For years, state and local officials have known about this shadow network of unlicensed care homes, where older and disabled Marylanders often end up in exchange for their Social Security or disability checks. Lawyers have called it “trafficking,” benefit exploitation and outright neglect.

A Spotlight on Maryland investigation found that state and local agencies have repeatedly failed to shut down dozens of known unlicensed facilities, allowing an underground industry to flourish in Baltimore’s neighborhoods. Hundreds of emergency calls, thousands of documents, and interviews with lawyers, families, caregivers, and business owners reveal a grim pattern: people in their final years left to die in squalor while government agencies look away again and again.

The Office of Health Care Quality (OHCQ) — the Maryland Department of Health agency responsible for monitoring and licensing the state’s health care facilities — said it takes “appropriate action” to protect seniors, but acknowledged that despite hundreds of complaints since October 2023, it has sent one referral for prosecution to shut down unlicensed assisted living facilities (ALFs). Maryland Attorney General Anthony Brown’s office separately confirmed that it received one.

That one referral was in August 2024. OHCQ and the AG’s office said zero complaints were referred for prosecution in 2025.

This Spotlight on Maryland investigative series will expose how government failures have built an economy of exploitation — and who profits, who enables it, and who allows the state’s seniors to be ignored behind closed doors.

Here’s an overview of Spotlight on Maryland’s findings, which will be reported in depth in the coming weeks and months.

A crisis in plain sight

The investigation began when Spotlight on Maryland noticed a pattern: repeated 911 calls to the same Baltimore addresses for elderly residents in distress. Many of the calls involved unrelated seniors of different ages and genders living at the same locations — properties that were not listed as licensed assisted living facilities.

A trail of government records, lawsuits and nearly 500 hours of fieldwork revealed a system that appears to be operating outside the law. Emergency responders frequently filed complaints with OHCQ detailing unlicensed assisted living facilities operating unchecked.

The complaints described strangers living together in cramped rowhouses, seniors left unwashed and unfed, and residents packed into bedrooms so crowded they violated city occupancy limits.

Maryland Legal Aid, a nonprofit law firm serving low-income residents, warned lawmakers in March 2023 that state protections for seniors and disabled adults were dangerously inadequate.

“It’s no secret that unlicensed ALFs engage in human and/or benefits trafficking, using coercion, deception, threats or other means to traffic a victim, moving them from one facility to another for the additional purpose of appropriating their benefits, such as Social Security Retirement, Food Stamps (SNAP), or other benefits,” the law firm said in its 2023 written testimony.

Those with low or no income are especially vulnerable to such exploitation because “they often have nowhere else to go,” Maryland Legal Aid said.

A licensed assisted living facility in Maryland costs about $4,000 per month, according to Maryland Legal Aid. Unlicensed operators charge far less — sometimes between $600 to $1,000 — creating an illicit market that preys on those least able to protect themselves, according to Spotlight on Maryland’s investigation.

There have also been federal warnings. An 81-page study from the U.S. Department of Health and Human Services in 2015 during the Obama administration said “unlicensed care homes appear to be widespread in some areas within some states.”

“They are commonly run in single family residences, but also were reported to operate inside buildings that had been schools or churches,” the HHS study said. “Although some … informants provided a few examples of unlicensed care homes where residents receive what they categorized as good care, it appears that abuse, neglect, and financial exploitation of these vulnerable residents is commonplace.”

The HHS report highlighted a handful of states, including Maryland, Georgia, Indiana, North Carolina, Pennsylvania, and Texas. In Maryland, federal researchers found that there may have been 78 unlicensed care homes serving more than 400 individuals in one county.

A separate federal report around the same time period estimated 370 to 400 beds in unlicensed assisted living facilities in Anne Arundel County.

Government documents show suffering

The suffering is laid bare in OHCQ complaints obtained by Spotlight on Maryland.

In one case, Baltimore police discovered a 74-year-old man who had been missing for four days, his body covered in maggots, found beneath a bush outside a suspected unlicensed home in Lake Walker.

In West Baltimore’s Forest Park neighborhood, officers found a 77-year-old male inside an alleged unlicensed ALF, lying in a hospital bed, unresponsive and “covered in a copious amount of dried feces.”

“[He] also [had] a large piece of what appeared to be an adult diaper in [his] mouth with feces present,” an emergency responder reported to OHCQ.

In yet another incident, a 60-year-old woman managed to call for help only after fighting to retrieve her cellphone from an alleged unlicensed ALF manager. Inside the ambulance, she told responders she could no longer urinate without severe burning and struggled to walk.

Spotlight on Maryland asked Rafael Lopez, secretary of the Maryland Department of Human Services, what his agency is doing to aid vulnerable adults living in unlicensed facilities. Lopez’s agency oversees Adult Protective Services.

“I’m not familiar with the specific question you’re asking,” Lopez said. “When any case comes to our attention of any kind of abuse of an adult, we act urgently and we make sure we treat that adult with the respect and dignity that they deserve.”

Despite Lopez saying his team would provide data on the number of contacts and referrals made from individuals living in unlicensed ALFs, his office did not supply that information and said the department does not categorize complaint data by setting.

The systemic cycling of elderly adults with nowhere to go

Each emergency visit to an area hospital triggers the same bureaucratic system: After treatment, hospitals scramble to find placement for what professionals call “complex cases.”

Some individuals — overwhelmingly elderly, Black, disabled and poor — are cycled from emergency rooms to unlicensed homes, then back again. Many suffer from dementia, Alzheimer’s, terminal cancer or substance use disorders.

Lawyers, health care workers, and family members described an unbroken loop in which hospitals discharge patients because they need the beds, and nobody checks where they end up.

In one case, Christina Talley said she called police for a welfare check after learning that her 69-year-old sister, who has Lewy body dementia, was left alone by home care professionals. Her sister — whom Talley asked not to name — had previously set her home on fire by accident because of her memory loss.

Talley said her sister later spent about four months at a Johns Hopkins hospital as doctors worked to determine the best medication and treatment plan for her complex condition. Eventually, a meeting was held between hospital staff and family members to discuss her sister’s long-term care.

Talley said she felt she had no choice when the hospital informed her family that her sister needed to be moved.

The government “needs to advocate for the aging,” Talley said. “There has to be laws, and rules, and regulations — a deep dive into how the aging system is being run and put them [the seniors] first instead of the bottom line, the money.”

Talley said the ongoing cycle between hospitals, residential placement organizations, and both licensed and unlicensed assisted living facilities has taken a toll on her sister and the entire family, with no clear end in sight.

A spokesperson for Johns Hopkins hospitals acknowledged Spotlight on Maryland’s questions about Talley’s experience and allegations but did not respond before publication.

‘I take it one day at a time’

George “Bobby” Gilliam, 62, is one of many older Marylanders with nowhere else to go. Standing outside a Garrison Boulevard building in early October, he described his living situation to Spotlight on Maryland.

“I pay $765 a month for rent … I can stay here as long as I can pay my rent,” Gilliam said. “They give medication, they send you to the day program. Right now, I’m trying to get food stamps.”

Gilliam’s brother, Frank Clark, said their family has struggled for years to find him adequate care and support. Speaking from his car outside his elderly parents’ home in Sumter, South Carolina, Clark said both parents — now in their 80s and hospitalized —have been desperate to ensure Gilliam is safe. Clark said his brother has a history of drug addiction and is vulnerable to exploitation.

“You’ve been there. You’ve seen the area. It’s the worst place in the world you could put them type of people because they’re susceptible to everything around,” Clark said. “I know this is his second, maybe third go around with them. They had a smaller house the first time. I think they still got that same house, I’m not sure.”

Although a staff member said the building’s residents are fed, Gilliam said he was still waiting for government assistance to supplement what he had in his apartment — a bag of rice and some water.

“At the end of the day, a long day, I pray, I just pray, and I sit back and I be quiet,” Gilliam said. “It gives me a peace of mind, and I go to a quiet place, a little quiet area, and I pray to God and Jesus Christ, and I take it one day at a time — that’s all I can do.”

His situation underscores a growing crisis in Maryland: Older residents with limited income or health challenges often end up in various housing settings with little oversight, but which fill a gap no one else will.

‘We take people 24 hours a day’

Gilliam lives in a building operated by Daquan Thomas, who identified himself to Spotlight on Maryland as founder of Aim to Inspire Care Forever Limited, a nonprofit running a multistory building on Garrison Boulevard in Walbrook Junction. He calls his business “supportive housing.”

“I would say one of our biggest supporters would be LifeBridge Health,” Thomas said. “They really don’t believe in, you know, putting people out on the streets, so, if anything, they’ll contact us. We take people 24 hours a day, seven days a week.”

LifeBridge Health confirmed to Spotlight on Maryland that it has a business relationship with Thomas’ organization, claiming it partners for “medical respite care.” When asked to define the partnership and what qualifies as an appropriate discharge to Thomas’s organization, LifeBridge Health’s spokesperson Sharon Boston responded, saying, “We have no further comment.”

Brian Mullen, a spokesperson for the University of Arizona Global Campus — the school that acquired and rebranded Ashford University in 2020 — said that Thomas, who claimed to hold a doctorate in health care administration from Ashford University, took only one course in 2010 and never graduated.

Mullen added that Thomas was enrolled in a bachelor’s program in human resources.

Spotlight on Maryland emailed Thomas about the discrepancy. Thomas was also questioned about his active $1.7 million lawsuit against his nonprofit and Gilliam’s claims of verbal abuse.

“[S]hut your mouth find factual information you are working for my landlord and my attorneys will be in contact with your company,” Thomas said in an emailed response. “My Ph. D [sic] is from a university you ask me which school I went to I advised you one of the many because your [sic] a snake in the grass working for the devil get a real story Gary as your time at your current company will end very soon.”

Court filings show multiple bankruptcy cases for Thomas spanning 15 years and a $1.7-million judgment for unpaid rent at his Garrison Boulevard property, where Thomas said he has also struggled to pay energy bills. Bankruptcy filings show that Thomas claimed to have earned income only from working in retail for the prescription eyeglass industry.

In July 2024, Thomas applied to be a nonprofit, and last month he told Spotlight on Maryland he has applied to receive state and local taxpayer funds.

“We’ve applied for multiple grants and federal funding,” Thomas said. “[W]e still haven’t gotten any type of, you know, help, unfortunately — but it is what it is. We’re still making it happen, you know, we have the hospitals that we work with who, you know, make private donations to the nonprofit.”

Thomas described the services the Garrison Boulevard location offers.

“Typically, it just depends on the client,” Thomas said. “If the client needs assistance with medication management, if the client needs assistance with light housekeeping, if the client needs trips back and forth to appointments, anything of that nature.”

The property’s owner, 211 W Garrison, LLC, has filed for receivership, alleging Thomas is illegally running an assisted living facility. Despite the legal troubles, Thomas claimed to be serving individuals living in 38 units in the building and between 200 and 400 people — most poor, disabled, struggling with mental illness, or battling addiction — since he started operating Maryland facilities in 2018.

But as the legal battle continues, residents like Gilliam are living in a last resort, paying rent to an operator who is being sued for allegedly failing to pay his rent, potentially putting their housing at risk.

‘Nobody’s noticing’

Spotlight on Maryland requested interviews with LifeBridge Health and Johns Hopkins, both identified by multiple sources as hospitals that outsource some discharge placements to third-party operators. Neither institution agreed to an interview.

“[Assisted living] facilities need to be licensed and monitored,” said Arthur Drager, outside counsel for Johns Hopkins hospitals and other Maryland hospital systems. “It’s not a matter of only getting a license. Someone or some entity needs to oversee and stop in, unannounced, in facilities, to see what is actually going on.”

Ellen Jordan “EJ” Hammann, a partner with the Baltimore medical malpractice firm Brown and Barron, said that those inside licensed and unlicensed facilities caring for seniors are not the only ones keeping silent. Seniors often won’t — or can’t — advocate for themselves.

“Our elderly population tends to be quiet, especially when they’re ill. They’re not making a lot of noise,” Hammann said. “What we have is a quiet generation slowly slipping away, and nobody’s noticing.”

Drager, the outside counsel for Johns Hopkins, said he “probably” has seen instances of seniors placed in an unlicensed ALF in his career after hospital discharge. Without naming the hospital, the elder care attorney for medical institutions said a guardianship client of his was shipped one day to an old farmhouse in Delaware.

When Drager arrived with hospital attorneys, he said he saw approximately half a dozen seniors sitting in a living room around a television set.

“I took this woman outside, with the attorney from the hospital,” Drager said. “She had bruises on her arms, she was frightened of the people who had the facility, and we let her know we were not going to leave without her.”

Hammann said lawyers who work on elder neglect and elder abuse talk about the absence of care. “And I think it is sometimes akin to warehousing. It’s like you’re renting a storage unit, you sign a contract, you put boxes in a storage unit, and you forget about them.”

Even as the crisis and the number of unlicensed facilities multiply, state lawmakers are considering loosening regulations. One bill introduced during the 2025 session would expand Medicaid funding for long-term rentals, a step advocates say could blur the line between supportive housing and unlicensed care homes.

In written testimony, Johns Hopkins said of the proposed Maryland expansion: “There are real benefits to providing this service, we know first-hand.”

A law with no enforcement

State Attorney General Anthony Brown’s office in 2023 pushed for legislative changes to make it a felony to operate an unassisted living facility. Two years ago, the Maryland General Assembly — at the request of Attorney General Brown — made operating an unlicensed assisted living facility a felony. The law had overwhelming bipartisan support and the backing of advocates for older adults.

“One thing has become clear … unlicensed assisted living facilities are hotbeds for the abuse and exploitation of vulnerable victims who cannot speak for or protect themselves,” said W. Zak Shirley and Lisa Hyle Marts, leaders in the Medicaid Fraud Control Unit in the attorney general’s office, in a March 30, 2023, memo. “By virtue of remaining unlicensed, these facilities operate in the shadows – enriching their unscrupulous owners/operators by taking advantage of people in desperate need of assistance.”

At the time, Baltimore City Mayor Brandon Scott’s office said the city’s health department knew of 80 unlicensed ALFs. That estimate has increased by nearly 50% over the past two years, based on counts now tracked by local and state agencies.

In a March 2023 letter to the state House Health and Government Operations Committee, the Mayor’s Office of Government Relations acknowledged “multiple complaints” about unlicensed assisted living facilities, citing financial, physical and psychological abuse, resident neglect, inadequate food for residents, mismanagement of their medications, and theft of their financial benefits.

Nearly three years later, the city declined to answer Spotlight on Maryland’s questions about unlicensed assisted living facilities. A city spokesperson said the request for information would be “handled by the Office of Health Care Quality — within the Maryland Department of Health — as they are responsible for licensing and regulating assisted living facilities, residential service agencies and nurse referral agencies.”

The Maryland Department of Health said it takes “appropriate actions” to combat unlicensed ALFs, including cease and desist letters, fines, and referrals to the attorney general for prosecution. A department spokesperson estimated receiving eight to 10 complaints per month about unlicensed facilities — consistent with a 2023 Health Department letter showing about 120 allegations investigated annually.

Spotlight on Maryland has filed a public records request with OHCQ to learn more about the complaints and referral process.

“OHCQ works closely with the Medicaid Fraud Control Unit (MFCU) within the Office of the Attorney General to investigate and prosecute these unlicensed programs,” said the 2023 letter from former Health Secretary Laura Herrera Scott.

Yet Brown’s office confirmed that no prosecutions have been brought under the new law since it took effect in October 2023.

Brown’s office said it received one criminal referral in August 2024 for a suspected unlicensed assisted living facility in Anne Arundel County. Jennifer Donelan, the AG’s spokesperson, said the office “declined to prosecute due to insufficient evidence.”

Privately, government officials have met about what they call a growing unlicensed ALF crisis, according to senior government officials not authorized to speak to the media. The same leaders who championed the 2023 legislation have failed to enforce it, overwhelmed by the growing number of aging Marylanders in need and the lack of legitimate housing alternatives.

Have you experienced or have direct knowledge about unlicensed assisted living facilities operating in Maryland? Do you have a tip related to this story? Reach Gary Collins at gmcollins@sbgtv.com or contact Spotlight on Maryland’s hotline at (410) 467-4670.  Spotlight on Maryland is a collaboration between The Baltimore Sun, FOX45 News, WJLA in Washington, D.C.

The exercise encouraged staff to empathize with their young patients who may need to wear them to provide enough oxygen to lungs suffering from flu or COVID-19 this winter, said Tina Humbel, nurse manager of the Pediatric Critical Care Unit at the University of Maryland Golisano Children’s Hospital.

“Kids don’t tolerate masks that well,” Humbel said. “It’s almost like you can sympathize with them a little more when you walk the walk.”

She learned to work under pressure as a U.S. Air Force Medical Service specialist and tactical EMT, Humbel said. Regular deployments during natural disasters, conflict areas and vaccine clinics honed the calm, precise approach she said she draws on to lead one of the hospital’s most demanding pediatric units today.

The University of Maryland Medical System honored veterans like Humbel with a breakfast on Tuesday to celebrate the kickoff of a new Veterans Network. The network is designed to help veterans support each other while providing care to their patients, the children’s hospital stated in a release. They also lit up the face of the University of Maryland Medical System buildings with green lights to celebrate Veterans Day.

Veterans like Humbel bring valuable skills like leadership, teamwork, agility and discipline to any workplace, according to the national nonprofit Wounded Warrior Project.

“Walking the walk” throughout her life prepared her to take the help of one of the nation’s preeminent children’s hospital intensive care units, Humbel said.

“I think it started with my father. I grew up as an Army brat,” she said. “My father was a drill sergeant, and from an early age, he impressed on us the importance of always being in readiness. The first thing every morning, we made our own beds to prepare for the day.”

She brings that sense of readiness to her work at the hospital, as well as a penchant for planning — including the Winter is Coming course to prepare for flu season.

“We are always looking at a situation in terms of how do we stay one step ahead and to be ready for anything,” Humbel said. “I like to have a plan and a backup plan, and a backup plan to the backup plan.”

The hospital’s Veterans Day recognition efforts spark pride in her service and in her fellow veterans, she said.

“The first thing I do on Veterans Day is call my brother, who was a Marine,” Humbel said. “I will tell him, ‘thank you for your service,’ how much I appreciate him and how much I love him. And then we spend a good amount of time reminiscing and talking about our father, who has passed away.”

“To everyone who has served, thank you for your service,” she added. “They’re appreciated, and this is their day.”

Have a news tip? Contact Karl Hille at 443-900-7891 or khille@baltsun.com.

JOHANNESBURG (AP) — Researchers and scientists in South Africa on Tuesday launched clinical trials on the first domestically developed vaccine.

The oral cholera vaccine, developed by the Cape Town-based pharmaceutical firm Biovac, is currently undergoing trials to determine its safety in adults and will be followed by trials to compare it to existing cholera vaccines that are already in the market.

Depending on the results, the vaccine could be approved and ready for use in Africa by 2028, Health Minister Aaron Motsoaledi said.

The development of the vaccine has been praised as a significant milestone for vaccine access in the country and across the rest of the continent.

Motsoaledi said that while South Africa experienced relatively low levels of cholera, many countries in Africa often hit hard by outbreaks would greatly benefit. He said the COVID-19 pandemic exposed how vulnerable African countries were to pandemics as they relied on imported vaccines.

South Africa often experiences cholera outbreaks due to cross-border movements. Other causes includes a lack of clean water in communities such as Hammanskraal, in the capital Pretoria, where provision of clean water remains a major problem.

A cholera outbreak in 2023 led to the death of 47 people and over 1,400 reported cases, but neighboring countries like Malawi, Mozambique and Zimbabwe have experienced far higher cases and deaths.

“When we can research, develop and manufacture vaccines locally, we reduce our vulnerability to supply chain disruptions, geopolitical pressures, international market competition and vaccine nationalism, which was apparent at the height of the COVID-19 pandemic,” said Motsoaledi.

The trials are being held in the provinces of Gauteng, Eastern Cape and KwaZulu-Natal, where cholera cases have previously been reported.

“This development addresses a critical, life-saving need, given the ongoing global shortages of the vaccine amid recurring cholera outbreaks,” said Biovac CEO Morena Makhoana.

Lerato Maleka, 44, who is one of the first participants in the clinical trial, said she enrolled because of the water issues in South Africa.

“I haven’t had cholera, but we know that sometimes they don’t maintain water and people died in Hammanskraal from cholera by drinking water, so I wanted to be safe from that,” said Maleka.

She said even though there had never been an outbreak where she lives in Diepkloof, Soweto, they often had to boil tap water as it was not clean.

Shadrack Makutu, 37, a resident from Limpopo province, is another participants who has previously experienced an outbreak in his village of Bushbuckridge.

“I do know people who share water with animals, so I know a few people who have been affected by this cholera,” said Makutu.

The World Health Organization estimates that as many as 4 million people around the world are affected by cholera every year, with between 21,000 and 143,000 people dying from it annually.

For more on Africa and development: https://apnews.com/hub/africa-pulse

The Associated Press receives financial support for global health and development coverage in Africa from the Gates Foundation. The AP is solely responsible for all content. Find AP’s standards for working with philanthropies, a list of supporters and funded coverage areas at AP.org.

Court records show Eugene White, 54, of Havre de Grace, has been held without bond since his arrest in early October. When a grand jury elevated his case to the Baltimore County Circuit Court this week, they issued six counts, including neglect and reckless endangerment.

When White was taken into custody, authorities accused him of involuntary manslaughter. Monday’s indictment, however, dropped the qualifier. In Maryland, manslaughter and involuntary manslaughter carry the same maximum sentence of 10 years in prison.

Although the public defender’s office had signaled its intent to represent White in district court, as of Tuesday, a specific attorney was not assigned to White’s case. A spokesperson for the office did not immediately respond to a request for comment Tuesday.

According to charging documents, on April 25, Baltimore County Police officers and paramedics responded to a cardiac arrest reported at the Halethorpe apartment where White lived. The father reportedly told authorities that his daughter had not woken up since taking her medication the night before.

Police described different developmental and sensory issues the toddler — who was either 2 or 3, but her birthdate was redacted — suffered from, and some of the medicine she required. According to charging papers, White was her sole caretaker, and when he returned from dropping off his other daughter at school that morning, he found her “unresponsive and cold to the touch.”

Medical personnel pronounced the toddler dead about an hour after the 911 call.

An autopsy was soon conducted, and less than a week after the girl’s death, the Office of the Chief Medical Examiner informed police that she had ingested methadone.

Authorities did not say that the toddler died of an overdose in charging documents but cited the cause of death as “Methadone Intoxication complicated by Influenza B Infection and Bacteremia.”

Investigators interviewed White two times, once at a hospital in Baltimore and again a couple of weeks later, according to court records. White reportedly told detectives the girl’s mother had used and sold methadone, but that “she hasn’t been at the residence for some time.”

He denied using the drug himself, according to police, but said if his daughter had methadone in her system, “he must have administered it as he is her caregiver.” According to charging documents, White said he might have used a dirty syringe to inject the girl’s medication through her feeding tube.

A few days after his daughter’s death, White consented to a drug screening from the county Department of Social Services. Police said he had tested positive for methadone and fentanyl.

As of Tuesday, his next court date had not been scheduled.

Have a news tip? Contact Luke Parker at lparker@baltsun.com, 410-725-6214, on X as @lparkernews or on Signal as @parkerluke.34.

“For me, Veterans Day is about, ‘what are we doing to take care of our veterans,’ ” said Craig Jones, a veteran and licensed clinical social worker with Columbia Mental Health. “We have a lot of veterans who are homeless or who we know have struggled with mental illness. When those challenges come up, there’s nothing wrong with asking for help if it’s more than we can handle on our own.”

Maryland is home to about 360,000 veterans and another 100,000 active-duty service members, reservists, national guard members, and their dependents, according to the state’s Department of Veterans and Military Families. The department’s website offers resources for housing, VA-backed home loans, health care, mental health, education and other needs.

In addition to Veterans Administration hospitals or clinics, Jones said military bases have family support centers and advocacy programs. Baltimore City and Baltimore County provide behavioral health services, and private institutions like Columbia Mental Health offer telehealth services for those without transportation. He also said to dial 911 or 988 in an emergency.

For family members, Jones said the best way to support your veteran is to listen.

“When your loved one is suffering, you are suffering as well,” he said. “It’s okay to say, ‘I don’t have the answers. Let me get you some help.’

“When your loved one is having a good day,” he added, “try to sit down and talk to them and ask permission to help. Ask them, ‘Can we make a plan for when you’re experiencing those bad moments. Can we have a code word or phrase to let you know that l see you’re not in a good place, and can we initiate our plan right now?”

Not all veterans have a hard time on Veterans Day or Memorial Day, he said, but the national holidays provide excellent opportunities to consider whether veterans or their families are getting the care and support that they need.

“The veterans that I have worked with personally are coming to me because they’re troubled by their military experiences,” he added. “That challenge, in that moment, is not just once a year on Veterans Day.”

Have a news tip? Contact Karl Hille at 443-900-7891 or khille@baltsun.com.

You won’t find dumbbells or weight machines in the gym Sean Keogh runs. At Calisthenics Club Houston, it’s all about training with body weight.

“That’s all we do,” Keogh said — but that’s enough to keep new members coming through the doors, excited to learn moves like handstands and pullups.

Keogh and his members have plenty of company. These days, content creators, independent gyms and megachains alike are promoting calisthenics, an age-old form of fitness that uses little or no equipment and instead relies on body weight for resistance.

In July, President Donald Trump even reestablished the Presidential Fitness Test, intending that youth across the country will again practice old-school exercises like situps, pushups and pullups.

It’s little surprise that these no-frills moves are making a comeback in our over-scheduled society, said Anatolia Vick-Kregel, director of the Lifetime Physical Activity Program at Rice University. “We don’t always have time to go to the gym,” she said. “This is what you can do at home or in your office.”

Another reason might be economic, said Michael Stack, an exercise physiologist and president of the Physical Activity Alliance, a coalition of groups that promote physical activity. With no equipment required, calisthenics-based programs are affordable for exercisers and profitable for gyms that offer them. Plus, people may have gotten used to exercising with few accoutrements during the pandemic.

“This trend has been building,” Stack said. “The pandemic definitely accelerated it.”

How effective are calisthenics?

There’s plenty of research to suggest that calisthenics can improve everything from muscle strength to aerobic conditioning, Vick-Kregel said.

“Body weight is phenomenal,” she said.

But there are limits to its effects, said John Raglin, a professor of kinesiology at the Indiana University School of Public Health, Bloomington. “It can be effective,” Raglin said. “But I think the idea that it can or should replace the use of even simple equipment is wrong-headed.”

Sometimes, Raglin said, using equipment can actually make exercises simpler or safer to perform. Many people, for example, do pushups with improper form.

“If you’re not strong enough or you have joint issues or arthritis, then lying on a bench and using small hand weights can actually be safer and more practical,” he said.

It all depends what your goal is

Beyond safety, people looking to significantly increase their strength or muscle size will likely see more dramatic results if they use weights, Raglin said. Doing so “utilizes more of your muscle and generates more force than you could otherwise,” he explained.

Lifting weights also damages muscle tissue in a way that can be productive, as muscles grow larger through the body’s repair process. Over time, though, it may take larger amounts of weight to keep seeing gains. Progress plateaus as the body gets used to exercises it’s done before.

It’s not impossible to grow muscle through calisthenics, Vick-Kregel said; it’s just harder to continuously level up exercises for sustained progress without increasing external weight.

“After you’ve done a couple workouts of squatting with your body weight, your body’s going to need external load to get stronger or to build muscle tissue,” Stack agreed.

In other words, if you’re after bulging biceps, you may need more than calisthenics to get there. But if you’re just looking to get moving and improve your health, your body is probably enough.

Particularly for the roughly 75% of Americans who aren’t meeting federal physical activity guidelines — which call for at least 75 minutes of vigorous or 150 minutes of moderate aerobic activity a week, plus two strength-training sessions — calisthenics are a great option, Stack said.

“Body weight is the simplest apparatus you can use,” Stack said. “I would encourage anyone who’s not exercising to start exercising with just their body.”

How to begin a calisthenics routine

First, assess your current fitness and mobility, Vick-Kregel said. With the help of a mirror, workout buddy or trainer, see if you can do exercises like planks, pushups and squats with correct form. If not, look for modifications, such as doing pushups from your knees.

Once you feel confident with the fundamentals, aim to perform calisthenics in 10- to 30-minute chunks, two to three times a week, she suggested. (For a little more structure, you can consult the The Five Basic Exercises Plan, or 5BX, a classic calisthenics program developed by the Royal Canadian Air Force in the 1950s.)

Progressively increase the duration and intensity of your workouts as you get fitter. “Gradual progression is critical,” Vick-Kregel emphasized.

As you get more experienced, though, calisthenics can be performed at high intensity. Keogh maintains that these exercises are not just for beginners. There are plenty of ways to increase the difficulty of body-weight exercises over time, making them both highly challenging and effective, he said.

For doubters, Keogh has a blunt message: “Try it.”

ByHeart, a manufacturer of organic baby formula, recalled all of its products sold nationwide Tuesday, days after some batches were recalled in an expanding outbreak of infant botulism.

At least 15 babies in 12 states have been sickened in the outbreak since August, with more cases pending, according to state and federal health officials. All of the infants were hospitalized after consuming ByHeart formula, officials said. No deaths have been reported.

ByHeart officials expanded the voluntary recall from two lots announced Saturday to all products in consumers’ homes and in stores. That includes ByHeart Whole Nutrition Infant Formula and Anywhere Pack pouches of powdered formula. The company sells about 200,000 cans of infant formula a month online and in stores such as Target, Walmart, Albertsons and Whole Foods, according to Dr. Devon Kuehn, chief medical officer.

Parents and caregivers who have the formula in their homes “should immediately discontinue use and dispose of the product,” Kuehn said.

Company officials said they enacted the unusual recall “in close collaboration” with the U.S. Food and Drug Administration even though no product that was previously unopened tested positive for the contamination. The type of bacteria that produces the toxin is widespread in the environment and could come from sources other than the formula, company officials said.

“This action underscores ByHeart’s core mission: protecting babies above all else,” the company said in a statement.

California health officials earlier confirmed that a sample from an open can of ByHeart baby formula fed to an infant who got sick contained the toxin-producing type of bacteria.

The U.S. Food and Drug Administration recommended that ByHeart expand its recall because of the number of ill infants that reported consuming the formula, the identification of additional lot codes, the growing case count and the results of the California testing.

The FDA is investigating 84 cases of infant botulism detected since August. Of those, 15 consumed ByHeart formula, the agency said in a statement.

“This information shows that ByHeart brand formula is disproportionately represented among sick infants in this outbreak, especially given that ByHeart represents an estimated 1% of all infant formula sales in the United States,” the FDA statement said.

Illnesses began between Aug. 9 and Nov. 10, federal officials said. Cases were reported in Arizona, California, Illinois, Kentucky, Minnesota, North Carolina, New Jersey, Oregon, Pennsylvania, Rhode Island, Texas and Washington.

Investigators have not identified any other infant formula brands or other sources of exposure in the outbreak, officials said.

ByHeart produces formula powder at a plant in Allerton, Iowa, and then ships it to a site in Portland, Oregon, for canning and distribution, Kuehn said. U.S. Food and Drug Administration inspectors were at the Portland plant Monday, she added.

In addition to the broad recall, the company said it is testing every batch of formula with an independent third-party laboratory, providing health officials full access to its sites and sharing results with regulators as they become available.

Infant botulism is a rare and serious illness that occurs in babies under age 1, whose gut microbiomes are immature. It is caused when the infants consume bacteria that contain spores that produce a toxin in the gut. Symptoms include constipation, poor feeding, drooping eyelid, weak muscle tone, difficulty swallowing and breathing problems, among others.

Babies who develop those symptoms need immediate medical attention. The sole treatment for the infection is BabyBIG, an IV medication made from blood plasma of people immunized against botulism.

The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education and the Robert Wood Johnson Foundation. The AP is solely responsible for all content.

The hospital put new practices into place to ensure expectant mothers had better information and were physically stronger before giving birth, said Jodie Bell, assistant director of maternal and newborn health at Greater Baltimore Medical Center. They also instituted practical changes during delivery.

“Prior to starting this work, we were estimating blood loss during and after delivery,” Bell said. “Now we are actively measuring blood loss.”

According to the Centers for Disease Control and Prevention data, 83.5% of serious complications for mothers were categorized as preventable. Postpartum bleeding accounts for more than two out of five of those complications, according to findings published by the Maryland Maternal Health Innovation Program.

Since 2022, Bell and her team have eliminated the racial disparity in morbidity from bleeding. They reduced the rate for Black patients from 10.42% in 2022 to 2.5% in 2025. They pushed back the severe bleeding risk for white patients from 5.4% to 4.1%.

One major factor was a higher rate of anemia, or iron deficiency, in Black moms-to-be, Bell said.

“When we started looking at it by race, we noticed white and Black patients were almost identical,” she said. “However, Black patients were more heavily impacted when it did happen.”

When a mother enters the hospital for delivery with anemia, they are much more likely to suffer severe effects of bleeding and recover more slowly, she said. The hospital reinforced prenatal instruction about anemia and iron supplements for all mothers.

“Now all our patients are coming into delivery a little stronger,” she added.

They implemented a Respectful Care Toolkit developed by the Association of Women’s Health, Obstetric and Neonatal Nurses to improve communication and patient autonomy.

“We heard from our patients in general that when things like postpartum hemorrhage occur, sometimes the patient left feeling traumatized,” Bell said. “We added a patient debrief to recap what happened, answer their questions and talk to family members. As a result, the patient really understands what happened and feels better about their experience.”

The hospital established a multidisciplinary Maternal Newborn Health Equity Committee in 2024 to build on its improvements. They produced informational handouts in more than 50 languages and host free educational and support sessions at Baltimore County Public Library locations.

Have a news tip? Contact Karl Hille at 443-900-7891 or khille@baltsun.com.

VENICE, Fla. — MAGA and MAHA are happily married in Florida, and nowhere more at home than in Sarasota County, where on a humid October night a crowd of several hundred gathered to honor state Surgeon General Joseph Ladapo, his wife, and an unlicensed Canadian radiologist who treats cancer with horse paste.

The event, titled “The 3 Big C’s: Courage, Censorship & Cancer,” was sponsored by the We the People Health and Wellness Center, a clinic, funded by a Jan. 6 marcher, where patients can bask in red light, sit in ozone-infused steam baths, or get their children treated for autism with an experimental blood concentrate.

In Venice, in Sarasota County, a “medical freedom” movement forged in opposition to COVID lockdowns blends wellness advocates, vaccine-haters, right-wing Republicans, and angry parents in a stew of anti-government absolutism and mystical belief.

Ladapo’s wife, Brianna, a self-proclaimed “spiritual healer” who says she speaks with angels and has prophetic visions, chaired a panel at the event at the Venice Community Center. The keynote speech was by William Makis, a litigious COVID conspiracist who, after losing his medical license in 2019, has made a living treating cancer patients with antiparasitic drugs including ivermectin, which was also championed in some circles as a COVID treatment during the pandemic.

Clinical trials showed that ivermectin didn’t work, but COVID skeptics viewed medicine’s rejection of it as part of a conspiracy by Big Pharma against a cheap, off-patent drug. Some of the patients in his care have what he calls “turbo cancers,” Makis says, blaming alleged impurities in mRNA vaccines that he says have killed millions of people.

For Makis, it’s all one big conspiracy — the virus, the vaccine, and the suppression of his therapies.

Brianna Ladapo has her own take on medicine, based on the idea of good and bad spiritual energy. She wrote in a memoir that as the pandemic began she intuited that it had been planned by “sinister forces” to “frighten the masses to surrender their sovereignty to a small group of tyrannical elites.” She has written that the government hides vaccination’s risks.

She sees “dark forces” all over the place, including, she said in a podcast interview earlier this year, in “chemtrails” shaped like a pentagram. “They’ve been plastering it in the sky right outside our house for the last few weeks,” Ladapo said. The chemtrails “they are dumping on us,” she said, had sickened her and her three sons. “The dark side are no fans of ours.”

(“Chemtrails” are a favorite topic of conspiracy theorists who say they think that contrails, the condensation formed around commercial airplane exhaust, contain toxic substances poisoning people and the terrain. Although there is zero evidence of that, Health and Human Services Secretary Robert F. Kennedy Jr. plans to look into whether they are part of a clandestine effort to use toxic chemicals to change the weather.)

Ladapo’s husband hasn’t publicly endorsed all her beliefs, but as surgeon general he’s reversing decades of accepted public health practice in Florida and embracing untested therapies. “We’re done with fear,” Joseph Ladapo said after being named surgeon general in 2021. He wants to ban mRNA vaccines in Florida, and on Sept. 3 he announced plans to end childhood vaccination mandates in the state.

A few days after the Venice event, Ladapo said he hoped to support Makis’ work — though his treatments are unproven and potentially dangerous — through a new $60 million cancer research fund created by Florida Gov. Ron DeSantis and his wife, Casey.

Vic Mellor, CEO of a local concrete business, founded and owns We the People. He’s an associate of retired Army Lt. Gen. Michael Flynn, who was briefly President Donald Trump’s national security adviser in 2017 before being dismissed for lying to the FBI about his contacts with Russians. Trump later pardoned him, and Flynn since has become a leader of the Christian nationalist movement.

We the People provides vitamin shots but no vaccines. In fact, many of its offerings are treatments for supposed vaccine injuries. Part of the We the People building is a broadcasting studio, where conservatives hold forth on what they see as the villainy of liberals and the American Academy of Pediatrics.

Mellor was at the U.S. Capitol during the riot on Jan. 6, 2021 — he said he “just knocked on front doors,” according to a Facebook post described by The Washington Post. He returned home and started building a 10-acre complex that hosts weddings and right-wing assemblies, with playgrounds, a butterfly garden, a zip line over a pond visited by alligators, and an attached, separately owned gun range.

Visitors who travel down a dirt road to The Hollow — named for the hollow-core concrete that made Mellor wealthy — can enter the compound through a dark, cavernous passage lined with neon signs illuminating maxims from the likes of Thomas Jefferson, Thomas Paine, and Flynn.

The Hollow has hosted clinics for unvaccinated kids and events for Ladapo, anti-vaccine activist Sherri Tenpenny (who in 2021 told legislators at an Ohio House hearing that COVID vaccine made people magnetic), and other “medical freedom” advocates. Mellor created a medical home for such ideas by opening We the People in 2023.

The year before, three “medical freedom” candidates had won seats on the board overseeing Sarasota’s public hospital and health care system, after protests over the hospital’s refusal to treat COVID patients with ivermectin and other drugs of choice for COVID contrarians.

On a recent afternoon at The Hollow, manager Dan Welch was clearing brush when approached by KFF Health News. As a foe of vaccinations, he welcomed Ladapo’s move to end vaccine mandates. “Maybe in their inception, vaccines were created to prevent what they were supposed to prevent,” Welch said. “But now there’s so much more in there, the metals, aluminum, mercury. Since they started vaccination, the autism rate went through the roof, and I believe these vaccines are part of it.”

The theory that vaccines cause autism has been debunked, and manufacturers removed mercury from childhood vaccines 24 years ago, although Welch said he doesn’t believe it.

Vaccination faces additional challenges in a century-old Sarasota County neighborhood of low-slung bungalows called Pinecraft, home to about 3,000 Mennonites — and double that number when Amish snowbirds arrive in the winter. Pastor Timothy Miller said that while Sarasota’s Mennonites are less culturally isolated than the Mennonite community in West Texas, site of a measles outbreak in January, many in his community also shun vaccination.

His cousin Kristi Miller, 26, won’t vaccinate her 9-month-old daughter or any of the other children she hopes to have, she said, because she thinks vaccines probably cause autism and other harms.

As for vaccine-preventable diseases like measles, she doesn’t worry about them. Like the Ladapos, “I don’t live in fear,” she said. “I have a God who’s bigger than everything.”

(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.)

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

NEW YORK — You keep your trusty reusable bottle filled with only clear, delicious water. Do you still need to wash it?

Experts say reusable bottles get grubby no matter what liquid they’re filled with, and it’s important to clean them regularly.

Water bottles pick up germs from our mouths when we take a sip, and from our hands when we touch the straw or lid. They’re covered in tiny, tough-to-reach nooks and crannies which can become breeding grounds for mold, bacteria and other microbes if left un-scrubbed.

“It seems like something mundane, but it is extremely important,” said nurse practitioner Michele Knepper, who works at the University of Pittsburgh Medical Center.

Unclean water bottles can cause stomach aches and itchy throats and even exacerbate allergies and asthma.

Experts disagree on when and how you should wash them, but they’re all in agreement on one thing: Give your water bottle a tender loving clean, because something is better than nothing at all.

“Is it that big of a deal? No. But it’s also not difficult to just wash your water bottle,” said Dr. Mike Ren, a family medicine physician at Baylor College of Medicine.

Some tips for a squeaky clean water bottle

Experts say the gunk doesn’t care what your water bottle is made of. Reusable metal, plastic and glass bottles all grow germy, but plastic bottles are more likely to get scratches or dings on the inside where microbial life can cozy up.

The best cleaning routine is a simple one: Use a sponge or bottle brush to scrub inside and out with warm, soapy water, rinse it out and let it dry so it’s ready for the next refill. A narrow or pipe cleaner-shaped tool can be useful to get into straws and tight crevices.

For a deeper wash, scientists recommend popping the bottle in the dishwasher if it’s safe to do so, or dissolving a denture or retainer-cleaning tablet in the bottle overnight. Scrubbing with a warm water solution of vinegar or baking soda works too.

Many experts recommend doing a simple, soapy water clean every day and a deeper clean once a week. If daily cleaning feels a little extra, Ren said to try to get to it at least every other week or so while maintaining other good habits like rinsing the mouthpiece over the sink during each refill.

But if you fill your reusable bottle with other beverages like protein shakes or exercise drinks, it really is important to clean every day. Sugary drinks leave a residue that bacteria love to snack on.

Do you need to dump the water in your bottle every day?

Is it okay to leave water in a reusable bottle overnight? Experts disagree.

Some say to dump the dregs out every refill, while others recommend emptying every few hours. Ren says it’s likely okay to leave some inside overnight, but to empty old water at least every few days.

“Guidelines are guidelines,” Ren said. “Everyone’s going to do it a little bit differently.”

If there’s visible mold on the bottle or the liquid inside has a weird smell, don’t drink it. Avoid refilling disposable plastic water bottles since chemicals can leach into the water, and they’re even more full of cracks and crevices that can harbor germs.

Water bottle cleaning routines may not all look the same — but it’s important to keep up the habit, said Ivy Sun, a hospitality expert at Georgia Southern University who has studied water bottle contamination. She washes her and her kids’ bottles with soapy water every day.

“This is just a very small step that we do, but it can largely help with our health,” Sun said.

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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education and the Robert Wood Johnson Foundation. The AP is solely responsible for all content.