Category Archives for Healthcare

RI State Budget must address long term care staffing crisis

Published in RINewsToday on February 21, 2022

As Rhode Island and states throughout the country loosen COVID-19 mask restrictions with the number of new coronavirus cases dropping by more than 75% since the highs in mid-January, and hospital admissions and death rates declining, AARP Rhode Island warns that now is the time to take steps to protect nursing facility residents from future COVID-19 surges in the state’s nursing facilities. 

In a statement released on Feb. 18, 2022, AARP Rhode Island, the state’s largest aging advocacy group for seniors, says that their “AARP’s Nursing Home COVID-19 Dashboard”, covering the four-week period ending January 23rd “paints a grim picture of the devastation caused by the surge of the Omicron variant in America’s nursing homes and underscores the need for booster shots to protect both residents and staff.”

A snapshot of COVID-19’s impact in nursing facilities

AARP Rhode Island’s statement notes that facility staff cases were more than 11 times as high nationwide as in last month’s Dashboard (covering the four weeks ending December 19), with resident cases nationwide more than eight times as high.

“Here in Rhode Island, staff cases increased nearly tenfold from the rate of 2.96 per 100 residents in December to 24.5 during the same time period in January. Resident cases spiked from a rate of 2.6 to 15.8. Nursing home resident deaths from COVID-19 increased from 0.18 per 100 residents in December to 0.30 in January,” says AARP Rhode Island.

AARP’s Nursing Home COVID-19 Dashboard also shows that as of January 23, 72% of nursing home residents in Rhode Island were fully vaccinated with a booster dose, an increase from mid-December’s 61.8%. Meanwhile, 35.6% of direct care staff had received a booster, an increase from 24.8% in mid-December.

“We know boosters save lives; we know they help prevent infections and severe illness,” said Catherine Taylor, State Director of AARP Rhode Island, which serves more than 130,000 members aged 50 and older in the Ocean State. “Even though the worst of the Omicron surge is hopefully behind us, the pandemic isn’t over. The delivery of booster doses to nursing home residents and staff must remain a high priority as these residents are among the most vulnerable to COVID-19 and its variants.,” she says, noting that the number of facilities in Rhode Island reporting a shortage of nurses or aides has also increased from 32.9% to 52.1%. in the four weeks ending January 23.

“The last two years have highlighted the chronic, ongoing issues that have long plagued nursing homes—such as the shortage of direct care workers, which is now a crisis; low pay that drives workers to take second and third jobs in multiple facilities; and shared rooms and bathrooms (for residents in facilities) – and that are chief contributors to poor infection control,” said Taylor.

John E. Gage, MBA, NHA, President & CEO, Rhode Island Health Care Association, says “AARP Rhode Island’s story is based mostly on national numbers, and RI’s situation is actually quite good” and its data recognizes the achievements of the state’s facilities as deserved. 

Nursing facilities continue to follow strict Covid-19 guidance provided by Rhode Island Department of Health (RIDOH) following CDC Guidance, says Gage, noting that residents and staff are among the highest vaccinated and boosted in the nation which has helped limit the impact of the latest Omicron surge.

“Numbers are dropping as quickly as they spiked, and we are hoping for a return of greater “normalcy” as we enter the Spring,” adds Gage as staff continue to utilize full PPE when providing care to residents, and masks are used at all times in nursing homes. They also continue to follow quarantine and isolation guidance for residents and staff as provided by the RIDOH – this guidance is updated frequently”, he says.

“Staff left early on in the pandemic because of fear of Covid. Remaining staff worked tirelessly throughout the first wave of the pandemic without vaccines and without the availability of sufficient PPE,” recalls Gage, stressing that “they are true heroes, but they are burned out, and many have chosen to leave for higher wages or less stress.” 

“Those who remain are working overtime – picking up shifts to help cover for the 20% vacancy rates in RI facilities,” he says, adding that facilities are paying higher wages, overtime, and bonuses to their existing staff, and they are forced to use temporary nurse staffing agencies at 4 times the pre-pandemic level.

The pandemic and RI’s staffing crisis

Now, in the midst of this crisis, facilities are expected to comply with the minimum staffing mandate passed during last year’s legislative session, says Gage, warning that it is impossible for the state’s 77 facilities to comply with the mandated staffing levels. “There are not enough willing applicants, Rhode Island Medicaid reimbursement does not allow facilities to make meaningful pay rate increases, and the staffing mandate is woefully underfunded,” he charges. In fact, when fully implemented, the unfunded mandate that is the minimum staffing statute will result in a $47 million/year reimbursement shortfall – that on top of the $50 million/year in pre-existing underfunding,” he says. 

“Then, when nursing homes are unable to meet impossible staffing thresholds in the midst of this workforce crisis, they will be fined millions of dollars for non-compliance (RIDOH estimated $8.3 million in fines in the first quarter alone). These fines will actually divert resources from nursing homes and further imperil the care and services our elder residents who reside in nursing homes so deserve. This is a true crisis in the making,” according to Gage.

“The intent of the minimum staffing statute was to provide more caregivers and better care but did not provide the resources to do so – the workforce or the appropriate reimbursement to pay that workforce. The state’s facilities have always had a reputation of providing among the best nursing home care in the country. That reputation is in peril now,” adds Gage.

“The pandemic will be with us for a while [and that] has highlighted the need to reimagine long term supports and services,” says  Maureen Maigret, state’s Long-Term Care Coordinating Council Aging (LTCCC) in Community Subcommittee.  “We need to provide incentives through low cost loans and reimbursement rates for nursing homes to convert to private rooms and bathrooms which would go a long way to prevent the spread of infections. We also need to enhance access to home and community-based services to give more persons the choice to get care at home.

And finally, we must urge our Governor and legislature to take immediate steps to address the workforce crisis by ensuring our direct care workers receive fair, competitive wages and opportunities for specialized training and advancement,” says Maigret, a former Director of the state’s Department of Elderly Affairs (renamed the Office of Healthy Aging).

Increasing Medicaid payments 

Last month, Gov. Dan McKee submitted a $12.8 billion state budget to address the pandemic, build more affordable housing, also providing increased funding to schools and small businesses.  In its statement, AARP Rhode Island called on the Rhode Island General Assembly to ” address the direct care workforce shortage through a combination of wage increases, paid training, professional development and enhanced benefits, and enact an enhanced rate for single rooms in nursing homes, retroactively.” Maigret said: “These are necessary for transforming how we provide nursing facility care. However, the Governor and lawmakers must address the immediate and urgent need to raise wages for direct care staff working in home and community programs as well,” she said, noting that the average wait time to get home care services paid by Medicaid is more than three months.”

Maigret adds: “It’s unacceptable that so many people wait so long to receive services due to the state’s failure to increase provider rates to allow them to pay our workers competitive and fair wages. It also inhibits reaching the state’s goals for providing people choice and receiving services in the least restrictive setting.”  

“The demographics are undeniable,” says Gage, noting that Rhode Island’s 85+ population will double in the next 15-20 years. “ Of course, we want everyone to have the option to live in the setting most appropriate for their needs.  However, this impending wave will overwhelm the state’s entire LTC continuum – home care, assisted living residences and nursing homes,” says Gage.

Gage calls on McKee and Rhode Island lawmakers to make sure that Rhode Island Medicaid ensures the long-term viability of the entire LTC continuum, including nursing facilities, to meet the needs of the most fragile Rhode Islanders today and in the coming years as demand will inevitably rise.

“The recently released AARP Nursing Home Dashboard data underscores the continued necessity of this advocacy, and the need for the legislature to pass these critical reforms this year,” says AARP’s Taylor.

Don’t forget the state’s most vulnerable

The AARP Nursing Home COVID-19 Dashboard  analyzes federally reported data in four-week periods going back to June 1, 2020. Using this data, the AARP Public Policy Institute, in collaboration with the Scripps Gerontology Center at Miami University in Ohio, created the dashboard to provide snapshots of the virus’ infiltration into nursing homes and impact on nursing home residents and staff, with the goal of identifying specific areas of concern at the national and state levels in a timely manner.

The full Nursing Home COVID-19 Dashboard is available at  www.aarp.org/nursinghomedashboard, and an AARP story about this month’s data is available here.

For more information on how coronavirus is impacting nursing homes and AARP’s advocacy on this issue,

visit www.aarp.org/nursinghomes. Medicare.gov’s Care Compare website now offers information about vaccination and booster rates within individual nursing homes and how they compare to state and national averages.

“Living Apart Together” couples need to discuss caregiving, health issues with family, each other

Published on February 14, 2022 in Rhode Island News Today

With divorce rates soaring since the 1990s, and aging baby boomers 50 and older having doubled in number, this trend, along with longer life expectancy and those becoming widowed, has resulted in many older adults forming new partnerships later in life. Researchers call this new phenomenon, “Living Apart Together’ (LAT),” as an historically new form of family that allows an intimate relationship without sharing a residence. And it is gaining popularity as an alternative form of commitment. 

According to Couple Therapies, Inc., a 2016 national survey by legal scholar Cynthia Grant Bowman, as many as 9% of older American couples have Living Apart Together (LAT) relationships.

A year after the death of my oldest sister, Mickey, in 2008, my brother-in-law, Justin, an endodontist who had become a widower, found love and began to date Ruth, also widowed. Over 10 and a half years (from their late 60s to late 70s), the couple shared companionship by LAT, traveled to interesting locations for his medical conferences, even traveling overseas to France and Italy. Both enjoyed dining out, attending theater, and enjoying music. “Our relationship was wonderful for this stage in our lives,” recalls Ruth. “At our age in life, and both having grown children, it was just easier to maintain our own homes and our separate lives, but we did many things together,” she said. 

Like Justin and Ruth, millions of older persons are discovering the benefits of LAT. It allows couples to enjoy autonomy in their own living space and to maintain pre-existing relationships with their friends and children. LAT couples are able to be in a loving, long-term, intimate relationship where they have emotional support without having to cohabitate or be married. Often, and especially for those who have been widowed, there is a desire to show respect to their loved one but not engaging in a formalization of the relationship through the legal and religious act of marriage.

LAT is being studied by researchers at the University of Missouri (UM) who say that while the trend is well understood in Europe, it is lesser known in the United States. This means that with increased longevity, it becomes challenging as to how LAT partners can engage in family caregiving or decision-making, and how it could affect family needs.

“What has long been understood about late-in-life relationships is largely based on long-term marriage,” said Jacquelyn Benson, an expert of older adult relationships from the University of Missouri (UM), in a Feb. 9, 2017, statement discussing their LAT partnered research. “There are now more divorced and widowed adults who are interested in forging new intimate relationships outside the confines of marriage. Recent research demonstrates that there are other ways of establishing long-lasting, high-quality relationships without committing to marriage or living together. However, U.S. society has yet to recognize LAT as a legitimate choice. If more people—young and old, married or not—saw LAT as an option, it might save them from a lot of future heartache,” she says.

In this UM study, “Older adults developing a preference for living apart together,” Benson and Marilyn Coleman, Curators Professor of Human Development and Family Science, interviewed adults who were at least 60 years old and in committed relationships but lived apart. The researchers found that couples were motivated by desires to stay independent, maintain their own homes, sustain existing family boundaries, and remain financially independent. Couples expressed challenges defining their relationships or choosing terms to properly convey the nature of their relationships to others, they say, many citing that traditional dating terms such as ‘boyfriend’ and ‘girlfriend’ to be awkward terms to use at their ages.

“While we are learning more about LAT relationships, further research is needed to determine how LAT relationships are related to issues such as health care and caregiving,” Benson said. “Discussions about end-of-life planning and caregiving can be sensitive to talk about; however, LAT couples should make it a priority to have these conversations both as a couple and with their families. Many of us wait until a crisis to address those issues, but in situations like LAT where there are no socially prescribed norms dictating behavior these conversations may be more important than ever,” she says.

Another UM research study, “Living apart together relationships in later life: Constructing an account of relational maintenance,” Benson found that if more people—young and old, married or not—saw ‘Living Apart Together’ as an option, it might save them from a lot of future heartache. However, caregiving needs might cause such couples to change living arrangements.

These couples choosing to “live apart” are tested when their partner requires caregiving. “While autonomy is paramount for these couples, participants in the study also emphasized the importance of having a flexible mindset about their relationships, especially when one partner needs additional care,” she says, noting that certain family issues that become important in your later years, like caregiving or medical decision-making, could be difficult to navigate for the LAT couples and their relatives.

“The societal standard for elder caregiving in the United States is to expect spouses and adult children to step in as primary caregivers; however, we do not know-how these expectations apply in LAT arrangements,” Benson said in a statement releasing the findings Jan. 8, 2018, study. “In our research we are learning that, while living apart seems to be almost universally viewed as a necessity for maintaining relationship satisfaction for these couples, paradoxically couples also are willing to make changes in living arrangements to provide caregiving support to one another,” she said. She found that for most of these couples, living apart and being independent was considered ideal.  Participants in the study recognized that keeping separate homes was the simplest strategy for safeguarding their autonomy, she said.

Benson cautioned against making any conclusions about actual caregiving behaviors. “Most of the individuals we interviewed had not been tested by the realities of caregiving [yet] within their current LAT partnerships. It will be important to follow LAT partners over time to see if their willingness transforms into action and understand the mechanisms that explain these care provision decisions,” she said. Benson called for further research to better understand repartnering in later life.

Medicare slow to fix equity issue for seniors’ access to at-home COVID test kits

Published on Feb. 7 in Rhode Island News Today

Today home test kits were made available in a variety of ways – but, for Medicare recipients, it was a different story, being forced to go thru a different purchasing and payment process than those having private insurance, or no insurance. That process required the oldest and most at-risk population to take more than several steps, put up their own money, do a lot of paperwork, to seek reimbursement.

The White House made changes in testing so that at-home tests are now fully covered by health insurances. Those insured can pick up their test kits in a store and have them paid for at the time of purchase by their insurance, at no cost to the person. They aren’t required to visit their physician or get a prescription to obtain the free test. They have a limit of 8 test kits per month.

But, when the program began, this was not the plan for those insured through the government’s Medicare and Medicare Advantage plans.

Red Tape… Upfront Charges for COVID-1

Jane, a 65-year old Medicare beneficiary from Warwick went through the steps to get a kit after a relative she had seen found out she was exposed to COVID.  Before Medicare announced easing up on the purchasing process of COVID-19 test kits, she expressed frustrations to this writer about the regulatory hoops she faced because she was on Medicare – purchasing the test kits and getting reimbursed for the upfront charges. “First, I had to request a prescription from my physician and say that I had either been exposed to someone who had COVID, or I was having symptoms, myself,” recalls the frustrated Medicare beneficiary.  “Once my physician sent the prescription over to CVS, I was notified that it would take a couple of days before I could pick up the kits and that I would only be given two kits per prescription”, she fumed, knowing that sometimes it takes 4 or 5 days of testing to test positive, but was only eligible to receive two, and she might have to go through the whole process again in a few days.

“Three days later CVS finally left me a message saying these kits were in. I used the drive-up window for pickup and the cashier asked me for $46,” Jane remembered.  “When questioning this charge, a pharmacist came to the window to assist and told me that I had to pay for the kits upfront and then seek reimbursement,” she added.

Paying for the kits, Jane went home, and called Blue Cross, her Medicare supplement company and was told she needed to request a copy of the prescription which took hours to finally request with the back and forth phone calls to her busy doctor’s office. It was almost two weeks later she finally got a copy of the receipt detailing her $46 payment for the kits. She was then able to upload the copy of the prescription and a copy of her receipt to a BCBS reimbursement screen on her computer (or she could have printed the form out and mailed the whole package in). At press time, Jane is still waiting for her reimbursement, being told it will take from 4 to 6 weeks to receive a check.

It’s better late than never, says Jane, when she heard that Medicare would now cover free over-the-counter COVID-19 tests. “Not everyone can put out $46 and wait two months to get it back, home health tests were made available in a variety of ways – but, for Medicare recipients, there was a different process. More concerning was all the steps I had to take to complete the process they had originally intended for us to do. How many people would really complete all those steps?” she says. “We talk a lot about equity, but seniors need equitable healthcare processes, too.”

Just days ago, the Centers for Medicare & Medicaid Services (CMS) announced that beneficiaries in either Original Medicare or Medicare Advantage will be able to get over-the-counter COVID-19 tests at no cost starting in early spring, estimated to be in April. Under the new CMS initiative, Medicare beneficiaries will be able to access up to eight over-the-counter COVID-19 tests per month for free. Tests will be available through eligible pharmacies and other participating entities. This policy will apply to COVID-19 over-the-counter tests approved or authorized by the U.S. Food and Drug Administration (FDA). A prescription will not be required.

CMS Unveils New Medicare Benefit

According to CMS, this new initiative will enable payment from Medicare directly to participating pharmacies and other participating entities to allow Medicare beneficiaries to pick up tests at no cost. This is the first time that Medicare has covered an over-the-counter test at no cost to beneficiaries.

CMS’s announcement follows last month’s announcement that the Biden-Harris Administration would be requiring commercial health insurance companies to cover at-home COVID tests for free.

Until the new benefit kicks in, Medicare beneficiaries can access free tests through a number of channels established by CMS, too. Now, they can request four free over-the-counter tests for home delivery at covidtests.gov. Or beneficiaries can access COVID-19 tests through health care providers at over 20,000 free testing sites nationwide. Many cities and towns are also giving out free test kits at drive-up handout programs as the state receives supplies.

CMS’s Feb. 3 statement noted that Medicare beneficiaries can also access lab-based PCR tests and antigen tests performed by a laboratory when the test is ordered by a physician, non-physician practitioner, pharmacist, or other authorized health care professional at no cost. In addition to accessing a COVID-19 lab test ordered by a health care professional, people with Medicare can also already access one lab-performed test without an order, also without cost sharing, during the public health emergency, says CMS.

In addition, CMS says that Medicare Advantage plans may offer coverage and payment for over-the-counter COVID-19 tests as a supplemental benefit in addition to covering Medicare Part A and Part B benefits. Medicare beneficiaries covered by Medicare Advantage should check with their plan to see if it includes such a benefit.

Finally, all Medicare beneficiaries with Part B are eligible for the new benefit, whether enrolled in a Medicare Advantage plan or not.

“AARP applauds today’s announcement that will guarantee access to at-home over-the-counter COVID-19 tests at no cost for Medicare’s 64 million beneficiaries and we thank [Health and Human Resources]Secretary Becerra and CMS Administrator Brooks-LaSure for their diligence in addressing this issue. Expanded access to no-cost testing will help protect seniors who have been hit hardest by the pandemic and ensure they can remain connected with their loved ones and community.,” says AARP Executive vice president and Chief Advocacy and Engagement Officer Nancy LeaMond in a statement issued with CMS’s Feb. 3rd announcement of the new Medicare benefit.

“Every American should have an easy way to get at-home COVID tests. We know that people 65 and older are at much greater risk of serious illness and death from this disease – they need equal access to tools that can help keep them safe. The cost of paying for tests and the time needed to find free testing options are barriers that could discourage Medicare beneficiaries from getting tested, leading to greater social isolation and continued spread of the virus, adds LeaMond.

Successfully Advocating the Seniors

Last month, Senators Sherrod Brown (D-OH) and Debbie Stabenow (D-MI) along with 17 of their  Senate colleagues including Rhode Island Democratic Senators Reed and Sheldon Whitehouse wrote to HHS Secretary Becerra and  CMS Administrator Brooks-LaSure urging them to expand Medicare coverage of free at-home rapid COVID-19 testing.

Aging groups also joined the Senators in pushing Medicare to offer the new testing kick benefit.  “It is clear that regular testing is a crucial part of managing the spread of COVID-19. That’s why AARP has been calling for coverage of at-home tests, says AARP’s LeaMond, noting that the nation’s largest aging advocacy group “will continue to watch for details about when and how at-home COVID tests are made available to those in Medicare.”

Thankfully CMS quickly heeded their calls.

For more information, please see these Frequently Asked Questions, https://www.cms.gov/files/document/covid-19-over-counter-otc-tests-medicare-frequently-asked-questions.pdf (PDF)

Stay tuned for free N95 masks to be made available to all coming up soon.