Senate Aging Panel Calls for Improved Emergency Preparation and Response

Published in the Woonsocket call on October 8, 2017

“Those who cannot remember the past are condemned to repeat it” — George Santayana, a philosopher, essayist, poet, and novelist

In the wake of Hurricanes Irma and Harvey, after the death of at least nine nursing facility residents due to heat-related illness due to sweltering heat at a Hollywood, Florida-based facility that had lost power to run its air conditioner, the Senate Special Committee on Aging put the spotlight on the challenges facing seniors during natural disasters at a hearing on Sept. 20, 2017.

News coverage of Hurricanes Irma and Harvey provided heartbreaking reminders that seniors and persons with disabilities are particularly vulnerable during a natural disaster. On Florida’s Gulf Coast, an assisted care facility for dementia patients lost electrical power for three days, causing 20 seniors to suffer from high indoor temperatures. Meanwhile, in Dickinson, Texas, a widely-shared photo showed elderly residents of an assisted-living center awaiting rescue as flood waters rose waist deep inside the facility.

Heeding the Lessons from Past Disasters

When Hurricane Katrina slammed into the Gulf Coast 12 years ago, more than half of those who died were seniors, according to a report from the National Institutes of Health. Since that devastating storm, disaster response officials have placed much emphasis at the national, state, and local level to better protect older Americans during an emergency.

“As we have learned from Hurricanes Irma and Harvey as well as past catastrophes such as Hurricane Katrina, some of our neighbors – especially seniors – face many obstacles during a crisis, and we must focus on the attention older adults may need,” said Senators Susan Collins (R-ME) and Bob Casey (D-PA), Chairman and Ranking Member of the Senate Aging Committee in a statement announcing the Senate panel hearing held in 562 Dirksen Senate Office Building.

In her testimony, Dr. Karen B. DeSalvo the former health commissioner for New Orleans after Hurricane Katrina hit the city in 2005, noted that medical records for most patients at the time of Katrina were kept only on paper and were destroyed, “turning to useless bricks,” or lost because of the disaster. For clinicians, treating patients who lost their medicines became a major challenge, she said.

Creating Registries to Protect the Vulnerable

Since Katrina, the New Orleans Health Department has been “working aggressively, to create a medical special needs digitized registry to maintain a list of high-risk individuals, those most in need of medical assistance for evacuation during preparations or in response operations, says Dr. DeSalvo

Dr. DeSalvo called for “leveraging data and technology” as a way of creating more efficient and effective strategies of identifying the most vulnerable in a community. All communities could create such registries by using state Medicaid data to locate where residents who are electricity-dependent live. The electronic system, called emPOWER, is available for use nationally, and she recommended Congress fund training exercises to respond to disasters. response.

A witness, Jay Delaney, fire chief and management coordinator for the City of Wilkes-Barre, Pennsylvania, suggests that Congress continue to fully fund the National Weather Service and the Federal Emergency Management Agency (FEMA). Investing in surveillance tools can enhance decision making by making crucial weather data available before, during, and after a disaster.

For nursing homes and assisted living facilities, it is “critical” they have detailed shelter-in-place emergency plans, says Delaney, but for those who stubbornly choose to not leave their homes during a disaster, preparedness for those is a “tough nut to crack.”

“When you have to evacuate 15,000 people in 10 hours, you don’t have time to say, ‘Mam or sir, here’s why you have to go,’” Delaney said.

In his testimony, Paul Timmons Jr., CEO and president of Portlight Inclusive Disaster Strategies, proposed the establishment of a National Center for Excellence inclusive Disability and Aging Emergency Management to improve emergency management responses to disasters to reduce injuries and save lives. “The initial focus of the center should include community engagement, leadership, training and exercise development, evacuation, sheltering, housing and universal accessibility,” he said, suggesting a five-year, $1 billion budget.

Finally, Witness Kathryn Hyer, a professor in the School of Aging Studies at the University of South Florida in Tampa, provided eight tips for the Senate Aging panel to protect seniors during disasters. She called for emergency plan for nursing homes and assisted living; required generators to support generators in the event of a power failure, more research on what types of patients will benefit from evacuation or sheltering in place; construction of facilities in places that minimize flooding risk; identification of and prioritization for nursing homes and assisted living communities by state and local management organizations for restoration of services; litigation protection for facilities that abide by regulations and provide care during disaster scenarios; and continued commitment to geriatric education programs.

Prioritizing Senior’s Needs in Disasters

On Sept. 26, one week after the Senate Special Committee on Aging hearing on disaster preparedness and seniors, Senators Collins and Casey called for a swift federal response to the growing humanitarian crisis in Puerto Rico and the U.S. Virgin Islands. In correspondence to three federal agencies, they urged the Administration to take all available steps to act swiftly and prioritize seniors in the response to Hurricane Maria The senators also urged the federal agencies to prioritize not only patients in acute health care facilities, but individuals in nursing homes and assisted living facilities, as well as seniors living at home.

“We urge the Administration to heed the lessons of the recent hurricane response efforts in Florida and Texas and take all available steps to prioritize seniors in the response to this devastating storm,” the senators wrote. “Seniors must be quickly identified and resources deployed to ensure that no older American is left in unbearable heat without air conditioning or without water and food as response efforts continue… During this recovery period, it is even more important to multiply our efforts and deploy sufficient resources to support and rescue seniors.

It has been reported that the intensity of North Atlantic hurricanes and the number of Category 4 and 5 hurricanes are increasing. With a high concentration of people and properties in coastal areas were hurricanes strike, it become crucial to learn emergency management lessons gleaned from past hurricanes and disasters, from Hurricane Katrina to Hurricane Irma. The Senate Select Committee on Aging is on the right track in seeking ways to put disaster emergency preparedness on the nation’s policy agenda. Now, it’s time for Congressional standing committees to adequate fund FEMA and the National Weather Service and strengthen emergency preparedness laws.

Analysis Says That Aging Veterans at Greater Risk of Alzheimer’s Disease

Published in Wonsocket Call on October 2, 2017

On Monday, October 2, at a press conference USAgainstAlzheimer’s, (UsA2), along with veterans groups, plan to release an issue brief, “Veterans and Alzheimer’s Meeting the Crisis Head on,” with data indicating that many older veterans will face a unique risk factor for Alzheimer’s as a direct result of their military service.

Following the release of this issue brief, on TuesdPbulisheday evening at a reception in room 106 of the Dirksen Senate Office Building, UsA2, a Washington, DC-based Alzheimer’s advocacy group whose mission is to stop Alzheimer’s disease by 2020, will launch VeteransAgainstAlzheimer’s (VA2), a national network of veterans and their families, military leaders, veterans groups, researchers, and clinicians, to focus on raising awareness of the impact of Alzheimer’s and other dementias on active and retired military service members.

Dramatic Increase in Veterans with Alzheimer’s

Forty nine percent of those aging veterans age 65 ((WW2, Korea, Vietnam and even younger veterans, from the Iraq and Afghanistan conflicts in the coming decades), are at greater risk for Alzheimer’s compared to 15 percent of nonveterans over age 65, note the authors of the issue brief. “There is a clear and compelling obligation for greater support to meet the needs of veterans with Alzheimer, they say.

The issue brief pulls together research study findings released by the U.S. Department of Veteran’s Affairs (VA). On study estimates that more than 750,000 older veterans have Alzheimer’s disease and other dementias, another noting that the number of enrollee with Alzheimer’s grew 166 percent from roughly 145,000 in 2004 to 385,000 in 2014.

The “Minority communities are at greater risk for Alzheimer’s and minority veterans are predicted to increase from 23.2 percent of the total veteran population in 2017 to 32.8 percent in 2037, says a VA study.

The issue brief also cites study findings that indicate that older veterans who have suffered a traumatic brain injury (TBI) are 60 percent are more likely to develop dementia, Twenty-two percent of all combat wounds in Afghanistan and Iraq were brain injuries, nearly double the rate seen during Vietnam – increasing these younger veterans’ lifetime Alzheimer’s risk.

Veterans also face a multitude of barriers to effective Alzheimer’s diagnosis and care, including a complex Veteran’s Administration health system, a lack of understanding about available benefits, and a stigma related to brain and mental health, say issue brief authors.

George Vradenburg, UsA2’s Chairman and Co-Founder, sums up the message to Congress and federal and state policy makers in the released issue brief: “We need to understand so much more about why brain injuries sustained in battle put veterans at greater risk for Alzheimer’s. We must encourage veterans to participate in clinical studies to learn about the long-term effects of brain injuries, so we can do everything in our power to mitigate the impact on those who have given so much to this country.”

A Call for Funding…

When former Lt. Gov. Elizabeth Roberts released Rhode’s Alzheimer’s plan in 2013, to guide and coordinate the state’s efforts to care for those with debilitating Alzheimer’s and those who care for them, she called the report a ”living document, ” to be continuing updated as needed. With the 5-year update of the State’s plan being due June 2019, to be submitted to the Rhode Island General Assembly, Lt. Gov. Dan McKee and the Executive Board of the Alzheimer’s disease and related disorders working group, roll up their sleeves to meet that legislative deadline.

McKee and his Alzheimer’s plan working group are now turning to philanthropic organizations, like the Rhode Island Foundation, to fund their efforts to update the State’s Alzheimer’s plan. Yes, it costs money to do this and with the incidence of Alzheimer’s increasing in the Ocean State, lawmakers and state policy makers need an updated plan to provided them with a road map to effectively utilize state resources and dollars to provide care for those afflicted with debilitating cognitive disorder.

In 2013, 24,000 Rhode Islanders were afflicted with Alzheimer’s disease and other cognitive disorders and this number will continue to grow each year. With the state being so small, every Rhode Islander is personally touched, either caring for a family member with the cognitive disorder or knowing someone who is a caregiver or patient.

Funding from the Rhode Island General Assembly and philanthropic organizations are needed to get the ball rolling on the state Alzheimer’s plan. When updating, don’t forget the needs of Rhode Island’s aging veterans.

Founded in 2010, UsAgainstAlzheimer’s has worked to secure the national goal of preventing and effectively treating Alzheimer’s by 2025 and to assist in securing nearly $500 million in additional public funding for Alzheimer’s research over the past few years. The nonprofit’s global efforts has influenced the leaders of the world’s most powerful nations, the G7, to embrace a similar 2025 goal and to call for greater levels of research investment and collaboration to combat Alzheimer’s . Finally, UsAgainstAlzheimer’s works to forge pharmaceutical industry commitments to improve efficiencies for an expedited drug discovery and approval process. For more information click here.

For details on the updating of Rhode Island’s Alzheimer’s Plan, call the office of Lt. Gov. Dan McKee at (401) 222-2371.

Senate Republicans Pushing to Vote on Latest Health Care Proposal

Published in the Woonsocket Call on September 24, 2017

With the September 30 expiration of its special Senate budget reconciliations status that allows the chamber to repeal and replace Obamacare with just a simple majority, Senate Republicains are rushing to bring their latest health care fix up for vote by the end of next week. The GOP’s last attempt failed by a razor thin margin.

Critics charge that the Senate Republicans push to quickly vote on their latest health care bill, crafted by Republican Sens. Lindsey Graham of South Carolina and Bill Cassidy of Louisiana, comes before the issuance of a complete analysis of the Congressional Budget Office (CB)) that would detail the legislative proposal would impact coverage nationwide.

AARP, the National Committee to Preserve Social Security and health care provider groups say that Graham-Cassidy’s fix to put the brakes to rising health care costs will increase premium and out-of-pocket costs for millions. They say that the nonpartisan CBO would give the details to its negative impact.

Even Gov. Chris Christie came out opposing the GOP health care over haul bill that Senate Republicans are pushing. “I can’t support a bill that takes $3.9 billion away from the people of the state of New Jersey,” said the New Jersey Governor, reported last Wednesday by the Trentonian News. Democratic Colorado Gov. John Hickenlooper and Gov. Republican Governor John Kasich, of Ohio, held a bipartisan news conference this week calling for a bipartisan approach to reforming health care.

Talk Show Host Jimmy Kimmel also came out swinging against the Graham-Cassidy proposal, calling Sen. Cassidy, a co-sponsor of the bill, a liar. Earlier this year the Republican Senator had appeared on his show and after hearing that Kimmel had an infant son with a heart condition, he assure Kimmel that any GOP proposal would protect those with pre-existing conditions. It does not, at least to Kimmel’s satisfaction.

For days, aging and provider groups and even Democrats on cable shows expressed concern that the Graham-Cassidy Bill would allow states to permit insurance companies to charge people with preexisting conditions (an estimated 25 million Americans age 50 to 64) just because they have cancer, diabetes, high blood pressure, asthma, etc.

Age Tax Hits Seniors Right in their Wallets

On September 20, 2017, AARP writer Dena Bunis, charges in a blog posting, “Latest Senate Health Care Bill Revives Age Tax for Older Americans,” the GOP’s latest effort to repeal President Obama’s landmark Affordable Care Act (ACA), imposes an “age tax” on older Americans by eliminating premium tax credits and cost sharing payments that helped low-income persons afford deductibles and copayments for medical services.

The Graham-Cassidy bill would also allow states to get federal waivers for insurers to charge older Americans more so as to lower the cost for younger policyholders. The ACA limits the expense for older policyholders at three times the amount younger ones pay, says Bunis.

To illustrate the “age tax” Bunis, citing an AARP analysis, notes, that for a 60-year-old earning $25,000 a year, premiums and out-of-pocket costs could increase by as much as $16,174 a year. If that 60-year-old lives in a state that allows insurers to charge older individuals dramatically higher premiums, he or she would face an additional $4,124 increase in premiums,” she says.

The Graham-Cassidy bill takes away the premium tax credits that help older adults pay for their health care coverage, notes Bunis. . “About 6 million 50- to 64-year-olds buy their health coverage in the individual market, and about half of those individuals receive tax credits to help pay their premiums, she says, citing an analysis by the AARP Public Policy Institute.

The Graham-Cassidy bill would also eliminate vital cost-sharing payments that help low-income persons — especially those over age 50 — afford deductibles and copayments for medical services, too, adds Bunis, noting that “about 58 percent of adults enrolled in ACA marketplace plans get cost-sharing assistance, and 35 percent of those individuals are between 50 and 64 years old.”

Bunis notes that the latest Senate health care proposal would shift federal funds to the state through block grants that would allow each state to develop their own specific health care coverage initiatives to reduce costs. But, she says that Medicaid per capita cap or block grants funding proposals, “fundamentally change the Medicaid program [covering 17.4 million older Americans and people with disabilities], which has been a safety net for millions of poor Americans and people with disabilities.

Receiving Medicaid eligibility for coverage and services would leave fewer doctors and other providers willing to take Medicaid patients or provide needed care because reimbursement is too low.

Block grants, mandated by the Graham-Cassidy bill, would only last through 2026, offering no replacement health care plan, says Bunis. “Over 20 years, Graham-Cassidy would slash Medicaid funding by $1.2 trillion to $3.2 trillion, turning control of the program to the states and shifting costs over time to states and Medicaid enrollees,” she says.

“Americans have a right to know how this bill would impact them. Regretfully, the Majority Leadership is rushing the Senate to blindly consider Graham-Cassidy without fully vetting this proposal in committee hearings and mark-up, where amendments could be considered, and without a full Congressional Budget Office (CBO) score. CBO previously estimated that repeal-without-replace would cause 32 million people to lose health coverage,” said Max Richtman, President and Chief Executive Officer of the National Committee to Preserve Social Security and Medicare (NCPSSM), in a statement to Senate Finance. The Senate panel is scheduled to hold a hearing on the Graham-Cassidy bill next week.

“Senate consideration of any bill that would change the accessibility and affordability of essential health care for millions of Americans without a complete CBO analysis and committee debate would be the height of legislative malpractice,” says Richtman.

NCPSSM calls the latest GOP Senate Health care proposal “deeply flawed” and suggests that it be referred to the Senate Committee on Health, Education, Labor and Pensions where Chairman Lamar Alexander and Ranking Member Patty Murray are attempting to hammer out a bipartisan solution to strengthen the ACA’s individual health insurance market reforms.

A Final Take

A press time, Republican Sens. Ron Paul (Kentucky) and John McCain (Arizona) give thumbs down to the Graham-Cassidy bill with the Portland Press Herald reporting that Sen. Susan Collins of Maine, saying “I’m leaning against the bill.” Fifty Republican Senators must give their thumbs up, with Vice President Mike Pence casting the tie-breaking vote, to get a simple majority for passage. Now, the votes are just not there for passage.

But, one long-time Republican Senator speaks honestly on the record why President Donald Trump his fellow Senate caucus members are pushing so hard for passage of the latest Senate health care proposal. “You know, I could maybe give you 10 reasons why this bill shouldn’t be considered,” Iowa Republican Senator Chuck Grassley. “But Republicans campaigned on this so often that you have a responsibility to carry out what you said in the campaign. That’s pretty much as much of a reason as the substance of the bill.”

Sadly, if true the Republican-controlled Congress has put millions of Americans at risk of losing their health care coverage and at risk for the sake of a political promise. Our lawmakers must become statesmen and vote on legislative proposals because it is the right thing to do, not politicians who vote by party-line.