Public policy

Apache is functioning normally

A cadre of Silicon Valley elites is drawing fierce criticism from local residents and environmentalists for planning a new city on the outskirts of the Bay Area, a project dubbed “California Forever.” But the effort should be applauded for revealing a truth about California’s failed housing policies.

This group of California’s most influential wants to build one or more new towns on the urban fringes, having spent about $900 million to buy an area roughly twice the size of San Francisco some 60 miles east of the city. The project breaks with the philosophy of the state’s housing policy, which has long been focused on urban densification.

Despite the state’s efforts to encourage residential development, California’s housing markets remain among the least affordable in the country. The homeownership rate is near the nation’s lowest. To afford a house at the median price today in Southern California, a family needs an annual income of $180,000, twice the region’s median.

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Some housing advocates insist that the solution is to force growth into existing neighborhoods. Yet the state’s supposedly pro-development new housing laws have yet to produce more homes at a scale sufficient to address the affordability crisis, and recent data suggest an accelerating decline in housing production.

Over the last five years, California has consistently lagged in construction not just of single-family housing but of multifamily housing as well. Not one California metropolitan area was among the top 50 in housing growth last year; Texas had six areas on that list, Florida 11. Los Angeles, the state’s dominant metropolitan area, didn’t crack the top 200.

Clearly we need a new approach that is more aligned with market demands. A recent report by London Moeder, a San Diego real estate consultancy, noted that California regulations make it difficult to build the kinds of housing people are looking for, particularly multi-bedroom homes that can accommodate families.

Research by Jessica Trounstine at UC Merced similarly found that “preferences for single-family development are ubiquitous. Across every demographic subgroup analyzed, respondents preferred single-family home developments by a wide margin. Relative to single-family homes, apartments are viewed as decreasing property values, increasing crime rates, lowering school quality, increasing traffic and decreasing desirability.”

Opposition to densification of existing neighborhoods remains staunch in many cities, with some threatening a voter initiative to restore municipal control of zoning.

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California’s focus on increasing density in urban areas is also at odds with the national shift toward remote work and retail and office growth in more suburban, lower-density areas.

A sensible California housing policy would respond to these trends and consumer desires, much as the Bay Area project promises to do. This does not mean we will need sprawling growth.

California’s population is dropping and is not expected to increase in the next four decades, which alters projections of future housing needs. The solution lies in strategic growth. Rather than force growth in places that are declining in population and resistant to development, including Los Angeles County and San Francisco, the state needs to look at the parts of California that are growing, places such as Riverside and Yolo counties.

To encourage growth where it’s happening naturally, the state could create a “Housing Opportunity Area” comprising the Central Valley and Inland Empire, subject to more liberal rules than the coast. Land costs are far lower in the interior of the state than in metropolitan Los Angeles, San Francisco, San Diego and San José. Policies that support inland development could help stem the outbound migration of Californians.

The rise of remote work means development away from urban centers is far more plausible and less environmentally toxic than in the past. Indeed, the International Energy Agency suggests that if everybody able to work from home worldwide were to do so just one day a week, it would save around 1% of global oil consumption for road transport per year. That would prevent 24 million metric tons of annual carbon dioxide pollution, equivalent to the bulk of greater London’s emissions. And roughly 40% of California’s jobs, including 70% of its higher-paying ones, could be done at home, according to research by the California Center for Jobs and the Economy.

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Equally promising, many new suburbs are being designed in consciously more sustainable ways, as MIT professor Alan Berger suggests. Sophisticated systems for controlling energy and water use can make suburban and exurban communities more environmentally responsible. Another promising innovation is broader use of manufactured housing, which has the potential to speed construction by as much as 50%, according to a 2019 McKinsey & Co. report. A single-family subdivision is under construction by 3-D printer in suburban Austin.

There are still opportunities for innovative housing production in dense urban cores such as downtown San Francisco and Manhattan. New York Mayor Eric Adams is seeking to quickly add 20,000 housing units through office building conversions. He has also proposed a larger program to convert more than 130 million square feet of office space to residential use, though he needs state legislation to reach that goal.

More such promising opportunities may lie in old, underused retail spaces in both cities and suburbs, which have the advantage of simple floor plans, ample parking and presence across metropolitan California. A recently announced plan to replace Buena Park’s vacant Sears building with 1,100 housing units could represent one piece of our housing future. Flagging malls in Orange County and throughout California provide similar possibilities.

Such developments are critical to our increasingly diverse middle and working class. Older, overwhelmingly white Californians have achieved high rates of homeownership, but the rates among millennials, African Americans and Latinos are well below the national average.

If they don’t leave the state entirely, younger generations will tend to continue to migrate outward in search of affordable suburbs. The majority of people of color in California live in suburbs, accounting for virtually all suburban growth over the past decade. Communities could be built in the exurbs and beyond for senior citizens, too, helping to produce new housing opportunities for young families near job centers. The outer suburbs and exurbs are the future homes of most Californians.

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We have the land for such a new vision. While other populous states have devoted as much as a third of their land to urban development, California’s developed lands constitute only 6% of the state. A “7% solution” to the California housing crisis would free up 1 million more acres to build the new communities that we largely stopped building around 2000, when we had 5 million fewer people.

Relying on billionaires to build new cities in the hinterlands isn’t a generally sustainable answer to California’s housing crisis. But the California Forever project does rightly suggest that our solutions must build on the state’s penchant for innovation, capitalism and a distinctly suburban lifestyle.

Joel Kotkin is the presidential fellow in urban futures at Chapman University. Wendell Cox is the principal of Demographia, a public policy consulting firm.

Source: latimes.com

Apache is functioning normally

Apache is functioning normally

Gender-affirming care encompasses a broad range of psychological, behavioral and medical treatments for transgender, nonbinary and gender-nonconforming people.

The care is designed to “support and affirm an individual’s gender identity” when it is at odds with the sex they were assigned at birth, as defined by the World Health Organization.

What is gender-affirming surgery?

Gender-affirming surgery refers to the surgical and cosmetic procedures that give transgender and nonbinary people “the physical appearance and functional abilities of the gender they know themselves to be,” according to the American Society of Plastic Surgeons. It is sometimes called gender reassignment surgery.

There are three main types of gender-affirming surgeries, per the Cleveland Clinic:

  • Top surgery, in which a surgeon either removes a person’s breast tissue for a more traditionally masculine appearance or shapes a person’s breast tissue for a more traditionally feminine appearance. 

  • Bottom surgery, or the reconstruction of the genitals to better align with a person’s gender identity.

  • Facial feminization or masculinization surgery, in which the bones and soft tissue of a person’s face are transformed for either a more traditionally masculine or feminine appearance.   

Some people who undergo gender-affirming surgeries also use specific hormone therapies. A trans woman or nonbinary person on feminizing hormone therapy, for example, takes estrogen that’s paired with a substance that blocks testosterone. And a trans man or nonbinary person on masculinizing hormone therapy takes testosterone.

Gender-affirming surgeries and treatments are the recommended course of treatment for gender dysphoria by the American Medical Association. Gender dysphoria is defined as “clinically significant distress or impairment related to gender incongruence, which may include desire to change primary and/or secondary sex characteristics,” according to the American Psychiatric Association.

Some LGBTQ+ advocates and medical professionals feel that gender dysphoria shouldn’t be treated as a mental disorder, and worry that gender dysphoria’s inclusion in the DSM-5 — the authoritative source on recognized mental health disorders for the psychiatric industry — stigmatizes trans and nonbinary people.

How much does gender-affirming surgery cost?

Gender-affirming surgery can cost between $6,900 and $63,400 depending on the precise procedure, according to a 2022 study published in The Journal of Law, Medicine and Ethics.

Out-of-pocket costs can vary dramatically, though, depending on whether you have insurance and whether your insurance company covers gender-affirming surgeries.

There are also costs associated with the surgery that may not be represented in these estimates. Additional costs may include:

  • Surgeons fees

  • Hospital fees

  • Consultation fees

  • Insurance copays

  • The cost of psychiatric care or therapy, as most insurance companies and surgeons require at least one referral letter prior to the surgery. An hour of therapy can cost between $65 and $250, according to Good Therapy, an online platform for therapists and counselors. 

  • Time off work. After bottom surgery, you can expect to miss six weeks of work while recovering. Most people miss around two weeks of work after top surgery. 

  • Miscellaneous goods that’ll help you recover. For example, after bottom surgery, you might need to invest in a shower stool, waterproof bed sheets, cheap underwear and sanitary towels. Top surgery patients may need, depending on the procedure, a mastectomy pillow, chest binder and baggy clothes.

Is gender-affirming surgery covered by insurance?

It’s illegal for any federally funded health insurance program to deny coverage on the basis of gender identity, sexual orientation or sexual characteristics, per Section 1557, a section of the Affordable Care Act. Section 1557 doesn’t apply to private insurance companies, though, and several U.S. states have passed laws banning gender-affirming care.

The following states have banned gender-affirming surgery for people under 18 years old, according to the Human Rights Campaign: Alabama, Arkansas, Florida, Georgia, Idaho, Indiana, Iowa, Kentucky, Louisiana, Mississippi, Missouri, Montana, Nebraska, North Carolina, North Dakota, Oklahoma, South Dakota, Tennessee, Texas, Utah, West Virginia. In four of these states — Alabama, Arkansas, Florida and Indiana — court injunctions are currently ensuring access to care.

And these states have either passed laws — or have governors who issued executive orders — protecting access to gender-affirming surgery, according to the Movement Advancement Project, a public policy nonprofit: California, Colorado, Connecticut, Illinois, Maryland, Massachusetts, Minnesota, New Jersey, New Mexico, New York, Oregon, Vermont and Washington, D.C.

But even if your state has enshrined protections for gender-affirming care, some private insurance companies may consider surgeries “cosmetic” and therefore “not medically necessary,” according to the Transgender Legal Defense and Education Fund. If you have private insurance or are insured through your employer, contact your insurance company and see if they cover gender-affirming care. Also, ask about any documentation the insurance company requires for coverage.

The Williams Institute estimates that 14% of trans Americans currently enrolled in Medicaid live in states where such coverage is banned, while another 27% of trans Americans live in states where coverage is “uncertain,” because their state laws are “silent or unclear on coverage for gender-affirming care.”

Because of Section 1557, Medicaid is federally banned from denying coverage on the basis of sex or gender; among the roughly 1.3 million transgender Americans, around 276,000 have Medicaid coverage, according to a 2022 report from the Williams Institute.

How to pay for gender-affirming surgery

If your private insurance company won’t cover gender-affirming care, and you’re unable to obtain coverage through the federal marketplace, consider these sources:

There are also several nonprofits that offer financial assistance for gender-affirmation surgeries. Those organizations include:

  • Point of Pride, which offers grants and scholarships to trans and nonbinary people seeking gender-affirming surgery and care.

  • Genderbands, which offers grants for gender-affirming surgeries and care. 

Source: nerdwallet.com

Apache is functioning normally

Apache is functioning normally

LAS VEGAS – With mortgage rates headed to 8%, the current housing slump is unlikely to reverse course until 2025, due to the Federal Reserve’s continued ratcheting up of interest rates, mortgage experts said at a conference in Las Vegas. 

Analysts continue to warn about overcapacity in the industry with too many lenders and employees to support current origination volumes. 

Federal Reserve Chair Jerome Powell signaled last week that interest rates need to stay higher for longer to tame inflation and that it could raise interest rates once more this year. The Fed’s policies have hit potential homebuyers the hardest as mortgage rates approach their highest levels in 23 years, analysts said.

“If the Fed keeps rates where they are today, then I think you’re going to easily see 8% mortgages because the survivors in the mortgage market — once we get rid of another 50% of capacity — are going to want to make money and that’s how they’re going to do it,” said Christopher Whalen, chairman of Whalen Global Advisors, on Tuesday at the National Mortgage News Digital Mortgage conference in Las Vegas.

Mortgage industry analyst Christopher Whalen, left, and Julian Hebron of the Basis Point, center, discuss housing policy with the former head of the Federal Housing Finance Agency Mark Calabria, right, during the National Mortgage News Digital Mortgage Conference on September 26 at the Wynn Resort in Las Vegas.

Whalen was joined by Mark Calabria, a senior advisor at the Cato Institute and the former director of the Federal Housing Finance Agency, in a debate about current public policy and its effect on the mortgage market.

Calabria said the main obstacle to buying a home is finding a house that is affordable. He  questioned the Biden administration’s public policy approach, which is focused primarily on providing access to credit to low and moderate-income communities at a time when mortgage rates are above 7% and home prices are still rising due to a lack of inventory.

“There’s just too much tension in Washington where the sense is that we’re going to make the mortgage market and mortgage policy the answer to all these other unrelated things which are real — there are very real social injustices we should fix —  but the mortgage market is not the solution for all of them,” Calabria said. “I worry that mortgage policy is bearing the weight of trying to fix a number of things that really have very little to do with the mortgage markets.”

Calabria, the author of “Shelter from the Storm: How a COVID mortgage meltdown was averted,” described how he resisted repeated calls for a bailout of mortgage servicers early in the pandemic. The Federal Reserve had stepped in with a broad array of actions including lowering interest rates, sparking a massive refinance boom in 2020 and 2021. Calabria then applied an adverse market fee to refinances but exempted lower-income borrowers. 

Julian Hebron, founder of the Basis Point, a consulting firm, and veteran mortgage executive, questioned whether the FHFA should be setting pricing in the mortgage market and asked whether it’s “appropriate for GSEs to raise fees to build capital to prepare for downturns.”

Calabria said the government-sponsored enterprises should be charging so-called g-fees for guaranteeing the timely payment of principal and interest on mortgage-backed securities because doing so covers projected credit losses from borrower defaults over the life of a loan. 

“Ultimately, I don’t think the regulator should be driving prices,” Calabria said.

He also said Fannie Mae and Freddie Mac will remain in conservatorship for the foreseeable future but also envisions a way out of government control — by having the GSEs raise fees.

“If you’re a CEO of one of these companies, it sucks being micromanaged, and I know that as somebody who micromanaged the CEOs,” he said. “If I was the CEO of one of these companies and I had the freedom to do it, I would jack up G-fees so I can build capital and get out two or three years earlier than I would otherwise. Because again, it sucks being in  conservatorship for these companies, at least at the top.”

Calabria took office in 2019 and sought to end government control over Fannie Mae and Freddie Mac, which guarantee 70% of the roughly $12 trillion U.S. mortgage market. Though Calabria was confirmed by the Senate to a five-year term, he was fired in 2021 by President Biden following a Supreme Court ruling. Biden named Sandra Thompson as Calabria’s successor. 

Whalen laid the blame for the current high interest rate environment squarely on the Fed and its actions in dropping rates in response to the pandemic. Roughly 90% of homeowners currently are locked in to mortgage rates below 6% and many are paying less than 4% on loans that were refinanced when the Fed held interest rates near zero. As a result, homeowners are not selling their properties, resulting in record-low inventory and a general gumming up of the mortgage market in a high-rate environment.  

“The trouble is that the Fed’s actions through COVID distortéd the market so much that lenders are losing 200 to 250 basis points on every loan they make,” said Whalen. “Even though the agencies and the FHA subsidize the cost of mortgages, that’s really what they do, it’s not about getting a mortgage, it’s about how much does it cost every month, which goes across every product in America.” 

Many forecasts that are well-founded in data have been upended by major events, such as COVID or a bank failure. Whalen said that the only way mortgage rates could get down to 6% or 6.5% in the near-term is if there is another bank failure. 

“If we see another surprise in the banking market, the Fed is going to be forced to back off,” said Whalen, adding that he is concerned that interest rates are making asset prices go down. “If we see another failure, they are going to probably have to turn to the Treasury for support or tax the industry to raise cash because there won’t be three or four buyers out in the room.”

Source: nationalmortgagenews.com

Apache is functioning normally

Apache is functioning normally

When you need to borrow cash, the last thing you want to encounter is a fraudster plotting to steal money from you. But as people increasingly shop for personal loans online, scammers are ready to take advantage.

Consumers reported losing nearly $8.8 billion in losses to fraud in 2022, according to the Federal Trade Commission. Those reports included imposters and scammers claiming to provide loans in exchange for information or money.

“Separating the legitimate lenders from the fakes can be really hard, and the scammers get better every day at making their pitches look more convincing,” says John Breyault, vice president of public policy, telecommunications and fraud at the nonprofit National Consumers League.

Before you provide personal or financial information, here are five signs the loan you’re considering may be a scam.

1. Text messages and robocalls

An out-of-the-blue robocall or text message inviting you to apply for a loan should give you pause, especially if you’ve had no prior contact with the lender.

The borrower usually makes the first move to get a personal loan by pre-qualifying or directly applying. In some cases, your bank or credit card issuer may send you a preapproved loan offer or an online lender may send follow-up emails after you check for offers with them.

But if the message makes you wonder how the lender found you, don’t trust it. Delete suspicious text messages and hang up on robocallers, Breyault says. Even saying “don’t contact me” could signal that you’re likely to respond, so the calls and texts may persist.

2. Advertisements of ‘guaranteed’ approval

A trustworthy lender can’t guarantee you’ll get a loan without reviewing your credit and finances, so avoid those that promise approval before you’ve even applied, Breyault says.

“Any legitimate lender is going to want to do a credit check on you to know if you’re going to be able to pay them back,” he says.

A high-interest lender may provide a loan with no credit check, but many at least do a soft credit pull and review your bank accounts before approval.

3. No state registration

Lenders are required by law to register in the state where they do business.

So if you have doubts about a lender, check to see if it’s licensed. The Consumer Financial Protection Bureau (CFPB) maintains a list of state bank regulators, and the National Association of Attorneys General has a list of states’ attorneys general, which are good places to start your search.

Just because a lender posts a license on its website doesn’t mean it’s real, Breyault says, so it’s best to confirm.

If you can’t find the license, treat it like a red flag and report it to your state regulator, says Suzanne Martindale, senior deputy commissioner for the consumer financial protection division at the California Department of Financial Protection and Innovation (DFPI).

4. A bad online reputation

You can also search online for the lender’s name and the word “scam,” which may surface regulatory actions against a legitimate lender or links to the community website Reddit where other people have shared their experiences. Even California’s DFPI uses Reddit to research companies, Martindale says.

“Online communities do tend to form when there have been red flags, and so it does pay to slow down, think before you click and do a little online research,” she says.

5. Asking for money or gift cards

Legitimate lenders never require payment in exchange for a personal loan. Personal loan scammers may request an Apple or Google Play gift card, or payment via an app like Venmo, Breyault says. Recently, payment requests via cryptocurrency have also become common, he says.

“The fact that you’re being asked to pay is a red flag,” he says, and “the fact that you’re being asked to pay in an unusual way is a really big red flag.”

What to do if you’ve been scammed

Learning you may have been swindled can leave you feeling embarrassed and frustrated, but keep in mind that people make millions of fraud reports each year.

Here are some steps to take if you suspect you’ve been scammed, and ways to find the cash you sought in the first place.

  1. Try to get your money back. Your debit and credit cards have certain protections that may help you recoup some or all of the stolen funds. Reach out to your bank card issuer immediately for the best chance of fast reimbursement. You’re less likely to get the money back if you sent it via gift card or digital wallet.

  2. File a report. Investigators prioritize scams that affect many people, so filing a report could get the scammer on their radar and help others avoid the same fate. Report fraud anonymously to the National Consumers League at fraud.org.

  3. Get support. If you’ve lost money, a nonprofit credit counseling service may help get you back on track. These organizations can help you budget, manage debt, negotiate bills and find community resources that may provide funds or other assistance.

  4. Find the cash you need. There are legitimate ways to borrow money, whether it’s from a loan company or friends and family. If a personal loan is your best option, compare loans from multiple reputable lenders to find affordable financing.

Source: nerdwallet.com

Apache is functioning normally

Lesley Alli and Andrew Greenberg both joined NMI Holdings to serve as senior vice presidents, announced the parent company of National Mortgage Insurance Corporation Monday in a statement.

Adam Pollitzer, president and CEO of National MI, said that the addition of Alli and Greenberg  would help drive value for borrowers, lenders and shareholders. 

“We’re delighted to have two executives as talented and experienced as Lesley and Andrew join our strong executive management team,” said Pollitzer in a statement.

Alli was named senior vice president of industry relations and corporate communications. In this role, she will lead the company’s efforts in external public and industry relations, touching on corporate communications, public policy, government enterprise and agency affairs. Prior to this new position, she served as the chief investor and industry relations officer of Home Point Financial Corporation. She also held senior managerial positions at Federal National Mortgage Association (Fannie Mae) and Countrywide Home Loans, amounting to a 20+ years career in the mortgage industry. 

Alli also received numerous accolades in her field: she was recognized as one of Housing Wire‘s 50 “Women of Influence” in 2021.

Meanwhile, Greenberg was promoted to senior vice president of finance where he will oversee investor relations, financial planning, analysis, data analytics and treasury. He previously served as senior vice president of business development and investor relations at Triton International Limited, a leading publicly-traded specialty finance company. From 2002 to 2014, Greenberg was a director of investment banking with Barclays where he led strategic advisory and capital raising efforts for financial institution clients. 

Source: housingwire.com

Apache is functioning normally

Thousands of New York City Airbnb listings are vanishing from the market as the city introduces some of the strictest regulations in the U.S. for short-term rentals.

Starting on Sept. 5, hosts of short-term rentals will need to register with the city, The Wall Street Journal reported. Airbnb hosts will have to meet several new requirements, including not renting out an entire apartment or home; and being present during guests’ short-term stays. 

Airbnb estimates that 5,300 existing reservations would be affected during the first week of enforcement, according to an August legal filing. There are around 10,800 illegal short-term rentals across the city, per municipal government estimates.

New York City’s Short Term Rental registration Law took effect March 6, 2023. It prohibits rental companies like Airbnb, Vrbo and Booking.com from processing transactions for unregistered rentals.

Airbnb has called the rules a de facto ban on short-term rentals.

A ripple effect in other cities?

Some industry stakeholders believe other cities might follow suit. City councils in Dallas, Philadelphia and New Orleans have passed their own restrictions on short-term rentals.

There are about 38,500 Airbnb listings in the New York City, not counting hotels that list on the platform, the report said. The annual net revenue for these listings is $85 million. The city estimates there are about 10,800 illegal short-term rentals citywide.

Local politicians and housing advocates argue that the new rules will safeguard the availability of affordable housing, while some property owners say Airbnb rentals offer reliable supplementary income, the Gothamist reported.

“We’re trying to find a path forward with the city but for the moment, it’s going to be complicated,” Nathan Rotman, Senior Public Policy Manager at Airbnb, told the Gothamist. “Parts of the city are going to lose out on the economic opportunity these visitors bring, and a lot of hosts are going to lose what little income they make from the short-term renting that they do on an occasional basis.”

Source: housingwire.com

Apache is functioning normally

With the typical cost of a home in Los Angeles soon topping $1 million, and the state’s median rent approaching $3,000, there’s a sense of doom around how unaffordable California has become. We clearly need more housing density to meet the current needs. But we don’t have to sacrifice the lifestyle to which Californians have grown accustomed.

Los Angeles is geographically vast — nearly twice the size of Chicago and significantly larger than New York City, with much lower population density than those two cities. Jobs are nearly as dispersed here as homes, and none of our transportation options work that well: We are too sparse for trains and we have under-prioritized bus service, which most Angelenos don’t use because it’s rarely the fastest option. L.A. is built around cars, yet it’s also now too dense for vehicle traffic to move efficiently.

But this kind of sprawl can be put to good use. In contrast to Chicago and New York, whose commercial centers dwarf job prospects elsewhere in each city, Greater Los Angeles has numerous clusters of job-rich areas. The Westside and Irvine rival downtown L.A., and employment centers in Glendale, the West Valley, Long Beach, Anaheim and the Inland Empire each contains roughly half as many jobs as there are downtown.

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We can reframe our planning for housing around these medium-density urban hubs, which are scattered throughout the region. This approach has been a successful and flexible model, especially outside the U.S. Consider the densely populated suburbs of Tokyo, which offer varied housing types and transportation options, or the suburbs of many major European cities built around lower density townhomes, row houses or smaller apartment buildings and duplexes. Often those developments are close to a commuter rail station that can take residents into the central city in less than 45 minutes.

Maximizing our multiple job centers requires that we shift course from our single-family-dominated residential landscape to hit a sweet spot that works for Californians: more density, but not so dense that Angelenos will have to sacrifice the space we’re used to. We should focus on increasing smaller multifamily housing (i.e. two to eight units) while still making it possible for people to live close enough to employment centers.

To do this, we have to reform our land use — including laws that discourage building for density — to provide alternatives to sprawling single-family neighborhoods. This does not necessarily mean obliterating the urban forms and communities that have been built in the past century. But without some densification, we’ll keep pushing people and development into the Inland Empire and other outlying areas (which is already happening). The result is predictable: more punishing commutes and, in all likelihood, still expensive housing.

I live in a single-family home on L.A.’s Westside, and I see firsthand how laws that favor my type of home hold the neighborhood back. Although I live next door to multifamily housing, those apartments and townhomes are the exception in my neighborhood. Restrictions on building anything but a single-family home or an accessory dwelling unit stretch a mile from my house to the nearest stop on the Metro E (formerly known as Expo) Line. Restrictions on building apartments apply to most land plots in a one-mile radius around that Metro stop.

These zoning limitations make no sense: They mean too few people can live close enough to generate the ridership necessary to justify the immense investment it took to build the E Line. Further, the neighborhood’s single-family housing is so astronomically expensive — a million dollars will get you … nothing — that the people most likely to rely on the E Line cannot afford to live there. There are several reasons why ridership is down on L.A. Metro’s trains and buses, and too little density near transit is a major reason.

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Remote work has also opened up new possibilities for housing in Southern California. A key factor that continues to drive up real estate in central cities is the increased tendency for higher-income households to live closer to highly urbanized areas. Remote work can help ease these rent pressures by making some central neighborhoods less appealing for higher-income office workers who no longer have to go into a downtown office.

Neighborhoods such as Echo Park and Boyle Heights might see some relief from constantly rising rents and displacement pressures. More strategic planning around transit-rich neighborhoods would further relax rent increases in these neighborhoods. If we can allow for greater density in more neighborhoods, particularly in zones close to dispersed job centers such as Santa Monica, Pasadena and Burbank, then the areas most at risk of gentrification should see some relief.

This approach would also allow greater flexibility in the type of development needed to meet state housing mandates. Under state guidelines, Southern California has to add 1.3 million housing units by 2029. If we have, by a conservative estimate, at least 12 major job centers, each hub should be zoned to serve 100,000 units of housing within commuting distance to reach the 2029 goal.

With remote work and less than daily commutes, the potential commuting distance many workers are willing to accept will be greater. In turn, this significantly expands the land area where we can build units to serve an employment hub, providing workers with many more potential housing possibilities. But only if we allow them to be built.

Los Angeles has a unique urban landscape. Because of our many dispersed employment-rich centers and broad geography, we don’t have to mimic East Coast cities to increase housing density. We don’t need to build condo towers or skyscraper apartment buildings to house everyone. The path to a more livable and equitable future is clear: Allow more housing in a diversity of well-connected neighborhoods, and L.A. can still remain L.A.

Michael Lens is a professor of urban planning and public policy, and associate faculty director of the Lewis Center for Regional Policy Studies at UCLA.

Source: latimes.com

Apache is functioning normally

Incessant patient-monitor alarms. Hospital food. Middle-of-the-night checks of vital signs. The audible suffering of random roommates.

Yes, being in the hospital is no fun, and not only because you’re receiving treatment for an acute illness or serious injury.

Decades ago, doctors began wondering if select patients presenting in hospital emergency rooms with certain illnesses and injuries couldn’t be sent home to be monitored closely and treated there, rather than being admitted to a hospital ward. This seemed feasible for many chronically ill patients experiencing flare-ups, such as people with complications from diabetes or certain heart conditions.

“Who wouldn’t want to be home rather than in the hospital?” says Dr. Jeff Levin-Scherz, an assistant professor at the Harvard T.H. Chan School of Public Health and a health management consultant at WTW, a financial services company. And the stressful hospital environment isn’t just unpleasant for patients; it can impede their healing.

“Who wouldn’t want to be home rather than in the hospital?”

Jeff Levin-Scherz, health management consultant

Adoption of the concept took off in late 2020, as the overcrowding of hospitals treating COVID-19 patients motivated the federal government to authorize and reimburse hospital-at-home care across the country. These programs, now available through nearly 300 hospitals in 37 states, are demonstrating some ability to provide acute, hospital-level care for patients in their own homes, through a variable mix of provider visits, infusions and other treatments, remote monitoring and portable diagnostics.

Many emergency department physicians are glad to consider home hospital care for appropriate patients. “It gives ER doctors an extra option for patients who they are thinking about admitting,” says Dr. Gregg S. Meyer, president of the Community Division and executive vice president of Value-Based Care for the Mass General Brigham health care system in Boston.

But home hospital care may not be the best option for everyone it’s offered to. Data on health outcomes is limited, and a patient’s personal preferences and home situation should factor into the choice of acute care setting. Insurance coverage for home hospital care may not be the same as for traditional inpatient care.

Here’s what you or someone close to you should know about home hospital care — just in case.

Which illnesses and conditions are suited to acute care at home?

Hospital-at-home programs can treat diseases like pneumonia, chronic obstructive pulmonary disease, diabetes, liver disease and heart failure (a chronic condition), as well as acute conditions like serious urinary tract or skin infections. Each provider institution creates its own list of diseases and conditions for which it may offer acute care at home.

In addition to direct medical care, institutions typically offer a range of services for a hospital-at-home admission. Health care provider Kaiser Permanente’s program for advanced care at home offers services such as medical equipment, oxygen, laboratory testing, medical meals and supplies, mobile diagnostics, pharmacy, blood draws and transportation.

Still, there is reason for caution. For one, the physicians’ task of choosing the right patients to be offered acute care at home — “those not too sick but sick enough” — is complex, wrote the authors of a 2023 paper analyzing the effectiveness of burgeoning hospital-at-home programs, published in Public Policy & Aging Report. “Minimal research informs this issue, and no reliable standards or diagnostics have yet been set.”

Will my insurance pay for home hospital?

If you have private insurance through an employer or state or federal marketplace, contact your insurer and inquire about your coverage for hospital-at-home services provided by specific hospitals in your area. Medicare has led the way with paying for home health care, reimbursing these programs for their services at the same rate as if the patient were in the hospital.

Medicaid coverage for home hospital care varies by state. Contact your state’s Medicaid office to learn more.

How does the quality of care compare?

Because hospital-at-home programs are just beginning to gain traction, research on the quality of care that they provide is limited. But so far, the data is mostly encouraging.

“There are dozens of randomized controlled trials that show that acute care at home is actually superior to traditional care in the hospital on many, many outcome metrics,” says Dr. David Levine, a clinician-investigator at Brigham and Women’s Hospital and an assistant professor at Harvard Medical School.

According to Mount Sinai Health System’s data on its home hospital program, 30-day re-admission rates for the New York City provider’s home hospital patients were less than half of those treated in the hospital: 7.8% versus 16.3% for the two years ending December 2016.

On another key metric, how long a patient remains in acute care, Mount Sinai’s impressive results were in line with those of many other home hospital programs. The average length of stay for acute care was 5.3 days for patients in the hospital versus 3.1 days for the system’s hospital-at-home patients. (Since 2020, the average home hospital stay has increased to 4.4 days, probably for reasons related to the COVID-19 pandemic.)

However, concerns about patient care quality and safety have made many physicians reluctant to send acutely ill patients to home hospital care, according to the Public Policy & Aging Report paper. “To date, a handful of rigorous studies have found positive cost and quality results, but these are based on tiny samples.”

How safe is home hospital care?

How does patient safety compare for home hospital versus inpatient care? Each environment has pros and cons. In a hospital ward, a registered nurse is always seconds away, and a doctor can be at a patient’s bedside in minutes; response times for home hospital care are longer. But hospitals have their own safety problems. In 2015, an estimated 72,000 patients with health-care-acquired infections died while in the hospital, according to the Centers for Disease Control and Prevention.

Overall, home hospital care has “very, very low unexpected mortality and very low rates of complications,” says Dr. Bruce Leff, director of The Center for Transformative Geriatric Research at Johns Hopkins Medicine.

Some patients receiving acute care at home say they feel safer in their own domestic environment than in a hospital. That was the case for Theresa Corcoran, 87, who in April 2023 suffered a cut on her leg that required many stitches. Weeks later, after developing a serious skin infection in the injured leg, Corcoran was evaluated at Brigham and Women’s Hospital in Boston during a 24-hour stay and then admitted to the system’s hospital-at-home program, which provided antibiotic infusions and wound care.

“Getting to the bathroom wasn’t easy for her” while she was in a hospital ward, says Bridget Ellis, a registered nurse. Ellis was one of the nurses who visited Corcoran during her time in hospital at home. Corcoran said that during her treatment she felt more confident moving around her own home in Belmont, Massachusetts.

The home environment also helps patients in acute care maintain their mental health while healing physically, Ellis says. “If someone wakes up in the hospital in the middle of the night, they’re very confused about where they are. Not being around familiar faces and surroundings, people do get very confused and some lash out — it can be difficult to keep them safe.”

A study at Johns Hopkins Medicine found that delirium was observed in 9% of hospital-at-home patients versus 24% of inpatients.

How does it feel to be a hospital-at-home patient?

When the hospital offered Corcoran admission to Mass General Brigham’s hospital-at-home program, “my first thought was, ‘Ooh, go home?’ That sounded good,” she says. “The places of comfort for me are in my own home.” In the hospital, “there were people in beds in the hallway.”

Corcoran says that at home, it was easier to heed her doctors’ advice. “One of the good things about this is that I can find a spot that’s comfortable in my house and keep my leg up.” Corcoran also says that sleeping in her own bed in peace and quiet and having meals on her own terms helped set the stage for healing.

When Corcoran entered hospital-at-home care, “we had a lot of people coming in, and a lot of phone calls, and a lot of doorbells ringing,” to set up the equipment and services that Corcoran would require, says Jane Chiarelli, Corcoran’s daughter. “I think it’s very important that the patient has somebody with them, at least at the beginning.”

Mass General Brigham home hospital patients do have the option of receiving 24-hour care with home health aides.

How do home hospital patients fare after discharge?

In Ellis’ experience, patients typically do better after they are released from hospital-at-home care than when they are discharged from a hospital ward.

“Being in the hospital, sometimes patients are in bed three or four days straight without getting up much,” she says. “Patients get very weak, and they do end up in rehab. At home, they’re not relying on nurses to bring them food, walk them to the bathroom or roll them in bed. They’re up and moving around a lot more, so they keep up their strength.”

Source: nerdwallet.com