State Must Rethink Its Driving Policies for Seniors

Published in Pawtucket Times on August 4, 2003

Not seeing the posted sign, 86-year-old Russell Weller drove onto a street closed to traffic and mowed down 50 pedestrians with his car, ultimately killing 10, in a Southern outdoor farmers market.

Just nine days later, Louis Nirenstein, 70, plowed into pedestrians at a local farmers market in Flagler Beach, Fla., injuring six people.

Both of these accidents follow on the heels of the tragic death of longtime R.I. state Rep. Mabel Anderson, who was killed while pushing her carriage at the front entrance of the Home Depot parking lot at the Bristol Place Shopping Center in South Attleboro.

A magistrate’s hearing to determine if vehicular homicide was committed by an 88-year-old Pawtucket driver is scheduled for Aug. 14 at the Attleboro District Court.

According to a report released by the Road Information Program last month the number of older drivers – ages 70 and above – killed in crashes nationwide increased by 27 percent from 1991 to 2001.

The latest data finds older drivers have not only lost their ability to manage complex traffic situations, but are more likely to have problems making left hand turns and understanding small signage that alerts motorists to upcoming changes in traffic patterns.

The aging process guarantees your driving skills will not be as shar as you get older.  Poor vision, caused by cataracts, glaucoma, macular degeneration, poor hearing, lack of flexibility, limited range of motion and reduced rection time make the complex tasks associated with driving more difficult for older motorists.

As older driver facilities increase and the death toll tied to older-drivers accidents sky-rocked, a growing number of states are looking at licensing restrictions as a way to delicately approach this complicated problem.

AARP and other aging advocacy groups will say not all seniors are equally affected as they age. One may lose the skills needed to drive safely at age 60, while another will not lose those skills until 90.

For many seniors, losing your driving privileges translates to the loss of independence. Meanwhile, public transportation may not be readily available.

States are grappling with this age-charged issue, not wishing to stir up the wrath of seniors. Aging advocates oppose any blanket solution to this problem, calling for licensing restrictions to be made on a case-by-case basis. They say age should not be used as a predictor of unsafe driving.

In Rhode Island, the Department of Motor Vehicles has decreased its renewal cycle from five years to two years for persons age 70 and older.  At license renewal time, some states require vision screening and road tests for older drivers.  Certain medical conditions or a succession of accidents my restrict your driving privileges in other states.

Even the limiting of driving hours or the types of roads driven on are examples of license restrictions that states can attempt to reduce age-related accidents.

The American Association of Motor Vehicle Administrators, the American Automobile Association, AARP and the National Safety Council, have recognized the thorny issues surrounding restrictive licensing and have developed special training courses to help older motorists drive more safety.

On the other hand, even if an older driver enrolls in one of these courses, they may choose not to recognize age-related limitations that impact on their driving.

With a growing age population, R.I. state officials must tackle this problem head-on. Why not consider mandating a battery of tests to examine an older drivers’ field of vision, flexibility and range of motion, reaction time, along with the person’s mental or cognitive abilities?

Intersections can be improved by widening left-lane turn lanes, adding overhead street signs and adding luminous lane markings.

Finally, street and highways can be improved by creating longer merge and exit lanes, making curves less sharp and using rumble strips to warn motorists when they are running off the road.

If the state chooses not to act, the result will allow a growing number of unsafe senior drivers on the road.

Ultimately, the burden falls on the family and physicians who must take the keys away from the driving-challenged senior.

Sometimes you just have to yank the keys away from an older family member, like my family needed to do several years ago. When my father could not stop my mother with dementia from driving, the only solution appeared to come from making a call to the Texas Department of Motor Vehicles (TDMV) by my family.

Mother’s deteriorating driving skills were reported and as a safe measure, the TDMV officials called her in for testing – where she failed the test thy gave her three times.

As difficult as a decision this was for my family to make ultimately, my mother, who was in mid-to-late state dementia, didn’t even realize that she had lost her driving privileges and her keys.

Sadly, we will continue to read about age-related traffic accidents and the death of innocent victims until states move to tighten driving licensure of older adults.

For information about AARP’s 55 Alive Driver Program for older people call 1-888-227-7669 or write them at 601 E. Street, N.W., Washington, D.C. 20049.

Aging Advocates Call for Override of Governor’s Veto

Published in Pawtucket Times on July 14, 2003

The General Assembly is poised to override  Gov. Don Carcieri’s veto Tuesday.

The political rhetoric has intensified as the governor picks apart the 2004 budget, which was recently passed by the Democratic-controlled legislature, forcing Democratic Majority Leader William J. Murphy and Senate President William V. Irons to explain how they shaped the budget.

Carcieri has called the General Assembly’s 2004 budget flawed because lawmakers have “missed opportunities” to stop the legislature’s habit of deficit spending.

The governor’s media blitz, beginning last week, is intended to build support for his efforts to defeat the legislature’s attempt to override his veto. Carcieri has called for the elimination of subsidies for greyhound kennel owners [also supported by this writer] and the reining in public-employee personnel costs.

Carcieri also opposes the spending of $ 52 million in federal Medicaid expenditure relief funds and the one percent restaurant sales tax.

When the dust settles after Tuesday’s legislative session to override Carcieri’s veto, aging advocates hope for an override. The 2004 budget crafted by the Democratic-controlled General Assembly puts increased state funding into senior programs and services.  Both provider groups and senior advocacy groups expressed disappointment when Carcieri’s budget proposal did not allocate funding for new aging-related initiatives. Moreover, his fiscal blueprint for state spending made cuts to existing senior programs and services.

“Once again, senior advocates have looked to the General Assembly to provide essential programs and services for the state’s growing senior population,” says Susan Sweet, a long-time aging advocate and consultant to nonprofit groups who also serves as a consumer representative to the state’s Long-Term Care Coordinating Council.

“We have not been disappointed,” Sweet said, in reference to the passage of the General Assembly’s 2004 budget.  “It’s sad that the Carcieri administration does not recognize the improvements the General Assembly has made to the budget and the lives of older Rhode Islander.”

Joan Crawley, executive director of Pawtucket’s Leon Mathieu Senior Center, added, “Although I can appreciate Carcieri’s frustration with trying to balance the state budget, as a senior advocate, I applaud the legislators for making the very difficult decision to fund legislative grants on behalf of the state’s  senior centers,” she said.

“At the Pawtucket town meeting, gubernatorial candidate Carcieri assured us that seniors would be a top priority of his administration should he be elected governor. He even distributed a brochure outlining his senior initiatives. So far, he has failed to address any of those initiatives in is budget, Crawley says.

So, what’s in the General Assembly’s 2004 budget that will improve the quality of life of Rhode Island seniors?

The budget will allocate new state funds totaling $ 300,000 to pay for nursing facility care of legal immigrant Rhode Island seniors who are not eligible for Medicaid.

The budget will also allocate $ 50,000 to support the efforts of the Ocean State Adult Immunization Coalition to get the word out about the importance of seniors getting influenza and pneumococcal vaccinations.

Meanwhile, lawmakers have allocated state monies for community grants. Initially, senior centers (in Carcieri’s budget ) were targeted with a 10 precent cut. To the relief of senior center providers, lawmakers passed the 2004 budget with no cuts

As previously reported to All About Seniors, an 18-month study by B.D.O. Seidman, a consulting firm hired by the state Department of Human Services, found Rhode Island was underpaying its nursing facilities in excess of $ 30 million annually.

It seems that the Rhode Island General Assembly agrees with the report’s assessment, because lawmakers made a partial allocation of new Medicaid dollars to overhaul the state’s ailing Medicaid system.

With passage of the budget, nursing facilities will receive a total of $ 18.8 million in state and federal dollars – a three-year phase-in will bring the total federal and state dollars up to $ 30 million.

Finally, the recently passed 2004 state budget has allocated $ 50,000 to provide dental services to nursing facility residents.

The 2003 budget that was supposed to expire June 30 stays in effect until Carcieri signs the 2004 budget into law. Until that time, new programs, policies, or program appropriations will be effectively put on hold.

An override of Carcieri’s veto will result in many new senior programs and services being funded in the 2004 state budget.

If the popular Republican governor is able to rally is troops – both Republican lawmakers and Carcieri Democrats – to support his veto, then lawmakers must begin their efforts to hammer out another budget.

….

As noted in last week’s All About Seniors column, not one dime in state funding was allocated in the state’s 2004 budget to beef up the state Department of Health’s regulatory oversight. Providers, aging advocates, and even state officials have called for new state dollars to fill one full-time surveyor position (a nurse) to ensure that assisted living residences across Rhode Island are inspected on a timelier basis.

The General Assembly has put laws on the books to protect frail Rhode Island seniors who received assisted-living services. Yet, Carcieri and lawmakers have failed to allocate the necessary funding in the 2004 state budget to allow Health Department regulators to comply with    their legislative oversight duties to inspect the state’s 72 assisted-living facilities and 155 assisted-living bed in nursing facilities on a timely basis.

That’s not all.  According to the state’s Department of Health, another seven assisted-living projects are expected to be up and running over the next 18 months.

Meanwhile, at Tuesday’s veto override, lawmakers will also take up legislative issues were not addressed in their haste to adjourn two weeks ago.  Maybe the state Health Department’s urgent need for more funding to adequately perform its oversight duties of assisted-living facilities will be acted on by lawmakers in both chambers.

Carcieri can become the white knight and save the day. He can choose to move forward and fix this policy flaw by either using contingency funds in his office budget or to take administrative action to hire one more full-time assisted living inspector.

Acting decisively to fix tis identified policy glitch is sound public policy that will ultimately protect the health and well-being of 1,700 assisted-living residents. Even with Carcieri’s calls for balancing the budget, taxpayers especially seniors won’t oppose allocated tax dollars to protect older Rhode Islander.

State Lawmakers Ok Many Senior Initiatives  

Published in Pawtucket Times on July 7, 2003

 As this year’s legislative session came to an end, even the widely publicized tight state budget did not keep aging advocates from seeing some of their legislative proposals get passed by the House and Senate.

With the passage of companion legislative proposals (H 5841/ S 876), the state’s long-term care ombudsman law will be revised to reflect federal law, expanding the scope and authority of the state’s ombudsman program.

The new statute changes will require the state ombudsman to represent the interests of nursing facility residents or clients of service providers before governmental agencies.

The state ombudsman will also be charged with seeking administrative, legal and other remedies to protect the health, safety, welfare and rights of Ocean State seniors.

Another legislative proposal also got the thumbs-up from lawmakers. With the passing of companion proposals  H 5418/ S 506, new state funds totaling $ 300,000 will pay for nursing facility care of legal immigrant Rhode Island seniors who ae not eligible for Medicaid.

Meanwhile, the Rhode Island General Assembly provided that it sees the value in preventative medicine and how it can ultimately save health care dollars.

The Ocean State Adult Immunization Coalition requested $ 103,000 in new state funding to expand the coalition’s efforts to get the world out about the importance of seniors getting influenza and pneumococcal vaccinations.  While not receiving the whole loaf, lawmakers gave a half loaf instead – about $ 50,000.

With state dollars now allocated up front, large savings will be realized down the road. The cost of a flu shot is $ 15 and a pneumonia shot is $ 30.

If a senior is hospitalized, the average length of stay for an older person with influenza is five days, costing $ 12,000.  That’s a huge savings.

Lawmakers also passed legislation to make pharmaceutical drugs more affordable to Rhode Island seniors.

With the passing of companion proposals H 5237/S 374, persons eligible to participate in the Rhode Island Pharmaceutical Assistance to the Elderly Program (RIPAE) who also have prescription drug coverage through a health plan, will now be allowed to use RIPAE to pay for an individual prescription drug once they reach the maximum level of coverage for that drug.

Also, companion measures H 5239/ S378 passed, expanding RIPAE to allow persons age 55 to 61 on Social Security Disability Insurance to receive a 15 percent RIPAE co-payment in addition to their RIPAE drug discount rate.

As previously reported in All About Seniors, an 18-month study of .B.D.O. Seidman, a consulting firm hired by the state Department of Human Services, found that Rhode Island was underpaying its nursing facilities in excess of $ 30 million annually.

It seems that the General Assembly agreed with that report’s assessment and made a partial allocation of new Medicaid dollars to overhaul the state’s ailing Medicaid system.

With the passage of the state’s budget, nursing facilities will receive a total of $ 18.8 million in state and federal dollars – a three-year phase in will bring the total federal and state dollars to $30 million.

On the other hand, some aging agenda items went down in flames.

Aging advocates called on Gov. Don Carcieri and state lawmakers to allocate taxpayer dollars in the FY 2004 budget to allow more low-and moderate-income persons to choose Medicaid waiver-funded assisted living.

Although the federal government has already approved an additional 180 units in the state’s Medicaid assisted living waiver program, state funding of this initiative is required.

No funding in this year’s budget ensures that low-and- moderate income seniors will continue to be denied an option of choosing a less restrictive level of care, an option that higher income seniors have.

Additionally, lawmakers chose not to pass companion proposals (H 5478/ S 299) which would have allowed Rhode Island residents to buy prescription drugs from Canadian pharmacies, where they are routine cheaper.

Finally, in the aftermath of the tragic Station nightclub fire, the General Assembly and governor moved quickly to tighten regulations and to hire additional staffing at the Fire Marshal’s office to protect the patrons of bars and restaurants from fire.  However, beefing up the state Department of Health’s regulatory oversight of the Ocean State’s assisted living facilities, where 3,700 plus seniors reside, did not receive one dime in funding in the FY 2004 budget.

An assisted-living provider group, aging advocates, the Long-Term Coordinating Council, the state ombudsman and officials at the state Department of Health, have all called for new state dollars to fill one full-time surveyor position ( a nurse) to ensure that assisted living residences across Rhode Island are inspected on a timelier basis.

Last year, state lawmakers passed legislation to protect frail Rhode Island seniors who receive assisted-living services.

As this legislative session ends, the governor and General Assembly have failed to allocate the necessary funding in the FY 2004 state budget to fully implement state law that would result in the inspection of the state’s 72 assisted-living facilities and 155 assisted-living beds in nursing facilities in a timely manner.

According to the state’s Department of Health, another seven assisted-living projects are expected to be up and running over the next 18 months.

The ball now moves to Carcieri’s court to either use contingency funds in his office budget or to take administrative action to hire more assisted-living inspectors.

While it has been reported that the governor is amenable to using funds flushed out by his “fiscal fitness program” to pay for a new surveyor position, the time to act is now, rather than later.

Acting now to fix this policy glitch is sound public policy.  I am sure that Rhode Island seniors and taxpayers will agree.