Author Archives for Herb Weiss

Statehouse Rally Calls for Passage of Nursing Home Payment Reforms

Published in Pawtucket Times on June 9, 2003

In the final days of this year’s legislative session, the Coalition to Ensure Funding for Quality Long-Term Care rallied its troops at the Statehouse rotunda to push for the passage of two legislative proposals that would fix an ailing Medicaid reimbursement system.

The goal of last Wednesday’s rally was to keep the Coalition’s two legislative proposals on the radar map of the Rhode Island General Assembly, which has been bogged down with a multitude of heated legislative issues – separation of powers , fire code changes, smoking bans in restaurants to name a few.

Even with an expected $ 225 million budget deficit for fiscal year 2004, the long-term care advocates, including provider groups, consumer advocates, state policy makers and legislators, urged lawmakers to pay a fair Medicaid rate for nursing facilities, required by state and federal law to provide quality of care to 9,000-plus vulnerable Rhode Island seniors who need intensive, 24-hour-a-day care.

Rally supporters gave a thumbs-up to two legislative proposals ( H 5803/ S 0899). The companion bills, if enacted would revise the state’s Principles of address the inadequate funding of the state’s nursing facilities.

The two legislative proposals, still in the House and Senate Financial Committee, reflected the findings of an 18-month study of B.D.O. Seidman, a consulting firm hired by the state Department of Human Resources to re view and recommend fixes to the state’s flawed reimbursement system.

A major finding of this state-financed study found that the state was underpaying facilities in excess of $ 29 million annually.

These bills call for an additional $ 14 million to state funding for Medicaid reimbursement to nursing facilities. With the infusion of state dollars, the federal government would then kick in $ 16 million for a total increase of $ 30 million.

Eighty percent of the state’s nursing facility residents rely on the Medicaid program to pay for their care, John Gage, administrator of the Coventry-based Riverview Health Care Community and a Coalition member, told those who intended the rally.

Many facilities are left struggling to remain open because Medicaid does not pay for the actual cost of care, he said, noting a number of Ocean State nursing facilities have already filed for bankruptcy of receivership, and some are even closing their doors.

An inadequate reimbursement rate continues to fuel Rhode Island’s critical nursing shortage, too, said Gage. Due to the current  reimbursement system, facilities are hard-pressed to come up with the necessary funds for increases in salaries and benefits to retain nursing staff.

Lt. Gov. Charles Fogarty, who chairs the state’s Long-Term Care Coordinating Council, warned the crowd that Rhode Island’s nursing home industry “is on verge of a meltdown.”

He- along with Sen. Stephen D. Alves (D-West Warwick) and Rep. Steven M. Costantino (D-Providence), sponsors of the Coalition’s nursing home payment reform bills – urged Gov. Donald Carcieri and House and Senate leaders to include funding in the fiscal year 2004 budget to begin the steps needed for Medicaid reform.

Throughout the afternoon rally, until 6:00 p.ml, the Coalition gathered hundreds of signatures to support efforts to increased Medicaid reimbursement to nursing facilities.

Meanwhile, posters strategy placed outside the House and Senate chambers illustrated the rally supporters point that the state is not paying enough for care  of family members in nursing facilities.

At one poster site, piles of dirt were placed on a 6-foot table.  A  poster said: “Did you know this mulch topsoil costs more than $ 5.63 – that’s more than the Medicaid system’s pay for an hour’s worth of nursing facility care for your loved one.  Isn’t your grandmother’s care worth more than the cost of a pile of dirt.”

In a previous All About Seniors column, this writer called for lawmakers to fix the state’s flawed Medicaid reimbursement system once and for all.

The legislative session will soon be ending, and immediate action must be taken now by lawmakers to pass the Coalition’s two legislative proposal, with Gov. Carcieri hopefully signing the bills into laws.

State policy makers must no longer use a Band-Aid approach to fix  broken Medicaid payment system, especially with the graying of the Ocean State’s population. A growing number of Rhode Islanders will soon require this level of intensive care.

It’s time for lawmakers to ratchet up the Medicaid rates to pay for actual costs of care, allowing facilities to deliver quality services.

Better Understanding of Strokes Can Help Seniors Protect Their Health

Published in Pawtucket Times on May 19, 2003

Even if Americans know about the negative impact of their lifestyle choices, that knowledge may not be enough to change their behaviors, especially those behaviors that lead to strokes.

According to a new survey released by the National Council on Aging (NCOA), Americans understand that those who have had a stroke are at a greater risk for a future one, ye stroke survivors are not taking all the possible steps to protect their health.

Strokes can result from a sudden interruption of blood flow to any part of the brain, which can ultimately injure or kill brain tissue.

Strokes can lead to severe impairments, including debilitation from paralysis, short-term memory loss and even speech and vision problems. About one-third of all strokes are recurrent, even though there are lifestyle changes and medications available today that can help to reduce that risk.

In this telephone survey, which was funded by a grant from Sanofi=Synthelabo and Bristol-Myers Squibb, 66 percent of the survey respondents said they knew someone who had suffered a stroke, but many of those who survived were not exercising regularly (32 percent), refraining from smoking (19 percent) or watching their diet (18 percent). These simple lifestyle changes are known to help prevent future strokes.

“Those who have already had a stroke can make changes to their everyday routines  to lower their risk for a second stroke or heart attack,” Mark Alberts, M.D., professor of neurology, at Northwestern University Medial School in Chicago, stated in a NCOA release.

“It is particularly important that stroke survivors and their families or caregivers work closely with their physicians to develop an individualized treatment plan, which will often include medication,”  says Alberts.

Along with the basic lifestyle changes, taking appropriate medications can also reduce the risk of recurrent strokes.

For instance, the researchers say many patients may benefit from antiplatelet therapy that prevents blood platelets from sticking together and clotting, helping to reduce stroke risks.

According to the NCOA study, after surviving a stroke, men have a 42 percent chance of having another within five years, and women a 24 percent chance during that same time period.

The general public seems to be confused regarding what stroke risks factors and symptoms are, the researchers found.

The NCOA survey findings indicate that many Americans incorrectly identified excessive stress (87 percent), overexertion while exercising (56 percent), dehydration (38 percent), asthma attacks (24 percent) and wearing constrictive clothing (16 percent) as risks factors for stroke.

Additionally, survey respondents also mistakenly selected shortness of breath (53 percent) and heart palpitations (50 percent) as stroke symptoms. Nearly two-thirds of those surveyed failed to recognize that age increases stroke risk, especially for those over age 65.

Although seniors are at the greatest risk of having a stroke, they seem to show little concern, researchers noted. While two-thirds of all strokes occur among those ages 65 and older, only 12 percent of those surveyed in that age group noted they are more concerned about suffering a stroke, given other choices like Alzheimer’s disease and diabetes.

A whopping 70 percent of the olde respondents told researchers they never talked to their doctors about stroke risk.

”For older Americans, strokes pose a significant health risk so it is alarming to us that so few seniors have discussed their personal risk for stroke with their doctors,” said James P. Firman. NCOA’s president and CEO. “Better education is clearly needed to help all Americans understand their risks of stroke to protect their health.”

Robert Marshall, Ph.D., who serves as assistant director of health at the state Department of Health, gave All About Seniors his thoughts about the NCOA research study.

He said strokes are the number-three killer in Rhode Island – in 2000, 964 Rhode Islanders age 50 and over died of stroke.

“We call these preventable deaths’ because we know that by reducing risk, such as smoking, obesity, lack of exercise, uncontrolled high blood pressure, many  people can avoid death and disability from stroke, adds Marshall.

“It is unfortunate, but not surprising, that so many strokes are recurrent,” said Marshall. “Human nature being what it is, many people find it difficult to change the behaviors that got them into trouble in the first place- things like smoking and lack of exercise,” he notes.

“We all need to do a better job supporting stroke survivors and helping them use the experience as a springboard to a longer healthier and happier life,” Marshall added.

Older Rhode Islanders can easily take charge of reducing their chances of having a stroke or a recurrent stroke.  Positive lifestyle changes (e.g., more exercise, a better diet, giving up cigarettes, and taking prescribed medications are key lifestyle changes to protecting your health.

Lawmakers to Consider Funding for Vaccine Immunizations for Seniors

Published in Pawtucket Times on May 12, 2003

Even with a state budget deficit looming, sometimes putting a little money into a statewide initiative can ultimately save big dollars.  It’s just the right thing to do.

For the second year, the Ocean State Adult Immunization Coalition (OSAIC) has approached the Rhode Island General Assembly for funding to promote the group’s efforts to get the word out about the importance of Rhode Island seniors  getting influenza and pneumococcal vaccinations.

OSAIC’s message is quite simple: “Avoid a Hospital Stay: Get Your Flu Shot Now!”

According to OSAIC, pneumonia and influenza deaths together are considered the six-leading cause of death in the nation.

Since 1999, there have been 300 deaths and 6,800 hospitalizations that were attributed to influenza and pneumococcal disease in the Ocean State.

OSAIC said vaccinations are a cost-effective way to prevent these unnecessary hospitalizations and deaths.

OSAIC, a coalition of 40 agencies, including hospitals, nursing facilities, vaccine manufacturers, medical societies, managed care groups, the Rhode Island Department of Health, Rhode Island Quality Partners, the Visiting Nurses Association, and Blue Cross Blue Shield of Rhode Island, call on Gov. Don Carcieri and lawmakers to see the big picture – preventative medicine care can ultimately save tax dollars.

Anne Marie Beadsworth, OSAIC’s chair, said the cost of a flu shot is $ 15 and a pneumonia shot is $ 30.

On the other hand, she added that the average length of stay for an older person with influenza is five days, costing $ 12,000.

Since OSAIC was established in 1997, Beadsworth has seen a steady progress in the coalition’s efforts to get more older Rhode Islanders immunized to prevent the influenza and pneumonia.

“The immunization coverage rates for those age 65 and over has increased by eight precent (from 67 percent to 75 percent) for influenza vaccine and 24 percent (from 43 percent to 67 percent) for pneumococcal vaccine,” she noted.

Beadsworth said OSAIC is working to reach the Healthy People 2010 goal of a 90 percent immunization rate for influenza and pneumococcal  for people age 65 and over.

“Through promotional efforts in five languages in 2002, more than 350 flu clinics were conducted throughout Rhode Island with the guarantee that any person age 65 and older, regardless of insurance status, could get a flu shot without any out-of-pocket expenses,” she said.

Furthermore, OSAIC’s gains have propelled the Rhode Island-based initiative into top 10 standings in the United States, says Beadsworth.

“We rank number seven for both flu and pneumococcal vaccination rates,” she added.

Beadsworth said that during last year’s legislative session, OSAIC’s efforts for the state funding fizzled because of state funding fizzled because of state budget cuts. The coalition was just not effective in getting its message out to lawmakers, she added.

During this year’s legislative session, OSAIC is pushing for $ 103,169 in new funding in Fiscal Year 2003-2004 to expand the coalition’s educational outreach efforts and to hire a part-time staffer to oversee its ongoing programs to improve the state’s immunization rates.

Currently, OSAIC is a volunteer-driven organization with its $ 50,000 working budget coming from member organizations and from the community.

It seems things may be different this year at the Rhode Island General Assembly. Support among lawmakers is growing for OSAIC’s ongoing preventative medicine initiatives.

“Quite a few advocates are coming to the Senate asking for funding,” said Sen. Stephen D. Alves (D-West Warwick), who said there is now growing support for OSAIC’s funding request.

Alves, who serves as chair in the Senate Finance Committee, told All About Seniors the funding request will be brought up during the chamber’s budget debates.

“Everyday, we talk about preventative medicine – funding this program is a step in the right direction,” said Alves.

Rep. Steven M. Costantino (D-Providence), who sits on the House Finance Committee, told me he sees the value of OSAIC’s efforts, too, and plans to call for funding OSAIC’s initiative during House budget deliberations.

Health Director Patricia A. Nolan also sees the positive benefits of OSAIC’s prevention campaign.

“Adults need their shots, too – especially people aged 50 and older or people with chronic health conditions. Vaccinations are one of the easiest and most effective ways to stay healthy,” she says.

As state revenue estimators meet to determine the breath and scope of the state’s budget deficit, Gov. Carcieri’s staff continue their ‘Big Audit” to identify ways to save taxpayer dollars.

When the dust settles, even with a projected budget deficit, it may be time for the governor and the General Assembly to view preventative medicine as a worthy cost containment approach for reining in skyrocketing health care costs. Even though state dollars have to be allocated up front, large savings might be realized down the road.

As the state’s final budget is being crated, we must not be “penny wise but pound foolish” when determining what bills live or die in the 2004 legislation hopper. Taxpayers will ultimately lose if this happens.