Do you know where your workplace’s automated external defibrillator is located? About half of all U.S. employees don’t, according to the results of an American Heart Association survey.

The survey also found that workers in the hospitality and service industry, which includes hotels and restaurants, were less likely to know the location of their workplace’s AED. About 66 percent of them didn’t know where it was. Workers in schools and other education facilities were the most likely to be able to find it: About 61 percent said they knew the AED’s location.

The low numbers surprised Dr. Michael Kurz, an associate professor of emergency medicine at the University of Alabama-Birmingham and an American Heart Association spokesperson.

“This is a relatively simple intervention, the provision of CPR training and providing an AED,” Kurz says. “A relatively simple intervention that has a rather significant return on investment, both in lives saved and, frankly, on the impact on your employees.”

“For every minute that you’re in cardiac arrest, you’re pulseless, your [chance of ] survival drops by 10 percent,” Kurz says.

An AED checks the heart’s rhythm and can send an electric shock to the heart to try to restore a normal rhythm.

More than 350,000 cardiac arrests take place in the U.S. in locations other than hospitals each year, according to the American Heart Association. In 2015, Kansas City, Kan., resident Nancy Holland became one of them.

She went into cardiac arrest in the restroom of a restaurant where she had been eating dinner with her husband. The restaurant’s manager performed CPR until paramedics arrived with an AED.

Holland says she’s lucky the restaurant’s manager knew CPR, because it kept her “salvageable” until the paramedics showed up. When he started working as a restaurant manager, she says, his mom had told him he owed it to the customers to learn CPR — just in case.

Now whenever she walks into a building, she scans the walls looking for an AED.

“I hope I never need it, but it’s always in the back of my mind,” Holland says.

She also gives talks about the importance of CPR and AED training, emphasizing that cardiac arrest can happen to anyone.

Holland was in her 40s and didn’t have any health problems when she went into cardiac arrest. She had been to her doctor for a checkup just three weeks earlier.

And she’s now a board member of her local chapter of the HeartSafe Foundation, which provides free training in hands-only CPR and works to improve public access to AEDs.

She also says businesses should take precautions before an emergency happens.

About 10,000 cardiac arrests happen in workplaces each year, the AHA says.

More than half of employees — about 55 percent — aren’t offered first aid or CPR/AED training through their employer, the American Heart Association survey found. And sometimes employees have access to only one form of training.

But most of the 2,000 employees surveyed say their employers should offer first aid and CPR/AED training. Ninety percent say they would participate in training if their employers provided them.

Cost and fear of liability are two reasons that businesses don’t install AEDs, Kurz says, but those are misperceptions.

A typical AED costs about $1,200 to $1,500, Kurz says, and prices have gone down over time as the technology becomes more widespread. Machines that once cost $3,000 now run under $1,000, according to the National Conference of State Legislatures, which tracks the passage of laws related to AEDs.

When it comes to legal liability if an AED is used improperly and someone is injured or killed, Kurz says in most states you’re protected by law.

In addition, AEDs have a built-in mechanism for analyzing heart rhythms and evaluating whether a shock is needed.

But AEDs do need to be maintained in order to be effective. Batteries should be replaced every two to five years, depending on the model. And the sticky pads that adhere to a cardiac arrest victim’s skin also come with expiration dates and need to be replaced about every two to three years.

The Occupational Safety and Health Administration doesn’t require workplaces to have AEDs, but it does encourage employers to have them on-site.

The American Heart Association launched a public awareness campaign this week to emphasize the value of CPR/AED training for employees, says Kurz.

“It’s unfortunate that 1 in 3 businesses thinks to put an AED in place only after an incident occurs,” he says. “We would like businesses to think proactively, like they do about their business, about their employees’ health.”

Let’s block ads! (Why?)

David Greene talks Thomas Binion of The Heritage Foundation, who offers the latest on the Senate health care debate. Democrats complain work on the bill is being done behind closed doors.

Let’s block ads! (Why?)

Let’s block ads! (Why?)

Steve Inskeep talks to Sen. Tim Kaine of Virginia and NPR’s Domenico Montanaro about Senate reactions to the baseball shooting, and reports about President Trump and the Russia investigation.

Let’s block ads! (Why?)

It’s morning meeting time at Our Place Day Services, a day center for adults with disabilities, housed in a small concrete and glass building on Lovers Lane in Slinger, Wis.

About 30 people are gathered here, around a long table, reciting the pledge of allegiance. One man paces alongside the table, another sits in a wheelchair a few feet away. There’s a woman holding a baby in her lap and a friendly dog — a goldendoodle — wandering around greeting people with a sniff and a lick.

A modest operation based north of Milwaukee, on Interstate 43, Our Place serves as a safe place for people with severe cognitive disabilities to spend their days and learn news skills while the family members who usually care for them are at work.

Clients at Our Place can participate in fun activities — do art or go bowling with staff from the center — and they also work on specific skills like money management or cooking. The center provides the sort of crucial support services that many people are concerned will no longer be offered if Republicans proceed with their planned cuts to Medicaid.

On this Monday morning the clients at Our Place are sharing their goals — big and small. One man wants to finish a mosaic he’s working on, while a woman down the table says she hopes to go to the movies with a friend someday.

Danielle Wirsbinski reads from a long list.

“To have a job, to do more volunteering, learn new skills, talk …. taking classes, go to school, to live on my own,” she says.

Another group member, Eric S. (who asked that we not use his last name because he’s not comfortable going public about his condition), describes the work he’s doing to be able to live on his own someday.

“Learning how to cook with Justine. Justine teaches me how to shop,” he says, referring to Justine Orr, a staffer who works with him at Our Place. “I learn how to clean with Justine and I did safety skills in the home.”

“We help men and women become the men and women they were meant to be,” says Donna Ellenbecker, director of Our Place.

But she’s worried about the Republican plan to overhaul Medicaid.

All but one of her 33 clients pay for their classes and care at Our Place with Medicaid dollars. Wisconsin’s Medicaid system includes a program called IRIS that grants people with disabilities a budget, based on their level of need, to use for services that help them live in the community.

The state’s approach is part of a national trend in recent decades to move people with severe developmental disabilities out of institutional settings by providing the support they and their families need to live more independently – either with their families, in community-based group homes or even on their own.

“Many of our people are interested in having their own apartment someday, and are living with their parents now,” Ellenbecker says. “They really need some help with the everyday skills of cooking and cleaning and doing the things that everyone else does to be able to live independently.”

President Trump and Republicans in Congress want to restructure the way Medicaid is funded. Instead of paying for all the medical care and services beneficiaries need, the health care bill Republicans passed through the House last month would grant each state a fixed sum per beneficiary based on what the state has spent in the past.

That per-capita allowance would increase over time, but at a slower rate than health care costs generally rise. So the Congressional Budget Office estimates that Medicaid funding under the plan would be 25 percent less in 10 years than it would be under current law.

“We’re no longer going to measure compassion by the number of programs or the number of people on those programs but by the number of people we got off those programs,” White House Budget Director Mick Mulvaneysaid last month. “We’re no longer going to measure compassion by the amount of money that we spend but by the number of people that we help.”

While Medicaid is best known as a health care program for poor people, more than 80 percent of its budget goes to care for the elderly, children and people with disabilities, according to the Kaiser Family Foundation. Only 15 percent goes to health care for able-bodied adults, the people that Mulvaney was likely referring to in his remarks.

The program has been growing in recent years and it now makes up almost 10 percent of federal spending. That’s why it’s the top target in President Trump’s proposed budget, and figures prominently in the House Republican proposal to replace the Affordable Care Act, also known as Obamacare. Some estimates suggest the program could be cut by more than a trillion dollars over 10 years.

But some Republicans in the Senate, who are now hammering out their own plan to replace Obamacare, are hesitant to make such big cuts to services for the poor, elderly people and those with disabilities.

The people who come to Our Place each day aren’t likely to be among those who can “get off” Medicaid. They’re likely to need care and support services for their entire lives.

Ellenbecker describes how her program helps people engage in the community.

“We actually have a class that’s a date,” she says. “You know, ‘how you go to the movies with a friend.’ “

That everyday joy has a number of steps — you have to figure out transportation, money, movie times and simply how to choose a seat in a theater.

To navigate all that, the woman who’d listed going to a movie as one of her goals “would need somebody to come with her to help her with all of those things,” Ellenbecker says, “because she doesn’t have the skills to be able to do it independently right now.”

Other group members benefit from a job coach who can help them learn how to find and do a job, or keep one. Others need help managing money, cleaning their homes or getting to work. And other clients have even more basic needs, such as personal care and help with eating.

Ellenbecker worries that if the current Republican plan is passed, or the kinds of budget cuts Trump is proposing go through, the money for those support services just won’t be there.

“It’s a 25 percent cut you know, and a 25 percent cut it is going to affect these programs,” she says. “There’s no way that a 25 percent cut can come out of any other program — except long-term care.”

That’s because many support services are considered optional under the law that governs Medicaid. So, if state lawmakers are forced to choose between say, job coaches, and traditional medical care, the job coaching is likely to lose out.

Let’s block ads! (Why?)

More than 190 Democrats in Congress are suing President Trump over foreign payments to his businesses. Also, a look at the future of the Republican health care plan, and white phosphorous use in Iraq.

Let’s block ads! (Why?)

We look at what the Senate is expected to do with the Republican health care plan passed by the House.

Let’s block ads! (Why?)

Steve Inskeep talks with Republican Rep. Rodney Davis, a member of the moderate Tuesday Group. He’s been a proponent of the Republican health care plan, and talks about what’s next for the bill.

Let’s block ads! (Why?)

Nevadans will find out this week whether their state will become the first in the country to allow anyone to buy into Medicaid, the government health care program for the poor and disabled.

Earlier this month, Nevada’s legislature, where Democrats hold the majority, passed a “Medicaid-for-all” bill, and it’s now on Republican Gov. Brian Sandoval‘s desk awaiting his signature or veto. If he does not act by Friday, it will automatically become law.

State lawmakers hope the proposal will give Nevadans a cheaper health insurance option as premiums for individual health insurance rise. The move comes as Republicans in the U.S. Congress are working to roll back the expansion of Medicaid that happened under President Barack Obama.

“With the uncertainty and mixed messages coming from our current federal administration in regard to health care and health care accessibility, there is an absolute need for states to become more reliant on providing insurance options to its citizens,” said Assemblyman Mike Sprinkle, who sponsored the bill.

Under the proposal, Medicaid coverage would be offered alongside commercial insurance on Nevada’s state-run health exchange starting in 2019. Sprinkle says he’s not sure what the coverage would cost. The state would conduct an analysis of the Medicaid program to determine the size of premiums.

They would likely be lower than traditional insurance premiums, because Medicaid reimburses doctors less than most insurance plans and also pays lower prices for prescription drugs.

“If the expansion goes away, I really think this is going to be a viable option for those who lose coverage,” Sprinkle says. He estimates about 300,000 Nevadans may enroll.

He says that if the Republican health care bill becomes law, people could use the tax credits in the bill to buy into Medicaid. And if it doesn’t, they could still use their tax credits and subsidies from the Affordable Care Act, or Obamacare, to buy in.

To be able to sell policies on the exchange, Nevada would have to get approval from the Centers for Medicare and Medicaid Services in the form of a waiver. Sprinkle says he has had discussions with CMS officials who were open to the idea.

CMS administrator Seema Verma has said she wants to allow states to experiment with their Medicaid programs and make it easier for them to get waivers.

Let’s block ads! (Why?)

By the time Stephenie Hashmi was in her mid-20s, she had achieved a lifelong dream — she was the charge nurse of one of Kansas City’s largest intensive care units. But even as she cared for patients, she realized that something was off with her own health.

“I remember just feeling tired and feeling sick and hurting, and not knowing why my joints and body was hurting,” she says.

Hashmi was diagnosed with systemic lupus, a medical condition in which the body’s immune system attacks its own tissues and organs. She’s had surgery and other treatments, but now, at age 41, Hashmi is often bedridden. She finally had to leave her job about six years ago, but when she applied to the Social Security Administration for disability benefits, she was denied.

“I just started bawling,” she recalls. “I felt like, if they looked at my records or read these notes, surely they would understand my situation.”

In the U.S., less than half of all peoplewho apply for disability benefits — about 45 percent — are ultimately accepted, says Lisa Ekman with the National Organization of Social Security Claimants’ Representatives. Getting a hearing takes an average of nearly 600 days.

“It is not easy to get disability benefits, and it’s a very complicated and difficult process,” she says.

It may become even harder for people like Hashmi, whose disability is difficult to actually see or measure. This spring, the Social Security Administration introduced changes to fight fraud and streamline the application process, including a new rule that removes special consideration given to a person’s longtime doctor. Ekman says this is a mistake.

“Those changes would now put the evidence from a treating physician on the same weight as evidence from a medical consultant employed to do a one-time brief examination, or a medical consultant they had do a review of the paper file — [who] may have never examined the individual,” Eckman says.

She says relying on these examiners who don’t know the patient could lead to more denials for disabled people with complex conditions like lupus, multiple sclerosis or schizophrenia. These illnesses can affect patients in very different ways and may be hard for an unfamiliar doctor or nurse to evaluate. Eckman says more denials will lead to more appeals, which will increase the backlog.

That backlog started snowballing about 10 years ago, says Jason Fichtner; he’s now a senior research fellow in public policy at George Mason University’s Mercatus Center, but was acting deputy commissioner of the Social Security Administration back then. During the recession, he says, a lot of people who applied for benefits were disabled, but not necessarily unable to work.

“They can work, but when the recession happens, those are the first people who tend to lose their jobs and then they apply for disability insurance,” Fichtner says.

There are now more than a million people across the country waiting for hearings, and, adding to the strain, the administration’s core operating budget has shrunk by 10 percent since 2010.

Fichtner says the agency is obligated to weed out any and all fraud that it can — including the rare cases in which a patient’s personal physician might be trying to tip the scale to get a patient benefits. Fichtner says the administration can still legitimately prioritize applicants, if its investigation shows that the patient’s disability, although not obvious, merits it.

“For patients that are really in a dire condition and really have major disabilities, I don’t think they have to worry about these rule changes,” he says.

Fichtner acknowledges that the backlog needs attention, and says the agency has safeguards to monitor whether the rule is working as it should.

But in Kansas City, Stephenie Hashmi is still struggling with lupus, and still struggling to get disability benefits. She’s increasingly pessimistic. After several rejections from the Social Security Administration, Hashmi’s now appealing again. Her hearing is scheduled for November — of 2018.

This story is part of NPR’s reporting partnership with KCUR and Kaiser Health News.

Let’s block ads! (Why?)