Rhode Islanders Will Benefit for Long-Term Care Improvements

Published in Pawtucket times on April 5, 2004

An AARP membership application just arrived last week, inviting me to join the nation’s largest senior advocacy group.

AARP’s invitation to join clearly announces my major milestone in my life, when my June birthday officially pushes me into my 50s.

Celebrating my 50th birthday is no problem for me on a personal level, especially with my philosophy that, as with wine, one gets better with age.

But, as a writer on health care and aging issues, I see problems as to how I might access needed home and community-based services or nursing hoe care in my later years, especially if the state does not fix its problematic long-term care deliverly system.

The graying of Rhode Island’s population is taxing the state’s existing long-term care delivery system and will continue to do so for years to come. In response, state policymakers have taken a Band-Aid approach in trying to fix the fragmented system.

Already the Ocean State’s senior population, ages 60 and over, comprises more than 18 percent of the state’s total population. Gov. Don Carcieri and state lawmakers should be very concerned that Rhode Island’s population continues to age at the same time its long-term care delivery system needs an immediate overhaul.

Everyone knows it is extremely difficult for caregivers and seniors to negative the Ocean State’s long-term care system. Just ask any aging baby boomer (persons born between 1946 and 1964), and many will say that it is extremely difficult to find the needed programs and services to k eep mom and dad at home.

Today, many adult children who are juggling careers and raising children are also shouldering additional caregiving responsibilities to their olde parents. Even if their parents have been able to put a little money aside for their retirement, their children see their inheritance quickly being whittled down by thousands of dollars a month, all spent on costly pharmaceuticals and long-term care services.

Money can buy you anything in life, including home and community-based care and nursing home services.  Staying independent at home is still difficult for may moderate-income Ocean State seniors who cannot pay or find providers , especially with the Department of Elderly Affair’s (DEA) co-pay program not being fully-funded.

DEA’s co-pay program aids more that 1,500 frail seniors who do not qualify for the state’s Medicaid program, but who require ongoing services to remain in their homes. This funding helps pay for certified nursing assistants, who assist seniors with bathing, meals, shopping, laundry and light house keeping. DEA’s co-pay program slso provides subsidies for adult day care.

Last October, DEA’s freeze on new admissions to its co-pay program left more than 200 frail seniors on a waiting list for home and community based services.

While Gov. Carcieri recently gave an additional $ 200,000 in funding to DEA’s co-pay program in his 2005 budget, senior advocates have warned this amount is not enough. It is estimated this additional funding will serve 60 to 80 seniors out of the 200 persons currently on the waiting list.

Meanwhile, DEA has even put a freeze on new admissions to its respite program, which enables caregivers to take a break from the grueling physical and psychological demands of taking care of a frail elderly family resident.  This freeze will continue for the rest of this fiscal year, and nobody is sure how long the freeze for this initiative will last.

Hugh Hall, chair of the R.I. Health Care Association, tells All About Seniors that nursing homes will also be especially hit hard as state funding continues to diminish at the same time as  the cost of services and regulatory requirements increases.

“The state’s budget crisis is causing the governor to not meet a commitment in restructuring an antiquated Medicaid reimbursement system that pays for the care provided to 75 percent of the 10,000 frail residents in nursing homes,” said Hall.

This year, Carcieri, citing budgetary constraints, did not keep his promise to move forward with Part Two of the Medicaid reimbursement restricting, said Hall.

“This will have serious effects on the financial viability and quality of care provided in more than 70 small nursing homes throughout the state,” he said.

The huge budget deficient will continue to force Carcieri’s and state lawmakers hacking of many worthy programs and services previously funded in the state budget.  However, the state’s 2005 budget must adequately fund DEA’s co-pay and respite initiatives that keep frail seniors at home in their communities through the use of less costly home and community-based services.

The state must also keep its promise to adequately fund the state’s nursing homes for providing the needed medical care to those who are too sick to stay at home.

Hopefully, in 15 years, when I reach my next milestone – turning 65 – the state policy makers will have hammered out a much improved long-term care delivery system.

A commitment by Carcieri and state lawmakers to fix today’s fragmented long-term care delivery system will have long-range consequences, ultimately beneiting aging baby boomers, their children, and their children’s children.

Indeed, all future generations in this state will ultimately benefit from sound long-term care policy.

Better Business Bureau Resource Book Offers Seniors Valuable Tips

Published in Pawtucket Times on March 29, 2004

Everyone has probably heard the old adage…If you don’t pay for it, you won’t appreciate it.”

Maybe this is true in some situations, but this is not the case should you pick up a “free” issue of the Rhode Island Senior Citizens Edition 2004, published by the Better Business Bureau Book (BBB) series.

The 53-page resource book is free and available at local grocery stores and retail sites throughout the state. It was written to address special needs of seniors by using reliable information.

Seniors and caregivers can become savvy shoppers by simply skimming through this annually updated publication when they seek out products and services.

Do you need to modify your home to adapt it to promote greater independence or to prevent falls?  BBB’s 2004 senior edition gives you sound advice when you begin your home fixups.

When shopping around, make sure the contractor you will use is both licensed and bonded.  Always get a written down payment and only make it a small down payment.

Your final payment should be made when the contractor completes the project to your satisfaction. Always contract Rhode Island’s Better Business Bureau (785-1212) for a reference.

While many may consider BBB’s useful recommendations as common-sense advice, sadly some seniors don’t follow the advice and become victims to unscrupulous contractors.

BBB’s 2004 senior edition is jam-packed with useful information, from outlining senior housing choices to tips on choosing a nursing home, medical insurance and long-term care insurance, eye care and dental prosthetics.

Do you need help with managing your assets or spending within your means?  Are you seeking a lawyer to write your will , creating a trust, durable power of attorney or advance directives?  Have you considered pre-planning your funeral. Yes. BBB’s senior 2004 edition gives timely suggestions on hiring financial planners, lawyers, or even choosing a funeral home.

About 30 percent of the nation’s seniors and 50 percent of those over 85 suffer from hearing impairment. Buying a hearing aid can be a frustrating, intimidating experience for many seniors.  BBB’s 2004 senior edition walks seniors through the process of purchasing a hearing aid.

The publication gives an easy-to-understand explanation of the types of hearing losses and where to turn to for treatment – an otologist, audiologist or a hearing aid retailor. Seniors can turn to page 27 to learn the  specifics about hearing aid products, what to expect during the hearing examination, what to look for in contracts and warranties and service and repair issues.

BBB’s 2004 senior edition warns that Rhode Island is now considered a “target state” for scams because of the state’s high percentage of seniors – 16 percent of the Ocean State’s population is over age 55. The resource book warns about seniors about Canadian telemarketing scams, thieves posing as utility workers or inspectors or Nigerian “fund transfer” scams and how to avoid them.

Finally, seniors are taught how to successfully complain via writing effective complaint letters.  Effective complaining begins by sending a letter addressed to the person in charge of the company, not the consumer protection agency. Always allow the company an opportunity to fix the problem.

When corresponding be courteous, describe the problem clearly and be reasonable when requesting your solution, and enclose “copies” of all appropriate documents. Most importantly, always give the company a reasonable amount of time to respond to your complaint. These are not bad suggestions for seniors or caregivers to follow when attempting to resolve a consumer issue.

In his forward to BBB’s 2004 senior edition, A. Michael Marino, BBB’s president, calls on the reader to keep this handy resource book in a very convenient location for easy reference.  You’ll be able to truly appreciate the sound advice and information this free BBB publication offers, despite the old adage about appreciating only the things we pay for.

Call 785-1212 for a copy of BBB’s senior edition, for pickup locations or for detailed information on how seniors can access BBB services.

Fogarty, Senior Advocates to Rally for Increased Funds for State’s Co-Pay Program

Published in Pawtucket Times on March 22, 2004

Research is just beginning to show what Rhode Island aging advocates already know – that more assistance is required for helping the disabled and seniors to reside independently in their homes in the community.

According to researchers at the Disability Statistics Center at the University of California at San Francisco, about 3.3 million community-residing adults who require assistance with two or more activities of daily living (ADLs) need help from another person.

Of these, almost one million people need increased care, more than they are receiving – particularly those who live alone.

ADLs include bathing, dressing, getting into or out of bed or a chair, toileting, eating and other activities that are required to maintain their homes, such as shopping and preparing meals.

This study, published in the March issue of The Journal of Gerontology: Social Sciences, is considered to be the first to estimate the level of care required to help people.

“Individuals who need personal assistance with two or more of the five basic ADLs [mentioned above] and whose needs are unmet, have a shortfall of 16.6 hours of help per week,” said lead author Dr. Mitchell P. LaPlante.  Joining him on the project were Drs. H. Stephen Kaye, Taewoon Kang, and Charlene Harrington, in a written statement.

Among adults whose assistance needs are not fully met, people living alone fare worse than those who live with others, the researchers said. The study found those living by themselves receive only 56 percent of the help they need, while those living with family members or friends receive 80 percent of the hours of help, they need.

The research findings indicate that having unmet needs is linked with numerous adverse consequences, including discomfort, weight loss, dehydration, falls, burns and dissatisfaction with the help they do receive.  This puts these people at risk of being forced to leave their homes and move into costly nursing facilities.

Additionally, the University of California at San Francisco study also reported that unmet needs among people living alone are more an issue for the elderly, since two-thirds of those living alone and needing more help are age 65 or older.

This research study, probably the first of may to come that estimates the assistance required by the nation’s disabled and elderly, should be delivered to the doorstep of Gov. Donald Carcieri and every state lawmaker.

Even with the graying of the Ocean State’s population, the governor and the Rhode Island General Assembly are moving too slow to adequately fund less costly community-based care programs.

Carcieri has given an additional $ 200,000 in funding to the Department of Elderly Affairs (DEA) co-pay program in his recently released proposed 2005 budget.

While appreciative for this increase in funding in the showdown of the state’s huge budget deficit, senior advocates say this is not enough to keep people off the waiting list for this worthy program.

DEA’s co-pay program keeps 1,500-plus low-income frail seniors who do not qualify for the state’s Medicaid program but who require ongoing services to remain in the community in their homes by providing a little bit of funding for certified nursing assistants (for assisting with bathing, meals, shopping, laundry, and light housekeeping). And DEA’s co-pay program also provides subsidies for adult day care.

Last October, a DEA freeze on new admissions to the co-pay program left 200 frail seniors on a waiting list for home and community-based care, said senior advocates.

According to the state’s Long-Term Care coordinating Council (LTCCC), the typical person in DEA’s co-pay program is between ages 65 and 104, with the average age being 84. Most are women and more than half live alone. Without the state’s co-pay, these seniors will have to pay the entire fee for their care –    which they cannot afford – or enter a nursing home, or go without the help they need to do simple things such as bathing, shampooing and dressing.

Susan Sweet, a consumer advocate  who sits on the LTCCC, expressed concern that a DEA freeze – putting the copayment program on hold – for those on the waiting lists still exists this fiscal year.

“These people have been waiting a long time to get the home care or adult day care services that they need. I am afraid that waiting longer will result in many of them entering nursing facilities prematurely,” said Sweet.

Sweet noted Carcieri’s proposed 2005 allocates an additional $ 200,000 in funding for next year’s DEA’s co-pay program.

“It will take more funding than that to take care of the frail seniors still left on a waiting list,” Sweet charged, noting that DEA Director Adelita S. Orefice, did say another $ 250,000 would be needed in FY 2005 to meet DEA’s co-pay program demand.

Lt. Gov. Charles J. Fogarty, who is chairman of the LTCCC, will join senior advocates today at 11:00 a.m. at the Statehouse, calling for the state to reopen admission to a state-funded co-pay program that helps limited-income seniors pay for home and community-based care.

The press conference is expected to draw several family caregivers and representatives of AARP-RI, Choices Coalition, Respite Services, R.I. Adult Day Care Services Association, Alzheimer’s Association of R.I., R.I meals on Wheels, R.I Partnership for Home Care, R.I. Senior Center Directors Association, Senior Agenda Consortium and the Silver-Haired Legislature.

“Freezing the DEA co-pay program is a fiscal folly,” Fogerty said in a written statement obtained by All About Seniors that will be released at today’s rally.

“It is shortsighted from both a financial and a human perspective. It is not as if this freeze will result in overall cost savings,” said the Lt. governor.

Fogarty said this freeze was ordered to avoid having the DEA spend more than what was budgeted for the program in the current fiscal year – an amount that was less than what was spent on the program in FY 2003.

At this rally Fogarty will call for the state to provide adequate funding in the FY 2005 budget for DEA’s co-payment program to address the unmet need.

“To the contrary,” Fogarty said, “it may wind up costing taxpayers much more, because these seniors are still going to need care and they’re going to get by being forced into nursing homes where the taxpayers will pay tens of thousands more than we would have paid for the co-pay program.”

According to Fogarty, in FY 2003, the state supported 1,457 seniors in the program, spending $ 3,650,117, or $ 2,505 per senior. That’s less than 1 percent of all long-term care spending. Contrast this, he said, in is written statement, with the annual cost per nursing home resident – between $ 32,000 and $ 53,700 (this figure excludes the average 20 percent patient contribution to care and includes state and federal dollars).

Fogarty said, “It boggles the mind that in tight budget times, we would opt for the more expensive solution – especially in light of the fact that the less costly option of keeping seniors in their homes is the most humane option.”

As mentioned in a previous column, there is also a freeze and waiting list for the state’s respite program, which provides assistance to family caregivers. This freeze continues and no additional funding has been allocated for this program in Carcieri’s proposed 2005 budget.

Carcieri and state  lawmakers must not continue to put patches on the state’s old dilapidated long-term care deliver system. As I previously mentioned, now is the time to tackle the thorny issues of long-term care and its rising costs.

Rhode Island must move to create a long-term care delivery system that will adequately provide funding for keeping seniors independent in the comfort of their homes while adequately providing reimbursement to nursing facilities that take care of sicker patients.

Seniors can support Fogarty’s call for adequate state funding for DEA’s co-pay program by attending the rally scheduled today at 11:00 p.m.at the Statehouse.

Meanwhile a DEA budget hearing will be held before the House Finance Committee later in the afternoon, at 1:00 p.m. in Room 35 of the Statehouse.

Seniors can attend this hearing to give their support for increased state funding for community-based care long-term programs. Testimony taken from the public will be televised on the state’s access cable channel.