Food Requirement

The kind and amount of food need by a person depend upon the following factors:

1. Age of the person: Young and growing children need more protein in their diet. Proteins are important in building up their body. Old people need less protein.
2. Sex of the person: A male need more food than a female. Similarly, a boy required more food than a girl.
3. Nature of work: A laborer doing manual work requires more food than a clerk doing table work in office.
You may be a vegetarian or a non-vegetarian depends upon the type of food you eat. The following table gives information about the amount of different food stuffs that children of your age should eat daily. This table is provided by ICMR.

Food	Requirement Dite for Vegetarian (10-12 years)	Requirement Dite for Non-Vegetarian (10-12 years)
1. Cereals	320 gm	320 gm
2. Pulses	60 gm	60 gm
3. Green leafy Vegetables	100 gm	100 gm
4. Other Vegetables	50 gm	50 gm
5. Fruits	50 gm	50 gm
6. Milk	250 gm	200 gm
7. Fats and Oils	35 gm	35 gm
8. Meat, Fish and Eggs	-	30 gm
9. Sugar and Jaggery	50 gm	50 gm

Stay the Course with SHIP

State budget cuts are not the only threat to seniors and people with disabilities. Federal reductions may be coming as well.

The US Senate is considering a 42% reduction in funding to the State Health Insurance Assistance Program, which counsels seniors and people with disabilities on their Medicare health plan options. SHIP funding would drop to a mere $20 million, diminishing the numbers and quality of the SHIP workforce.

SHIP is Necessary Now More than Ever

Every day, 10,000 Americans become eligible for a Medicare system that is increasingly more complex. Medicare beneficiaries pay the price for the confusion:

700,000 Medicare are paying the Part B Late Enrollment Penalty because they missed the deadline to sign up,
Medicare Part D beneficiaries in Low-Income Subsidy are often unaware of lower priced options,

SHIP counselors are trained to sort through the mess of enrollment rules and multitude of health plan options. The Illinois program includes 600 SHIP counselors located across the State. These counselors provide free, unbiased counseling on Medicare, Medicare supplemental policies, Medicare managed care and long-term care insurance. Seniors can turn to SHIP counselors for assistance with fraud and abuse issues, billing problems and filing appeals. Annually, the Illinois SHIP creates a comparison guide for all Medicare supplemental policies, a vital resource to figure out the alphabet soup of options.

Poorer Trained, Less Helpful

The federal cuts would compromise SHIP's ability to adequately serve everyone who needs help. One and a half million fewer people would receive assistance. Moreover, most of the SHIP counselors are volunteers who donate almost two million hours of help. Cuts could also result in reduced or compromised volunteer training, which increases the risk of erroneous advice and reduces the quality of services beneficiaries receive.

No Substitute

Those in favor of the cuts claim there are less costly alternatives to SHIP. This is untrue. The materials suggested as substitutes, 1-800 Medicare, Medicare.gov and the Medicare Enrollment Handbook, all list SHIP as a resource for people to use with additional questions. A brochure is no substitute for one-on-one, expert advice.

What You Can Do

Tell your Senator to fight cuts to the SHIP program, that your family, friends, even you personally, benefit from the free services that SHIP counselors provide. It's easy:

Send our Senators this model letter drafted by the National Council on Aging. Just copy and paste the text into their contact forms:  Sen. Kirk's form  Sen. Durbin's form (remember to sign your name!)
Tweet your advocacy with this graphic we created – and tag @SenatorKirk @SenatorDurbin
Feel free to personalize with your story, or the story of loved ones. Personal stories make a difference!

Go ahead, spread the word, fight the cuts. And as you do, share your efforts with Illinois Health Matters!


Bryce Marable MSW
Health Policy Analyst
Health & Disability Advocates

The Price We Pay for Cutting Gym

Photo via Jordan Richmond

According to a Center for Disease Control report 26 percent of New York City public school Kindergarten through 8th grade students are obese. Think about that. One in four New York City public school students are obese. With such a startling statistic you would think physical education is a top priority for the New York City Department of Education. But New York City Comptroller Scott M. Stringer's report, “Dropping the Ball: Disparities in Physical Education in New York CitySchools,” reveals a severe lack of certified physical education teachers, lack of space for physical education classes, and dismal reporting procedures implemented by the New York City Board of Education.

Specifically the report reveals:

- 41 percent of high schools have no physical fitness space

- 35 percent of middle schools have no physical fitness space

- 230,000 students lack a full-time, certified Physical Education teacher

- 91,000 students attend a school that does not have access to an outdoor school yard or nearby park

Bronx Health REACH’s school wellness program, Healthy Schools NY, works with 22 Bronx schools involving school staff, parents, and administrators to change policies and practices on nutrition and physical activity. One of the goals is to achieve the New York State-mandated 120 minutes of physical education per week. When children engage in school-day physical education, results can be seen in improved academic classroom performance such as better concentration, attentiveness and success in the classroom.

This is not the first time a New York City Department of Education audit has been conducted by the NYC Comptroller. A 2011 NYC Comptroller audit revealed that 100 percent of 31 elementary schools examined (at the time) were out of compliance with State PE regulations. A 2001 study conducted by a local non-profit group in partnership with the NYC Board of Education analyzed 391 schools (one third of the New York City public schools in the system that year) and concluded that “physical education [was] among the last areas of the New York City school system to recover from the fiscal crisis of the mid-1970s” and had been “persistently undervalued” and “sacrificed to the push for academic achievement, despite research showing that organized sports and physical fitness improve children’s performance both academically and socially.

Inset of Bronx public schools that lack a full-time certified PE teacher.

So here we are in 2015 and the problems still persist. Spaces for physical education in the schools disappeared as the Board of Education converted gyms and school yards into classrooms and parking lots, permitting athletic facilities to fall into disrepair. Lack of accountability can be traced back to the New York State Education Department failing to enforce its own regulations around physical education. When asked by the Comptroller's Office, State officials responded that they “counted on local school districts to monitor their own compliance.” Without full and complete data the Comptroller’s Office was not able to do a complete analysis of whether New York City schools are meeting New York State physical education instructional time requirements or contractually agreed-upon class size mandates.

According to Department of Education data, 2,216 full-time, licensed Physical Education teachers at general education schools are assigned to 1,072 schools leaving 506 schools citywide (over 32 percent) without a fulltime, certified PE teacher. A parent speaking to the New York Daily News stated, "All our kids are dealing with health and weight issues," said Synthia Bachman, 42, a programmer from Manhattan whose son attends the Children's Workshop School in the East Village. Kids and parents at the Children's Workshop School said the school has no gym. Students said they use an adjacent playground for exercise when the weather is good and the school's lobby for gym class in the winter." Yes, you read that correctly. The school’s lobby is being used as a gym.

Inset of Bronx public schools lacking fitness spaces.

Providing physical education to over 1 million New York City public school students can be a challenge but the New York City Board of Education must take steps to improve students’ access to physical education by implementing a system that tracks and monitors where resources are needed.

With that in mind the Comptroller recommends the following:

- Comply with state regulations requiring that all New York City public school students receive physical education instruction from, or under the supervision of, a certified physical education teacher

- Update the New York City Department of Education’s District Physical Education Plan, submit it to NYSED and post a copy on the DOE website

- Develop instruments for tracking and monitoring schools’ provision of physical education for all students

- Develop internal systems allowing the agency to track and monitor schools’ compliance with State PE regulations

- Post physical education data for every New York City school on the Department of Education website

Lack of physical education in New York City public schools over the long term wreaks economic havoc as children become adults. In New York City alone, obesity is projected to cost the City over $4 billion in health care expenses annually. Eventually we all end up paying these costs that can easily be prevented by holding those accountable and meeting physical education mandates for every school that will improve the health and well-being of all New York City children.

Images used above by NYC Dept of Education, Citizens' Committee for Children used in the Stringer report, “Dropping the Ball: Disparities in Physical Education in New York CitySchools.”

Active Design Toolkit for Schools Celebrated at Earth School Rooftop Garden

The Partnership for a Healthier New York City released the Active Design Toolkit for Schools with a celebration at the Earth School’s rooftop garden, “the Fifth Street Farm.” The Earth School is a featured success story in the new toolkit, which was developed by the Partnership for a Healthier NYC in collaboration with representatives from New York City’s Departments of Health & Mental Hygiene, Education and Transportation. The Partnership for a Healthier Bronx and Partnership for a Healthier Manhattan, the Institute for Family Health and the Icahn School of Medicine at Mount Sinai all worked in concert on the toolkit. A strong group of community advocates, parents and students gathered to mark the launch of the new publication, which promotes creative changes, like the Earth School’s rooftop garden, to guide schools to design spaces that make physical activity and healthy foods easy, accessible choices.

The Active Design Toolkit for Schools provides ideas, resources and tools to help school communities and advocates foster physical activity and promote well-being of students across New York City schools.  The focus areas include Active Recreation, Healthy Food and Beverage, Green Spaces and Nature, and Getting to and From School.

Among those in attendance was Charmaine Ruddock, Director of Bronx Health REACH at the Institute for Family Health. She noted, “With the crisis of overweight and obese children,  especially in the Bronx, the toolkit provides schools with the necessary information to make changes that have a real impact on how students interact with and move in their environment. Resources found in the toolkit are adaptable to a range of school settings. Active Design for Schools creates ample opportunities for children to be physically active in school settings where they spend so much of their time.”

The Active Design Toolkit for Schools believes that "Every child deserves a healthy, positive school environment. Children’s physical, emotional and social development all benefit from daily physical activity and healthy eating. Better fitness levels are also associated with better academic performance."

At present only 20% of New York City high-school students are getting 60 minutes of daily physical activity and less than half participate in daily school physical education.  Another shocking statistic is that 40% of New York City students in kindergarten through 12th grade are overweight or obese, and this could become a greater problem as they can be at greater risk for chronic diseases as they enter adulthood. The physical spaces in schools makes a difference as to whether children will or will not become physically active. The benefits of children being physically active at school include: more focus and attentiveness on school tasks, higher self-esteem, and lower risk of chronic diseases as they enter adulthood.

Two Bronx schools are included in the Active Design Toolkit for Schools: P.S. 87 in the Wakefield section of the Bronx and Jonathan D. Hyatt School (P.S. 154), located in Mott Haven. P.S. 87 transformed an asphalt yard into a sports park featuring a soccer field, running track, play equipment, and a water fountain. Built over three years, Jonathan D. Hyatt School (P.S. 154) created a  fruit and vegetable garden for the school's Gardening Afterschool club that also includes a chicken coop. Used as an outdoor classroom to educate students about healthy eating, the school would like to partner with the Department of Education SchoolFoods's Garden to Cafe program and create a student-run farm stand. Now there may be more farmers markets coming to a school near you.

Success Story: Lucero Elementary School Hosts Second Annual Family Fitness Night

On the evening of May 21^st, Lucero Elementary School in the Bronx held its second Family Fitness Night since the school opened in 2013. The event featured physical activity stations, a nutrition education workshop led by Corbin Hill and New Settlement Apartments, tastings from the SchoolFood Alternative Menu facilitated by George Edwards of Garden to Café, and a variety of healthy food samples for students and their families.

The event was organized by Lucero’s School Wellness Council, spearheaded by Ms. Muia, the PE teacher. The school has won Gold for the Excellence in School Wellness Award for the past two years, and this year Ms. Muia was recognized as runner up for School Wellness Champion of the Year. She was also chosen to participate in the NYC Department of Education’s new PE Focus Grant, an opportunity for select PE teachers to participate in professional development and promote best practices for physical education among other schools in their district.

Family Fitness Night was the culminating event of Fitness Week—a school-wide effort to promote physical activity among the student body. Each day of the week fostered awareness around a different activity, such as Move Around Monday and Touch Your Toes Tuesday. Regular announcements made over the intercom reminded students to get up and stay active throughout the school day. Since regular physical activity is linked with improved academic performance in addition to better health outcomes, we hope other schools will follow Lucero’s lead in providing more opportunities for students to be physically active.

What Really Happens After Enrolling in Medicaid Managed Care?

 

Health & Disability Advocates (HDA) is monitoring the rollout of the Medicare-Medicaid Alignment Initiative (MMAI) and has heard from frustrated case managers working with consumers who are confused about the enrollment process and their rights. In response, HDA developed an enrollment timeline that explains what new enrollees can expect from Managed Care Organizations (MCOs) and plan representatives upon enrollment. To produce the timeline, HDA researched the MMAI demonstration contract developed by the State of Illinois and approved by the Center for Medicare and Medicaid Services (CMS)  HDA also solicited input from health plans on whether their on-the-ground practices were accurately reflected in the timeline.

The finished product outlines important points for case managers and their clients to consider.

One Day Changes Everything

Consumers who are enrolled in a managed care plan after the 12th day of the month will not see their coverage start until the month after next. This is relevant for consumers choosing a specific managed care plan in order to see a particular provider or specialist in that plan’s network. Submitting paperwork after the cut-off date means consumers would have to wait longer than expected for necessary treatment. Helping consumers submit required documents in a timely manner can guarantee they are connected to the medical treatment they need, which promotes continuity of care.

Stratification Sets Up Future Contact Standards

Once enrolled in a plan, all enrollees can expect to complete a Health Risk Screening within 60 days. The screen collects information on the enrollee’s physical and mental health conditions and identifies their current medical providers. This is what IlliniCare’s Health Screen looks like. Health plans use the screen to establish intensity of services and frequency of contact with Care Coordinators by stratifying the enrollee as low, moderate or high risk.

Enrollees stratified as low risk will receive annual follow-ups from their Care Coordinators while those stratified as moderate or high risk will have quarterly follow-ups. Moderate and high risk enrollees will also complete a Health Risk Assessment and create an Individualized Care Plan within 90 days. These enrollees will help form their own Interdisciplinary Care Team of healthcare providers that meets quarterly to review the Individualized Care Plan.

The Care Coordinators’ Role

Care Coordinators focus on enrollees’ healthcare needs by connecting them to necessary tests, doctors and treatment. They also facilitate information sharing among providers by leading the Interdisciplinary Care Team. Addressing enrollees’ medical needs is their priority. Care Coordinators direct less attention to linking enrollees to social supports, like housing and public benefits.

It’s also important for case managers to know that Care Coordinators must manage a substantial caseload of up to 600 enrollees. Caseloads include a blend of low, moderate and high risk enrollees, with each risk level weighted differently.

Understanding what a care coordinator can—and cannot—be expected to do is advantageous to case managers. When roles are clearly recognized, case managers know how care coordinators can be used as a resource. And in what instances an alternative referral would be more appropriate. This establishes a stronger professional relationship between case managers and care coordinators, which ultimately benefits the enrollee.

Case managers and Care Coordinators are on the front lines of healthcare reform and fostering solid working relationships between these two players will be a critical component of the success or failure of these efforts. Knowing what case managers and their clients can expect from managed care plans can lay the foundation for a strong relationship that supports the health of individuals while also furthering the goals of healthcare reform.

Bryce Marable MSW

Health Policy Analyst

Health & Disability Advocates

People With Disabilities Who Opt Out of ‘Voluntary’ Wellness Programs Will Pay the Price, and the EEOC’s Okay With That.

The following originally appeared on the American Civil Liberties Union's Speak Freely Blog.

 Voluntary wellness programs at work can provide benefits to employees, but employers are increasingly adopting “voluntary” wellness programs that unfairly burden workers with disabilities the most of all. Worse, the Equal Employment Opportunity Commission seems to think that’s okay, undermining core antidiscrimination protections it used to defend.

Here’s why.

Imagine a woman living with rheumatoid arthritis and severe depression who, under doctor’s care, has finally returned to work. Her medications — a corticosteroid and an antidepressant — have triggered weight gain. Now imagine this woman facing her employer’s “wellness activities:” She is instructed to fill out a detailed questionnaire about her medical conditions; she is weighed and pronounced overweight; she is told to lose weight. Oh, and the program is voluntary — but if she doesn’t comply, she will have to pay hundreds of dollars more in annual health care premiums. 

This imaginary example is all too real: Persons with disabilities risk discrimination and stigma if their employers gain access to their private medical information. And disabled workers are far more likely to have a condition targeted by wellness programs, such as high blood pressure, high blood glucose, or being overweight. 

Historically, the Americans with Disabilities Act has provided employees with disabilities some protections against overly intrusive and punitive wellness programs. The EEOC has maintained, sensibly, that voluntary medical examinations and inquiries cannot impose penalties on employees who decline to participate. 

Until now.

The EEOC has recently proposed new regulations and guidance language on wellness programs that would allow employers to implement wellness programs that add up to 30 percent of the cost of the employee’s health insurance to an employee’s health care bill. Based on the average annual premium, this translates to an extra cost for disabled employees of about $1,800 per year, either because they don’t want to answer questions that could expose their disability to their employer or because they cannot meet the health goal

The EEOC describes these programs as “voluntary,” but workers with disabilities are the least likely to be able to afford additional health care premiums. According to the U.S. Census Bureau, median household income for people with disabilities is less than half of household income for people without disabilities: $25,974 compared to $61,103. At the same time, there is little evidence that these programs are effective. 

If the EEOC is going to allow employers to charge workers hundreds more each year, it needs to be sure important privacy and disability protections are in place.

Three safeguards matter the most. First, the EEOC needs to provide guidance language that workers with disabilities have the right to request a reasonable accommodation waiver from a wellness program, so that their medical status can be taken into account in their ability to comply. The guidelines should also protect disabled workers’ privacy, so that their decision to join or not join the wellness program doesn’t broadcast the details of — or even the existence of — their medical condition to their employer. Finally, disabled workers should rest assured that the guidelines protect them from disability-based discrimination in the workplace, such as harassment of employees who cannot comply with “normal” health standards. 

Comments on the proposed regulations are due this Friday, June 19, 2015. Tell the EEOC not to permit employers to subject their disabled workers to a Hobson’s choice: Submit to the prescribed wellness activities, or pay hundreds more each year. The EEOC should instead insure that workers with disabilities can opt out of these programs without penalty. 

Claudia Center

Senior Staff Attorney

American Civil Liberties Union