Could the shingles vaccine lower your risk of dementia?

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A recent study has suggested Shingrix, a relatively new vaccine given to protect older adults against shingles, may delay the onset of dementia.

This might seem like a bizarre link, but actually, research has previously shown an older version of the shingles vaccine, Zostavax, reduced the risk of dementia.

In this new study, published last week in the journal Nature Medicine, researchers from the United Kingdom found Shingrix delayed dementia onset by 17% compared with Zostavax.

So how did the researchers work this out, and how could a shingles vaccine affect dementia risk?

Melinda Nagy/Shutterstock

From Zostavax to Shingrix

Shingles is a viral infection caused by the varicella-zoster virus. It causes painful rashes, and affects older people in particular.

Previously, Zostavax was used to vaccinate against shingles. It was administered as a single shot and provided good protection for about five years.

Shingrix has been developed based on a newer vaccine technology, and is thought to offer stronger and longer-lasting protection. Given in two doses, it’s now the preferred option for shingles vaccination in Australia and elsewhere.

In November 2023, Shingrix replaced Zostavax on the National Immunisation Program, making it available for free to those at highest risk of complications from shingles. This includes all adults aged 65 and over, First Nations people aged 50 and older, and younger adults with certain medical conditions that affect their immune systems.

What the study found

Shingrix was approved by the US Food and Drugs Administration in October 2017. The researchers in the new study used the transition from Zostavax to Shingrix in the United States as an opportunity for research.

They selected 103,837 people who received Zostavax (between October 2014 and September 2017) and compared them with 103,837 people who received Shingrix (between November 2017 and October 2020).

By analysing data from electronic health records, they found people who received Shingrix had a 17% increase in “diagnosis-free time” during the follow-up period (up to six years after vaccination) compared with those who received Zostavax. This was equivalent to an average of 164 extra days without a dementia diagnosis.

The researchers also compared the shingles vaccines to other vaccines: influenza, and a combined vaccine for tetanus, diphtheria and pertussis. Shingrix and Zostavax performed around 14–27% better in lowering the risk of a dementia diagnosis, with Shingrix associated with a greater improvement.

The benefits of Shingrix in terms of dementia risk were significant for both sexes, but more pronounced for women. This is not entirely surprising, because we know women have a higher risk of developing dementia due to interplay of biological factors. These include being more sensitive to certain genetic mutations associated with dementia and hormonal differences.

Why the link?

The idea that vaccination against viral infection can lower the risk of dementia has been around for more than two decades. Associations have been observed between vaccines, such as those for diphtheria, tetanus, polio and influenza, and subsequent dementia risk.

Research has shown Zostavax vaccination can reduce the risk of developing dementia by 20% compared with people who are unvaccinated.

But it may not be that the vaccines themselves protect against dementia. Rather, it may be the resulting lack of viral infection creating this effect. Research indicates bacterial infections in the gut, as well as viral infections, are associated with a higher risk of dementia.

Notably, untreated infections with herpes simplex (herpes) virus – closely related to the varicella-zoster virus that causes shingles – can significantly increase the risk of developing dementia. Research has also shown shingles increases the risk of a later dementia diagnosis.

A woman receives a vaccination from a female nurse.
This isn’t the first time research has suggested a vaccine could reduce dementia risk. ben bryant/Shutterstock

The mechanism is not entirely clear. But there are two potential pathways which may help us understand why infections could increase the risk of dementia.

First, certain molecules are produced when a baby is developing in the womb to help with the body’s development. These molecules have the potential to cause inflammation and accelerate ageing, so the production of these molecules is silenced around birth. However, viral infections such as shingles can reactivate the production of these molecules in adult life which could hypothetically lead to dementia.

Second, in Alzheimer’s disease, a specific protein called Amyloid-β go rogue and kill brain cells. Certain proteins produced by viruses such as COVID and bad gut bacteria have the potential to support Amyloid-β in its toxic form. In laboratory conditions, these proteins have been shown to accelerate the onset of dementia.

What does this all mean?

With an ageing population, the burden of dementia is only likely to become greater in the years to come. There’s a lot more we have to learn about the causes of the disease and what we can potentially do to prevent and treat it.

This new study has some limitations. For example, time without a diagnosis doesn’t necessarily mean time without disease. Some people may have underlying disease with delayed diagnosis.

This research indicates Shingrix could have a silent benefit, but it’s too early to suggest we can use antiviral vaccines to prevent dementia.

Overall, we need more research exploring in greater detail how infections are linked with dementia. This will help us understand the root causes of dementia and design potential therapies.

Ibrahim Javed, Enterprise and NHMRC Emerging Leadership Fellow, UniSA Clinical & Health Sciences, University of South Australia

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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  • 52 Small Changes – by Brett Blumenthal

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    We see a lot of books that exhort us to get a six-pack in a month, change our life in 7 days, learn Japanese in 24 hours. The reality is, things take time!

    Brett Blumenthal is more realistic while being just as motivational:

    The idea is simple… Make one small change per week for 52 weeks, and at the end of the year, you’ll be healthier and happier.

    At 10almonds, we’re big fans of small changes that add up (or rather: compound!) to make big differences, so this one’s absolutely our style!

    Best of all, she offers us not just “do this” advice, but also “and here’s the information and resources you’ll need to make this change work the best it can for you”

    The advices range in topic from nutrition to exercise to sleep to mental wellness to interpersonal stuff and more. The biggest focus is on personal health, though, with small changes to exercise and nutrition making up the lion’s share of the changes.

    Bottom line: this is a book you’ll want to grab once a week. Consider setting a reminder on your phone to check in with it each Sunday, for example!

    Take the first step and order “52 Small Changes” from Amazon today!

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  • Astrology, Mental health and the Economics of Well Being

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    Ultimately can the mental health system single-handedly address the concerns of inequality and economic access in society?

    Around 75 per cent of the Indian population lives in rural areas, but their access to quality mental health care is limited and traditional approaches continue to be in use. The shortage is to such a large extent that there are only  0.7 physicians per 1000 population and only one psychiatrist for every 343,000 Indians. While over the years the mental health sector has seen major developments, like the 2017 mental health care act. This act establishes equal access for all citizens, to avail government-run or funded mental health services in the country. However, it does not bridge the gap in society as the majority of the population remains deeply unaware or unable to access these services. 

    While the uncertainties of the pandemic brought mental wellbeing to the forefront, the national budget for the sector dropped, making this an issue of human rights. This accessibility to services is further corroborated by the recurring financial expenses of medications and frequent visits to government clinics. The cost of sessions is steep and a single session is not ideal. Spending exorbitant amounts on healthcare is a burden most families can’t afford leading to debt. In the absence of insurance and healthcare schemes and provisions, therapy remains a luxury to many Indians.

    Economic struggles are only one of the causes of this discerning gap in the mental health sector. Barriers caused by sexuality, gender, caste and religion also play a major role in mediating people’s perception and access to therapeutic services. The persistent stigma surrounding mental health, especially in India continues to be a hindrance to seeking help. The supernatural inhibitions and disparity in knowledge across communities only create more confusion. The notion that mental well being is an optional expense is popular, even though the country’s population is in a dire state. Data collected in a WHO report found that nearly 15 per cent of Indian adults need active intervention for one or more mental health issues.

    The population disregards the very prevalence of such mental disorders and more than often finds it fruitless to receive treatment. Some who are open-minded fail to afford the hiked fees that therapists in urban settings charge, leaving them with no option. While for years Indians attributed the systemic weakness of the mental health system to the people’s attitudes, a 2016 survey showed more than 42% of people have positive attitudes toward mental wellbeing and treatment. While the skeptics remain, these underprivileged sections of society too struggle to gain the accessibility they deserve.

    This is where astrology, tarot card reading and other spiritual practices, have created a market for themselves in the well-being industry. The sceptics, and those from poor socio-economic backgrounds resort to these local and easily accessible ways of coping, to instil the faith they so desperately need. Astrology is a layman’s substitute for therapy, or for some even a supplement when they cannot afford extended periods of treatment. Visiting a local astrologer in many ways breeds the self-awareness one would expect from a session in therapy. These practices even hold certain similarities to actual psychotherapy settings, in the way they define, and alleviate aspects of one’s personality and behaviour.

    Very often one simply needs an explanation, or an answer to the ‘why’ no matter how scientifically rooted that response truly is. Astrologers impart a level of faith, that things will get better. For those in rural areas, struggling to provide the bare necessities to their family affording therapy is impossible, so their local psychic, astrologer or pandit becomes their anchor during emotional duress. Tarot cards and other practices primarily focus on the future and act as a guide point for how to deal with the things ahead. For a farmer coping with anxiety, access to anti-anxiety medication is strained, and so is therapy. His best bet remains to consult his next-door jyotish about his burdens.

    A famous clinician Caroline Hexdall in an interview said that “ Part of the popularity of astrology and tarot today has to do with their universal nature”. With growing technology and the pervasiveness of social media, people can gain easy access to self-care and astrology resources. Apps and web pages provide daily tarot cards, zodiac signs readings and astrological predictions for people, and almost serve the purpose of a therapist. Is reading the lines on our palm, and checking the alignment of the stars enough to cure the mental illness they undergo? Is it a solution or a quick fix as a consequence of an ignorant healthcare system?

    Several studies have also shown the deteriorating effects of depending on astrology. Cases of worsening and onset of depression, anxiety and personality disorders are common for those who use astrology as more than just a temporary coping mechanism. It also becomes a source of losing control, as every feeling is attributed to fate and destiny, instilling a sense of helplessness. Ultimately can the mental health system single-handedly address the concerns of inequality and economic access in society?

    Maahira Jain is a third-year student at Ashoka University studying Psychology and Media studies. She is a movie buff and is extremely passionate about writing and traveling.

    This article is republished from OpenAxis under a Creative Commons license. Read the original article.

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  • Chia Seeds vs Pumpkin Seeds – Which is Healthier?

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    Our Verdict

    When comparing chia seeds to pumpkin seeds, we picked the chia.

    Why?

    Both are great! But chia is best.

    Note: we’re going to abbreviate them both to “chia” and “pumpkin”, respectively, but we’ll still be referring to the seeds throughout.

    In terms of macros, pumpkin has a little more protein and notably higher carbs, whereas chia has nearly 2x the fiber, as well as more fat, and/but they are famously healthy fats. We’ll call this category a subjective win for chia, though you might disagree if you want to prioritize an extra 2g of protein per 100g (for pumpkin) over an extra 16g of fiber per 100g (for chia). Chia is also vastly preferable for omega-3.

    When it comes to vitamins, pumpkin is marginally higher in vitamin A, while chia is a lot higher in vitamins B1, B2, B3, B9, C, and E. An easy win for chia.

    In the category of minerals, for which pumpkin seeds are so famously a good source, chia has a lot more calcium, copper, iron, magnesium, manganese, phosphorus, and selenium. On the other hand, pumpkin has more potassium and zinc. Still, that’s a 7:2 win for chia.

    Adding up the categories makes for a very compelling win for the humble chia seed.

    Want to learn more?

    You might like to read:

    If You’re Not Taking Chia, You’re Missing Out: The Tiniest Seeds With The Most Value

    Take care!

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  • Could my glasses be making my eyesight worse?

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    So, you got your eyesight tested and found out you need your first pair of glasses. Or you found out you need a stronger pair than the ones you have. You put them on and everything looks crystal clear. But after a few weeks things look blurrier without them than they did before your eye test. What’s going on?

    Some people start to wear spectacles for the first time and perceive their vision is “bad” when they take their glasses off. They incorrectly interpret this as the glasses making their vision worse. Fear of this might make them less likely to wear their glasses.

    But what they are noticing is how much better the world appears through the glasses. They become less tolerant of a blurry world when they remove them.

    Here are some other things you might notice about eyesight and wearing glasses.

    Lazy eyes?

    Some people sense an increasing reliance on glasses and wonder if their eyes have become “lazy”.

    Our eyes work in much the same way as an auto-focus camera. A flexible lens inside each eye is controlled by muscles that let us focus on objects in the distance (such as a footy scoreboard) by relaxing the muscle to flatten the lens. When the muscle contracts it makes the lens steeper and more powerful to see things that are much closer to us (such as a text message).

    From the age of about 40, the lens in our eye progressively hardens and loses its ability to change shape. Gradually, we lose our capacity to focus on near objects. This is called “presbyopia” and at the moment there are no treatments for this lens hardening.

    Optometrists correct this with prescription glasses that take the load of your natural lens. The lenses allow you to see those up-close images clearly by providing extra refractive power.

    Once we are used to seeing clearly, our tolerance for blurry vision will be lower and we will reach for the glasses to see well again.

    The wrong glasses?

    Wearing old glasses, the wrong prescription (or even someone else’s glasses) won’t allow you to see as well as possible for day-to-day tasks. It could also cause eyestrain and headaches.

    Incorrectly prescribed or dispensed prescription glasses can lead to vision impairment in children as their visual system is still in development.

    But it is more common for kids to develop long-term vision problems as a result of not wearing glasses when they need them.

    By the time children are about 10–12 years of age, wearing incorrect spectacles is less likely to cause their eyes to become lazy or damage vision in the long term, but it is likely to result in blurry or uncomfortable vision during daily wear.

    Registered optometrists in Australia are trained to assess refractive error (whether the eye focuses light into the retina) as well as the different aspects of ocular function (including how the eyes work together, change focus, move around to see objects). All of these help us see clearly and comfortably.

    young child in clinical chair with corrective test lenses on, smiling
    Younger children with progressive vision impairments may need more frequent eye tests. Shutterstock

    What about dirty glasses?

    Dirty or scratched glasses can give you the impression your vision is worse than it actually is. Just like a window, the dirtier your glasses are, the more difficult it is to see clearly through them. Cleaning glasses regularly with a microfibre lens cloth will help.

    While dirty glasses are not commonly associated with eye infections, some research suggests dirty glasses can harbour bacteria with the remote but theoretical potential to cause eye infection.

    To ensure best possible vision, people who wear prescription glasses every day should clean their lenses at least every morning and twice a day where required. Cleaning frames with alcohol wipes can reduce bacterial contamination by 96% – but care should be taken as alcohol can damage some frames, depending on what they are made of.

    When should I get my eyes checked?

    Regular eye exams, starting just before school age, are important for ocular health. Most prescriptions for corrective glasses expire within two years and contact lens prescriptions often expire after a year. So you’ll need an eye check for a new pair every year or so.

    Kids with ocular conditions such as progressive myopia (short-sightedness), strabismus (poor eye alignment), or amblyopia (reduced vision in one eye) will need checks at least every year, but likely more often. Likewise, people over 65 or who have known eye conditions, such as glaucoma, will be recommended more frequent checks.

    older woman positioned for eye testing apparatus
    Eye checks can detect broader health issues. Shutterstock

    An online prescription estimator is no substitute for a full eye examination. If you have a valid prescription then you can order glasses online, but you miss out on the ability to check the fit of the frame or to have them adjusted properly. This is particularly important for multifocal lenses where even a millimetre or two of misalignment can cause uncomfortable or blurry vision.

    Conditions such as diabetes or high blood pressure, can affect the eyes so regular eye checks can also help flag broader health issues. The vast majority of eye conditions can be treated if caught early, highlighting the importance of regular preventative care.

    James Andrew Armitage, Professor of Optometry and Course Director, Deakin University and Nick Hockley, Lecturer in Optometric Clinical Skills, Director Deakin Collaborative Eye Care Clinic, Deakin University

    This article is republished from The Conversation under a Creative Commons license. Read the original article.

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  • With Medical Debt Burdening Millions, a Financial Regulator Steps In to Help

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    When President Barack Obama signed legislation in 2010 to create the Consumer Financial Protection Bureau, he said the new agency had one priority: “looking out for people, not big banks, not lenders, not investment houses.”

    Since then, the CFPB has done its share of policing mortgage brokers, student loan companies, and banks. But as the U.S. health care system turns tens of millions of Americans into debtors, this financial watchdog is increasingly working to protect beleaguered patients, adding hospitals, nursing homes, and patient financing companies to the list of institutions that regulators are probing.

    In the past two years, the CFPB has penalized medical debt collectors, issued stern warnings to health care providers and lenders that target patients, and published reams of reports on how the health care system is undermining the financial security of Americans.

    In its most ambitious move to date, the agency is developing rules to bar medical debt from consumer credit reports, a sweeping change that could make it easier for Americans burdened by medical debt to rent a home, buy a car, even get a job. Those rules are expected to be unveiled later this year.

    “Everywhere we travel, we hear about individuals who are just trying to get by when it comes to medical bills,” said Rohit Chopra, the director of the CFPB whom President Joe Biden tapped to head the watchdog agency in 2021.

    “American families should not have their financial lives ruined by medical bills,” Chopra continued.

    The CFPB’s turn toward medical debt has stirred opposition from collection industry officials, who say the agency’s efforts are misguided. “There’s some concern with a financial regulator coming in and saying, ‘Oh, we’re going to sweep this problem under the rug so that people can’t see that there’s this medical debt out there,’” said Jack Brown III, a longtime collector and member of the industry trade group ACA International.

    Brown and others question whether the agency has gone too far on medical billing. ACA International has suggested collectors could go to court to fight any rules barring medical debt from credit reports.

    At the same time, the U.S. Supreme Court is considering a broader legal challenge to the agency’s funding that some conservative critics and financial industry officials hope will lead to the dissolution of the agency.

    But CFPB’s defenders say its move to address medical debt simply reflects the scale of a crisis that now touches some 100 million Americans and that a divided Congress seems unlikely to address soon.

    “The fact that the CFPB is involved in what seems like a health care issue is because our system is so dysfunctional that when people get sick and they can’t afford all their medical bills, even with insurance, it ends up affecting every aspect of their financial lives,” said Chi Chi Wu, a senior attorney at the National Consumer Law Center.

    CFPB researchers documented that unpaid medical bills were historically the most common form of debt on consumers’ credit reports, representing more than half of all debts on these reports. But the agency found that medical debt is typically a poor predictor of whether someone is likely to pay off other bills and loans.

    Medical debts on credit reports are also frequently riddled with errors, according to CFPB analyses of consumer complaints, which the agency found most often cite issues with bills that are the wrong amount, have already been paid, or should be billed to someone else.

    “There really is such high levels of inaccuracy,” Chopra said in an interview with KFF Health News. “We do not want to see the credit reporting system being weaponized to get people to pay bills they may not even owe.”

    The aggressive posture reflects Chopra, who cut his teeth helping to stand up the CFPB almost 15 years ago and made a name for himself going after the student loan industry.

    Targeting for-profit colleges and lenders, Chopra said he was troubled by an increasingly corporate higher-education system that was turning millions of students into debtors. Now, he said, he sees the health care system doing the same thing, shuttling patients into loans and credit cards and reporting them to credit bureaus. “If we were to rewind decades ago,” Chopra said, “we saw a lot less reliance on tools that banks used to get people to pay.”

    The push to remove medical bills from consumer credit reports culminates two years of intensive work by the CFPB on the medical debt issue.

    The agency warned nursing homes against forcing residents’ friends and family to assume responsibility for residents’ debts. An investigation by KFF Health News and NPR documented widespread use of lawsuits by nursing homes in communities to pursue friends and relatives of nursing home residents.

    The CFPB also has highlighted problems with how hospitals provide financial assistance to low-income patients. Regulators last year flagged the dangers of loans and credit cards that health care providers push on patients, often saddling them with more debt.

    And regulators have gone after medical debt collectors. In December, the CFPB shut down a Pennsylvania company for pursuing patients without ensuring the debts were accurate.

    A few months before that, the agency fined an Indiana company working with medical debt for violating collection laws. Regulators said the company had “risked harming consumers by pressuring or inducing them to pay debts they did not owe.”

    With their business in the crosshairs, debt collectors are warning that cracking down on credit reporting and other collection tools may prompt more hospitals and doctors to demand patients pay upfront for care.

    There are some indications this is happening already, as hospitals and clinics push patients to enroll in loans or credit cards to pay their medical bills.

    Scott Purcell, CEO of ACA International, said it would be wiser for the federal government to focus on making medical care more affordable. “Here we’re coming up with a solution that only takes money away from providers,” Purcell said. “If Congress was involved, there could be more robust solutions.”

    Chopra doesn’t dispute the need for bigger efforts to tackle health care costs.

    “Of course, there are broader things that we would probably want to fix about our health care system,” he said, “but this is having a direct financial impact on so many Americans.”

    The CFPB can’t do much about the price of a prescription or a hospital bill, Chopra continued. What the federal agency can do, he said, is protect patients if they can’t pay their bills.

    KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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  • In Crisis, She Went to an Illinois Facility. Two Years Later, She Still Isn’t Able to Leave.

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    Series: Culture of Cruelty:Inside Illinois’ Mental Health System

    State-run facilities in Illinois are supposed to care for people with mental and developmental disabilities. But patients have been subjected to abuse, neglect and staff misconduct for decades, despite calls for change.

    Kaleigh Rogers was in crisis when she checked into a state-run institution on Illinois’ northern border two years ago. Rogers, who has cerebral palsy, had a mental health breakdown during the pandemic and was acting aggressively toward herself and others.

    Before COVID-19, she had been living in a small group home; she had been taking college classes online and enjoyed going out with friends, volunteering and going to church. But when her aggression escalated, she needed more medical help than her community setting could provide.

    With few viable options for intervention, she moved into Kiley Developmental Center in Waukegan, a much larger facility. There, she says she has fewer freedoms and almost nothing to do, and was placed in a unit with six other residents, all of whom are unable to speak. Although the stay was meant to be short term, she’s been there for two years.

    The predicament facing Rogers and others like her is proof, advocates say, that the state is failing to live up to the promise it made in a 13-year-old federal consent decree to serve people in the community.

    Rogers, 26, said she has lost so much at Kiley: her privacy, her autonomy and her purpose. During dark times, she cries on the phone to her mom, who has reduced the frequency of her visits because it is so upsetting for Rogers when her mom has to leave.

    The 220-bed developmental center about an hour north of Chicago is one of seven in the state that have been plagued by allegations of abuse and other staff misconduct. The facilities have been the subject of a monthslong investigation by Capitol News Illinois and ProPublica about the state’s failures to correct poor conditions for people with intellectual and developmental disabilities. The news organizations uncovered instances of staff who had beaten, choked, thrown, dragged and humiliated residents inside the state-run facilities.

    Advocates hoped the state would become less reliant on large institutions like these when they filed a lawsuit in 2005, alleging that Illinois’ failure to adequately fund community living options ended up segregating people with intellectual and developmental disabilities from society by forcing them to live in institutions. The suit claimed Illinois was in direct violation of a 1999 U.S. Supreme Court decision in another case, which found that states had to serve people in the most integrated setting of their choosing.

    Negotiations resulted in a consent decree, a court-supervised improvement plan. The state agreed to find and fund community placements and services for individuals covered by the consent decree, thousands of adults with intellectual and developmental disabilities across Illinois who have put their names on waiting lists to receive them.

    Now, the state has asked a judge to consider ending the consent decree, citing significant increases in the number of people receiving community-based services. In a court filing in December, Illinois argued that while its system is “not and never will be perfect,” it is “much more than legally adequate.”

    But advocates say the consent decree should not be considered fulfilled as long as people with disabilities continue to live without the services and choices that the state promised.

    Across the country, states have significantly downsized or closed their large-scale institutions for people with developmental and intellectual disabilities in favor of smaller, more integrated and more homelike settings.

    But in Illinois, a national outlier, such efforts have foundered. Efforts to close state-operated developmental centers have been met with strong opposition from labor unions, the communities where the centers are located, local politicians and some parents.

    U.S. District Judge Sharon Johnson Coleman in Chicago is scheduled in late summer to decide whether the state has made enough progress in building up community supports to end the court’s oversight.

    For some individuals like Rogers, who are in crisis or have higher medical or behavioral challenges, the state itself acknowledges that it has struggled to serve them in community settings. Rogers said she’d like to send this message on behalf of those in state-operated developmental centers: “Please, please get us out once and for all.”

    “Living Inside a Box”

    Without a robust system of community-based resources and living arrangements to intervene during a crisis, state-operated developmental centers become a last resort for people with disabilities. But under the consent decree agreement, the state, Equip for Equality argues, is expected to offer sufficient alternative crisis supports to keep people who want them out of these institutions.

    In a written response to questions, Rachel Otwell, a spokesperson for the Illinois Department of Human Services, said the state has sought to expand the menu of services it offers people experiencing a crisis, in an effort to keep them from going into institutions. But Andrea Rizor, a lawyer with Equip for Equality, said, “They just don’t have enough to meet the demand.”

    For example, the state offers stabilization homes where people can live for 90 days while they receive more intensive support from staff serving the homes, including medication reviews and behavioral interventions. But there are only 32 placements available — only four of them for women — and the beds are always full, Rizor said.

    Too many people, she said, enter a state-run institution for short-term treatment and end up stuck there for years for various reasons, including shortcomings with the state’s discharge planning and concerns from providers who may assume those residents to be disruptive or difficult to serve without adequate resources.

    That’s what happened to Rogers. Interruptions to her routine and isolation during the pandemic sent her anxiety and aggressive behaviors into overdrive. The staff at her community group home in Machesney Park, unsure of what to do when she acted out, had called the police on several occasions.

    Doctors also tried to intervene, but the cocktail of medications she was prescribed turned her into a “zombie,” Rogers said. Stacey Rogers, her mom and legal guardian, said she didn’t know where else to turn for help. Kiley, she said, “was pretty much the last resort for us,” but she never intended for her daughter to be there for this long. She’s helped her daughter apply to dozens of group homes over the past year. A few put her on waitlists; most have turned her down.

    “Right now, all she’s doing is living inside a box,” Stacey Rogers said.

    Although Rogers gave the news organizations permission to ask about her situation, IDHS declined to comment, citing privacy restrictions. In general, the IDHS spokesperson said that timelines for leaving institutions are “specific to each individual” and their unique preferences, such as where they want to live and speciality services they may require in a group home.

    Equip for Equality points to people like Rogers to argue that the consent decree has not been sufficiently fulfilled. She’s one of several hundred in that predicament, the organization said.

    “If the state doesn’t have capacity to serve folks in the community, then the time is not right to terminate this consent decree, which requires community capacity,” Rizor said.

    Equip for Equality has said that ongoing safety issues in these facilities make it even more important that people covered by the consent decree not be placed in state-run institutions. In an October court brief, citing the news organizations’ reporting, Equip for Equality said that individuals with disabilities who were transferred from community to institutional care in crisis have “died, been raped, and been physically and mentally abused.”

    Over the summer, an independent court monitor assigned to provide expert opinions in the consent decree, in a memo to the court, asked a judge to bar the state from admitting those individuals into its institutions.

    In its December court filing, the state acknowledged that there are some safety concerns inside its state-run centers, “which the state is diligently working on,” as well as conditions inside privately operated facilities and group homes “that need to be addressed.” But it also argued that conditions inside its facilities are outside the scope of the consent decree. The lawsuit and consent decree specifically aimed to help people who wanted to move out of large private institutions, but plaintiffs’ attorneys argue that the consent decree prohibits the state from using state-run institutions as backup crisis centers.

    In arguing to end the consent decree, the state pointed to significant increases in the number of people served since it went into effect. There were about 13,500 people receiving home- and community-based services in 2011 compared with more than 23,000 in 2023, it told the court.

    The state also said it has significantly increased funding that is earmarked to pay front-line direct support professionals who assist individuals with daily living needs in the community, such as eating and grooming.

    In a statement to reporters, the human services department called these and other improvements to the system “extraordinary.”

    Lawyers for the state argued that those improvements are enough to end court oversight.

    “The systemic barriers that were in place in 2011 no longer exist,” the state’s court filing said.

    Among those who were able to find homes in the community is Stanley Ligas, the lead plaintiff in the lawsuit that led to the consent decree. When it was filed in 2005, he was living in a roughly 100-bed private facility but wanted to move into a community home closer to his sister. The state refused to fund his move.

    Today, the 56-year-old lives in Oswego with three roommates in a house they rent. All of them receive services to help their daily living needs through a nonprofit, and Ligas has held jobs in the community: He previously worked in a bowling alley and is now paid to make public appearances to advocate for others with disabilities. He lives near his sister, says he goes on family beach vacations and enjoys watching professional wrestling with friends. During an interview with reporters, Ligas hugged his caregiver and said he’s “very happy” and hopes others can receive the same opportunities he’s been given.

    While much of that progress has come only in recent years, under Gov. JB Pritzker’s administration, it has proven to be vulnerable to political and economic changes. After a prolonged budget stalemate, the court in 2017 found Illinois out of compliance with the Ligas consent decree.

    At the time, late and insufficient payments from the state had resulted in a staffing crisis inside community group homes, leading to escalating claims of abuse and neglect and failures to provide routine services that residents relied on, such as help getting to work, social engagements and medical appointments in the community. Advocates worry about what could happen under a different administration, or this one, if Illinois’ finances continue to decline as projected.

    “I acknowledge the commitments that this administration has made. However, because we had so far to come, we still have far to go,” said Kathy Carmody, chief executive of The Institute on Public Policy for People with Disabilities, which represents providers.

    While the wait for services is significantly shorter than it was when the consent decree went into effect in 2011, there are still more than 5,000 adults who have told the state they want community services but have yet to receive them, most of them in a family home. Most people spend about five years waiting to get the services they request. And Illinois continues to rank near the bottom in terms of the investment it makes in community-based services, according to a University of Kansas analysis of states’ spending on services for people with intellectual and developmental disabilities.

    Advocates who believe the consent decree has not been fulfilled contend that Illinois’ continued reliance on congregate settings has tied up funds that could go into building up more community living options. Each year, Illinois spends about $347,000 per person to care for those in state-run institutions compared with roughly $91,000 per person spent to support those living in the community.

    For Rogers, the days inside Kiley are long, tedious and sometimes chaotic. It can be stressful, but Rogers told reporters that she uses soothing self-talk to calm herself when she feels sad or anxious.

    “I tell myself: ‘You are doing good. You are doing great. You have people outside of here that care about you and cherish you.’”

    This article is republished from ProPublica under a Creative Commons license. Read the original article.

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