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.

New resources to protect Seniors before, during and after Natural Disasters

Published in RINewsToday on July 18, 2022

Just last year alone, the Washington, DC-based AARP noted that the nation experienced more than 1,300 tornadoes, 21 named storms (with winds of 39 mph or greater), nearly 59,000 wildfires that burned more than 7.13 million acres, along with numerous ice storms and other weather events that caused major damage and fatalities. With hurricane season now approaching, AARP teamed up with the U.S. Federal Emergency Management Agency (FEMA), announcing the release of new resources specifically designed to help local and state officials and Emergency Management Agency (EMA) officials protect seniors in their communities.

“By 2034, adults ages 65 and over will outnumber those under 18 in the United States for the first time. This has profound implications during natural disasters and extreme weather events,” said Nancy LeaMond, Executive Vice President and Chief Advocacy & Engagement Officer at AARP, in a statement announcing the released resources. “State and local leaders and emergency officials must be better equipped and prepared to ensure that older adults are kept safe and their needs are met when a disaster strikes,” warns LeaMond.

The 9-page, Guide to Expanding Mitigation: Making the Connection to Older Adults, released by FEMA, highlights how natural hazards uniquely affect seniors and provides specific remedies as to how local mitigation and emergency planners can include seniors in community efforts to lower their risks.

Throughout its 44 pages, the AARP Disaster Resilience Took Kit features strategies to help local, state and community leaders and aging advocates reduce the risk and impact of disasters on older persons. 

The guide and tool kit are the result of a multi-year collaboration between AARP and FEMA to identify and provide resources, spark ideas and encourage organizations to better engage older Americans in disaster mitigation, preparedness, response and recovery operations. This long-term, strategic alliance aims to advance accessible, safe and livable communities for people of all ages, says AARP.

“Adults aged 65 and older are a growing demographic who are often disproportionately impacted by severe weather. These disparities can be compounded by other factors, such as low-income or chronic illness, producing inequitable results for this vulnerable population when it comes to disaster preparedness,” said FEMA Administrator Deanne Criswell in a statement. 

“Effective mitigation planning requires that we consider the needs of all populations, and FEMA’s partnership with AARP on these guides will help community planners ensure our older communities are more resilient in the face of hurricanes and other natural disaster,” she said.

According to AARP, a growing body of evidence compiled shows that seniors are disproportionately impacted by the types of weather-related emergencies and natural disasters that are becoming increasingly frequent and severe. Individuals who have chronic illnesses, functional limitations or disabilities are especially vulnerable, as evidenced by the impact of the global COVID-19 pandemic on seniors.  Not only are older people at a higher risk of death from infectious diseases and disasters, but the long-term effects on those who survive often undermine their physical and mental health, economic security and overall well-being.

Although many communities support older adults in preparation for disasters, expanded mitigation planning can help reduce the loss of life and property by minimizing the impact of disasters before they happen, says AARP, noting that mitigation actions and strategies that make cities, towns and neighborhoods safer for older adults can benefit all residents and increase community resilience overall.

Protecting Seniors from Natural Disasters in the Ocean State

“One standout recommendation from the AARP/FEMA report was the adoption of more resilient and efficient building and land use standards, including the consideration of hazards in siting senior living facilities,” says RI Lieutenant Governor Sabina Matos, who oversees the Emergency Management Advisory Council that reviews information and programs regarding emergency management and makes recommendations to the Governor on these issues.

“One of my highest priorities is the creation of more affordable housing of every kind, and we have to walk the line of growing not only quickly, but thoughtfully. As we consider how to use this budget’s $250 million investment in housing, we want to ensure that new developments meet FEMA standards and will keep Rhode Islanders safe. We’re already working with local communities’ EMA departments to review their community disaster preparedness plans, as well as their applications for FEMA Hazard Mitigation Grants — funding to help implement exactly the strategies outlined in this report,” she says.

“One omission that stands out to me is resources for unhoused seniors. According to the Rhode Island Coalition to End Homelessness’s 2021 State of Homelessness report, over 500 Rhode Islanders aged 55 or older experienced homelessness over the course of a year. We need to strongly consider what kinds of hazard mitigation strategies could help this uniquely vulnerable population. Additionally, Rhode Island must especially focus on preparing sustainable mitigation and response systems that account for the effect of climate change on our coastal communities, which we know have large senior populations and will become increasingly vulnerable to flooding,” says Matos.

”FEMA has provided a very valuable tool with the Guide to Expanding Mitigation – Making the Connection to Older Adults guide. At the Rhode Island Emergency Management Agency,  we work with our local emergency managers, non-profits (Rhode Island Community Food Bank, Red Cross of Rhode Island, United Way and more) and other state agencies including the Department of Health and the Office of Healthy Aging to ensure older Rhode Islanders have the resources they need when disaster strikes. These reports will help us in our efforts to continue to support individuals in this vulnerable group,” says Director Marc Pappas, of the Rhode Island Emergency Management Agency.

“Preparedness is a core function of public health. This is especially true when it comes to climate change and older adults. As these resources highlight, it is critical that the unique needs of older adults are considered when planning for weather-related emergencies and natural disasters. This is already a priority for us at the Rhode Island Department of Health when it comes to emergency preparedness, and it will continue to be a focus,” says Joseph Wendelken, Public Relation Officer for the Rhode Island Department of Health.

“Before, during and after a natural disaster, the safety and wellbeing of older Rhode Islanders must always be a top concern,” said AARP Rhode Island State Director Catherine Taylor

“Emergency planners and managers at the state and especially local levels, along with first responders and many others, play a critical role in reducing anxiety and any subsequent harm when disaster strikes. Whether it’s a hurricane, flooding, extreme heat or infectious disease, ongoing planning and the coordination of all available resources is necessary to minimize consequences,” says Taylor.

“The AARP/FEMA guide and toolkit can go a long way towards mitigating deaths and long-term impacts among Rhode Island’s most vulnerable citizens. We encourage all leaders involved in Rhode Island public safety and public health to take advantage of this new resource. There are many aspects of age-friendly, livable communities – resilience in the face of disaster is chief among them,” Taylor adds.

AARP Rhode Island Volunteer State President Marcus Mitchell has firsthand disaster management experience. “As a former Division Commander with the US Coast Guard Auxiliary and Community Emergency Response Team Instructor for Providence Emergency Management Agency, I am actively involved with emergency & disaster mitigation, response and recovery efforts that dramatically and profoundly impact our older population physically, emotionally and financially,” he said. 

“Not only are seniors often hit first and hardest but their families are deeply affected as well,” Mitchell added. “We hope to save lives throughout the community, mitigate damages and reduce injury by vigorously distributing the new guide and toolkit to our members and the community at large.”

West Warwick resident Vincent Marzullo gives a thumbs up to AARP/FEMA’s released resources, saying that their information will be extremely valuable to the State and local EMA officials charged with protecting the state’s aging and vulnerable population during natural disasters. “Several barriers prevent older adults from evacuating when needed. Many older adults cannot drive and do not have access to reliable, accessible public transportation, depend on home-based medical equipment, require specialized accessibility supports, or cannot bring pets when evacuating. Some older adults are caregivers to spouses or partners with one or more vulnerabilities that may also hinder their ability to take timely action and remain safe, says Marzullo, who served for 31 years as a federal civil rights & social justice director for the Corporation for National & Community Service and a Federal Disaster Cadre Coordinator for the National Service Agency.

“State and local EMA officials must regularly outreach to the older Rhode Islander on the Rhode Island Department of Health’s “Special Needs Emergency Registry” to check their status/needs, especially individuals who are isolated and immobile.  There are approximately 15,000 individuals with chronic illnesses that have opted-in to the registry in order to be checked in times of emergency/disasters.  These older adults are vulnerable and need periodic support,” says Marzullo.

Marzullo calls for on-going disaster resilience webinars to be available to better prepare State and local EMA officials and organizations to respond to sudden natural disasters.  Targeted organizations might include the Red Cross, AARP RI, Senior Agenda Coalition of RI, Senior Center Directors Association, AARP members, RIElder Info, 211/The Point, and the Emergency Management Advisory Council (EMAC).

Melissa Carden, RIEMA’s Chief Public Affairs Officer says while winter storms, hurricanes and flooding are most common in the Ocean State, expect climate change to have a profound effect on the weather, including more storms and greater precipitation. “This fuels other extreme weather events like flooding (coastal and inland – remember the flooding in RI in 2010). Although scientists are uncertain whether climate change will lead to an increase in the number of hurricanes, there is more confidence that warmer ocean temperatures and higher sea levels are expected to increase their intensity and impacts.”

 To view and download the Guide to Expanding Mitigation: Making the Connection to Older Adults, visit  https://www.fema.gov/sites/default/files/documents/fema_mitigation-guide_older-

adults.pdf

To download a PDF of the AARP Disaster Resilience Tool Kit, featuring strategies to help local, state and community leaders and advocates reduce the risk and impacts of disasters on older adults, go to  https://www.aarp.org/content/dam/aarp/livable-communities/tool-kits-resources/2022/AARP%20Disaster%20Resilience%20Tool%20Kit-singles-060122-.pdf

The following (free) Livable Publication booklets and guides, go to https://www.aarp.org/livable-communities/tool-kits-resources/livable-publications-order-form/https://www.homecareassistancerhodeisland.com/

Lawmakers can do more for Seniors next year

Published in RINewstoday on July 11, 2022

Just days before July 1, 2022, Gov. Dan McKee was joined for the signing of the $13.6 billion state budget (2022-H7123aa) for fiscal year 2023 by Lt. Gov. Sabina Matos, House Speaker K. Joseph Shekarchi, Senate President Dominick J. Ruggerio, House Finance Committee Chairman Marvin L. Abney and Senate Finance Committee Chairman Ryan W. Pearson.

Taking a Look at the Budget’s Dollars and Cents

Let us take a look as ho the state’s FY2023 budget, signed by McKee on June 27, 2022, impacts older Rhode Islanders.

The budget doubled the funding for the Livable Homes Modification Program, from $500,000 to $1 million, which reimburses half the total retrofit costs, up to $4,000, to support home modifications and accessibility enhancements to allow individuals to remain in community settings. The increase is intended to address an anticipated surge in applications.

For retirees, the Assembly raised from $15,000 to $20,000 the amount of annual pension income that is exempt from state taxation.

The FY 2023 Budget also allocated an additional  $200,000 to the Office of Healthy Aging’s budget for senior centers, bringing total funding to $1 million. That is a 25% increase.

The budget also makes significant investments in the quality of healthcare for seniors, providing rate increases to many kinds of providers of health care, nursing homes, home and community-based services for elderly (increase in starting pay to $15 hour), in addition to seeking a study by the Office of the Health Insurance Commissioner on appropriate reimbursement rate levels into the future.  The budget also includes substantial increase to reimbursement rates for Meals on Wheel meals ($400,000), ensuring that the program is able to provide high-quality therapeutic and culturally appropriate meals to participants.

Lawmakers also added $4 million to increase the “circuit breaker” tax credit available to qualifying elderly and disabled residents, raising the maximum credit from about $400 to $600 beginning in tax year 2022 and indexing that amount to inflation. They also made credit available to more Rhode Islanders by increasing the income threshold for eligibility from $30,000 to $ 35,000.

Those with military pensions will no longer have to pay any income taxes on them, beginning in the 2023 tax year. The governor had proposed phasing out military pension taxation over five years, but legislators instead made them tax-free in their entirety in one year.

Lawmakers also kept the Governor’s plan to invest $168 million in upgrades to Eleanor Slater Hospital, including $108 million to construct a new long-term care acute care hospital at the Zambarano campus in Burrillville.

The plan accelerates the six-year phase-out of Rhode Island’s motor vehicle excise tax, eliminating what would have been the final year of the tax next year.  The amended budget provides replacement license plates for free.

The state budget included a year-long pilot program to provide free service on the Rhode Island Public Transit Authority’s business route, the “R” line that runs from Pawtucket to Cranston.

It also added $11.5 million general revenue funds to launch a retail Supplemental Nutrition Assistance Program (SNAP) pilot program, beginning Jan. 1, 2023.  Eligible households would receive an incentive payment of 50-cents for every dollar spent on fruits and vegetables, subject to limits.  The state also requested a waiver from the Federal Nutrition Service to streamline the application process for elderly and disabled individuals seeking assistance from the SNAP program.

Lawmakers also allocated $10 million for rebalancing the state’s long-term care continuum, for funding home care agency workforce recruitment, retention and training.  Also, money in Rhode Island’s new budget includes $8.1 million to increase Medicaid Dental rates to increase access to dental services for older adults.

Finally, lawmakers kept in the $250 million total from the American Rescue Plan Act (ARPA) federal funds in the approved budget to address state’s affordable housing crisis.

Taking a peek at new state laws

The Rhode Island General Assembly passed H-7942/S-2623 which increases access and utilization of Accessory Dwelling Units (ADUs) and provides age-friendly housing options for older adults, family caregivers, and people of all ages and abilities.

McKee also signed the Let RI Vote Act into law. This new law makes voting safer, easier, and more accessible for all Rhode Islanders. Some of the major provisions of the bill include no-excuse mail ballots and emergency voting; online mail ballot applications; permanent absentee list opt-in for nursing home residents; no witness or notary requirement to vote by mail;  multilingual voter information hotline, community ballot; and voter registration list maintenance.

A new law also seeks to develop broadband in Rhode Island by creating a Broadband Advisory Committee. It’s director will be responsible for connecting with federal agencies to access funds for broadband infrastructure deployment pursuant to federal grants, facilitating broadband service adoptions, expanding digital literacy for residents (especially seniors), experiencing economic hardship, and for future economic development.

Following the passage of S-2228, the definition of an elderly person in regard to exploitation has changed from someone 65-years-old to someone who is 60 years old, making the definition of an elderly person consistent with state law.

Finally, the proposed Perry Sullivan one-year exemption has been eliminated. This preserves $38.6 million for home and community-based services for 2023.

Gearing up for next year’s legislative session

“Despite the lack of passage of H-7616 sponsored by Rep. Lauren Carson to elevate the Rhode Island Office of Healthy Aging to full Department status, I’m confident that it will be reintroduced early in 2023. I also anticipate broad community conversations to fine tune the design and identify the needed resources,” says Vin Marzullo, a well-known aging advocate who served as a federal civil rights and national service administrator.

“AARP Rhode Island worked hard on Smith Hill during the 2022 legislative session to achieve a number of important wins for the age 50 and over Rhode Islanders,” stated Catherine Taylor, AARP Rhode Island State Director. “We will find it easier to vote, have access to more housing options and assistance for accessibility modifications, see our direct care workforce better paid and better trained, and so much more. And, as always, AARP Rhode Island is committed to ensuring that those age 50 and our families know about these changes and how they will improve our lives,” she says.

 “Although there was some very good news for seniors coming out of the 2022 legislative session, overall, the results were modest when we think about the projected growth of our older population, that 42% of older Rhode Island households have income less than $ 40,000 and that our Office of Healthy Aging is under resourced. So much advocacy work remains,” warns Maureen Maigret, chair of the Aging in Community Subcommittee of the Long-Term Care Coordinating Council and Policy Advisor for the Senior Agenda of Rhode Island, representing 21 organizations to mobilize people to enhance the quality of life of older Rhode Islanders.

However, Maigret sees a big win in the state budget language calling for rate review for state contracted providers as far too many services important for all ages have become so difficult to access due to poor payment rates to providers for many years. One example is that dental rates under Medicaid have not increased since the early 1990’s so older adults have had an extraordinarily hard time getting detail care, she says.

“Another big win that the Senior Agenda worked tirelessly for was removing the suspension of the $38.6 millions of “Perry-Sullivan” funds for FY 2023 that was in Gov. McKee’s proposal,” says Maigret.

However, Maigret expressed disappointment that the state’s budget only calls for minimum wage for home care direct care staff of $15 per hour. “Advocates tried to get this up to at least $17 to address the homecare workforce crisis that leaves some seniors waiting months for service,” she says.

According to Maigret, other items that will help older adults and persons with disabilities with rising housing costs are the expansion of the Property Tax Relief program sponsored by Rep. Ruggiero and Sen. Coyle.

“While we are appreciative overall for the gains that have been made for Rhode Island’s seniors in this legislative session, it is just a start toward what our state needs to do to meet the needs of our aging population,” says Bernie Beaudreau, Executive Director of Senior Agenda Coalition of Rhode Island. “I am disappointed that the minimum wage of $15 per hour was set so low.  This wage level will not do much to attract workers and solve the severe workforce shortages that home care agencies are facing. We also have to be vigilant about the administration of this new law as we have already seen a draft regulation suggesting that $15 will be the “average wage,” not the “minimum wage” of home care workers.