Category Archives for Healthcare

Home Foot Care Legislation Gains Momentum Toward Passage in RI

Published in RINewsToday on April 13, 2026

Through the efforts of aging advocates and older Rhode Islanders, the House last week followed the Senate’s lead in passing legislation that would allow certified foot care nurses to provide routine foot care to homebound patients. Under the legislative proposal, nurses must receive proper training and certification and demonstrate clinical competency.

At press time, the two chambers must still reconcile and pass identical versions of the bill before the legislation can be sent to the governor for signature.

On April 7, the Senate unanimously passed S. 2116A, introduced by Sen. Lori Urso, to expand access to routine foot care for homebound patients. Two days later, the House followed suit, passing Rep. Jennifer Boylan’s H 7029A by a vote of 65–0.

The sponsors—Rep. Boylan (D-Dist. 66, Barrington and Riverside) and Sen. Urso (D-Dist. 8, Pawtucket) —say the legislation addresses a critical need for basic, preventive foot care in the home. Many elderly and disabled patients require assistance with services such as toenail care and treatment of corns and calluses, yet are often unable to access care outside the home, including visits to a podiatrist.

Under the legislation, nurses must demonstrate knowledge and clinical competency in foot and nail structure and function, common foot conditions, and appropriate care techniques. They must also be certified by a national professional organization, such as the American Foot Care Nurses Association (AFCNA), or an equivalent approved by the Rhode Island Department of Health. Additionally, two of the required 10 continuing education hours per certification period must focus specifically on foot care. In addition to CEUS, 30 hours of training with a podiatrist are required for certification.

“This bill is about expanding access for vulnerable Rhode Islanders who currently have no safe options for routine foot care,” said Sen. Urso. “While this care may seem simple to some, for others it is difficult or even impossible to perform safely on their own.” She noted that similarly trained nurses already provide this care in most other states, including Massachusetts, whose regulations served as a model for the legislation.

Urso also pointed to the state’s aging demographics. “With the City of Pawtucket joining the AARP Age-Friendly initiative, along with several other Rhode Island communities, it is imperative that we support residents who wish to age in place,” she said. “Rhode Island has more residents over age 65 than under age 20, and initiatives like this help meet their needs.”

Rep. Boylan emphasized the broader issue of healthcare access. While many Rhode Islanders are aware of shortages in primary care and specialty providers, she said, fewer realize that essential services like in-home foot care are largely unavailable. This gap leaves many older adults without safe options.

“It’s especially dangerous for individuals with diabetes, who are prone to infections and other foot problems that can lead to serious complications or even death,” Boylan said.

Strong Backing from Leadership and Advocates

House and Senate leadership, along with aging advocates, say the proposal addresses a longstanding gap in home- and community-based care.

“This legislation will provide a lifeline for vulnerable Rhode Islanders who rely on in-home health services and currently face significant barriers to receiving basic but essential foot care,” said Senate President Valarie J. Lawson. She described the bill as a common-sense solution that improves the quality of life for both patients and caregivers.

House Speaker K. Joseph Shekarchi  called the measure a practical response to a widespread problem. “As someone with diabetes, I understand the serious risks associated with a lack of routine care. This bill helps protect the health and safety of Rhode Islanders,” he said.

Tina McDonald, a registered nurse licensed in both Rhode Island and Massachusetts who is certified in foot care, testified in support of H. 7029A. With 12 years of experience in foot care nursing, she argued that there is a significant unmet need among homebound elderly and chronically ill residents who can no longer visit a podiatrist’s office.

“It’s not a question of doctor versus nurse. It is a matter of nurse versus no one,” McDonald told House lawmakers, warning that podiatrists are not filling this gap in care.

Addressing the primary opposition from podiatrists, she clarified that nurses would not be practicing medicine but instead addressing a “self-care deficit” within the established nursing scope of practice.

During her testimony, McDonald emphasized that nurses are highly trained in assessment, infection control, and wound care.

Carol Anne Costa, executive director of the Senior Agenda Coalition of Rhode Island (SACRI), said the legislation would benefit homebound and mobility-challenged residents and their caregivers.

“SACRI was proud to testify in strong support of this bill,” she said. “It represents a vital step toward ensuring that older adults have the care and support they need to age safely and with dignity in their communities.”

Costa noted that allowing trained nurses to provide limited foot care services at home supports both family caregivers and broader home- and community-based care systems. “Those needing these services are often older adults or individuals with disabilities who face mobility challenges, making it difficult to access care outside the home,” she said.

She added that aging and underlying health conditions can make nail care more difficult and increase the importance of proper foot care.

Catherine Taylor, AARP Rhode Island State Director, echoed those concerns. “Access to in-home foot care is critical for older adults facing mobility, vision, or chronic health challenges,” she said. “Without regular care, minor issues can progress into infections, pain, or mobility limitations that increase fall risk and lead to more serious conditions. Home-based care supports prevention, early detection, and aging in place.”

“The bill would provide relief not only to patients, but also to families and caregivers who are often forced to choose between going without care or attempting to provide it themselves,” Taylor added.

Mary Lou Moran, director of the Pawtucket Division of Senior Services at the Leon Mathieu Senior Center, highlighted the local impact.

“This bill removes unnecessary barriers to essential preventive care and helps close a significant service gap,” she said. “Many individuals we serve cannot safely perform their own foot care and face transportation, mobility, or financial challenges accessing clinic-based services.”

Moran added that regulated, in-home care provided by qualified nurses can help prevent avoidable complications, reduce healthcare costs, and improve quality of life.

Podiatry Association Flags Concerns

Following House passage of H 7029A, the Rhode Island Podiatric Medical Association (RIPMA) issued a statement acknowledging improvements in the bill while raising concerns.

“This issue has always been about ensuring patients can access care from certified and credentialed providers,” the statement read. “We appreciate the inclusion of language requiring nurses to be certified by an accredited organization approved by the Department of Health.”

The organization noted that the bill could benefit truly homebound patients by reducing the risk of self-injury, but emphasized that it is not a substitute for physician care. Patients who can access a podiatrist (in the home or office)—especially those with underlying medical conditions—should continue to receive regular professional treatment.

RIPMA also cited studies showing that Medicare patients with diabetes who receive podiatric care experience fewer hospitalizations and amputations. The group expressed interest in collaborating with certified nurses to ensure safe, appropriate care.

At the same time, Past RIPMA President Dr. Michael Reuter, DPM, FACFAS, voiced concerns about the legislation’s broader impact.

“The legislation aims to solve a problem, but I am concerned it may create new ones,” he said.

Reuter, a board-certified podiatric foot and ankle surgeon in Rhode Island, criticized the absence of a Rhode Island Department of Health recommendation requiring collaboration between nurses and podiatrists. He said such coordination is essential to ensure timely referrals when needed.

“I hope the Department of Health establishes strong safeguards and oversight for providers entering vulnerable patients’ homes,” he said.

He also noted potential cost implications. “Patients will have to pay out of pocket for these services, whereas visits to a podiatrist—whether in-office or through a home visit—are covered by insurance,” he said.

Here is the link to the Feb. 10th House Committee on Health and Human Services on H 7029 A, go to House Committee on Health & Human Services – RISE: 2-10-2026

Here is the link to the March 3rd Senate Committee on Health and Human Services on S. 2116 A, go to Senate Committee on Health & Human Services: 3-3-2026

Caregiving Still a Crisis in America, Pew Report Confirms

Published in RINewsToday on March 9, 2026

Last summer, AARP and the National Alliance for Caregiving (NAC) released their 133-page report, Caregiving in the U.S. 2025, widely regarded as one of the most comprehensive sources of data on family caregivers in America. Seven months later, the Pew Research Center (PRC) expanded the national caregiver debate, releasing its own report, Family Caregiving in an Aging America. This report confirmedthe results of AARP and NAC’s sweeping report, while adding fresh insight to a rapidly growing body of research on caregivers.

These two caregiver reports highlight a powerful demographic trend: the continued graying of America’s population, creating a growing need for Congress and state governments to enact laws to assist the nation’s 63 million family caregivers. At the same time, mounting evidence reveals that increasingly family members are stepping into caregiving roles and responsibilities. The Pew survey released last week which examined the experiences of caregivers, found that the demands of caregiving intensify as family members reach the age of 75 and older.

“Aging in America is one of the most profound demographic trends shaping our society today,” observes Kim Parker, PRC’s director of social trends research, in a Feb. 26, 2026, statement announcing the results of its first-ever caregiver study. Parker emphasized that caregiving for an aging family member encompasses a wide range of responsibilities, including running errands, managing finances, navigating medical issues, and providing hands-on personal care.

“Helping in these ways has a direct impact on the lives of caregivers,” Parker said, stressing that caregiving often strengthens relationships between caregivers and those receiving care. But particularly when it comes to supporting an aging parent, many caregivers say it has taken a toll on their personal well-being, finances, careers, and even their social lives, Parker added.

Taking a Look at Key Findings

The study findings revealed that one in ten U.S. adults reported being a caregiver for a parent aged 65 or older. Another 3% cared for a spouse or partner in that age group.  Fewer than 1% reported caring for both an aging parent and an aging spouse or partner. However,  survey data show that caregiving rates rise significantly among those with older loved ones: 24% of adults with a parent aged 65 or older identify themselves as caregivers, as do 25% of those with an aging spouse or partner.

Consistent with previous research, gender plays a role in taking on caregiving roles and responsibilities. Among adults with an aging parent, spouse, or partner, 28% of women identify as caregivers, compared with 23% of men.

Men and women caring for an aging parent are about equally likely to say that helping with activities of daily living has strengthened their personal relationships.

However, women note that they are more likely than men to report negative effects on their emotional well-being (47% vs. 30%) and physical health (38% vs. 26%).

As to finances, the study found that income also plays a role in who becomes a caregiver.  Among adults with an aging parent, spouse, or partner, 39% of lower-income adults identify as caregivers, compared with 23% of middle-income adults and 16% of upper-income adults.

What Caregivers Do

Roughly two-thirds of adults caring for an aging parent (68%) and a similar share caring for an aging spouse or partner (66%) regularly provide help with at least one key activity of daily living. These tasks include running errands, managing household chores and home repairs, scheduling medical appointments, managing medications, handling finances and paying bills, and also assisting with activities of daily living such as bathing or dressing.

The survey findings also indicate that adults who provide care for an aging parent with at least one of the tasks tend to report that this has had a more positive than negative impact on their relationship with their parent. On balance, caregivers find that this experience has a more negative impact on their physical health, emotional well-being, job (among those employed), finances, and even their social life.

While caring for an aging spouse or partner regularly involves helping them with activities of daily living, they say that this experience has had a more positive impact on their relationship. But unlike their peers caring for an aging parent, their views on physical health, emotions, finances, and social life are more mixed, rather than mostly negative.

Advocates Say Caregiver Crisis Demands Swift Action

“The PRC’s survey findings further validate what other research and caregivers themselves have been telling us — that they’re sacrificing their health, their finances, and their careers to care for the people they love, often with very little support,” says Jason Resendez, NAC’s President & CEO.

According to Resendez, the PRC’s survey findings confirm the findings of AARP and the NAC’s Caregiving in the U.S. 2025 report.  He noted that caregiving falls hardest on those least equipped to handle it. Lower-income families and women carry a disproportionate share of the load. These patterns are consistent with what caregivers on the ground routinely describe.

Like other research findings, Resendez notes that PRC’s report highlights that social isolation, financial strain, and career disruption are widespread among caregivers — yet these tend to get overshadowed in public conversation by the more visible emotional toll. The sharp increase in caregiving demands once a parent crosses into older age brackets is also an underappreciated threshold that catches many families off guard, he says.

PRC’s survey findings, says Resendez, paint burnout not as a single breaking point but as a compounding experience — emotional exhaustion layered with their own declining physical health, shrinking social lives, strained finances, and career setbacks, all happening simultaneously.

“Women in particular experience this accumulation more acutely than men, suggesting burnout has a deeply gendered dimension,” he says.

“The PRC report shows broad, bipartisan public support for concrete interventions: tax relief, respite care, paid family leave, and direct financial assistance,” says Resendez.  Preparation means building infrastructure around these supports before the aging population surge overwhelms families who are already stretched thin, he adds.

When asked what success would look like in reducing caregiver burden by 2030, he responded: “Success would mean closing the income and gender gaps in who bears the caregiving burden, fewer caregivers reporting harm to their health and well-being, and widespread adoption of the financial and workplace supports that the public already overwhelmingly favors. The benchmark is simple: caregiving should not systematically impoverish or exhaust the people doing it,” he says.

Inside the Beltway, aging groups are pressing Congress to support financially struggling caregivers. AARP, representing 38 million older adults, reports that on average, family caregivers spend over $7,200 annually—26% of their income—on out-of-pocket expenses.

“America’s family caregivers put family first, helping their parents, spouses, and others stay at home,” said Nancy LeaMond, AARP Executive Vice President and Chief Advocacy & Engagement Officer. “They spend thousands of dollars every year on this care, while juggling work and family responsibilities. We urge Congress to put money back into the pockets of hardworking family caregivers by passing the bipartisan bill, The Credit for Caring Act,” she says.

The Senate bill (S 925), introduced in the Senators Shelley Moore Capito (R-WV) and Michael Bennet (D-CO) and in the House (H.R. 2036) by Representatives Mike Carey (R-OH) and Linda Sánchez (D-CA), offers up to a $5,000 nonrefundable federal tax credit to help offset caregiving expenses, addressing the significant personal and financial sacrifices caregivers make to support their loved ones.

AARP says respite care is essential to preventing caregiver burnout, yet access remains limited and uneven, leaving many caregivers without the breaks they need to continue caring for loved ones. The aging advocacy group is calling on Medicaid to strengthen home- and community-based services, reduce unnecessary red tape, and ensure that family caregivers can access supports such as respite care and training.

Family caregivers provide more than $600 billion worth of care each year, and that labor should earn them benefits through Medicare and Medicaid, says Maggie Ornstein, PhD, a public health geographer, guest faculty member at Sarah Lawrence College, and a family caregiver for more than 30 years who writes extensively on caregiver issues.

Ornstein agrees with AARP’s call to strengthen Medicaid and argues that home care should be a required benefit under the program, just as institutional care is. “Wages for home care workers need to be increased,” she says, noting that providing living wages would make these jobs more desirable and, in turn, better support family caregivers.

“There is also an urgent need for Medicare to cover home care and related services,” Ornstein adds. “Coverage should also be available to caregivers before the standard age of eligibility. Similar to how people with permanent disabilities qualify for Medicare, eligibility could be expanded to caregivers who provide more than 20 hours of care per week,” she says.

Ornstein notes that direct payment to caregivers is popular (63% in PRC’s study) and would have the biggest impact on caregivers. “We know that caregivers often have to reduce paid employment or leave work entirely, so direct payment in the form of wages or ‘caregiver allowances,’ as provided in countries like Canada, Australia, Germany, and the UK, would help with financial security,” she says.

Research suggests, says Ornstein, that caregivers lose more than $300,000 in wages and benefits over their lifetimes. “Tax credits, while often the most widely discussed policy response, would do little to help the lowest-income and most vulnerable caregivers. Proposed tax credits would need to be refundable to have the most impact, but even then, direct payments would better bolster financial well-being, which should be a main policy priority,” she says.

Other policies, such as the Social Security Caregiver Credit Act, need more public attention, too, says Ornstein, emphasizing that providing Social Security credits to caregivers who leave work to provide care would be transformative for their retirement.

Finding a Care Giver Policy Fix in Rhode Island

With the release of the PRC caregiver survey findings, it is more important than ever to spotlight the vital role of our state’s caregivers, says SACRI Policy Advisor Maureen Maigret, who calls caregivers the backbone of Rhode Island’s long-term services and supports system.

According to Maigret, the PRC report highlights that lower-income adults with an aging parent, spouse, or partner are more likely to serve as caregivers than those with higher incomes. “That is why SACRI views the passage of a caregiver tax credit bill as a priority,  one that will help offset the financial burden faced by so many caregivers,” she says.

H7241, sponsored by Rep. Susan R. Donovan (D-Dist. 69, Bristol, Portsmouth), and S. 2246, sponsored by Sen. Linda L. Ujifusa (D-Dist. 11, Portsmouth, Bristol), would provide a tax credit of up to $1,000 for a family caregiver caring for an older adult or a person receiving Social Security Disability who requires assistance with two activities of daily living. The proposal would cover up to 50 percent of eligible expenses, capped at $1,000.

Supporters say that establishing a caregiver tax credit would help older adults and people with disabilities remain in their homes while also reducing costly Medicaid expenditures on nursing home care, which can exceed $100,000 annually.

A Final Note…

One of the biggest unanswered questions about caregiving in America today is whether there is the political will in Congress to support family caregiving.

“The PRC’s report shows that relationships are strengthened through both providing and receiving care. When caregivers are not supported in that care, they experience significant stress,” Ornstein said.

“We have an opportunity to value the care provided by family and non-kin caregivers across the country and, in doing so, strengthen our communities. Instead, we have a system that abandons, neglects, and exploits family caregivers. We need more people to decide that this is unacceptable and to demand the support caregivers earn through the work they do every day,” Ornstein adds.

To read PRC’s caregiving report, go to https://www.pewresearch.org/social-trends/2026/02/26/family-caregiving-in-an-aging-america/

To get a copy of Caregiving in the US 2025: Key Trends, Strains, and Policy Needs, go to https://www.aarp.org/pri/topics/ltss/family-caregiving/caregiving-in-the-us-2025/

For state-specific caregiving data, go to https://www.aarp.org/pri/topics/ltss/family-caregiving/caregiving-in-the-us-2025-caring-across-states/

HHS Shake-Up Sends Shockwaves Through Aging Network

Published on April 31, 2025

Taking a page from President Donald J. Trump’s to “Make America Great Again,” last week the U.S. Department of Health and Human Services (HHS) announced a major restructuring of the federal agency to “Make America Healthy Again.” The dramatic restructuring in accordance with Trump’s Executive Order, “Implementing the President’s ‘Department of Government Efficiency’ Workforce Optimization Initiative.”

The U.S. Department of Health and Human Services (HHS), under management of HHS Secretary Robert F. Kennedy, Jr., last week announced a major restructuring and renaming of the federal agency under the initiative “Make America Healthy Again.” This dramatic reorganization follows Trump’s Executive Order, Implementing the President’s ‘Department of Government Efficiency’ Workforce Optimization Initiative.

“We aren’t just reducing bureaucratic sprawl. We are realigning the organization with its core mission and our new priorities in reversing the chronic disease epidemic,” said HHS Secretary Robert F. Kennedy, Jr. in a statement announcing the massive overhaul. “This Department will do more—much more—at a lower cost to taxpayers.”

“Over time, bureaucracies like HHS become wasteful and inefficient, even when most of their staff are dedicated and competent civil servants,” Kennedy added. “This overhaul will be a win-win for taxpayers and those HHS serves. That’s the entire American public, because our goal is to Make America Healthy Again.”

During the Biden administration, HHS’s budget increased by 38%, and its staffing grew by 17%, prompting the new HHS chief to place the federal agency on the budgetary chopping block.

According to HHS, this restructuring will not impact critical services while saving taxpayers $1.8 billion per year through a reduction of approximately 10,000 full-time employees. When combined with other cost-cutting initiatives, including early retirement, and the Fork in the Road program, the total downsizing will reduce HHS’s workforce from 82,000 to 62,000 employees.

HHS also plans to streamline departmental functions. Currently, the agency’s 28 divisions contain redundant units. Under the restructuring plan announced on March 27, 2025, these units will be consolidated into 15 new divisions, including a newly created Administration for a Healthy America (AHA). Additionally, core organizational functions—such as Human Resources, Information Technology, Procurement, External Affairs, and Policy—will be centralized. The number of regional offices will be cut from 10 to five.

As part of the restructuring, several agencies will see workforce reductions. The U.S. Food and Drug Administration (FDA) will cut approximately 3,500 full-time employees, focusing on streamlining operations and centralizing administrative functions, though HHS asserts these reductions will not affect drug, medical device, or food reviewers, nor inspectors.

Similarly, the U.S. Centers for Disease Control and Prevention (CDC) will downsize by approximately 2,400 employees, refocusing its efforts on epidemic and outbreak response. The National Institutes of Health (NIH) will eliminate 1,200 positions by centralizing procurement, human resources, and communications across its 27 institutes and centers. Meanwhile, the Centers for Medicare and Medicaid Services (CMS) will cut around 300 positions, targeting minor duplication within the agency. HHS insists these changes will not impact Medicare or Medicaid services, but improve them.

Restructuring HHS to Focus on Chronic Illness Prevention

HHS’s overhaul aligns with the agency’s new priority of ending America’s chronic illness epidemic by focusing resources on ensuring safe, wholesome food, clean water, and the elimination of environmental toxins.

The Administration for a Healthy America (AHA) will consolidate five agencies—the Office of the Assistant Secretary for Health, the Health Resources and Services Administration, the Substance Abuse and Mental Health Services Administration, the Agency for Toxic Substances and Disease Registry, and the National Institute for Occupational Safety and Health—into a single entity. This unification aims to enhance health resource coordination for low-income Americans, emphasizing primary care, maternal and child health, mental health, environmental health, HIV/AIDS, and workforce development.

Additionally, the Administration for Strategic Preparedness and Response, responsible for national disaster and public health emergency response, will be transferred to the CDC to strengthen its core mission of protecting Americans from health threats.

To combat waste, fraud, and abuse, HHS will create a new Assistant Secretary for Enforcement, overseeing the Departmental Appeals Board, the Office of Medicare Hearings and Appeals, and the Office for Civil Rights.

Furthermore, HHS will merge the Assistant Secretary for Planning and Evaluation with the Agency for Healthcare Research and Quality to form the Office of Strategy, enhancing research to inform policy decisions.
Critical programs under the Administration for Community Living (ACL), which supports older adults and people with disabilities, will be integrated into other HHS agencies, including the Administration for Children and Families, the Office of the Assistant Secretary for Planning and Evaluation, and the Centers for Medicare and Medicaid Services (CMS). HHS assures that these changes will not impact Medicare or Medicaid services.

Sounding the Alarm

Following the announcement of HHS’s restructuring plans, which would broad without a lot of detail, aging advocacy groups quickly released statements to voice strong concerns.

“For decades, the federal health programs that retirees and people with disabilities depend on have been ably administered under both Democratic and Republican administrations. However, the radical cutbacks proposed by the Trump administration place the delivery of these programs in jeopardy,” warned Dan Adcock, Director of Government Relations & Policy at the National Committee to Preserve Social Security and Medicare (NCPSSM).

Adcock also noted that HHS plans to eliminate the ALC and divide its responsibilities between two offices with no prior experience in this area. “This administration has already demonstrated a reckless disregard for public interests in favor of slashing operations and staff under the guise of ‘efficiency,’” he added. “So far, all they have done is create chaos and confusion, disrupting essential programs for seniors and the disabled. We view Secretary Kennedy’s plans with alarm.”

Nancy LeaMond, Executive Vice President and Chief Advocacy and Engagement Officer at AARP, also urged HHS to prioritize older Americans’ health needs. “HHS must ensure access to senior centers, community health centers, nutritious meals, Medicare assistance, and other vital services that countless older Americans rely on. Health is central to the lives, well-being, and financial security of AARP’s members and the more than 100 million Americans over age 50,” she emphasized.

Terry Fulmer, PhD, RN, FAAN, President of the John A. Hartford Foundation, echoed these concerns. “The announcement of workforce cuts at HHS comes at a time of unprecedented growth in America’s aging population. The proposed reorganization of ACL and its integration into other agencies requires careful consideration.”

Fulmer stressed that ACL administers programs essential to older adults’ daily lives, such as meal delivery, transportation to medical appointments, and chronic disease management. Absorbing these functions with far fewer staff demands careful planning. The government’s commitment to older adults requires a cautious approach, she said.

The Center for Medicare Advocacy also expressed deep concerns, particularly regarding plans to restructure ACL and consolidate oversight of Medicare appeals. “Given what we have seen with Social Security Administration cuts and restructuring, HHS’s claim that these changes won’t impact critical services rings hollow,” said Co-Director David Lipschutz.

LeadingAge, a national association representing nonprofit aging services providers, called for HHS to ensure older adults and their caregivers are not overlooked. “Cutting staff responsible for critical agency functions raises serious concerns. How will the work our members rely on get done? How will this impact quality care for older adults?” asked President and CEO Katie Smith Sloan.

Sloan also cautioned that reducing HHS’s field offices from 10 to five could impact CMS’s ability to oversee nursing home surveys and provider compliance. “A 25% workforce reduction must be undertaken with extreme care—especially given the millions of older adults who depend on these services,” she emphasized.

For a fact sheet on the HHS restructuring, visit https://www.hhs.gov/about/news/hhs-restructuring-doge-fact-sheet.html