Author Archives for Herb Weiss

New efforts on Smith Hill to increase Medicaid reimbursement rates

Published in RINewsToday on April 18, 2022

On March 8th, a press conference on Smith Hill put the legislative spotlight on introduced rate setting legislation intended to fix Rhode Island’s long-time problem of paying insufficient reimbursement rates to human-service agencies delivering social, human and clinical services to Medicaid recipients. 

Over 80 human service providers, clients, and aging advocates, came to support Sen. Louis DiPalma and Rep. Julie Casimiro’s two pieces of legislation to fix a broken Medicaid payment reimbursement system. These bills would provide for periodic rate review/setting processes to ensure accurate and adequate reimbursement of social, human and clinical services.

“Senate President Dominick J. Ruggerio came, giving his blessings, too. “It is critical that we undertake a review of reimbursement rates so that we have a thorough understanding of the data and we can make informed decisions,” said the top Senate lawmaker. “These bills will help bridge the gap and bring reimbursement rates where they need to be,” he said.

The Reimbursement Fix…

DiPalma and Casimiro’s bills do not specify dollar amounts for adequate hourly wages but would hammer out the “periodic rate review and setting process.”

The first bill (2022-S 2311 / 2022-H 7180) establishes a process which would require the Executive Office of Health and Human Services (EOHHS), assisted by a 24 member advisory committee, to provide review and recommendations for rate setting and ongoing review of social service programs licensed by state departments, agencies and Medicaid. 

The second one (2022-S 2200 / 2022-H 7489) establishes a process which would require Executive Office of Health and Human Services (EOHHS), assisted by a 24 member advisory committee, to provide review and recommendations for rate setting and ongoing review of medical and clinical service programs licensed by state departments, agencies and Medicaid.

At press time, legislation has been referred to the Senate and House Finance committees for review. 

“Years of stagnation in our state’s Medicaid reimbursement rates have negatively affected hundreds of thousands of Rhode Islanders who rely on a wide range of services,” claims DiPalma, (D-District 12, Middletown, Little Compton, Newport and Tiverton), a long-time advocate at the Rhode Island General Assembly for human services providers and disabled Rhode Islanders.  

DiPalma says a comprehensive rather than a piece meal approach is now needed to address this reimbursement issue. Stressing that the two bills would fix the continuing reimbursement issue. “For our providers, the people they serve, and the future of our state, it is imperative we act now,” he warns. 

Rhode Island’s healthcare system is suffering a crisis of care that’s only worsened due to the pandemic, charges Casimiro (D-Dist. 31, North Kingston and Exeter), noting that the state’s human health agencies are understaffed and under-supported and it is hurting the state’s most vulnerable residents.  

“Our reimbursement rates have remained too-low and unchanged for many years and the residents of our state cannot access the crucial services they need if there is no one there to provide the care,” said Casimiro, urging Rhode Island lawmakers to stop the exodus of human services workers for their jobs.  Proper oversight of the rate setting process and appropriate reimbursement rate increases will ensure a high-level of care provided, sorely needed now, she says.    

Providers call for ratcheting up RI’s Medicaid payment rates

Long-time aging advocate and former Representative, Maureen Maigret, translated the rate payment issue into a “dollar and cents” example. Maigret, a policy consultant who previously chaired the Long-Term Care Coordinating Council’s Aging in Community Subcommittee, noted that the Bureau of Labor Statistics show in 2020 in Rhode Island the average wage for a home health aide was less than $15 per hour and nursing assistants slightly $16. “These low wages do not come close to meeting one’s basic needs, forcing workers to work more than one job or, as more are doing, just abandoning this type of work altogether for better pay, she added, stressing that this was before these workers faced 7% inflation and gas prices reaching over $5 per gallon,” she said.

“High workforce turnover rates are especially troubling for patients receiving homecare, who value building a long-term relationship with someone coming into their home frequently, says Bernie Beaudreau, Executive Director, the Senior Agenda Coalition of Rhode Island, “Seniors cannot age with independence and dignity if homecare workers are not treated with respect in wages and working condition,” he says.

This legislation is a step in the right direction and provides the state an opportunity to move toward the realignment of reimbursement rates that accurately reflect the actual cost of the delivery of behavioral health treatment and services,” says Susan Storti, President and CEO of The Substance Use and Mental Health Leadership Council of Rhode Island.

“These bills ask our state a clear, direct question: do we, or do we not, support inclusive lives in our communities? We must reply with an equally clear answer: ‘Yes, we do’ and pass S-2311 and H-7180, says Tina Spears, Executive Director, Community Provider Network of Rhode Island, noting that for CPNRI and its members it is all about inclusion of children and adults with disabilities and behavioral health conditions in our society. 

Time to pay providers adequately  

With all 38 Senators co-sponsoring both his Senate bills, DiPalma is pleased with the positive reception his legislation has received in the upper chamber. “We cannot delay any longer. The time to act is now,” he says, stressing that it’s important for lawmakers to get these bills over the “goal-line. “There are hundreds of thousands of Rhode Islanders counting on us to get this done,” he adds.

DiPalma says that a Senate hearing is being planned  to consider S 2311 and S 2200 on Thursday, April 28 at the Rise of the Senate in the Senate Lounge. All are encouraged to attend the hearing and voice their support. 

AARP poll: women over 50 to decide control of congress, state capitols

Published in RINewsToday on April 11, 2022

It’s just 214 days until the upcoming midterm elections scheduled for Nov. 8, 2022, (Rhode Island’s primary is 167 days away scheduled for Sept. 13, 2022). During the 117th Congress, with a slim majority of 222 Democrats to 212 Republicans, the Democrats control the House chamber. When the dust settles after the election we’ll see if the Democrats retain their grip on this chamber. Washington insiders say that Senate Democrats, holding the majority with a 50-50 split with vice president Kamala Harris’ having a tie-breaking vote, could lose control of the upper chamber if the Republican Party flips seats. Thirty-five Senators are up for reelection.

Twenty Republican and 16 Democrat gubernatorial seats (including Rhode Island) are also up for grabs this election cycle, too.

A new AARP study finds that women voters aged 50 and over who haven’t decided which candidate to support will decide who controls Congress and state capitols across the nation in the next election.

Taking a Look at Older Women Voters

AARP’s  new research findings released April 6th, in partnership with pollsters Celinda Lake, Christine Matthews, Kristen Soltis Anderson, and Margie Omero, found that only 17% of women in this key voting bloc have made up their mind about who they will support in the upcoming 2022 elections. Not quite two-thirds (65%) of these voters say they will not make their decisions until weeks or even days before Election Day.

“Contrary to conventional wisdom, women voters aged 50 and over do not solidly belong in either party’s camp — and the vast majority haven’t made up their minds about how they’ll vote in November,” said Nancy LeaMond, AARP Chief Advocacy and Engagement Officer. “The instability and uncertainty of the economy, the pandemic, and the political environment are leading these women to demand that candidates address quality of life and pocketbook issues like the cost of living, supply chain problems, and ways to end the discord permeating politics today,” she says.

The pollsters found that the most important issues for r women voters aged 50 and over are “kitchen table budgets” and the “day-to-day experience of rising prices.” Nearly half of those surveyed (46%) see rising cost of living as the most important issue facing the nation today. And 59% say rising prices are the most important issue to them, personally, when reflecting about the economy.

According to AARP, women aged 50 and over are one of the largest, most reliable group of voters. According to voter file and census bureau data, they make up a little more than one-quarter (27%) of registered voters and cast nearly a third (30%) of all ballots in both the 2020 and 2018 elections.  In 2020, 83% of registered women voters in this age group turned out and in 2018, the last midterm election, they were 15% more likely to vote than the population at large, says the nation’s largest advocacy group.  

Concerns About Rising Costs and the Nation’s Economy 

AARP’s national survey also found that 72% of the woman respondents are concerned about having enough income to cover rising costs, with 48% saying they are very concerned. Fifty two percent say the economy is not working well for them, a 15-point change from 2019, when just 37% of women said the economy was not working well for them.

The pollsters found that most are not optimistic about their own financial futures in the next 12 months – with 47% saying they think their personal financial situation will stay the same, while 39% think it will get worse and only 13% think it will improve. The survey findings also indicated that those respondents age 50-64 are intensely worried about saving for retirement and their financial future – with 51% saying they are very concerned about Social Security being there for their retirement and 30% saying they are most concerned about having saved enough for retirement.  

According to the AARP survey, women voters aged 50 and over also expressed concern about political division in the country, and they are unimpressed with the job elected officials are doing on a range of issues, including their dominant concern of rising prices.

By more than a two-to-one margin, the pollsters say that these voters want politicians who are willing to work together to get things done, even if the result is an occasional compromise that goes against voters’ values (67%), over politicians who consistently fight for their values but don’t often find solutions (30%). This finding remains consistent across party identifications, with 77% of Democratic women and 57% of Republican women preferring a politician compromise to get things done, while 21% of Democratic women and 40% of Republican women prefer a values-prioritizing politician.

Taking a deeper look, the pollsters found that women voters 50 and over are divided evenly by party (44% R – 45% D), in sharp contrast to their male counterparts who are solidly Republican (51% R – 38% D).  In a generic ballot, the Democratic candidate for Congress (48% will vote for) has a 7-point advantage over the Republican candidate (41% will vote for) among these women voters.

Similar Observations from the Pollsters 

“Addressing the rising cost of living is an issue that any smart candidate for office will put front and center this year,” said Kristen Soltis Anderson, founding partner, Echelon Insights. “Especially in midterm elections, women voters aged 50 and over will be a critical group that both parties must compete for, and cost of living is clearly the top issue on which they want leaders to be focused,” she said.

Celinda Lake, founder and president, Lake Research Partners, agrees with Anderson that women aged 50 and over can be the significant voting bloc in the 2022 elections. “They are sure to turn out in high numbers when many other voters are disengaging. These voters have yet to make up their minds and are dissatisfied with the jobs their elected leaders are doing, especially on the kitchen table economic issues they face every day,” she notes.

“Women over 50 may not only be the decision-makers in their households, but they may also be the decision-makers of the midterm elections,” said Margie Omero, Principal at GBAO.

Christine Matthews, President of Bellwether Research, says“Women over 50 are arguably the most important voting cohort for the 2022 midterm elections – and they are not happy,” “They are extremely worried about the impact rising prices – particularly groceries – are having on their budget and their ability to save for retirement,” she says.

Matthew adds,” A majority say the economy is not working for them – a significant uptick from two years ago. They want politicians to work together to find solutions to inflation and other key issues, but they are not pleased with what they see. Elected officials should be prepared to demonstrate to this key group that they are working productively on cost-of-living issues,” she says.

The AARP national survey was conducted by phone and online from Feb. 18 to March 3, 2022, using 1,836 voters aged 50 and over who are likely to vote in 2022, with samples of Black voters, Hispanic/Latino voters, Asian American/Native Hawaiian and Pacific Islander voters, as well as American Indian/Alaska Native voters. 

A Final Note…

It’s just seven months before the upcoming midterm elections. The historical voting pattern of midterm elections is clear. “The sitting president’s party almost always loses House seats in the midterms. Going back to Harry Truman’s presidency, the president’s party has lost, on average, 29 House seats in each president’s first midterm election,” says James M. Lindsay, senior vice president, director of studies, and Maurice R. Greenberg chair at the Council on Foreign Relations, in a blog article, “The 2022 Midterm Congressional Elections by Number,” published on March 8, 2022.

Lindsay, senior vice president and director of studies and Maurice R. Greenberg chair, says, “The betting money is that the Republican Party will be the winner on election night, taking back control of one, if not both houses of Congress,” he says, noting that eight months can be a lifetime in politics. 

Republicans are optimistic in picking up seats because of Biden’s low job approval rating, inflation being at a 40-year high, 31 incumbent Democrats retiring (it’s more difficult to defeat an incumbent) and the COVID-19 pandemic still killing 1,500 American’s daily, says Lindsay. But Lindsay predicts Democrats may do better at the polls just because “the midterms are still eight months away,” and who knows where the country will be then. “The redistricting of House seats is going well for the Democrats with several states throwing out Republican redistricting plans and others enacting redistricting plans to benefit the Democrats, he says.

“The Senate math favors Democrats, the party just defending 14 seats while Republicans must keep 21 Senate seats,” adds Lindsay. “Ideologically extreme candidates” will push away moderate voters in House and Senate races, he says. 

But AARP’s national poll warning to Senators, House lawmakers, and Governors to not ignore the concerns of older women voters should be heeded. Not listening has a political cost. It may well determine the balance of power in the next election. 

AARP report: 6 Pillars of Brain Health – lifestyle changes and community policies

Published in RINewstoday on April 4, 2022

The Washington, DC-based AARP releases its latest Global Council on Brain Health (GCBH) report citing strong scientific evidence that behavior changes and lifestyle habits can positively impact one’s brain health – yet many adults struggle to implement such simple changes.

In a new report released last month, “How to Sustain Brain Healthy Behaviors: Applying Lessons of Public Health and Science to Drive Change,” GCBH outlines how individuals age 50 and over, communities, and policymakers can all take steps to support brain health.

The World Health Organization predicts that the number of people living with dementia is expected to grow to 82 million by 2030 and skyrocketing to 152 million by 2050. The GCBH report notes to lower this expected trajectory it will take “effective behavior and cultural changes, initiated and driven by all the pertinent actors working in concert at all levels of society.”

The 38-page report and its recommendations are based on a review of the current state of science and the consensus of 20 experts from across the world in an array of disciplines, notes the report. GCBH is an independent collaboration of scientists, health professionals, scholars and policy experts from all over the world who are working in the area of brain health related to human cognition to promote brain health.

GCBH’s 38-page report, released March 15, 2022, provides tips to support brain-healthy behavior. Over the past six years, the GCBH has issued reports on broad topics taking a look at whether adults’ behavior and lifestyle style habits could affect their brain health as they grow older.

“While we encourage people to make good decisions, the GCBH recognizes that an effective strategy to enhance brain health must be framed broadly, and that individual choices are made in a larger social and environmental context… Simply putting research findings forward and expecting people to change their behaviors and sustain healthy lifestyles accordingly is unrealistic,” say the report’s authors. 

Calls for Supporting Positive Brain Health

In the latest GCBH report, the authors share what they have learned about how to persuade and motivate people to maintain brain-healthy lifestyles, and how community policies can be shaped to promote this vital goal. 

“We know what works to support brain health – this report focuses on how to make that happen,” says Sarah Lenz Lock, GCBH’s Executive Director. “Our experts have identified specific, practical tips to help older adults, communities and policymakers support the habits that are good for brain health. We show that change is possible, and why supporting brain health for an aging population makes good health and economic sense for communities and society as well as individuals,” Lock says.

“We describe why implementing programs designed to promote brain health for older adults makes good health and economic sense for communities and societies as well as individuals. GCBH experts advise individuals to set specific goals, be realistic about what they choose, and approach their goals step by step,” says the report’s authors. 

“We encourage community-based organizations to create opportunities for peer-to-peer coaching. And we urge policymakers to raise public awareness that people can take steps to help themselves. These and many other recommendations along with a framework for achieving change for individuals, community organizations and policymakers are provided in the final report approved by the GCBH Governance Committee,” they add. 

The GCBH report also calls for addressing the disparities in health and access to care that undermine the cognitive well-being of underserved communities including many African Americans and Hispanics.

Hearing loss, high blood pressure, obesity, and depression are among the health issues that may be linked to cognitive decline and should be properly managed with access to health care.

The Six Pillars of Brain Health

After a careful analysis of scientific findings, GCBH’s report notes that “evidence continues to mount” that people may be able to lower their risks for cognitive decline by engaging in healthy lifestyle behaviors, referred to as the six pillars of brain health.

Specifically put:

“Be social” and continue to maintain and expand your social network.  Keep tabs on family and friends and don’t isolate yourself from others. 

  • Find new interests and hobbies to “engage your brain” and to stimulate your thinking. 
  • Meditate, relax, and maintain a consistent schedule to “manage stress.”
  • Don’t forget the importance of “ongoing” exercise” and schedule at least 2.5 hours of moderate to vigorous exercise a week.  
  • Achieve “restorative sleep” by at least getting 7-8 ours of restful sleep daily.
  • Finally, “eat right” by choosing a nutritious, heart healthy diet to limit high blood pressure, of fish, poultry, nuts, low-fat dairy, vegetables, whole grains, fruits, and vegetable oils. 

The GCBH recommendations urge people to avoid smoking and not drink alcohol.  But if you drink, limit alcohol to more than one drink a day for women and two drinks a day for men.

The Brain-Heart Connection is examined in GCBH’s report.  Hypertension is a serious risk to brain health that can lead to stroke, mild cognitive impairment, or dementia. With knowledge of this, the report notes that people can lower blood pressure by increasing physical activity and reduce overeating, excess drinking, smoking and even reducing sodium (salt) intake.

The GCBH report provides simple, easily obtainable steps to make successful behavioral changes to improve brain health.  Specifically, people can:

Set a goal, identify a specific action you want to take on.

Be thoughtful and realistic about the goals you choose.

Find something that is fun and choose what is enjoyable for you.

Re-purpose some of your free time.

Rethink your environment to reduce the temptations and encourage better choices.

Celebrate the wins.

Learn from the setbacks.

Involve friends and family with common goals to reinforce healthy choices; and

Pick a good start time. 

While brain health behavior changes can be achieved by individuals, these changes require the support health care providers, employers, and community organizations.  Health care providers can help their patients improve their lifestyle habits and make healthy choices to reduce risks and alleviate the symptoms of disease. Employers can promote healthy behaviors too by creating healthier work environments, offering wellness initiatives, health screenings, immunizations, supporting healthy sleep by minimizing shift work, not requiring employees to respond to emails 24/7 and respecting vacations and breaktimes.  These all can promote better brain and mental health, says the GCBH report.

Mission-driven organizations, like AARP, the Arthritis Foundation, and the Heart Association, can also provide individuals with needed information and tools to access their own wellness and motivate a person to make positive behavior changes.

Finally, policymakers can set goals to improve the public’s brain health with a focus on building equity, fighting the sigma of dementia, and implementing best practice to improve brain health from around the world. They can also become aware of how public policies in other areas, such as the built environment, nutrition, and education, can have a lifelong impact on brain health. Some specific examples of successful public health policies include seat-belt laws and smoking cessation requirements.

“A chasm remains between what researchers are discovering about brain health and how little this knowledge has been applied for the public good. Progress will require the combined actions of individuals and communities, reinforced by public policies that facilitate healthy lifestyles,” says the report’s authors. “By applying lessons of public health and science, we can improve brain health for the benefit of individuals, communities and countries around the world,” they say, noting that this report lays out the steps needed to achieve this goal.

The full report on “How to Sustain Brain Healthy Behaviors” is available by going to https://www.aarp.org/content/dam/aarp/health/brain_health/2022-03/gcbh-behavior-change-report-english.doi.10.26419-2Fpia.00106.001.pdf.

To obtain all of the GCBH’s past reports on brain health, go to https://www.aarp.org/health/brain-health/global-council-on-brain-health/resource-library/.

To see how staying socially active impacts brain health, go to https://thriveglobal.com/stories/spumoni-s-where-everybody-knows-your-name-study-says-being-socially-active-may-improve-cognitive-functioning-2/