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TheAssociatedPress SANJOSE Women in Cal- ifornia can now get birth control directly from a pharmacist without a pre- scription from their doctor. A law that allows Califor- nia pharmacists to directly provide prescription con- traceptives went into effect Friday. The new law gives phar- macists the ability to dis- pense hormonal contra- ceptives that women can administer themselves, in- cluding transdermal, vagi- nal and injection prescrip- tion birth control methods, the San Jose Mercury News reported. But it's not a simple over- the counter process. Women requesting birth control will have to complete a health questionnaire, and a pharmacist will also con- sult with the patient about the most suitable form of birth control. If the contraceptive re- quested poses a high blood pressure risk, the woman's blood pressure must be taken before a prescription is issued. Women still need to see a doctor to get an IUD or a contraceptive implant since they require a medical pro- cedure to be administered. "Community pharma- cies are the face of neigh- borhood health care — open beyond normal business hours, and patients do not need an appointment to see their pharmacist," said Jon Roth, CEO of the California Pharmacists Association, which sponsored the orig- inal legislation on behalf of the state's 6,500 com- munity pharmacies. "That means pharmacists provid- ing contraception will go a long way to expand wom- en's birth control." California joined Oregon as the only states that allow pharmacists to prescribe birth control. Critics say the new law sends the wrong message to teenage girls by allow- ing them to more easily get contraceptives. "They say it's for women, but they mean anyone," in- cluding teenage girls, Cali- fornia Right to Life spokes- woman Camille Giglio said. "The ability to get contra- ceptives from yet another source is not a benefit to young people," she added. "It is a barrier to commu- nication between a mother and a child." Information from: San Jose Mercury News, http:// www.mercurynews.com. CALIFORNIA Women can get birth control from a pharmacist By Steven Moore Eureka Times Standard A silent killer lurks in homes with gas or oil fur- naces, or appliances run- ning on natural gas includ- ing refrigerators, clothes dryers, ranges, water heat- ers and space heaters. Carbon monoxide also is a by-product of fire- places, charcoal grills, generators and wood burning stoves. Given all those sources for carbon monoxide production, most Humboldt County residents are at some risk for the colorless, odorless, tasteless gas. County Public Health Of- ficer Dr. Donald Baird said improper ventilation for any device creating car- bon monoxide, or CO, can lead to a build up that puts people at risk. Power out- ages during storms and floods can prompt people to use generators as a power source. "The biggest risk is put- ting the generators in the garage with improper ven- tilation," Baird said. "If that leaks into the house, that can be dangerous." California is one of 26 states that requires all sin- gle-family homes with an attached garage or a fos- sil fuel source to install carbon monoxide alarms within the home, and own- ers of multi-family leased or rental dwellings, such as apartment buildings, also are required to comply. Senate Bill 183, known as the Carbon Monoxide Poi- soning Prevention Act, was signed into law in 2010 by then-Gov. Arnold Schwar- zenegger to promote pub- lic safety in the same way the smoke detector require- ment protected people from waking up to a smoke-filled house. Chris Emmons, a battal- ion chief with Humboldt Bay Fire, said his crews look for functional CO de- tectors as part of their rou- tine inspections of certain facilities, especially big apartment complexes. Em- mons recalls an incident before California's CO de- tector law was enacted in which crews responded to several medical aid calls from the same house be- cause one of the girls in the family was complain- ing of headaches, short- ness of breath and flu-like symptoms. On one of the calls, the crew members themselves were affected, Emmons said. "As soon as they went in- side, they started getting headaches," he said. A check of the premises showed CO saturation at harmful levels, and a plan for corrective action on the home was possible to pre- vent additional harm to the family. "We had a whole family that got really lucky there, but that was before the law," Emmons said. Emmons and Baird agreed CO detectors make as much sense as have a smoke alarm, and both should be considered fun- damental elements of res- idential safety. CO detec- tors and combination CO and smoke alarms are avail- able at home improvement stores. "Even if it's not required, older homes are the ones that people should consider installing carbon monoxide detectors," Baird said. A check for CO detectors is part of the inspection for any home up being sold or refinanced to make sure the house is in compliance with the law. As of March, 30 states have statutes regarding carbon monoxide detec- tors, and another 11 have administrative regula- tions in place, according to the National Conference of State Legislatures. Cali- fornia also requires detec- tors in school buildings, and the State Fire Marshal is charged with developing an approved carbon monox- ide device list, and prohib- iting the marketing, distri- bution or sale of devices not on the list. About 430 people die each year from carbon monoxide poisoning in the United States, according to the U.S. Centers for Disease Control and Prevention. Carbon monoxide poi- soning was suspected in the deaths of at least 10 peo- ple in one week alone last month. From March 20-26, four people were found dead in a Delaware apartment build- ing, a man was found dead inside a storage building in Texas, a Vermont cou- ple died in their home, and three people died after an Oklahoma man woke up to find his family unrespon- sive. In each of the inci- dents, carbon monoxide poisoning is the suspected cause. Of those four states, only Vermont requires carbon monoxide detectors in pri- vate dwellings by state stat- ute, the conference of state legislatures says. Carbon monoxide is hard to detect without a device, and the signs of poisoning can be subtle, Baird said. "Oftentimes, it's not that obvious. You might have a dull, aching headache in the beginning," he said. "Confusion can follow, and that can lead to coma if it's severe." People who are sleep- ing or intoxicated can be- come gravely affected, lead- ing to memory loss, perma- nent brain damage or death without fresh air or emer- gency medical care. Car- bon monoxide concentra- tions build in the blood- stream, replacing oxygen in red blood cells, which de- prives tissues and organs of oxygen. Other symptoms include weakness, dizziness, nausea or vomiting, shortness of breath and blurred vision. Steven Moore can be reached at 707-441-0510. RESIDENTIAL SAFETY Detectors reduce the risks of carbon monoxide poisoning SHAUNWALKER—THETIMES-STANDARD Mark Larsen describes how a carbon monoxide detector works at Pierson Building Center in Eureka on Thursday. By Alejandra Cancino The Associated Press CHICAGO The federal gov- ernment is pushing states to keep more low-income seniors out of nursing homes and, instead, enroll them in home and commu- nity-based programs. The shift comes as de- mand for long-term care is rising. By 2050, the number of people older than 85 is ex- pected to triple to more than 18 million. These seniors tend to have the highest dis- ability rate and the greatest need for long-term care. The tug-of-war between rising demand and con- trolling costs has advocates for seniors worrying about quality of care. Medicaid is one of the largest expenses for states, and a it's a program they look to for savings when budgets are tight. Medicaid spending on long-term care was $146 billion in fiscal year 2013, including nearly $89 billion just for seniors. Advocates say programs for seniors often wind up on the chopping block. For example, Illinois is considering changes to its home and community- based program that would reduce funding by about $200 million. "I think that often- times people are afraid of change, regardless of what that change is," said An- drea Maresca, director of federal policy and strat- egy at the National Associ- ation of Medicaid Directors. There's room to improve the programs, Maresca said, and states are also trying to make sure seniors don't lose access to services. Loren Colman, of the Minnesota Department of Human Services, said it took that state roughly 25 years to shift from in- stitutional care to home and community-based pro- grams. The focus now is on help- ing older adults remain at home, delaying expensive nursing home care and sup- porting family caregivers. To rein in costs, some states are changing pay- ment systems from fee-for- service to managed care, which generally pays a per-person rate to provid- ers who manage seniors' health and social services. Gwen Orlowski, an attor- ney at Central Jersey Legal Services, said New Jersey's managed care program is an improvement over its previous system, but not without issues. She's had to help some seniors appeal service cuts. "I do worry that the deliv- ery of services is beholden to the money that the man- aged-care companies are receiving (from the state) and the money they want to make," said Orlowski, whose office provides free legal assistance to low-in- come seniors. To address fears, new fed- eral regulations have been proposed to strengthen pro- tections for seniors in man- aged care, including help with appeals. A final rule is expected this spring. Already, states are work- ing on implementing earlier rules from 2014 aimed at im- provingqualityofcareacross programs. In exchange for federal dollars, states must ensure that seniors have a say over where they want to live,andgettreatedwithdig- nity and respect. Robyn Grant, director of public policy and advo- cacy for the National Con- sumer Voice for Quality Long Term Care, said reg- ulations are a "step in the right direction," but there needs to be proper enforce- ment. "Unfortunately, that's very nebulous," Grant said. The cornerstone of home and community-based pro- grams is personal care ser- vices, such as providing an aide who helps with cook- ing or cleaning. Those ser- vices cost a fraction of nurs- ing home care. The average per-person cost of Illinois' Community Care Program is $860 per month, less than a third of the cost for a nursing home. Over the last decade, how- ever, enrollment has dou- bled to more than 83,000 people, costing the state nearly $1 billion in fiscal 2015. One of those seniors is Yuen Chu Wong, 71, of Chi- cago, who worked at a choc- olate factory until she re- tired nearly a decade ago. Wong requested a home- care aide about seven years ago when her health began deteriorating. The aide, Wan Ling He, does laundry for Wong and her husband, cleans the apartment and prepares traditional Chinese soups. The two women have de- veloped a friendship, often talking in their native Can- tonese about food and cook- ing shows. Wong calls her aide "an old friend." Illinois is now propos- ing to move about half the seniors in its program to a new initiative it says will in- crease flexibility while low- ering costs. For example, it may pay for Uber rides to doctors' appointments in- stead of sending a driver to seniors' homes. Lori B. Hendren, associ- ate state director of advo- cacy and outreach at AARP Illinois, said the new pro- posal raises questions about the state's commit- ment to seniors aging inde- pendently and with dignity at home. "Where will the savings come from?" Hendren said. "The devil is in the details." 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