Jeremy T. Ringfield's Blog, page 473

Stranded in the ER, seniors await hospital care and suffer avoidable harm

By Judith Graham, KFF Health News

Every day, the scene plays out in hospitals across America: Older men and women lie on gurneys in emergency room corridors moaning or suffering silently as harried medical staff attend to crises.

Even when physicians determine these patients need to be admitted to the hospital, they often wait for hours — sometimes more than a day — in the ER in pain and discomfort, not getting enough food or water, not moving around, not being helped to the bathroom, and not getting the kind of care doctors deem necessary.

“You walk through ER hallways, and they’re lined from end to end with patients on stretchers in various states of distress calling out for help, including a number of older patients,” said Hashem Zikry, an emergency medicine physician at UCLA Health.

Physicians who staff emergency rooms say this problem, known as ER boarding, is as bad as it’s ever been — even worse than during the first years of the COVID-19 pandemic, when hospitals filled with desperately ill patients.

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While boarding can happen to all ER patients, adults 65 and older, who account for nearly 20% of ER visits, are especially vulnerable during long waits for care. Also, seniors may encounter boarding more often than other patients. The best estimates I could find, published in 2019, before the COVID-19 pandemic, suggest that 10% of patients were boarded in ERs before receiving hospital care. About 30% to 50% of these patients were older adults.

“It’s a public health crisis,” said Aisha Terry, an associate professor of emergency medicine at George Washington University School of Medicine and Health Sciences and the president of the board of the American College of Emergency Physicians, which sponsored a summit on boarding in September.

What’s going on? I spoke to almost a dozen doctors and researchers who described the chaotic situation in ERs. They told me staff shortages in hospitals, which affect the number of beds available, are contributing to the crisis. Also, they explained, hospital administrators are setting aside more beds for patients undergoing lucrative surgeries and other procedures, contributing to bottlenecks in ERs and leaving more patients in limbo.

Then, there’s high demand for hospital services, fueled in part by the aging of the U.S. population, and backlogs in discharging patients because of growing problems securing home health care and nursing home care, according to Arjun Venkatesh, chair of emergency medicine at the Yale School of Medicine.

The impact of long ER waits on seniors who are frail, with multiple medical issues, is especially serious. Confined to stretchers, gurneys, or even hard chairs, often without dependable aid from nurses, they’re at risk of losing strength, forgoing essential medications, and experiencing complications such as delirium, according to Saket Saxena, a co-director of the geriatric emergency department at the Cleveland Clinic.

“It’s a public health crisis.” —Aisha Terry, president of the board of the American College of Emergency Physicians

When these patients finally secure a hospital bed, their stays are longer and medical complications more common. And new research finds that the risk of dying in the hospital is significantly higher for older adults when they stay in ERs overnight, as is the risk of adverse events such as falls, infections, bleeding, heart attacks, strokes, and bedsores.

Ellen Danto-Nocton, a geriatrician in Milwaukee, was deeply concerned when an 88-year-old relative with “strokelike symptoms” spent two days in the ER a few years ago. Delirious, immobile, and unable to sleep as alarms outside his bed rang nonstop, the older man spiraled downward before he was moved to a hospital room. “He really needed to be in a less chaotic environment,” Danto-Nocton said.

Several weeks ago, Zikry of UCLA Health helped care for a 70-year-old woman who’d fallen and broken her hip while attending a basketball game. “She was in a corner of our ER for about 16 hours in an immense amount of pain that was very difficult to treat adequately,” he said. ERs are designed to handle crises and stabilize patients, not to “take care of patients who we’ve already decided need to be admitted to the hospital,” he said.

How common is ER boarding and where is it most acute? No one knows, because hospitals aren’t required to report data about boarding publicly. The Centers for Medicare & Medicaid Services retired a measure of boarding in 2021. New national measures of emergency care capacity have been proposed but not yet approved.

“It’s not just the extent of ED boarding that we need to understand. It’s the extent of acute hospital capacity in our communities,” said Venkatesh of Yale, who helped draft the new measures.

In the meantime, some hospital systems are publicizing their plight by highlighting capacity constraints and the need for more hospital beds. Among them is Massachusetts General Hospital in Boston, which announced in January that ER boarding had risen 32% from October 2022 to September 2023. At the end of that period, patients admitted to the hospital spent a median of 14 hours in the ER and 26% spent more than 24 hours.

Maura Kennedy, Mass General’s chief of geriatric emergency medicine, described an 80-something woman with a respiratory infection who languished in the ER for more than 24 hours after physicians decided she needed inpatient hospital care.

“She wasn’t mobilized, she had nothing to cognitively engage her, she hadn’t eaten, and she became increasingly agitated, trying to get off the stretcher and arguing with staff,” Kennedy told me. “After a prolonged hospital stay, she left the hospital more disabled than she was when she came in.”

When I asked ER doctors what older adults could do about these problems, they said boarding is a health system issue that needs health system and policy changes. Still, they had several suggestions.

“Have another person there with you to advocate on your behalf,” said Jesse Pines, chief of clinical innovation at US Acute Care Solutions, the nation’s largest physician-owned emergency medicine practice. And have that person speak up if they feel you’re getting worse or if staffers are missing problems.

Alexander Janke, a clinical instructor of emergency medicine at the University of Michigan, advises people, “Be prepared to wait when you come to an ER” and “bring a medication list and your medications, if you can.”

To stay oriented and reduce the possibility of delirium, “make sure you have your hearing aids and eyeglasses with you,” said Michael Malone, medical director of senior services for Advocate Aurora Health, a 20-hospital system in Wisconsin and northern Illinois. “Whenever possible, try to get up and move around.”

Friends or family caregivers who accompany older adults to the ER should ask to be at their bedside, when possible, and “try to make sure they eat, drink, get to the bathroom, and take routine medications for underlying medical conditions,” Malone said.

Older adults or caregivers who are helping them should try to bring “things that would engage you cognitively: magazines, books … music, anything that you might focus on in a hallway where there isn’t a TV to entertain you,” Kennedy said.

“Experienced patients often show up with eye masks and ear plugs” to help them rest in ERs with nonstop stimulation, said Zikry of UCLA. “Also, bring something to eat and drink in case you can’t get to the cafeteria or it’s a while before staffers bring these to you.”

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

©2024 Kaiser Health News. Visit khn.org. Distributed by Tribune Content Agency, LLC.

SF Giants snap Rockies’ 7-game win streak, get Blake Snell back next

SAN FRANCISCO — As soon as Thairo Estrada’s line drive cleared the left field wall Friday evening, the Giants could rest easy.

The wall-scraping three-run blast in the fifth inning put the Giants ahead for good in their first of three games against the red-hot Rockies, a 10-5 win, and officially erased whatever damage was done against their starting pitcher, Mason Black, who may be the last temporary solution required for this troublesome rotation spot.

Next time around, the Giants should have the reigning National League Cy Young winner on the mound.

As Black walked off the mound in the top of the fourth down 4-1, Blake Snell was nearing the end of his final rehab start returning from an adductor strain. About 90 minutes east of Oracle Park, Snell made easy work of his competition for the Triple-A River Cats, striking out 10 over five hitless innings.

Combined with his rehab start for Single-A San Jose on Sunday, Snell has struck out 19 batters and walked one over nine innings without allowing a hit.

“If you’re looking for quality to make it back here, the last two games would suggest that,” manager Bob Melvin said. “Even in his bullpen, we said before, it looked like his mechanics were a lot better and certainly the performance the last couple games would suggest that.”

Thairo Estrada #39 of the San Francisco Giants celebrates hitting a home run against the Colorado Rockies in the bottom of the fifth inning at Oracle Park on May 17, 2024 in San Francisco, California. (Photo by Kavin Mistry/Getty Images)

Albeit against minor-league competition, that is the type of dominance the Giants believed they were signing up for when they agreed to a two-year, $62 million contract with Snell, 31, on March 19. In nine times through his rotation spot, however, the Giants won Friday night for only the second time.

When Melvin came out to get Black after the first batter of the fourth inning — catcher Jacob Stallings, whom he hit with his first pitch of the inning — it looked like the Rockies were heading toward their eighth consecutive win; they hadn’t lost since the Giants beat them at Coors Field last Saturday.

Making his third career start, Black didn’t have much of a leash after the first four Rockies to led off the game with hits — three for extra bases — and he served up a solo home run in the second to the No. 9 hitter, Jordan Beck. Tagged for four runs on six hits, Black’s ERA rose to 7.71.

In eight prior turns through Snell’s spot in the rotation — three starts by Snell, two by Black, two by Daulton Jefferies and a bullpen game — Giants pitchers had a 9.13 ERA entering Friday’s game.

It required the relief work of Sean Hjelle to keep the score close, recovering from a leadoff double by the first batter he faced that put runners on second and third with nobody out to complete two scoreless innings. Since taking the loss April 24, Hjelle has limited opponents to two runs over 11⅓ innings, a 1.59 ERA, and struck out 15 batters without issuing a walk.

“That’s a huge momentum swing at the time to get us back in the dugout and all of a sudden we hopefully have a chance to score some runs,” Melvin said of Hjelle’s tightrope work in the fourth. “I think this year he’s just had a different mindset going in, where he feels like he can really contribute. … There are a number of roles that we’re using him in now that are probably a lot more important than maybe in the past where it was just length. I think he came into this spring expecting that, digging for that, and he’s certainly gotten it.”

Sean Hjelle #64 of the San Francisco Giants reacts after the final out in the top of the fourth inning against the Colorado Rockies at Oracle Park on May 17, 2024 in San Francisco, California. (Photo by Kavin Mistry/Getty Images)

Besides Estrada’s big knock, the bulk of the Giants’ offense continued to come from their recent infusion of rookies.

Learning before the game that they had lost their exciting, young center fielder, Jung Hoo Lee, for the season, the Giants plan to give regular opportunities to another young outfielder, Luis Matos, who drove in five more runs in a multi-hit performance.

Until Estrada’s homer, nine of the Giants’ past 12 runs had been driven in by Matos or Heliot Ramos, who started in left for the injured Michael Conforto. Since being called up Sunday, Matos has come to plate 11 times with runners in scoring position and delivered five hits for 11 RBIs.

“It seems like he’s one of those guys that just absolutely loves runners on base,” Melvin said. “There are times where you have to shrink the zone. He can get a little aggressive, but it’s working for him at this point in time. It’s not just fastballs; he’s hitting breaking balls, too. Five RBIs is a pretty good night, and it seems like since he’s been here, he’s really embraced guys on base. That’s been a problem for us.”

The ailing Giants did get one piece back in their lineup, designated hitter Jorge Soler, who missed the past 10 games with a strained right shoulder.

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Inserted into the leadoff spot typically occupied by Lee, Soler reached base twice and played the role of table setter in the fifth. He led off the inning by lining a single back up the middle at 108.9 mph, followed by an equally well-struck single from LaMonte Wade Jr. that brought Estrada to the plate as the go-ahead run.

Presented a middle-in fastball on a 3-1 count, Estrada deposited the pitch where it belonged — in the left-field bleachers — and the Giants never looked back.

“At some point in time you have to put a crooked number up like we did in the fifth,” Melvin said. “That was huge. We took a lead and never gave it back after that and added on runs. We haven’t done a ton of that this year, so it was good to see.”

Notable

SS Marco Luciano recorded his first career RBI in the seventh inning, poking a two-strike slider into right field to score Mike Yastrzemski for the second of two seventh-inning runs. With Casey Schmitt optioned back to Triple-A Sacramento before the game, Luciano is being given the opportunity to take the position and run with it as long as Nick Ahmed (wrist) is sidelined.

Up next

LHP Kyle Harrison (3-1, 3.42) vs. LHP Ty Blach (1-1, 3.00) in the second game of the series, with first pitch scheduled for 1:05 p.m.

Reggie Crawford could be in SF Giants’ bullpen by end of this season

SAN FRANCISCO — Once viewed as a two-way project hampered by his lack of health, Reggie Crawford is all of a sudden one step away from the major leagues.

Crawford, 22, was promoted to Triple-A Sacramento this week and, according to Farhan Zaidi, the Giants’ 2022 first-round draft pick could be pitching out of the big-league bullpen by the end of the season.

Standing 6-foot-4 and 235 pounds, Crawford throws a fastball that reaches the upper 90s from the left side that overpowered Double-A hitters to the tune of 19 strikeouts in 9⅔ innings. Making his first appearance for Sacramento on Wednesday, Crawford walked a batter and hit another but otherwise recorded a scoreless inning on 12 pitches.

“Not to trivialize the competition, but he can just throw his fastball by guys in Double-A,” Zaidi said of the decision to promote Crawford to the highest level of the minor leagues despite only 28⅔ professional innings. “It didn’t seem to be the best learning environment for him to throw his best offspeed pitches and learn some of the nuances of pitching that we wanted to see if he just reared back and threw 99 past them. Triple-A will be more of a test for him.”

The Giants drafted Crawford 30th overall out of UConn in 2022 and initially planned to develop the muscular left-hander as a two-way player. But with his career slowed by injuries — recovering from Tommy John surgery when he was drafted, a bout of mononucleosis at the tailend of that rehab and a lat strain this spring after being invited to his first major-league spring training — Crawford abandoned that path to focus on pitching and accelerate his path to the major leagues.

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Once he refines his selection of secondary pitches, the Giants believe Crawford has the chops to be a starting pitcher. But as they try to balance the workload on his developing arm and the potential impact he could have on the big-league team, the plan is to continue to work him in shorter bursts — two innings at a time, separated by four days of rest, initially.

In 21 career appearances, Crawford has never pitched more than two innings at a time.

“He’s only got so many innings this year, realistically,” Zaidi said. “Even though long-term we still think of him with starter potential I think it’s possible he pitches for us here this year at the big league level. For him to be able to do that, we need him to be able to come back and forget about a back-to-back, even just one day rest, he’s never done those things. Rather than stretch him out, I think our schedule and our plan is more to get him pitching in more typical intervals for a reliever and see if he can handle that.”

College baseball: Late inning rally falls short for CSUMB in West Regionals

SEASIDE — The late inning dramatics that have carried Cal State Monterey Bay throughout the playoffs, didn’t materialize in the manner that has come to be an expectation.

As a result, its baseball season will be in the balance Saturday after the Otters ninth inning rally fell a run short in a 3-2 loss to San Francisco State in the NCAA Division II West Regionals at the Otter Complex.

The reigning three-time California Collegiate Athletic Association champions will now have to beat the Gators twice Saturday to extend their season in the double-elimination tournament.

“I told the kids it was a good college baseball game,” CSUMB coach Walt White said. “We have been in this situation before. We know what kind of team we are. Lets get after it.”

CSUMB came into Friday’s game having gone 5-2 this spring against the Gators, using a two-out, five-run rally in the CCAA conference tournament title game seven days ago for a 12-9 win.

“We had another ninth inning rally today,” White said. “These are two teams that match up so well. I’m not sure why we are not hitting their pitching. We’ve had what — four of the eight games decided by one run?”

Three of those one-run nailbiters haven’t gone the Otters way, falling in extra innings in the regular season, by a run in last week’s tournament, and again on Friday.

“We’re done with one-run games,” joked White. “I don’t feel we let one slip away. It was a well played game, where one thing here or there goes another way, it’s a different result. That’s baseball.”

The setback snapped a six-game home winning streak for the Otters, who came into the game having gone 9-1 in their last 10 games, with the one loss coming from San Francisco State.

The two teams will meet again at noon on Saturday with former Hollister High and Monterey Peninsula College pitcher Ryan Platero scheduled to start for the Otters (36-19).

In two starts against San Francisco State, the right-handed Platero (6-3) has thrown 12.2 innings, striking out 10 with a win and a no decision.

Having finished fourth the CCAA during the regular season, the Gators (34-24) have gone 5-1 in their last six games, with the lone setback coming from CSUMB in the conference tournament title game.

For the second time this season, former Aptos hurler David Eichhorn handcuffed the Otters at the plate, allowing two runs in 8.2 innings of work to pick up the win.

The son of former Toronto Blue Jays reliever Mike Eichhorn, the former Cabrillo College right-hander has allowed just three runs in two starts against CSUMB — both wins.

“The Eichhorn kid raised his level of competition,” White said. “He had a sinker that was working. His change up kept our left-handed hitters out in front.”

Eichhorn threw 134 pitches before being relieved after the Otters had the potential game tying run in Max Farfan at second base with two outs.

Farfan was pinch running for Garrett Santos, whose one-out, pinch hit run-scoring single brought the potential winning run to the plate. Eichhorn got one more out before Nathan Shinn came in to induce a ground ball to end it.

“To me the eighth inning was huge,” said White, whose squad opened the West Regionals with a 6-3 win over Northwest Nazarene on Thursday. “We had runners on first and third with one and Eichhorn induced a double play to end it.”

Jaden Sheppard continued his hot postseason with two more hits, having gone 11-for-25 in six playoff games. JJ Engman and Kyle Barileaui also had two hits for the Otters.

Keaton Winn becomes SF Giants’ latest injury victim with forearm strain

SAN FRANCISCO — Add Keaton Winn’s name to the list.

Winn, 26, was placed on the 15-day injured list Friday with a forearm strain that forced him from his start two days earlier. Mason Black, 24, was recalled from Triple-A Sacramento to fill his spot on the 26-man roster and received the start Friday in the opener of the Giants’ three-game series against the Rockies.

Becoming the eighth Giants player to land on the IL in the past two weeks, Winn’s ailment is believed to be mild, according to president of baseball operations Farhan Zaidi. Winn received an MRI after feeling tightness in his forearm Wednesday that he said felt like a cramp.

“It was good enough news (on the MRI) where it was a little bit of a decision to IL him,” Zaidi said. “We thought he may even be able to pitch in a game 10 days from now or something like that. But being a young guy, someone who isn’t going to be a 180-inning guy anyway, it just made sense to use the offdays that we have in this stretch to exercise some caution and give him the full 15 days. That’s a reflection of the mildness.”

The Giants had their first day off in 16 days on Thursday and have another Monday before Winn is eligible to return May 30.

In nine starts this season, Winn has a 6.17 ERA, inflated by his past three starts, over which he has combined to allow 17 runs in 8⅓ innings. Prior to his recent rough stretch, Winn had strung together three consecutive starts of six-plus innings and one run or fewer, lowering his ERA to 3.17.

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On the bright side, the number of Giants on the injured list didn’t swell any larger with the addition of Winn.

Batting leadoff Friday was Jorge Soler, making his return from a 10-game absence with a shoulder strain that he suffered on a swing in Philadelphia. Soler, 32, played two rehab games for Triple-A Sacramento, going 3-for-7 with a walk, a strikeout and a pair of singles.

Outfielder Michael Conforto (hamstring) also resumed light baseball activities, though Austin Slater (concussion) was still dealing with “fogginess,” according to manager Bob Melvin, after crashing into the center field fence Monday. Catcher Patrick Bailey (concussion) visited Dr. Mickey Collins, the same concussion specialist who treated Brandon Belt, and will resume full baseball activity this weekend.

“We’re sort of on the other side of this,” Zaidi said. “We’ve got guys coming back. … You almost start looking at the backend of this when we have to start picking who can stay on this roster and who can we continue to find at-bats for.”

Before shoulder injury, Jung Hoo Lee had ‘happiest moments of my baseball career’ in SF Giants debut

SAN FRANCISCO — It took the Giants almost a week and multiple medical opinions before they could confirm what Jung Hoo Lee knew as soon as his left shoulder collided with the chain-link cutout in the center field fence Sunday afternoon.

“When I hit the fence, I knew at that moment that I had dislocated it,” Lee said Friday through interpreter Justin Han.

After 37 games, his rookie season is over. Lee, 25, will undergo surgery in the coming weeks to repair the labrum he tore on the play. Initial MRIs revealed structural damage, and a second opinion from Dr. Neal ElAttrache in Los Angeles on Thursday confirmed the need for surgery.

“It’s not how I thought about ending my rookie season,” Lee said, addressing reporters for the first time since suffering the season-ending injury. “From all the baseball career I’ve had, this could be one of the most disappointing seasons I’ve had.”

At the same time, the rookie said the past six weeks “was the happiest moments of my baseball career.

“I’ll never forget the time here that I have spent this season,” he continued. “I’ll keep it in my heart for next season, and I’ll try to play better with that experience that I have. Baseball is something that I really love. I just really want to come back with a strong mind.”

The Giants expect Lee to recover in time to begin spring training at full strength in 2025, the second year of the six-year, $113 million contract he signed in December. Lee had a similar procedure in 2018 and returned without issue.

Recovery from the operation comes with a timeline of approximately six months, per Farhan Zaidi, the Giants’ president of baseball operations.

The parties involved weighed the possibility of putting off surgery until the offseason, Zaidi said, but “in this case, given his age and the fact that he’s injured the shoulder before and just the consensus medical opinion, it made sense to get this taken care of right away and give him as much of a head start preparing for 2025 as possible.”

Zaidi called the injury “a real bummer,” while manager Bob Melvin said losing Lee for the season “will take a little bit to sink in.”

Batting .262/.310/.331, Lee showed no trouble adjusting to the major leagues, where the pitchers throw harder and with more movement than they do in Korea and, to boot, the large majority of whom Lee had never before studied. His 9.6% strikeout rate put him in the company of Luis Arraez and Steven Kwan, two of the game’s purest contact hitters.

“We all saw he had a really patient approach, didn’t swing and miss much, which was good to see,” Zaidi said. “But we talked to him about all the first-pitch fastballs he was getting because he was a patient hitter who liked to see a pitch or two. We talked to him about being more aggressive and getting something to hit early in the count. Really the last week or 10 days before he got hurt, you were starting to see that. He was starting to ambush some first pitches.

“I think as much as anything to me it was from day one of spring training he never looked out of place. He looked like he belonged as a big leaguer. Seeing guys come from other leagues internationally, even guys who ascended to All-Star status here, they don’t always hit the ground running right when they start. So he started off way ahead of some other really good players I’ve seen come over, and I think that was the most impressive thing.”

What stood out from day one was the fire with which Lee plays and the effort he brought on every play, which ultimately was his downfall.

On the Giants’ first road trip of the season, Lee nearly ran a hole through the wall at Dodger Stadium, later joking, “I feel OK; I’m just worried about the fence.” That was on display again in Boston, charging to make a diving catch, and in Philadelphia, chasing down a deep fly ball and backhanding it with his glove.

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“I never thought this would happen to me, so I would always put in 100% effort,” Lee said, citing the playing style of fellow Korean major leaguer Ha-Seong Kim. “When the ball is popped up into the air, my body reacts to it. But now I’ve got to have a second thought about whether I go for it or not. I want to put the importance on playing baseball out there, but I for sure did learn a lesson this time.”

Lee will spend the remainder of the season rehabbing with the team, going between its facilities in San Francisco and Arizona.

In the meantime, the Giants plan to continue to give Luis Matos an opportunity to play there every day.

“I think there was a little bit of an adjustment those first couple games in center field,” Zaidi said of Matos, 22. “We know he’s got the ability to play a good center field. We’ve seen it for stretches. I know our coaches are encouraged by the tools. They want him to be really aggressive. Outfield play comes easy to him, so it’s easy for him to kind of fly to the ball and play with that rhythm. But we’ve asked him to go all out, really cover as much ground as he can.”

SF Giants’ Jung Hoo Lee to undergo season-ending surgery

SAN FRANCISCO — Jung Hoo Lee, the Giants’ Korean sensation, will not play again this season.

The 25-year-old center fielder will undergo surgery in the coming weeks to repair a torn labrum in his left shoulder, the club announced Friday.

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Lee dislocated his shoulder Sunday when he collided with the outfield wall while attempting to make a leaping grab. While initial MRIs revealed structural damage, a second opinion from Dr. Neal ElAttrache in Los Angeles on Thursday confirmed the need for surgery.

The timeline to return to the field, according to president of baseball operations Farhan Zaidi, is approximately six months, and the Giants expect him to make a “full recovery,” Zaidi said. Lee previously had his left labrum operated on while in Korea in 2018.

The injury brought a premature end to Lee’s inaugural MLB campaign, batting .262/.310/.331 over 37 games. He accumulated 0.4 Wins Above Replacement, according to Baseball-Reference, seventh among Giants position players.

Lee signed a six-year, $113 million free-agent contract in December that was both the largest signed by any Korean player and biggest sum handed out by the Giants to any free-agent position player. He is expected to be ready for Opening Day in 2025 and will be under contract for three more seasons before he has the ability to opt out after 2027.

Horoscopes May 17, 2024: Nikki Reed, take the plunge

CELEBRITIES BORN ON THIS DAY: Nikki Reed, 36; Derek Hough, 39; Trent Reznor, 59; Craig Ferguson, 62.

Happy Birthday: You have more going for you than you realize. Embrace life; don’t let it pass you by. Take the plunge and do what motivates you. Get involved, expand your knowledge, skills and experience, and get out and enjoy what life has to offer. This year is about movement, taking a chance and following your heart. It’s up to you to make things happen. Stop dreaming and start doing. Your numbers are 6, 17, 22, 29, 31, 34, 48.

ARIES (March 21-April 19): Keep moving, but pay attention to detail and oversee every step to ensure you get the most out of your day. Refrain from sharing financial information or secrets to your success, regardless of who applies pressure. Work hard and reap the rewards. 3 stars

TAURUS (April 20-May 20): Don’t fold under pressure. Clear your head, look at the facts and start your journey. Listen, share ideas and participate in events and activities that interest you. If you are willing to step up and participate, there is plenty to gain. Embrace change and make things happen. 5 stars

GEMINI (May 21-June 20): Hide out and accomplish all you can. What you achieve will be impressive and influence how others treat you. A change at home or to how you handle work will turn out better than anticipated. Trust and believe in yourself and your ability to excel. 5 stars

CANCER (June 21-July 22): Establish your intentions, make connections and participate in events to help you excel. Take the initiative, and be the one to motivate and influence what happens next. Feel free to initiate a move when change is necessary. 4 stars

LEO (July 23-Aug. 22): Oversee every detail. Incorporate wiggle room to offset a wrong move or unexpected adjustment that might cost you. Staying ahead of the crowd is one of your fortes but will require fancy footwork. Stifle anyone who tries to pressure you. 3 stars

VIRGO (Aug. 23-Sept. 22): Enjoy life. Who or what you encounter will pique your curiosity and encourage you to expand your skills and knowledge. What you add to your resume will enable you to explore your options. A change of pace, place or people will support positive change. 3 stars

LIBRA (Sept. 23-Oct. 22): Don’t spend frivolously. Invest your time, energy and cash into getting ahead and securing your position and prospects to promote your desired lifestyle. Pressure tactics won’t work, but premium products and offers will. 3 stars

SCORPIO (Oct. 23-Nov. 21): Build momentum; you will want to continue once you start. Get the energy flowing and see what happens. The people you attract and the opportunities you develop will pave the way to success if you respond quickly. A positive change in your personal life is apparent. 4 stars

SAGITTARIUS (Nov. 22-Dec. 21): Take it easy, be a good listener and don’t offer personal information that someone can use against you. Focus on your responsibilities and finish what you start to avoid being judged harshly by someone trying to outmaneuver you. 2 stars

CAPRICORN (Dec. 22-Jan. 19): Engage, experience what life offers and spend time with someone who makes you think. A change to how or what you pursue will be influenced by who you are with and what you do next. Gather information and use your skills to accommodate what’s trending. 5 stars

AQUARIUS (Jan. 20-Feb. 18): If something doesn’t feel right, take a pass. Don’t be coerced into being a follower. Put your energy into self-improvement, heading in a beneficial direction or walking away from negativity and interference. Be true to yourself and follow your heart. 3 stars

PISCES (Feb. 19-March 20): Stand your ground until you get what you want. Initiate change that will improve your relationships. Evaluate your position personally, financially and professionally, and adjust your lifestyle to fit the circumstances. Romance is on the rise. 3 stars

Birthday Baby: You are changeable, curious and ambitious. You are innovative and dynamic.

1 star: Avoid conflicts; work behind the scenes. 2 stars: You can accomplish, but don’t rely on others. 3 stars: Focus and you’ll reach your goals. 4 stars: Aim high; start new projects. 5 stars: Nothing can stop you; go for gold.

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College baseball: Otters power past Northwest Nazarene in DII West Regionals

SEASIDE — Perhaps the regular season was just a sneak preview to what Jaden Sheppard had in store for the postseason.

Because the Cal State Monterey Bay slugger has been on a different universe in the playoffs.

For the second straight game and third time in five postseason games, Sheppard sent a ball into orbit, ripping a two-run homer in the Otters 6-3 win over Northwest Nazarene in the NCAA Division II West Regionals.

The significance of his 11th home run in the fifth inning was it ended up being the game-winning runs for the Otters, who will host conference rival San Francisco State Friday at 2 p.m. at the Otter complex.

“He was seeing a lot of breaking balls during the season hitting in the middle of the order,” CSUMB coach Walt White said. “He’s learned how to hit the breaking ball, as well as the fastball.”

Owners of six straight wins at home, CSUMB is 9-1 in its last 10 games to improve to 35-18 overall and 24-7 at home.

“We’re playing some good baseball at the right time,” White said. “I thought in the conference tournament, we played as well as we have all year. We got our defense squared away and got a couple of pitchers back.”

Earlier in the week Sheppard was named to the National Collegiate Baseball Writers Association Division II All-West Region first team as a first baseman along with center fielder KW Quilici.

In five postseason games, the 6-foot-6 Fresno State transfer is 7-for-20 at the plate with seven runs batted in, giving him 59 RBI on the season.

“He has a presence in the lineup and has saved games for us with his defense,” White said. “Jaden’s attitude is built for our program. He’s a big man. He’s a rock.”

The Otters and San Francisco State will be meeting for the third time in seven days, having faced each other twice in the California Collegiate Athletic Assocation tournament, including the title game.

“Right now there are four teams left in the two West Regional brackets,” White said. “Three of them are from our conference. You’re bound to run into one at some point.”

The two teams have faced each other seven times this season, with CSUMB holding a 5-2 advantage, rallying for five runs with two outs in the ninth inning in the conference title game last Saturday to secure a 12-9 win.

“We’ve had success against San Francisco State,” White said. “However, they have been close games. A lot of them have come down to the wire. San Francisco is a viable opponent.”

One of the assistant coaches for the Gators is former Salinas High and Sonoma State catcher Nick White, who serves as the teams catching coordinator.

Having hit 63 homers coming into the West Regionals, the Otters connected for two more when Nico Hartojo hit a three-run homer in the fourth inning to erase a brief 1-0 deficit.

Nate Rohlicek went the first six innings for CSUMB, striking out eight to earn his team leading sixth win of the season. Giovanni Costello tossed three scoreless innings of relief, fanning four to earn the safe.

Northwest Nazarene (36-14), who won the Great Northwest Athletic Conference season and tournament titles, was eliminated from the regionals, having fallen to San Francico State 8-6 earlier in the day.

The reigning three-time CCAA champion Otters will send Mitchell Torres and his 5-0 record and 3.36 earned run average to mound Friday. Regardless of the outcome, the two teams will meet again on Saturday in the double-elimination tournament.

Pacific Grove seniors take on corporate owners of Forest Hill

PACIFIC GROVE >> Residents of a senior living facility in Pacific Grove on Wednesday peppered a representative of the company that owns the retirement community with questions about allegations that the company has failed to meet prior contractual agreements as well as some safety problems.

Wednesday’s meeting between residents of Pacific Grove Senior Living and a representative from San Diego-based Pacifica Companies LLC, the owners of the facility, drilled down into allegations made in a March report to the California Attorney General’s Office of substandard conditions.

Formerly called Forest Hill Manor, the 100-year-old building was purchased in 2022 for $300 million by Pacifica following a 2021 bankruptcy filing of prior owners California-Nevada Methodist Homes.

When the for-profit company acquired the senior residential facility, Pacifica had to meet specific conditions set down by the state Attorney General’s office, which also assigned a monitor to make a report on findings at the facility. The 22-page report was prepared by the assigned monitor, Dr. Terry Hill, to the California Department of Justice, Healthcare Rights and Access Section.

Hill is board-certified in internal medicine and geriatrics, and has served as a medical director of several community and public-sector skilled nursing facilities.

His report cites a dozen issues that were either not keeping with established conditions of the apartments or failing to meet contractual agreements made with Methodist Homes before PG Senior Living was purchased by Pacifica.

A voicemail left with Pacifica’s chief executive Deepak Israni on Wednesday was not immediately returned, neither was an email sent to the company requesting comment. Pacifica, a real estate investment company, operates eight senior housing properties in California, Texas and Florida, according to the company’s website. It runs an additional eight properties in India.

It also operates more than two dozen other properties ranging from hotels and resorts to retail centers and office buildings.

While senior company officials did not respond to requests for interviews, Beau Ayers, the regional manager for Pacifica who met with PG Senior Living residents Wednesday, refuted the allegations, saying 10 of the 12 issues cited in the report contained inaccuracies.

He referenced an issue of standing water in the parking garage that generated a citation from California Department of Health, but that it was the only citation the state issued out of 19 complaints. The garage leak has since been corrected, he said.

The other issue Ayers acknowledged was a company promise to meet with residents on a quarterly basis, which it has not done, but will in the future, he said.

In addition to the garage leak, the state Health Department fined Pacifica $3,000 in March for failing to “review risks and benefits of bed rails with the resident or resident representative and obtain informed consent prior to installation. These failures resulted in the patients and patient’s (responsible parties) not being fully informed on the risks of the use of bed rails and had the potential to place the patient at risk of serious injury,” the citation reads. (https://shorturl.at/cfAEN)

Many of the allegations centered on issues like meals that didn’t meet the quality level promised by the company when it bought the property. Residents say they have come to expect better meals considering they pay $350,000 to buy into the property and another $8,000 a month in fees for a two-bedroom apartment in the independent living wing.

One woman, the daughter of one of the residents, told Ayers at Wednesday’s meeting that the food served is not healthy and contains an abundance of fat, sugar and salt. Salt can be dangerous to some seniors battling high blood pressure or heart conditions.

“It’s pretty scary,” she said. “It’s not sustainable. The big problem is not having a dietician.”

Ayers responded that a corporate dietician reviews all the company’s menus and that there is a dietician in the skilled nursing wing of the facility.

Robert Sadler, the president-elect of PG Senior Living’s resident association, said in an email sent to residents Thursday that he doesn’t expect Pacifica to act on most of what Ayers heard from residents at the meeting.

“Pacifica Senior Living will continue to stonewall all criticism it receives from customers, vendors, regulators and the Attorney General’s office,” Sandler said. “That’s the message we heard from Beau (Ayers) yesterday at our town hall meeting. There were many excellent, heartfelt comments and concerns expressed and, once again, Beau is impervious to hearing them much less acting on them.  I’m not surprised but I’m certainly disappointed.”

Ayers, meanwhile, reminded residents that the state Health Department oversees the operations and that many of the problems began before Pacifica acquired the property. When acquiring the bankrupt property, the sale was based on an “as-is” condition, Ayers said.

“We’re getting blamed for a lot of things the previous owner neglected,” he said.

Sadler said the issue is the “ruthless profiteering” that occurred when the property transitioned from a nonprofit to a for-profit entity, and that the issues are being neglected in order to increase profits for its investors.

Meanwhile, both sides will be waiting for any comments or decisions that Attorney General’s office makes. When that would happen is not known.