Monthly Archives for September 2023

Increased funding must be tied to nursing home mandated minimum staffing

Published in RINewToday on Sept 25, 2023

The Centers for Medicare and Medicaid Services (CMS) issued a proposed rule to establish comprehensive staffing requirements for nursing homes—including, for the first time, national minimum nurse staffing standards. The proposed rule seeks to would ratchet up the quality of care in the nation’s 18,700 skilled nursing facilities, delivering care to 1.2 million residents each day.

“Establishing minimum staffing standards for nursing homes will improve resident safety and promote high-quality care so residents and their families can have peace of mind,” said HHS Secretary Xavier Becerra in comments on Sept. 1, 2023. “When facilities are understaffed, residents suffer. They might be unable to use the bathroom, shower, maintain hygiene, change clothes, get out of bed, or have someone respond to their call for assistance. Comprehensive staffing reforms can improve working conditions, leading to higher wages and better retention for this dedicated workforce,” says Becerra.

The Nuts and Bolts of CMS’s proposed ruling

Under CMS’s proposal, nursing homes participating in Medicare and Medicaid would be required to meet specific nurse staffing levels that promote safe, high-quality care for residents. Nursing homes would need to provide residents with a minimum of 0.55 hours of care from a registered nurse per resident, per day, and 2.45 hours of care from a nurse’s aide per resident, per day, exceeding existing standards in nearly all states. CMS estimates approximately 75% of nursing homes would have to strengthen staffing in their facilities. As the long-term care sector continues to recover from the COVID-19 pandemic, the proposed standards take into consideration local realities in rural and underserved communities through staggered implementation and exemptions processes.

In addition, nursing homes would also be required to ensure a registered nurse is on site 24 hours a day, 7 days per week, and to complete robust facility assessments on staffing needs. Facilities would continue to be required to provide staffing that meets the needs of the individual residents they serve, which may require higher levels of staffing above the proposed minimum standards.  

CMS also proposed to require states to collect and report on compensation for workers as a percentage of Medicaid payments for those working in nursing homes and intermediate care facilities. These policies build on CMS’ recent proposals to support compensation for direct care workers in home and community based settings and to publish Medicaid data on average hourly pay rates for home care workers. This enhanced transparency will aid efforts to support and stabilize the long-term care workforce across settings strengthening access to high-quality long-term care both at home, in the community as well as in nursing homes and other facilities.

Attracting and supporting Nursing Home staff

Additionally, CMS announced a national campaign to support staffing in nursing homes. As part of the HHS Workforce Initiative, CMS will work with the Health Resources and Services Administration and other partners to make it easier for individuals to enter careers in nursing homes, investing over $75 million in financial incentives, such as scholarships and tuition reimbursement. This staffing campaign builds on other actions by HHS and the Department of Labor to build the nursing workforce.

More than 500,000 direct care workers provide care in nursing homes, assisting residents with daily tasks, such as bathing, dressing, mobility, and eating. This work, often performed primarily by women of color, is significantly undervalued. Direct care workers across long-term care settings earn low wages, rarely receive health and retirement benefits, and experience high injury rates. Improving working conditions and wages will lead to improvements in the recruitment and retention of direct care workers and enable nursing staff to provide safer care.  

CMS and the HHS Office of the Inspector General called for increased transparency and enhance enforcement of existing standards. This would result from increased audits of nursing homes’ staff, improving nursing  home inspections, oversight as to how nursing homes spend taxpayer dollars and cracking down on prescribing inappropriate antipsychotic drug prescribing practices.  The proposed rule would also undertake new efforts to improve resident safety during emergencies. 

Mandating more staffing during a severe labor shortage – pushback on an unfunded mandate

“It is unfathomable that the Biden administration is proceeding with this federal staffing mandate proposal. Especially when just days ago, we learned that CMS’ own study found that there is no single staffing level that would guarantee quality care, says Mark Parkinson, President and CEO of the American Health Care Association, a national nursing home trade group representing 14,000 nursing homes and other long-term care facilities across the nation taking care of five million residents each year.

“At the very same time, nursing homes are facing the worst labor shortage in our sector’s history, and seniors’ access to care is under threat. This unfunded mandate, which will cost billions of dollars each year, will worsen this growing crisis, warns Parkinson, noting that the proposed rule requires nursing homes to hire tens of thousands of nurses that are simply not there and then penalizes the facilities and threatens to displace hundreds of thousands of residents.

“Already, hundreds of nursing homes across the U.S. have closed because of a lack of workers,” states Parkinson. 

​John E. Gage, President, and CEO of the Rhode Island Health Care Association, with offices in Warwick, agrees with Parkinson’s assessment of the harm such proposals will trigger and its devastating impact on nursing homes and residents. “The federal staffing proposal is unfunded and is being implemented at a time when additional staff is simply not available,” he said.  

According to Gage, six Rhode Island-based facilities have closed since the beginning of the pandemic in March 2020. Three others are currently in receivership. Arbitrary federal staffing mandates will result in more closures, and residents will be displaced from their homes just as they were most recently when Charlesgate Nursing Center in Providence was forced to close because of skyrocketing costs, a scarcity of staff and chronically inadequate Medicaid funding. 

Unintended consequences of mandating minimum staffing

James Nyberg, president, and CEO of LeadingAge Rhode Island, with offices in East Providence, views see a staffing ratio mandate as a blunt enforcement instrument that does not consider the numerous challenges facing providers, including Medicaid underfunding, lack of workforce, and the diversity of resident needs. Moreover, the imposition of severe financial penalties on homes that are unable to meet a staffing ratio is counterproductive: fines siphon off scarce resources that providers need as they seek to address their workforce and resident care needs,” he says. 

“Our state’s experience illustrates the numerous challenges and unintended consequences of a staffing ratio mandate: the severity of fines, how compliance is measured and calculated, compliance costs, backlogs of people in hospitals waiting for skilled nursing care after admissions have been reduced due to a lack of staff and other access-related issues,” notes Nyberg, noting that even those homes that are currently able to comply with the staffing ratio are doing so at an unsustainable cost. 

While Kathleen Heren, executive director of the Alliance for Better Long-Term Care and the state’s Long-Term Care Ombudsman, supports HHS’s minimum staffing standard, the administration must adequately fund to train recruited workers and to pay a livable wage to retain them. “Rhode Island doesn’t have an issue with its nursing home inspection process as other states do, she says, noting that newly hired RI Department of Health surveyors are “doing a great job.” 

“RIDOH surveyors only cite facilities, when necessary,” says Heren, noting that administrators can challenge any cited deficiency if they view it as unfair, and she doesn’t see a problem in the use of antipsychotic medications in Rhode Island facilities “but acknowledges that there’s always room for improvement.”

Direct Caregivers, mainly women, undervalued despite significant work demands

“Almost 80 percent of nursing home care is paid for with government programs (Medicare and Medicaid), so it is hugely important that those dollars provide quality care,” says Maureen Maigret, chairperson of the aging in community subcommittee for the Long Term Care Coordinating Council.  She noted that studies show a clear relationship between staff levels and quality care but there is tremendous variation across the states in hours of direct care staff provided in nursing homes. 

“Rhode Island has required 24/7 RN staffing for many years and a 2021 state law requires minimum direct care staffing levels although implementation has been challenging due to the critical workforce shortage. Importantly, the proposed federal regulation would require states to report on compensation for workers as a percentage of Medicaid payments. For too long our direct care workers, mostly women, have been undervalued despite the significant demands of their work. It is time for them to receive a living wage and  shedding light on where our Medicaid dollars are going will help advocate for better wages helping to recruit and retain these essential workers,”  she says.

There will be a 60-day comment period for the notice of proposed rulemaking, and comments must be submitted to the Federal Register no later than November 6, 2023.  

For a copy of the federal register detailing CMS’s proposed rules on minimum staffing issued on Sept. 6, 2023, go to 

https://www.govinfo.gov/content/pkg/FR-2023-09-06/pdf/2023-18781.pd

For a copy of a CMS Fact Sheet on CMS’s proposed rules on minimum staffing, go to https://www.cms.gov/newsroom/fact-sheets/medicare-and-medicaid-programs-minimum-staffing-standards-long-term-care-facilities-and-medicaid

The Village helps grandparent/kinship caregivers in need

Published in RINewsToday on September 18, 2023

When we dream about our retirement years, these dreams most likely don’t include images of diapers, children’s tantrums, and school buses. However, for some grandparents and other kinship caregivers, their later years include these images, as they become primary caregivers for their grandchildren/kin children.

Nationally, more than 2.5 million children are being raised in kinship families which includes grandparents, other extended family members, or anyone with an existing relationship with the child or family. When these children cannot be with their parents, the next best thing is being placed with kin.

There are many benefits to staying with kin rather than being placed into the state’s foster care system. These can include experiencing less trauma; increased stability, higher rates of permanency; better behavioral and mental health outcomes; more feelings of belonging and being accepted, increased likelihood of living with or staying connected to their siblings, and a greater sense of cultural identity and connections to family.  

Additionally, kinship caregivers save the U.S economy approximately $ 6 billion dollars per year by keeping children out of formal foster care. Across the nation, there is a growing recognition of the importance and value of kinship caregivers. However, all of this comes at a physical, mental and financial cost to the kinship

The challenges of being a kinship caregiver

A new research study, Caregiver Profile: A Closer Look at Grandparents Caring for Grandchildren, by the National Rehabilitation Research and Training Center on Family Support (NCFS) at the University of Pittsburg, grandparent caregivers are experiencing a litany of adverse effects causing them to become a particularly vulnerable group. Grandparents are facing a higher rate of disability, lower employment, and a greater likelihood of poverty, says the study’s findings. One quarter of grandparents raising grandchildren live below the poverty line.

“Many challenges exist for grandparent and kin caregivers of children when it comes to navigating the legal and custody landscape while supporting their own needs, from physical and mental health to financial and employment security. We think this data [detailed in the 16 page report released in Sept. 2023] showcases the need to move forward on the recommendations developed by the Advisory Council to Support Grandparents Raising Grandchildren (SGRG) and the Recognize, Assist, Include, Support, and Engage (RAISE) Act Family, Caregiving Advisory Council that can help to support grandparent and kin caregivers,” said Meredith Hughes, JD, MPH, Senior Policy Analyst at University of Pittsburgh Health Policy Institute and Assistant Professor in the School of Public Health.”

 It is important to provide supportive services for grandparents raising grandchildren as many of these caregivers lack the necessary resources to fully support the children in their care. Support in areas such as kinship navigator programs that provide a single-entry point for learning about housing, health services, and financial and legal assistance, along with improved household resources and access to mental health services are needed. Rhode Island has a kinship navigator program for families involved with the department, but currently one does not exist for those who are not involved.  For every family involved with the Rhode Island Department of Children, Youth & Families, (DCYF), there are 5 who are not.

Grandparenting in the Ocean State

cording to the U.S. Census bureau, over 13,968 children are living with and being raised by their grandparents in Rhode Island, who make up the largest percentage of relative caregivers. Some kin families are involved with the child welfare system when children have to be removed from their home on an emergency basis. Rhode Island is one of the leading states in the nation in finding and placing children with kin. The state’s long-held philosophy is that children do better by living with kin. Of all the children in the state’s foster care system, around 70% are placed with kin.

For families involved with the DCYF, (known as “formal” kin caregivers) while it can be a distressing experience, they do gain access to needed resources and services, as well as receive monthly stipends and other supports to care for the children. For families who have private arrangements and are not involved with DCYF (“informal” caregivers), finding those resources and services can be challenging. Many if not most of kinship families are not involved with the child welfare system and have no idea that there are any resources. Finding and supporting those families has become one mission of the Cranston-based The Village for RI Foster and Adoptive Families (The Village) and the Warwick-based Hispanic Foster and Adoptive Parents Organization of Rhode Island (The Heart Tree).

The Village, established in 2016 by a group of five foster and adoptive families, provides peer support to all RI foster, adoptive and kin families. The Village provides support through peer mentoring, peer-led support groups and family events, as well as running a “Closet” where families both donate and receive material things such as clothing, toys, diapers etc. The Heart Tree, a sister organization, also provides those same supports in a culturally appropriate manner to our Spanish speaking families. The Heart Tree was established in 2021 to meet the unique needs of Spanish speaking foster, adoptive and kin families.

Sixty-three-year-old Laurie Tapozada is a kinship caregiver who sees the value of the assistance provided by the The Village in raising her 8-year-old grandson. “When it first happened and I was suddenly raising a baby at age 55, I didn’t know one single other family like mine, she said.

“My life was turned on its head, I was struggling to manage my hectic work schedule with a baby and dealing with all sorts of messy and painful family dynamics that come with being a kinship caregiver,” says Tapozada.

According to Tapozada, she had to re-educate herself as to how to safely raise a baby without getting support from family and friends who thought she was “crazy” for taking this on. It was overwhelming and distressing until she received a call from a friend who suggested that she “call the Village and they will understand.”  From that point Tapozada has become actively involved in the kinship community and network, “It been a life changer for me,” she says.

Although Rhode Island is recognized as a leader in ensuring that children removed from homes are placed with kin, increasing support for kin families is a pressing need.  In 2022, the Rhode Island Office of Healthy Aging awarded a grant (through funding from the U.S. Administration for Community Living overseen by the U.S. Department of Health and Human Services) to the Village and the Heart Tree, to identify informal kin families and help connect them to existing resources, and to the growing kinship caregiver community. 

RIOHA’s grant also funded a multi-faceted effort, in person and online activities, and incorporating traditional print, broadcast, digital and social media communication and training.  Throughout the year, exhibit tables were placed at family events, informational meetings and festivals to get the word out about available resource for kindship caregivers. This grant also created a statewide website where these individuals could go and learn more about resources, as well as find out what is happening in the kin community. This website is www.kinshipcommunityconnections.org.

Project Director Shannon Dos Santos, of the Village, sees the value and positive impact of this grant on Rhode Island’s kinship caregiver families. “I have seen the joy on the faces of many Kinship Caregivers aged 55 and over and their families over the last fifteen months as a result of this grant,” she says, noting that reaching out to this population and getting them to engage has been a challenge. “But when they do – it is beautiful to watch.”

According to Dos Santos, many just feel isolated, overwhelmed and alone. “This grant has allowed us to focus on community outreach and engagement as well as provided us with opportunities to enhance what we at the Village do so well – peer support and family activities!  “It has been a blessing to watch these families come together at these events, form relationships with others in  similar situations and feel safe sharing their experiences,” she says.  

The Village’s Chairman of the Board, Sue Babin, who is also full-time employee and a kinship caregiver, too, added, “This exciting grant initiative has provided The Village with an opportunity to continue to do what we do best… peer outreach and support from people with lived experiences.” And, while RI OHA’s grant ends this month, additional funding will extend the program for 12 months, she says.

For info about The Village for RI Foster & Adoptive Families (The Village), go to https://www.rivillage.org/. Or call (401) 481-5483.

For info about Hispanic Foster and Adoptive Parents Organization of Rhode Island (The Heart Tree), go to https://sites.google.com/view/thehearttree/homeinicio?authuser=1.  Or Call (401) 306-9652.

For info about Kinship Community Connections, go to https://kinshipcommunityconnections.org/

WPRI 12’ s Rhode Island Video on Foster Care Month, go to https://www.youtube.com/watch?v=AhI206EXBfQ.

For a copy of the recently released research study, Caregiver Profile: A Closer Look at Grandparents Caring for Grandchildren, by NCFS at the University of Pittsburg, go to

https://www.caregiving.pitt.edu/caregiver-profile-closer-look-grandparents-caring-grandchildren

Age Wave study sees shift in how nation perceives aging

Published in RINewsToday on September 11, 2023

“Old Age” enters a new age.  That’s how Age Wave sees it after releasing its new Harris Poll results, revealing that the graying of America is shifting how the nation views growing old and its perception on longevity, health, retirement and sense of purpose.  

“Everywhere we turn in American culture today, we see signs that we’ve entered a new age of aging. Bruce Springsteen is selling out concerts at the age of 73; Martha Stewart is a Sports Illustrated Swimsuit cover model at 81; Warren Buffet continues to dispense financial wisdom at 92. “Old age isn’t what it used to be” has become a familiar refrain,” says Age Wave’s statement released in April 2023, announcing the study’s results. 

“This is the first study of its kind. There have been many studies about aging and longevity. We at Age Wave have conducted dozens of them in the United States and all over the world, but never one quite like this. For The New Age of Aging study, we cooked up a series of questions we thought would yield very unusual and provocative answers, and we were not disappointed,” says Ken Dychtwald, Ph.D., CEO of Age Wave, a California-based think tank focusing on the lifestyle, marketing, healthcare, economic, leisure, workforce, and political implications of the age wave.  He is also the author of 19 books including his new memoir Radical Curiosity: My Ride on the Age Wave.

A new aging normal

The Age Wave study, The New Age of Aging, found that 79% of adults aged 50 and over think today’s older adults are far more active, and 58% say they are more open-minded and curious compared with the previous generation.

The study’s findings reveal that the nation’s definition of what’s considered to be “old” is also dramatically changing. While age 60 was considered “old” in their grandparents’ day, now age 80 is the median age considered to be “old” today, the report’s authors researchers say, noting that with these changes, vocabulary is starting to shift, too.  “Sixty-nine percent of U.S adults aged 50 and over find the term “longevity” more appealing to use than the term “aging. the survey found.  

Eighty three percent of the respondents say it’s more important for them to feel “useful” and have a continued sense of purpose than striving for being “youthful” in their retirement years. 

Life lessons are the most importance legacy we can leave before our passing, say the study report’s authors. “The study shows that 65% of adults 50+ think that values and life lessons are the most important thing to pass onto their heirs and loved ones. Only 22% said financial assets and/or real estate were the most important. 

According to the report’s authors, with longevity, “anxiety plummets while happiness soars.” The study’s findings indicate that today’s older adults feel happier, freer, and less anxiety-ridden than younger generations. And they aren’t looking back, reflecting on the good old times.  Seventy one percent say the best time of their lives is right now or in front of them, the findings indicate.

Today’s definition of “retirement” is also changing with the nation’s shift in the perception of growing old and the long-held cultural beliefs and social norms as how they are supposed to look and act. The study found that 97% of adults over age 65 agreed that it’s important to stay curious and be willing to learn new things throughout life’s later years. Similarly, 66% of Americans aged 50 and over see retirement as a new chapter in life, while only 16% say it’s principally a time for rest and relaxation. 

Retirement is not just sitting on a rocking chair or taking trips. With increasing longevity and the nation’s changing views of retirement, 59% of pre-retirees and retirees say they want to work in some form in retirement, say the researchers, noting that employee benefits like flex-work, remote-work, sabbaticals, and paid leave can help retain these older workers. 

 Reflections on Age Wave’s new study

“Aging has finally come of age,” said Dychtwald. Workplaces, homes, medical systems, transportation, shopping centers, lifelong education, digital technology, and social media must all adapt to meet the demographic realities of this new age of aging,” he says.

Dychtwald sees a changing media’s marketing message is reflecting the nation’s changing perception of growing older.

In the 1990s, a client, Lou Gerstner, CEO of American Express, asked to see “all of the great 50+ oriented TV ads” being shown at that time. “Amazingly, on all of television, there were only four ads that featured anyone over 50. There was Mr. Whipple, who squeezed toilet paper in the supermarket. There was a gal named Clara Peller who was in a Wendy’s ad yelling, “Where’s the beef?” There was Mrs. Olson from Folgers Coffee. And then there’s our friend Wilford Brimley, who became the spokesperson for Quaker Oats,” remarked Dychtwald.  

“Look at ads today and we see not only diversity, equity, and inclusion in terms of people’s racial and ethnic backgrounds, but also in terms of age and generations. We see multigenerational families. We see older people and younger people together. There’s no question that we’re entering what we set out to study—a new age of aging,” he says.

Dychtwald observes that a few powerful global forces are converging to create a new age of aging.  “We had a bit of a backslide during COVID, but we are still living far longer than humans have ever lived before. “Throughout 99 % human history, the average life expectancy was under 18 years. At the start of the 20th Century, life expectancy in the U.S. was 47 years. Today it’s around 77, says the Age Wave Study.  

However, the study also notes that for decades while lifespans have been extended, a person’s health span (i.e., the years of dependable good health) have not kept up, remaining at an age of 66 years. Americans will spend a median of 12 years living with a disability or serious disease. Looking globally, the U.S. ranks #1 in healthcare expenditures per capita but only #68 in healthy life expectancy.

Dychtwald calls for an integrated health care system. “If you’re the 60, or 70, or 80, or 90-year-old wandering through the health care system, it’s confusing. It’s like a bowl of spaghetti. You might have three doctors who don’t talk to each other, and you might have lots of different medications. And nobody’s ever really studied if you should be taking all those medications at the same time, what’s called polypharmacy.

Further, it can be difficult knowing how to access a particular health care system, particularly if you’re of lower income or perhaps English is your second language. Or you may live in a rural community where health care is not easily accessible. That’s simply not fair. We ought to be able to create healthy longevity for everyone, he says.

The second global force that’s helping to create this new age of aging is declining fertility, notes Dychtwald. “There’s not one country in Europe that’s having enough kids to replace themselves. We’re near replacement level in the U.S., which is 2.1 kids per family. But that’s not enough for young people to balance out older people in our population,” he adds.

“Over the next 30 years, our 65 and over population is going to grow by 53%. The third global force that comes into play is younger generations replacing our new older population. “It’s not our grandmas or grandpas who are becoming the older people of today and tomorrow. It’s the Baby Boomers and Gen Xers who have a big appetite for trying new things, and who think of this as a “third age” of life. It’s not necessarily a time to wind down, but maybe a time to try new things, to go back to school, to fall in love again. It’s a time to volunteer or get involved with your church or mosque or synagogue, or maybe to make new friends and maybe even make new friends across generations,” he says.

Capability Vs. Age in choosing political leaders

While Age Wave’s study didn’t gauge the older respondents views as to how they felt about older political leaders, Dychtwald has his personal views.  Political leaders should be chosen because of their capacity to make decisions as well as their intelligence and decency as human beings., he says. “They may be 30, they may be 50, they may be 80. We’ve somehow turned a lot of our political races into a WrestleMania competition, where we make fun of people if they’re too short or if they move too slowly—if, they have extra body weight or they’re at a certain age,” he says.

“I think what’s more important is capability than age. But it is true that older people are more and more present in the political arena and running for or holding very high-level offices. And there’s some worry about that,” he says, asking these questions: “What happens if they stumble and fall? What happens if they have cognitive impairment? What happens if they don’t make the right decision?”

On behalf of Age Wave, the Harris Poll conducted an online, nationally representative survey among 2,054 U.S. adults ages 18+, including 934 adults ages 50+ from June 6-8, 2023. Results were weighted to bring them into line with their actual proportions in the population.

For a copy of Age Wave’s study report, The New Age of Aging, go to https://agewave.com/wp-content/uploads/2023/08/08-07-23-Age-Wave-The-New-Age-of-Aging-Report_FINAL.pdf.

To know more about Age Wave’s reports, studies, and polls and Ken Dychtwald’s new book Radical Curiosity: My Life on the Age Wave, go to: https://.AgeWave.com