Published in Woonsocket Call on June 18, 2017

With America’s baby boomers beginning to turn age 80 in 2026, days ago the Washington, DC-based AARP released Scorecards detailing how each state spends its dollars on long-term services and supports (LTSS) to assist older adults and adults with disabilities. The report findings revealed a need for state legislatures to quicken the pace of improving LTSS for their older residents. LTSS include assistance with activities of daily living provided to older adults and people with disabilities who cannot perform these activities on their own because of physical, cognitive, or chronic health conditions. The types of assistance include such things as help with bathing, dressing, managing medications, preparing meals, and transportation, as well as support for family caregivers.

The latest comprehensive state-by-state Scorecard report was funded by AARP Foundation with support of the nation’s leading organizations behind quality long-term care, The Commonwealth Fund and SCAN Foundation. This is the third edition of the Scorecard, initially released in 2011 and again in 2014.

AARP’s 2017 report, “Picking Up the Pace of Change: A State Scorecard on Long-Term Services and Supports for Older Adults, People with Physical Disabilities, and Family Caregivers (“Scorecard”), released on June 14, finds that although Rhode Island and most states have taken small steps to make some progress, this pace of change overall remains too slow and has not kept up with demographic demands.

“This Scorecard sounds the alarm, but it also provides a range of tools states can use to spark new solutions and create systems that are aligned with the new realities of aging and living with a disability,” said Susan Reinhard, RN, PhD, Senior Vice President and Director, AARP Public Policy Institute. “The proposed cuts to Medicaid—the largest public payer of long-term assistance—would result in millions of older adults and people with disabilities losing lifesaving supports.”

“This new Scorecard shows that it’s time for all states to accelerate care improvements for older adults and people with disabilities,” said Bruce Chernof, MD, FACP, President and CEO of The SCAN Foundation. “States that consistently rank at the top have strategically planned for their aging population across the main sectors of health, housing, transportation and family caregiving.”

Like previous two LTSS scorecards, states are ranked on their performance in five categories: Affordability and access, Choice of setting and provider; Quality of life and quality of care; Support for family caregivers; and Effective transitions between nursing homes, hospitals and homes. Within the five categories, states are scored on their performance in 25 specific indicators, including such things as Medicaid spending, nursing home cost, home health aide supply, antipsychotic medication use in nursing home residents, long nursing home stays, employment rate of people with disabilities, and support of working caregivers.

But this year, AARP has made changes in LTSS Scores in the way information is presented on its interactive website (www.longtermscorecard.org), making it easier for a user to customize data to suit their specific needs. Visitors to the Scorecard site will be able to access videos, called Impact Stories, that show how improving on the Scorecard can impact the lives of real people.

Users can also download Promising Practices as well as Emerging Innovations (updated throughout the year) that state officials can use as they work to improve their long-term care delivery systems.

Rhode Island Improves in Delivering LTC Services

In the 2017 AARP report, Rhode Island ranks 32nd overall when it comes to meeting the long-term care needs of older residents and people with disabilities, but showed improvement in all but one Scorecard category. AARP warns more must be done, at an accelerated pace, to meet changing demographic demands. Rhode Island ranks 22nd nationally Support for Family Caregivers and 24th in Quality of Life & Quality of Care. The state ranks 35th in Effective Transitions – the only category in decline

“The vast majority of older Rhode Islanders want to live independently, at home, as they age—most with the help of unpaid family caregivers,” says Kathleen Connell, State Director of AARP Rhode Island, which serves more than 138,00 members age 50 and older in the state. “Even facing tight budgets, Rhode Island is making progress to help our older residents achieve that goal. However, this Scorecard shows we have more to do, and we need to pick up the pace.”

According to Connell, today, unpaid family caregivers provide the bulk of care for older Rhode Islanders in part because the cost of long-term care remains unaffordable for most middle-income families. In Rhode Island, more than 134,000 residents help their aging parents, spouses and other loved ones stay at home by helping with bathing and dressing, transportation, finances, complex medical tasks like wound care and injections, and more. The value of this unpaid care totals about $1.78 billion.

“When it comes to helping older Rhode, Islanders live in the setting of their choice, family caregivers take on big responsibilities,” explains Connell. “Many juggle full-time jobs with their caregiving duties; others provide 24/7 care for their loved ones. With every task they undertake, these family caregivers save the state money by keeping their loved ones out of costly nursing homes – most often paid for Medicaid. They have earned some basic support.”

“That’s why AARP Rhode Island has fought for Caregiver, Advise, Record, Enable (CARE) Act; caregiver temporary leave insurance; and caregiver tax credits, adds Connell.

Rhode Island has made progress to improve long-term services and supports for older adults and people with disabilities, as highlighted in this Scorecard. But, proposals in Washington, D.C. to drastically cut federal Medicaid funding would threaten these advancements, likely resulting in our most vulnerable citizens losing the lifesaving supports that they count on,” says Connell.

“The single strongest predictor of a state’s long-term care system is the reach of its Medicaid long-term care safety net,” says Connell, noting that’s why AARP fights to expand services provided at home and in the community, by shifting funds away from and more expensive nursing home care. “While the percent of long-stay nursing home residents hospitalized within a six-month period has decreased, the Scorecard highlights additional serious issues related to institutional care in Rhode Island, such as residents with pressure sores and residents with low care needs],” she notes.

While Rhode Island has improved its rank from 50th to 44th in the percentage of Medicaid long-term care dollars for older adults and people with physical disabilities that support care provided at home and in the community—the care setting that most Rhode Islanders prefer—the Scorecard spotlights areas that call for improvement, including choice of setting and provider; and effective transitions.

Specifically, the percent of

• Medicaid and state-funded LTSS going to HCBS;
• Medicaid LTSS users first receiving services in the community;
• People with 90+ day nursing home stays successfully transitioning back to the community;
• Nursing home stays lasting 100 days or more.

“This Scorecard gives us a snapshot of how well Rhode Island serves our older residents, those with disabilities, and family caregivers—and shows us where we must sharpen our focus to better assist hardworking Rhode Islanders,” concludes Connell. “We will continue to work with the governor, legislative leaders and policymakers to take the actions needed now to protect our expanding needs.”

Connell says that of the 25 Scorecard indicators, many may be improved through state policy changes, pointing to the importance of AARP’s multi-state advocacy campaign, launched in 2014, to help older Americans live independently, at home, and the family caregivers that support them.

Director Charles Fogarty, of Rhode Island’s Division of Elderly Affairs, sees the importance of AARP’s Rhode Island’s Scorecard, to evaluate progress in meeting the needs of older Rhode Islanders. “This report reinforces what we already know: while Rhode Island is showing improvements in some areas, there is still much to be done to provide the level of care and services our seniors deserve. Our improved ranking from 50th to 44th in the percentage of Medicaid long-term care dollars spent on home and community care options is a step in the right direction,” says Fogarty.
“We must continue to build upon the success of Reinventing Medicaid and move towards rebalancing of the long-term care system while preserving access and quality of care for older Rhode Islanders,” adds Fogarty.

AARP Scorecard Snap Shot of the National Delivery of LTSS

Washington State and Minnesota are top-ranked states again (followed by Vermont, Oregon and Alaska), but all states lag in helping care for the nation’s growing populations of older persons with people aging and living with disabilities.

AARP’s LTSS Score card noted that the bottom ranking states were Indiana, (No. 51), Kentucky (No. 50, Alabama, (No. 49), Mississippi, (No. 48), and Tennessee (no. 47).

According to researchers, overall, states made incremental LTSS improvements since the previous report in 2014, but the pace of change has been slow and uneven. However, two states—Tennessee and New York—showed the most improvement across measures since the last Scorecard.

States made the most significant progress in reducing inappropriate ‘off label’ use of antipsychotic medications among nursing home residents and increasing support of family caregivers.

In general, states showed the most significant declines in employment rates for people with disabilities and rates of transitioning long-stay nursing home residents back into the community. Notably, the majority of states showed no real change on ‘Affordability and Access,’ meaning that the cost of LTSS over time continues to be much higher than what the majority of families can afford.

Herb Weiss, LRI’12 is a Pawtucket writer covering aging, health care and medical issues. To purchase Taking Charge: Collected Stories on Aging Boldly, a collection of 79 of his weekly commentaries, go to herbweiss.com.

Published in Woonsocket Call on June 4, 2017

Last month, President Donald Trump submitted his Fiscal Year 2018 budget proposal to a GOP controlled Congress. Critics of the Republican president and Democratic lawmakers called the 62-page budget proposal, “Dead on Arrival.” Now, with Congressional recess over, look for the House and Senate to begin drafting their own fiscal blueprint.

Massive Cuts to Entitlements and Discretionary Spending

Trump’s $4.1 trillion spending plan proposes historic, massive cuts by eliminating funding for 19 federal agencies to offset the cost of $54 billion to increase defense spending, to pay for infrastructure and the construction of a border wall between Mexico and the U.S., and to fund school voucher programs and a new paid leave initiative. The Trump budget also slashed funding from the budgets of other executive departments and agencies as well. The Environment Protection Agency, the State Department and Agriculture Department took the biggest funding cuts.

The core philosophy of Trump’s first full budget request, “A New Foundation for American Greatness,” can be described as “Taxpayer First,” says Director Mick Mulvaney, of the Office of Management and Budgets.

Mulvaney, a former Republican Congressman now serving as Trump’s budget director, told reporters one day before the release of Trump’s budget, “This is, I think, the first time in a long time that an administration has written a budget through the eyes of the people who are actually paying the taxes.”
We’re not going to measure our success by how much money we spend, but by how many people we actually help,” added Mulvaney.

Many aging advocates fear that Trump’s budget proposal will fray the nation’s social safety net forcing seniors to fall into poverty.
With the release of the Trump Budget proposal, the Washington, DC-based AARP, representing over 38 million members was quick to issue this statement. Executive Vice

President Nancy LeaMond said “AARP opposes the budget proposed today because it explicitly harms the very people we are counting on the President to protect. Today’s budget proposes to cut Social Security benefits, as well as funding for critical health, hunger, housing, and transportation assistance to low and middle-income seniors. This budget sends a powerful message to older Americans and their families that their health and financial security is at risk.”

“We do want to acknowledge the Administration’s paid leave proposal. Although it must be improved so that it addresses the workplace needs of all family caregivers, we hope that it leads to a national conversation about ways to support family caregivers in the workplace,” adds LeaMond.
The Washington, DC-based National Committee to Preserve Social Security and Medicare (NCPSSM), believes Trump’s released budget proposal “literally leaves seniors in the cold.”

“This heartless budget does not reflect true American values,” says Max Richtman, President and CEO of the National Committee to Preserve Social Security and Medicare in a statement. “In our America, we do not cast seniors into the cold. We do not take food out of their mouths or make it harder to get the healthcare they so desperately need. In short, we do not cut off our most vulnerable citizens at the knees to pay for a massive tax break for the wealthy and big corporations.”

“This budget undermines the President’s promises to seniors. It guts Medicaid, which he promised to protect. The cuts to Social Security Disability Insurance (SSDI), [a program that helps disabled beneficiaries to say at work or return to work] violates his pledge not to tamper with Social Security. It also casts into serious doubt his pledge as a candidate to defend Medicare. No one who is serious about protecting these vital programs would propose a budget so harmful to seniors,” says Richtman.

Richtman says, “Make no mistake: the $64 billion in SSDI cuts are very real – and would cause real pain for Americans with severe disabilities. These are people deemed by the Social Security Administration to be too disabled to work. The qualification requirements are stringent, and the cases dire. Though SSDI helps younger Americans, too, most of its beneficiaries are 55 or over – meaning any cuts to the program will hit older Americans particularly hard. In fact, an average 1 in 6 men on SSDI die within 5 years of claiming benefits. For women, the figure is 1 in 7.”

Trump Budgetary Cuts Hurt Seniors, Poor

According to NCPSSM’s Government Relations and Policy staff, Trump’s budget proposal would drastically slash or eliminate funding for programs that benefit America’s seniors. Here is a sampling of budgetary cuts they identified.

Trump’s budgetary cuts of SSDI has an impact on older disabled persons. It would limit the retroactivity of applications for disability benefits from 12 months to six months and denies unemployment compensation payments to certain SSDI beneficiaries. Finally, it unreasonably caps the amount of payable to individuals who receive SSDI while living with other Supplemental Security Income recipients.

The president’s budget proposal also slashes more than $600 billion from the Medicaid program, which undermines seniors’ access to long-term care. It also eliminates the Community Services Block Grant ($715 million), the Community Development Block Grant ($3 billion) and the Social Service Block Grant ($1.7 billion) which helps fund some Meals-on-Wheels program, delivering hot meals to needy seniors.

Trump calls for eliminating the Low Income Home Energy Assistance Program (LIHEAP) which assists seniors with heating costs. LIHEAP received $3.39 billion in President Obama’s Fiscal Year 2017 budget. Of the 6.8 million household’s assistance, it is estimated that 2.26 million are over age 60.
Federal funding is also reduced for the National Institutes of Health (NIH) by $5.67 billion (including nearly $300 million for the National Institute on Aging), which will negatively impact research into cancer, Alzheimer’s, Parkinson’s and other diseases affecting older Americans.

With flat-line funding in the president’s budget proposal, we can expect longer waits at the local offices of Social Security Administration (SSA) and even extended waits when calling SSA’s telecommunication centers. The agency has been critically underfunded since 2010 – reducing the quality of service to SSA beneficiaries. This will continue.

Finally, Trump’s budget proposal eliminates funding for the Senior Corps programs, including the Retired and Senior Volunteer Program, Foster Grandparents and Senior Companions. These programs enable older adults to remain act in their homes.

Rhode Island Lawmaker Gives His Two Cents

U.S. Rep. David N. Cicilline notes, who serves as Co-Chair of the House Democratic Policy and Communications Committee “If a budget is a statement of your priorities and values, then Donald Trump’s budget shows he doesn’t understand the challenges facing Rhode Island seniors. This budget would cut Medicaid by up to $1.3 trillion over the next decade, jeopardizing health coverage that more than 18,000 Rhode Island seniors rely on to access high-quality affordable care.”

“Additionally, despite the President’s campaign promise not to touch Social Security, this budget carves out tens of billions in cuts to SSDI. That would have a devastating impact on SSDI recipients – most of whom are over the age of 55 – who have worked their entire lives and are physically unable to earn additional income,” says the Democratic lawmaker.

Cicilline warns, “Trump’s proposal to slash $193 billion – over 25 percent of total funding – over a decade to the Supplemental Nutrition Assistance Program (SNAP) would undermine the health and well-being of more than 16,300 Rhode Island seniors who receive assistance for their basic food and nutrition needs every month.”

“This budget would eliminate the Low Income Home Energy Assistance Program (LIHEAP), which helps low-income people, including thousands of seniors, pay their heating and cooling bills. It also eliminates the Social Services Block Grant and State Health Insurance Program, both of which provide critical federal support to help states meet the individualized needs of their seniors,” adds Cicilline.

“Plain and simple, this is a budget written by the wealthiest Americans for the benefit of the wealthiest Americans. But it’s a setback for the middle class and millions of seniors who have worked hard and played by the rules for their entire lives. Along with my colleagues in the House Democratic Leadership, I will do everything I can to reverse these devastating cuts and shape a budget that invests in the future of our country and puts honest, hardworking families first,” says Cicilline.

AARP, NCPSSM and aging advocates, now turn their attention to the House and Senate to keep Trump’s draconian budgetary vision out of the final FY 2018 budget. But, voters must also oppose huge cuts in Medicare, Medicaid and Social Security entitlement programs and discretionary funding for programs for older Americans at town meetings held by their Congressman and Senators.

Midterm elections will take place on Tuesday, November 6, 2018, All 435 seats in the House and 34 of the 100 senate will be up for grabs. Maybe GOP lawmakers will craft a budget proposal that will benefit their constituents, not support their political party’s policy positions.