Monthly Archives for February 2002

Staffing Crisis Hits Nation’s Nursing Facilities

Published in the Pawtucket Times on February 25, 2002

A yet-to-be released federal report paints a very bleak picture about the quality of care provided in the nation’s nursing facilities.

According to an article published last week by The New York Times, a draft federal report finds that 90 percent of the nation’s nursing facilities do not have enough nursing staff to properly care for their residents.

Simply, put, the lack of staffing reduces the quality of care provided in nursing facilities, increasing the incidence of bedsores, falls, malnutrition, weight loss, urinary tract infections and blood-borne infections, the report notes.

According to the draft report, which was ordered by Congress, is expected to be officially released by the U.S. Department of Health and Human Services in April, reaching appropriate staffing in nursing facilities would cost the federal government big bucks.

With a $ 7.6 billion annual price tag, about an 8 percent increase over current expenditures – the report – entitled “Appropriateness of Minimum Nurse Staffing Ratios in Nursing Homes” – recommends cheaper ways to fix the staffing crunch in the nation’s facilities.

Rather than regulate minimum ratios of nursing staff to residents, the report calls for better management techniques and training of certified nursing aides CNAs) to increase staff productivity and to decrease CNA turnover. Additionally, market demand sparked by an informed public that has access to publicly reported nursing staff data may even increase nurse staffing levels in facilities, the report notes.

The New York Times article does not get to the root of the nation’s staffing problems in nursing facilities, charges Al Santos, executive director of the Rhode Island Health Care Association, the state’s largest trade group that represents nursing facility providers.

“While the article only focused on the inadequacies of staffing levels across the country, it failed to report on its cause – a lack of adequate government reimbursement for nursing facility care,” Santos said.

Santos stated the federal report, which is detailed in the New York Times, is correct in its assessment that the shortage is “likely to become worse.

It should come as no surprise to policymakers that in order to increase wages and to make frontline nursing jobs competitive. Medicaid can no longer pay roughly $ 4 per hour, per patient for shelter, meals, labor costs, special care, certain therapies and other items,” Santos adds. “Costs far outweigh government reimbursements for patient care, and chronic under-funding of Medicaid directly impacts staffing.”

There is no doubt in my mind that the lack of adequate staff in facilities create poor quality of care,” says Roberta Hawkins, executive director of the Alliance for Better Long-Term Care, who also serves as the state’s ombudsman on nursing facility issues. Hawkins said she fears that the continuing staff shortage in Rhode Island facilities will chip away the past 25 years of improved resident care that has resulted from state and federal nursing facility reforms.

Although inadequate pay and benefits are obstacles to retaining staff, Hawkins predicts that it will become even more difficult to recruit CNAs when more horror stories about poor care appear in local newspapers or on state or federal agency websites.

“As a society, all of us are responsible for the care not being provided to nursing facility residents. If we don’t provide that money to pay for the best of care, we are partially responsible for that care not being provided,” Hawkins said.

Hawkins sees as permanent fix to this ongoing staffing shortage found in Rhode Island facilities – tie the reimbursement rate to the level of resident care provided. For instance, facilities with heavy-care residents would receive a higher Medicaid reimbursement rate, which takes into account the increased staffing needs of those residents.

But adequate Medicaid funding is not the only solution to the continuing staff shortage dilemma facilities face, Hawkins warned.

“We need to create upward mobility in nursing jobs, improve training specialty care provided to Alzheimer’s residents, bedridden residents and to those requiring rehabilitation,” she said.

The new federal study doesn’t surprise Lt. Gov. Charles J. Fogarty, who chairs the state’s Long-Term Care Coordinating Council (LTCCC) and to those involved in providing or regulating nursing facility care in the Ocean State.

Just last year, a statewide LTCCC study found Rhode Island’s nursing facilities reported a shortage of certified nursing assistants, the staff who provide 90 percent of the direct care to residents.

“The report gives us useful information to look at the issue of staffing and quality in Rhode Island nursing facilities,” Fogarty said. “It also should serve as a clear signal to Congress that it must do a better job of planning and funding long-term care.”

A state commission chaired by Human Services Director Jane Haywood, is currently studying how the existing Medicaid reimbursement system can be improved.

Even with a mounting state budget deficit, it is now time for the governor, state lawmakers and state officials to put the energy and resources into tackling this ongoing staff shortage issue.

With major input from the nursing facility industry and from Hawkins and her resident advocates, Haywood’s final blueprint for changes in the state’s Medicaid program must be taken seriously. With a state election looming in November, candidates running for governor, the Rhode Island General Assembly and Congress must do their homework, study the staffing crisis in the state’s nursing facilities, and develop their positions to confront this pressing policy issue.

More than 10,000 nursing facility residents and their families pray that the report to be issued by the Department of Human Services will not end up in some back office on a dusty shelf.

Aging Programs Get Slashed in Bush’s War Budget

Published in Pawtucket Times on February 18, 2002

In the shadow of the horrific terrorist attacks on Sept. 11th, domestic programs take the backseat in President Bush’s $ 2.13 trillion fiscal year 2003 budget, released in early February, with significant funding increases being targeted for both military and  homeland defense.

As 77 million baby boomers approach their 65th birthdays within the next decade, aging groups say the President’s wartime budget does not go far enough in many areas to meet the aging baby boomer’s needs in the coming years.

One of the most hotly debated Congressional issues is affordable prescription drugs. With the Congressional election looming next year, this is certain to be a key issue in every state. Don’t look for this issue to lose importance to seniors or to the aging groups who call for meaningful Medicare drug benefits.

According to the Congressional Budget Office, over the next 10 years, Medicare beneficiaries will spend about $1.6 trillion out-of-pocket on prescription drugs. But the recently released Bush budget proposal only contains $ 190 billion over 10 years for Medicare reform, including $ 77 billion to assist seniors with prescription drugs.

The National Council on Aging (NCOA), a Washington, D.C.-based advocacy group, estimates that on average, the Bush administration’s proposal would cover less than one out of 10 dollars spend on drugs by seniors.

Martha A. McSteen, president of the National Committee to Preserve Social Security and Medicare, agreed that Bush’s budget proposal shortchanges seniors and the disabled in providing needed health care and services.

In his State of the Union address, the president restated his campaign promise to provide prescription drug coverage for every senior, noted McSteen, who added, “That is an empty promise if the budget does not contain these needed resources.

“At least $ 450 billion is needed over the next 10 years to provide a comprehensive and affordable prescription drug benefit as part of the Medicare program,” McSteen says.

John Rother, AARP’s Policy and Strategy Director, said, “Although federal budget constraints are greater than last year, so too is the need for affordable prescription drugs for Americans age 65 and over. Unfortunately, disease and pain did not disappear with the budget surplus.”

However, U.S. Sen. Lincoln Chafee, R-Rhode Island, said he believes the President’s budget request recognizes the precarious state of the Medicare system, as well as other challenges faced by the nation’s seniors.

“The president has acknowledged the need for a Medicare prescription drug benefit as well as [the need] for a significant increase in funding for disease research conducted by the National Institutes of Health,” he said.

While Chafee said he will push for legislation that will create more comprehensive Medicare prescription drug benefits than the legislation proposed by the president, he warned the deficit created by the combination of the economic slowdown, the war on terrorism and last year’s tax cut will make enactment of any new spending programs more difficult to accomplish.

Meanwhile, programs under the Older Americans Act, are provided with less funding in Bush’s budget proposal than they were last year.

“Around the country, people are on waiting lists for meals-on-wheels programs and congregate meals programs,” said McSteen.

“There are state and local programs that need additional federal funds to counter the increasing problems of elder abuse. The administration’s funding request for these programs is woefully inadequate.”

Other federal programs get sliced and diced under the Bush administration’s FY 2003 budget, according to U.S. Rep. Patrick Kennedy, D-Rhode Island, who pointed to an 8 percent cut for the Centers for Disease Control and Prevention’s budget for chronic care.

The four-term Congressman and member of the House Aging Caucus said he finds this cut troubling due to the significant gains that have been made in efforts to prevent and treat diseases that effect an aging population.

With a growing number of families caring or loved ones with Alzheimer’s Disease, Kennedy said he strongly opposes the Bush administration’s axing of the Missing Alzheimer’s Disease Patient Alert Program, which helps protect and locate missing patients with the devastating disease.

The program has assisted in the return of more that 5,700 wanderers and increased its data base to 67,000 persons with Alzheimer’s,” said Kennedy. “It has succeeded in its many efforts on a budget of $ 898,000 in fiscal year 2002.”

While prescription drugs comes up a loser in the Bush budget, some aging initiatives are clearly on the White House’s radar screen.

Bush’s budget proposal provides about $ 3 billion in additional funds toward research and is the final installment in a five-year effort to double the size of the National Institute of Health budget, says McSteen. She said she believes increased federal funding would assist in “producing breakthroughs in the prevention, treatment, management of conditions associated with aging.”

The Administration’s budget also provides a personal exemption to home caretakers of family members and the funding of respite and direct care worker demonstration projects.

Now Bush’s Budget proposal moves to Congress, where a Republican-controlled House and Democratic Senate will make major revisions, ultimately hammering out a final road map to federal spending.

The funding of federal programs to meet the needs of older Americans is crucial as our nation’s population ages.

Furthermore, with an increasing federal budget deficit, Republican and Democratic lawmakers must not get tied down to partisan wrangling as they attempt to iron out differences in creating a Medicare benefit to make prescription rugs more affordable to seniors.

As the Congressional elections get closer, seniors will call for concrete legislative action, not political rhetoric or fancy words.

AARP Sets Up Shop Here in Rhode Island

Published in Pawtucket Times on February 11, 2002

Up until last year, the American Association of Retired Persons operated a regional office in Boston, just a 45-minute drive from the Ocean State. The closing of the Boston regional office cleared the way for the nation’s largest group serving people ages 50-plus to open up a state office in Rhode Island.

With a state office up and running, AARP will better serve its 17 Rhode Island chapters, whose membership now totals more than 129,000 persons.

With AARP’s new office at 10  Orms St., Providence, Rhode Island has become one of the last remaining offices to open a local office.

“We’re happy as quahogs in our new digs.” This quote, superimposed on dozens of quahogs, decorates the front cover of AARP’s open house invitation.

The design sets the stage for last week’s Ocean State bash to celebrate the opening of AARP’s plush 4,200-square-foot Providence office. The opening reception, featuring a sampling of Rhode Island delicacies from each region of the state, reinforced the point AARP was trying to make – that its new home is Rhode Island.

One hundred and fifty people came to AARP Rhode Island’s grand opening bash, including AARP chapter presidents and volunteers, elected state officials and lawmakers, staff from the state’s various Congressional delegation and representatives of a myriad of aging organizations.

For more than two hours, they mingled and enjoyed the plentiful food and drink whipped up and served by Eastside Catering. Many even took tours of the new office, as well.

“Having an office in our capital city sends a message to our members and community partners that we are raising the visibility of AARP in Rhode Island and intend to rev up our advocacy and educational initiatives throughout the state,” said State AARP Director Kathleen S. Connell, welcoming the crowd of well-wishers.

Providence Mayor Vincent “Buddy” Cianci brought his official greets to AARP’s gathering, too.

“It’s cause for great celebration that we now have direct representation in Providence of one of the most effective and beneficial associations advocating for retired persons in the world today,” Cianci told the crowd gathered in the packed conference room.

Cianci can be a tough act to follow, but AARP National Board Member Virginia Tierney, held her own.

Tierney, who came from Quincy, Mass. To attend the festivities, gave her thumbs up to the office’s opening.

“Having a state office will speak to an ongoing priority for our organization -diversity,’ she said, noting that with offices in every state, the group can better position itself to reach people ages 50-plus from all walks of life. “AARP’s membership should mirror the rest of our population.”

With the conclusion of AARP’s 20-minute speaking program, a 6-foot ribbon held by AARP staffers was cut by Cianci, who  was surrounded by Tierney, Secretary of State Ed Inman, General Treasurer Paul Tavares, and acting State President Virgilio DeVecchis.

So, what’s so special about AARP’s new “digs?”

AARP’s new office, right across from the Providence Marriott Hotel, has a very large conference room with video tele-conferencing capabilities. This room, is large enough to fit  30 people around a large rectangular conference table. Got room for an educational program or large meeting?  No problem. The space allows for the setting up of 100 chairs theater-style.

Meanwhile, a smaller conference room provides ample space to meet in small groups. Additionally, another small room is equipped with multiple phone hookups to allow AARP staffers and volunteers to use in their advocacy efforts and for compiling information through phone surveys. AARP’s four staffers each have an office with one office available for use by visiting AARP Regional and National Staff.

AARP’s office is colorfully decorated. Wall-to-wall mulberry-colored carpet, dark stained wood along the grayish walls, a teal-colored sofa and chairs in the reception area and heavy dark-stained office furniture throughout the office to create a traditional, conservative look.

Colorful prints provided by the Rhode Island School of Design’s Museum of Arts adorn the grayish walls in the front office area.

“Great turnover,” said AARP volunteer Marie Kerr of Middletown.  The former school nurse and teacher states that AARP members now have a home to come to. “It’s a good location, too, for statewide meetings,” she says.

Volunteer Mary Garrett, a former special education teacher from Newport, adds that the new office is a great place for AARP Members to gather with peers.