Senators Seek to Identify Subpar Nursing Homes

Published in the Woonsocket Call on July 14, 2019

Last month, U.S. Senators Bob Casey (D-PA) and Pat Toomey (R-PA) succeeded in prodding the Centers for Medicare and Medicaid Services (CMS) to publicly release the April listing of underperforming nursing homes across the nation that require closer regulatory scrutiny but are not receiving any. Before CMS released the listing of candidates to the Special Focus Facility (SFF) program, the federal agency, charged with overseeing the care and quality in nursing homes, had not publicly identified these troubled facilities.

Less than 6 percent (88 facilities) out of more than 15,700 nursing homes nationwide are participants of the SFF program. CMS publicly identifies these facilities to the public. But an additional 2.5 percent (or approximately 400 facilities) qualify as candidates for the program because of having a “persistent record of poor care” but are not selected because of limited resources at CMS, according to a 26-page report, “Families’ and Resident’s Right to Know: Uncovering poor care in America’s Nursing Homes,” released in June 2019 by Pennsylvania’s two U. S. senators.

Nursing homes that are part of the SFF program have 12 to 18 months to correct any deficiencies and have two clean CMS surveys. If a facility fails to meet that target, it is are subject to increased regulatory enforcement, including being dropped from the Medicare and Medicaid programs.

Calls for Transparency

On March 4, 2019, Casey and Toomey wrote to CMS requesting information on its oversight of nursing homes in the SFF program. In that letter, the Senators requested the federal agency to provide the names of the 400 SFF candidates, calling for details about programs operations, scope and overall effectiveness. On May 3, 2019, CMS provided a written response and two weeks later, on May 14, the Senators received the listing of SFF candidates for April 2019. The names of these SFF candidates were not made public until Cassy and Toomey forced the issue by releasing this information in their report on June 5.

In CMS administrator Seema Verna’s May 14 letter to the two senators, Rhode Island-based participants and candidates in the SFF program were identified. They are: Charlesgate Nursing Center (SFF Candidate); Hebert Nursing Home (SFF Candidate); Oak Hill & Rehabilitation Center (SFF); St. Elizabeth Manor East Bay (SFF Candidate); and Tockwotton on the Waterfront (SFF Candidate).

In responding to the senators, Verma said that regardless of whether a nursing home is part of the SFF program, “any facility that performs poorly on surveys and continues to jeopardize residents’ health and safety will be subject to CMS enforcement,” which includes civil money penalties, denial of payment for new admissions or termination from the Medicare and Medicaid programs. Verma also stressed that in addition to her agency’s regulatory oversight, its Nursing Home Compare website has been improved to include “new, more reliable sources for obtaining staffing and resident census data, as well as including more claims-based quality measures.”

“Regardless of participation in the SFF program, any facility that performs poorly on surveys and continues to jeopardize residents’ health and safety will be subject to CMS enforcement remedies, such as civil money penalties, denial of payment f-or new admissions, or termination,” adds Verma.

Casey and Toomey believe that the list of SFF candidates is information that must be publicly available to individuals and families seeking nursing care for their loved ones. For that reason, the Senators have released the April 2019 list of SFF candidates and are continuing to work with CMS to make future lists public.

Through the release of the SFF candidate list and the Senate report, which details preliminary findings from surveys and public information about these candidate facilities, the Senators aim to provide Americans and their families with the transparency and information needed to choose a nursing home that would provide quality care to a loved one.

CMS Inquiry Identifies Issues

Casey and Toomey’s CMS inquiry into the SFF program put the spotlight on several issues. It became apparent to the two senators that a nursing home’s participation in the SFF program was not easily understandable to the public or would-be residents and their families. It became clear that CMS’s Nursing Home Compare, the agency’s online website, was not consistently updated to reflect any changes in the SFF program. “For example, in March 2019, the small icon used to indicate that a facility is an SFF participant was not on the webpage of five of the 17 newly-added SFF participants,” noted the Senate report. Most important, CMS’ website did not identify SFF candidates.

According to the released Senate report, only CMS and the state regulatory agency in which the nursing home is located and the facility itself, had knowledge of who is an SFF candidate. While CMS requires every nursing home to notify residents and its community of its regulatory SFF participant designation, these requirements do not apply to SFF candidates.

Aside from CMS recently updating its Nursing Home Compare webpage to more clearly indicate which nursing homes are SFF participants, it lacks details about the SFF program. There is no information explaining the reason for a facility’s participation in the program, the length of time it has been in the program or whether it has fixed the care issue. Most important, CMS does not include information on facilities that routinely cycle in and out of the SFF program, says the Senate report.

“There are few decisions more serious or life-altering than that of choosing a nursing home. I am pleased that CMS has taken the work that I have done with Senator Toomey seriously and is heeding our call to release the list of nursing facilities that are nominated to the Special Focus Facility program,” said Casey. “Our bipartisan work will ensure that families have all the information at their fingertips when choosing a nursing home. Now we must work in a bipartisan fashion to ensure the SFF program is working properly and that CMS has the funding it needs to improve underperforming nursing homes nationwide,” he says.

Adds, Toomey, “Ensuring that families have all the information they need about a nursing home will improve the quality of care at facilities across the country.”

Bills Passed to Assist Rhode Island’s Seniors, Disabled

Printed in the Woonsocket Call on July 7, 2019

With the dust settling after the adjournment of the Rhode Island General Assembly’s 2019 legislative session on June 30, 2019, Rhode Island Governor Gina Raimondo halfheartedly signed the state’s 2020 fiscal year $9.9 billion budget into law.

The newly enacted budget closes a $100 million budget gap while avoiding new taxes for businesses, fully funding the state’s education aid formula, continuing to phase-out the car-tax, maintaining fiscal support for municipalities. And, State lawmakers did not forget older Rhode Islanders and disabled persons, putting tax dollars into programs assisting them.

Included in the state budget signed by Raimondo is $499,397 to fund the Rhode Island Livable Home Modification Grant Act that was introduced by Rep. Joseph M. McNamara, D-Warwick, Cranston and Sen. Walter S. Felag Jr., D -Bristol, Tiverton, Warren.

The grant allows eligible homeowners and renters to retrofit their residence to nationally recognized accessibility standards and receive 50 percent of the total sum spent, up to $5,000, to retrofit their existing residence.

The intent of this state program is to assist older Rhode Islanders and disabled persons to stay safely in their homes longer rather than being admitted to costly nursing homes, which costs taxpayers millions of dollars each year in Medicaid costs. With the graying of state’s population, there is a need for housing that is safe and adapted to the needs of their older occupants. (The Livable Home Modification Grant Application and Post-Retrofit Claim form can be found at http://www.gcd.ri.gov.)

Meanwhile, aging advocates gave the thumbs-up to Rhode Island lawmakers who eliminated a sunset provision in the state budget for a program that provides fare-free bus passes to low-income seniors and elderly Rhode Islanders, making this program permanent.

Awaiting the Governor’s Signature

The General Assembly passed legislation (S 0691A, H 6219), introduced by Senator Frank S. Lombardi, D-Cranston and Rep. Evan P. Shanley, D-Warwick, that would help caregivers to build onto their houses to provide space for relatives. The measure now moves to the governor’s office for consideration.

The passed legislation expands the definition of “family member” for purposes of zoning ordinances to include child, parent, spouse, mother-in-law, father-in-law, grandparents, grandchildren, domestic partner, sibling, care recipient or member of the household.

Under the legislation, the appearance of the home would remain that of a single-family residence with an internal means of egress between the home and the accessory family dwelling unit. If possible, no additional exterior entrances would be added. Where additional entrance is required, placement would generally be in the rear or side of the structure.

This legislative session, State lawmakers also approved legislation sponsored by Sen. Adam J. Satchell D- West Warwick and Rep. Robert E. Craven, D- North Kingstown, to establish a formal process recognizing “supported decision making,” a structure of support for disabled or aging individuals.

The legislation, which now heads to the governor’s desk, establishes a system of personal support that is less restrictive than guardianship to help individuals maintain independence while receiving assistance in making and communicating important life decisions. It is aimed at providing an alternative with more self-determination for individuals who are aging or who have developmental or intellectual disabilities.

Under the bill (2019-S 0031A, 2019- H5909), Rhode Islanders would be able to designate another person, or a team of people, as a supporter who would help them gather and weigh information, options, responsibilities and consequences of their life decisions about their personal affairs, support services, medical or psychological treatment, education and more. The supporter would also help the individual communicate the person’s wishes to those who need to know.

The legislation creates a legal form that establishes the agreement between individuals and their supporters, and designates the types of decisions with which the supporter is authorized to help. The bill establishes that decisions made with support under such an agreement are legally valid, and allows supporters to assist with the accessing of an individual’s confidential health and educational records.

It also requires that any other person who is aware that an individual is being abused, neglected or exploited by their supporter is obligated to report that abuse to the proper authorities.

Protecting Rhode Island’s Seniors and Disabled from Financial Exploitation

Sen. Valarie J. Lawson, D-East Providence and Rep. Joe Serodio’s D-East Providence, legislation (2019-0433A, 2019-H 6091A), “Senior Savings Protection Act,” was passed by the General Assembly and now heads to the Governor’s desk for signature.

The act would require certain individuals to report the occurrence or suspected occurrence of financial exploitation of persons who are age 60 and over or those with a disability between the ages of 18 and 59 years old.

According to the legislation, if a qualified individual, a person associated with a broker-dealer who serves in a supervisory, compliance or legal capacity, believes that financial exploitation is taking place, or being attempted, the individual must notify Rhode Island’s Department of Business Regulation and Division of Elderly Affairs, and law enforcement. The individual may also alert immediate family members, legal guardians, conservators, or agents under a power of attorney of the person possibly being financially exploited.

The legislation also calls for the Department of business Regulation and the Division of Elderly Affairs to develop websites that include training resources to assist in the prevention and detection of financial exploitation against Rhode Island’s seniors and disabled.

Combating Alzheimer’s Disease

With the number of persons with Alzheimer’s Disease expected to increase in the coming years, the General Assembly approved bills to better support Rhode Islanders affected by debilitating mental disorder and to protect against elder abuse. There are an estimated 23,000 Rhode Islanders age 65 and older living with Alzheimer’s disease. In just six years, the number is expected to increase to 27,000.

The Rhode Island General Assembly approved legislation (S 20223, 2019-H 5178) sponsored Sen. Cynthia A.Coyne, D-Barrington, Bristol, East Providence, and House Majority Leader K. Joseph Shekarchi, D-Warwick, to establish a program within the Department of Health dedicated to Alzheimer’s disease, and create a 13-member advisory council that would provide policy recommendations, evaluate state-funded efforts for care and research and provide guidance to state officials on advancements in treatment, prevention and diagnosis. The bill is based on legislation signed into law last year in Massachusetts.

The legislation requires the Department of Health to assess all state programs related to Alzheimer’s, and maintain and annually update the state’s plan for Alzheimer’s disease. It would also require the Department of Health to establish an Alzheimer’s disease assessment protocol specifically focused on recognizing the signs and symptoms of cognitive impairments, and appropriate resource information for effective medical screening, investigation and service planning. The legislation would also require caseworkers working with the Department of Elderly Affairs to become familiar with those protocols. Additionally, the legislation would require a one-time, hourlong training on diagnosis, treatment and care of patients with cognitive impairments for all physicians and nurses licensed in the state.

Most importantly, adoption of the legislation would enable Rhode Island to qualify for federal funding that is available to help states with their efforts to support those with Alzheimer’s disease.

Also gaining final Rhode Island General Assembly approval was legislation (2019-S 0302A, 2019-H 5141) sponsored by Sen. Coyne and Rep. Joseph M. McNamara, D-Warwick, Cranston, to allow the spouses or partners of patients residing in Alzheimer’s or dementia special care unit or program to live with them, even if they do not meet the requirements as patients-themselves.

Finally, Sen. Coyne, who lead the Senate’s Special Task Force to Study Elderly Abuse and Financial Exploitation, successfully spearheaded an effort this session to pass legislative proposals to beef up the state’s efforts to combat elder abuse, that is growing and vastly under reported. For details, go to herbweiss.wordpress.com, to access the June 30 commentary, “Senate Task Force Calls for Action to Combat State’s Growing Elder Abuse.”

Religious Groups Urge House to Combat Antisemitism and Racism

Published in the Woonsocket Call on July 1, 2019

For the second year in a row, the Rhode Island General Assembly’s Senate Judiciary Committee heard a resolution, introduced by State Senator Donna Nesselbush (Democrat, District 15, Pawtucket), calling on lawmakers to denounce and oppose white nationalist and neo-Nazi groups. The resolution was co-sponsored by Senators Samuel Bell (Democrat, District 5, Providence), Joshua Miller (Democrat, District 28, Cranston), Gayle Goldin (Democrat, District 3, Providence) and Ana Quezada (Democrat, District 2, Providence),

The initial resolution, introduced in 2017, urged state police to consider White Nationalists and Neo Nazi groups as terrorists. Because of First Amendment concerns expressed by the American Civil Liberties Union of Rhode Island that resolution was held for further study, and the language was reworked this run so as not to run afoul of free speech concerns.

Senate Moves to Fight Antisemitism and Racial Intolerance Head On

At the May 30 hearing, Nesselbush (Democrat, District 15, Pawtucket) pushed for passage of S0829, a resolution calling on Rhode Island to “denounce and oppose and the totalitarian impulses, violent terrorism, xenophobic’ biases, and bigoted ideologies that are promoted by white nationalists and neo-Nazis.” She reminded the Senate panel that Rhode Island was founded on Roger William’s principles of religious tolerance, and the state should denounce any type of white supremacy or neo-Nazism and take a stand for religious freedom and tolerance.

Nesslebush’s Senate resolution unanimously passed in Senate Judiciary Committee and ultimately on the Senate Floor. With its passage, no further action is required and the resolution will be transmitted to the Secretary of State, who is charged in the resolution with transmitting certified copies of the resolution to President Donald J. Trump, the members of the Rhode Island Congressional delegation, and Governor Gina Raimondo.

When asked about a House companion resolution that denounces and opposes White Nationalists and Neo Nazi groups, Larry Berman, the House’s Director of Communication, says that Rep. Jean Philippe Barros (Democrat, District 59, Pawtucket) had planned to introduce one but “because it was getting late in the session” he was unable to get his bill introduced. It should be noted that Senate President Dominick J. Ruggerio allowed Nesselbush to introduce her Senate resolution recognizing its merit and importance to the Jewish community.

Calls for the House to Confront the Boldness of Hate Groups

As the House is poised to release its anticipated state budget, religious groups and supporters of Nesselbush’s resolution, call for the lower chamber to take a strong stand to denounce and oppose White Nationalists and Neo Nazi groups.

As President of the Board of Rabbis of Greater Rhode Island, being active and serving as Rabbi at Temple Beth-El, Rabbi Sarah Mack, says it’s not too late for the to take a stand against antisemitism. “As Jews, we fight against bigotry and extremism because as a people we have experienced the danger of hate firsthand. While it is important to focus on extremism in all of its forms, we appreciate this resolution that calls attention to white supremacists, neo-Nazis and their hateful agenda. Because of this, I am so thankful to the Senate for passing this resolution, and I beseech our House leadership to do the same.”

Adds Adam Greenman, President and CEO of the Jewish Alliance of Greater Rhode Island, “we are committed to combating hatred in all forms. This resolution would give our state the opportunity to stand up against groups that promote anti-Semitism, white supremacy and other forms of toxic and dangerous rhetoric. We ask those in the House of Representatives to join us in supporting this resolution.”

Rev. Dr. Donnie Anderson, Executive Minister, of the Rhode Island State Council of Churches, notes the importance for the House to support Nesslebush’s Senate resolution to fight hate. “In recent years hate speech has found a new platform in social media and is flourishing in the current political climate. This explosion of hate DEMANDS a response from our political leaders. Rhode Island is blessed with wonderful interfaith leaders who interact on a regular basis and have built an atmosphere of caring, respect and trust. This group consistently and often speaks against hate, but we need to hear from ALL of our political leaders. We urge passage of this timely and thoughtful resolution.”

Steve Ahlquist, a reporter at UpriseRI, a Rhode Island news web site covering progressive issues, testified in support of Nesselbush’s Senate resolution, gives his two cents about the importance of politicians combating hate groups. Ahlquist stressed, “Though this resolution is largely symbolic and does not have the force of law, it is important nonetheless that our elected officials ally themselves with Rhode Islanders most at risk of white supremacist violence. It has been documented by myself and others that these groups have twice come to our state to engage in violence, and have promised to return. Residents of Rhode Island need to know that our elected officials will have our backs when they are confronting these hate groups.”

“Our elected officials should be eager to repudiate white supremacy and neo-Nazism. There has been violence done and violence planned in Rhode Island by hate groups visiting our state. There has been and hate crimes at synagogues and mosques. The Senate passed a resolution with ease. It is truly the least we can expect from the House to follow suit,” says Ahlquist.

Rhode Island Religious Community Takes a Stand

For years, it has been reported that antisemitism is becoming firmly entrenched in the Ocean State. In 2017, the Providence Journal reported that the New England chapter of the Anti-Defamation League recorded 13 incidents of antisemitism in Rhode Island. Nazi swastikas were painted on a Providence building, at Broad Rock Middle School in North Kingstown, and even at a Pawtucket synagogue in Oakhill, just a five-minute walk from my house, reported Rhode Island’s largest daily.

When I testified for passage of Senate Resolution 0829, I told the Senators that I often wondered what I would have done if I stood on a street in Germany in 1938 seeing all those windows broken (during a two-day pogrom, referred to as Kristallnacht. Would I have the courage or the gumption to go up to somebody dressed in a brown shirt with a swastika armband and stop him from hitting an elderly Jew?
Hopefully yes, but who knows.

But, on May 30, 2019, at the Senate Judiciary Committee hearing, I sat beside Sen. Nesselbush and Steve Ahlquist as we “took a stand,” calling on the Committee to pass S 082. Knowing the wisdom in denouncing and opposing the hateful philosophy of white nationalist and neo-Nazi groups that is becoming all too common in Rhode Island, the Senate took its stand.

After all, Rhode Island was founded by Roger Williams on the principle of religious tolerance, and we’re the home of America’s oldest synagogue, the Touro Synagogue, in Newport. What does it say to the nation, and especially to the state’s Jewish, racial, ethnic, LGTBQ communities if the House does not take an opportunity to oppose and denounce hate in their own backyard?

Hopefully, House Speaker Nicholas Mattiello will reconsider allowing a resolution, with no fiscal cost, to be introduced to give House lawmakers, like their Senate colleagues, an opportunity to oppose white nationalists and neo-Nazi groups. It is important for both chambers to take a legislative stand to combat the rising incidence of antisemitism and racist incidents. The resolution serves the purpose of sending the message, hate groups who are planning to come to Rhode Island to cause violence are not welcome here.