Gubernatorial Candidates Put Spotlight on Rhode Island’s Fragmented LTC Continuum

Published in RINewsToday on August 8, 2022

Last week, hundreds of seniors and aging advocates gathered at East Providence High School to learn more about aging policy positions from 6 Rhode Island Gubernatorial candidates. Many more watched virtually as the event was streamed online.

During the 143-minute forum, the invited Gubernatorial candidates (five Democratic and one Republican, gave two-minute responses to seven questions previously given to them and hammered out by the Senior Agenda Coalition of Rhode Island (SACRI) and its 17 cosponsors, that would elicit how each, if elected Governor, would fix Rhode Island’s fragmented long-term care continuum and provider payment systems.

According to Bernard J. Beaudreau, Executive Director of the Providence-based SACRI about 300 seniors and aging advocates came to personally see the Gubernatorial candidates outline their position on aging issues. Multiple platforms on Facebook and YouTube were promoted by a variety of senior advocacy groups that resulted in the over 300 virtual audience. Some held “watch parties” at one or more of the 12 senior centers, with approximately 135 people participating from throughout the state.

Before the forum began at 10:00 a.m., Deborah Burton, Executive Director of RI Elder Info, one of the forum’s sponsors, provided the welcome, explaining why it was so important for older voters to understand the aging agenda of the next Rhode Island Governor and their commitment to funnel funding and resources to the state’s aging program and services. “The policies of the incoming Governor will impact a large number of baby boomers in the state,” said Burton, noting that the Gen X’s, often forgotten, are right behind them. “We need to have a system [long-term care continuum] in place that is effective, that is funded, and is what we need and want as we age,” she said.

“It was very evident that these candidates came prepared and took the forum and all the issues impacting older Rhode Islanders very seriously,” said a very pleased Beaudreau.

Talking the Talk about Senior Issues

Here is a sampling of policy issues touched on by the candidates:

The attending candidates gave their thoughts as to how they would rebuild and sustain a viable workforce of nursing homes and homecare providers.

Two term Secretary of State Nellie Gorbea said she felt that we, as a society, do not value caregiving. She called for investing in the workforce of nursing home providers by increases tothe state’s Medicaid rates. The educational sector can become a pipeline to “nurture and grow” jobs for this sector, she said.

Governor Dan McKee stated he addressed staffing issues at home health agencies and nursing homes by expanding the Wavemaker Fellowships to include healthcare workers and increasing reimbursement rates for home health agencies by $ 900,000 annually. McKee also noted that in last year’s budget it gave the state’s nursing facilities a cost-of-living increase to ensure funding to increase their workforce.

Healthcare provider businesswoman Ashley Kalus, a Republican candidate, also called for increasing the Medicaid reimbursement rate. “Respect long-term care as a career choice which means there needs to be a path from home health care aide, to certified nursing assistant, licensed practical nursing, registered nurse and Nurse Practitioner through apprenticeship and training programs,” she said.

Former CVS Executive Helena Foulkes supports expanding Medicaid, but we must hold the nursing homes accountable to make sure that the increases of state funding go to workers and not to equity owners of nursing homes.

Healthcare advocate Dr. Luis Daniel Luis Muñoz says we should increase reimbursement rates for providers. He calls for the creation of a state-based medical school to create more dental professionals and physicians. “That is how we can increase the providers necessary to serve Rhode Islanders,’ he says.

Former Secretary of State Matt Brown blamed Rhode Island’s staffing shortage on the General Assembly slashing Medicaid reimbursement rates over the years. He called for an increase in Medicaid reimbursement rates and increasing minimum wage to direct care workers in Medicaid nursing facilities to $20 per hour. This would attract workers from Southern Massachusetts, he predicted.

The attending candidates also gave their thoughts as to their strategies for Medicaid rebalancing and the program’s expansion to improve home and community-based care opportunities along with ensuring financial viability of nursing homes.

Muñoz called for a targeted approach to supplementing wages for providers taking care of seniors, noting that “twenty dollars is not a livable wage. We lost the culture of taking care of people,” he said, “but it will take money, increasing providers; but programmatically the state needs to make a commitment to expand its community and home-based programs working with multiple departments, to bring back this culture of care.”

Brown warns that 87 percent of nursing homes are in risk of closing and the state must address this by increasing Medicaid rates so as to give these facilities the financial stability they need. As to home care, pay must be increased to direct home care workers. But do not forget about family caregivers.

“We do not have an adequate paid Family Leave program in the state,” he says. As Governor, Brown would call for creation of a program to give 16 weeks of adequate pay.

Kalus calls for seniors to be placed in the least restricted setting. There should be adequate senior housing available to allow a person to live independently in the community. “We must reimage the continuum of care,” says Kalus, stressing that different types of care must be working together.

According to Kalus, if you go to a hospital there should be an incentive to discharge you to a nursing home with rehab, if that is possible, and then provide an incentive to move a person to less restricted continuum of care from there, such as home care and then independent living. An organization, like an Accountable Care Organization, must ensure there are no incentives to keep you in one type of care environment, over a less restrictive one, she says.

McKee touted the $10 million dollars invested this year to rebalance the long-term care continuum. He announced that he plans to shortly issue an Executive Order to direct state agencies to review existing policies through a healthy aging lens and address accessibility and impacts on Rhode Island’s aging population. He will also direct state agencies to appoint a representative to the task force that will create a Statewide Aging Plan.

Foulkes called for the state to create a long-term comprehensive plan for providing programs and services for seniors. Politicians seem to implement short term fixes year to year, making small timeframe moves. She urges improving discharge planning and technology and compensating family members to keep seniors at home. Nursing home care should be changed to provide single rooms with single-use bathrooms to ensure their dignity of living in a nursing home, and prevent spread of infectious diseases, a lesson learned from the pandemic.

Gorbea says Rhode Island is “clearly off the mark” as to how it spends its Medicaid dollars on home care services. Twenty six percent of the state’s Medicaid budget is spent on home care, compared to many states allocating over 41 percent. “That’s where we have to go,” she says. “If you are going to encourage people to stay at home, you must have housing and transit options,” she notes.

In Retrospect…

“While there were similar opinions, each candidate presented their own perspective,” said SACRI’s Beaudreau, noting that he did not hear anything anyone said that would be objectionable to aging advocates. “We now have on record their pledge and commitment that there will be a plan and anaction agenda that will benefit all seniors of the state,” says Beaudreau, “if they are elected Rhode Island’s 77th Governor next November.

“It is clear we have a slate of very quality candidates,” says Beaudreau at the conclusion of the forum.

Maureen Maigret, chair of the Long-Term Care Coordinating Council’s Aging in Community Subcommittee and SACRI Board Member stated, “the Forum exceeded my expectations in terms of attendance (in-person and virtual), and I consider it an absolute success.”

Maigret reported that all candidates supported: “making the Office of Healthy Aging a full cabinet/department with review of sufficiency of resources; expansion of Medicare Savings Program which I have been advocating for at least 5 years and adding a state COLA to SSI payments; requiring better data on minority older adult inclusion; addressing community living, housing and transportation needs of older persons and developing and implementing a comprehensive, interdepartmental strategic Plan on Aging.

What was most important is that this event made them really pay attention to the fact the state has a significantly growing number of older persons which calls for transformative change. By highlighting some policies needed to address these demographic changes and getting candidates on record in support of them, they can be held accountable,” says Maigret. “The other significant outcome was to have so many co-sponsors come together in support of the policies put forward,” she added.

“There needs to be immediate leadership and follow-thru with all appropriate stakeholders to design and implement a seamless state/local delivery system for “aging in place” services, including increased care payments and efficient reimbursement to providers,” says Vincent Marzullo, well-known aging advocate who served as a federal civil rights and national service administrator. “With vision and commitment, Rhode Island can be a more appealing retirement community by aggressively addressing healthcare disparities and elevating the RI Office on Healthy Aging to full Departmental status with broader authority/responsibilities. This conversation must now include our General Assembly leaders,” said Marzullo, a West Warwick resident who serves on SACRI’s Board.

Co-sponsoring this event was a broad coalition of 18 service providers and advocates: 

A Community Together, Alzheimer’s Association of RI, Carelink, Community Partners Network of RI, Economic Progress Institute, Leading Age RI, NAACP Providence Branch, Ocean State Center for Independent Living, PACE, Progreso Latino, RI Assisted Living Association, RI Elder Info, RI Health Care Association, RI Organizing Project, RI Senior Centers Directors Association, SEIU Healthcare 1199, Senior Agenda Coalition of RI and Village Common of RI.

To watch the forum, go to https://www.youtube.com/watch?v=okQ5FguKMao.

For info about the Senior Agenda Coalition of Rhode Island, go to https://senioragendari.org/.

RI Gubernatorial Forum to ask, “what’s your Senior Agenda”

Published in RINewsToday on August 1, 2022

The Senior Agenda Coalition of RI (SACRI) has joined 17 organizations to bring you Rhode Island’s 2022 Gubernatorial Forum where candidates will talk about senior issues. The event is scheduled for Wednesday, August 3, 2022, at 10:00 a.m. at the East Providence High School’s new 900-seat capacity auditorium. Seating is limited to 450 people, leaving space for social distancing. Doors will open at 9:30 a.m. At press time, 350 seniors and aging advocates have registered to attend in person or virtually.    

“Senior issues must be viewed as a public policy priority because Rhode Island’s older population is growing dramatically,” says Bernard J. Beaudreau, SACRI’s Exec. Director, and one of the event’s organizers. According to Beaudreau, the U.S. Census Bureau estimates that the state’s total population of 65 years and older has grown by 20% from 152,183 in 2010 to 182,486 in 2020, adding 30,303 people in this age group. Rhode Island’s statewide planning projections also indicate that people sixty-five and older will grow to over 247,000 by 2030, an increase of 65,000 seniors over the 2020 census.

Gubernatorial candidates to delineate positions on key Senior Issues

“During the 90-minute forum, the gubernatorial candidates will share their positions on seven questions, hammered out by event cosponsors, as to how they would address a variety of policy issues impacting older Rhode Islanders,” says Beaudreau.  “Attendees will learn how candidates would rebuild and sustain a viable workforce for nursing homes and homecare providers. They will also be asked about their plans for Medicaid rebalancing and expansion to improve home and community-based care opportunities while ensuring the financial viability of nursing homes,” he says. 

Beaudreau says the forum also gives the gubernatorial candidates an opportunity to detail their strategies on how resources can be increased to significantly support healthy aging in the community. They will be asked by the moderator what type of assistance will be given to low-income seniors, and will they support a yearly cost-of-living adjustment to the state SSI payment and increase eligibility for the Medicare Savings Programs for seniors and people with disabilities to at least 185% FPL.

The attendees will also learn how the candidates, if elected governor, will ensure that an adequate amount of the $250 million in funding for affordable housing is allocated for seniors and how they will work to ensure equal access to high quality healthcare and information about available health care resources.

Finally, the gubernatorial candidates will be asked to make a pledge to address the needs of Rhode Island’s older population and provide the leadership and resources necessary to create and implement a Rhode Island Strategic Plan on Aging.

Recognizing the political clout of Seniors

“SACRI’s upcoming Gubernatorial Candidates’ Forum is important as older adults historically have high turnout in elections and the Forum provides an opportunity to hear the candidates’ views on issues important to seniors,” says Maureen Maigret, Chair of the Long-Term Care Coordinating Council’s Aging in Community Subcommittee. “The Forum should cause candidates to take a serious look at the state’s demographics, to note how the older population is growing, and to reflect on how government can best support older adults’ desire to remain healthy and living in the community and provide quality facility care when needed,” says Maigret.

“The Forum allows us to set forth policy priorities and hold whoever is elected accountable for addressing them. An example of this is when former Governor Raimondo was elected. She had been presented with priorities for restoring budget cuts to senior services such as Meals on Wheels and some of the cuts were restored in her budgets,” Maigret noted.

SACRI’s Beaudreau says that the senior vote will influence the outcome of the upcoming primary and mid-term. “Rhode Island seniors 60 years of age and older represent 34% of all registered voters and accounted for 42% of the vote in the 2020 general election. Rhode Island seniors have higher voter participation rates than the rest of the population,” says Beaudreau, this being 77% compared to 57% for voters under 60 years of age. “We have a powerful voice to be exercised to impact public policy,” he says.

Political pundit Wendy J. Schiller sees seniors as a crucial voting bloc in American politics. “On average, 72% of voters over the age of 65 turn out to vote in presidential elections, as compared to about 48.6% of voters under the age of 30. Seniors are consistent and typically well-informed voters on issues concerning Social Security and Medicare,” says Schiller, Royce Family Professor of Teaching Excellence in Political Science and Director of the Taubman Center on American Politics and Policy, Brown University. 

According to Schiller, in the past 3 elections, “seniors have split about 55-56% for the Republicans, and 45-46% for Democrats. Seniors have been viewed as more conservative (Sun City AZ, the Villages FL) but the data do not really bear that out as you can see. There is a tilt, but not a full lean toward the GOP; this midterm season might be different though. If the 22 midterm elections were held tomorrow, you might expect to see even a bigger swing toward GOP candidates than usual because of inflation alone. Inflation is just one area where there is a gap in issue concerns between older and younger voters. Older voters worry a great deal about inflation eating into their savings and pensions that are not adjusted for inflation while younger voters may be as concerned with climate change and abortion rights as much or even more than they are worried about inflation,” she says.  

Schiller says that seniors are like all other voters in that they are highly influenced by their political party affiliation, even in cases where the party proposes policies that run against their interests. “The GOP has proposed cutting Medicare ever since it was created, most recently under President Trump, but they are not careful to say that such cuts would not affect current recipients or even people aged 55 or over and the majority of seniors voted for Donald Trump in 2020. Democrats ran into some trouble with seniors when Bernie Sanders and others proposed Medicare for All because seniors thought it would dilute their own services through Medicare, and/or raise their premiums,” adds Schiller.      

Adds well-known Rhode Island Political Strategist, Rob Horowitz, “As a group, seniors vote more regularly than any other age group. In the 2020 presidential election, for example, more than 3-in-4 people eligible voters between the ages of 65 to 74 voted as compared to about 2-in-4 eligible voters between the ages of 18 to 24. Since Rhode Island has an older population, seniors are a key group in pretty much every state and local election.  Winning campaigns in Rhode Island and throughout the nation devote time and advertising dollars to reaching seniors.”

According to Bob Weiner, former chief of staff director of the House Select Committee on Aging under Florida Congressman Claude Pepper and former spokesman for both the Clinton and Bush White Houses, no one can forget the clout of older voters because they are the most motivated demographic group to vote. “They can’t be broken out by political parties as people expect,” observes Weiner, noting that it is a very close 50-50 split vote. “Older voters vote Democratic and Republican; the Democrats must do more to capture the senior vote.  It’s close. In 2020, while Joe Biden won the popular vote by 7 million, Donald Trump won the senior vote 52% to 47%. It’s not a matter of party. Seniors’ quality of life is not political,” he says.

“But on the issues, they will tear apart a candidate who doesn’t support Social Security, Medicare and the rights of seniors to have continued employment and privileges in society,” Weiner notes.

“So, anybody who thinks they can get away with some horrible position, such as cutting back Social Security or Medicare in five years or utilizing the myth that Social Security is in deficit crisis, they can’t  because it has a 2 trillion surplus resulting from Claude Pepper negotiations to keep the program fully solvent through 2034,” Weiner says, noting that it only needs a “little repair” to keep it going.    

“Anybody who thinks that they are going to use Social Security and seniors to fund other federal government operations is badly mistaken,” says Weiner. “When President Bush wanted to privatize Medicare and Social Security and made a campaign out of that he actually helped lose congressional seats in an off-year election,” said Weiner, warning political candidates to think twice when thinking about balancing the federal budget on the backs of the nation’s elderly. 

“Voting Gives You Power”

“In Rhode Island and across the country, the data clearly show that voters aged 50+ will be the deciders in the 2022 elections,” said AARP Rhode Island State Director Catherine Taylor. “We are working with dozens of advocacy volunteers who are fighting for voters 50+ to make their voices heard on the issues that matter – especially in Rhode Island where we are in the midst of a housing crisis, nursing homes are in jeopardy, the cost of long-term care is skyrocketing and where people want leaders who are committed to making local communities more livable.

“At the federal level, older voters want to know candidates’ positions on protecting and strengthening the Social Security benefits Americans have paid into and earned through years of hard work, protecting and improving Medicare benefits, lowering prescription drug prices, and supporting family caregivers who risk their careers and financial futures to care for parents, spouses, and other loved ones,” Taylor said.

“Voting gives you the power to decide what our future looks like,” she continued “But you have to be in the know to vote. AARP Rhode Island has collected the most up-to-date election information, including key dates and deadlines, to make sure that the voices of voters 50+ are heard. We are doing everything we can to make sure older Rhode Islanders are prepared to vote and know the safe and secure voting options included in the new, AARP Rhode Island-backed Let RI Vote Act. In mid-August, we will offer a Video Voter Guide posted along with all the latest election information at aarp.org/RIvotes,” Taylor said.

Co-sponsoring this event is a broad coalition of 18 service providers and advocates: 

A Community Together, Alzheimer’s Association of RI, Carelink, Community Partners Network of RI, Economic Progress Institute, Leading Age RI, NAACP Providence Branch, Ocean State Center for Independent Living, PACE, Progreso Latino, RI Assisted Living Association, RI Elder Info, RI Health Care Association, RI Organizing Project, RI Senior Centers Directors Association, SEIU Healthcare 1199, Senior Agenda Coalition of RI and Village Common of RI.

in the high school’s new 900-seat capacity auditorium. 

To read AARP web blog articles discussing the impact of senior voters at the polls, go to: 

www.aarp.org/politics-society/government-elections/info-2022/older-voters-midterm-issues.html

www.aarp.org/content/dam/aarp/research/surveys_statistics/politics/2022/aarp-targeted-congressional-districts-survey-voters-18-older.doi.10.26419-2Fres.00550.033.pdf

https://press.aarp.org/2022-4-6-Women-Voters-Age-50-Over-Will-Decide-Balance-Power-Next-Election

HHS Climate and Health Outlook tackles climate-related hazards

Published in RINews Today on July 25, 2022

Over two and a half months ago, the Biden administration launched a new initiative, called the Climate and Health Outlook, to serve as a resource to help people, health professionals, and communities protect individual and community health impacted by climate events.

On May 6, 2022, the U.S. Department of Health and Human Services’ (HHS) Office of Climate Change and Health Equity (OCCHE) launched the first installment of its new public information series called the Climate Health Outlook – https://www.hhs.gov/sites/default/files/climate-health-outlook-may-2022.pdf (Outlook). HHS’s new Outlook series connects weather forecasts to health resources to create actionable data they say will saves lives and reduces illness and health risks associated with climate-related hazards like extreme heat, wildfires, hurricanes, droughts, and vector-borne diseases that impact human health.

According to HHS, this inaugural edition of the Outlook will take on extreme heat, which has been a key target of the Biden administration’s efforts to build resilience to the impacts of climate change. As part of this and future editions, the Outlook series will add a health lens to seasonal weather and climate outlooks from the National Oceanic and Atmospheric Administration (NOAA) to inform health professionals and the public about weather- and climate-related health risks months in advance and provide resources to prepare.

“We’ve seen what exposure to extreme heat can do,” said HHS Secretary Xavier Becerra in a statement announcing the new federal initiative. “It can lead to illness and death and makes it much harder to do a day’s work outdoors. Many people in the United States have jobs that require them to work outside to feed their families regardless of the weather. Our new Climate and Health Outlook protects people and their health by giving advance notice to the communities that will be most impacted in the coming months.” she said.

“Our communities across the country will soon be facing heatwaves that will be an additional strain on our health systems,” adds  Assistant Secretary for Health Admiral Rachel Levine. “This information will save lives when used by public health officials, employers with outdoor workers, and schools and local health departments and the individuals they serve. Having information in advance can reduce illness and deaths from extreme heat exposure,” she says.

The Outlook illustrates where the greatest health risks from heat will be in the United States during the early 2022 heat season, presenting estimates of which U.S. counties are expected to experience extremely hot days and identifies the vulnerable populations in those counties that could be impacted by heat exposure. It also provides a set of actionable resources from HHS that are targeted to the public, specific populations, health care professionals, and public health officials to reduce health risks from heat.

HHS says that the Outlook will be updated and improved regularly as future data and feedback are collected. Future editions will address other climate-related threats to the health of people living in the United States, with a focus on those most vulnerable. For a copy of  HHS’s Office of Climate Change and Health Equity’s May issue of Climate and Health Outlook: Extreme Heat, go  to https://www.hhs.gov/sites/default/files/climate-health-outlook-may-2022.pdf.

On a Personal Note… Surviving the Dog Days of Summer

Just days ago, Rhode Island officials announced its first heat wave  It took 3 days of 90 degrees or above to make this call. 

Despite the fact that 618 people throughout the nation killed by extreme heat annually, according to the U.S. Centers for Disease Control and Prevention (CDC), says heat-related deaths and illnesses are preventable.  

The following tips provided by CDC’s website provide sound tips for helping us stay safe when the temperatures soar.

During an ongoing heat wave, seniors, infants and young children, and people with mental illness, those overweight, and chronic diseases (including heart disease) are at the highest risk of heat-induced illness that can cause a person to become confused or lose consciousness. Seek medical attention immediately for anyone showing signs of heat stroke. Heat stroke can be life-threatening.

With temperatures rising, wear appropriate clothing that is lightweight, light-colored and loose fitting. 

During extreme heat and humidity, stay in your air-conditioned house or air-conditioned room, if you have that option. Electric fans may provide temporary comfort, but when the outside temperature soars into the high 90s, they won’t prevent heat-related illnesses. Try taking a cool shower or bath. 

Keep in mind: Use your stove and oven less during the heatwave to reduce the inside temperature. Try traveling to an air-conditioned place like a shopping mall, movie theatre, or even go to your local library or cooling shelter? Each city and town, or one nearby, should have cooling centers open. In Providence pools and splash pads have extended hours. For a listing of cooling shelters by city and town, go to https://riema.ri.gov/planning-mitigation/resources-businesses/cooling-centers  (If you need additional assistance call 2-1-1). Even being in a cool space for just a few hours can help your body stay cooler when you have to go back outside.

During a heatwave, go to your local gym to exercise so you can limit your outdoor activities. If you go outside, do this in the morning or evening hours when it’s cool. Start your working or exercise slowly and slowly pick up the pace. If the heat makes your heart pound and you gasp for breath, stop all activity. Go immediately to a shady area especially if you become lightheaded, confused, weak or faint, to cool off, this will allow your body to recover from the heat. Drink water.

Sunburn can affect your body’s ability to cool down and can make you dehydrated. So, when going outside, wear a wide-brimmed hat, sunglasses, and put on sunscreen of SPF 15 (“broad spectrum” or “UVA/UVB protection”) or higher 30 minutes before going outside.  Continue to reapply it according to the package directions. 

Hot heavy meals can heat up your body. When going outside drink plenty of fluids, regardless of how active you are.  Don’t wait until you’re thirsty to drink. Most important, if your doctor limits the amount you drink or has you on water pills, ask how much you should drink while the weather is hot.

Also, stay away from very sugary or alcoholic drinks because they cause you to lose more body fluid. You might consider avoiding cold drinks, because they can cause stomach cramps. Room temperature water is better now.

Finally, heavy sweating removes salt and minerals from your body, and they need to be replaced.  A sports drink can replace the salt and minerals you lose when sweating. If you are on a low-salt diet, have diabetes, high blood pressure, or other chronic conditions, always talk with your doctor before drinking a sports beverage or taking salt tablets. 

Do not leave children or your pets in cars that can quickly heat up to dangerously high temperatures even with a window cracked open. You put them at risk of getting heat stroke or dying. If you leave your pets outside, leave them plenty of water and in a shaded area. Watch metal pieces in your car, like seatbelts, which can heat up to unbelievably high – and even burning to the skin – temperatures.

During a heat wave, always visit or get in touch with older adults (family or friends) at risk at least twice a day and closely watch them for signs of heat exhaustion or heat stroke. Infants and young children, of course, need much more frequent watching.

For CDC’s website page on “Extreme Heat” go to https://www.cdc.gov/disasters/extremeheat/.

For warning signs and symptoms of heat-related illness and what to do, go  to https://www.cdc.gov/disasters/extremeheat/warning.html.