Science
Can $1,000 a month help more students land nursing careers? An L.A. pilot effort says yes
Community colleges play a critical role in addressing California’s persistent demand for healthcare workers, preparing students to become the state’s next generation of nurses, medical assistants and physical therapy aides.
But in the Los Angeles Community College District, where more than half of all students report incomes near or below the poverty line, many people struggle to complete their degrees while also holding down jobs to pay rent, buy groceries and cover child-care costs.
A pilot program at the L.A. district — the state’s largest, with nine colleges and 194,000 students — aims to address these seemingly intractable challenges with a targeted remedy: $1,000 a month in guaranteed income.
Late last year, the district launched an initiative that provides cash payments for 12 months to 251 students with a demonstrated financial need who are pursuing health careers. The funding is unrestricted, so participants can use the money however they see fit.
The goal of the effort, dubbed Building Outstanding Opportunities for Students to Thrive, or BOOST, is to eliminate financial insecurity so that students can focus on achieving their academic goals and the college system can deliver a diverse, multilingual healthcare workforce to serve L.A. in the process.
The Times followed one student through the first months of the new initiative to learn how a guaranteed basic income might influence the lives and choices of L.A. community college students.
“I want to give him opportunities, and in order to do that, I have to get ahead,” Adriana Orea, a single mom, says of her decision to pursue a career as a registered nurse.
Adriana Orea, 32, has known for years that she wanted to pursue a career in nursing. She had worked for a time as a licensed vocational nurse, and found the experience rewarding. But after giving birth to a son two years ago, she set her sights on a higher-paying position as a registered nurse, which generally requires a bachelor’s degree from an accredited nursing program.
“I want to give him opportunities, and in order to do that, I have to get ahead,” said Orea, a single mother. “I don’t want him to feel like he’s missing out on something because I’m not able to provide it for him.”
She had recently returned to school, enrolling at L.A. City College in the prerequisite courses she’ll need to get accepted into a nursing school, when she was selected for BOOST. She received her first cash payment on Thanksgiving.
“I feel very blessed to have been picked,” she told The Times a few days later. “At the same time, I feel like I want to be very responsible with this, because it’s not something to be taken lightly.”
Orea lives with her parents and her curly-haired 2-year-old, Kevin, in a rent-controlled building near MacArthur Park. In early December, she was taking three classes and working eight hours a week at the front desk of the college counseling department — a position she got through the state’s welfare-to-work program.
Adriana Orea says her parents, both Mexican immigrants who work night shifts as janitors, are crucial partners in helping raise her son, Kevin.
She is quick to express gratitude for her parents, who are crucial partners in helping raise her son. Her parents, both Mexican immigrants who work night shifts as janitors, watch Kevin while Orea is on campus. She covers most of the family’s food expenses with her CalFresh benefits, spending between $500 and $600 a month on groceries, and also pitches in for rent.
“It’s just been living on a budget, which is definitely doable, because I have so much support,” she said.
Of the first $1,000 payment, she spent about $600 on outstanding bills for Kevin’s newborn check-ups that had resulted from a lapse in health insurance. She also used some of the money to buy Christmas gifts for her family and a holiday outfit for herself. She received the second payment in mid-December, and was determined to not dip into it.
“I’m just treating it like I’m not receiving it,” she said.
By January, she already felt more financially secure, having squirreled away $1,000 and knowing more would be coming.
“I might actually have something in the back pocket,” she said. “It’s not just a paycheck-to-paycheck thing.”
Adriana Orea says the $1,000 a month she gets through BOOST has made a world of difference in her stress levels: “I can literally just concentrate on studying for my classes.”
More than 150 guaranteed income pilot programs have launched nationwide in recent years, but BOOST is one of the first focused on community college students.
Proponents tout unconditional cash as a way to provide greater stability to vulnerable community members. But as the concept has gained steam, it has also spurred backlash. Several Republican-led state legislatures are banning or trying to preempt cities and counties from launching direct cash initiatives, arguing publicly funded programs are a waste of taxpayer resources.
The BOOST program is privately funded with more than $3.1 million from the Eli and Edythe Broad Foundation, and $867,500 from the California Community Foundation’s Young Adults Forward Fund. It represents a rare philanthropic investment in California community college students, who number 2.1 million statewide. Typically, more than half of California high school graduates start at a community college.
There is a “massive mismatch of where private philanthropic dollars go and where students in California go to school, particularly if we think about low-income, first-generation and students of color,” said Kelly King, executive director of the Foundation for the Los Angeles Community Colleges. “This level of investment in community college students is very unusual, unfortunately, but it’s very much needed.”
To be eligible for BOOST, students must have selected a health-related major and express interest in pursuing a health career, as well as have a demonstrated financial need and be considered low-income for L.A. County. Participants in the pilot were selected by lottery, with 251 receiving the monthly payments and an additional 370 enrolled in a control group.
Of the total participants, 72% are female, 65% are Hispanic or Latino, and 29% report that the primary language in their household is Spanish, according to data provided by the community college district. The average annual household income is $31,853, and 47% report having children in the household.
Like other pilots, BOOST is designed as a research study. In this case, the Center for Guaranteed Income Research at the University of Pennsylvania is analyzing how the unrestricted payments effect the well-being of students and what role it might play in keeping them on track in completing their healthcare degrees.
“Lack of basic needs, food insecurity and unexpected financial shocks create barriers for students that often push them out of education,” said Amy Castro, the center’s co-founder and faculty director. “Dreaming about your future should be a feature of young adulthood that is open to all — not just the wealthy or those with the good fortune to have ironclad access to higher education.”
Among other benefits, Adriana Orea says the money she is saving through BOOST has allowed her to start an emergency fund in case she or her son falls ill and she can’t work.
By mid-February, the guaranteed payments had made a big difference in Orea’s life.
Determined to take advantage of the financial support, she enrolled in four classes for the spring semester. She felt as if her momentum was snowballing, and realized that with better time management, she could also take on a few more hours at work and make a bit more money.
Despite having more on her plate, Orea seemed less stressed. Knowing she didn’t need to hold down a full-time job, or a second part-time gig, to support her son was in itself a huge relief.
“I can literally just concentrate on studying for my classes,” she said.
She had started amassing an emergency fund in case she or Kevin gets sick and she’s unable to work.
She was also feeling more comfortable spending the money. She bought her family a Valentine’s Day lunch at Sizzler, treating her mom to the buffet and her dad to his favorite steak and shrimp dish. She took Kevin to Big Bear to see snow. And if she ran out of time to pack a lunch from home, she didn’t stress about grabbing a sandwich at a doughnut shop near campus.
“I see my bank account going up — I feel like I’m saving,” she said. So, she’s able to tell herself: “This is not a big splurge, I can treat myself.”
By early April, Orea had received $5,000 through BOOST.
She opened a high-yield savings account, with the goal of using her money to make money. She purchased Disneyland tickets to celebrate her mom’s 60th birthday. She had recently received two parking tickets, and while she said she was disappointed to lose money, it wasn’t the crisis hit to her budget that it would have been in the past.
She said receiving the cash — and knowing it was temporary — has made her “laser-focused” on her goals: Finish her prerequisite courses this spring; work part-time as a licensed vocational nurse this summer while studying for her nursing school entrance exam; then apply to schools in the fall and start a nursing program next spring.
“Having this opportunity made me take a hard look at myself and be like, ‘This is what you want. How are you going to get there? Take advantage that you have this,’” she said.
At the same time, her horizons have expanded. Receiving the guaranteed income had freed her from the suffocating sensation of constantly worrying about money.
“Once you feel like there’s one less thing stressing you out, you just feel this relief,” she said. “It clears your mind a little more and you just feel less stressed about everything else.”
Orea said she expects the money she has saved through BOOST will smooth her transition to nursing school. She hopes to receive financial aid to attend a nursing program at L.A. City College or a Cal State university, but said she would take out loans if needed to attend a more expensive private school. She plans to live at home and pick up a couple of shifts each week as a licensed vocational nurse while in school, but said her savings from this year should help ensure she isn’t stretched thin during the two-year program.
She will likely remain in L.A. County after nursing school, she said. She worked in geriatrics previously, but is interested in exploring work in a birthing or neonatal unit. No matter where she works, she will use her Spanish fluency to communicate with patients and their families.
This article is part of The Times’ equity reporting initiative, funded by the James Irvine Foundation, exploring the challenges facing low-income workers and the efforts being made to address California’s economic divide.
Science
His computer simulations help communities survive disasters. Can they design a Palisades that never burns?
In what used to be a dry cleaner’s on Sunset Boulevard, Robert Lempert listened, hands clasped behind his back, as his neighbors finally took a moment to step away from recovery’s endless stream of paperwork, permits, bills and bureaucracy to, instead, envision a fire-resilient Pacific Palisades in 2035.
As a researcher at RAND, Lempert has spent decades studying how communities, corporations and governments can use computer simulations to understand complex problems with huge uncertainties — from how an Alaska town can better warn its residents about landslides to how climate change is worsening disasters and what strategies the United Nations can support to address them.
In January, one such complex problem ran straight through his neighborhood and burned down his house.
As Lempert and his wife process their own trauma forged by flames, Lempert has become fixated on capturing the flickers of insights from fellow survivors and, hopefully, eventually, transforming them into computer programs that could help the community rebuild the Palisades into a global leader in wildfire resilience.
“Otherwise, we won’t end up with a functional community that anybody wants to — or can — live in,” he said. “You can spin out all sorts of disaster scenarios” for the Pacific Palisades of 2035. If the community fails to confront them in rebuilding, “you make them a hell of a lot more likely.”
Lempert doesn’t see a mass exodus from high-fire-hazard areas as a viable solution. Out of the more than 12 million buildings the climate risk modeling company First Street studies in California, 4 in 10 have at least a 5% chance of facing a wildfire in the next 30 years. (Out of the nearly 10,000 buildings First Street studies in the Palisades, 82% carry that level of risk.) And the areas without significant fire risk have their own environmental challenges: flooding, earthquakes, landslides, hurricanes, tornadoes, droughts. Learning to live with these risks, consequently, is part of the practice of living in California — and really, in most of the places humans have settled on Earth.
After two of the most destructive fires in the state’s history, The Times takes a critical look at the past year and the steps taken — or not taken — to prevent this from happening again in all future fires.
So, Lempert has taken to the modus operandi he helped develop at RAND:
Identify the problem. In this case, living in Pacific Palisades carries a nonzero risk you lose your house or life to fire.
Define the goals. Perhaps it is that, in the next fire, the Palisades doesn’t lose any homes or lives (and, ideally, accomplishes this without spending billions).
Then, the real work: Code up a bunch of proposed solutions from all of the groups with wildly disparate views on how the system (i.e., Southern California wildfires) works.
Stress-test those solutions against a wide range of environmental conditions in the computer. Extreme winds, downed communication systems, closed evacuation routes — the list goes on.
Finally, sit back, and see what insights the computer spits out.
It’s easy enough to agree on the problem, goals and environmental factors. For the proposed solutions, Lempert set out to collect data.
Poster paper with residents’ handwritten ideas now fills the walls of the former dry cleaner’s, now the headquarters of the grassroots organization Palisades Recovery Coalition. It’s through these “visioning charrettes” that Lempert hopes his community can develop a magic solution capable of beating the computer’s trials.
Lempert holds a photo of his home as it looked before it was destroyed by the Palisades fire.
The streets could be lined with next-generation homes of concrete and steel where even the tiniest gaps are meticulously sealed up to keep embers from breaching the exterior. Each home could be equipped with rain-capture cisterns, hooked up to a neighborhood-wide system of sensors and autonomous fire hoses that intelligently target blazes in real time. One or two shiny new fire stations — maybe even serving as full-blown fire shelters for residents, equipped with food and oxygen to combat the smoke — might sit atop one of the neighborhood’s main thoroughfares, Palisades Drive. The street, formerly a bottleneck during evacuations, might now have a dedicated emergency lane.
Every year, the community could practice a Palisades-wide evacuation drill so the procedures are fresh in the mind. Community brigades might even train with the local fire departments so, during emergencies, they can effectively put out spot fires and ensure their elderly neighbors get out safely.
Lempert, who now lives in a Santa Monica apartment with his wife, doesn’t entertain speculation about whether the Palisades will ever reach this optimistic vision — even though his own decision to move back someday, in part, hinges on the answer.
Right now, all that matters is that change is possible.
He pointed to an anecdote he heard once from the fire historian Stephen Pyne: American cities used to burn down — from within — all the time in the 19th century. Portland, Maine, burned in 1866 thanks to a Fourth of July firecracker. Chicago in 1871, after a blaze somehow broke out in a barn. Boston the following year, this time starting in a warehouse basement. Eventually, we got fed up with our cities burning down, so we created professional fire departments, stopped building downtowns out of wood and bolstered public water systems with larger water mains and standardized fire hydrants. Then, it stopped happening.
Now we face a new fire threat — this time, from the outside. Maybe we’re fed up enough to do something about it.
“Cities shouldn’t burn down,” Lempert said with a chuckle, amused by the simplicity of his own words. “So let’s just design them so they don’t.”
As an American reporter living in Beijing, I’ve watched both China and the rest of the world flirt with cutting-edge technologies involving robots, drones and self-driving vehicles.
But China has now raced far beyond the flirtation stage. It’s rolling out fleets of autonomous delivery trucks, experimenting with flying cars and installing parking lot robots that can swap out your E.V.’s dying battery in just minutes. There are drones that deliver lunch by lowering it from the sky on a cable.
If all that sounds futuristic and perhaps bizarre, it also shows China’s ambition to dominate clean energy technologies of all kinds, not just solar panels or battery-powered cars, then sell them to the rest of the world. China has incurred huge debts to put trillions of dollars into efforts like these, along with the full force of its state-planned economy.
These ideas, while ambitious, don’t always work smoothly, as I learned after taking a bullet train to Hefei, a city the size of Chicago, to see what it’s like to live in this vision of tomorrow. Hefei is one of many cities where technologies like these are getting prototyped in real time.
I checked them all out. The battery-swapping robots, the self-driving delivery trucks, the lunches from the sky. Starting with flying taxis, no pilot on board.
Battery-swapping robots for cars
Of course, far more people get around by car. And navigating Hefei’s city streets shows how China has radically transformed the driving experience.
Electric vehicles (including models with a tiny gasoline engine for extra range) have accounted for more than half of new-car sales in China every month since March. A subcompact can cost as little as $9,000.
They are quite advanced. New models can charge in as little as five minutes. China has installed 18.6 million public charging stations, making them abundant even in rural areas and all but eliminating the range anxiety holding back E.V. sales in the United States.
Essentially, China has turned cars into sophisticated rolling smartphones. Some have built-in karaoke apps so you can entertain yourself while your car does the driving.
You still need to charge, though.
Lunch from the sky
China’s goal with ideas like these is to power more of its economy on clean electricity, instead of costly imported fossil fuels. Beijing has spent vast sums of money, much of it borrowed, on efforts to combine its prowess in manufacturing, artificial intelligence and clean energy to develop entirely new products to sell to the rest of the world.
Drone delivery has a serious side. Hospitals in Hefei now use drones to move emergency supplies, including blood, swiftly around the city. Retailers have visions of fewer packages stuck in traffic.
But does the world need drone-delivered fast food? And how fast would it really be? As afternoon approached, we decided to put flying lunches to the test.
We decided to eat in a city park where a billboard advertised drone delivery of pork cutlets, duck wings and milk tea from local restaurants, or hamburgers from Burger King. Someone had scrawled in Chinese characters on the sign, “Don’t order, it won’t deliver.” A park worker offered us free advice: Get someone to deliver it on a scooter.
Undeterred, we used a drone-delivery app to order a fried pork cutlet and a small omelet on fried rice. Then, rather than wait in the park, we went to the restaurant to see how the system worked.
Very rapid transit
China’s bullet trains are famous for a reason. Many can go nearly 220 miles per hour — so fast that when you blast past a highway in one of these trains, cars look like they’re barely moving.
In less than two decades China has built a high-speed rail network some 30,000 miles long, two-thirds the length of the U.S. Interstate highway system. As many as 100 trains a day connect China’s biggest cities.
Building anything this enormous creates pollution in its initial construction, of course, using lots of concrete and steel. Construction was expensive and the system has racked up nearly $900 billion in debt, partly because it’s politically hard to raise ticket prices.
But the trains themselves are far less polluting than cars, trucks or planes. And they make day trips fast and easy. So we decided to hop over to Wuhan, more than 200 miles away.
Taxis that drive themselves
We rolled into Wuhan looking forward to catching a robot taxi. While a few U.S. cities have experimented with driverless cars, China leads in the number on the road and where they can operate.
Wuhan is one of a dozen or more Chinese cities with driverless taxis. Hundreds now roam most of the city, serving the airport and other major sites.
But train stations are a special problem. In big cities, some stations are so popular that the streets nearby are gridlocked for blocks in every direction.
That was the case in Wuhan. Autonomous cars have not been approved in the chronically gridlocked streets next to the train stations, which meant that, to meet our robot taxi at its pickup spot, we either needed to walk 20 minutes or hop on a subway. (We walked.)
Of course if you want your own personal self-driving car, dozens of automakers in China sell models with some autonomous features. However, you are required to keep your hands on the wheel and eyes on the road. Just this month, regulators told automakers to do more testing before offering hands-free driving on mass production cars.
We wanted the full robot chauffeur experience.
Robot trucks don’t need windows
After a meal at one of Wuhan’s famous crawfish restaurants, we headed back to Hefei.
We had enjoyed Hefei’s airborne lunches, but there’s a lot more autonomous delivery in that city than just food. China still has many intercity truck drivers, but is starting to replace them with robot trucks for the last mile to stores and homes.
The trucks look strangely faceless. With no driver compartment in front, they resemble steel boxes on wheels.
The smaller ones in Hefei carry 300 to 500 packages. The trucks go to neighborhood street corners where packages are distributed to apartments by delivery people on electric scooters or a committee of local residents. Larger trucks serve stores.
Robot delivery trucks now operate even in rural areas. I recently spotted one deep in the countryside as it waited for 13 water buffalo to cross a road.
Subways get a makeover
Cities across the country are rapidly building subways. So many, in fact, that China has become the world’s main manufacturer of automated tunnel-boring machines.
It has also pioneered the manufacture of prefab subway stations. They’re lowered in sections into holes in the ground. Building a new station can take as little as two months.
Nearly 50 cities in China have subway networks, compared with about a dozen in the U.S., and they tend to be popular and heavily used.
As in many Chinese cities, people in Hefei live in clusters of high-rises, and many live or work close to stations. The trains cut down on traffic jams and air pollution.
And like so many things, new ones are usually driverless.
The changes are spreading across the country.
Many Chinese cities have not only replaced diesel buses with electric ones but are also experimenting with hydrogen-powered buses. And driverless buses. And driverless garbage trucks. And driverless vending machines.
One such vending machine was operating in the Hefei park where we ordered our drone lunches. According to a nearby hot dog vendor, the brightly lit four-wheeler drove into the park every morning, though always accompanied by a person on a bike who made sure nothing went wrong.
A robotic snack machine that needs a chaperone — how practical is that? But the fact that they are rolling around the streets of Hefei at all says something about China’s willingness to test the boundaries of transportation technologies.
Some ideas may not work out, and others might suit China but not travel well. For example, Beijing can essentially order arrow-straight rail lines to be built almost to the heart of urban areas with little concern for what’s in the way. Other countries can’t replicate that. Chinese-built bullet trains in Nigeria and Indonesia, which travel from one city’s suburbs to the next, haven’t proven nearly as popular.
Still, China shows a willingness to take risks that other countries may not. In San Francisco the death of a bodega cat, killed by a self-driving taxi, has hurt the industry’s image. But in China, fleets of similar cars are operating widely and censors delete reports of accidents. The cars are improving their software and gaining experience.
As for me, after several days putting Hefei’s idea of the future to the test, it was time to head for my next reporting assignment, in Nanjing. By bullet train, of course.
In the first 90 days after the Palisades and Eaton fires erupted in January, the caseload at Cedars-Sinai Medical Center’s emergency room looked different from the norm.
There were 46% more visits for heart attacks than typically occured during the same time period over the previous seven years. Visits for respiratory illnesses increased 24%. And unusual blood test results increased 118%.
These findings were reported in a new study published Wednesday in the Journal of the American College of Cardiology. The study, part of a research project documenting the fires’ long-term health effects, joins several recent papers documenting the disasters’ physical toll.
While other U.S. wildfires have consumed more acres or cost more lives, the Palisades and Eaton fires were uniquely dangerous to human health because they burned an unusual mix of materials: the trees, brush and organic material of a typical wildfire, along with a toxic stew of cars, batteries, plastics, electronics and other man-made materials.
There’s no precedent for a situation that exposed this many people to this kind of smoke, the paper’s authors said.
“Los Angeles has seen wildfires before, it will see wildfires again, but the Eaton fire and the Palisades fire were unique, both in their size, their scale and the sheer volume of material that burned,” said Dr. Joseph Ebinger, a Cedars-Sinai cardiologist and the paper’s first author.
The team did not find a significant increase in the overall number of visits to the medical center’s emergency room between Jan. 7, the day the fires began, and April 7. The department recorded fewer in-person visits for mental health emergencies and chronic conditions during that time compared to the same time period in earlier years, said Dr. Susan Cheng, director of public health research at Cedars-Sinai and the study’s senior author.
The increase in visits for acute cardiovascular problems and other serious sudden illnesses made up the difference.
The study team also looked at results from blood tests drawn from patients visiting the ER for serious physical symptoms without immediate explanation — dizziness without dehydration, for example, or chest pains not caused by heart attacks.
Their blood tests returned unusual results at a rate more than double that seen in previous years. These atypical numbers cut across the spectrum of the blood panel, Cheng said. “It could be electrolyte disorder, change in protein levels, change in markers of kidney or liver function.”
The rate of unusual test results held steady through the three-month period, leading the team to conclude that exposure to the fires’ smoke “has led to some kind of biochemical metabolic stress in the body that likely affected not just one but many organ systems,” Cheng said. “That’s what led to a range of different types of symptoms affecting different people.”
Joan Casey, an environmental epidemiologist at the University of Washington who was not part of the Cedars-Sinai team, noted that the study found health effects lasting over a longer period than similar studies have.
Three months “is a substantial length of time to observe elevated visits, as most studies focused on acute care utilization following wildfire smoke exposure find increased visit counts over about a weeklong period,” Casey said. Her own research found a 27% increase in outpatient respiratory visits among Kaiser Permanente Southern California members living within 12.4 miles of the burn zones in the week following the fires.
“The L.A. fires were such a severe event, including not only smoke, but also evacuation and substantial stress in the population, that effects may have lingered longer,” Casey said.
Thirty-one people are known to have died as a direct result of injuries sustained in the fires. But researchers believe that when taking into account deaths from health conditions worsened by the smoke, the true toll is significantly higher.
A research letter published earlier this year in the Journal of the American Medical Assn. calculated that there were 440 excess deaths in L.A. County between Jan. 5 and Feb. 1. That paper looked at deaths caused by a variety of factors, from exposure to air pollution to disrupted healthcare as a result of closures and evacuations.
On Tuesday, a team from Stanford University published itsprojection that exposure to the fires’ smoke, specifically, led to 14 deaths otherwise unaccounted for.
Wildfire is a major source of fine particulate pollution, bits measuring 2.5 microns or less in diameter that are small enough to cross the barriers that separate blood from the brain and the lungs’ outer branches.
Compared with other sources, wildfire smoke contains a higher proportion of ultrafine particles miniscule enough to penetrate the brain after inhalation, Casey told The Times earlier this year. The smoke has been linked to a range of health problems, including dementia, cancer and cardiovascular failure.
In the last decade, increasing numbers of wildfires in Western states have released enough fine particulate pollution to reverse years’ worth of improvements under the Clean Air Act and other antipollution measures.
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