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.

Drug Company CEOs Receive Plea  for Lower Drug Costs

Published in Pawtucket Times on March 15, 2004

Seniors can only hope the pen is mightier than the sword as senior advocates send correspondence to CEOs of major drug companies, urging them to take more responsibility in putting the brakes on skyrocketing pharmaceutical drug costs.

Last Monday, AARP CEO William D. Novelli drafted a letter challenging 16 CEOs of major drug companies to lower the nation’s spiraling drug costs.

AARP’s CEO charged in this correspondence -which has been obtained by All About Seniors – that even with last year’s newly enacted Medicare prescription drug law, high drug prices are still a very serious issue for the nation’s seniors.

“Too many people cannot afford the drugs they need,” Novellis said, resulting in a “very substantial non-compliance with physicians’ recommendations.

Also contributing to higher drug prices, said AARP’s top official, is that seniors do not use geriatrics despite their “comparable effectiveness and lower cost.”

Novelli called on each drug company CEO to limit their company’s price increases to no greater than the level of inflation for current drug products. Additionally, he requested they stop price increases of new drugs, asking them to use their influence to stop drug mark-ups throughout the drug distribution chain.

Novelli urged the drug company CEOs to support drug-importation legislation, subject to proper FDA oversight to ensure safety of the imported medications. (Currently there is legislation being considered by Rhode Island lawmakers to allow drug importation from Canada).

Furthermore, Novelli asked CEOs for their drug companies’ strong endorsement of federal and state funding “to support clinically based, comparative effectiveness research that will permit objective, scientific comparisons of specific drugs in the same therapeutic class.”

Novell even urged the CEOs not to oppose any federal legislation introduced that would provide the Secretary of Health and Human Services with appropriate negotiating authority in the event the competitive private purchasing system does not produce the anticipated cost savings for the Medicare program.

The Republican-crafted Medicare law does not allow the federal government to negotiate for lower drug prices – a move that’s been opposed by the Democrats.

To put the brakes on rising out-of-pocket costs for seniors, Novelli also asked the CEOs to support a disclosure of pricing information by pharmaceutical benefits managers to their payer clients. This would assure that those enrolled in the Medicare program will receive full advantage of negotiated discounts and rebates.

Better displays of drug information regarding the risks, side effects and proven effectiveness of their consumer advertising is needed, Novelli told the CEOs. He also called for generics to be quickly moved into the marketplace when the patent has expired for brand name drugs.

In his correspondence, Novelli called on the CEOs to follow the ethics guidelines of the American Medical Association when it comes to giving gifts to physicians and sponsorships of educational meetings.

Last month, Lt. Gov. Charles J. Fogarty, chairman of the state’s Long-Term Care Coordinating Council, in Feb. 19 correspondence, called on Alan F. Holmer, president and CEO of PhRMA, to join the lead of drug manufacturer Merck in providing medication at no cost to low-income Medicare beneficiaries who participate in the new federal Medicare prescription drug discount card program.

Low-income seniors would be eligible for the Merck benefit once they use up their $ 600 federal allotment on their cards. Fogarty said in his written statement.

The Medicare drug discount cards are an interim measure put in place by the federal government until 2006, when newly passed Medicare changes will take affect, said Fogarty. The lieutenant governor, along with many of the state’s senior advocacy groups and the state’s Congressional delegation, have given their thumbs-down to the Republican-backed enacted Medicare revisions and have urged Congress to scrap the law and “to back to the drawing table.”

By accepting his invitation to help lower the cost of pharmaceutical rugs, Fogarty believes, “This will give the industry the opportunity to partner with the government and make a significant difference for those in need.”

The seniors’ battle to slash the out-of-pocket costs of pharmaceuticals must take place both on Capitol Hill, inside the Washington, D.C. Beltway, and at the Rhode Island Statehouse in Providence.  Novelli and Fogarty are now taking the fight to the boardrooms of major drug manufacturers across the nation.

Seniors may well hope that the pen is indeed mightier than the corporate sword.

The Best of…Some Tips to Take Lying Down

            Published March 1, 2004, Pawtucket Times

             Sometimes I just can’t sleep.  When this happens, I just lay in bed tossing and turning, staring through the darkness at the ceiling.  It is 2 a.m.  All I want is a good night’s sleep.

              According to a publication released by the New York-based International Longevity Center-USA (ILC-USA) and the AARP Foundation, I am not along in trying to get a good night’s sleep-a whopping one-third of the nation’s seniors will find themselves sleepless in their bedrooms (not in Seattle).  Lack of sleep can even lead to serious health disorders.

           The AARP-ILC consumer publication, “Getting Your ZZZZZZZZs: How Sleep Affects health and Aging,” takes a look at common sleep disorders, their effects on the brain and body and what someone who suffers from these conditions might do to get a good night’s sleep.

           “Not getting the right amount of sleep can become a serious health problem, and it is not a natural part of aging,” says Robert N. Butler, M.D., ILC-USA’s president and CEO in a written statement promoting the publication.

           “A large number of older persons often suffer from this medical condition and go unrecognized or are not treated appropriately,” he said.

           “According to the 12-page AARP-LLC consumer-oriented publication, sleep problems in your later years are caused by a combination of factors.  Sleep problems can result from physical changes associated with growing old.

            Sleep problems can also be caused by pain and discomfort associated with aging and traumatic life experiences, such as the death of a spouse, or the loss of a job.

           Even decreased physical activity and lack of exposure to sunlight can also  impact on a person’s ability to sleep.

           “Sleeplessness sets up a vicious cycle.  Older people have problems that disturb their sleep, which often affects their other body systems, especially hormone production and metabolism causing more problems that disturb sleep even more,” states the AARP ILC publication.

           “New studies highlight the signficant impact of sleep on physical and mental well-being, especially for older men and women,” the AARP-ILC publication points out.  Loss of sleep can lead to memory problems, depression and greater risk of falling.  Lack of sleep may also cause changes in the nervous system that affect cardiovascular health.

           According to the AARP-ILC publication, snoring may indicate as serious health problem, considered the most common form of sleep apnea.  This sleep disorder causes sleeplessness because the sleeper wakes up frequently from the lack of oxygen caused by this labored breathing.

          Findings from the Nurses health Study indicate that snoring was associated with hypertension as well as weight-related health problems.

          Several other research studies have shown that people who suffer from sleep apnea also have high rates of automobile accidents and are at risk for diabetes.

         Insomnia caused by depression, serious mental or physical illness, or unhealthy lifestyle choices, is considered another major sleep disorder. Proper treatment requires a physician to diagnose the cause.  In addition, obesity, alcohol, smoking, nasal congestion and menopause are also suspected of affecting a person’s ability to fall asleep.

          Meanwhile, report gives tips on getting your ZZZZZZZs.

          The AARP-ICU consumer publication notes a regular schedule of exercise and a healthier lifestyle can help you enhance the quality of your sleep.

          Recent studies also indicate taking short naps during the day of no more than 20 to 30 minutes may actually help a person sleep at night.

          Although medications can be used for short-term problems, it does not seem to solve long term sleep problems.

         Always check your medications.  Some actually act as stimulants.  Avoid alcohol and nicotine.  Both can disrupt your sleep.  Also, avoid overeating and drinking large quantities of liquids before bedtime.

          Finally, create a sleep-friendly bedroom.  A cool, quiet room can enhance your sleep. Make sure that your mattress is comfortable. Use the bed for only sleep or sex to strengthen the mind’s association between bed and sleep.

         Meanwhile, the AARP-ILC publication notes two  new ides, light therapy and two drugs, melatonin and valarian, are thought by some experts to be effective treatments for seniors with insomnia problems.  However, the authors of the publication call for more studies to ensure that these alternative treatments are safe and effective.

         “Our nation’s oldest adults need not accept poor sleep as a penalty for being old,” said Dr. Butler.  “As researchers learn more about how the human body controls sleep, effective treatments for sleep disorders in older and younger people, will become increasingly possible.”

         Call 212-606-3383 to get copies of “Getting Your ZZZZZZZs: How Sleep Affects Health and Aging.”  English and Spanish versions of this publication can be downloaded from the ILC-USA’s Web site at www.ilcusa.org.

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