This week’s blog topic is of our choosing. I would like to connect everything that we have talked about in class to try and determine why Paterson, NJ has been hit so hard by COVID-19. As I have talked about in previous blogs, Paterson has 7,091 confirmed cases, and Wayne has 1,330 confirmed cases. So why are the number of cases so different?

Population/Housing

One blaring reason for the difference in the number of COVID cases is that Paterson is a lot bigger than Wayne. Paterson’s population is around 148,000 people while Wayne’s population is roughly 54,000. It is simple math, if there are more people, more of them will be infected.

Another aspect of life in Paterson that needs to be considered is the housing arrangements. Paterson has an average of 3.21 people per household while Wayne only has 2.83. It is very common in Paterson that a family will move into a two-floor apartment and the grandparents will live on the bottom flood and the parents and children will live on the second floor. This housing arrangement is often referred to as a multifamily home. Here are some examples of multifamily homes for sale in Paterson.

Multifamily Home in Paterson NJ 

The Economy

Another aspect that needs to be looked at in comparing Wayne and Paterson is the economies of both. The median household income in Paterson is Paterson’s median household income is $36,106 , and Wayne’s median income is $118,004. When these are factored into the national average, the poverty rate in Paterson is 28.1% and in Wayne it is 4.3%. Incase the message was not clear enough I will give another statistic. The total retail sales per capita in 2012 in Paterson was $5,852 and in Wayne it was $50,799. There are clear differences between the economies in Wayne and Paterson. People in Paterson simply do not have the extra money to out and spend it on a gym membership, or buy a $6 salad rather than buying a $2 Big Mac.

Big Mac vs Salad

Insurance

As I have talked about in previous blogs 19.4% of people under 65 in Paterson do not have insurance, whereas in Wayne, 5.5% of people under 65 do not have insurance As mentioned above this makes sense. Due to the economic limitations people in Paterson simply cannot afford insurance.

Paterson, NJ

Race is Not the Issue

We have often heard in the news that this virus is having a dramatic impact on Black and Hispanic communities The population of Paterson, NJ is 60.7% Hispanic or Latino, 25.7% Black or African American Alone, and 8.49% White Alone. However, race is not the issue; it is the situation that the people in Paterson are in. They are in a never-ending loop. Their economic situations do not allow them to eat healthy or exercise because they do not have access to other alternatives. They also do not have access to health insurance because they cannot afford it. This leads to people in Paterson living overall less healthy lifestyles because they do not have any other options.

 

So Why Has COVID Hit Paterson So Hard?

Paterson NJ is the perfect storm for COVID-19. To begin with, people are living with multiple generations in one house. This makes social distancing virtually impossible. Next, the people living in these houses do not have the financial accessibility to healthy foods, and healthy lifestyles such as gyms. This causes people living in Paterson to be more susceptible to diabetes, heart disease, and many other health conditions. As research has shown, COVID attacks people with preexisting health conditions such as heart disease and diabetes. Another reason COVID has it so hard is that people in Paterson often do not have the luxury of working from home like people in Wayne do. This makes social distancing impossible because people need to work in order to put food on their table.

The people that are “at risk” are at risk because this is simply the lifestyle they are forced to live due to their economic situation. It does not matter what race of people were living in Paterson, if they were forced to make the same decisions, they too would have higher levels of heart disease and diabetes, which would then put them “at risk” for COVID. The sad reality is that Paterson is the perfect example of what is happening all over this country. People living in cities that are in tough financial situations are often suffering from preexisting health conditions, which COVID just so happens to exploit.

 

How can this be Fixed?

The first thing that needs to be done is to help get people living in Paterson the proper healthcare they need. This would include more free health clinics, nutrition classes, and even free exercise classes. These simple activities could help allow the population in Paterson and cities all across America to access healthier lifestyles.

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Potential Free Outdoor Gyms

 

 

 

 

 

 

 

 

Living in Northern New Jersey, I am probably in one of the hardest hit COVID areas in the country. New Jersey has had over 150,000 cases and over 10,000 deaths. In this blog post I am going to discuss how my area has handled this terrible virus.

Testing

If you were to become infected with COVID-19 the first step would be to get tested. New Jersey has set up over 46 testing locations. If someone in Wayne were to want to get tested, the closest location is William Paterson University, which is actually right in the middle of Wayne. However, the William Paterson testing site requires patients to have a doctor’s referral/prescription to be tested. The good thing about this testing site is that patients have to drive through it. But this brings up something that we have often discussed in this class; access. What if a patient does not have a car? Well the answer to that is that they would need to find a way to get to another testing site such as the Clifton Rite Aid. If a patient does test positive and their condition is bad enough, they will then be hospitalized.

Testing at William Paterson University

Atlantic Health Hospitals

For this blog post, I would like to focus on the Atlantic Health Hospitals, which include Chilton Memorial Hospital, Morristown Medical Center, Overlook Medical Center, Hackettstown Medical Center, and Newton Medical Center. The reason that I would like to focus on these hospitals is because my mom is actually a nurse for an outpatient Cardiology group based out of Morristown Medical Center. My mom has still been going into the office everyday. They have her answering the phone for the COVID hotline they have set up. They also have her managing her normal patients, as they cannot be forgotten during this pandemic. My mom has been amazing to her patients during this, even calling an elderly patient’s church to ensure that she would get the groceries she needed. So there’s my shout-out to my mom!

Morristown Medical Center 

Telehealth

As we have discussed in class, telehealth has become so popular during this pandemic. Telehealth was not all that common before this, so everyone using it would most likely be considered a novice now. People should not worry though, as Atlantic Health has a webpage devoted to FAQs about telehealth. One of the most interesting things on this webpage was a diagram about proper camera angles, which is shown below.

In the Hospitals

The hospitals in this area, including Atlantic Health Hospitals, have canceled all elective procedures. Hopefully these will be able to resume soon so people can get the treatment they need. The hospitals in this area are also being extremely strict about visitors. Atlantic Health Hospitals are following these rules:

-One visitor/support person for patients in hospice or end-of-life care

-One visitor/support person in the NICU

-One visitor/support person for pediatric patients

-One visitor/support person for cognitively impaired patients

-One designated support person for patients in the maternity centers

 

Donations

Atlantic Health Hospitals are asking for all sorts of donations. The first type of donation is for the healthcare providers on the frontline. Atlantic Health Hospitals have set up a webpage where people can donate to help healthcare providers with remote hotel stays to limit family exposure, rent or mortgage assistance, groceries, utilities, transportation to and from work, and emergency child and eldercare. This is the least that we could do for those people putting their lives on the line. Atlantic Health Hospitals are also asking for PPE donations. If people do not have any masks to donate, they are also accepting homemade masks! If people feel that giving masks is not enough, Atlantic Health Hospitals are also asking people to donate their blood. They are asking for regular blood donations, and also plasma donations of those that have recovered from COVID-19. It is great to see that everyone is able to play some sort of role in helping those on the frontlines.

 

My experience with end of life care has been more than most people my age. Last year my dad passed away. Leading up to this, he had been on dialysis for 7 years with a very long list of preexisting health conditions. It reached a point where the dialysis was no longer working and we reached the tough decision to no longer continue with dialysis. Unlike other topics I have discussed in this blog, I would like to take the perspective of the patient’s family rather than the healthcare provider, as what follows is my perspective on my dad’s end of life care. 

Assisted Living in Wayne NJ 

Leading up to this decision, my dad had been in a private assisted living center called Sunrise Assisted Living. Here they provided him all of his daily needs such as food, administering his prescribed medications, and any daily routine that he may have needed help with. The staff at this facility were awesome and they made the whole experience a lot easier. The only catch to this facility was that insurance didn’t cover it and we had to pay $7700 a month for this assisted living center. 

Sunrise Assisted Living in Wayne NJ 

Once we made the decision to stop dialysis, we knew there was not much time left. 1 week passed since we made the decision to stop dialysis to my dad passing. We made the decision to place my dad on hospice on wednesday and he passed on Sunday. Between the assisted living facility, my dad’s primary care doctor, and his dialysis center, they facilitated ordering and arranging hospice.  

 

Hospice in Wayne NJ 

Valley Hospital Hospice was in charge of my dad’s last few days of life. They helped to administer his medications and make sure that he was comfortable. Valley Hospital Hospice were amazing, their website says that they shift the focus of treatment to comfort care and quality of life is when a cure is no longer likely for a patient with advanced illness. Valley Hospice can make this transition easier for patients and their families, and this is exactly what they did. The hospice care did not cost us anything, as it was covered by my dad’s insurance. 

As we mentioned in class, most people on hospice are either in an assisted living facility or the hospital when they pass. The hospice care team that helped my dad were incredible. My dad was no easy patient in his last few days of life. This experience showed me that being a hospice worker requires patience, compassion, and being an overall good person. What they did for my dad in his last few days made the whole experience for me and my mom so much easier as we did not have to worry about whether my dad was comfortable or not, as the hospice workers were taking amazing care of him and making sure he was comfortable.  

Other Hospice Options in Wayne NJ 

My family was lucky because my dad was in an assisted living facility so they helped us arrange hospice for him. But what if a family member wanted to pass at home and not in a hospital or an assisted living facility? The process is not much different. If a loved one you know is about to pass away you simply contact their physician, and have them order hospice for your family member. Once this has been ordered, they will help you arrange hospice. One pressing issue is what if you do not have insurance? 

As I have discussed in my previous blogs, many people living in my town and the neighboring towns do not have insurance. If you do have insurance, hospice is most likely covered by it. Thankfully though, even if you do not have insurance, Most hospice services will not turn you away because of an inability to pay. As it says on the Valley Hospital Hospice website, As an independent community-based, not-for-profit healthcare provider, Valley Hospice accepts eligible hospice patients, regardless of their ability to pay. The goal at Valley Hospice is never to deny care to those who need it. This is an amazing thing that the hospice providers do because no one should be denied end of life care due to their financial situation. 

Comforting a Patient

 

This week the topic is “diverse patient” populations. I would like to discuss 2 very different populations in Wayne, NJ. The two groups are spanish speaking patients and those patients with any mental illness. 

Language 

While Wayne, NJ is 86% White and only 12.4% Hispanic I have talked about Paterson in my previous blogs and the same cannot be said about Paterson. Paterson is 29% white and 60.9% Hispanic. This means that more than 60% of potential patients in Paterson will need a doctor that is able to speak spanish in order for them to get the best treatment they can. Language is something that we all take for advantage, and is something that can greatly have an impact on a patient’s access to medicine.  

There is no doubt that any doctor that speaks Spanish and English has an advantage over a doctor who just speaks English. In Wayne if a doctor were to only speak English, this would allow the doctor to communicate with most of the patients. In Paterson however, a doctor that only speaks English would have a very difficult time treating patients as they would not be able to communicate with over half of the population. Known as the Silk City, out of the 146,199 people that live in Paterson, 61 percent of them speak a language other than English. At least 57 percent of the people living in Paterson identify as Hispanic or Latino. But the city is home to many immigrant communities. Many Turkish, Syrian and other Middle-Eastern immigrants call South Paterson home, for example. This goes to show that if a doctor wanted to practice medicine in Paterson, they would need to speak at least some Spanish. Luckily, there are many doctors in the area that do speak Spanish. (See map below) Having many Spanish speaking doctors in the area allows the local Spanish community to get the same access to care as someone that speaks English. 

Map of Spanish Speaking Doctors in Wayne

Psychiatric Patients 

The second group of “diverse patients” I would like to talk about in Wayne is those patients with a mental illness. Unfortunately in Wayne there is no hospital with a psychiatric unit. However, Paterson’s St. Joseph’s Regional Medical Center in Paterson does have a psychiatric unit. This allows those patients with a psychiatric illness to get the treatment they need. The Psychiatric Emergency Services is in charge of handling any patient that may come into the hospital with a mental illness, “The mission of the PES/Screening Center is to assist any individual in resolving any crisis/conflict associated with psychiatric illness. Staff promptly evaluate clients in order to determine type of treatment required and arrange for the provision of such treatment in least restrictive setting as close to home as possible. The expectation is that the provision of services and relevant supports will result in resolution of the crisis.” This ensures that any patient that needs psychiatric treatment will be taken care of at St. Joseph’s Regional Medical Center. 

Image of St. Joseph’s Regional Medical Center

COVID Effects Diverse Patient Populations

This week, Wayne went up to 1,334 (from 1,001) and Paterson is up to 5,971 (from 5,115). There is no doubt that Paterson is getting hit hard by this terrible virus. As I mentioned earlier, Paterson is 60.9% Hispanic, which means they are also getting hit hard by COVID-19. I am not going to get into whether one group of people is more susceptible to this virus than another. Rather I will tell you what NJ officials are doing to help the hispanic population in Paterson. One thing that the NJ Department of Health is doing is spreading flyers around in Spanish and English that tells people what they need to know. This ensures that everyone is on the same page so that we can all get through this together. 

Being in a hospital during this pandemic has to be extremely stressful and scary and I cannot even imagine how the patients in the Psychiatric Unit at St. Joes in Paterson are feeling. One of the most important things to remember about a psych unit is that the patients that are in there are in there for a reason, “It can be difficult to isolate patients who have behavioral dysregulation from symptoms of active mania and psychosis.” It must be extremely difficult for nurses to try and quarantine a mentally ill patient. The only way to get through this is to socially distance and that is very difficult to do in a Psych unit. However, most hospitals in the area have closed their doors to visitors. While this may be good to stop the spread of COVID-19 it may not be the best thing for those patients in the Psychiatric unit, “The stressor of a pandemic may worsen psychiatric symptoms for individuals—for example, those with psychosomatic delusions may experience more intense paranoia.” Hopefully things will return to “normal” so that these patients can get the care they truly need.

This week’s blog topic is: What factors determine who has access to healthcare, and who may not. There are many factors that can play a role into who is able to access healthcare such as transportation methods and number of hospitals in the area. However, I discussed both of those topics in my blog last week. New Jersey is able to get people to their medical appointments via 150 public buses and 11 major rail lines, and NJ access link. There are numerous hospitals where I live. The factor that impacts a patient’s access to healthcare that I would like to discuss this week is the financial factor. 

As I discussed last week, Wayne has 5.5% of people under age 65 that are uninsured, and Paterson has 19.5% of people under age 65 that are uninsured. Let us first look at the group of people that are insured. Those with insurance are able to schedule appointments with primary care doctors and specialists as long as the doctor is in the insurance network. The biggest issue for people that have insurance is that some doctors do not accept certain insurances. I would like to focus on those with no insurance as they are faced with many tough decisions. 

Paying for Healthcare With No Insurance 

In The US, you cannot be turned away due to EMTALA, which ensures public access to emergency services regardless of ability to pay. Oftentimes, patients will let their health issues build up until they can no longer take it, because they cannot afford care elsewhere. Then they will go to the emergency room because they cannot be turned away there. This is a very dangerous game that these patients are being forced to play. If someone with a cardiac issue is putting off care, they do not know when that big heart attack is coming because they are not able to pay to see a doctor. When patients do finally go to the emergency room, they will get a big bill. This is where NJ Family Care will help them out. “NJ Family care includes: children, pregnant women, parents/caretaker relatives, single adults and childless couples. Financial eligibility will be determined by the latest federal tax return which, when filed, will be electronically verified.” To be more specific parents/ caretakers are eligible for coverage “with income up to 138% FPL ($3,013/month for a family of four) and must have tax dependent children in their household in order to be eligible under this category.” This allows patients to get financial help for their much-needed medical procedures. Another alternative to waiting to go to the emergency room is to take advantage of a free medical clinic. In Paterson one such clinic is the Paterson Community Health Center. The Paterson Community Health Center provides medical and dental care at little to no charge. 

COVID Payment In Wayne

I would like to turn to the COVID-19 pandemic in my area, and how it has amplified the issue of patients not being able to pay for healthcare. The number of cases in Wayne went up to 1,001 (from 964), and Paterson went up to 5,115 cases (from 4,751). I would now like to discuss an issue I posed at the end of last week’s blog: How are all of the uninsured people in Paterson going to pay for COVID-19 treatment. COVID-19 Treatment is very expensive. Being on a ventilator costs about $400 a day. Studies are showing that COVID-19 treatment can cost upwards of $30,000. In order to cope with this, New Jersey’s Governor Phil Murphy requested that the federal government open a Special Enrollment Period (SEP) in New Jersey to allow uninsured and underinsured residents to enroll in health coverage through the federal health insurance exchange “Therefore, as New Jersey transitions from a State Based Exchange on the Federal Platform to a State Based Exchange, I respectfully urge the Administrator of the Centers for Medicare & Medicaid Services to authorize a Special Enrollment Period in New Jersey to allow individuals to access affordable health insurance options through the federal platform.” This allows patients that do not have insurance to get the treatment they need. While doing research, I found that, “Health insurers Cigna and Humana are now waiving patient cost-sharing on all treatment for coronavirus, including hospitalizations and ambulance transfers, for their insured members and employer plans.” It is good to see that both people who are uninsured and insured are being given a break during this pandemic.

National COVID Payment Plan and The Future 

But how are hospitals paying for the treatment of those uninsured patients? The answer is that President Trump set up a $100 billion fund to reimburse hospitals and other health care providers for their coronavirus expenses. This is great for the current situation we are in, but what happens when we go back to a “normal” life. Are the patients in Paterson who are being treated for free now, still going to be treated for free in the future? Or are they going to have to wait to get treated in an emergency room because they cannot afford care until then.  

 

          I have grown up in Wayne, New Jersey my entire life. Wayne is a suburb located approximately 30 miles from New York City. Wayne’s population is about 55,000 people, 86% are white, 2% are African American, 8% are Asian, and 8% are Latino. This week’s blog focuses on what factors influence the health of my local community. In Wayne, access to proper healthcare is not the issue, rather affordability is. As the map below shows, there are a number of hospitals located within a 30-minute drive of Wayne. In fact, Wayne has its own hospital, and within 10 minutes there are 3 other hospitals that could be accessed. (See Map Below for Hospitals Near Me) Transportation to any of these hospitals is not a big issue. Because we are so close to New York City, Uber is very popular in my town. In New Jersey we have public transportation in the form of buses and trains. However, if a person was not able to use public transportation due to a disability, they could use a state run program called NJ Access Link. In order to be eligible for this service, patients simply have to interview with a transportation representative explaining your disability and why you cannot take public transportation.

 

            As I stated earlier, transportation to hospitals is not the issue but payment at the hospital is. Wayne’s median household income was $100,638 in 2017. Wayne is located right next to Paterson, New Jersey, whose median household income was $36,983 in 2017. In Wayne, as of 2018, 5.5% of people under the age of 65 did not have insurance. While in 2018, Paterson had 19.5% of people under the age of 65 uninsured. This goes to show that paying for medical treatment is an issue where I live. To help deal with this, New Jersey has a program called The New Jersey Hospital Care Payment Assistance Program, often referred to as Charity Care. Charity Care covers inpatient and outpatient treatments. In order to qualify for Charity Care, “You will be eligible for full Charity Care coverage in 2018 if your annual gross income for the 12 months before your hospital care was not more than 200% of the federal poverty level, which is $24,280 in 2018 for a single person.” (NJ.gov) This program has a sliding scale that allows patients to get the medical treatment they need, no matter their financial situation. 

            To finish up this blog I would like to discuss the COVID-19 Pandemic in Wayne, New Jersey. New Jersey has been a hot spot for the coronavirus, with over 95,000 confirmed cases. As of April 28, Wayne has 964 confirmed cases, while Paterson has 4,751 confirmed cases. One of the big issues has been testing people for this terrible virus. As this whole blog has been about affording medical treatment I thought of the question, how are people that can’t pay for COVID-19 testing getting tested? After doing some research I found a letter published by the NJ Department of Health saying, “To ensure that cost-sharing is not a barrier to testing for COVID-19, the Department of Health (“Department”) is instructing hospitals not to charge uninsured patients for (1) the CDC 2019 Novel Coronavirus Real Time RT-PCR diagnostic test panel and (2) COVID-19-related ICD-10-CM diagnosis codes communicated through the Medicaid Newsletter.” It is now thought that New Jersey has gotten over its COVID-19 peak. An interesting question to ask now is, how is New Jersey planning on helping those that can not pay for COVID-19 treatment. Now that people have been tested, there needs to be a plan for follow up care. We could ask how are people getting to the follow up care? In these unprecedented times, there are so many unanswered questions. I will give a COVID-19 update next week and discuss how people are accessing the healthcare system.