ to policies that make our workplaces more family friendly, ‘yes’ to ending gender discrimination and strengthening consumer protections in health insurance, and ‘yes’ to a more patient- and family-centered health care system.

And voters said ‘yes’ to a president who stands ready to block every single effort to wage war on women. It’s a good day for women and a good day for the country.

This election was noteworthy. At the national level, there was unprecedented attention to issues that matter deeply to women, including fair pay and reproductive health. That women helped carry the day for a president who took — and touted — his support for measures that will end gender discrimination and protect women’s health should not be a surprise.

The election was also noteworthy in that a number of candidates for high-level office made horrifying statements that demonstrated deep ignorance — and real callousness — about rape and its consequences. It is certainly encouraging that voters soundly rejected those candidates in Missouri, Indiana, Illinois and Washington state.

Our country’s rich diversity was evident in this election, which was deeply personal to many people as evidenced by their commitment to vote despite long lines and other obstacles. And although the electorate is, in some ways, divided, it is clear that the nation does not want to return to the days when discrimination was commonplace, almost no workplaces were family friendly, women could not access safe, legal abortion, women paid more than men for the same health coverage and even those of us with health insurance had to hope and pray that we didn’t lose our homes and our life savings when a family member got sick.

It was not long ago that issues like fair pay, abortion rights, health reform and family and medical leave had bipartisan support. At the National Partnership, we hope they will all have bipartisan support again very soon. We urge every official who was elected to abandon attacks on women and the politics of division, and instead work together for the progress the nation needs. With the toughest of budget and fiscal decisions just ahead, it is absolutely imperative that all lawmakers make it a priority to protect the most vulnerable among us by preserving and strengthening the safety net.

That is what the nation wants. Voters were determined to make their voices heard, and they voted for a future where the basic American values of fairness, opportunity and compassion are a reality for all of us.

Election 2012: Hope for Workers and Families

Published on November 8, 2012 in Vicki Shabo. 1 Comment

Vicki Shabo, Director of Work and Family Programs

For those who advocate day in and day out for family friendly policies, this election brings hope. Not the more naïve and dreamy hope of 2008, but a hope borne out of the reality of the last four years and a growing recognition of the real demographic changes in our society. Hope that springs from the demonstrated desire of people in the United States to have government policies that help workers and families succeed in joining and staying in the middle class.

Hope also springs from a growing consensus that leaders must work together to find common sense solutions to working families’ struggles. New York Times columnist David Brooks nailed it the day after the election: “If you look at the polls, and I’ve been looking all day at Asian-Americans and Latinos, how they look at America, they believe ferociously in work. And they think some government programs help them work harder.” Brooks goes on to say that the central question for leaders to face is: “How do we help people work harder and make their lives better?” (Read more here.)

Family friendly policies fit the bill. Workers who earn paid sick days can work more productively and in healthier workplaces because they don’t have to work sick, and they can work with greater economic security because they don’t have to worry about losing income or risking their jobs when a child comes down with the flu. Workers who can take paid family leave after the birth of a child are more likely to return to work, to be more attached to their employers, to earn higher wages over time and to rely less on public assistance. And workers who have flexibility and control over their schedules need not worry that their jobs are on the line when family responsibilities arise. All of these common sense, pro-work policies fall into the bucket of government standards that would help people work harder and smarter.

For the public, family friendly policies unite rather than divide. Most Republicans, Independents and Democrats support common sense standards. Three-quarters of adults in the United States support a national paid sick days law so that workers don’t have to risk losing their jobs or wages because they or a child are sick, and a similar share believe that family and maternity leave are very important workplace standards. Voters who have had the opportunity to hear a fulsome debate about a paid sick days standard overwhelmingly believe that elected officials who support paid sick days policies are standing up for working people and understand their real-life challenges. On all of these questions, support holds firm across partisan divides.

As we move forward, let us answer the question “How do we help people work harder and make their lives better?” by looking to the obvious: paid sick days, paid leave and greater efforts to make workplaces more family friendly. Together, we will forge that path forward.

Election 2012: A Win for Reproductive Rights, But We’re Not Taking Anything for Granted

Published on November 8, 2012 in Andrea Friedman and Reproductive Health. 3 Comments

Andrea Friedman, Director of Reproductive Health Programs, National Partnership

This election was a rebuttal to those politicians and activists who are trying to turn back the clock on women’s reproductive rights and health, but it was also a sobering reminder that women’s basic reproductive health care is under siege and at risk. On November 6th, women sent a clear message that our right to truly be equal participants in society, our right to control our bodies and therefore our lives, cannot and will not be taken for granted.

After we pause to celebrate, we must look to the future and how we will advance real access to comprehensive reproductive health care for all women. A woman should be able to access safe abortion – in her community and without unnecessary medical procedures and delays. Yet in many states, women are forced to travel long distances, undergo biased counseling and unnecessary invasive procedures, and deal with needless and insulting waiting periods.

No woman’s decision should be made for her because she can’t afford abortion care. For too many women, that’s exactly what happens, and we cannot rest until we repeal the discriminatory and harmful Hyde Amendment banning coverage of abortion in Medicaid.

The election victory was not untarnished. In Montana, voters approved an amendment to create a burdensome parental notification requirement that takes away young women’s rights and endangers their health. Montana became the 39th state requiring parental involvement in a young woman’s abortion decision. Even as we move forward, new barriers are being put up.

We look to our champions who stood with us, and the new ones who are now joining us, to stay vigilant in this fight. Women did not ask for this fight, but it is one we will continue – and November 6^th was a step in the right direction.

What Montana Teens Really Need

Published on November 2, 2012 in Lynsey Bourke, Repro Health Watch and Reproductive Health. 3 Comments

Lynsey Bourke,Blue Mountain Clinic Family Practice, Missoula, MT

LR120’s language would lead Montanans to believe that hoards of young women are rushing to clinics in an effort to end secret pregnancies. This depiction couldn’t be further from the truth. The small percentage of young women who do choose abortion come to clinics with a trusted adult — an auntie, grandma or older sibling — or their parent. These young women are not “coerced” into an abortion, as the language of LR120 implies; however, the results of LR120 could be to force young women to carry pregnancies to term against their will. LR120 hits close to home. Had parental notification been in place when I was 15, many friends of mine would have been directly impacted. One friend writes:

I write this letter with my daughter kicking inside my belly. I do not take the ballot initiative LR120 lightly, as it forces me contemplate her future and my past.

When I was 15, I was pregnant with my high school boyfriend’s baby. At the time, I knew that abortion was the right decision. My home life was not exactly a stable loving environment, and I know my parents would not have consented to my abortion if the choice were left up to them. With the support of my boyfriend and his mother, I was able to get an abortion very early on. If there had been legislation like LR120, my entire life trajectory would be different.

Today, I am in a loving marriage, have a good education, and am 7 months pregnant. I feel physically and emotionally ready to give this pregnancy and then child what she needs.

LR120 attempts to improve family communications through mandating that clinics notify parents before their daughter gets an abortion. However, for young women like my friend, informing her parents would have made her life increasingly complicated. Had she been forced to have a baby at 15, she is well aware that her life would be very different.

In Idaho many pieces of legislation conspire to make abortion close to impossible. In the last year, a story of a woman who ordered the abortion pill online and induced her own procedure has been publicized. While abortion is legal, this woman would have had to travel long distances and find accommodation during her procedure. She felt financially unable to access legal care, so she took matters into her own hands.

While it is very possible that LR120 will pass in Montana, the greatest fear is that young women will resort to extreme measures before getting accurate information on alternatives or having the opportunity to access a timely judicial bypass. It will be the job of choice advocates to make this process as easy to navigate and as transparent as possible. Like my friend, who made a difficult choice for herself and her future, all young women in Montana need support, not more obstacles.

Lynsey Bourke, Director of Development, Outreach and Communications
Blue Mountain Clinic Family Practice, Missoula, MT