TABERNASH, Colo. -- November is National Hospice and Palliative Care Month, and advocates hope all Coloradans will consider these under-utilized health-care services for themselves and family members.

Katie Sue Van Valkenburg, medical social worker for Namaste Home Health, said everyone will go through an end-of-life journey, and hospice care, which is available to anyone facing a prognosis of 6 months or less to live, can help families and friends make the most of their remaining time together.

"And just like we celebrate babies being born, I want to make sure that we are celebrating people as they leave this life," Van Valkenburg urged. "Because hospice is covered by insurance, why not utilize it, so you can have a much more enjoyable and comfortable end-of-life experience, both for you and your family?"

Palliative care focuses on improving the quality of a patient's life, as opposed to curing a specific illness. Hospice teams provide medical care and pain management and give family caregivers a break by helping with showering and other daily activities. They help navigate Medicare and Medicaid paperwork, and offer emotional and spiritual support, including 13 months of bereavement services for family members and friends.

Matt Whitaker, national director of integrated programs for Compassion and Choices, noted most people access hospice through a doctor's referral, and added you can also find options online.

One common misunderstanding about palliative care is patients are giving up so-called battles with their illness.

Whitaker pointed out many patients continue chemotherapy and other regimens as they struggle with powerful diseases.

"And what we have to do is support people as they make the decision to move from focusing on cure to focusing on care," Whitaker contended. "Making sure that they are able to spend the days that they have left doing what gives them the most meaning possible."

Van Valkenburg emphasized she hopes Namaste's new operation in Grand County will help more patients stay in their homes. Before Nameste arrived, palliative care had not been available in the area for 8 months, which is not uncommon in many rural communities.

"But most of the time if they require a nursing home or a secure unit because of advanced dementia, they were being shipped down to Denver," Van Valkenburg explained. "Which means they are no longer close to family, which can definitely cause a lot of emotional stress and trauma for everyone involved."

Access to reduced-price medication is a necessity for many rural Missourians with low income.

Rep. Cindy O'Laughlin, R-Shelbina, the Senate Floor Leader, said Big Pharma is trying to confuse legislators with unrelated hot-button topics such as abortion access and illegal immigration in a last-ditch effort to stop the state from joining a program to force drugmakers to sell medicines at a discount.

"Appealing to nuclear topics, which really do not apply in this situation, is a disingenuous way to try to defeat a bill that is actually good for Missouri," O'Laughlin asserted.

O'Laughlin pointed out the program is transparent, and uses the tax money saved to help low-income families deal with chronic conditions such as diabetes.

The drugmakers object to the government forcing them to give significant discounts, arguing hospitals' and for-profit pharmacies' bottom lines, particularly those owned by pharmacy benefits managers, are being exploited. Nationally, 46% of contract pharmacy agreements involve pharmacies linked to the three largest benefits managers.

Rep. Tara Peters, R-Rolla, introduced the 340B contract pharmacy access billand said the lobbying is absurd.

"Federally, 340B program does not allow for abortion drugs," Peters stressed. "Why would any legislation that we're trying to pass in the state allow for that? I mean, the thought of that even being in existence is absolutely ludicrous."

The Missouri Senate passed the bill 27-3 on Monday and it now goes to the House.


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Alabama is running out of time to tackle Medicaid expansion this legislative session.

More than 230 people gathered earlier this month with the group Alabama Arise, urging state lawmakers to prioritize the issue. Their message: Access to health care isn't just a matter of policy, it can be a matter of life and death.

Debbie Smith, Cover Alabama campaign director for Alabama Arise, said as the session winds down, the group will continue to echo the call for increased access to health coverage. She thinks it would not only save lives but revitalize communities across the state.

"Over 80% of our rural hospitals are operating in the red," Smith pointed out. "Not a great stat. About 19 rural hospitals are at immediate risk of closure, and those are the lifeblood of those communities. They're on life support."

Smith emphasized hospitals at financial risk also put their workforce at risk. Those who are against Medicaid expansion believe it is ultimately unaffordable for the state. However, Smith argued it could save the state nearly $400 million over the next six years. According to the Public Affairs Research Council of Alabama, those savings would be enough to cover the cost.

The council's study also showed Medicaid expansion would generate nearly $2 billion of economic growth. Beyond economic benefits, Smith pointed to the stark disparities in maternal and infant mortality rates in Alabama.

She stressed Medicaid expansion would do more than provide health care coverage during pregnancy or postpartum, it is about ensuring comprehensive coverage.

"We've been lucky enough to expand Medicaid coverage up to 12 months postpartum but we still need to figure out how to cover people before they even get pregnant," Smith asserted. "It's really important for people to have health coverage so they can address any kind of issues they might have, like if they have diabetes or high blood pressure that might affect their pregnancy in the future."

With limited time left in the legislative session, she noted one option could be Gov. Kay Ivey's executive authority to enact Medicaid expansion. Smith added using the power could be the simplest path forward, backed by the promise of additional funding from the American Rescue Plan.

A Connecticut bill would expand the state's paid sick leave law.

The initial 2011 law requires 40 hours of paid sick leave for workers at employers with 50 businesses or more. The new bill covers all workers regardless of their employer's size.

Janée Woods Weber, executive director of the nonprofit She Leads Justice, said the legislation can benefit workers without access to paid sick leave.

"These are people for whom taking a few hours off when their child has a cold or perhaps they need to take themselves to a doctor's appointment are the kinds of challenges that many of us don't worry about, those of us who do have access to paid sick days," Woods Weber explained.

Small businesses were concerned about how the change could affect them. To address worries, the bill has a three-year implementation cycle giving them time to adapt. It also creates a task force studying the feasibility of providing tax credits to businesses with the smallest workforces. The bill passed the House and awaits a vote in the Senate.

An estimated 11% of workers are eligible for paid sick leave under the current criteria. Though expanding the law has taken over a decade, Woods Weber argued it has always been necessary.

"Nobody should be forced to make what is often times a very difficult and sometimes impossible choice between their livelihood," Woods Weber emphasized. "Getting a paycheck and getting to take paid time off to take care of themselves or a loved one if they get sick."

She added that once the bill is passed, the state can build off it by allowing people to earn more than 40 hours of paid sick time. Woods Weber said the isolation requirements during the pandemic forced anyone who got COVID-19 to use their allotted sick time all at once for isolation.


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