SACRAMENTO, Calif. — Alice McMenamin loves her home. It's a place she shares with her husband and animals.

McMenamin has been living with Multiple Sclerosis since the 1990s. While it may not have impacted her spirit, it has impacted her ability to take care of herself.

McMenamin was forced to seek help, but she feared losing the freedom she has at home.

"It was very difficult," she said

In-home healthcare is expensive and in short supply. Kaiser Health News reported that home healthcare agencies are turning away 40% of referrals because of a lack of workers.

The shortage is blamed on burnout, low wages and being recruited away by hospitals and other work with better pay and hours. The median wage for an in-home healthcare worker is approximately $10 an hour.

According to PHI, an industry research group, there are just over 2 million home healthcare workers, but the 65 and older population is expected to double by 2050, reaching nearly 90 million.

The increased demand and decreasing supply have led to some creative solutions in the private sector.

Trina Kaplow is one of the founders of Alice Care, a new app-based home care provider. Similar to a rideshare app, clients can schedule help with a task, like a bath, and licensed home care providers can choose to take the task.

"The difference is a traditional agency will require a four-hour minimum and often multiple times a week, which can be very expensive and excessive," said Kaplow.

"It's super flexible and I decide what I'm going to do in the moment," said Maria Vazquez, a CNA who works as a provider on the app.

In this great resignation mindset of an economy, where the employee has more power, Vazquez believes a flexible schedule in a traditionally unflexible career is a gamechanger.

"I have three children. I'm still taking classes. I'm applying to nursing school. Like my life is hectic. That's the reason I gravitated towards it," said Vazquez said.

Industries are changing, and healthcare is no different. As more creative solutions are being found to address worker shortages, people like McMenamin are grateful something is being done.

"Eventually one of my complications will get, get the better of me, but until then, it's not gonna win," she said.

New Mexico plans to build a new abortion clinic in a town near the Texas border.

The announcement came after the state's Democratic Gov. Michelle Lujan Grisham signed an executive order Wednesday, committing $10 million from her capital allocation funds to build the new clinic in Doña Ana County.

In a news release, Grisham said the new clinic would offer a "full spectrum of reproductive health care," including abortion.

In New Mexico, abortion is legal. However, the Associated Press reported that its neighboring states, Texas and Oklahoma, have banned abortions after about six weeks of pregnancy.

“As more states move to restrict and prohibit access to reproductive care, New Mexico will continue to not only protect access to abortion but to expand and strengthen reproductive health care throughout the state,” said Gov. Lujan Grisham in the news release. “Today, I reaffirm my resolve to make sure that women and families in New Mexico – and beyond – are supported at every step of the way.”

Other services the clinic would provide include family planning, prenatal care, and postpartum care and support.

Lujan Grisham has been a proponent when it comes to abortion rights.

Three days after the U.S. Supreme Court overturned Roe v. Wade, she signed an executive order that would ensure safe harbor to those seeking abortions or providing abortions in the state, the Associated Press reported.

DENVER, Colorado — Adversity has a way of knocking us off our intended path. For many doctors, nurses, and first responders, the uncertainty of the pandemic has made them feel as if they're lost in the woods — far away from the calling that first brought them to their career.

"When we get burned out, there's this sort of surreptitious trick with burnout that causes us to forget why we do what we do every day and what we love about our job," said Rev. Mike Guthrie, the director of spiritual care at Presbyterian/St. Luke’s & Rocky Mountain Children Hospital in Denver.

"I just had to try to help connect people back to calling back to purpose, why they're here," he said.

"I think there's been a rise in people asking the big questions, you know, 'Where do I go when I die? What's going to happen?'" said Mike Neil, the president of the Washington State Chaplain Foundation.

Guthrie is a hospital chaplain and Neil, recently retired, has been a law enforcement chaplain. Both men have been doing this work for nearly 20 years.

"It's called a ministry of presence," said Neil.

Their job is to be present for patients, victims, and their colleagues when their jobs get too heavy, whether that's through a conversation about faith or just being there to listen.

However, being "present" has been tough these last two years.

"We all feel like we're a prizefighter with our hands tied behind her back. Everybody's wearing a mask, try to relate to someone that you can't see their face. You can't see their facial expressions," said Neil.

"We walk this tension between wanting to support our patients, but also having these restrictions in place to protect everybody else from accidental exposure," said Guthrie.

A tight line to walk, but the emotional and spiritual support they have been offering through these tough times has never been more important.

"We will never go back to being the same person we were before COVID hit. I think the lifelong lessons in the impact and experiences that we've been through over the last two years, and continue to go through, will change us in a lasting way," said Guthrie, "and the goal is to make sure that that change is done in a healing way."

For these chaplains, and chaplains across the country, these last two years, though hard, have made them more sure than ever in their own vocation to their jobs, being the heroes to our heroes.

"It's been my calling. That's why I did it in the beginning, it's not for me, it's not for me in my soul, but it's for them," said Neil.

In 2016, President Obama used the Affordable Care Act to extend federal sex discrimination protections to people who identify as transgender.

But after a recent move by the Trump administration, some of those protections are now gone.

“What happened with the recent Trump administration ruling is that they basically said they were taking out that definition of sex discrimination and stated that it only applied to a person’s birth sex and couldn’t be applied to their gender identity and that they were no longer going to enforce any protections on the basis of gender identity," said Dr. Eliabeth Kvach.

“I think there’s something to be said, to think about what it’s like to be a person where the government says you don’t deserve to get accessible health care,” said Andrew Miller

Kvach and Miller both work at Denver Health in Colorado. Both call the recent rule change in DC a direct threat to the lives of transgender men and women.

“We have for example, 300 patients on our list to be able to receive vaginoplasty or gender confirming surgery for transgender women. And if you’re waiting years to get that surgery and then all of a sudden you’re worried about whether your insurance is going to cover it, that is enormously psychologically devastating to people,” said Kvach.

“I think that we’re already seeing that with cases coming out of hospitals denying care to transgender and non-binary folks," said Miller.

“I certainly think that it is dangerous to the lives of transgender and non-binary people,” said Kvach.

Denver Health is a LGBTQ+ Center of Excellence. For the health system it means any patient regardless of sexual orientation, gender identity, or other LGBTQ identification can receive treatment from any doctor for any health need

“LGBTQ health care isn’t specialty care, it’s just health care,” said Miller.

And while Miller is an employee at Denver Health, this is an extra important issue for him personally.

“I identify as a transgender man, and as I said before, my pronouns are he, him, his. I was born female, and at a certain point in my life, I recognized that being a woman didn’t fit for me, it was like I was living this false life,” said Miller

For him, and many trans people, being called the wrong name or the wrong pronoun isn’t just a simple mistake

“When we say hey, my name is Andrew, that’s what I go by, but you call me my birth name, what I hear is, 'It doesn’t matter that I told you my name.' You get to be more of an expert on me than I get to be on me. Why should I feel safe that you’re going to actually take care of me, if you can’t even call me my name?” Miller said.

For trans people around the country, this rule change might mean they could be denied hormone therapy or gender reassignment surgery. Procedures the transgender and health care providers who treat them, deem medically necessary.

“Medical treatment with hormones and with surgery help a person’s body align with who they are, with their gender identity,” Kvach said.

But it also means they have to be worried about being denied treatment for anything from a sore throat to life saving surgery.

“I’m from the south, I think about it all the time. What it would be like to go back home and have a medical emergency and not be able to get care. To be a person denied health care, and it’s terrifying,” said Miller.

And that increased anxiety can lead to bad health outcomes from avoiding preventative treatment to suicide.

A survey from the Trevor Project released this month shows that more than half of kids who identify as transgender and nonbinary have seriously considered suicide in the last 12 months.

While this rule change may be disheartening to many, institutions like Denver Health reaffirm their commitment to treating transgender people, like people

“I want folks to be able to go to the doctor and feel safe. I want my community to survive,” Miller said.

NEW YORK —

Eighteen former NBA players were charged Thursday with pocketing about $2.5 million illegally by defrauding the league’s health and welfare benefit plan in a scam that authorities said involved claiming fictitious medical and dental expenses.

"The defendants' playbook involved fraud and deception," U.S. Attorney Audrey Strauss told a news conference after FBI agents across the country arrested 15 ex-players and one of their wives in a three-year conspiracy that authorities say started in 2017.

According to an indictment returned in Manhattan federal court, the ex-players teamed up to defraud the supplemental coverage plan by submitting fraudulent claims to get reimbursed for medical and dental procedures that never happened.

Strauss said prosecutors have travel records, email and GPS data that prove the ex-players were sometimes far from the medical and dental offices at the times when they were supposedly getting treated.

In one instance, she said, an ex-player was playing basketball in Taiwan when he was supposedly getting $48,000 worth of root canals and crowns on eight teeth at a Beverly Hills, California, dental office in December 2018.

The indictment said the scheme was carried out from at least 2017 to 2020, when the plan — funded primarily by NBA teams — received false claims totaling about $3.9 million. Of that, the defendants received about $2.5 million in fraudulent proceeds.

Strauss said each defendant made false claims for reimbursements that ranged from $65,000 to $420,000.

A request for comment to the league wasn't immediately returned.

Michael J. Driscoll, the head of New York's FBI office, said the case demonstrated the FBI's continued focus on uncovering health care fraud scams that cost the health care industry tens of billions of dollars a year.

Strauss said the conspiracy was led by Terrence Williams, who began his career as a first-round NBA draft pick in 2009. The indictment said he submitted $19,000 in fraudulent claims to the plan in November 2017 for chiropractic care. The claims led to a $7,672 payout for Williams.

The indictment said he then recruited other former NBA players to defraud the plan and offered to provide fraudulent invoices from a chiropractor and dentist in Southern California and a wellness office in Washington state.

At least 10 of the ex-players paid kickbacks totaling about $230,000 to Williams, according to the court papers. A lawyer who has represented Williams in the past declined to comment.

What was then the New Jersey Nets picked Williams as No. 11 in the 2009 draft. He went on to play with four franchises — the Nets, Boston, Houston and Sacramento — over four seasons as a role player, averaging 7.1 points per game. He was waived by Boston two days after his 26th birthday in 2013 and hasn’t appeared in the league since.

Among those charged was Tony Allen, a six-time All-Defensive team selection and a member of the 2008 champion Boston Celtics. His wife was also indicted. Notably, Allen is set to have his jersey retired by the Memphis Grizzlies later this season. Tony Allen was not in custody as of Thursday afternoon.

For the most part, though, the ex-players charged had journeyman careers playing for several different teams and never reached anywhere close to the enormous stardom or salary that top players command.

Still, the 18 players combined to make $343 million in their on-court NBA careers, not counting outside income, endorsements or what any may have made playing overseas.

Strauss declined to speculate on their motivations or financial situations, saying to do so would go beyond the facts in the indictment.

Another former player charged in the scheme was Sebastian Telfair, a one-time high school star in New York who was highly touted when he turned pro, though his NBA career with eight franchises never brought the stardom some had expected.

Those charged also included four NBA champions. Glen Davis, along with Allen, was part of that 2008 title team in Boston. Shannon Brown won two championships with the Los Angeles Lakers, and Melvin Ely won a title with San Antonio in 2007.

Among others who were charged, Anthony Wroten, Ruben Patterson and Darius Miles were the only players who averaged double figures for their NBA careers.

Wroten averaged 11.1 points in 145 career games. Patterson averaged 10.7 points per game with six different teams. Miles, the No. 3 pick in the 2000 draft, averaged 10.1 points per game and played with four different franchises.

ALBUQUERQUE, New Mexico — Since the passage of Senate Bill 8, which prohibits abortion once a heartbeat is detected, many Texans who need abortions have left home for care. It's lead to a surge in patients at clinics in surrounding states

Planned Parenthood of South Texas would normally be filled with patients receiving different types of care for abortion. Jeffrey Hons, the president and CEO, says they had no choice but to shut down those procedures.

“It’s eerily quiet here now and that’s been the case here for the month of September," Hons said. “And then when the Supreme Court turned its back on not only the women of Texas, but the legal framework of the United States of America, then things went eerily quiet here when people realized finding abortion in Texas had essentially become nearly impossible and the flurry of activity has now moved across state lines where people are desperately trying to find the care very very far away that they should be able to find right here.”

Hons says it feels wrong for them to not be offering the services their patients desperately need.

“And for those people finding abortion care that is legal, safe and offered without judgement and without stigma, it’s essential. It’s a human dignity, it’s a human right. And so, it is very painful right now, to be experiencing the emotion and physic toll that Senate Bill 8 is creating for staff who want to help people but can’t," Hons said.

This reality has put some people in a tough spot; their options are slim.

“There is so much to be worried about right now. I mean when you talk to abortion providers in neighboring states, whether that be Louisiana, New Mexico Oklahoma, they are seeing an uptick in the number of patients who are reporting Texas zip codes as their home address," Hons said.

The New Mexico Religious Coalition for Reproduction Choice is seeing that firsthand.

Brittany Defeao, the program manager, shows us some context. She says In September 2019, they performed 20 abortions, in September of 2020 that number dropped to 15, and this year, it’s up to 50 people, 80% of whom are Texans.

“We were not really seeing new Mexico patients, it’s a very small amount of what we serve. We do anyone. Anywhere you come from, we will support you. Clearly Texas is the majority, it always has been, now it’s overwhelming, it is all Texas people," Defeao said.

To look at it another way, in 2020 they provided abortions to 216 people and they have already surpassed that this year with three months to go.

“It’s not how it used to be. It’s like they scatter in, they are just showing up. A lot of them are flying in in the morning. I’m getting them at the airport, taking them straight to an appointment, picking them up, getting food, they are flying back," Defeao said.

She says their phones have not stopped ringing; people are terrified to submit an application while still in Texas and are unsure of the boundaries around Senate Bill 8.

“So, we have the people who are afraid to travel, the people who are afraid to travel in a pandemic, and the people who are afraid that they are going to go to jail if they come out here to access care," Defeao said.

On top of all of that, their resources are slim.

“So, what we’re seeing is really low income, marginalized communities, the people that need the help the most," Defeao said. “These are people that have nothing, that don’t have access to birth control, to health care, to food, to safety.”

That’s why this clinic in New Mexico is making sure the people of Texas are reminded that they do have options.

“Just like confirming that community and trying to break that shame and stigma that’s even heavier because of this law," Defeao said.

NORWOOD, Ohio —

For most, Wasson Way is a trail for walking or running. Today, it was a Cincinnati Public School Teacher's canvas for art.

Aimee Costandi began leaving encouraging messages on the trail at the beginning of the pandemic. This week, she made her way to Norwood aiming to do more. “I know that there’s a lot of really good people that like to walk this trail and a lot of health care workers," she said, "this was a good place to start.”

With chalk, paint and brushes in hand, Costandi offered walkers and runners the chance to leave a heart, message or name of a health care worker. “I know the kind of stress that health care professionals are under right now and I see them crying on TikTok videos and it breaks my heart and I wanted to just give them a message that we really appreciate what you’re doing,” Costandi said.

Though these hearts and names will wash away with the rain, Costandi hopes the kind words won’t. She also created a Twitter account where people can leave their messages permanently. “So I'm hoping that it turns into a place where health care workers can hop on to a Twitter feed." said Costandi, "Wouldn’t it be nice to have a place where there are lots of positive messages of encouragement before you drift off to sleep from a really hard day?”

For Costandi, this project is a form of therapy. She explained further, “...doing this type of project really helps me cope with my feelings because I feel for them. Because we’re all part of this world, we’re all Americans and you know, we should care about one another.”

The mural also serves as a reminder of togetherness for the community. “I wanted to spend my time doing something that makes me feel good and let other people know that we’re all in this together,” Costandi said.

Costandi shared that she would be having more pop-up events around the Greater Cincinnati Area in the future.

If you'd like to leave a message of encouragement for local health care workers, you can visit the Twitter Costandi created. Just search: @suppcincyhc

The Butler County Care Facility continues to struggle to find workers despite a raise in union wages as several management positions remain open, and the new federal vaccination mandate could complicate matters.

The county has spent about $554,000 this year on contracted front-line workers to man the county-owned nursing home. The commissioners have had a contract with Professional Review Network Inc. for a facility administrator and this week agreed to extend the contract on a month-to-month basis, it included an $85 per hour increase up to $200.

The county has paid $72,930 for the temporary administrator. Last year during the height of pandemic when vacancies soared the home paid $1.24 million for temporary workers.

The top job at the county-run nursing home — which pays between $84,223 and $124,800 — has been vacant since former administrator Chamika Poole resigned last October. County Administrator Judi Boyko told the Journal-News the hourly increase was included because Professional Review Network was “grossly undercompensated” under the previous agreement.

She needed a new month-to-month agreement in case she finds a new administrator soon.

“The county is continuously seeking candidates and evaluating qualifications for compatibility at the facility. Based on the greater market of health care candidates have been few and far between,” Boyko said. “I thought I had identified a candidate but terms couldn’t be reached.”

The director of nursing also recently quit and they have posted that position. Human Resources Director Laurie Murphy said there are 4 to 5 vacant nursing positions and 10 to 12 openings for front-line workers. She said they are hoping the pay raise in the recently negotiated union contract — from $13.35 to $15 per hour — plus generous county benefits will help them attract more job candidates.

“There remains an overall shortage of clinical workers in the healthcare field and the hiring challenges we face are not unique to the Care Facility,” Murphy said. “The global impact of the pandemic and recent uptake in the Delta variant cases continues to impact hiring and retention across the entire healthcare industry.”

The assistant nursing director and assistant business office manager positions are also open. Boyko said they are holding off on filling those jobs because the daily census of patients has dropped to less than half capacity at around 50 in the 109-bed facility. Because of strict nursing home restrictions during the pandemic, families were choosing to remove their loved ones from congregate care.

“Since the census now has been below 50 we’ve been maintaining that just from a business operations and funding perspective,” Boyko said. “Definitely we will replace the director of nursing and we’ll just continue to monitor to see if there is a void without an assistant director of nursing and assistant business office manager.”

Adding to existing staffing issues, President Joe Biden has tied Medicaid funding to mandatory vaccinations for nursing home employees. The county home’s main source of revenue is reimbursement from Medicaid for patient care. Murphy said it is too soon to predict the impact of the new directive.

“The mandate was just reported yesterday and the actual regulation has not been issued,” Murphy said. “We will certainly continue to monitor the impact of the mandate and its implications on county operations at the Care Facility.”

Commissioner Don Dixon, who is in the elderly care field, said he personally thinks it’s a good idea but believes it could cause a “whole lot of problems.”

Commissioner T.C. Rogers said he is also concerned about the mandate’s impact on the Care Facility, especially with what is going on in the area where hospitals have already mandated vaccines for their employees.

“I’m also concerned about all of our hospitals which have made vaccinations mandatory for their medical staff and doctors have told me that they’re short-handed now,” Rogers said. “Yeah I’m concerned.”

The pandemic slammed businesses, including health care systems. On top of the stress of COVID-19, they also saw more cybersecurity attacks.

“Health care has always been a target, but it tremendously just blew up when the pandemic started,” said Angela Kobel, Chief Financial Officer of Lincoln Health in Hugo, Colorado.

She’s talking about cybersecurity. As the pandemic stressed health care systems, the industry also saw more attempted cyberattacks.

“A lot of our employees were working remotely as we closed the hospital down, which made us vulnerable,” Kobel said. “Everybody was so busy fighting COVID and trying to figure out what was happening with COVID that we didn't have the resources to put towards IT security.”

Hospitals are at a higher risk for attacks. Many of us have personal, private information shared with our doctors, often stored digitally. So for the past few years, Lincoln Health has used a third-party company to manage its IT system. That’s where Lance Goudzwaard with ReliableIT comes in.

“Health care organizations, they need to be very careful with that information. And I'll tell you the value of each of these records is very high. It's scary to think how much a hacker can sell one record for,” said Lance Goudzwaard, Virtual CIO at ReliableIT.

And hacking is getting easier.

“My 15-year-old daughter could go to the internet and download instructions on how to hack a lot of health care systems,” Goudzwaard said.

“It's incredibly easy to find and use hacking tools, and there are services you can outsource all of this too, if you want to,” cybersecurity expert Nathan Evans said.

It’s not just hospitals that are seeing these data breaches and ransomware attacks. Earlier this year, a cyberattack on the Colonial Pipeline caused a disruption in fuel transportation, leading to gas shortages in the southeastern U.S.

And JBA USA, a large meat supplier, recently announced it too was targeted by a cybersecurity attack. There are more that go unreported, as there aren’t regulations in place in most industries to report these incidents.

“The health care sector and financial sector have government requirements to report when they actually get breached,” said Nathan Evans, an assistant teaching professor at the University of Denver.

So what does all of this mean for your data, and your accounts? Evans said part of it is trust in the organization you give your information to.

“There's not really anything we can do on an individual basis to protect our medical information. There are HIPAA guidelines that require you to, if you're handling patient data, to encrypt it and make sure it's protected when it’s in transit or in storage,” Evans said.

Another safety net you can control is enabling two-factor authentication for your accounts.

“Two-factor authentication is combining something you know, which would be like a password, with something physical, so either your cell phone or a hardware key device,” he said. “The idea is that if an attacker gets just your password, they won't be able to log into your account because they won't have this second factor.”

It all boils down to education.

“The more we are aware of these common exploits, the better job we’re going to do at preventing them,” Goudzwaard said.

He said they are able to educate employees about common attacks and tools they can use to monitor themselves, especially with e-mails where many hackers can pose as co-workers, clients, or vendors.

“We’ve definitely become more aware,” Kobel said.