Category Archives for Healthcare

Rhode Island Lawmakers Poised to Give Retirees Financial Tax Relief

Published in Woonsocket Call on May 31, 2015

During the 2014 legislation session, Rep. Robert E. Craven, (District 32) introduced and successfully pushed for passage in the General Assembly. This legislative proposal would ultimately being signed into law by the Governor. Little did the North Kingston law maker realize that door knocking to get reelected in last November’s election would give him an issue to tackle on Smith Hill this year.

At hundreds of homes, he heard the same issue from his older constituents. One such comment was etched sharply in Craven’s memory: “You’re a nice guy, buy I am not going to vote for you because I am leaving the state, the older voter told him. The puzzled lawmaker asked “why?” The response, “We decided the state is so expensive to live in because of taxes we’re going to sell our house and move to Florida. Wanting the specifics, Craven asked, what specific tax bothers you? “We are only of a few states that tax social security benefits, that’s the straw that broke the camel’s back,” said the older voter.

Craven’s legislative proposal, H 5000, was heard Wednesday night before the House Finance Committee. Strongly supported by House leadership, he says, the legislation would ease the tax burdens on Rhode Island retirees by exempting them from paying state income tax all Social Security benefits as well as income received from federal, state and local government retirement plans, disability benefits, military pensions and private pension plans and deferred-compensation plans.

Among its more than 40 co-sponsors are Rep. Stephen M. Casey (D-Dist. 50, Woonsocket), Rep. Michael A. Morin (D-Dist. 49, Woonsocket), Rep. Samuel A. Azzinaro (D-Dist. 37, Westerly) and Rep. Cale P. Keable (D-Dist. 47, Burrillville, Glocester).

If enacted, Rhode Island would join 27 other states – including Massachusetts and Maine – and the District of Columbia that specifically exempt Social Security income from taxation. (Although Rhode Island does not specifically tax Social Security benefits, that income is identified on federal tax returns. Since Rhode Island’s income tax is based on the federal adjusted gross income of federal tax form filers, the end result is that Rhode Island generates a portion of its income tax collections from Social Security benefits.)

According to Craven, his legislative proposal would financially benefit Rhode Island seniors who receive retirement benefits. ”After paying into the Social Security system their entire working lives, or putting a little money away into private pension plans, or working at jobs that provide them with a pension, it doesn’t seem right that retirees are having taxes eat away at benefits they depend on for their very livelihood,” he says.

“Retirees living on a fixed income are probably more severely impacted by taxes and tax increases than other population groups,” observes Craven. “If we are committed to helping retirees have a safe and secure life in their later years, and if we want to help seniors afford to stay in Rhode Island rather than moving to more tax-friendly locations, we need to ease their financial burdens. Exempting retirement income from the state income tax is one step we should take,” he adds.

Tax Exemption in House Budget

Weaving its way through the legislative process Craven ultimately expects his legislative proposal to be modified to not give older tax payers a complete exemption on paying taxes for their social security income. Specifically, the revised language would say, “If your house hold income is under $100,000 or less than your Social Security is tax exempt from state income taxation.”

While a Senate companion measure has been introduced by Senator Walter S. Felag, Jr., representing Bristol, Tiverton and Warren, an amended H 5000 will be placed in the House Budget because of its cost, says Craven.

The price tag could be between $30 and $35 million, Craven says, noting that better than expected revenues enable it to be funded. “It’s a priority to the state’s economic recovery, he says.

Older retirees, making from $35,000 to $100,000, from Social security and their pensions, will just put their dollars in the local economy, adds Craven. “It’s a good investment and we owe it to them. These retirees have been here all their lives, he says, noting that they ask very little for benefits from municipalities. “They have a lot of time on their hands to volunteer [in their communities] and are very philanthropically included in offering money and services to charities.”

Says House Speaker Nicholas Mattiello, “Representative Craven’s bill to exempt the state tax on Social Security will be included as part of the budget that the House Finance Committee will be considering within the next few weeks. Governor Raimondo included this exemption for low-wage earners in her original budget proposal, but the House will be broadening it to assist the middle-class retirees as well. The House budget exempts retirees, age 65 and over, who have income thresholds of up to $80,000 for individuals and $100,000 for joint tax filers.”

“We believe that by incorporating Rep. Craven’s bill into the budget, this will begin to stop the exodus of retirees leaving Rhode Island for many other states where there is no state tax on Social Security benefits,” adds Mattiello.

Gov. Gina M. Raimondo sees Social Security is a key source of income for older Rhode Islanders, noting that her submitted March budget proposal eliminates state taxes on Social Security benefits for low and middle income seniors “to help them make ends meet and stimulate our economy.”
With Rhode Island unions hit hard by the state’s recent pension reform, Craven’s proposal has received thumbs up from some.

James Parisi, field representative and lobbyist for the Rhode Island Federation of Teachers and Health Professionals, says his union supports Craven’s legislative proposal. “Unlike some other tax cut proposals introduced this session, his bill includes state and local government pension benefits. About half of the state’s teachers were never eligible to participate in social security so any tax cut proposal that is limited exclusively to social security benefits would be unfair to thousands of retired public school teachers,” he says.

Jim Cenerini, a lobbyist for Council 94, AFSCME also says his union is squarely behind H 5000. “Council 94 believes that legislation deserves careful consideration and support because: many other states provide some type of income tax exemption to retirement benefits/Social Security; in 2014 Kiplinger ranked Rhode Island as one the least tax friendly states for retirees; and since a significant majority of public employees remain in Rhode Island, and contribute to our local economy by spending on goods and services, it’s important to provide an incentive to remain in-state.”

A Final Note…
Other legislation proposals have also been thrown into the legislative hopper this session to protect older taxpayers. H 5446, introduced by Woonsocket law maker Rep. Stephen M. Casey, would protect the pocket books of retired teachers who are receiving a pension from Massachusetts. “These retirees, whose pension are overseen by Massachusetts Teachers Retirement System, are essentially double taxed because of the state’s tax code,” he says.

On Friday, May 29, the Rhode Island Public Expenditure Council (RIPEC) issued a report noting that the state may have significantly more funds available in fiscal 2015 and 2016 than anticipated when Gov. Raimondo submitted her budget in March. Specifically, state revenues are expected to be up by $106.8 million this year and $36.6 million next year, with additional funds available from expenditure reductions.

For this writer, its sound public policy to use some of the anticipated surplus identified in RIPEC’s report to enact H 5000 and H 5446 to lessen the tax burdens of Rhode Island’s retirees. As mentioned earlier, older taxpayers pull less resources from their cities and towns. But, most important, these retirees have greatly contributed to the quality of life in their communities throughout their working years.

Herb Weiss, LRI ’12, is a Pawtucket-based writer covering aging, health care and medical issues. He can be reached at hweissri@aol.com.

Bridging the Generations Through Multi-generational Trips

Published in Woonsocket Call on May 24, 2015

        For America’s 76 million baby boomers who spend $120 billion annually in leisure travel, three generation family vacations, including kids, parents, aunts/uncles and grandparents, are becoming a popular way to bond and create lasting memories, says a new AARP study about travel patterns of age 45 and over persons.

Researchers say that “a multi-generational trip is not typically inspired by a special event, but rather a desire to spend quality time together as a family.”  Although grandparents are more likely to pick up the tab for the trip, typically each family pays for their own expenses, they note.  Eighty one percent of travelers stayed at the same accommodation with their entire family.

The February 2015 research study on Multi-Generational Travel, offers insights into multi-generational vacations including why families are going, where they’re going, what they do on these family vacations, the challenges to plan them and why they create memories of a lifetime.

“Multi-generational family travel is becoming the new trend in family vacations. Our AARP 2015 Travel Trends found initial evidence that they would be popular in 2015 and now we know why,” said Stephanie Miles, Vice President, Member Value, AARP. “Our multi-generational travel research found 98 percent of travelers who took a multi-generational trip were highly satisfied and 85 percent are planning to take another one in the next 12 months.”

According to the study’s findings, 80 percent of the respondents traveled domestically in the U.S. and many chose active cities, beaches, amusement parks (Disney, too).  Also, California and Hawaii were two popular states to visit.  Domestic generational trips usually spans from 4 to 7 days.

Twenty percent traveled internationally with half heading to the Caribbean, Mexico or South America, says the findings.  Cruising is also a popular way to vacation for 25 percent of international travelers.  But, almost 40 percent chose nostalgic destinations to share a childhood memory.

The study finds that regardless of the location of the multi-generational trip, “dining out is the primary activity that engages the whole group.” While selecting and planning a trip may challenging, especially choosing the travel date, 98 percent of the multi-generational travelers were satisfied with their most recent trip.

Researchers found that traveling with parents, kids and grandparents can be positive in many ways.  Eighty three percent say that the trip brings the entire family together, while 69 percent stressed it helped to build special memories.  Fifty percent of the respondents noted that they were able to spend time with grandkids and 36 percent note the quality one-on-one time with family/spouse experienced during traveling.  Twenty nine percent say there were benefits of adult relatives spending time with younger generations.

The new research conducted by AARP Travel offers valuable insights into multi-generational travel, findings that Collette certainly can relate to, says Amelia Sugerman, Communications & Public Relations for Pawtucket-based Collette, a third-generation family-owned travel company.  “Over the past five years, Collette has witnessed an increase in family travel by about 20%,” she says, noting that this might be tied to age 65 and older adults who feel an urgent need to create ever lasting memories with their families.

“In a day and age where text messaging and face time has become the norm, it’s a unique chance to spend quality time together as one unit.  Although we do agree that bringing the family together and helping to build memories are top benefits of multi-generational travel, we have also identified many families who use the experience to celebrate a momentous occasion or event, says Sugerman, noting that the AARP study did not find special events triggering the planning of a Multi-Generation Vacation.

An older traveler, who took Collette’s National Parks tour, recently shared the details why this trip was so important to her family.  “My husband and I are getting older. Of course we think about the time we have left to spend with our grandchildren. This experience was the perfect way to celebrate our 50th wedding anniversary.”

Like many of Collette’s older travelers, this customer was ambivalent about the destination. adds Sugerman, noting that the older couple did not want to travel too far and wanted everyone to enjoy themselves, but the experiences were far more important than the sights of the destination.”

Sugerman says the benefits of touring organized by companies like Collette, is that guests of all ages can have a great experience and no one has to worry about the details of planning.  This reflects findings in the AARP study that found 20 percent of families identify the task of coordinating the trip to be the toughest.

“Guided travel takes the guess work out of it [traveling] and leaves valuable time for guests to simply enjoy their time together, says Sugerman.

Don’t forget to document your family multigenerational trips, suggests Patricia S. Zacks, proprietor of the Camera Werks, on Hope Street in Providence.   “While it’s trendy to be taking pictures on your cell phone or selfies documenting your vacation, people tend not to print these pictures,” she says, noting that statistics indicate that these pictures stay on a disk or memory card.

Taking special pictures of your family members on a trip will give you images that you can look at and reflect on, says Zacks. ‘There is nothing more special to look at than a 100 year old printed photo.  The younger generation geared to cell phones won’t have this experience.

For more information about Multi-Generational Travel vacations, go to http://www.gocollette.com

For details on planning a stress free family vacation, go to travel.aarp.org/articles-tips/articles/info-10-2013/how-to-plan-a-stressfree-multigenerational-trip.html.

Herb Weiss, LRI ’12 is a Pawtucket-based writer who covers aging, health care and medical issues.  He can be reached at hweissri@aol.com.

Palliative Care Can Provide Comfort to Dying Residents

Published in Woonsocket Call on May 10, 2015

           A recently published study, by Brown University researchers, takes a look at end-of-life care in America’s nursing facilities, seeking to answer the question, is knowledge and access to information on palliative associated with a reduced likelihood of aggressive end-of-life treatment?

Brown researchers say when a nursing facility resident is dying, oftentimes aggressive interventions like inserting a feeding tube or sending the patient to the emergency room can futilely worsen, rather than relieve, their distress. While palliative care can pull resources together in a facility to provide comfort at the end of a resident’s life, the knowledge of it varies among nursing directors.  A new large national study found that the more nursing directors knew about palliative care, the lower the likelihood that their patients would experience aggressive end-of-life care.

Susan C. Miller, professor (research) of health services, policy and practice in the Brown University School of Public Health and lead author of the study in the Journal of Palliative Medicine, published March 16, 2015, worked with colleagues to survey nursing directors at more than 1,900 nursing facilities across the nation between July 2009 and June 2010.  The researchers hoped to learn more about their knowledge of palliative care and their facility’s implementation of key palliative care practices.

Knowledge Is Power

According to the findings of the Brown study, the first nationally representative sample of palliative care familiarity at nursing homes, more than one in five of the surveyed directors had little or no basic palliative care knowledge, although 43 percent were fully versed.

“While the Institute of Medicine has called for greater access to skilled palliative care across settings, the fact that one in five U.S. nursing home directors of nursing had very limited palliative care knowledge demonstrates the magnitude of the challenge in many nursing homes,” Miller said. “Improvement is needed as are efforts to facilitate this improvement, including increased Medicare/Medicaid surveyor oversight of nursing home palliative care and quality indicators reflecting provision of high-quality palliative care,” she said, noting that besides quizzing the directors the researchers also analyzed Medicare data on the 58,876 residents who died during the period to identify the type of treatments they experienced when they were dying.

When researchers analyzed palliative care knowledge together with treatment at end of life, they found that the more directors knew about basic palliative care, the lower likelihood that nursing facility residents would experience feeding tube insertion, injections, restraints, suctioning, and emergency room or other hospital trips. Meanwhile, residents in higher-knowledge facilities also had a higher likelihood of having a documented six-month prognosis.

The study shows only an association between palliative care knowledge and less aggressive end-of-life care, the authors say, noting that knowledge leads to improved care, but it could also be that at nursing facilities with better care in general, there is also greater knowledge.  But if there is a causal relationship, then it could benefit thousands of nursing facilities residents every year for their nursing home caregivers to learn more about palliative care, the authors conclude.

Progress in Providing End-of-Life Care

Virginia M. Burke, J.D. President and CEO of the non-profit Rhode Island Health Care Association, said, “We were gratified that the authors found that most of the nursing directors who responded to their survey gave correct answers on all (43% of respondents) or most (36%of respondents) of the “knowledge” questions on palliative care.  We were also gratified to see that the number of hospitalizations during the last thirty days of life has declined significantly over the past ten years, as has the number of individuals who receive tube feedings during their last thirty days.  The need for continued progress is clear.”

Burke, representing three-quarters of Rhode Island’s skilled nursing and rehabilitation centers, adds, “It is not at all surprising that greater understanding of palliative care leads to better application of palliative care.”

The states’s nursing facilities are committed to providing person-centered end of life care, says Burke, noting that according to the National Palliative Care Research Center, Rhode Island’s hospitals are among the top performers for palliative care.  “We suspect that our state’s nursing facilities are as well.  We would be very interested in state specific results in order to see any areas where we can improve.”

Says spokesperson Director Michael Raia, of Rhode Island’s Health & Human Services Agency, “We need to provide the right care in the right place at the right time for all patients.”

When it comes to nursing facilities, Raia calls for reversing the payment incentives so that facilities are rewarded for providing better quality care and having better patient outcomes.  He notes that the Reinventing Medicaid Act of 2015 reinvests nursing home reimbursement rate savings into newly created incentive pools for nursing homes and long-term care providers that reward facilities for providing better quality care, including higher quality palliative care.

Bringing Resources to Families

With caregiving one of AARP’s most important issues, it’s no surprise that the organization provides a great deal of guidance on palliative care, stressing that “it involves organizations and professionals coming together to meet a person’s needs both in terms of pain management, along with emotional and spiritual perspectives,” said AARP State Director Kathleen Connell.

Connell says that “It’s is truly a team effort in which nursing home staff become key players. The resources are important to patient with chronic and terminal issues. Their families need help, too. So it is important any time we learn more about ways we can address this very important healthcare need.”

Adds Connell, “In Rhode Island, I’m confident that we have nursing homes that are dedicated to easing the difficulty of this particularly stressful stage of life. They give patients and their families enormous comfort. We certainly applaud their compassion and hope the report is helpful anywhere it identifies a need for improvement,” adds Connell.

AARP’s Caregiving Resource Center (http://www.aarp.org/home-family/caregiving/) includes an End of Life section. Check out a specific palliative care resource at  http://assets.aarp.org/external_sites/caregiving/multimedia/EG_PalliativeCare.html

To read the Brown Palliative Care Study go to http://online.liebertpub.com/doi/abs/10.1089/jpm.2014.0393.

Herb Weiss, LRI ’12 is a Pawtucket writer covering aging, health care and medical issues.  He can be reached at hweissri@aol.com.