Author Archives for Herb Weiss

Older Americans Month: great time to bring back House Aging Committee

Published in RINewsToday on May 9, 2022

On April 29, President Joe Biden proclaimed the month of May, Older Americans Month for 2022 to honor the nation’s 54.1 million Americans aged 65 and over “who contribute their time and wisdom to make our communities stronger, more informed, and better connected.”

“Older adults have always been a vital source of strength and resilience in America,” stated Biden in the proclamation.  During the pandemic, many seniors came out of retirement to serve their communities in health care and education roles, filling job vacancies in critical shortage areas. Moving forward, we must ensure that older Americans have the appropriate resources to maintain their independence and stay connected to their communities,” he said.

The proclamation also noted that the nation is celebrating the 50th anniversary of the Older Americans Act Nutrition Program — the first federal program to support the well-being of older Americans through meal deliveries, nutrition services, educational programs, and counseling. This year is also the 10th anniversary of the nation’s National Plan to Address Alzheimer’s Disease and recommit to building upon this important work being done.

Biden recognizing this month in honor of seniors follows the footsteps of 11 presidents, beginning with President John F. Kennedy in 1963, when only 17 million Americans had reached their 65thbirthday. At that time,  about a third of America’s seniors lived in poverty and there were only a few federal programs to meet their needs. A meeting in April 1963 between Kennedy and the National Council of Senior Citizens led to designating May as “Senior Citizens Month,” later renamed “Older Americans Month.”

Over the years, OAM is a time the nation acknowledges the contributions of past and current older persons to our country, in particular those who defended our country. Communities across the nation pay tribute at ceremonies, events, and fairs, or in other ways to older persons in their communities.  

OAM – a great time to bring back the House Aging Committee

As the nation celebrates OAM, an eblast to over 90,000 seniors by the National Committee to Preserve Social Security and Medicare (NCPSSM) urged these older voters to call their congressmen to request them to cosponsor Rhode Island Congressman David Cicilline’s H. Res. 583, to reestablish the House Select Committee on Aging (HSCoA). “It couldn’t be a better time to highlight the urgent need to reinstate this investigative committee which would help restore Congressional focus on key policy issues [Social Security, Medicare, housing, prescription drugs, and long-term care] impacting the nation’s seniors says the Benefits Watch newsletter.   

“Today, with seniors representing a growing portion of the U.S. population and several federal programs that seniors rely on at an inflection point, there is an increasing need for a House committee that advocates for older Americans,” says NCPSM’s email, noting that’s why the Washington, DC-based advocacy group has signed onto the Leadership Council on Aging Organization’s (LCAO) letter calling on the House to pass H. Res. 583. 

“While there are other committees with jurisdiction over seniors’ programs, there is no single committee dedicated to keeping an eye on the big picture for seniors.  Fortunately, the Senate Special Committee on Aging has continued to operate in the absence of a House counterpart,” notes NCPSSM’s email, noting that “seniors would benefit from a reinstated and robust HSCoA, whose sole mission would be to look out for older American’s needs.

National Aging Groups, former Pepper staffer weighs in

“Older Americans month would be the perfect time to bring back the Aging Committee,” says Bob Weiner, former Chief of Staff under chairman Claude Pepper of the House Select Committee on Aging. “It’s sorely missing now. With Pepper’s legacy as the guide, pandemic deaths, nursing homes, home health care, Social Security, and Medicare would be improved by the sunlight of oversight. Seniors are now vulnerable and threatened by what could happen and having the Aging Committee back would reinstate the wall of protection that Pepper gave them,” he says. 

“The LCAO supports the establishment of HSCoA to provide an important forum for discussion, debate and exploration of issues impacting an aging society,” says Katie Smith Sloan, chair of the Leadership Council of Aging Organizations (LCAO), a coalition of 69 Washington, DC-based aging organizations. “Addressing the needs of older adults and families, which are increasingly prevalent with our population shifts, now, as we celebrate Older Americans Month, is appropriate – and urgent,” says Sloan. LCAO sent a letter to members of Congress on March 4, 2022, urging them to cosponsor H. Res. 583. 

“Passing H Res 583 in May to coincide with it being Older Americans month would make eminent policy and political sense.  It is an investment in having a stronger and dedicated advocacy voice for older adults in the House which has been missing for almost 20 years,” says Robert B. Blancato, National Coordinator of the Elder Justice Coalition, who was the longest serving staff person on the original House Aging Committee, from 1977 to 1993.

“As our country’s older adult population continues to grow each day, so does the urgency with which we need to pursue effective solutions to myriad aging issues,” says Erika Kelly, Chief Membership and Advocacy Officer of Meals on Wheels America. “To see the House pass this resolution to reestablish the HSCoA during Older Americans Month would be a tremendous step forward,” she says.

“Older Americans Act programs, like Meals on Wheels, will undoubtedly face the lingering impact of the pandemic and other challenges for years to come. Having this HSCoA come [back] to life again, especially during this celebratory month, would provide critical leadership and attention when it’s needed most and make a difference in the lives of tens of millions of older adults,” says Kelly.

Finally, Cicilline, H. Res. 583’s sponsor and the NCPSSM tells us why it is important for House Speaker Nancy Pelosi and her Democratic leadership colleagues to support and bring H. Res. 583 to the House Rules Committee for a vote during Older Americans Month.

“With Older Americans Month upon us, this is an important moment to underscore how the pandemic has disproportionately impacted seniors. Now, with growing concerns about inflation, seniors on fixed incomes will bear the burden of the rising cost of prescription drugs, food, housing, and other essentials. A House Permanent Select Committee on Aging would help Congress focus on, study, and address the issues that affect seniors to make sure they can live the rest of their lives with dignity and security,” says Cicilline.

“When there was a HSCoA before it was abolished in 1995, the investigative House committee held hearings on aspects of the Older Americans Act leading up to the 1992 reauthorization of the law,” noted NCPSSM’s Dan Adcock, Director of Government Relations and Policy. “The findings of these hearings were helpful to the House Committee on Education and Labor which had legislative jurisdiction over the Older Americans Act.  The Subcommittee on Human Resources [now called the Civil Rights and Human Services Subcommittee] under the full Education and Labor Committee held several of its own hearings on the OAA, too – including field hearings held across the country — leading to the enactment of the 1992 reauthorization., he said. 

According to Adcock, during that period of time, there was significant communication between the House Aging Committee staff and the Ed and Labor Committee and Human Resources Subcommittee staff.  But the legislative language was written and marked up by the latter. “A reestablished HSCoA could play a similar role in the future, but the panel’s ability to have an impact on legislation drafted by the authorizing committees would depend on the cooperation between the respective committee chairs and staff and the degree of relevancy of the hearings held by a reconstituted House Aging Committee,” he says. 

Over 400 senior groups support H. Res. 583

While LCAO is a pretty diverse group of national aging organizations – each with their own policy priorities, the coalition of 69 members, representing over 100 million over 50, and 50 million over 65 came together to endorse and affirm their support of Cicilline’s resolution.  

Ms. Nancy Altman, President of Social Security Works and Chair of the Strengthen Social Security Coalition, strongly supports the passage of H. Res. 583 and that her coalition of 350 national and state organizations representing 50 million Americans endorses Rep. Cicilline’s resolution.  

As we celebrate OAM, it is key to House Speaker Nancy Pelosi, Majority Leader Steny Hoyer (D-MD) and Whip James Clyburn (D-SC) to join Cicilline along with Congresswomen Jan Schakowsky (D-IL) and Doris Matsui (D-CA), cochairs of the Task Force on Aging and Family and 43 cosponsors of H. Res 583, giving the green light to the House Rules committee to vote, and if approved send it quickly to the floor.

H. Res. 583 does not require Senate consideration and only requires a House Rules and floor vote for passage.  Passing the reestablishment of an investigative committee in the House would send a powerful message to older Americans that Congress following in Pepper’s footsteps will again get serious in addressing aging issues. 

As mentioned in previous commentaries, bringing back the HSCoA is a winning federal policy to positive impact America’s seniors and this group.  It’s the  right thing to do especially at a time when seniors have been a disproportionately impacted by the continuing COVID-19 pandemic.    

Over 450 national and state aging organizations representing conservatively over 150 million seniors, support the enactment of H. Res. 583. That’s a great reason for the lower chamber to strongly support.

To see the LCAO’s letter sent to Congress on March 4, 2022, endorsing H. Res. 583, go to https://www.lcao.org/wp-content/uploads/2022/03/House-Aging-Committee-LCAO-Letter-3-4-22.pdf.

For a historical background of the HSCoA and details about H. Res. 583, go to https://rinewstoday.com/congressman-cicilline-poised-for-legacy-as-next-fiery-advocatsie-on-aging/.

For details about Congressman Claude Pepper (D-FL) Congressman, during his six-year serving as chair of the HSCoA, go to https://rinewstoday.com/congressman-cicilline-poised-for-legacy-as-next-fiery-advocate-on-aging/.

Aging in Place in Your Rhode Island Community

Published in Pawtucket Times on May 2, 2022

As the graying of the nation’s population continues, older persons are choosing to live out their remaining years remaining in their communities in their homes, whenever possible. A new just-released study of adults age 50 and older from the AP-NORC Center for Public Research and the SCAN Foundation, finds a majority of older persons would like to age in place and are confident they can access needed services that will allow them to stay at home in their community for as long as possible.  

Gathering Thoughts About Aging in Place

According to this new national study released last week, two-thirds of the respondents think their communities meet their needs for accessing services like health care, grocery stores and social opportunities. The researchers found that all types of health care services are widely perceived as easy to access in their communities, and most feel that local health care understand their needs (79%) and take their concerns seriously (79%).

But, a closer examination of the small proportion of older Americans (Blacks and Hispanics) who feel less prepared and less supported in their community raises concerns about equity in access to the resources necessary to age in place.

However, the study reported that a few respondents say they had a hard time accessing needed services because of communication obstacles like a language barrier (11%), cultural barrier (8%) or age gap (8%); issues with affordability (15%); or issues of respect for their religious (4%) or cultural (3%) background. 

Those in urban areas—and suburban areas especially—describe their communities as having more supports for aging in place than those in rural areas. Older adults in suburban areas see their communities as doing the best job with meeting needs for healthy food, internet access, and the kinds of foods they want to eat. Suburban areas are also seen as better than rural areas in particular at meeting needs for health care and social activities. Older rural Americans are less likely than those living elsewhere to use a range of services simply because they aren’t available in their area. They are less likely to feel that community services are easy to get and designed for people their age than those in urban or suburban communities as well. And they are less likely to think a variety of health care services would be easy for them to access.

Income disparities are also associated with access to critical aging services. Those with incomes of $50,000 and below are less likely than those earning more to have access to services that are in their language (73% vs. 82%), close by or easy to get to (58% vs. 65%), respectful of their religious beliefs (57% vs. 65%), or designed for people their age (53% vs. 63%). When it comes to medical services, they are also less likely to have easy access to dental care, physical therapy, pharmacies, nursing homes, and urgent care than those earning more.

Additionally, those age 65 and older generally feel more prepared and report better access to important community services than those ages 50-64.

Aging in Place in the Ocean State 

For older adults aging in place, in their own homes, is by far the preferred model, says Mary Lou Moran, Director, Pawtucket Division of Senior Services at the Leon Mathieu Senior Center. “In fact, the theme of this year’s federal observance of Older Americans Month “Age My Way” focuses specifically on this very topic. The coordination, accessibility, and connection to services and programs is critical to the successful delivery of services and is where much work needs to be done,” she says. 

Moran says that senior centers located in communities throughout the state deliver needed information and assistance to older adults on accessing the needed  services to age in place.  Social isolation, access to transportation, food and housing insecurity, economic stability, and connectivity to services, are obstacles to enabling a person to stay in the community in their homes, adds Moran.

Over the years, Rhode Island’s inadequate Medicaid rates have become major obstacles to allowing a person to stay at home. However, recent state legislation, H 7616, to recreate a Department of Healthy Aging, spearheaded by Reps Carson, Ruggiero, McLaughlin, Contvriend, Speakman, Ajello and Potter, addresses some of the challenges that service providers are facing when trying to assist individuals to age in place. Moran adds, as the number of older adults continues to grow exponentially, the time has come to fully put the needs of our elders in the fore front to enable them to age with choice, dignity and respect.

According to Maureen Maigret, policy consultant and Chair of the Aging in Community Subcommittee of the Long-Term Care Coordinating Council, “Rhode Island is fortunate to have a number of government-funded programs that help older adults to age in place.” These programs include Meals on Wheels home-delivered meals program; Medicaid home and community services including home care, adult day services; assisted living and self-directed programs; Caregiver respite and support services; Home Modification grants to help make homes accessible; and elder transportation assistance for those age 60+ for medical trips, to get to adult day.  She also mentioned the Office of Healthy Aging’s Home Cost Share program for persons age 65+ and persons underage 65 with dementia who are not Medicaid eligible with income up to 250% of the federal poverty level and the wonderful programs offered at the state’s senior centers.

However, Maigret says that for some of these services such as home care there may be wait lists due to worker shortages. (People can find out about these programs or to find out what benefits they may be entitled to by calling the POINT at 401-462-4444).

There are also private services available for almost any service needed to help people age in place if they have the financial means to pay for them,” says Maigret.  

The National Village to Village Movement Comes to Rhode Island

While some of these volunteer programs in RI may offer some type of services such as transportation, a relatively new initiative has come to Rhode Island. “The Village Common of Rhode Island (TVC) provides a variety of supports through the efforts of almost 200 trained and vetted volunteers,” says Maigret. 

Maigret says that the goal of TVC is to help older persons to stay in their own homes and connected and engaged with their community. “This “neighbor helping neighbor” model started 20 years ago in Beacon Hill Boston and now there are 300 nonprofit “villages” operating across the country. TVC supports include transportation, running errands, home visits and telephone assurance, minor home repairs and light yard work, assistance with technology, and a virtual caregiver support program. A robust weekly calendar offers virtual events, and a monthly newsletter keeps members and guests informed. All this is done with a lean 1.5 person staff, a working board of directors and almost 200 volunteers,” she notes. 

“I had heard about the “village” model some years back and supported efforts to start a “village” in Rhode Island, she says. “It amazes me that a small band of committed volunteers were able to put all the pieces in place to operationalize a “village” and to see what has been accomplished. There are now active “villages” in Providence, Barrington, Edgewood/Cranston and Westerly with almost 300 members and more “villages” are under development. One of the priority goals of the Board is to reach out to underserved neighborhoods in our urban and rural areas to listen to people and find out what is important to them and what type of “village” program might work in their area,” she says. 

“We know that transportation is a huge issue for folks living in our rural areas and that is a huge concern. And, based on findings of the 2021 RI Life Index: Older Adults in Rhode Island(from RI Blue Cross Blue Shield//Brown University School of Public Health), we know that older persons of color living in our core cities have lower perceptions of community life, access to healthcare and experience lower food security and access to technology,” adds Maigret.  

“Research on the fairly new “village” programs shows promise in fostering feelings of being connected to others and suggest older women living alone with some disability most likely to experience improved health, mobility and quality of life (https://pubmed.ncbi.nlm.nih.gov/28509628/.),” says Maigret, noting that this is an important finding as Rhode Island has such a high portion of older adults living alone.

TVC President Anne Connor (74) says she has been a member and volunteer since 2015. “That we are volunteer supported is noteworthy and having an Executive Director, Caroline Gangji, (formerly acting Executive Director at Age Friendly RI), improves our ability to serve our members”, says the retired librarian and paralegal.

As TVC founder Cy O’Neil once said, ” …you don’t create a fire house when the house is burning.”  TVC is more than services – it is the relationships we build that are key to our success, says Connor.  

For details about The Village Common Rhode Island, go to https://www.villagecommonri.org/.

For specifics programs and services offered by the Rhode Island Office of Healthy, go to  https://oha.ri.gov/.  

Controversial move by CMS limits coverage for new Alzheimer’s drug, Aduhelm 

Published in RINewsToday on April 25, 2022

Earlier this month, amid the pleas of the Alzheimer’s Association, the National Committee to Protect Social Security and Medicare, and other aging advocacy groups, the Centers for Medicare & Medicaid Services (CMS) made its final decision to limit their Medicare coverage of the controversial Alzheimer’s drug, ADUHELM® , for only those Medicare recipients participating in clinical studies overseen by the National Institutes of Health (NIH) or in other approved clinical trials.

When releasing its decision on April 7, CMS noted from the onset, the federal agency “ran a transparent, evidence-based process that incorporated more than 10,000 stakeholder comments and more than 250 peer-reviewed documents into the determination” to make its decision.

Calls for More Rigorous Studies

According to CMS, over 6 million older Americans are believed to have Alzheimer’s, and this prevalence is expected to rise to 14 million by 2060, barring effective interventions. CMS stated that effective treatments are needed, and because of the early, but promising, evidence and the immense burden of this devastating disease on the Medicare population, the agency is finalizing Medicare coverage, calling for rigorous studies approved by the U.S. Federal Drug Administration (FDA) and NIH to help answer whether this class of drugs improves health outcomes for patients.

“Science, evidence, and stakeholder input led our team of career civil servants and clinicians through this national coverage determination process. There is potential for promise with this treatment; however, there is not currently enough evidence of demonstrating improving health outcomes to say that it is reasonable and necessary for people with Medicare, which is key consideration for CMS when making national coverage determination, said Dr. Lee Fleisher, CMS Chief Medical Officer and Director of the Center for Clinical Standards and Quality, in a statement announcing CMS’s regulatory payment decision.

“In arriving at this final decision, we looked at the unique circumstances around this class of treatments and made a decision that weighed the potential for patient benefit against the significance of serious unknown factors that could lead to harm,” added Fleisher. “If a drug in this class shows evidence of clinical benefit through the traditional FDA approval process, then CMS will provide broad access and ensure the results from the rigorous trials are generalizable for people with Medicare participating in a CMS-approved study, such as a registry,” she said, noting that this decision was made to provide CMS flexibility to respond quickly to providing coverage for any new drugs in this class showing a clinical benefit. 

Biogen, a biotechnology company that manufacturers ADUHELM®m , was quick to give its opinion about CMS’s final decision about coverage of this drug. The Cambridge, Massachusetts based company charged that “this unprecedented decision effectively denies all Medicare beneficiaries access to ADUHELM®m , the first and only FDA approved therapy in a new class of Alzheimer’s drugs. It may also limit coverage for any future approved treatment in the class. These coverage restrictions, including the distinction between accelerated approval and traditional approval, have never been applied to FDA-approved medicines for other disease areas.”

When additional data from this new class of treatments become available, Biogen urged CMS to reconsider its final decision for all FDA-approved amyloid-beta targeting therapies. The company says that it is carefully considering its options and will provide updates as the company further evaluates the business impact of this decision.

Creating Unnecessary Barriers to Care 

Calling the CMS decision wrong, the Chicago-based Alzheimer’s Association expressed deep disappointment, charging that it has essentially ignored the needs of people living with Alzheimer’s disease. “CMS has created unnecessary barriers for individuals with Alzheimer’s disease. Patients with Alzheimer’s, a fatal disease, should have FDA approved treatments covered by Medicare just as those facing other diseases do,” said Harry Johns, Alzheimer’s Association chief executive officer. 

Notably, CMS has said in its decision the only way for patients to access the first approved FDA treatment targeting amyloid in those living with Alzheimer’s is to enroll in a clinical trial. While we note CMS has expanded where those clinical trials may take place, in reality this remains an unnecessary and never before imposed barrier to access an FDA-approved treatment, says Johns.

“People living with MCI, Alzheimer’s disease and other dementia deserve the same access to therapies given to those living with other conditions like cancer, heart disease and HIV/AIDS. They deserve the opportunity to assess if an FDA-approved treatment is right for them,” said Joanne Pike, Dr.P.H., Alzheimer’s Association president. “Drugs that treat people in the early stages of Alzheimer’s could mean more time for individuals to actively participate in daily life, have sustained independence and hold on to memories longer,” she said.

According to the Alzheimer’s Association, CMS has incorporated one of its recommendations into the final rule. “Importantly, CMS has decided to utilize a registry for future treatments granted full FDA approval. The Alzheimer’s Association registry will play an important role in collecting and analyzing real-world data. This registry will monitor and report clinical and safety endpoints for patients treated with FDA-approved AD therapies, including accompanying diagnostics, to track the long-term outcomes associated with these therapies in real-world settings. Similar successful registries in heart disease and cancer have enabled researchers, clinicians, health systems and payers to track the long-term performance of therapies using a large, real-world evidence dataset,” the advocacy group says. 

The Alzheimer’s Association also expressed strong concern about the immediate impact CMS’s decision will have on Alzheimer’s and dementia research and innovation. “The agency’s decision to essentially reject the Accelerated Approval Pathway for monoclonal antibodies targeting amyloid for the treatment of Alzheimer’s disease is broad overreach. Accelerated approval is a pathway created by Congress and utilized by FDA to allow for earlier approval of drugs that treat serious conditions, and that fill an unmet medical need. Alzheimer’s is a deadly disease with no survivors,” stated the advocacy group.

“The decision by CMS is a step backward for families facing Alzheimer’s disease,” said Maria C. Carrillo, Ph.D., Alzheimer’s Association chief science officer. “Years of increased research funding has led to more progress and innovation than ever before, but today’s decision may halt this progress as developers question if there is a pathway forward to coverage,” she said.

Calls for Reducing Cost of Medicare Part B Premiums

Max Richtman, President and CEO of the National Committee to Preserve Social Security and Medicare, calls on CMS to “swiftly reduce the hefty 2022 Medicare Part B premium increase ($21.60 per month), now that the agency has made its final decision to limit coverage of the controversial Alzheimer’s drug, ADUHELM®m, to patients in clinical trials.” 

“The spike in Medicare Part B premiums was partly based on the drug’s exorbitant cost (originally priced at $56,000 per year) and the potential expense of wider coverage,” says Richtman, noting that the agency is still “reviewing” Part B premiums, under previous direction from HHS Secretary Xavier Becerra. “Medicare beneficiaries struggling to pay their bills need relief from this year’s premium increase as soon as possible, warns Richtman. .

“The Aduhelm controversy highlights the urgent need for Medicare to be able to negotiate drug prices with Big Pharma. If the price of Aduhelm had been negotiated, it is unlikely that it would have impacted Medicare premiums so dramatically in the first place,”  adds Richtman, 

For a fact sheet on Medicare coverage policy for monoclonal antibodies directed against amyloid for the treatment of Alzheimer’s disease, visit https://www.cms.gov/newsroom/fact-sheets/medicare-coverage-policy-monoclonal-antibodies-directed-against-amyloid-treatment-alzheimers-disease.

To read the final NCD CED decision memorandum, visit https://www.cms.gov/medicare-coverage-database/view/ncacal-decision-memo.aspx?proposed=N&ncaid=305.