Author Archives for Herb Weiss

Hail Mary PR Effort Puts Spotlight on Inadequate RI Nursing Home Medicaid Plan

Published in RINewsToday on December 4, 2023

Last week, a campaign by Linn Health & Rehabilitation told of its efforts to keep its doors open.  With no immediate state reimbursement fix in sight, the nonprofit nursing home, established 52 years ago, launched a savvy PR move, calling it a “Hail Mary” effort to find its Christmas miracle donors and funding to prevent it from closing or forcing the displacement of 71 residents and the laying off of 150 staff members. A clever twist on the message resulted in a story on Rhode Island television stations, talk radio, and pick up by other media outlets.

For over 10 years, Linn Health, which had only recently been named a 2024 “Best Nursing Home” and “High-Performing” short-term rehabilitation home in the nation by U.S. News & World Report, has been fighting rampant inflation, rising food and utility costs, high temporary staffing agency rates, and low state Medicaid reimbursement rates that haven’t kept pace with increasing expenses – as most nursing homes have been as well. 

Linn Health & Rehabilitation is currently losing $100,000 a month, notes Richard Gamache, MS, FACHCA, chief executive officer of Aldersbridge Communities which is the nonprofit that operates the nursing facility, senior housing, affordable assisted living, and outpatient rehab for older Rhode Islanders.

“For years, we’ve operated with a slight loss, but the other Aldersbridge entities were able to subsidize that loss.  As a mission-driven provider for low-income people and those on Medicaid, we aren’t here to make money, we’re here to serve our community’s needs,” he says, noting that the gap between the facility’s costs and its daily Medicaid rate is now just too great.

“Bleeding Cash” drastically impacts facility’s bottom line

Gamache noted that Aldersbridge Communities had been able to support its nursing home but it has now reached a “tipping point.”  During COVID the federal and state governments were very generous with grants. “That’s no longer an option, and the money is running out quickly,” he says.

“We’re in dire straits, financially,” admits the seasoned CEO, who has been in the long-term care field for over 43 years.  “We’re struggling.  We have some vendors who understand and are being patient with us, and others who tack on charges if we don’t pay on  time,” he says.

“Eighty-two percent of our residents are on Medicaid and don’t have families who can take care of them. We are their family and support system, and some have been discharged from other assisted living communities because they ran out of money,” he says. 

In recent months, Gamache reports he has meet with peers, East Providence lawmakers, state officials, and even nursing facility trade groups seeking a viable solution to the state’s Medicaid reimbursement issues. “I have proposed options such as bridge funding and higher Medicaid reimbursement rates, as many other states have done, to address this nationwide problem. It seems only nursing home residents, their families, employees, leaders of surviving homes that are hanging by their fingernails, and some advocacy groups care about the financial predicament we are in. We’ve made everyone aware and we will not stop fighting for funding that we need,” he says.  

According to Jamie L. Sanford, LNHA, LCSW, administrator of Linn Health & Rehabilitation, since 2022, six nursing homes in Rhode Island have shut their doors permanently, not counting the four that closed prior to the COVID-19 pandemic. Three more have filed for bankruptcy, she says, noting that many nursing homes throughout the nation are in the same financial predicament. 

“Linn’s Medicaid reimbursement rate averages $255 per patient per day, and it costs $411 to care for each patient per day,” states Sanford. “The general population thinks that nursing homes make a lot of money. Perhaps that’s true in some for-profit organizations where they are owned by large corporations, but nonprofit homes are robbing Peter to pay Paul. These are the homes – like us – that are on life support, operationally speaking,” she notes.

Joseph Wendelken of the RI Department of Health says that the state is attempting to ease the financial burden of facilities providing care to Rhode Island nursing facility residents. “Nursing homes in Rhode Island received an increase in Medicaid reimbursement rates on October 1, 2023. The increase varied by facility, but it was approximately 6.9%. Per Rhode Island legislation, there is a mandatory review of nursing home expenses every three years called the ‘re-array.’ The current re-array is in progress and any potential increase in the nursing home rates would begin as of October 1, 2024,” he noted.  

But facilities can’t wait a year for the state’s Medicaid adjustment to kick-in and immediate action must be taken. “Essentially, the state is breaking its own law by not conducting the re-array every three years, which was put in place to keep up with the national nursing home inflation index. The last re-array was in October of 2012. Even with an increase next fall, it won’t be enough to help close the funding gap now,” charges Michael Cole, vice president of the Board of Trustees for Aldersbridge Communities.

It’s time for a savvy PR campaign   

With no immediate financial solutions in sight, Gamache and his management team staff have been working on their own grassroots PR campaign, calling it a “Hail Mary” effort, to save Linn Health from having to displace its staff and residents.  

Linn Health’s PR campaign was seen as the next logical step to quickly tackle its financial problems, after months of alerting staff officials of the need for action. 

“Everyone with the authority to do something to help has all the information they need. Now we need action. I often hear, ‘there’s not enough money in the budget’ but the fact is, these are policy decisions. It’s about priorities,” says Gamache. 

“Do we value our older adults enough to provide for their basic needs? What kind of values do we have as a state and as a society?” asks Gamache. 

“Now it’s time to get the story into the public domain. Many people feel that nursing homes are making money hand over fist and that we’re all diverting funds to pay for yachts,” says Gamache. “Although it’s true that there are some bad apples in this profession, I believe most of us want to do what’s right, and for Linn Health and Aldersbridge Communities, a mission-driven non-profit, we’ve always cared more about better outcomes for our people than more income. We just can’t afford to operate much longer,” he warns.

The residents and staff at Linn are doing everything they can, including holding baked goods sales to raise funds. “No one wants to leave Linn, and no one wants us to be sold to another organization,” Sanford comments. “During this season of holiday miracles, we’re working to find donors who believe in what we’re doing now, and for our future. There must be a donor out there who can help us fight the proverbial ‘grinch’ that is causing nursing homes to disappear throughout the country and in our state. All we want for Christmas is to keep caring for our residents who depend on us,” she says.

“This situation exemplifies the dire straits that RI nursing homes are in, especially the community-based ones like non-profit providers.  We have been working with state officials, including the Governor’s office, EOHHS, the Health Department, and other stakeholders to highlight the crisis and the need for immediate action,” says James Nyberg, president and CEO of LeadingAge Rhode Island.  LeadingAge, founded in 1989, is a not-for-profit membership organization of not-for-profit providers of aging services, including not-for-profit nursing homes, assisted living residences, and senior housing providers, and adult day health services. 

“They have recognized our concerns and we are hopeful that some action will be taken ASAP to provide an infusion of funding.  Any nursing home closure has profound and disruptive consequences for residents, staff, families, and the broader community.  With six nursing homes closing and three in receivership, how many more proverbial canaries in the coal mine do we need?” adds Nyberg.

“Unfortunately, Linn Health’s story is emblematic of a wider crisis facing Rhode Island nursing facilities.  Nursing facilities are facing unprecedented increases in nearly all aspects of providing care – staffing costs, energy prices, inflation on food, medical supplies, etc. At the same time, Medicaid rates have not kept pace,” says John Gage, president and CEO of the Rhode Island Health Care Association.  In 2023, RI’s nursing homes are being paid by Medicaid based on the actual allowable cost of care from 2011 with an average of approximately 1% increase annually,” he said.  RIHCA was founded in 1972, and has 63 skilled nursing facilities who are members.

Finally, Maureen Maigret, former Director of the RI Department of Elderly Affairs who serves as a member of the Long-Term Care Coordinating Council and chair of its Aging in Community Subcommittee, weighs in. “The financial challenges faced by Linn Health are worrisome and point to a need for the State to take a very close look at the financial status of Rhode Island nursing homes in general,” she said, noting that few persons can afford privately paid nursing home care at an average cost of $113,000 per year. 

“So unless skilled care is paid by Medicare, Medicaid becomes the payer for a large percent of nursing home care in Rhode Island and rates must be adequate to provide the quality care we expect our loved ones to receive if they need the round the clock care provided in nursing homes,” Maigret adds. 

Linn is asking that interested charitable organization and donors willing to help Linn Health & Rehabilitation’s financial situation to contact Aldersbridge Communities Director of Development, Elise Strom at estrom@aldersbridge.org, 401-438-4456 ext. 136.

Countdown to 2024 elections heating up about what to do about Social Security

Published in RINewsToday on November 27, 2023

The political clock is ticking. It’s 340 days before the upcoming presidential elections and control of Congress and the White House are up for grabs.  As education, abortion, foreign policy, immigration, crime are emerging as upcoming campaign issues, fixing Social Security and Medicare are also on the voter’s radar screens, too.  

As the Democrats call for expanding and shoring up the existing Social Security Program (by introducing H.R. 4583, Social Security 2100 Act and S. 393, Social Security Expansion Act and other legislative proposals), Republicans are calling for changes in the program including looking at raising the eligibility age for full-time retirement, possible means-testing, and adjusting benefits for higher income earners.

The Nov. 9th Republican debate was not reassuring for younger taxpayers who are counting on collecting the Social Security benefits they earn with every paycheck, says Max Richtman, President and CEO, National Committee to Preserve Social Security & Medicare. Two of the GOP presidential hopefuls promised, in effect, to cut Social Security for future beneficiaries,” he said. 

However, former President Donald J. Trump, who didn’t participate in this debate, has warned the other candidates not to make cuts in Social Security and Medicare benefits. While he opposes raising payroll taxes to ensure the fiscal solvency of these programs, he doesn’t provide specific proposals as how to do this. 

Presidential GOP candidates call for fixes to an unsustainable Social Security system 

According to Richtman, Nikki Haley claimed that Social Security is going “bankrupt,” and she would raise the retirement age for workers who are now in their 20s, and also means-test benefits. Chris Christie also said he would raise the retirement age and eliminate benefits for higher earners, essentially converting Social Security into a safety net program, instead of an earned benefit. 

“Governor Christie and Ambassador Haley fail to recognize that future generations of retirees will rely on their Social Security benefits even more than today’s seniors do — and that means testing would cut deep into the heart of the American middle class,” says Richtman.  “Ron DeSantis — to his credit — promised not to cut Social Security, but demonstrated a fundamental misunderstanding of the program’s finances by perpetuating the myth that the government is ‘stealing’ from the trust fund,” he added.

On Oct. 25, the newly sworn in Republican House Speaker, Mike Johnson (R-LA) sent a message to his caucus calling for Social Security and Medicare reforms to be made by a debt commission to tackle changes being targeted for these programs. Richtman warns that this approach is “designed to give Congress political cover for cutting Americans’ earned benefits.”  In response, the Biden Administration described such a commission as a “death panel” for Social Security.

Over six years ago, Congressman Johnson (now newly elected House Speaker) called for cuts to Social Security. According to Independent News Network, Meidas Touch Network, in a 2018 speech before the American Enterprise Institute, as incoming chair of the Republican Study Committee, he called for cuts in Social Security, Medicare and Medicaid.  He viewed these programs as “essential threats” to the American way of life, even suggesting that the government might cease to exist if they continued to be fully funded the way they are now. 

Slashing SSA benefits through a Debt Reform Commission

“That is why these commissions have been rightly described as ‘death panels’ for Social Security and Medicare. It is unfortunate and disappointing that one of the Speaker’s first priorities is creating a mechanism intended to slash programs that American workers pay for in every paycheck, fully expecting the benefits to be there when they need them,” says Richtman, charging that the House Speaker “clearly wishes to break this compact with the American people.”

“Congress should address Social Security in the sunlight, through regular order, as it always has,” said Nancy Altman, President of Social Security Works, and former top assistant to Alan Greenspan on the 1983 commission. “The only reason to create a fast-track, closed door commission is to overthrow the will of the American people by cutting their hard-earned benefits. Anyone who supports this commission is supporting benefit cuts.”

In a Nov. 13 correspondence to Congress, Jo Ann C. Jenkins of the Washington, DC-based AARP, also opposes the creation of s debt commission.  She strongly disputes the GOP’s claim that Social Security is a driver of the annual deficits or national debt, stressing that the program is self-financed.

According to Jenkins, 90% of the retirement program is financed through payroll contributions from workers and their employers.  Around 4% of its funding comes from federal income taxes on some Social Security benefits and 5.4% comes from interest earned on U.S. Treasury bonds held by the Social Security Trust Funds.

“Any argument that claims that Social Security is a driver of the national debt – simply because it receives interest from the U.S. Treasury bonds- is disingenuous,” says Jenkins, noting that U.S. Treasury bonds are of the world’s safest investments.

Alex Lawson, Executive Director of the Washington, DC-based Social Security Works, agrees with Richtman’s assessment of House Speaker Johnson’s ongoing approach to Social Security and Medicare. “The Louisiana Congressman recently joined the vast majority of his caucus to vote for a commission designed to fast-track cuts to Social Security and Medicare behind closed doors”, notes Lawson. 

“As Chair of the Republican Study Committee from 2019-2021, Johnson released budgets that included $2 trillion in cuts to Medicare and $750 billion in cuts to Social Security,” says Lawson. This includes raising the retirement age, decimating middle class benefits, making annual cost-of-living increases smaller and ultimately moving towards privation of Social Security and Medicare,” he notes.  

With Johnson pushing for the creation of a debt commission, over 100 organizations have become co-signers on Nov. 8 correspondence to Congress opposing the legislative proposal.   

Aging groups begin to mobilize

While the Social Security Trust Fund Report, released in April 2023, warned that Social Security funds will become depleted in 2033, making the program totally insolvent in 2034 when beneficiaries could only receive about 80 percent of their scheduled benefits, the cosigners say the program’s projected short falls are “manageable by size and still a decade away, are fully understood.” 

“In this Congress alone, several legislative proposals that do just that have been introduced with numerous cosponsors. The only reason to make changes to Social Security via a closed-door commission is to cut already modest earned benefits — something the American people overwhelmingly oppose  — while avoiding political accountability, say the co-signers. 

“Congress already has a process to confront the federal debt. That process is known as reconciliation. Revealingly, Social Security cuts are excluded from the reconciliation procedure, because, as previously stated, the program is totally self-funded, cannot pay benefits or associated costs without the revenue to cover the costs, has no borrowing authority, and, therefore, does not add a penny to the deficit. Consequently, if a debt commission with jurisdiction over Social Security were to be formed, its purpose would be clear: to cut its modest benefits, while avoiding political accountability,” warn the cosponsors.

But the shortfall is real

In an article in Money magazine, the writer notes, “Taxpayer funds cover the bulk of Social Security payments, but if the program’s reserves run dry, beneficiaries would face immediate 20% cuts to their checks come 2034. Any decrease to Social Security payments would likely be extremely unpopular, considering they’re a major source of retirement income for tens of millions of people.” According to a new report from the ​​American Academy of Actuaries, the longer the issue is put off, the harder it will be to address the looming shortfall.

The Third Rail of national politics 

According to AARP research, “85% of older Americans, regardless of party, strongly oppose targeting Social Security and Medicare to reduce federal budget deficits. Specifically, the survey found that 88 percent of Republicans, 79 percent of Independents, and 87 percent of Democrats strongly oppose cutting Social Security. Similarly, 86 percent of Republicans, 80 percent of independents, and 88 percent of Democrats said they strongly oppose cutting Medicare.”

Washington insiders consider Social Security to be the “third rail of a nation’s politics”, a metaphor coming from the high-voltage third rail in some electric railway systems. Stepping on it usually results in electrocution and the use of the term in the political arena refers to “political death”.

Next November, can the GOP politically survive stepping on the third rail by targeting the nation’s most popular social welfare programs (Social Security and Medicare) for adjustments to reduce the federal budget deficit? When the dust settles after November, 2024 elections, we’ll see if younger voters, who have the most to economically lose, view Social Security and Medicare as a key issue influencing their vote and “untouchable.”

We’ll see. 

Eating your favorite Thanksgiving foods without sabotaging your health 

Published in RINewsToday on November 22, 2023

We look forward to gathering around the Thanksgiving table with family and friends to enjoy good company and good food.

“For individuals with chronic diseases such as diabetes or heart disease, holiday social gatherings can be more challenging and at times anxiety inducing,” says Marilyn Csernus, a former, now retired Registered Dietitian and Certified Diabetes Care and Education Specialist, living in Mendota, Illinois.

Csernus suggests that the best way to prevent stress and enjoy your Thanksgiving meal is planning ahead and being prepared.  “Planning ahead can include making sure your health condition is as well managed as possible going into Thanksgiving or any other holiday,” she says. 

Strategies for Managing Your Holiday Meals

“If we look at a specific holiday such as Thanksgiving as one day, rather than giving ourselves permission to overindulge all the way through New Year’s Day, it can be more manageable, especially for those with a chronic disease,” says Csernus.  She gives the following ten tips that will hopefully help you enjoy your favorite holiday foods without sabotaging your health:

1.     Don’t skip breakfast. It is important to maintain regular meals even if the timing may be off a bit on a particular holiday. It can be dangerous for anyone taking insulin and certain oral diabetes medicines to skip meals. 

2.     Try to continue your regular activity or exercise plan as much as possible. Maybe gather up a group to take a walk after enjoying a holiday meal.

3.     Don’t drink your calories. Steer clear of sweetened beverages. 

4.     Whether Thanksgiving is a sit-down meal or served buffet style, take a quick overview of what is on the menu. Decide which items you really want to eat and which you can skip. Choose small portions of holiday favorites that are unique to the holiday rather than filling up on foods that are available anytime of the year. For example, maybe enjoy a small serving of Aunt Sue’s sweet potato casserole rather than eating mashed potatoes which are available anytime of the year, or stuffing rather than bread or rolls.

5.     Enjoy larger servings of non-starchy vegetables such as asparagus, cauliflower, green beans, broccoli, spinach, carrots or green salads. These items are both low in calories and low in carbohydrates. 

6.     If you have a choice, always choose higher fiber options such as brown rice, or whole wheat bread over white rice or white bread.

7.     If there is a buffet table, don’t hang around the buffet. Fill your plate with small portions of your favorites and enjoy your Thanksgiving meal. Stop eating when you are no longer hungry rather than eating to the point of being uncomfortably full. If tempted to go back for seconds wait fifteen to twenty minutes and see if you are really still hungry. It takes that long for your stomach to signal your brain that you are full.   After eating spend your time socializing away from the buffet. Sip on unsweetened beverages throughout the day.

8.     When attending a holiday celebration at someone’s home and you are concerned that there may not be the best options for your usual meal plan, offer to bring a couple of dishes.

9.     If you have diabetes continue to monitor your blood glucose as you would on any other day.

10. If you do overindulge a bit, just get back on track the next day.

 For more diabetes educational resources including recipes, go to diabetes.org.