By Jariel Arvin, KFF Health News

On Fridays, Stephanie Johnson has a busy schedule, driving her navy-blue Jeep from one patient’s home to the next, seeing eight in all. Pregnant with her second child, she schleps a backpack instead of a traditional black bag to carry a laptop and essential medical supplies — stethoscope, blood pressure cuff, and pulse oximeter.

Forget a lunch break; she often eats a sandwich or some nuts as she heads to her next patient visit.

On a gloomy Friday in January, Johnson, a nurse practitioner who treats older adults, had a hospice consult with Ellen, a patient in her 90s in declining health. To protect Ellen’s identity, KFF Health News is not using her last name.

“Hello. How are you feeling?” Johnson asked as she entered Ellen’s bedroom and inquired about her pain. The blinds were drawn. Ellen was in a wheelchair, wearing a white sweater, gray sweatpants, and fuzzy socks. A headband was tied around her white hair. As usual, the TV was playing loudly in the background.

“It’s fine, except this cough I’ve had since junior high,” Ellen said.

Ellen had been diagnosed with vascular dementia, peripheral vascular disease, and Type 2 diabetes. Last fall, doctors made the difficult decision to operate on her foot. Before the surgery, Ellen was always colorful, wearing purple, yellow, blue, pink, and chunky necklaces. She enjoyed talking with the half dozen other residents at her adult family home in Washington state. She had a hearty appetite that brought her to the breakfast table early. But lately, her enthusiasm for meals and socializing had waned.

Johnson got down to eye level with Ellen to examine her, assessing her joints and range of motion, checking her blood pressure, and listening to her heart and lungs.

Carefully, Johnson removed the bandage to examine Ellen’s toes. Her lower legs were red but cold to the touch, which indicated her condition wasn’t improving. Ellen’s two younger sisters had power of attorney for her and made it clear that, above all, they wanted her to be comfortable. Now, Johnson thought it was time to have that difficult conversation with them about Ellen’s prognosis, recommending her for hospice.

“Our patient isn’t just the older adult,” Johnson said. “It’s also often the family member or the person helping to manage them.”

Stephanie Johnson examines her patient Ellen’ s foot. Ellen had been diagnosed with vascular dementia, peripheral vascular disease, and Type 2 diabetes. Last fall, doctors made the difficult decision to operate on her foot. ((Jariel Arvin for KFF Health News)/KFF Health News/TNS)

Nurse practitioners are having those conversations more and more as their patient base trends older. They are increasingly filling a gap that is expected to widen as the senior population explodes and the number of geriatricians declines. The Health Resources and Services Administration projects a 50% increase in demand for geriatricians from 2018 to 2030, when the entire baby boom generation will be older than 65. By then, hundreds of geriatricians are expected to retire or leave the specialty, reducing their number to fewer than 7,600, with relatively few young doctors joining the field.

That means many older adults will be relying on other primary care physicians, who already can’t keep up with demand, and nurse practitioners, whose ranks are booming. The number of nurse practitioners specializing in geriatrics has more than tripled since 2010, increasing the availability of care to the current population of seniors, a recent study in JAMA Network Open found.

According to a 2024 survey, of the roughly 431,000 licensed nurse practitioners, 15% are, like Johnson, certified to treat older adults.

Johnson and her husband, Dustin, operate an NP-led private practice in greater Seattle, Washington, a state where she can practice independently. She and her team, which includes five additional nurse practitioners, each try to see about 10 patients a day, visiting each one every five to six weeks. Visits typically last 30 minutes to an hour, depending on the case.

“There are so many housebound older adults, and we’re barely reaching them,” Johnson said. “For those still in their private homes, there’s such a huge need.”

Laura Wagner, a professor of nursing and community health systems at the University of California-San Francisco, stressed that nurse practitioners are not trying to replace doctors; they’re trying to meet patients’ needs, wherever they may be.

“One of the things I’m most proud of is the role of nurse practitioners,” she said. “We step into places where other providers may not, and geriatrics is a prime example of that.”

Practice limits

Nurse practitioners are registered nurses with advanced training that enables them to diagnose diseases, analyze diagnostic tests, and prescribe medicine. Their growth has bolstered primary care, and, like doctors, they can specialize in particular branches of medicine. Johnson, for example, has advanced training in gerontology.

“If we have a geriatrician shortage, then hiring more nurse practitioners trained in geriatrics is an ideal solution,” Wagner said, “but there are a lot of barriers in place.”

In 27 states and Washington, D.C., nurse practitioners can practice independently. But in the rest of the country, they need to have a collaborative agreement with or be under the supervision of another health care provider to provide care to older adults. Medicare generally reimburses for nurse practitioner services at 85% of the amount it pays physicians.

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Last year, in more than 40 states, the American Medical Association and its partners lobbied against what they see as “scope creep” in the expanded roles of nurse practitioners and other health workers. The AMA points out that doctors must have more schooling and significantly more clinical experience than nurse practitioners. While the AMA says physician-led teams keep costs lower, a study published in 2020 in Health Services Research found similar patient outcomes and lower costs for nurse practitioner patients. Other studies, including one published in 2023 in the journal Medical Care Research and Review, have found health care models including nurse practitioners had better outcomes for patients with multiple chronic conditions than teams without an NP.

Five states have granted NPs full practice authority since 2021, with Utah the most recent state to remove physician supervision requirements, in 2023. In March, however, Mississippi House Bill 849, which would have increased NP independence, failed. Meanwhile, 30 Texas physicians rallied to tamp down full-scope efforts in Austin.

“I would fully disagree that we’re invading their scope of practice and shouldn’t have full scope of our own,” Johnson said.

She has worked under the supervision of physicians in Pennsylvania and Washington state but started seeing patients at her own practice in 2021. Like many nurse practitioners, she sees her patients in their homes. The first thing she does when she gets a new patient is manage their prescriptions, getting rid of unnecessary medications, especially those with harsh side effects.

She works with the patient and a family member who often has power of attorney. She keeps them informed of subtle changes, such as whether a person was verbal and eating and whether their medical conditions have changed.

While there is some overlap in expertise between geriatricians and nurse practitioners, there are areas where nurses typically excel, said Elizabeth White, an assistant professor of health services, policy, and practice at Brown University.

“We tend to be a little stronger in care coordination, family and patient education, and integrating care and social and medical needs. That’s very much in the nursing domain,” she said.

That care coordination will become even more critical as the U.S. ages. Today, about 18% of the U.S. population is 65 or over. In the next 30 years, the share of seniors is expected to reach 23%, as medical and technological advances enable people to live longer.

Patient and family

In an office next to Ellen’s bedroom, Johnson called Ellen’s younger sister Margaret Watt to recommend that Ellen enter hospice care. Johnson told her that Ellen had developed pneumonia and her body wasn’t coping.

Watt appreciated that Johnson had kept the family apprised of Ellen’s condition for several years, saying she was a good communicator.

“She was accurate,” Watt said. “What she said would happen, happened.”

A month after the consult, Ellen died peacefully in her sleep.

“I do feel sadness,” Johnson said, “but there’s also a sense of relief that I’ve been with her through her suffering to try to alleviate it, and I’ve helped her meet her and her family’s priorities in that time.”

Jariel Arvin is a reporter with the Investigative Reporting Program at the University of California-Berkeley Graduate School of Journalism. He reported this article through a grant from The SCAN Foundation .

©2025 KFF Health News. Distributed by Tribune Content Agency, LLC.

By CATHY BUSSEWITZ, Staff Writer

NEW YORK (AP) — Jeremy Didier had taken her son to a psychologist for a possible ADHD evaluation when she spotted an article about women with the condition. As she read it in the waiting room, she thought to herself: They’re describing me.

“Lots of risk-taking, lots of very impulsive behavior growing up,” Didier said. As the magazine described, she’d excelled in school but gotten in trouble for talking too much. She’d amassed too many speeding tickets as an adult. She turned to her husband and said, “I think I might have ADHD.”

Didier is now the board president of Children and Adults with Attention-Deficit/Hyperactivity Disorder, a nonprofit advocacy and support organization. Her realization mirrors the experiences of other adults who wonder if they have ADHD after a child’s diagnosis.

Attention-deficit/hyperactivity disorder is a neurodevelopmental condition characterized by inattention, hyperactivity or a combination of the two. Common symptoms such as trouble concentrating or sitting still can create challenges at work.

People with ADHD are often passed over for promotions, said Andrew Sylvester, a psychiatrist at UCHealth, a hospital in Longmont, Colorado. Difficulties with attention may lead the mind to drift during meetings, and cause someone to miss important discussion nuances. The disorder may interfere with organization, planning and remembering details.

Yet some adults think of having ADHD as a source of personality strengths and ways of thinking that benefit employers. Diagnostic manuals may call it a disorder, but it also can be a superpower, they said.

“Our brains work differently and so we’re more likely to be able to think outside the box and come up with different things, and sometimes that’s because we’ve had to do that in order to to survive,” Didier said.

Here are some ways to cope with and channel ADHD in the workplace.

Finding community

Getting diagnosed with ADHD doesn’t always lead to a quick fix. While doctors often recommend medication and therapy, not everyone can take medication, and those routes don’t necessarily eliminate all symptoms.

Didier floundered with a messy house and lots of yelling as she and four of her five children were diagnosed with ADHD. She experimented with medicine, diets and reward charts, and discovered what helped her the most: a community of parents who had children with ADHD.

“There’s nothing like talking to other people who are going through what you’re going through to help you feel … that you’re not alone,” she said.

Didier eventually became a social worker and now runs support groups for adults with ADHD, teaching skills they can use at work.

Some organizations have employee resource groups organized around neurodiversity to provide camaraderie and support to adults with ADHD, autism, dyslexia and other conditions.

GPS of the brain

People with ADHD often struggle with executive function, which Didier describes as “your brain’s GPS” for navigating your day. Executive function is a set of mental skills that includes making plans, managing time and flexible thinking. It also includes working memory, which helps us keep track of what we’re doing.

To keep from getting derailed, experts recommend breaking large tasks into chunks, writing detailed to-do lists and taking breaks.

Personal chef Bill Collins, 66, who was diagnosed with ADHD two years ago, writes structured lists when he’s making a meal for a client. He creates categories for kitchen areas — counter, stove and oven — and then lists tasks such as “chop carrots, boil water for pasta” underneath each category. Then he numbers each task so he knows exactly what to do, where and when.

“That’s how I got around my unknown ADHD early on, just making lists,” Collins said. “If it’s something I don’t want to do, I put it at the top of the list so I can be done with it.”

Another technique is called “body doubling,” which involves a pair of work colleagues meeting over Zoom or in-person to focus on completing projects. The two may choose to perform separate tasks — one might build a presentation deck while the other files tax reports — but help each other stay accountable.

“You’re just sitting there during that dedicated time, getting things done,” Didier said.

Insurance company Liberty Mutual provides an AI tool that helps break down large projects into manageable tasks and provides reminders about deadlines, to help employees with ADHD stay focused and organized, said Head of Benefits Verlinda DiMarino.

Getting through meetings

Meetings can be difficult for people with ADHD if their minds drift or they feel an urge to get up out of a chair. They also may struggle with impulse control and find it hard to wait their turn to speak.

Nicole Clark, CEO of the Adult and Pediatric Institute, a mental health practice in Stuart, Florida, suggests asking for meeting topics in advance and writing up talking points. If you think of questions during the meeting, write them down.

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Some employers use a voice-to-text service, projecting what a speaker is saying on a screen, which helps people with attention difficulties stay focused, Clark said.

Sylvester, the psychiatrist, recommends practicing active listening by repeating in your head what someone just said, or taking a brief time-out from a meeting to reset.

Tell them, “’I need five minutes. I’ll be right back.’ Get up and walk out. Do what you need to do,” he said.

Mariel Paralitici-Morales, chief medical officer of the Adult and Pediatric Institute, who has ADHD, sits close to whoever will be speaking to help sustain attention.

“Having something in my hand helps,” said Paralitici-Morales, who sometimes holds a fidget spinner. “If we have to talk, I found it’s easier for me to be the first one and break the ice” to keep herself from second-guessing what she planned to say.

Seek accommodations

People with an ADHD diagnosis can request accommodations at work through the Americans with Disabilities Act. Noise-canceling headphones may help. Consider asking for the ability to take a break every 20 minutes, Sylvester said.

“Set a timer for five to 10 minutes. Get up and walk around. Make some coffee. Go play with the dog,” he said. “When that timer goes off, go back to a 15 to 20 minute hard productivity cycle.”

Employees can also request a flexible schedule or ability to work from home, which can enable time for therapy or self-care.

Antoinette Damico, 23, who coordinates events at an executive search firm in San Francisco, said she practices meditation, writes daily goals in a journal and stays off short-form media to improve her concentration.

Celebrate your strengths

Having ADHD can be an asset in the workplace, and many CEOs and entrepreneurs are neurodiverse, Didier said.

“We bring all kinds of unique talents to our workplaces. Hyper-focus, lots of energy, resilience, the ability to multitask,” she added. “There’s something about people with ADHD that seems to unmask or give us a greater capacity for creativity and innovation.”

Damico also thinks her ADHD provides some advantages. When she’s interested in a topic, she can be extremely focused, reading extensively and talking about the topic nonstop, a trait others with ADHD report.

“It can generate a real passion in you that is a bit unique,” she said. “It really creates this grit in me in terms of when I really want to accomplish something, there’s this boost of energy.”

Share your stories and questions about workplace wellness at cbussewitz@ap.org. Follow AP’s Be Well coverage, focusing on wellness, fitness, diet and mental health at https://apnews.com/hub/be-well

July stargazing is certainly a late show, but it’s worth losing some sleep over because it’s now prime time for summer constellations.

I suggest lying back on a reclining lawn chair and letting it all soak in. The brightest actual star in the sky this month is Arcturus, perched high in the western sky as night falls. Arcturus appears to be at the tail of a giant kite, formally known as the constellation Bootes, the hunting herdsman. Not far away, check out the great Hercules globular cluster with a telescope. The attached July star map will help you. The Hercules cluster, otherwise known as Messier object 13, is a spherical cluster of thousands and thousands of stars around 25,000 light-years away. It’s a stargazing summer classic!

(Mike Lynch)

In the eastern heavens, you’ll see more of the prime stars of summer on the rise. The best way to find your way around that part of the sky is to locate the “Summer Triangle,” made up of three bright stars, the brightest in each of their respective constellations. You can’t miss them. The highest and brightest star is Vega, also the brightest star in a small constellation called Lyra the Lyre. The second-brightest star on the lower right is Altair, the brightest in Aquila the Eagle. The third-brightest at the left corner of the summer triangle is Deneb, the brightest star in the tail of Cygnus the Swan. A large part of Cygnus is known as the “Northern Cross” because that’s what it really resembles.

In the northwest sky, look for the Big Dipper hanging from its handle. The Big Dipper isn’t an official constellation but the very bright rear end and extended tail of Ursa Major, the Big Bear. The fainter Little Dipper, also known as Ursa Minor, the Little Bear, is standing on its handle (or tail), just to the upper right of the Big Dipper. The moderately bright star Polaris, also known as the North Star, is at the end of the Little Dipper’s handle.

In the south-southeastern evening sky this month is the classic constellation Scorpius the Scorpion, which really looks like a scorpion! In higher northern latitudes though, the beast’s tail never rises above the horizon. Not far from Scorpius in the lower southeast sky is one of my favorite constellations, Sagittarius the Archer. It’s supposed to be a half-man, half-horse shooting an arrow, but it looks much more like a giant teapot.

As lovely as our summer evening skies are this month, we’re a bit planet-challenged. The only naked-eye planets visible before midnight are Mars and, just barely, Mercury. Mars resides this month in the low southwestern sky as evening twilight fades but slips below the horizon shortly after. Outside of its obviously ruddy tinge, it doesn’t have much to offer visibly right now. Even with a larger telescope, all you’ll see is an orange-red dot. It’s just so far away this month, over 174 million miles away.

Planet watching is slightly better in the early morning , both before and during the opening of morning twilight. Before twilight kicks in, look for a lone moderately bright “star” in the low southeast sky. That’s Saturn, nearly 900 million miles away. It would be a little brighter, but the thin and highly reflective ring system is still on edge from our vantage on Earth, but slowly, over the next several years, the angle between the ring system and the planet will open up again.

Shortly before morning twilight kicks in, the extremely bright planet Venus emerges above the eastern horizon, continuing its stint as this summer’s “morning star.” Venus is going to have some company this month. In late July, Jupiter jumps into the predawn sky right on the heels of Venus.

The full moon this month is on the 10th. It has several nicknames. It’s most commonly known as the Buck Moon because new antlers begin to sprout from buck deer during this time of year. Summer full moons take a very low path across the celestial dome, mirroring the low path the sun takes in the winter.

Mike Lynch is an amateur astronomer and retired broadcast meteorologist for WCCO Radio in Minneapolis/St. Paul. He is the author of “Stars: a Month by Month Tour of the Constellations,” published by Adventure Publications and available at bookstores and adventurepublications.net. Mike is available for private star parties. You can contact him at mikewlynch@comcast.net.

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A Burnsville property owner wants to turn a former garbage dump into a high-tech driving range and pickleball stadium, an ambitious concept that has drawn scrutiny from the Minnesota Pollution Control Agency over plans they say fail to address decades-old underlying contamination at the site.

Michael McGowan recently unveiled development plans for Big Hits at the Gateway, an entertainment complex centered around a three-story golf driving range, restaurant and pickleball complex with indoor and outdoor courts. Currently, the Chalet Driving Range sits on the site, which rests along Interstate 35W and the Minnesota River in Burnsville. McGowan is the second-generation owner of the site, where the long-closed Freeway Dump once operated.

While McGowan’s Freeway Properties development team has celebrated what could be a regional draw for the area, MPCA officials are concerned with the pollutants in the ground. Those pollutants, left in place, eventually could contaminate area drinking water. The MPCA is also concerned with the old dump’s proximity to the Minnesota River.

The Freeway Dump operated from 1960 to 1969, when few regulations concerning the operation and location of landfills or dump sites existed. The waste is currently covered with grass and other vegetation. There is also a nearby landfill site that was operated by the McGowan family, northwest of the Chalet Golf site, known as the Freeway Landfill. The unlined landfill accepted refuse from 1969 to 1990.

The Big Hits development would not involve the Freeway Landfill site.

McGowan said his father, Richard, has been trying to redevelop the land for 55 years, since the dump closed. Decades ago, there was talk of a furniture store. Then, murmurs about a car dealership, he said, recalling preliminary chats with the Walser and Luther automotive groups. In 2000, a large-scale amphitheater to be placed on top of the old Freeway Landfill reached planning stages, in partnership with then-ownership of the Minnesota Wild.

But over time, nothing came to fruition.

“The common stumbling block has always been the MPCA,” McGowan said. “All the McGowans want is to be treated fairly like similar brownfield sites. We have absolutely not been treated like other landfills.”

MPCA officials said they talked to the developers about plans last year, but have not had discussions about the most recent concept. Representatives from Freeway Properties said they have reached out to the MPCA to discuss plans.

In terms of how the MPCA views the site compared to other former dumps, MPCA Assistant Commissioner for Land Policy and Strategic Initiatives Kirk Koudelka said this site brings several unique characteristics, particularly due to the proximity to drinking water and the Minnesota River.

“The specifics matter,” Koudelka said. “We have to be protective of those drinking water sources in the area.”

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Through the last few decades, the McGowans and MPCA officials have gone back and forth about how to best mitigate the site. Two main options from the MPCA emerged.

The first option involved creating a new, modern landfill on the old Freeway Landfill site and moving the refuse from the old Freeway Dump to the new landfill at an estimated cost of $117 million.

The second option was excavating both the old landfill and the old dump and moving the contents to a different, modern landfill site, with projected costs of anywhere between $165 million and $538 million.

At the end of the day, the concerns are the same, Koudelka said.

“At this time we have a number of concerns, and they don’t address the underlying issue,” Koudelka said. “The previous plans we have seen do not address the actual source of waste.”

Garbage to golf

Plans for Big Hits at the Gateway — so named for how the parcel of land has been referred to as the “gateway of Burnsville” — call for a three-story structure with 100 golf driving bays, a full-service restaurant and bar, and corporate and event center space.

The concept also includes 17 pickleball courts spread across indoor and outdoor facilities, with one of the courts outfitted to attract professional tournament play, LSE Architects CEO and co-founder Mohammed Lawal said. His firm has been brought into the fold as part of the project development team.

The plans also include trail connections to the Minnesota River Trailhead, Lawal said.

On the west side of the proposed driving range, a lined and capped berm would be created to store the old waste excavated in creating the site’s new building. (Courtesy of Freeway Properties)

On the west side of the driving range, a lined and capped berm would be created. That would store the old waste excavated in creating the site’s new buildings, he said. A lined stormwater collection pond would rest along I-35W, along with pollinator gardens throughout the property.

The McGowan development team has created websites detailing the history of the area, and their development efforts, at FreewayLandfillFacts.com and BetterforBurnsville.com.

The plans have been submitted to the city of Burnsville. The Burnsville planning commission will formally review the project and make a recommendation by late summer or early fall. The Burnsville City Council would then review the project proposal.

Worries about future water

While the groundwater table is currently safe, and drinking water is healthy, MPCA officials maintain they are concerned about the future.

The cities of Savage and Burnsville pump drinking water from the nearby Kraemer Mining and Materials quarry. The quarry currently pumps water for its operations, too, thereby depressing the groundwater table and keeping groundwater away from the underground dump sites.

The fear, Koudelka said, is that once the Kraemer quarry stops pumping water, the groundwater table will rise, flooding the old polluted sites, and contaminating the drinking water of Savage and Burnsville.

The timeline of when Kraemer Mining will stop pumping has not been announced.

The MPCA has already installed a network of groundwater monitoring wells, showing that contamination is widespread within the waste footprint and also has moved outside the perimeter of the old dump sites. Tests have shown elevated levels of heavy metals and chemicals like per- and polyfluoroalkyl substances (PFAS), vinyl chloride, benzene and 1,4-dioxane.

For their part, McGowan’s development team said they have engaged with four different engineering firms, and that they believe the site in its current state is not a hazardous risk to the public. Freeway Properties officials are confident they could control groundwater at the old dump sites in order to mitigate any potential contamination.

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“We feel the site is developable,” McGowan said.

They believe the new plans, with ongoing monitoring of the site, would suffice.

The MPCA, however, believes differently.

Building a new project on the site without properly disposing of the contaminants below would also make future efforts to clean up the area even more difficult and costly, Koudelka said.

“We’re supportive of getting the sites cleaned up, but plans need to address the underlying issue,” Koudelka said. “The contamination is needed to be addressed to protect the drinking water for the communities of Burnsville and Savage.”