Today, we peer into long-term care in America — those services, both medical and non-medical, that patients in old age or with chronic illness need to perform activities of daily living.

More than half of older Americans will eventually require long-term care. And this number will only swell as we reach into the next decade when, for the first time in our nation’s history, there will be more elderly than children. Of these Americans, the vast majority would prefer to age at home and in their communities. But our long-term care system, such as it is, is ill-equipped to accommodate them. 

Nearly 1 million Americans nationally languish on waiting lists for home-based care, with an average wait time that exceeds 3 years. More than 50 million, meanwhile, serve as unpaid caregivers for their family. And 3 in 4 worry about not being able to afford a nursing home, which on average, costs $100,000 a year. By way of reference, the median household income among those 65 or older in 2018 was $44,000.

Medicare, the federal insurance program for older Americans, does not cover long-term care. Nor do most private insurance programs — which themselves exact exorbitant costs. Wealthy Americans can pay out of pocket, and Medicaid covers the very poor and disabled. But the vast majority — or “forgotten middle” — of Americans, have no sustainable option for accessing care.

Here to discuss this broken system — and why COVID-19 has exposed and exploited all those caught in its breach — is Dr. David Grabowski, Professor of Health Care Policy at Harvard Medical School and an acclaimed decades-long researcher of long-term and post-acute care. David has published dozens of articles on the economics of aging and is the perfect person with whom to explore both the challenges and the opportunities for long-term care in the United States. His reflections on this moment are not to be missed.

For more on Civic Rx, visit civic-rx.org.

While COVID-19 continues to dominate news headlines, another crisis lurks unabated and largely unaddressed: climbing maternal deaths. Among industrialized nations across the globe, the United States stands out as the most dangerous for pregnant women. Over 700 women die each year, 60% of them from preventable causes, during pregnancy or delivery. And Black women are 3 times more likely to die than White women.

Perhaps surprisingly, it didn’t used to be this way.

For much of the 20th century, the US enjoyed an almost unmitigated decline in its maternal mortality rate, driven by scientific advances and improvements in general living conditions. But in the late 1980s, that progress began to stall. The maternal mortality rate in 1987 was 7.2 deaths per 100,000 births; by 2017, that rate had more than doubled. Today, the US is the only country in the developed world to see its maternal mortality rate go up; American mothers are 50 percent more likely to die in childbirth than their own mothers were. And it has the highest maternal mortality rate of any wealthy nation in the world.

What’s provoked such a dramatic rise in America's maternal mortality rates — just as the rest of the developed world has pushed its' down? Why are women of color disproportionately vulnerable? And what can we do, at the hospital level and the state and federal levels, to redress maternal health inequities?

Few are better poised to shed light on these questions than Dr. Elizabeth Howell, Chair of the Department of Obstetrics & Gynecology at the University of Pennsylvania’s Perelman School of Medicine. Dr. Howell is a practicing ob/gyn and a nationally recognized leader in redressing maternal and child health disparities. And on today's episode, together, we begin to unpack America’s maternal mortality crisis.

For more, check out the below:

- to learn about the Black Maternal Health Momnibus Act

- to watch Dr. Howell’s TEDMED talk

- to understand the Alliance for Innovation on Maternal Health’s (AIM) safety bundles, and

- to get a “primer” on maternal mortality in the U.S., from the Commonwealth Fund

And to learn more about Civic Rx, go to civic-rx.org.

Just last week, Dr. Rochelle Walensky became the first CDC director in more than 20 years to call for federal action against gun violence. Meanwhile, President Biden both on the campaign trail and since has vowed his commitment to advancing meaningful gun reform, publishing six executive orders on the issue this April. And the NRA — long the swaggering villain in this saga — has been steadily losing sway, as it’s mired in bankruptcy and litigation.

Is this a tipping point in the fight for gun safety?

Today, we talk with Shannon Watts and DeAndra Dycus, two extraordinary mothers and founder and volunteer, respectively, of Moms Demand Action: America’s largest grassroots movement to prevent gun violence. Together, we explore why this fight is so often marked by cycles of tragedy and neglect, what might be done to break the political stalemate, why we need gun owners at the table, and which policy solutions are most likely to be effective — as well as the stories of Shannon and DeAndra themselves. 

It’s a humbling conversation. No matter your stance on gun safety, I hope you’ll join us and take a listen.

To learn more and join the gun violence prevention movement, visit momsdemandaction.org or text JOIN to 644-33.