Sunday is Global Heat Action Day, to raise awareness about the risks posed by heat and ways to stay safe.

In Nebraska and across the Midwest, the combination of higher temperatures and rising humidity is making outdoor workers more susceptible to heat-related illnesses. Agricultural workers are among the most vulnerable.

Athena Ramos, an associate professor at the University of Nebraska Medical Center's College of Public Health who is affiliated with the Central States Center for Agricultural Safety and Health, said heat-related illness is preventable. She pointed to the importance of letting people become acclimated to heat before working in it and providing sufficient amounts of cool, clean water.

"A worker will need about 32 ounces of water an hour in hot temperatures, so about four cups of water an hour," she said. "And even if somebody doesn't feel thirsty, we need to encourage them to drink water. It's very, very important to help the body prevent overheating."

Ramos also stressed the importance of rest breaks, shade and training on the multiple signs and symptoms of heat exhaustion and heat stroke. And she encouraged the use of a "buddy system." In 2018, heat caused a farmworker's death in a Nebraska cornfield, and his body wasn't found until the next day.

Long workdays contribute to agricultural workers' risk of heat-related illnesses. Ramos said 10-hour days are not unusual for Nebraska farmworkers.

"And a lot of the migrant farmworker crews will be working more than 10 hours a day, because they're coming in for a relatively short period of time," she said. "And they have specific tasks that have to get done, and they only have four or five weeks to actually do it."

To date, California, Colorado, Minnesota, Oregon and Washington have enacted state heat standards. Ramos said the Occupational Safety and Health Administration is working on federal standards, but heat currently falls under the "General Duty Clause."

"Within that clause, it basically says that employers have a duty to ensure a safe working environment," she said. "So, you already have that responsibility as an employer, although a lot of farmworker advocacy groups would say we need something more specific."

She said OSHA has also been doing more heat-related inspections under a "Special Emphasis Program."

The Delaware General Assembly has approved legislation to allow terminally ill adults access to prescription drugs so if they are suffering, they can choose to die peacefully in their sleep.

Called the End-of-Life Options Act, the bill was approved this week by the state Senate following its passage in April in the House. Legislators have wrestled with this issue for almost a decade.

Judy Govatos, a resident of Wilmington, has battled cancer for much of the same time period. She is currently in remission but when the time comes, she said she wants to "die with dignity."

"At 80, I still have lymphoma, so it's not gone and it's in my bone marrow, and it'll come back, and I'm old, and I'll die," Govatos said. "But I really don't want to do any kind of chemo again. It's just too much. I want quality of life."

Gov. John Carney has not said whether he plans to sign the bill and his office did not respond to a request for comment. Several Republican lawmakers have expressed moral concerns about the bill, questioning the need for it with recent advances in hospice and palliative care.

The bill, backed by groups such as Compassion & Choices and other advocates, allows mentally capable, terminally ill adults to request and self-ingest prescription medication to end their suffering. Two health care providers must certify the person seeking aid has fewer than six months to live.

Govatos thinks many people have unrealistic notions about their life's end.

"If you ask them, 'How do you want to die?' 'I want to be hit by a bus, or die in my bed.' Unfortunately, more than 80% of Americans will die in a hospital or a nursing home," Govatos pointed out. "I don't want to be in either one of those. Having this is the security of knowing that I can leave gracefully."

The measure is supported by three of four Delaware physicians. While the bill passed the General Assembly mostly along party lines, Govatos hopes it will be seen differently.

"What I would like for this, honestly, is that this wouldn't be a right-left, red-blue dogma issue," Govatos added. "This is about having choices at the end of life and to leave life gracefully, saying goodbye and I love you."

Virginia doctors are reminding people how important it is to stay heart healthy in extreme heat.

Temperatures across the U.S. have skyrocketed, and climatologists estimate 2024 will surpass 2023 as the hottest year on record. Virginia's average temperature has gone up almost 3 degrees in the last 20 years.

Dr. Deepak Talreja, clinical chief of cardiology at Sentara Health in Norfolk, said rising temperatures can be hard on your heart.

"The heart muscle is really susceptible to problems from heat, especially when a person gets dehydrated, or when they're not drinking enough fluid and they get their electrolytes off," Talreja explained. "That can cause rhythm problems, changes in blood pressure, and an increase in the risk of passing out."

Enough stress on the body ultimately leads to heart attack and stroke. Drinking water often is key to maintaining good heart health in the heat. While doctors said people should drink eight glasses of water daily, Talreja thinks people should drink 1.5 times that during extreme heat to stay hydrated.

Other drinks high in electrolytes are helpful for hydration but Talreja noted you should check the sugar content. High blood sugar with or without heat is harmful to the heart. He added there are misconceptions about caffeinated drinks in intense heat.

"Drinks with caffeine in them actually act as diuretics, they make you pee more and so, you have to be careful about heavily caffeinated beverages," Talreja advised. "Also, you have to be careful because you want to avoid beverages with a lot of sugar; sodas that cause excess weight, excess blood sugar."

Talreja noted another problem is not planning ahead and being in more heat than you may realize. He recommended anytime you go out, you should grab some water and know where to find a cool, shady spot.


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A critical shortage of direct care workers in Maine is leaving residents without needed health services, according to a new report.

It showed more than 23,000 hours of approved home care for older adults go undelivered each week, while waitlists for behavioral health care have grown into the thousands.

Arthur Phillips, analyst at the Maine Center for Economic Policy, said low pay and poor benefits make it tough to retain enough workers to meet demand.

"Even if you feel really dedicated to the work that you do and the people who you serve, if it's having negative impacts on your own life, then you're faced with a tough choice," Phillips pointed out. "I think a lot of people are leaving."

It is estimated the state needs to hire more than 2,300 direct-care workers just to meet existing needs. Phillips argued the state should raise its median wage for workers to at least 140% of the minimum wage to remain competitive or just under $20 an hour.

Maine already has the oldest population in the U.S. and the share of people age 65 or older is projected to grow to nearly 30% by 2050. AARP Maine estimates more than 160,000 unpaid caregivers, including family and friends, are currently filling the state's health care gap for the age group.

Phillips noted it can lead to greater stress on everyone and a loss of economic activity for the state.

"While we think that this will require significant resources and that this group of workers should be prioritized, I think it's also true that the costs of inaction are far greater," Phillips emphasized.

Phillips added the legislature raised the reimbursement rate for direct care workers in 2021, allocating some $120 million for recruitment and longevity bonuses, and needs to take action again. He recommended the state improve its data systems to get a clearer picture of Maine's health care needs, including both direct care workers and those they serve in the process of policy changes to ensure all needs are met.