Category: Health

This fall, unlike the one before it, and the one before that, America looks almost like its old self. Schools and universities are in session; malls, airports, and gyms are bustling with the pre-holiday rush; handwashing is passé, handshakes are back, and strangers are packed together on public transport, nary a mask to be seen. On its surface, the country seems ready to enjoy what some might say is our first post-pandemic winter.

Americans are certainly acting as if the crisis has abated, and so in that way, at least, you could argue that it has. “If you notice, no one’s wearing masks,” President Joe Biden told 60 Minutes in September, after proclaiming the pandemic “over.” Almost no emergency protections against the virus are left standing; we’re dismantling the few that are. At the same time, COVID is undeniably, as Biden says, “a problem.” Each passing day still brings hundreds of deaths and thousands of hospitalizations; untold numbers of people continue to deal with long COVID, as more join them. In several parts of the country, health-care systems are struggling to stay afloat. Local public-health departments, underfunded and understaffed, are hanging by a thread. And a double surge of COVID and flu may finally be brewing.

So we can call this winter “post-pandemic” if we want. But given the policy failures and institutional dysfunctions that have accumulated over the past three years, it won’t be anything like a pre-pandemic winter, either. The more we resist that reality, the worse it will become. If we treat this winter as normal, it will be anything but.

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By now, we’ve grown acquainted with the variables that dictate how a season with SARS-CoV-2 will go. In our first COVID winter, the vaccines had only just begun their trickle out into the public, while most Americans hadn’t yet been infected by the virus. In our second COVID winter, the country’s collective immunity was higher, but Omicron sneaked past some of those defenses. On the cusp of our third COVID winter, it may seem that SARS-CoV-2 has few plot twists left to toss us.

But the way in which we respond to COVID could still sprinkle in some chaos. During those first two winters, at least a few virus-mitigating policies and precautions remained in place—nearly all of which have since come down, lowering the hurdles the virus must clear, at a time when America’s health infrastructure is facing new and serious threats.

The nation is still fighting to contain a months-long monkeypox outbreak; polio continues to plague unvaccinated sectors of New York. A riot of respiratory viruses, too, may spread as temperatures cool and people flock indoors. Rates of RSV are rising; flu returned early in the season from a nearly three-year sabbatical to clobber Australia, boding poorly for us in the north. Should flu show up here ahead of schedule, Americans, too, could be pummeled as we were around the start of 2018, “one of the worst seasons in the recent past,” says Srinivasan Venkatramanan, an infectious-disease modeler at the University of Virginia and a member of the COVID-19 Scenario Modeling Hub.

Read: Fauci addresses ‘The pandemic is over’

The consequences of this infectious churn are already starting to play out. In Jackson, Mississippi, health workers are watching SARS-CoV-2 and other respiratory viruses tear through children “like nothing we’ve ever seen before,” says Charlotte Hobbs, a pediatric-infectious-disease specialist at the University of Mississippi Medical Center. Flu season has yet to go into full swing, and Hobbs is already experiencing one of the roughest stretches she’s had in her nearly two decades of practicing. Some kids are being slammed with one virus after the other, their sicknesses separated by just a couple of weeks—an especially dangerous prospect for the very youngest among them, few of whom have received COVID shots.

The toll of doctor visits missed during the pandemic has ballooned as well. Left untreated, many people’s chronic conditions have worsened, and some specialists’ schedules remain booked out for months. Add to this the cases of long COVID that pile on with each passing surge of infections, and there are “more sick people than there used to be, period,” says Emily Landon, an infectious-disease physician at the University of Chicago. That’s with COVID case counts at a relative low, amid a massive undercount. Even if a new, antibody-dodging variant doesn’t come banging on the nation’s door, “the models predict an increase in infections,” Venkatramanan told me. (In parts of Europe, hospitalizations are already making a foreboding climb.)

And where the demand for care increases, supply does not always follow suit. Health workers continue to evacuate their posts. Some have taken early retirement, worried that COVID could exacerbate their chronic conditions, or vice versa; others have sought employment with better hours and pay, or left the profession entirely to salvage their mental health. A wave of illness this winter will pare down forces further, especially as the CDC backs off its recommendations for health-care workers to mask. At UAB Hospital, in Birmingham, Alabama, “we’ve struggled to have enough people to work,” says Sarah Nafziger, an emergency physician and the medical director for employee health. “And once we get them here, we have a hard time getting them to stay.”

Read: The strongest sign that Americans should worry about flu this winter

Clinical-laboratory staff at Deaconess Hospital, in Indiana, who are responsible for testing patient samples, are feeling similar strain, says April Abbott, the institution’s microbiology director. Abbott’s team has spent most of the past month below usual minimum-staffing levels, and has had to cut some duties and services to compensate, even after calling in reinforcements from other, already shorthanded parts of the lab. “We’re already at this threshold of barely making it,” Abbott told me. Symptoms of burnout have surged as well, while health workers continue to clock long hours, sometimes amid verbal abuse, physical attacks, and death threats. Infrastructure is especially fragile in America’s rural regions, which have suffered hospital closures and an especially large exodus of health workers. In Madison County, Montana, where real-estate values have risen, “the average nurse cannot afford a house,” says Margaret Bortko, a nurse practitioner and the region’s health officer and medical director. When help and facilities aren’t available, the outcome is straightforward, says Janice Probst, a rural-health researcher at the University of South Carolina: “You will have more deaths.”

In health departments, too, the workforce is threadbare. As local leaders tackle multiple infectious diseases at once, “it’s becoming a zero-sum game,” says Maria Sundaram, an epidemiologist at the Marshfield Clinic Research Institute. “With limited resources, do they go to monkeypox? To polio? To COVID-19? To influenza? We have to choose.” Mati Hlatshwayo Davis, the director of health in St. Louis, told me that her department has shrunk to a quarter of the size it was five years ago. “I have staff doing the jobs of three to five people,” she said. “We are in absolute crisis.” Staff have left to take positions as Amazon drivers, who “make so much more per hour.” Looking across her state, Hlatshwayo Davis keeps watching health directors “resign, resign, resign.” Despite all that she has poured into her job, or perhaps because of it, “I can’t guarantee I won’t be one of those losses too.”

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This winter is unlikely to be an encore of the pandemic’s worst days. Thanks to the growing roster of tools we now have to combat the coronavirus—among them, effective vaccines and antivirals—infected people are less often getting seriously sick; even long COVID seems to be at least a bit scarcer among people who are up-to-date on their shots. But considering how well our shots and treatments work, the plateau of suffering at which we’ve arrived is bizarrely, unacceptably high. More than a year has passed since the daily COVID death toll was around 200; nearly twice that number—roughly three times the daily toll during a moderate flu season—now seems to be a norm.

Part of the problem remains the nation’s failed approach to vaccines, says Avnika Amin, a vaccine epidemiologist at Emory University: The government has repeatedly championed shots as a “be-all and end-all” strategy, while failing to rally sufficient uptake. Boosting is one of the few anti-COVID measures still promoted, yet the U.S. remains among the least-vaccinated high-income countries; interest in every dose that’s followed the primary series has been paltry at best. Even with the allure of the newly reformulated COVID shot, “I’m not really getting a good sense that people are busting down the doors,” says Michael Dulitz, a health worker in Grand Forks, North Dakota. Nor can vaccines hold the line against the virus alone. Even if everyone got every shot they were eligible for, Amin told me, “it wouldn’t make COVID go away.”

Read: America created its own booster problems

The ongoing dry-up of emergency funds has also made the many tools of disease prevention and monitoring more difficult to access. Free at-home tests are no longer being shipped out en masse; asymptomatic testing is becoming less available; and vaccines and treatments are shifting to the private sector, putting them out of reach for many who live in poor regions or who are uninsured and can least afford to fall ill.

It doesn’t help, either, that the country’s level of preparedness lays out as a patchwork. People who vaccinate and mask tend to cluster, Amin told me, which means that not all American experiences of winter will be the same. Less prominent, less privileged parts of the country will quietly bear the brunt of outbreaks. “The biggest worry is the burden becoming unnoticed,” Venkatramanan told me. Without data, policies can’t change; the nation can’t react. “It’s like flying without altitude or speed sensors. You’re looking out the window and trying to guess.”

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There’s an alternative winter the country might envision—one unencumbered by the policy backslides the U.S. has made in recent months, and one in which Americans acknowledge that COVID remains not just “a problem” but a crisis worth responding to.

In that version of reality, far more people would be up-to-date on their vaccines. The most vulnerable in society would be the most protected. Ventilation systems would hum in buildings across the country. Workers would have access to ample sick leave. Health-care systems would have excesses of protective gear, and local health departments wouldn’t want for funds. Masks would come out in times of high transmission, especially in schools, pharmacies, government buildings, and essential businesses; free tests, boosters, and treatments would be available to all. No one would be asked to return to work while sick—not just with COVID but with any transmissible disease. SARS-CoV-2 infections would not disappear, but they would remain at more manageable levels; cases of flu and other cold-weather sicknesses that travel through the air would follow suit. Surveillance systems would whir in every state and territory, ready to detect the next threat. Leaders might even set policies that choreograph, rather than simply capitulate to, how Americans behave.

We won’t be getting that winter this year, or likely any year soon. Many policies have already reverted to their 2019 status quo; by other metrics, the nation’s well-being even seems to have regressed. Life expectancy in the U.S. has fallen, especially among Native Americans and Alaskan Natives. Institutions of health are beleaguered; community-outreach efforts have been pruned.

The pandemic has also prompted a deterioration of trust in several mainstays of public health. In many parts of the country, there’s worry that the vaccine hesitancy around COVID has “spread its tentacles into other diseases,” Hobbs told me, keeping parents from bringing their kids in for flu shots and other routine vaccines. Mississippi, once known for its stellar rate of immunizing children, now consistently ranks among those with the fewest young people vaccinated against COVID. “The one thing we do well is vaccinate children,” Hobbs said. That the coronavirus has reversed the trend “has astounded me.” In Montana, sweeping political changes, including legislation that bans employers from requiring vaccines of any kind, have made health-care settings less safe. Fewer than half of Madison County’s residents have received even their primary series of COVID shots, and “now a nurse can turn down the Hepatitis B series,” Bortko told me. Health workers, too, feel more imperiled than before. Since the start of the pandemic, Bortko’s own patients of 30 years, “who trusted me with their lives,” have pivoted to “yelling at us about vaccination concerns and mask mandates and quarantining and their freedoms,” she told me. “We have become public enemy No. 1.”

Read: The pandemic’s soft closing

At the same time, many people with chronic and debilitating conditions are more vulnerable than they were before the pandemic began. The policies that protected them during the pandemic’s height are gone—and yet SARS-CoV-2 is still here, adding to the dangers they face. The losses have been written off, Bortko told me: Cases of long COVID in Madison County have been dismissed as products of “risk factors” that don’t apply to others; deaths, too, have been met with a shrug of “Oh, they were old; they were unhealthy.” If, this winter, COVID sickens or kills more people who are older, more people who are immunocompromised, more people of color, more essential and low-income workers, more people in rural communities, “there will be no press coverage,” Hlatshwayo Davis said. Americans already expect that members of these groups will die.

It’s not too late to change course. The winter’s path has not been set: Many Americans are still signing up for fall flu and COVID shots; we may luck out on the viral evolution front, too, and still be dealing largely with members of the Omicron clan for the next few months. But neither immunity nor a slowdown in variant emergence is a guarantee. What we can count on is the malleability of human behavior—what will help set the trajectory of this winter, and others to come. The U.S. botched the pandemic’s beginning, and its middle. That doesn’t mean we have to bungle its end, whenever that truly, finally arrives.

When Sara Laub’s period was late, the New York City resident shrugged it off. She’d used an intrauterine device, or IUD, for three years and knew her odds of getting pregnant were extremely slim. But after 10 days had passed, Laub, 28, took a home test in early July and got unwelcome news: She was pregnant.

Laub went to a Planned Parenthood clinic because she knew someone could see her immediately there. An ultrasound found no sign of a developing embryo in her uterus. That pointed to the possibility that Laub might have an ectopic pregnancy, in which a fertilized egg implants somewhere outside the uterus, usually in a fallopian tube.

Such pregnancies are rare, occurring roughly 2% of the time, but they are extremely dangerous because a growing embryo might rupture the tiny tube, causing massive and potentially life-threatening internal bleeding. Laub was experiencing no pain, bleeding, or other obvious symptoms of trouble. Still, a Planned Parenthood staffer recommended that she go to a hospital emergency department right away.

Laub didn’t realize it, but she was embarking on a lengthy — and very expensive — treatment to end the pregnancy. Even in a state that strongly supports a person’s right to make her own choices regarding pregnancy — New York legalized abortion in 1970, three years before Roe v. Wade made it legal nationwide — Laub’s experience shows the process can be arduous.

An ectopic pregnancy in the fallopian tube is never viable. But following the June reversal of Roe by the Supreme Court, reproductive health experts say treatment may be dangerously delayed as some states move to limit abortion services.

Some of those consequences are already being noted in Texas, where strict abortion limits were instituted last fall before the Supreme Court’s decision. Since abortion is now allowed in Texas only in medical emergencies, doctors might wait to perform abortions until pregnant patients are facing life-threatening complications in order to comply with the law.

“In Texas, we saw people not treating ectopic pregnancies until they ruptured,” said Dr. Kristyn Brandi, an obstetrician-gynecologist in Montclair, New Jersey, who is board chair of Physicians for Reproductive Health, which supports abortion rights.

The 2021 Texas law banned most abortions at about six weeks of pregnancy. University of Texas-Austin researchers interviewed doctors about the impact of the law on maternal and fetal care. A specialist at one unnamed hospital said the facility no longer offers treatment for certain ectopic pregnancies.

About half of states have enacted restrictions on abortion or are trying to do so.

Laub, who is being identified by her middle and last name because of her concerns about privacy, said she couldn’t help thinking about the recent Supreme Court decision as she went through diagnosis and treatment.

“As scary as my ordeal felt at the time, I was acutely aware that I was fortunate to have easy access to treatment, and elsewhere women with my condition face much worse experiences,” Laub said.

At Lenox Hill Hospital’s emergency department on New York’s Upper East Side, doctors ran more tests and gave Laub two options: an injection of methotrexate, a cancer drug that destroys rapidly dividing cells and is often used to end an ectopic pregnancy, or surgery to remove her fallopian tube, where the fertilized egg was lodged.

Laub opted for the injection. After getting the shot, patients need follow-up hormone blood tests to confirm that the pregnancy is ending. Laub returned to the emergency department for bloodwork and an ultrasound three days after the shot. She returned again three days later and was given a second shot of methotrexate since the pregnancy hadn’t terminated. The following week, she repeated the treatment in two follow-up visits. On July 20, after 12 days and five emergency department visits, Laub was scheduled for laparoscopic surgery to remove her fallopian tube.

The total charges to date for the medical treatment: an eye-popping $80,000. Because her health plan had negotiated discounted rates with the hospital and the other providers, all of whom were in her provider network, Laub’s out-of-pocket cost will be only a fraction of that total. It now appears Laub will owe a little more than $4,000.

That still seems like a lot, she said.

“On the one hand, I feel grateful that I was able to get treated when I was not in an acute state,” Laub said. “But it’s an awful feeling to know that the decision I made as to the best path forward for care comes at such a high cost.”

The hospital pointed out, however, that its charges were reduced by Laub’s insurer discount. “Charges are based on the specific services provided in the treatment of the patient,” said Barbara Osborn, vice president of public relations at Northwell Health, a system that includes Lenox Hill Hospital. “Any amount due from the patient is based upon the benefit design and cost sharing provisions of the patient’s insurance plan.” 

Understanding hospital charges can be a head-scratcher since they often don’t appear to align with the actual cost of providing care. That’s true in this case. According to a breakdown by WellRithms, a company that analyzes medical bills for self-funded companies and others, on average Lenox Hill Hospital charges $12,541 for the surgery that Laub underwent, based on publicly available data that hospitals submit to the federal Centers for Medicare & Medicaid Services. But the hospital charged Laub’s health plan $45,020.

“Hospitals will charge whatever they can,” said Jordan Weintraub, vice president of claims at the Portland, Oregon, company. “They put it on the payer to deny items rather than billing appropriately.”

Even more revealing is how much it actually costs the hospital to perform the surgery. According to WellRithms’ analysis of the federal data, Lenox Hill’s cost to perform the laparoscopic procedure is $3,750. The average cost statewide is $2,747.

Nationally, the average outpatient charge for the surgical procedure Laub received is $13,670, according to data from Fair Health, a nonprofit that manages a large database of health insurance claims. The average total amount paid by the health plan and patient is $6,541.

Surgical charges for managing an ectopic pregnancy vary widely depending on location. But the charges don’t necessarily correlate with the ease of access to medical care to end a pregnancy. In the New York City metropolitan area, the average charge is $9,587, for example, while in San Francisco, the average charge is $20,963, according to Fair Health. Both New York and California have generous abortion access laws. Meanwhile, locations with more restrictive abortion standards don’t necessarily charge more for ectopic pregnancy surgery. For example, in the Dallas area, the average charge is $14,223, while in Kansas City, Missouri, it’s $16,320, both lower than the average charges in Chicago ($18,989) or Philadelphia ($17,407).

Many women opt for methotrexate over surgery to treat ectopic pregnancy. The drug is successful between 70% and 95% of the time without requiring surgery.

The drug is often administered at a hospital because OB-GYNs are unlikely to keep the cancer drug in their offices, experts say. After the injection, patients must be followed closely until the pregnancy ends, because the risk of a life-threatening rupture remains. In addition, patients must get bloodwork at intervals after an injection to confirm that their pregnancy hormone levels are falling.

After receiving her first injection at the emergency department, Laub was told she needed to return for follow-up bloodwork after each injection. Charges for those emergency department visits were likely significantly higher than the charges would have been had Laub received follow-up care from an OB-GYN in an outpatient setting. The hospital charged between $4,700 and $5,400 for each of those follow-up visits. Laub’s share of the cost was about $500 each time.

“She had a long course of treatment, and if it was all done through the emergency room that would be unfortunate,” said Dr. Deborah Bartz, an OB-GYN at Brigham and Women’s Hospital in Boston. “It would be really nice if instead she could have been worked into the outpatient setting with a protocol for managing surveillance.”

In a statement, Osborn defended the hospital’s approach.

“Ectopic pregnancies, which can be life-threatening conditions, require close surveillance and management to ensure a successful resolution,” Osborn said. “The emergency setting allows for immediate availability of critical surgical services, as was ultimately necessary in this patient’s case.”

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Drugs like magic mushrooms and LSD can act as powerful and long-lasting antidepressants. But they also tend to produce mind-bending side-effects that limit their use.

Now, scientists report in the journal Nature that they have created drugs based on LSD that seem to relieve anxiety and depression – in mice – without inducing the usual hallucinations.

“We found our compounds had essentially the same antidepressant activity as psychedelic drugs,” says Dr. Bryan Roth, an author of the study and a professor of pharmacology at UNC Chapel Hill School of Medicine. But, he says, “they had no psychedelic drug-like actions at all.”

The discovery could eventually lead to medications for depression and anxiety that work better, work faster, have fewer side effects, and last longer.

The success is just the latest involving tripless versions of psychedelic drugs. One previous effort created a hallucination-free variant of ibogaine, which is made from the root bark of a shrubby plant native to Central Africa known as the iboga tree.

“It’s very encouraging to see multiple groups approach this problem in different ways and come up with very similar solutions,” says David E. Olson, a chemical neuroscientist at the University of California, Davis, who led the ibogaine project.

An unexpected find

The new drug comes from a large team of scientists who did not start out looking for an antidepressant.

They had been building a virtual library of 75 million molecules that include an unusual structure found in a number of drugs, including the psychedelics psilocybin and LSD, a migraine drug (ergotamine), and cancer drugs including vincristine.

The team decided to focus on molecules that affect the brain’s serotonin system, which is involved in regulating a person’s mood. But they still weren’t looking for an antidepressant.

Roth recalls that during one meeting, someone asked, “What are we looking for here anyway? And I said, well, if nothing else, we’ll have the world’s greatest psychedelic drugs.”

As their work progressed, though, the team realized that other researchers were showing that the psychedelic drug psilocybin could relieve depression in people. And the effects could last a year or more, perhaps because the drug was helping the brain rewire in a way that was less prone to depression.

“There [were] really interesting reports about people getting great results out of this after just a few doses,” says Brian Shoichet, an author of the study and a professor in the pharmaceutical chemistry department at the University of California, San Francisco.

So the team began refining their search to find molecules in their library that might act the same way.

Ultimately, they selected two.

“They had the best properties,” Shoichet says. “They were the most potent, and when you gave them to a mouse, they got into the brain at the highest concentrations.”

The two molecules were also “extremely effective” at relieving symptoms of depression in mice, Roth says.

How to tell when a mouse is tripping

Scientists have shown that a depressed mouse tends to give up quickly when placed in an uncomfortable situation, like being dangled from its tail. But the same mouse will keep struggling if it gets an antidepressant drug like Prozac, ketamine, or psilocybin.

Mice also kept struggling when they got the experimental molecules.

But they didn’t exhibit any signs of a psychedelic experience, which typically causes a mouse to twitch its nose in a distinctive way. “We were surprised to see that,” Roth says.

The team says it needs to refine these new molecules before they can be tried in people. One reason is that they appear to mimic LSD’s ability to increase heart rate and raise blood pressure.

But if the approach works, it could overcome a major obstacle to using psychedelic drugs to treat depression.

Currently, treatment with a psychedelic requires medical supervision and a therapist to guide a patient through their hallucinatory experience.

That’s an impractical way to treat millions of people with depression, Shoichet says.

“Society would like a molecule that you can get prescribed and just take and you don’t need a guided tour for your trip,” he says.

Another advantage of the new approach is that the antidepressant effects would occur within hours of taking the drug, and might last a year or more. Drugs like Prozac and Zoloft often take weeks to work, and must be taken every day.

Drugs based on psychedelics “take us a step closer to a cure, rather than simply treating disease symptoms,” Olsen says.

Since the U.S. Supreme Court ruled in 2018 that states could legalize betting on sports, California — with 40 million people and numerous professional teams — has been the great white whale, eluding gambling companies and casino-hosting tribal communities. At stake is $3.1 billion in annual revenue, according to one industry consulting firm.

It’s little surprise, then, that voters will face not one but two ballot propositions this fall aimed at capturing California’s sports betting market. Although neither appears to have strong public support, gambling addiction experts are worried about one far more than the other.

Proposition 26, supported by some of the state’s largest tribal casino owners, would permit sports betting, but only within existing brick-and-mortar establishments that already offer gambling and at horse-racing venues. By contrast, Proposition 27, designed and funded by such national corporate gambling sites as DraftKings, FanDuel, and BetMGM, would legalize online sports betting, essentially opening the door for people to bet on games — and the athletes and plays within them — whether they’re sitting in the bleachers or on a couch.

Each measure would likely increase instances of problem gambling and gambling addiction, but mental health experts say the sheer ease of online betting — on scores, player point totals, the number of penalties in a game, and almost everything else connected to a sporting event — increases the chance for trouble.

“You don’t get addicted to full-season fantasy football; you get addicted to in-game betting,” said Dr. Timothy Fong, a psychiatrist and co-director of the UCLA Gambling Studies Program. “Instead of one bet on the Rams-Chargers game, I now can make an infinite amount right from my phone.”

Sports betting is already legal in some form in 36 states and Washington, D.C., and calls to gambling hotlines spiked in Michigan, Connecticut, New York, and other states after they allowed that form of gambling. The National Problem Gambling Helpline Network reported a 45% increase in year-over-year inquiries in 2021, when 11 states went live with some new form of sports betting.

Although gambling addiction doesn’t involve the ingestion of drugs or chemicals, it does involve the stimulation of regions of the brain the same way that other addictive disorders do. The American Psychiatric Association classifies gambling as such, placing it in the same category as tobacco, alcohol, cocaine, cannabis, and opioids. Research shows that mesolimbic dopamine, which provides the brain feelings of reward and pleasure, is released in larger quantities in pathological gamblers than in people in control groups. Gamblers get hooked on that reward.

For many states, the lure is obvious: tax revenue. In 2020, Pennsylvania collected $38.7 million from gambling — three-quarters of it generated by mobile sports betting. California’s nonpartisan Legislative Analyst’s Office estimates the state will collect hundreds of millions in tax dollars each year, but likely not more than $500 million annually, if Proposition 27 passes. The office pegged state revenue from Proposition 26 at tens of millions of dollars a year. Some of that money would come from taxing 10% of sports bets at racetracks, and some could come from tribal casinos, which would need to renegotiate compacts with the state.

For weeks, Californians have been bombarded by competing ads in what’s become the nation’s most expensive ballot-initiative fight, at $400 million and counting. The fight may have turned voters off. A recent poll by the UC-Berkeley Institute of Governmental Studies found 42% of likely voters opposed to Proposition 26, compared with 31% in support. Support for Proposition 27 was even smaller, with 53% of likely voters opposed and only 27% in favor.

Both ballot measures offer limited new resources to help people with gambling problems or addictions, and neither requires the state to improve tracking or treatment.

The authors of Proposition 26 included a provision to direct 10% of the sports betting revenue from horse-racing tracks to the state Department of Public Health, with some of that money set aside “to prevent and treat problem gambling,” according to material furnished to KHN by supporters of the initiative. But racetracks have been in decline for decades, and their share of sports betting would be the smallest slice of the pie. Additionally, the amount that could be generated from tribal casinos is uncertain because it would depend on whether new compacts require additional payments and direct money to treatment programs.

Kathy Fairbanks, a spokesperson for the Vote Yes on Proposition 26 campaign, noted that tribes already contribute roughly $65 million a year to the state Gambling Control Commission, which funds the Office of Problem Gambling. “Prior to tribes getting casino gambling in California 20-plus years ago, there was no dedicated funding for problem gambling,” Fairbanks said. California has had racetrack wagering since the 1930s, and the lottery started in 1985.

Proposition 27 would require participating companies to pay 10% of gross gambling revenues to the state. Of that, 85% would be designated for homeless and mental health programs, including those for problem gambling.

Nathan Click, a spokesperson for the Yes on 27 campaign, said the initiative would enact “the strongest problem gaming safeguards for online sports betting in the country” and would require each authorized gambling platform’s employees to be trained on how to spot problem gambling.

But psychologists say that online betting is immediate, accessible, and nearly effortless. Anyone with a phone, tablet, or computer can get started with a credit card. And there’s virtually no limit on the bets that can be placed on a single game, even while the game is being played.

“People don’t become addicted to Mega Millions,” Fong said. “They become addicted to scratchers, with more bets per minute.”

One way the gambling industry entices people to keep playing is through promotional credits that essentially allow them to begin betting without spending their own money. Rick Benson, founder of Algamus Gambling Treatment Services, said “free play” offers are not just common in casinos but are also heavily marketed by websites and on social media, potentially luring new gamblers into thinking they have nothing to lose.

That makes Proposition 27 a bigger concern. Researchers at McGill University and the Oregon Research Institute found that online gaming is a gateway to behavioral disorders, including problem gambling, marked by continued gambling despite negative consequences in a person’s life, or full addiction, which is uncontrollable. Gambling can lead to ruinous results, such as bankruptcy, mental health and family issues, and substance use.

Because Proposition 26 restricts betting to casinos and racetracks, it could moderate the activity. “Studies have shown that gambling participation is in some ways tied to access,” said Robert Jacobson, executive director of the California Council on Problem Gambling. “The rates of participation go up once people are within 50 to 60 miles of a casino.”

Still, how Proposition 26 would affect gambling prevalence isn’t clear because the provision also clears the way for tribal casinos to add Las Vegas-style games, such as roulette and craps.

It’s also not understood how big of a problem gambling addiction is in California, mostly because the state’s Office of Problem Gambling has not updated its data since 2006. In August, a state audit declared that the office, which has an annual budget of roughly $8.5 million, “has not effectively evaluated its programs.” The office doesn’t know how many California residents are experiencing or have recently experienced gambling-related issues.

Addiction researchers, however, believe the problem has remained consistent, with about 4% of residents experiencing either problem gambling or gambling addiction. That equates to about 1.6 million Californians who may have a gambling issue, although the number could be much higher because fewer than 1 in 10 people with gambling disorders seek treatment.

The two initiatives would amend the constitution so the legislature could create new sports betting laws. State agencies would then have to come up with regulations for implementing sports betting, which, the experts say, could be gamed by gambling interests.

“The votes,” Jacobson said, “are only the front end of the activity.”

This story was produced by KHN, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

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The global coronavirus pandemic disrupted almost everything about our lives, from how we work and go to school, to how we socialize (Zoom happy hours, anyone?!), and ultimately strained trust in many of the overarching systems we depend on, from health care to government.

New research suggests it may have changed Americans’ personalities, too, and not for the better.

Typically, major personality traits remain fairly stable throughout life, with most change happening in young adulthood or when stressful personal life events occur. It’s rare to see population-wide personality shifts, even after stressful events, but in a new study in the journal PLOS One, psychologists found just that in the wake of the pandemic.

The researchers had previously found a small, counterintuitive change in personality early in the pandemic: They found a decrease in neuroticism, the personality trait associated with stress and negative emotions. In the current study, they were curious if they would find different personality changes in the second and third year of the pandemic.

“And we did. There was a completely different pattern of change,” says study author Angelina Sutin, an assistant professor of behavioral sciences and social medicine at the Florida State University College of Medicine.

In the later period of the pandemic, the researchers noted significant declines in the traits that help us navigate social situations, trust others, think creatively, and act responsibly. These changes were especially pronounced among young adults.

Sutin hypothesizes that personality traits may have changed as public sentiment about the pandemic shifted. “The first year [of the pandemic] there was this real coming together,” Sutin says. “But in the second year, with all of that support falling away and then the open hostility and social upheaval around restrictions … all the collective good will that we had, we lost, and that might have been very significant for personality.”

Maturity interrupted?

To measure the changes, Sutin and her team analyzed surveys from three time periods: once pre-pandemic, before March 2020, once in the early lockdown period in 2020, and once either in 2021 or 2022. All the responses came from the longitudinal Understanding America Study, organized by University of Southern California.

The surveys gathered results from a widely-accepted model for studying personality, the Big Five Inventory, that measures five different dimensions of personality: neuroticism (stress), extroversion (connecting with others), openness (creative thinking), agreeableness (being trusting), and conscientiousness (being organized, disciplined and responsible).

While these traits don’t typically change radically throughout a lifetime, there’s a general trend for young people to see a decrease in neuroticism as they mature, and an increase in agreeableness and conscientiousness. Sutin calls this trajectory “development towards maturity.” But the study findings suggest a reversal of that pattern for younger adults as the pandemic dragged on.

Between the first stages of pandemic lockdown in 2020 to the second and third years of the pandemic in 2021 and 2022, the researchers found that extroversion, openness, agreeableness and conscientiousness all declined across the population, but especially for younger adults, who also showed an increase in neuroticism.

Joshua Jackson, an associate professor of psychology at Washington University in St. Louis, who studies the factors responsible for personality change and was not involved in this study, says that finding was significant.

“Younger individuals have less resources, they’re less established in their social context, in their jobs and friends,” he says. “So any sort of disruption, they’re the ones that are going to have this fewer number of resources to ride out the storm.”

Sutin notes that even in more normal times, young adults are more likely to see change in their personality. But in the pandemic, “all the normal things that younger adults are supposed to do were disrupted: school, socializing, work.” Although older adults were at greater risk from the virus, their lives were “in a much more stable place in general,” Sutin says.

These particular personality changes in young people have the potential for negative long-term impacts, too, says Jackson. “[Agreeableness and conscientiousness] are characteristics that are associated with success in the workforce, and in relationships,” he says.

The study authors concur, writing that high conscientiousness is associated with higher educational achievement and income and lower risk of chronic diseases. Neuroticism is linked with risky health behaviors and poor mental health.

Long-term personality change or ‘short-term shock’

The personality changes documented were not huge, but they were equal to the typical amount of personality change normally found in a decade of life, and they were seen across race and education level.

Jackson says the fact that the findings were seen across the population point to just how unprecedented the pandemic has been.

“The general rule is that life events don’t have widespread impact on personality,” he says. For that reason, Jackson hopes further study will determine whether the personality changes this study found will sustain over a lifetime or be more of a “short-term shock.”

It’s worth noting that the changes are relatively modest in scope, says Brent Roberts, a professor of psychology at the University of Illinois Urbana-Champaign who studies continuity and change in personality across adulthood, and was also not involved in the study.

With a personality shift across population in these areas, “there’s going to be a slight elevation of some of the negative outcomes … predominantly related to mental health and health,” Roberts says.

And though the findings are significant at a population level, they’re probably not reason for any individual alarm. So before you go blaming your bad mood on the pandemic, remember that personalities are typically resilient long-term.

“It’s not a simple question of either people being fixed and not changing at all, which is clearly wrong, or being rudderless ships battered about by the winds of change — it’s something in between,” says Roberts. Overall, the environmental changes we’ve experienced over the past few years aren’t likely permanent either, which means the psychological consequences might very well change again, too.

The study had some limitations. For one thing, it didn’t have a control group to compare results — there wasn’t a group of people who didn’t live through the pandemic for comparison in this case. And Roberts says it’s hard to tease out what, exactly, over the past few years had the biggest impact on these shifts in personality.

The COVID crisis could have been the main driver of personality change, but other societal changes or reckonings we experienced in the same time frame – the mass shift to virtual school and work, increased economic stratification, the insurrection at the U.S. Capitol, or the rise of the Black Lives Matter movement, for instance.

Or it could be related to economic stress and “long-term disparities that are occurring in our society,” Roberts says.

“It’s been pretty clear from a lot of surveys, especially the younger folks feel a lot less hope for their future economic viability. … And if that’s the case, then, there’s your alternative for why you see this subtle decrease in these kinds of personality traits that are often related to feeling connected to and effective in society.”

And perhaps the findings are the result of more than one thing at the same time. The other group that showed significant personality trait change, for instance, were Hispanic/Latino respondents, who, Sutin points out, bore the brunt of the pandemic in more ways than one, “both in terms of being more vulnerable to the illness and the more severe consequences of also being on the front lines [as essential workers].”

Either, or both, of which might have taken a toll on personality in the population.

Maggie Mertens is a freelance journalist in Seattle who writes about gender, culture, health, and sports.

When Trevor Freeman tilts into his backswing and sends a golf ball sailing, there’s nothing to suggest his blood cells aren’t shaped like everyone else’s.

Nor does his busy life fit in with stereotypes about limitations imposed by sickle cell disease.

Along with earning a varsity letter at East Kentwood High School, he competes in extracurricular golf tournaments. He likes math. He’s learning to drive. He likes listening to music and hanging out with friends.

And while sickle cell disease can sometimes cause him pain and fatigue, Trevor has become an expert in his own right when it comes to managing his symptoms and care.

“I don’t have many problems or much pain,” Trevor, 16, said. “And when I do, I just take some Tylenol and go to sleep. It doesn’t affect me much, and I can still do things I want to do.”

That’s been his family’s goal since his diagnosis—to help him care for symptoms without treating him like he’s fragile.

“We never say, ‘No,’” Antoinetta, his mom, said. “We don’t shatter dreams. We just keep them realistic.”

A complex diagnosis

Doctors diagnosed Trevor with sickle cell disease, an inherited red blood cell disorder, at birth.

While Antoinetta knew she was a trait carrier, her husband, Roger, was adopted, so his status wasn’t clear.

“When the nurse came in to tell me, she was shaking. She was so nervous,” Antonietta said. “I just looked at her and said, ‘He has sickle cell, doesn’t he?’ And she was so relieved that she didn’t have to tell me.”

The couple had been ready for the diagnosis.

But the nurse encouraged them to prepare for the challenges ahead.

For the first year of Trevor’s life, Antoinetta “lived on pins and needles.

“I was at the doctor’s with him for every little thing,” she said. “One day, I sat back and said, ‘I have to do this differently.’”

With some prayer and perspective, she formed a new attitude.

“I realized the Lord gave me this child to give him the best life possible,” she said. “And I realized that if I treat him as if something is wrong and he has a disability, so will everyone else.”

At that moment, she said, “Team Freeman was formed. We decided we wouldn’t say no, but let him explore and do everything that he wants to do.”

Sickle cell symptoms

Trevor’s relatively mild symptoms underscore what experts say is one of the most important things to understand about sickle cell disorders: They can be incredibly varied.

“It’s a very heterogeneous disorder,” said Matthew Pridgeon, MD, who specializes in pediatric hematology-oncology at Spectrum Health Helen DeVos Children’s Hospital. “It’s an umbrella term we use for several different conditions.”

All types of sickle cell disease are inherited.

Healthy blood cells are round and they carry oxygen easily throughout the body.

In sickle cell, they become hard and sticky. They take on a telltale C shape, like farm tools known as sickles.

These cells die early, creating an ongoing shortage of red blood cells. They can clog small blood vessels, causing pain and other serious complications, such as infection and stroke.

“The clinical courses of each can vary in severity, and even within each type, while there may be a general pattern, there’s considerable variety,” Dr. Pridgeon said. “It presents in many different forms.”

Trevor has an alpha-cell gene mutation, which the doctor said “tempers his sickle cell disease and makes him more likely to thrive.”

But while Trevor has had fewer crises than many patients with sickle cell, that doesn’t mean his challenges haven’t been intense.

At age 8, Trevor was hospitalized with pneumonia and a temperature of 104 degrees.

“They couldn’t break his fever, and they had to give him a blood transfusion,” Antoinetta said.

Amid that, Trevor had looked at her and said, “Just tell God I’m not done here yet. I’ve got a lot of things to do.”

At that moment, she said, “I realized I could lose my son.

“Now, I tell him every day that it’s a blessing to wake up with him, to talk to him, to see him,” she said. “We know he’s doing great now, and hope that continues. But with this disease, that can change tomorrow.”

Managing care

Treatment can include hydroxyurea, a medication that makes red blood cells bigger and better-behaved, Dr. Pridgeon said.

Trevor is doing so well, he recently decided to go off the medication. It’s important to point out that Trevor—not his parents—made that call, Dr. Pridgeon said.

The push toward autonomy is essential to raising kids with chronic health conditions, Dr. Pridgeon said.

“We want to teach children, especially as they move through adolescence, to step into the role of advocating for themselves,” he said.

Antoinetta said she has tried to take a back seat at medical appointments, so Trevor can learn to steer his care.

And while Trevor may drive the bus, the entire family is on board.

After Trevor’s birth, they learned his dad also has a sickle cell trait, as do both of Trevor’s sisters, Achante’, 23, and Kennedy, 14.

“So out of the five of us, four are trait carriers and one has the full-blown disease,” Antoinetta said.

The Freemans have relocated often, so they’ve become strong advocates and educators, Antoinetta said.

“We’ll meet the staff and principal at a new school, so everyone knows what to look for and to make it easy for him to discreetly say to a teacher, ‘Hey, I’m not feeling well,’” Antoinetta said. “We want him to feel safe and comfortable without calling attention to himself.”

And they hope his dreams—attending the University of Michigan on a golf scholarship and playing professionally someday—come true.

Trevor first picked up a club at age 7.

He was selected to attend First Tee’s Game Changers Academy this year, based on an essay he wrote about the importance of diversity in golf.

“We’ve made it our model to make sure that he lives a prosperous, blessed life and that he doesn’t feel that his disease hinders him,” Antoinetta said.

That’s important, Dr. Pridgeon said.

Many people have stereotypical ideas about how difficult sickle cell can be, imagining patients are always in pain and living with considerable limitations.

And, conversely, people too often make assumptions that, since a child has a milder form, “that they will always be doing well,” Dr. Pridgeon said.

The goal: Respect that each patient is on their own journey.

“We walk with them throughout that, helping them succeed at the things that they want to do,” Dr. Pridgeon said. “We are doing what we can to minimize risks and catch any medical complications as early as possible, so we can get things under control as soon as we can.”

For some, the prospect of regular, vigorous exercise is cause for excitement. It’s a path to improved health and it can deliver endless benefits in the way of energy, mood and vitality.

For those who struggle with depression and anxiety, however, the notion of physical activity can feel overwhelming.

But research has shown that even slight reductions in sedentary behavior can positively impact mood in the short-term and in the long run.

So what’s a good start?

Less than 10 minutes of exercise each day can have a positive impact on mental health, according to Allyn Richards, PhD, a clinical psychologist with Spectrum Health.

“While formal exercise is a recommended activity to combat depression and anxiety, any form of movement can help,” Dr. Richards said. “It could be gardening or housework. Even getting up and walking around during TV commercials.”

Fight the avoidance cycle

The challenge? Depression and anxiety can make it difficult to engage in physical activity.

These conditions can lead to feelings of fatigue, decreased motivation, reduced interest in activities and increased self-doubt, which can make the idea of exercise feel daunting.

It can be especially overwhelming when there are expectations to work out for extended periods of time, or at a high intensity.

Dr. Richards said this can lead to avoidance, which is often a hallmark of depression and anxiety. Avoidance provides short-term relief and reinforces inactivity, but it can contribute to worsened mood in the long-term.

A person with depression or anxiety can get stuck in this avoidance cycle. It makes it harder to experience the reward of exercise—and harder to increase feelings of motivation.

“Often, we wait to feel motivated to do something,” Dr. Richards said. “But when depressed or anxious, it is harder to experience feelings of motivation.”

A possible solution: Find ways to change the negative reward for not exercising into a positive incentive.

This often comes down to taking some action, Dr. Richards said.

“The secret is that, once action is taken, motivation and positive feelings are more likely to follow,” she said.

Getting started is usually the hardest part.

Start slow, for a short duration.

“I often encourage people to identify the smallest amount of activity that they feel willing to try, even if that is starting with one minute,” Dr. Richards said.

Planning can help.

Write out how to do a particular exercise or activity. Identify when and how you will fulfill the plan. Some people may find it helpful to put the exercise or activity plan on their daily schedule.

“The more you can reduce barriers to engaging in a plan or getting started, the better,” she said. “For example, if you’re going to exercise after work, put on your workout shoes just before you leave work so there is less need to stop and have to re-start action once you get home.”

Set reachable goals

Try to stay realistic in setting goals and meeting them, Dr. Richards said.

Your activity doesn’t have to be perfect. Break free from the all-or-nothing attitude.

“Focus on progress, not perfection,” she said. “Focusing on a full exercise regimen can be overwhelming. Something is always better than nothing. Also, making the activity fun and enjoyable can make it feel less like a chore.”

Another tip: Add a social component to the activity.

“Find an accountability partner,” Dr. Richards said. “We sometimes find it easier to honor our commitments to others than to ourselves, so making a plan to exercise with a family member or friend can be helpful.”

A group activity such as a fitness class might work for some people, she said.

Going too fast and intense at first can result in negative feelings after a workout. Feeling sore and fatigued after a workout doesn’t reinforce doing the exercise again.

For some people, a low-intensity activity helps clear the mind. A walk may be less overwhelming, and there are fewer barriers to getting started.

No matter what you choose, remember: It’s the start of a good beginning.

Every morning, Pamela and Gordon Love sit on their porch, drink coffee and watch the sun rise over Croton Pond.

They have done this since their retirement eight years ago.

But these days, it’s even more special.

“We sit there and we talk and laugh,” Pamela said. “And then all of sudden we think about Gordon having this new gift of life. And then we sit there and cry and cry.

“Just this morning, we were talking about our kids and, I looked over, and he had tears going down his face.”

The Loves are overflowing with gratitude for the gift that came their way on Dec. 30, 2021—a heart transplant for Gordon, 70.

He became the 184th person to receive a heart transplant through the Spectrum Health Richard DeVos Heart and Lung Transplant Program, which began in 2010 at the Spectrum Health Fred and Lena Meijer Heart Center.

A genetic disease

Gordon first became a heart patient around 14 years ago when he was seeing a doctor for knee surgery.

An EKG found that Gordon’s heart was in V-fib—ventricular fibrillation, or irregular heartbeat. Instead of scheduling knee surgery, Gordon set up an appointment with a cardiologist.

At that time, he was diagnosed with cardiomyopathy, a heart disease that can lead to heart failure.

Doctors told Gordon it’s a genetic disease, likely passed down from someone in his family.

Suddenly, things started making sense.

Gordon’s oldest brother died of a massive heart attack at the age of 33 while tap-dancing on Broadway. His second-oldest brother had a heart transplant years ago. He had been told his great-grandfather died suddenly at age 42.

“I was involved in athletics in college and did a lot of strenuous things, like wrestling and football,” Gordon said. “I’m probably lucky I didn’t go down.”

After that first visit, doctors implanted a defibrillator in Gordon’s chest, designed to detect and correct life-threatening irregular heartbeats. It delivers electric shocks to restore a regular heart rhythm.

“Every month I was having 12 to 18 arrhythmias,” he said. “It was correcting them, and I never felt it that much.”

But in 2021, his heart started to deteriorate, with more arrhythmias and becoming enlarged.

“The left side of my heart started to deteriorate more and more. I noticed I was getting weaker and having more shortness of breath,” he said. “I just kind of kept plugging along.”

In fall 2021 he fell ill. He was hospitalized in November and again in early December, after the right side of his heart went into A-fib (atrial fibrillation) for 29 hours.

“We put him on medications to make his heart stronger, and it just wasn’t enough,” said Ryan Grayburn, DO, a Spectrum Health cardiologist who serves as medical director for the transplant program.

On Dec. 13, the team of cardiologists recommended him for transplant.

On Dec. 17, while awaiting transplant, doctors put an axillary balloon pump in Gordon to help his heart pump more blood, Dr. Grayburn said.

‘It’s a blessing’

Gordon and Pamela will never forget Dec. 29.

Gordon’s stepson, Bryan Anderson, works as a physician assistant for Spectrum Health cardiothoracic surgery.

Doctors on the transplant team told Bryan they’d found a heart for his father. They let him pass along the good news.

“He came in and the team was with him,” Gordon said. “He said, ‘We found you a heart.’ I told him, ‘Come on, don’t be joking with me.’ His mask was on so I couldn’t tell if he was grinning. He said, ‘Seriously, we found one.’”

Gordon can’t share the story without getting emotional.

“It was pretty amazing,” he said. “It’s a blessing. We just thank God because I think He orchestrated it. That’s the way I feel about it.”

The transplant happened that night and was completed in the wee hours of Dec. 30.

But Gordon would have to fight one more time.

Immediately after the transplant, Gordon had what doctors call primary graft dysfunction. Dr. Grayburn said it’s not common, and there’s no definitive reason it happens in some transplant patients.

“You sew the heart in and it just does not start beating the way it should,” Dr. Grayburn said. “It’s not rejection. It just happens, and we don’t always know why.”

But they did know the treatment.

They immediately placed Gordon on ECMO, or extracorporeal membrane oxygenation, a heart-lung machine that pumps blood outside of the body and sends oxygen-filled blood back in.

Gordon did well on ECMO, Dr. Grayburn said. They also administered medications to stimulate the heart.

On Jan. 5, he came off ECMO and the ventilator.

Sitting by his side was his son, Brandon, who’d flown in from Oregon.

Only one family member could be in the room at a time because of COVID-19 precautions.

Pamela had made sure it was Brandon that day.

Gordon tells the story this way: “I just remember waking up, and I felt pretty good. I looked over to the right and there’s Brandon. When he was a little kid, I would put my hand on his head and say, ‘You’re a good boy.’ So, I asked him to come over, and I put my hand on his head, and I told him that.”

Hobbies and grandkids

Gordon now lives for more moments with his six children and 14 grandchildren.

Soon, he and Pamela will be great-grandparents.

After being released from Spectrum Health Butterworth Hospital, Gordon went home, and physical therapists and occupational therapists worked with him there. He also did some outpatient cardiovascular rehabilitation at Spectrum Health Gerber Memorial Hospital.

He’s now doing everything he can to rehabilitate and take advantage of the second chance at life he has been given.

A lifelong athlete and coach of wrestling and football for 15 years, being physically fit has helped his recovery.

He’s continuing to work out in his home gym.

Gordon worked in many professions throughout his life—first as a carpenter for his father’s construction business, then as a builder in the construction business and finally as a building trades teacher for Martin and Otsego Public Schools, as well as in the state of Wyoming.

Later, he taught and worked as a placement coordinator for Kent Career Technical Center.

For many years, he did remodeling work on the side.

He’s retired now, looking forward to getting back to his wood-working hobby.

He made a live-edge table for his youngest daughter. His oldest wants one, too.

“I think she will get her table now,” Gordon said.

Dr. Grayburn said it’s gratifying to see Gordon doing so well.

“For us, that’s our gift … when we get a good outcome, and we have someone who is motivated and wants to use this new heart to get a second chance and do what they want to do in life,” he said.

Through tears, Gordon sends a message to the family of his heart donor: “I just want them to know I’m taking good care of it.”

If there is one thing that appears to be quite common among the elderly, it would be that they simply aren’t getting the nutrition they need to maintain a healthy lifestyle. Often, it’s because they cannot cook for themselves anymore, and other times it’s a matter of getting groceries in. Then there are those elderly people who have difficulty eating because of conditions like dysphagia. Here are some things you can do to ensure your aging parents are eating well.

Monitor Mealtimes

If at all possible, have someone available to monitor their mealtimes. It is essential to ensure they get ample nutrients through a good assortment of healthy foods. If you cannot be there with them to oversee what and how they are eating, it may be time to consider assisted living Trumbull CT. Mealtimes can be shared in common with other residents or taken in their apartments, but there will always be someone available to oversee mealtimes.

Be Their Shopper

If your aging parents can’t get out on snowy, icy roads, you can be their personal shopper. Make a weekly list to ensure they have everything they need on hand. It never hurts to have a backup supply of some of the most common staples in their cupboards just for situations like this. You may not be able to get out easily either!

Help with Food Preparation

Whether your elderly parents are living in a senior living residence or at home, the one thing you can do is help a bit with food preparation. Many working mothers use this strategy, allowing them to have healthy meals on the table 7 days a week. On one of your days off, make a couple of large casseroles that can be divided into meal-size portions and frozen. This way, they can take a meal out of the freezer, zap it in the microwave, and within minutes they can be seated with a deliciously healthy meal. Soups work well for this too. Simply freeze the leftovers, and that’s another meal highly appreciated on cold winter days.

Delight Them with Herbal Teas

While there are dozens of commercial herbal teas on the market, you can do better than that! Help them plant a small window herb garden they can access when cooking or for a nice, warm, herbal tea throughout the day. Some of the best herbs to grow in a window garden are peppermint, which can be used for tea but also help with digestive issues.

Even if you can’t personally be there with them to oversee what and how they eat, you can have someone else available to step up to the plate. This is why senior living residences are so important. With qualified staff on duty 24/7, you can be assured they are eating well and safely. The critical thing to remember is that their diet must consist of nutritious foods prepared for people in their advanced years.