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Photo by Gerard Romano

By Nancy Marr

The $4.2 billion Clean Water, Clean Air, and Green Job Bond Act proposition on our ballot in 2022 will allow our state to undertake vital and urgent environmental improvement projects via issuing bonds; not a tax increase.

Long Island’s waterways are impaired by failing sewage and septic systems, and algae and nitrogen pollution impacts our sole-source aquifer system which provides drinking water to three million state residents. We need to find a way to conserve open space to benefit wildlife habitats, food production, and outdoor recreation. Many marginalized communities are harmed by pollution and have no access to open space, clean air and water.

There have been eleven environmental bond acts passed since the early 20th century. The conservation movement of the late 19th and early 20th centuries was a response to vast deforestation, natural resource depletion and industrialization. The “forever wild” clause was added to the New York State Constitution in 1894 to enshrine the protection of lands in the Adirondacks and Catskills. 

In 1910 voters passed a bond act for $2.5 million, in 1916, for $10 million, and in 1924, for $15 million, all for the purposes of land acquisition and the establishment of parks. The 1965 Bond Act funded infrastructure to limit the flow of wastewater from untreated sewage overflows. In the 1970’s and 80’s, attention was galvanized by the problems with Love Canal, near Niagara Falls, the site of thousands of tons of toxic waste from the Hooker Chemical Company, which led policymakers in the US to establish hazardous waste regulatory systems.  The majority of the funding from the Environmental Quality Bond Act of 1986 went to manage hazardous waste in sites under the State Superfund program which had been established in 1979. The Clean Water/Clean Air Bond Act of 1996 allocated the bulk of its $1.75 billion to safe drinking water and treatment of solid waste. 

The infrastructure in New York City, which supplied water to approximately 40 percent of NYS’s population, had already exceeded its life span by 2008 when the NYS Department of Health estimated that $38.7 billion would be needed over the next twenty years for drinking water infrastructure. The Legislature responded with an initial allocation in 2017 of $2.5 billion. In 2019 it passed the Climate Leadership and Community Protection Act, which established clear statewide goals for emissions reduction and clear energy. 

Governor Hochul’s budget released the Clean Water, Clean Air, and Green Jobs Environmental Act of 2022. The final version, $4.2 billion, makes climate change its largest category of funding and designates that a portion of the total funding must be allocated to disadvantaged communities that bear a disproportionate share of negative environmental consequences. The 2022 Bond Act includes:

Climate Change Mitigation (includes money for electrifying school buses) — $1.5 billion: Will fund projects that expand clean energy infrastructure, increase energy efficiency, reduce green gas emissions, and protect air and water quality to help fight and mitigate climate change. 

Restoration and Flood Risk Reduction — $1.1 billion: Damage caused by severe storms and flooding is projected to cost over $50 billion statewide. Funding would provide investments in NY’s natural and manufactured coastal resilience systems such as shoreline protection, wetland restoration, local waterfront revitalization, green infrastructure, and voluntary buyout programs.

Open Space Land Conservation and Recreation — $ 650 million: The Bond Act funding will expand open space conservation programs, promote outdoor recreation, protect natural resources, improve biodiversity, benefit threatened and endangered species and help farmers who are facing the challenges of climate change. Funding will invest in restoring and maintaining native fish populations and increasing public access to our waterways to support LI’s maritime culture. 

Water Quality Improvement and Resilient Infrastructure — $650 million: A long-term solution is needed to fund our backlog of water quality and infrastructure needs which continue to outpace available funding; the Bond Act will help fill the gaps in funding by investing at least $659 million in protecting water quality, spending 35% of the total in disadvantaged communities.

On Election Day 2022, remember to turn over your ballot and vote for the Environmental Bond Act proposition! 

Nancy Marr is Vice-President of the League of Women Voters of Suffolk County, a nonprofit nonpartisan organization that encourages the informed and active participation of citizens in government and influences public policy through education and advocacy. For more information, visit www.lwv-suffolkcounty.org or call 631-862-6860.

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Caroline Mota Fernandes Photo by Jonas Nascimento Conde

By Daniel Dunaief

Fungal infections represent a significant health risk for some patients, killing about 1.5 million people globally each year. Doctors struggle to provide medical help for some of these patients, especially those whose weakened immune systems offer insufficient protection against developing pathogens.

Invasive fungal infections, which people typically contract by inhaling them as spores, account for about half of all AIDS-related deaths.

Maurizio del Poeta, Distinguished Professor at the Renaissance School of Medicine at Stony Brook University, has been studying ways to boost the body’s defenses against these potentially deadly infections, even among people with weakened immunities.

Recently, Caroline Mota Fernandes, a postdoctoral researcher in del Poeta’s lab, published research in the journal mBIO, a publication of the American Society for Microbiology, that demonstrated that a heat-killed, mutated version of the fungus Aspergillus conveyed protection in an animal model of an immunocompromised individual.

“The biggest news is that we can simply use the ‘autoclaved’ mutated version,” explained del Poeta in an email. “This version cannot be more dead!”

An autoclave is like a scientific oven: it raises the temperature or pressure. In this case, it can kill the mutated fungus, leaving only the mutated signal that primes the immune system.

The mutated and heat-killed version of the fungus, however, still provided full protection in a condition in a model of a weakened immune system.

“That means this formulation is highly stable and resistant to heat degradation,” del Poeta added.

Del Poeta’s lab had conducted similar research with another fungus called Cryptococcus.

By demonstrating that this approach also works with Aspergillus, del Poeta said the result “validates the cryptococcal vaccine (after all, it uses a mutant of the homolog gene, Sg11 in Crypto and SglA in Aspergillus.”

It also shows that protection exists under an additional type of immunodepression that is different from the one used in the cryptococcal vaccine.

The encouraging results, while in the preliminary stages, are relevant not only for immunocompromised people in general, but also for those who have been battling Covid, as Aspergillus was the cause of death for many patients during the worst of the pandemic.

Homologous genes

Del Poeta’s lab has focused on genes that catalyze the breakdown of steryl glucosides, which scientists have also studied in the context of plants. Crops attacked by various fungi become less productive, which increases the need to understand and disrupt these pathways.

“Folks working with plants started observing that these molecules had some kind of immunomodulatory property,” said Fernandes. “That’s where the idea of this steryl glucosides, which also is medicating fungal virulence, came from.”

The mutation Fernandes studied removed the sterylglucosidase gene sglA. Without the enzyme that breaks up the steryl glucose, the fungus had less hypha, which are necessary for the growth of the fungus. The mutation also changed the cell wall polysaccharides. Mice vaccinated with this heat-killed mutation had a one hundred percent survival rate in response to exposure to the live fungus.

“What was a very great achievement of our work was getting 100 percent protection,” said Fernandes. For immunocompromised people for whom a live attenuated fungus might threaten their health, the effectiveness of the heat-killed mutation proved especially promising.

In the experiment, she administered the vaccine 30 days before exposure, while providing boosters as often as every 10 days.

Fernandes, who started her post doctoral research in del Poeta’s lab in 2018, said several questions remain. “After this study, we are going to try to characterize exactly how this strain induces the immunity and protection to a secondary challenge of Aspergillus,” she said. Dr. Veronica Brauer, another post doctoral researcher in del Poeta’s lab, is conducting this research.

At this point, it’s unclear how long protection against a fungal infection might last.

“For us to estimate the duration of the protection, we have to have a more specific understanding of which immune components are involved in the response,” said Fernandes.

As of now, the mice vaccinated with the mutated and heat-killed fungus had no off target effects for up to 75 days after vaccination.

Fernandes is also working to characterize the mechanism of action of a new class of antifungal drugs previously identified by the lab, called acylhydrazones. She hopes to identify a new virulence protein in Cryptococcus as well.

Collaboration origins

Fernandes, who was born and raised in Rio de Janeiro, Brazil, first worked in del Poeta’s lab in 2013, while she was conducting her PhD research at Federal University of Rio de Janeiro. She was studying antifungal peptides and explained to the Brazilian government why coming to Stony Brook would contribute to her research.

Fernandes started studying fungi when she was in her second year of college at Federal University of Rio de Janeiro.

The daughter of two chemists, Fernandes said she grew up in a house in which she had pH strips, which she used to test the acidity of shampoo, water and anything else she could test. She also entered numerous science fairs.

Fernandes met her husband Jonas Conde, who is a virologist at Stony Brook University and who has studied Covid-19, when they were in nearby labs during their PhD research.

Residents of Port Jefferson, Fernandes and Conde have a four-month-old son named Lucas.

Having a child “motivates me to be better in my work and to set an example for him to be committed in doing some good for other people,” Fernandes said.

Del Poeta described Fernandes as being “extremely effective” in managing her time and has “extraordinary motivation.” He appreciates her commitment to her work, which is evident in the extra papers she reads.

Fernandes appreciates being a part of del Poeta’s lab. She described him as an “amazing” researcher and supervisor and said being a part of his group is “an honor.”

Del Poeta said Fernandes will continue to make mutants for additional fungi, including Mucorales and Rhizopous, for which antifungal therapy is not particularly effective.

Del Poeta added that the urgency of this work remains high. With several other Stony Brook faculty, he has submitted grants to study Sgl1 as a vaccine and antifungal target.

“Imagine [making] a drug that not only can treat the primary infection, but, by doing so, can potentially prevent the recurrence of a secondary infection?” he asked rhetorically. “Exciting!”

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The American Cancer Society recommends women 45-54 get annual screenings. METRO photo
New research on bisphosphonates helps clarify their role in prevention

By David Dunaief, M.D.

Dr. David Dunaief

Breast cancer is the most common cancer diagnosed in U.S. women. Experts estimate that 30 percent of 2022 cancer diagnoses in women will be breast cancer (1). Only 15 percent of cases occur in those who have a family history of the disease, and 85 percent of new diagnoses will be invasive breast cancer.

A primary objective of raising awareness during October is to promote screening for early detection. Screening is crucial, but it is not prevention, which is just as important. Prevention strategies should include primary prevention, preventing the disease from occurring by lowering your risk, and secondary prevention, preventing breast cancer recurrence.

Here, we will discuss current screening recommendations, along with tools to lower your risk.

What are current screening recommendations?

There is some variation in screening guidelines; experts don’t agree on age and frequency. The U.S. Preventive Services Task Force currently recommends mammograms every other year, from age 50 through age 74, with the option of beginning as early as age 40 for those with significant risk (2). These 2016 guidelines are currently undergoing a review and are pending publication.

The American College of Obstetricians and Gynecologists encourages a process of shared decision-making between patient and physician to determine age and frequency of exams, including whether to begin exams before age 50 or to continue after age 75 (3). Generally, it recommends beginning annual or biennial mammograms starting no later than 50 and continuing until age 75. 

The American Cancer Society’s physician guidelines are to offer a mammogram beginning at age 40 and recommend annual exams from 45 to 54, with biennial exams after 55 until life expectancy is less than 10 years (4).

It is important to consult with your physician to identify your risk profile and plan or revise your regular screening schedule accordingly.

When do bisphosphonates help?

Bisphosphonates, which include Fosamax (alendronate), Zometa (zoledronic acid) and Boniva (ibandronate), are used to treat osteoporosis. Do they have a role in breast cancer risk prevention? The short answer: it may help prevent recurrence but doesn’t appear to provide primary protective benefits.

In a meta-analysis involving two randomized controlled trials (RCTs), FIT and HORIZON-PFT, results showed no benefit from the use of bisphosphonates in reducing breast cancer risk (5). The study population involved 14,000 postmenopausal women from ages 55 to 89 women who had osteoporosis, but who did not have a personal history of breast cancer. In other words, bisphosphonates were being used for primary prevention.

However, it does appear that bisphosphonates have a role in preventing breast cancer recurrence. The recent SUCCESS A phase 3 trial considered the optimal time for treatment. Findings published in 2021 indicate that two years of treatment for patients with high-risk early breast cancer reduced recurrence risk as much as five years of treatment (6). This could alter the current paradigm of 3-to-five years of treatment to prevent recurrence of certain types of breast cancer, reducing incidences of troublesome side effects.

A Lancet metanalysis focused on breast cancer recurrence in distant locations, including bone, and survival outcomes did find benefits for postmenopausal women (7). A good synopsis of the research can be found at cancer.org.

What’s the role of exercise?

We know exercise is important in diseases and breast cancer is no exception. In an observational trial, exercise reduced breast cancer risk in postmenopausal women significantly (8). These women exercised moderately; they walked four hours a week over a four-year period. If they exercised previously, five to nine years ago, but not recently, no benefit was seen. The researchers stressed that it is never too late to begin exercise. Only about one-third of women get the recommended level of exercise every week: 30 minutes for five days a week. Once diagnosed with breast cancer, women tend to exercise less, not more. We need to expend as much energy and resources emphasizing exercise for prevention as we do screenings.

What about soy?

Contrary to popular belief, soy may be beneficial in reducing breast cancer risk. In a meta-analysis, those who consumed more soy saw a significant reduction in breast cancer compared to those who consumed less (9). There was a dose-response curve among three groups: high intake of >20 mg per day, moderate intake of 10 mg and low intake of <5 mg. Those in the highest group had a 29 percent reduced risk, and those in the moderate group had a 12 percent reduced risk when compared to those who consumed the least. In addition, higher soy intake has been associated with reduced recurrence and increased survival for those previously diagnosed with breast cancer (10). The benefit from soy is thought to come from isoflavones, plant-rich nutrients.

Hooray for Breast Cancer Awareness Month stressing the importance of mammography and breast self-exams. However, we need to give significantly more attention to prevention of breast cancer and its recurrence. Through potentially more soy intake, as well as a Mediterranean diet and modest exercise, we may be able to accelerate the trend toward a lower breast cancer incidence.

References: 

(1) breastcancer.org. (2) uspreventiveservicestaskforce.org. (3) acog.org. (4) cancer.org. (5) JAMA Intern Med. 2014;174(10):1550-1557. (6) JAMA Oncol. 2021;7(8):1149–1157. (7) Lancet. 2015 Jul 23. (8) Cancer Epidemiol Biomarkers Prev. 2014 Sep;23(9):1893-902. (9) Br J Cancer. 2008; 98:9-14. (10) JAMA. 2009 Dec 9; 302(22): 2437–2443.

Dr. David Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, visit www.medicalcompassmd.com.

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Insomnia. METRO photo

By Leah S. Dunaief

Leah Dunaief

Have you been waking up thinking at night? There is so much to think about, even to be deeply concerned about. There is COVID-19, of course. No one wants to get the disease, and if you already had it, you don’t want to get it again, as some people reportedly have. You also don’t want any of the long-hauler symptoms to afflict you: fatigue, brain fog, aches and pains, trouble breathing, dizziness, headache, and at least nine more on a reported list. In fact, the list is so comprehensive, it’s enough to give you anxiety, especially if you already have had the illness. Oh yes, and anxiety is also one of the symptoms.

Then there is the Ukraine. Normally a country that was somewhere in Eastern Europe, in the same general area as “Fiddler on the Roof,” now its whereabouts as Russia’s western neighbor are known around the world. We watched as Putin sent more than 100,000 soldiers to overrun its borders. Poor little Ukraine, horrid bully Russia. We are sending them an unprecedented amount of money and military aid, and we have lowered our national oil and gas supplies. Will we have enough resources if we are attacked? Even as we cheer the valiant resistance and success of the victims of naked aggression, we worry about Putin’s possible use of nuclear arms. He has over 2000 small such weapons, apparently, and it’s the Cold War all over again.

The problem of immigration was brought right to our door with the arrival of immigrants sent by southern governors of border states. They have been literally deposited here by the thousands via buses, and they have been humanely received, if we are to accept what we are told by the media. As I have written in this column before, they can represent an opportunity as well as a challenge for areas in need of Help Wanted. Indeed, I am now reading that some of the immigrants are put to work cleaning up the devastation wrought by hurricane Ian in Florida. They are even being sent back down there to help. Who knows what to believe?

If you are going into New York City, how likely are you to ride the subway? The reports of incidents underground are frightening. So are horrible, unprovoked attacks on the streets. Now, I grew up in the city, and I am used to all sorts of miserable statistics concerning crime there, but I somehow never felt fearful. With some eight million people, crime is unfortunately inevitable. And NYC isn’t even statistically the worst. New Orleans is. But somehow, these recent incidents seem more violent.

Climate change has finally penetrated national conversation. The destruction and deaths in Puerto Rico and now in Florida and the Carolinas caused by the last two hurricanes have made those of us who live on islands and along the shores more conscious of future threats. While there have always been hurricanes, some with even legendary force, the prospect of more and stronger blasts due to climate change has prompted scary instruction about emergency bags and escape routes.

Inflation and its direction are also of grave concern. Going to the supermarket now seems to net about half as many bags of groceries for the usual food budget. Restaurants have decidedly become more expensive, as they have to pay more to function. And home values seem to have stopped rising and begun to cool. The stock market, while it is not the economy, has dropped like a rock. That negates the “wealth effect” homeowners and investors feel that encourages them to spend more freely.

Heck, I even worry about the New York Yankees. Yes, they have won their division, and you might say, “handily.” That’s exactly the problem. The last time they won by a big margin, they lost their competitive edge, along with the series, remember? It even happened this year right after the All-Star break. Teams do better when they have to fight until the last minute.

Awww, forgeddaboutit! Go back to sleep.

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Pixabay photo

By Michael Christodoulou

Michael Christodoulou
Michael Christodoulou

There are no shortcuts to investment success  — you need to establish a long-term strategy and stick with it. This means that you’ll want to create an investment mix based on your goals, risk tolerance and time horizon — and then regularly review this mix to ensure it’s still meeting your needs.

In fact, investing for the long term doesn’t necessarily mean you should lock your investments in  forever. Throughout your life, you’ll likely need to make some changes.

Of course, everyone’s situation is different and there’s no prescribed formula of when and how you should adjust your investments. But some possibilities may be worth considering.

For example, a few years before you retire, you may want to re-evaluate your risk exposure and consider moving part of your portfolio into a more risk-averse position. When you were decades away from retiring, you may have felt more comfortable with a more aggressive positioning because you had time to “bounce back” from any market downturns. But as you near retirement, it may make sense to lower your risk level. 

And as part of a move toward a reduced-risk approach, you also may want to evaluate the “cash” positions in your portfolio. When the market has gone through a decline, as has been the case in 2022, you may not want to tap into your portfolio to meet short-term and emergency needs, so having sufficient cash on hand is important. Keep in mind, though, that having too much cash on the “sidelines” may affect your ability to reach your long-term goals.  

Even if you decide to adopt a more risk-averse investment position before you retire, though, you may still benefit from some growth-oriented investments in your portfolio to help you keep ahead of — or at least keep pace with — inflation. As you know, inflation has surged in 2022, but even when it’s been relatively mild, it can still erode your purchasing power significantly over time.

Changes in your own goals or circumstances may also lead you to modify your investment mix. You might decide to retire earlier or later than you originally planned. You might even change your plans for the type of retirement you want, choosing to work part-time for a few years. Your family situation may change — perhaps you have another child for whom you’d like to save and invest for college. Any of these events could lead you to review your portfolio to find new opportunities or to adjust your risk level — or both.

You might wonder if you should also consider changing your investment mix in response to external forces, such as higher interest rates or the rise in inflation this year. It’s certainly true that these types of events can affect parts of your portfolio, but it may not be advisable to react by shuffling your investment mix. 

In the first place, nobody can really predict how long these forces will keep their momentum — it’s quite possible, for instance, that inflation will have subsided noticeably within a year. But more importantly, you should make investment moves based on the factors we’ve already discussed: your goals, risk tolerance, time horizon and individual circumstances.

By reviewing your portfolio regularly, possibly with the assistance of a financial professional, you can help ensure that your investment mix will always be appropriate for your needs and goals.

Michael Christodoulou, ChFC®, AAMS®, CRPC®, CRPS® is a Financial Advisor for Edward Jones in Stony Brook. Member SIPC.

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Disaster Emergency Supplies. METRO photo

Once again, Suffolk County residents find themselves in the midst of hurricane season.

Hurricanes Fiona and Ian recently reared their ugly heads. While Long Island was spared, the headlines featuring the wreckage left behind in places such as Puerto Rico and Florida remind us of how devastating these storms can be.

In the Atlantic and Caribbean, hurricane season officially begins June 1 and lasts until Nov. 30. The height of the season is typically August, September and October.

Many Long Island residents remember the wrath of Gloria in 1985, and while it was downgraded to a superstorm once it hit our shores nearly 10 years ago, Sandy started as a hurricane, leaving damage and death behind, from the Caribbean to Canada.

Though we are well into hurricane season, it’s never too late to take precautionary measures.

The Centers for Disease Control and Prevention recommends preparing before a storm hits by programming all emergency phone numbers into cellphones, writing down the numbers and placing them on the refrigerator or near home phones. CDC officials also advise locating the nearest shelter and researching different routes to get there. Pet owners should also find pet-friendly shelters and hotels or an out-of-town friend or relative who can take in pets during the case of an evacuation.

The CDC suggests having emergency supplies handy in case of a weather emergency. People should keep in mind that water and electricity could be cut off, and it’s imperative to have a supply of items such as batteries, bottled water, flashlights, medications and important documents that are easily accessible.

All family members should know where the fire extinguishers are in the home and how to use them. And, most importantly, families should go over their emergency plan regularly.

When a storm is predicted, the CDC says to clean up any items outside of the house that could potentially blow around and cause damage. Installing storm shutters or putting plywood on windows can prevent shattered glass coming into a home. Carbon monoxide detectors should be checked to prevent CO poisoning.

The most important tip various agencies give is to follow the advice of government officials and first responders regarding evacuating or sheltering in place at home. When evacuating, take only what you need as well as your emergency kit. Drivers should travel on roads they are instructed to use even if there is traffic, and avoid any downed wires.

Those staying at home need to remember not to go outside, even if it seems calm, until news that the hurricane has finally passed. Also, stay away from windows and, of course, always be prepared to leave if responders tell you that it’s necessary.

For those who have a trip planned, AAA cautions travelers to be proactive when a storm is predicted to hit by monitoring weather conditions of one’s departure city and destination before leaving. When traveling after a weather event such as a hurricane, it’s imperative to call hotels to get an update on the storm’s impact and to confirm if flights are scheduled to leave on time. Remember that even if an area wasn’t directly hit by a storm, it could still be negatively impacted.

A bit of preparation and caution can help a person and families navigate most storms. Hopefully, Long Islanders won’t need the advice this season.

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Cell phone etiquette. METRO photo

By Daniel Dunaief

Daniel Dunaief

You’re meeting with your boss, and you can feel your phone vibrating in your pocket with a new text message, an incoming email or a good old-fashioned phone call.

What do you do?

You’d be on pins and needles if someone you knew, your spouse or partner, perhaps, were expecting a baby. Or, perhaps, someone was traveling a great distance through a storm and you were eager to hear that your friend or family member had arrived safely.

But most of the time, the stakes aren’t quite as high with incoming information. In fact, some of the time, we’re getting spam that seeks our attention.

So, when we are talking to our boss, we generally realize that responding to our demanding electronics probably isn’t a great idea.

But what about when we are talking to a parent, a friend, a child or a neighbor?

Given the frequency with which I have seen the tops of people’s heads as they look down at their phones instead of in their eyes, it seems people have concluded that eye contact is so 20th century.

Since when did people outside the room become so much more important and demanding than the ones with whom we are interacting? If we can’t find people who are as interesting in person as the ones far away, perhaps it is time to move to interact with some of those fascinating folks.

I understand that people online don’t have bad breath and messy hair and aren’t wearing the same clashing outfit that they wore last week, and that continues to threaten to give us a migraine.

Maybe we ought to consider classes in electronic etiquette that teachers can share with students or with people who are receiving their first phone.

We can address not only how to handle an incoming text while in the middle of a conversation, but also how to unplug ourselves and our lives from endless messages, games, movies and TV shows.

If I could go back to the time when we handed phones to our children, ensuring that the phone would eventually replace bedtime stories, dinnertime conversation and eye contact, I would consider establishing our own “Ten Commandments” of phone ownership and usage.

These might be:

10. Limit the time each day when you use your phone, with only extraordinarily limited exceptions. If you need to use your phone for schoolwork for two or three hours, that still counts as phone usage.

9. Leave the phone in another room when you’re not using it.

8. If you can’t say something supportive or pleasant on social media, don’t say anything.

7. No anonymous messages or criticism. If you can’t use your name or stand behind what you write, you shouldn’t have written it in the first place.

6. Don’t take embarrassing pictures of your parents and share them with your friends. Older people don’t tend to look as glamorous in digital pictures as younger people, so be kind.

5. Internet fame is not a life goal.

4. When you become better at using your phone than your parents (which occurs in a surprisingly short time), share your wisdom and skills with them. Think of it as familial community service.

3. Don’t assume everything you find online is true. In fact, at least once a week, or even once a day, find something on the internet that you think is false. Use trusted sources to contradict what you think an internet provider got wrong.

2. If it looks like everyone else is having a better time than you, put your phone down. They aren’t.

1. If you can tell your parents to wait while you respond to a text or call from a friend, make sure you tell your friends the same thing when your parents reach out to you.

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Stock photo

By Nancy Burner, Esq.

Nancy Burner, Esq.

Skilled nursing care is a high level of care that can only be provided by trained and licensed professionals, such as registered nurses, licensed professional nurses, medical directors, and physical, occupational, and speech therapists. 

Skilled care is short-term and helps people get back on their feet after injury or illness. Skilled nursing facilities are residential centers that provide nursing and rehabilitative services to patients on a short-term or long-term basis. Examples of the services provided at a skilled nursing facility include wound care, medication administration, physical and occupational therapy, and pulmonary rehabilitation.

Generally, patients who are admitted to skilled nursing facilities are recovering from surgery, injury, or acute illness, but a skilled nursing environment may also be appropriate for individuals suffering from chronic conditions that require constant medical supervision. If you or a loved one is interested in using Medicare for skilled nursing, though, there are specific admission requirements set by the federal government:

• The individual has Medicare Part A (hospital insurance) with a valid benefit period. The benefit period will start from the date of admission to a hospital or skilled nursing facility and last for up to 60 days after the end of the stay.

• The individual has a qualifying hospital stay. This generally means at least three in- patient days in a hospital.

• The doctor has recommended skilled nursing care for the individual on a daily basis. The care must be provided by skilled nurses and therapists or under their supervision and should be related to the condition that was attended to during the qualifying hospital stay.

• The individual is admitted to a skilled nursing facility that is certified by Medicare. A skilled nursing facility must meet strict criteria to maintain its Medicare certification.

Usually, the skilled nursing care services covered by Medicare include the room charges, provided that it is a semi-private or shared room, meals at the facility, and any nutritional counseling, as well as costs of medication, medical supplies, medical social services, and ambulance transportation. It also covers rehabilitative services that are required to recover from the condition, such as physical therapy, respiratory therapy, and speech therapy.

Medicare generally offers coverage for up to 100 days of treatment in a skilled nursing facility. Note that if the patient refuses the daily skilled care or therapy as recommended by the doctor, then the coverage by Medicare may be denied for the rest of the stay at the skilled nursing facility. Many patients are advised that they will not get the full 100 days of Medicare benefits because they had reached a “plateau” or that they failed to improve. This is known as the Improvement Standard and was a “rule of thumb” used to evaluate Medicare patients. 

Applying the Improvement Standard resulted in the denial of much needed skilled care for thousands of Medicare patients. The denials were based on a finding that there was no likelihood of improvement in the patient’s condition. This standard ignored the fact that the patients needed skilled care in order to maintain their current state of health and to prevent them from deteriorating. More often than not, if the patient was not improving, Medicare coverage was denied. While this standard was widely used, it was inconsistent with Medicare law and regulations.

A court case brought by Medicare beneficiaries and national organizations against the Secretary of Health and Human Services (Jimmo v Sebelius) sought to change this. The plaintiffs argued that even though the term “plateau” does not appear in the Medicare regulations, it is this term that is often used and relied upon to deny coverage. The appropriate standard should be: will the covered services “maintain the current condition or prevent or slow further deterioration,” not whether the individual was showing signs improvement.

As a result of this litigation and the settlement on Jan. 24, 2013, patients should be able to continue receiving services provided by Medicare, even where improvement in the patient’s condition cannot be documented. However, the old standard continues to be used. Patients and their advocates should educate themselves on the correct standard to make sure coverage is not cut prematurely.

Nancy Burner, Esq. is the founder and managing partner at Burner Law Group, P.C with offices located in East Setauket, Westhampton Beach, New York City and East Hampton.

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