Thomas Claxton, born in Baltimore, Md. entered the Navy as a midshipman 17 December 1810. He was mortally wounded after gallant service in the Battle of Lake Erie 10 September 1813, dying at Erie, Pa., 17 October 1813.
(DD-140: dp. 1,090; 1. 314'; b. 31'; dr. 8'8"; s. 35 k.;
epl. 122; a. 4 4", 1 3", 12 21" tt.; cl. Wickes)
The first Claxton (DD-140) was launched 14 January 1919 by Mare Island Navy Yard; sponsored by Mrs. F. W. Kellogg; and commissioned 15 September 1919, Lieutenant Commander F. T. Leighton in command.
Claxton operated on the west coast until 18 June 1922, when she was decommissioned at San Diego, Calif. Recommissioned 22 January 1930, she served on the west coast and on reserve training from New Orleans until September 1933, when she joined the Special Service Squadron for patrol duty off Cuba. Between January and November 1934 she was in rotating reserve at Charleston, then returned to Cuban patrols until October 1935. After exercising with the battle force, she was assigned to the Naval Academy during 1936 and 1937, making three coastal cruises.
Duty with Squadron 40-T, formed to patrol European waters protecting American interests during the civil war in Spain, occupied Claxton from October 1937 until November 1938. In January 1939 she returned to duty at the Naval Academy, but in September began service on the neutrality patrol off the Florida Straits. In January and February 1940, she patrolled off the New England coast, and after training cruises on the east coast, arrived at Halifax, Nova Scotia, 21 November 1940. On 26 November she was delivered to British authorities in the destroyers-for-bases exchange. She was decommissioned 5 December 1940, and commissioned in the Royal Navy the same day as HMS Salisbury.
She arrived at Belfast, Northern Ireland, 30 December 1940 for duty with the Western Approaches Command escorting Atlantic convoys. In April and May 1942, she joined in escorting USS Wasp (CV-7) on her two voyages to fly planes off for beleaguered Malta. Returning to the Clyde, Salisbury guarded troop convoys in the Atlantic until September, when she was assigned to the Royal Canadian Navy. Based on St. John's, Newfoundland, Salisbury served on local escort duty until November 1943, when with newer escorts available, she was placed in care and maintenance status at Halifax, and paid off on 10 December. She was sold for scrapping 26 June 1944.
HMS Salisbury (viirinumero I52) oli Britannian kuninkaallisen laivaston Town-luokan hävittäjä toisessa maailmansodassa. Alus oli alun perin Yhdysvaltain laivaston Wickes-luokan hävittäjä USS Claxton, joka luovutettiin Halifaxissa Kuninkaalliselle laivastolle sopimuksen mukaisesti.
|Rakentaja||Mare Islandin laivastontelakka, Yhdysvallat|
|Kölinlasku||25. huhtikuuta 1918|
|Laskettu vesille||14. tammikuuta 1919|
|Palveluskäyttöön||5. joulukuuta 1940|
|Palveluskäytöstä||Kanadan laivastolle syyskuussa 1942|
|Loppuvaihe||myyty romutettavaksi 26. kesäkuuta 1944|
|Uppouma||1 090 t|
|Nopeus||35 solmua (65 km/h)|
|Aseistus||4 x 4" tykkiä|
1 x 3" ilmatorjuntatykkiä
12 x 21" (533 mm) torpedoputkea
Claxton được đặt lườn vào ngày 25 tháng 4 năm 1918 tại Xưởng hải quân Mare Island, Vallejo, California. Nó được hạ thủy vào ngày 14 tháng 1 năm 1919, được đỡ đầu bởi bà F. W. Kellogg, và được đưa ra hoạt động vào ngày 13 tháng 9 năm 1919 dưới quyền chỉ huy của Hạm trưởng, Thiếu tá Hải quân F. T. Leighton.
USS Claxton Sửa đổi
Claxton hoạt động dọc theo bờ Tây Hoa Kỳ cho đến ngày 18 tháng 6 năm 1922, khi nó được cho xuất biên chế tại San Diego, California. Được cho nhập biên chế trở lại vào ngày 22 tháng 1 năm 1930, nó tiếp tục phục vụ tại vùng bờ Tây cũng như huấn luyện nhân sự Hải quân Dự bị từ New Orleans cho đến tháng 9 năm 1933, khi nó gia nhập Hải đội Đặc vụ để tuần tra ngoài khơi Cuba. Từ tháng 1 đến tháng 11 năm 1934, nó ở trong lực lượng dự bị luân phiên tại Charleston, rồi quay trở lại nhiệm vụ tuần tra tại Cuba cho đến tháng 10 năm 1935. Sau khi thực hành cùng với Lực lượng Chiến trận, nó được phân về Học viện Hải quân Hoa Kỳ trong các năm 1936-1937, thực hiện ba chuyến đi ven biển.
Nhận nhiệm vụ cùng Hải đội 40-T, đơn vị được thành lập để tuần tra tại vùng biển Châu Âu nhằm bảo vệ những lợi ích của Hoa Kỳ trong cuộc Nội chiến tại Tây Ban Nha, Claxton đã hoạt động tại châu Âu từ tháng 10 năm 1937 đến tháng 11 năm 1938. Vào tháng 1 năm 1939, nó quay trở lại nhiệm vụ cùng Học viện Hải quân, nhưng đến tháng 9 lại được điều động vào nhiệm vụ Tuần tra Trung lập ngoài khơi Florida Straits. Vào tháng 1 và tháng 2 năm 1940, nó tuần tra ngoài khơi bờ biển New England và sau các chuyến đi huấn luyện tại vùng bờ Đông, nó đi đến Halifax, Nova Scotia vào ngày 21 tháng 11 năm 1940. Đến ngày 26 tháng 11, nó được chuyển giao cho Anh Quốc theo Thỏa thuận đổi tàu khu trục lấy căn cứ. Claxton được cho xuất biên chế vào ngày 5 tháng 12 năm 1940 và nhập biên chế Hải quân Hoàng gia Anh cùng ngày hôm đó như là chiếc HMS Salisbury thuộc lớp Town.
HMS Salisbury - HMCS Salisbury Sửa đổi
Salisbury đi đến Belfast, Bắc Ireland vào ngày 30 tháng 12 năm 1940 để hoạt động cùng Bộ chỉ huy Tiếp cận phía Tây trong nhiệm vụ hộ tống các đoàn tàu vận tải vượt Đại Tây Dương. Vào tháng 4 và tháng 5 năm 1942, nó tham gia lực lượng hộ tống cho tàu sân bay Hoa Kỳ Wasp trong hai chuyến đi vận chuyển máy bay đến Malta đang bị phong tỏa. Quay trở về Clyde, Salisbury được cải biến tối ưu cho nhiệm vụ hộ tống tàu buôn bằng cách tháo dỡ ba trong số các khẩu pháo 4 in (100 mm)/50 caliber và một trong số các dàn ống phóng ngư lôi ba nòng để giảm bớt trọng lượng bên trên, lấy chỗ chứa thêm mìn sâu và trang bị một dàn hedgehog (súng cối chống tàu ngầm).  Nó bảo vệ cho các đoàn tàu vận tải chuyển quân tại Đại Tây Dương cho đến tháng 9, khi nó được chuyển cho Hải quân Hoàng gia Canada. Đặt căn cứ tại St. John's, Newfoundland, HCMS Salisbury hoạt động hộ tống vận tải tại chỗ cho đến tháng 11 năm 1943, khi các tàu hộ tống mới hơn đã sẵn có. Nó được đưa về chế độ bảo trì tại Halifax, Nova Scotia và được cho ngừng hoạt động vào ngày 10 tháng 12 năm 1943. Nó bị bán để tháo dỡ ngày 26 tháng 6 năm 1944 tại Vancouver, British Columbia.
Die US Navy verfügte seit dem 8. Dezember 1942 wieder ﲾr eine USS Claxton (II) (DD 571). Das zweite Schiff der US Navy mit diesem Namen war am 9. September 1940 als Zerstörer der Fletcher-Klasse bei der Consolidated Steel Corporation in Orange (Texas) bestellt worden. Nach dem Baubeginn am 25. Juni 1941 war der neue Zerstörer am 1.ਊpril 1942 vom Stapel gelaufen und getauft worden. Am 8.ꃞzember 1942 wurde der Zerstörer von der US Navy in Dienst gestellt. →siehe USS Claxton (DD-571)
Der im April 1946 aus dem aktiven Dienst entlassene Zerstörer wurde am 15.ꃞzember 1959 der deutschen Bundesmarine ﲾrgeben und als Z 4 (D-178) eingesetzt. Am 26.ruar 1981 wurde er in Griechenland von der Bundesmarine aur Dienst gestellt und zugleich von der griechischen Marine als Materialersatzteilträger ﲾrnommen. Im Juni 1992 wurde das Schiff dann in Eleusis abgebrochen.
Ab dem Februar 1957 verfügte die Royal Navy wieder ﲾr eine HMS Salisbury. Dieses Schiff vom Type 61 (aircraft direction frigate) war am 23. Januar 1952 auf dem Devonport Dockyard begonnen worden Stapellauf und Taufe folgten am 25. Juni 1953. Die Fregatte war an der Beira Patrol – dem wenig erfolgreichen Versuch, Rhodesien von der Ölversorgung abzuschneiden – und am letzten der sogenannten Kabeljaukriege mit Island beteiligt. Bei letzterem kam es zu Kollisionen mit isländischen Patrouillenbooten. Ein 1978 erwogener Verkauf des Schiffes an Ägypten kam letztlich nicht zustande. Zeitweise als stationäres Schulschiff eingesetzt, wurde die Salisbury schließlich am 30. September 1985 als Zielschiff versenkt.
Claxton DD- 140 - History
Currency Conversion Page
page created by Harold Marcuse,
Professor of German History at UC Santa Barbara
(Prof. Marcuse's homepage)
page created August 19, 2005, last updated 10/7/18
What is old German money worth? (back to top)
- How much old German paper money is worth on the market today? I can't tell you.
This page is about how past amounts in Marks can be converted to past and present US dollars.
- For market values of old German bills you may have, I suggest looking on ebay under:
Ebay > Currency > Germany.
- Sammler.com has a page Collector Values of Old German banknotes with lots of information.
- Richard Holmes was a collector of 1920s German Notgeld (inflationary "emergency" money) until 1997. He put together an excellent Notgeld website with historical background, scans and links, and a page on how they can be valued (scroll down for tables). [links updated 8/2/10, thanks to Harry Brown]
I welcome suggestions for additions to this page: [email protected]
In 1938 Fritz earned 6000 Marks, what would his equivalent salary be today? (back to top)
- First, using the tables immediately below, convert the 1938 Marks to 1938 dollars.
In 1938, 2.49M=$1 or 12.4M=1£ means 6000M=$2409= £484.
- Now go to the inflation calculators section below, and see what $2409 (or £484) in 1938 would be worth today (the MeasuringWorth.com calculator is excellent--I think it might be more accurate to use the UK calculator than the US calculator, as Germany's economic indicators may have tracked those more closely). Inflating to the year 2017 the various indexes yield the following results:
£29,400 or $41,900 using the Consumer Price Index
£27,500 or $33,700 using the GDP deflator
$98,100 using the value of consumer bundle [reconverting in 2017: £70,700]
£78,500 or $91,000 using the average earnings / unskilled wage *
£132,000 or $214,000 using the nominal GDP per capita [good for estimating the "status" of that income]
£183,000 or $537,000 using the relative share of GDP [good for estimating the share of national wealth]
- Which measure would be most appropriate? Read the explanatory page on the MeasuringWorth.com site, Choosing the Best Indicator to Measure Relative Worth. For a salary or annual income, you will see that the "Consumer Bundle" or "GDP per capita" would be the best measures.
Thus Fritz's salary would be between $98,100 and $214,000 today [Or $170,000 inflating the UK £.]
Or using the UK inflator and converting the £ to $: £132,000 = $170,000 in 2017 would be the high end instead of $214k.
For the value of a simple commodity (loaf of bread, gallon of gas), you'd use the CPI.
For the cost of a building or public works project, you'd use the GDP deflator.
Good luck with your historical conversion!
US-German Currency Conversion Tables, 1913-2005 (back to top)
- The tables on the left below were scanned from R.L. Bidwell, Currency Conversion Tables: A Hundred Years of Change (London: Rex Collings, 1970), 22-24.
[UCSB library HG219.B5]
- The tables on the right were generated at the Economic History Association's eh.net site. In 2007 moved to: measuringworth.org/globalexchange
- original source: Lawrence H. Officer, "Exchange Rates," in Susan B. Carter, Scott S. Gartner, Michael Haines, Alan Olmstead, Richard Sutch, and Gavin Wright, eds., Historical Statistics of the United States, Millenial Edition (New York: Cambridge University Press, 2002). (see Lawrence Officer's Univ. Illinois/Chicago faculty page)
- T hese are annual averages (Bidwell's are for the listed month).
The 1971-2005 data in this left-hand table are from Triacom, a translation services company in Barendorf, Germany.
They generated it from oanda.com see: Daily Rates section, below.
The discrepancy with the eh.net table on the right is because the left-hand table has first trade date of the year values, while the right-hand table has annual averages. If a year's value in the right-hand table is higher, then the year average dollar rate was stronger than at the start of the year (said another way: the DM got weaker that year).
Lawrence H. Officer, Professor of Economics at the University of Illinois at Chicago, on his InfoEurope page:
"From 1913 onward, all the European series are annual averages of daily exchange rates in the New York market."
Prof. Officer also gives the following details about German currency names:
"On October 11, 1924 the monetary unit of Germany was changed from the mark to the reichsmark, where 1 reichsmark = 1,000,000,000,000 mark. Federal Reserve quotations switched from the mark to the reichsmark on October 29, 1924. In June 1948 the monetary unit was changed to the deutsche mark, where 1 deutsche mark = 10 reichsmark."
Notes for this update
Under certain circumstances, there is a known uninstallation issue that affects SQL Server 2017 CU 20. After you uninstall CU 20, SQL Server doesn’t come online, and the following error entry is logged in the SQL Server log:
The script level for 'system_xevents_modification.sql' in database 'master' cannot be downgraded from XXXXXXXXX to XXXXXXXXX, which is supported by this server. This usually implies that a future database was attached and the downgrade path is not supported by the current installation. Install a newer version of SQL Server and re-try opening the database.
Mitigation is to enable Trace Flag - T902, then SQL server will come online and you are done. You don’t have to uninstall it again. To upgrade to the new CU, you have to first remove this flag.
SQL Server 2017 CU21 or any later CU release contains the fix.
Hybrid environments deployment
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Install the update on the passive node.
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Our editors will review what you’ve submitted and determine whether to revise the article.
Black Death, pandemic that ravaged Europe between 1347 and 1351, taking a proportionately greater toll of life than any other known epidemic or war up to that time.
How many people died during the Black Death?
It is not known for certain how many people died during the Black Death. About 25 million people are estimated to have died in Europe from the plague between 1347 and 1351.
What caused the Black Death?
The Black Death is believed to have been the result of plague, an infectious fever caused by the bacterium Yersinia pestis. The disease was likely transmitted from rodents to humans by the bite of infected fleas.
Where did the Black Death originate?
The plague that caused the Black Death originated in China in the early to mid-1300s and spread along trade routes westward to the Mediterranean and northern Africa. It reached southern England in 1348 and northern Britain and Scandinavia by 1350.
What were the symptoms of the Black Death?
Yersinia causes three types of plague in humans: bubonic, pneumonic, and septicemic. Although there is DNA evidence that Yersinia was present in victims of the Black Death, it is uncertain which form the majority of the infection took. It is likely that all three played some role in the pandemic.
Bubonic plague causes fever, fatigue, shivering, vomiting, headaches, giddiness, intolerance to light, pain in the back and limbs, sleeplessness, apathy, and delirium. It also causes buboes: one or more of the lymph nodes become tender and swollen, usually in the groin or armpits.
Pneumonic plague affects the lungs and causes symptoms similar to those of severe pneumonia: fever, weakness, and shortness of breath. Fluid fills the lungs and can cause death if untreated. Other symptoms may include insomnia, stupor, a staggering gait, speech disorder, and loss of memory.
Septicemic plague is an infection of the blood. Its symptoms include fatigue, fever, and internal bleeding.
How did the Black Death affect Europe?
The effects of the Black Death were many and varied. Trade suffered for a time, and wars were temporarily abandoned. Many labourers died, which devastated families through lost means of survival and caused personal suffering landowners who used labourers as tenant farmers were also affected. The labour shortage caused landowners to substitute wages or money rents in place of labour services in an effort to keep their tenants, which benefited those surviving tenants. Wages for artisans and other workers also increased. Art in the wake of the Black Death became more preoccupied with mortality and the afterlife. Anti-Semitism greatly intensified throughout Europe, as Jews were blamed for the spread of the Black Death, and many Jews were killed by mobs or burned at the stake en masse.
What are other names for the Black Death?
The Black Death has also been called the Great Mortality, a term derived from medieval chronicles’ use of magna mortalitas. This term, along with magna pestilencia (“great pestilence”), was used in the Middle Ages to refer to what we know today as the Black Death as well as to other outbreaks of disease. “Black Plague” is also sometimes used to refer to the Black Death, though it is rarely used in scholarly studies.
The Black Death is widely believed to have been the result of plague, caused by infection with the bacterium Yersinia pestis. Modern genetic analyses indicate that the strain of Y. pestis introduced during the Black Death is ancestral to all extant circulating Y. pestis strains known to cause disease in humans. Hence, the origin of modern plague epidemics lies in the medieval period. Other scientific evidence has indicated that the Black Death may have been viral in origin.
Deinstitutionalization: Unfinished Business (Companion Paper to Policy Toolkit)
The unfinished business of closing state-run institutions and other public and private institutional settings that have traditionally served people with intellectual disabilities and developmental disabilities (ID/DD) is an important first step and should be a top public policy priority in every state where such institutions exist. Equally important is ensuring that these people have access to services and supports in their communities that will enable them to lead rich and meaningful lives.
In reviewing the history of the movement to close institutions and examining efforts to focus the nation’s resources on ensuring that people with ID/DD have access to community living, two key truths emerge:
- People with ID/DD have a legal right to live in the community and to receive necessary services and supports.
- Life in the community provides opportunities for dignity, freedom, choice, and a sense of belonging that are not possible in an institutional environment.
These truths are at the core of both the Americans with Disabilities Act (ADA) and the Olmstead decision. The courts have consistently upheld a person’s right to receive services in the least restrictive environment possible. Closing institutions is not about “dumping” people into the community, nor is it about closing large institutions and moving people to smaller institutions or institution-like settings. Closing institutions is about developing strong and inclusive community supports and allowing people to have control over how they live their lives.
In 2011, the National Council on Disability (NCD) took a position on the evolving definition of an institution. NCD focused on the importance of the number of people who live in the same home and defined institutional settings as housing situations in which more than four people with ID/DD disabilities live in the same housing unit. This position reflects the belief that a smaller housing situation offers an opportunity for a higher quality of life.
This paper discusses the lessons learned regarding how to close large institutions, but it focuses on the movement to smaller community living settings that meet NCD’s new definition. Regardless of the size of the institution, bringing people back into the community is only the beginning of the quest to help them achieve the highest possible quality of life. The paper examines some of the factors that advocates and self-advocates believe are important in defining “community living” and looks at how quality of life in the community can be and is being measured.
There is a growing consensus that true community living is defined by the extent to which people with ID/DD can choose how they spend their time, interact with others outside the home, and make decisions that affect their daily lives and schedules.
The paper identifies the most effective approaches and supports to help people with ID/DD transition from institutional settings of all sizes. With a focus on quality of life and community inclusion, the transition is certainly possible for both individuals and states.
This section, “Deinstitutionalization: The Right Thing to Do,” reviews the history of life in institutions it includes personal reflections of people with ID/DD who remember what institutional life was like and reflections on their lives in the community. This section also looks at the civil rights history of the deinstitutionalization movement and provides an overview of the evolving definition of “institution.”
“Evolution: From Institution to Community” tracks the history of the movement from institution to community and identifies the role Medicaid has played in the development of home and community-based service systems and national deinstitutionalization efforts.
“Institutions: Definitions, Population, and Trends” paints a picture of the current state of the ID/DD housing system and explains that, although significant progress has been made, progress has been uneven and the job is incomplete.
“Deinstitutionalization: Goal and Strategies” describes what the deinstitutionalization movement seeks to accomplish and outlines specific actions that interested parties can take to bring us closer to protecting all the rights of each and every American citizen.
“Forging Ahead: Developing a Plan and Building Community Capacity” describes the basic elements of a closure and transition plan, as well as strategies for building a community’s capacity to provide vital services and supports to community members.
“Overcoming Misconceptions: Myths and Realities” looks at key misconceptions that still exist in states and communities these misconceptions can influence stakeholders if they do not have access to accurate information.
“Case Studies: Closing Institutions and Building Community Support Systems” looks at the closure experience in two states: Oregon, which has closed all state institutions, and Georgia, which has just begun the process as part of its settlement agreement with the Department of Justice (DOJ 2011).
“Reflections: Individual Voices” highlights the experiences of people with disabilities in Georgia and Oregon who previously lived in institutions and now live in the community. Their stories are told in their own voices.
This paper is based on an extensive literature review and input from professionals, stakeholders, self-advocates, and government representatives obtained through interviews, focus groups, and the project’s panel of experts. A companion toolkit provides more in-depth discussion of these important issues. The toolkit can be accessed at:/publications/2012/DIToolkit/.
Deinstitutionalization: The Right Thing to DoDeinstitutionalization is Possible
Ten states and the District of Columbia have no large state institutions and have found ways to provide care in the community to all people with intellectual disabilities or developmental disabilities (ID/DD), regardless of the severity of their disability. However, the remaining states continue to maintain facilities and deliver services in institutions, despite most families’ preference for community-based services. As of 2009, 122,000 people with ID/DD were on waiting lists for residential services. [i] Even though they met the eligibility criteria for institutional care, which would be provided at no cost to them, they and their parents or caretakers opted against that setting, clearly rejecting institutional placement.
“It is pretty sad that you are put in prison because you have a disability.”
Most of these facilities, often called “developmental centers,” were built between 50 and 100 years ago and were designed for many times the number of people they now house. By all estimates, the cost to provide services to people in this outdated mode of service far exceeds the cost to provide services in the community, and research consistently demonstrates that people with ID/DD achieve better outcomes in community settings. [ii] Deinstitutionalization is a human and civil rights issue. People should not be required to give up their rights to receive the services they need.
Under the Americans with Disabilities Act (ADA, 1990), the Supreme Court’s decision in Olmstead v. L.C. (1999), the New Freedom Initiative (NFI, 2001), the Developmental Disabilities Assistance and Bill of Rights Act (2000), and the Rehabilitation Act of 1973, community living should be the rule, rather than the exception.
The institution model costs $6 billion a year at a time when less costly and more effective service delivery models are available. Spending scarce resources on expensive and inhumane service models deprives people with disabilities of access to appropriate services.
Deinstitutionalization is the Right Thing to Do
Oregon helps us put a human face on this issue. The state closed all its institutions in 2007—an example of committed and creative deinstitutionalization. Oregon advocates have spent considerable time and energy documenting the reasons why this effort is so important, including the human costs and civil rights issues related to institutionalization. In Erasing Fairview’s Horror, Sara Gelser says, “As the visible reminders of Fairview disappear, we must ensure that its history is not forgotten or sanitized.” [iii]
That history includes labeling individuals with developmental disabilities “inmates,” performing more than 2,600 forced sterilizations, and, according to Governor John Kitzhaber, using “inhumane devices to restrain or control patients, including leather cuffs and helmets and straightjackets, and inappropriately high dosages of sedatives and psychotropic medications.”
A study published in the American Journal of Forensic Medicine and Pathology found that between 1963 and 1987, Fairview residents were more than twice as likely to die from unnatural causes as noninstitutionalized people in Marion County. [iv]
The voices of people with developmental disabilities who lived in Oregon’s institutions serve as stark reminders of the importance of this movement:
“I was handicapped, but it made me sicker to be there. It was like a prison. Handcuff. Shut door.”
“They were strict at Fairview. You got beat up, yelled at. They put us in closets.”
“If you don’t behave yourself, they’d get you with the scalding hot water.” [v]
Oregon remembers but is moving on. Perhaps this progress is best illustrated by the experience of one person who returned to Fairview with Michael Bailey, statewide community organizer for the Community Partnerships Project, when the institution closed its doors in 2000. After their visit Bailey said,
“We drove off with one of the former ‘inmates.’ She had to return to her full-time job and at the end of the day would go home to her own apartment. There she would be alone with the memories of a life that had once labeled her a ‘victim of…’ and an ‘inmate’ and now, finally,… a respected, financially independent and successful professional woman.”
—Michael Bailey, Oregon advocate
These experiences were well documented in Oregon, and instances of abuse continue to occur in institutions across the country. For example, the 2009 Texas “fight club” incident—in which institution workers forced residents to fight one another while employees taped the fights on their cell phones—made national news. In 2007 the Atlanta Journal-Constitution published an exposé of state mental health hospitals that revealed more than 100 suspicious patient deaths during the previous five years. [vi] The 2002 death of Brian Kent at Kiley Center in Waukegan, Illinois, revealed a pattern of neglect caused by unprofessional attitudes, administrative indifference, lack of competence, and caregiver fatigue. [vii]
Deinstitutionalization is a Civil Right
Clearly, deinstitutionalization and the development of a strong community-based system that helps people with ID/DD live in the community is both morally and ethically the right thing to do, but it is also a civil rights issue: The law supports the individual right to live in the community.
In crafting the ADA of 1990, Congress found that “the Nation's proper goals regarding individuals with disabilities are to assure equality of opportunity, full participation, independent living, and economic self-sufficiency for such individuals.”
In 1995, two residents of institutions in Georgia sued the state, claiming they had the right to receive care in the most integrated setting appropriate and their unnecessary institutionalization was discriminatory, in violation of the Americans with Disabilities Act (ADA). Eventually the case was heard by the United States Supreme Court. In 1999, the Court ruled in the case of Olmstead v. L.C., 527 U.S. 581 (1999), that unnecessary institutionalization of people with disabilities constitutes discrimination under the ADA (Olmstead v. L.C., 527 U.S. 581).
The decision included some definitive language about institutionalization. It said,
- Unjustified isolation, we hold, is properly regarded as discrimination based on disability.
- Institutional placement of persons who can handle and benefit from community settings perpetuates unwarranted assumptions that persons so isolated are incapable or unworthy of participating in community life.
- Confinement in an institution severely diminishes the everyday life activities of individuals, including family relations, social contacts, work options, economic independence, educational advancement and cultural enrichment.
The Olmstead decision requires community placement when the following three conditions are met:
- The person can handle or benefit from community placement,
- The transfer is not opposed by the affected person, and
- Community placement can be reasonably accommodated (i.e., would not impose a fundamental alteration, which the state must prove).
The Olmstead case focused on people who were currently in an institution and seeking community-based care. Subsequent cases have applied Olmstead to people at risk of institutionalization, including those on waiting lists, arguing that cuts in community services that would force a person into an institution violate the ADA.
In 2009, the Civil Rights Division of the Department of Justice (DOJ) launched an aggressive effort to enforce the Olmsteaddecision.
President Obama issued a proclamation launching the “Year of Community Living,” and has directed the Administration to redouble enforcement efforts. The Division has responded by working with state and local government officials, disability rights groups and attorneys around the country, and with representatives of the Department of Health and Human Services, to fashion an effective, nationwide program to enforce the integration mandate of the Department's regulations implementing Title II of the ADA. [viii]
A technical assistance guide has been created to help people understand their rights and to help public entities understand their obligations under the ADA and Olmstead. [ix]
Evolution: From Institutions to Community
Over the past 40 years, more than 230,000 people with intellectual and developmental disabilities were discharged from state institutions. As of June 30, 2009, 33,900 remained institutionalized. This movement from institutions to community is heavily influenced by the role of Medicaid funding in each state’s plan.
Institutions and the ICF/DD Program
Large State Institutional Settings
The national peak of institutionalization for people with ID/DD was in 1967, when 194,650 people were housed in large state institutions and an additional 33,850 were housed in state psychiatric facilities. [x] However, even at the height of institutionalization, most people with developmental disabilities lived with families, as they do today. Families had few other options. Most residential care outside the family home was provided in large state-run facilities and financed entirely by state, local, and private funding.
In 1971, in response to evidence of the horrific conditions in which people with ID/DD were being warehoused, Congress established the Intermediate Care Facilities for the Developmentally Disabled (ICF/DD) program (formerly Intermediate Care Facilities for the Mentally Retarded (ICF/MR)) [xi] as a Medicaid benefit. The ICF/DD program was offered as an optional Medicaid program. A state could opt to include the program in its Medicaid plan, or it could continue to fund its institutions without federal financial participation. However, once a state included ICF/DD program dollars in its plan, it had to provide the service to anyone who was eligible for Medicaid services.
By the 1980s, all 50 states had adopted the ICF/DD program. In exchange for federal Medicaid funds, institutions had to comply with minimum federal requirements for safety, staffing levels, appropriate active treatment, qualified professional staff, and many other conditions.
Small State Institutional Settings
The ICF/DD program focused on large state institutions. However, federal regulations and guidelines made it clear that the same level of care could be delivered in state and private facilities that served 16 or fewer people. These smaller facilities offered another option for people with ID/DD. They were typically located in the community and were managed and financed through the state’s optional ICF/DD program. However, they provided a regulated program of services in a formally certified setting, which meant that residents were still living an institutional life.
Community and the HCBS Waiver
Unlike the institutional setting, the community setting starts with recognition that people with ID/DD should have control over the delivery of services and supports, as well as the location and setting in which they receive them. These settings vary in size and type, but they are substantially smaller than the institutional setting. They include both in-home with family settings and out-of-home group settings, and offer a variety of services and supports.
In 1981, Congress established the Medicaid Home and Community-Based Services (HCBS) waiver program. The HCBS waiver allows states to receive federal matching funds for a variety of residential services and supports to Medicaid beneficiaries who would otherwise require institutional care.
By 2009, 48 states and the District of Columbia operated 125 different HCBS waivers for people with DD, including waivers serving the broad population of people with DD and waivers targeting people with particular conditions, such as autism spectrum disorders and intellectual disabilities. The two other states, Arizona and Vermont, provided similar services as part of research and demonstration waivers authorized by Section 1115 of the Social Security Act. [xii]
Community-based settings are available in a variety of types and sizes, and with various characteristics. The relationship between provider and consumer, the number of residents, and the style of service and support delivery are among the attributes that differentiate the choices available through the HCBS waiver.
Community-based setting types include specialized institutional facility, group home, apartment program, independent home/apartment, parent/relative’s home, foster care/host home, and nursing facility.
Additional Community Program Funding
The Federal Government, through changes in the Medicaid program, has promoted community living through several initiatives in the past seven years, including the following:
Deficit Reduction Act (DRA) of 2005: This legislation created a new Medicaid option that covers certain HCBS waiver services without requiring states to go through the lengthy waiver application and approval process. [xiii]
Money Follows the Person (MFP), 2005: The MFP demonstration, first authorized by Congress as part of the 2005 DRA and then extended by the 2010 Patient Protection and Affordable Care Act (PPACA), provides grants to states to (1) transition people from nursing homes and other long-term care institutions (such as ICF/DDs) to homes, apartments, or group homes of four or fewer residents, and (2) change state policies so that Medicaid funds for long-term care services and supports can follow the person to the setting of his or her choice. As of 2010, the Center for Medicare and Medicaid Services (CMS) had awarded MFP grants to 30 states and the District of Columbia, and the demonstration is authorized through 2016. [xiv] To ease the transition to the community, the state provides MFP participants with a richer mix of services than is available to regular waiver participants, and states receive an enhanced federal match for providing these additional services.
American Recovery and Reinvestment Act of 2009 (ARRA): ARRA provides enhanced federal matching funds that enable states to continue funding HCBS waivers and other Medicaid services. The maintenance-of-eligibility requirement in ARRA restricts state options for reducing eligibility for services. [xv]
Community First Choice Option (2011): This proposed rule implements Section 2401 of the Affordable Care Act (ACA), which establishes a new state option to provide home and community-based attendant services and supports. The Community First Choice Option adds a new section 1915(k) to the Social Security Act that allows states to provide home and community-based attendant services and supports under their state plans. First Choice, available beginning October 1, 2011, allows states to receive a 6 percentage point increase in federal matching payments for expenditures related to this option.
Community Choice Act (not enacted): The Community Choice Act (CCA), introduced in Congress in 2007 and again in 2009, would require state Medicaid plans to cover community-based attendant services and supports for people with disabilities, regardless of age or disability. The CCA would allow the dollars to follow the person and would allow eligible people or their representatives to choose where they would receive services and supports. Any person who is entitled to nursing home or other institutional services could choose where and how these services were provided. Despite advocacy efforts, the bill never got out of committee and the concept was not included in the 2010 health care reform. [xvi]
The Historical Horror of Childbirth
Childbirth in much of human history has been a class act. The upper classes were encouraged to reproduce as much as possible, and a woman who was pregnant or recovering from childbirth took time to rest while servants took care of her and the child. The lower classes worked right up to and soon following birth, as they had to work to eat. The upper classes also had the latest medical knowledge at their fingertips, but this wasn't always such a good thing.
Class distinctions in childbirth during the Renaissance were recorded. In 15th-century Florence, women were married as teenagers and often had five to ten children, depending on whether she survived childbirth. Childbirth was so dangerous that a woman would make out her will as soon as she found out she was pregnant. An age-old method of birth control is extended breastfeeding, which is nature's way of spacing out children. However, the custom among the upper classes was to farm out breastfeeding to wet nurses, which meant that the mother would soon be pregnant again.
It was during the Renaissance that medical doctors began to take part in childbirth, although not without a struggle. Women as whole were sheltered and their bodies hidden under plenty of clothing. It was unseemly for any man to take part in the intimate process of childbirth, and midwives did not want to give up their power or expertise in the area. Midwives had experience on their side physicians had the authority that comes with the title. Therefore, most of the writings and advice from the period come from prominent physicians, and a lot of their advice was guesswork.
Three women were pregnant when they boarded the Mayflower on its journey to America. One child, Oceanus Hopkins, was born during the voyage and died during the first winter in Massachusetts. Another, Peregrine White, was born shipboard off Cape Cod and lived to an old age. The third child was stillborn at Plymouth the mother died in childbirth. Such stories were not at all shocking, as a woman's chances of dying during childbirth were between one and two percent -for each birth. If a woman gave birth to eight or ten children, her chances of eventually dying in childbirth were pretty high. The infant mortality rate was even higher. The chances of a child dying before his fifth birthday were estimated to be around 20 percent, depending on the community (accurate records are scarce). In addition to the fear of death or the fear of the child dying, there was no pain relief during labor, except for whisky in some places. In Puritan communities, pain during childbirth was God's punishment for Eve and all women who came afterward.
Motherhood in early America was even more frightening for slaves. Infant mortality among African and African-American slaves in the 18th century ranged from 28-50 percent, and mortality in children under ten was 40-50 percent, due to maternal malnutrition, overwork, disease, and lack of medical access. Slave owners blamed the mothers for infant deaths, and there is evidence that some babies were deliberately smothered to spare the child a life of slavery, but other factors contributed greatly to the infant death rate.
As Europe became more crowded in the 17th and 18th centuries, communicable diseases caused even more frequent deaths in childbirth. Puerperal fever had been around, but the rise of physician-assisted births increased its rate. It is a bacterial infection that became apparent within days of giving birth. The rise of maternity wards in hospitals meant that many women gave birth within shouting distance of each other. Doctors, in those days before germ theory, went from patient to patient, unknowingly carrying the bacteria on their instruments and their unwashed hands. In the 1790s, Alexander Gordon stressed that the disease was spread from one patient to another. He "bled" his patients at the first sign of puerperal fever, which actually helped in some cases, but no one understood why. In 1842, Thomas Watson recommended that physicians and birth attendants wash their hands and use chlorine between patients. In 1847, Ignaz Semmelweis reduced the rate of fever in his obstetric ward by ordering hand washing, but the idea was still rejected by the medical industry at large. A famous victim of puerperal fever was Mary Wollstonecraft, mother of Frankenstein author Mary Shelley. In 1797 she gave birth to her daughter Mary with the assistance of a midwife. But then a doctor was called to help remove the placenta and he came quickly, with unwashed hands. Wollstonecraft died a painful but typical death over the next week.
Pioneers who settled the American West didn't have it much better than their eastern or European counterparts. Both doctors and midwives were scarce, and the midwives who were able to help in childbirth rarely had more knowledge than the experience of giving birth themselves. Infant mortality remained high, but the isolation of living on wilderness farmland many miles away from settled towns had one advantage: the spread of disease was lessened somewhat.
Childbirth changed dramatically in the 19th century with the introduction of anesthetics. Dentist William Morton developed the use of ether for surgery in 1846. Obstetrician Sir James Young Simpson introduced chloroform as an anesthetic in 1847. Queen Victoria used chloroform during her eighth delivery in 1853. The practice of childbirth anesthesia spread quickly afterward, despite protests from the clergy, who claimed that labor pains are God's will.
In 1914, a method called Twilight Sleep was developed, which involved morphine and scopolamine. The mother slept through delivery, but the drugs also affected the baby, and sometimes the child didn't breathe at all. The morphine also caused some mothers to die in childbirth.
In the 20th century, advances in medicine and germ theory raced ahead of public health and the access of the lower classes to medical care. When Dr. Josephine Baker was appointed as city health inspector for the Hell's Kitchen area in 1901, she found that 1,500 newborn babies died in the district every week. Her crusade to improve prenatal care and child health practices involved inventing formula, opening clinics, launching a school lunch program, training babysitters, and opening milk stations in the city, and it resulted in a huge decrease in infant and child deaths.
Childbirth, though still an ordeal, is much safer today for mothers. Children are much more likely to survive to adulthood. And widely available birth control gives people the option of deciding when and how many children to have. But the hard part comes after childbirth -raising a family, which is more complicated every day. And that's why you should honor your mother this Mother's Day.
Changes Since Katrina
The failures in response during Katrina spurred a series of reforms initiated by Congress. Chief among them was a requirement that all levels of government train to execute coordinated plans of disaster response. In the decade following Katrina, FEMA paid out billions in grants to ensure better preparedness.
Meanwhile, the Army Corps of Engineers built a $14 billion network of levees and floodwalls around New Orleans. The agency said the work ensured the city&aposs safety from flooding for the time. But an April 2019 report from the Army Corps stated that, in the face of rising sea levels and the loss of protective barrier islands, the system will need updating and improvements by as early as 2023.
Watch the video: Mortar: Type N or Type S (January 2022).
- For market values of old German bills you may have, I suggest looking on ebay under: