Rhode Island Nursing Homes Scramble to get Dental Coverage for Residents

Published in Pawtucket Times on March 3, 2003

According to Alfred Santos, executive director of the Rhode Island Health Care Association (RIHCA), one company’s business decision has left Rhode Island nursing homes scrambling to bring dental coverage to thousands of nursing home residents.

Over the last two months, Santos has met with state regulatory officials to inform them of this latest health-care access problem.

Here’s the scoop:

Access Dental Care, a major provider of dental services to nursing facilities, announced in a Nov. 4 member to its 40 nursing home clients that it would no longer offer onsite dental care, beginning Jan 1, 2003. The brief memo cited the extreme physical challenge to dental staff who provided dental services to residents outside the normal dentistry setting as the rationale for dropping onsite dental care.

But a nursing home trade group says that there may be a bigger issue behind Access Dental Care’s decision to not provide onsite dental services to nursing home residents.

RIHCA’s Dental Services Committee believes the actual reason for this business decision may well be tied to a low Medicaid reimbursement for dental care services, said Chair john Gage, who also serves as the trade group’s vice-president. Currently, Gage is the administrator at Riverview Heatlh Center in Coventry.

Gage said 80 percent of nursing home residents rely on Medicaid to pay for their dental services. Access Dental Care’s decision to not perform dental services on site will force m any frail, bedridden residents to be transported outside the facility for treatment, causing needless pain and suffering to them, he said.

“With a severe staffing shortage facing many facilities it will be even more difficult to assign a staff person to accompany the resident,” Gage noted.

According to Gage, it’s not so easy for nursing homes to find other providers to deliver onsite dental services. Complicating this health care access issue, Geage said, is HealthDrive’s policy not to contract with any nursing home to only provide dental services.

At press time, state officials from the Department of Health and Human Services were unavailable for comment about this payment issue.

State Sen. H. Elizabeth Roberts

(D-Cranston), who is chairing a subcommittee of the state’s Long-Term Care Coordinating Council (LTCCC) is currently looking at Medicaid issues, said Access Dental Care’s decision to not provide treatment to Medicaid recipients in the nursing home setting only exacerbates an ongoing problem. That Is, low Medicaid reimbursement keeps low income seniors from receiving the appropriate preventative and restorative dental care they need.

Roberts said, “inadequate Medicaid rates make it hard for dentists to see residents, because the rates are so far below their costs. When combined with the medical complexity of nursing home patients, the low reimbursement is even more of a barrier, she said.

Robert’s LTCCC subcommittee plans to turn their attention to investigating the obstacles that keep dental care from being provided to Medicaid-eligible seniors in nursing homes and in their homes.

Bringing dental services to low-income children and seniors became an important issue to Roberts when care to a young constituent in the Rlte Care program required the use of an operating room for dental work because of severe tooth decay.

This operation could have been prevented with ongoing dental care, she said, noting that it “took the attention of state government to locale a provider who would accept the low Medicaid provider rate.”

Roberts is working to ratchet up the Medicaid reimbursement for dental care and to streamline the payment process through legislation she has recently introduced. The senator intends to bring together the state’s Dental Society and nursing homes to develop a plan to bring dental care to facilities that no longer received onsite dental service.

Robert Hawkins, state ombudsman and executive director of the Alliance for Better Nursing Home Care, agreed with Roberts’ assessment that there has been limited access to dental services in nursing homes over the past couple of years.

Hawkins has been pushing for appropriate dental treatment for nursing home residents for more than 25 years.

“Medicaid-eligible seniors who are mobile can more easy travel to dental clinics, if they can find treatment, especially with the low Medicaid rates,” Hawkins said. “For the old, sick and feeble, why should they have to go to through the turmoil of leaving the facility to get their dental care?

“Lack of access to dental care is a form of discrimination for those unfortunate to be lower-income and on Medicaid, Hawkins charged.

The Medicaid system has always been “penny wise and pound foolish,” Hawkins said. “When you don’t treat a dental problem early, residents don’t eat, they lose weight, develop bed sores, ultimately requiring costly hospital care.

“Can any one remember having a tooth ach all night long with no where to go?,” Hawkins asked.

Susan Sweet, a consultant to nonprofit groups and a longtime elder rights advocate, added there is also a lack of dental care for low-income seniors that extends into the community as well.

“For some reason, dental care is treated in the health care community as less important as other medical care,” she said, adding that reimbursement for dental care has lagged behind reimbursement for other medical care.

So where do we go from here?

Roberts’ plans to bring the state’s Dental Society together with nursing homes to craft a short-term solution is the first step in removing the obstacles of providing dental services to Medicaid-eligible residents. But a more permanent solution is needed.

With Gov. Don Carcieri poised to shortly release his budget, I hope he and the General Assembly counter Medicaid’s traditional “penny wide and pound foolish,” philosophy by increasing Medicaid payments for dental services. An inadequate reimbursement rate will ultimately reduce the needless pain and suffering that dental problems cause in nursing homes across the state.

The Best Of…Former Sen. Moss’ Advocacy Commitment Will Be Missed

Published on February 3, 2003

Last Wednesday evening, former U.S. Sen. Frank Moss of Utah died.

After he received his law degree in 1937 from Washington, DC-based George Washington University, Moss briefly worked on the legal staff of the U.S. Securities and Exchange Commission.

Throughout his legal career, he would sharpen his legal skills by working in a variety of settings. Initially, clerking at the Utah Supreme Court, he would ultimately win an election putting him on the bench of the Salt Lake City Municipal Court in 1940.

During the World War II, he would serve on the Judge Advocate General’s staff of the U.S. Armory Corps in England. After the war, Moss would be elected in 1950, reelected in 1954, to serve as Salt Lake County attorney.

Two years after his unsuccessful bid for Utah Governor, in 1956, Moss would run for Senate and win, by less than 40 percent of the vote.

Obituaries in newspapers stated that the liberal three-term Senate Democrat was best known for his environmental work that included the establishment of national parks and recreational areas in Utah. Moss was also recognized for drafting a series of bill protecting consumers, ranging from mandating labeling on cigarette packages about the health hazards of smoking, banning cigarette advertising on radio and television, to developing minimum safety requirements for automobiles.

But for me and many of my colleagues in the field of aging, we will always remember Moss as being a true advocate for the nation’s elderly.

Moss worked closely with President Kennedy, Vice President Lyndon Johnson, who would later become President, Hubert Humphrey and Claude Pepper getting Medicare and Medicaid enacted into law.

Moreover, Moss will always be remembered for being the driving force behind the establishment of the Senate Special Committee on Aging in 1961.

He also played a major role in establishing the House Committee on Aging with the late Rep. Claude Pepper. The two special committees would later put the spotlight on aging policy issues, generating both the public and political will to bring about the needed policy changes.

Throughout his Senate Career, in addition to authoring legislation that would require federal minimum standards for nursing homes and helping to create the Medicare and Medicaid home health care benefits. Moss held the first hearing on hospice care and introduced legislation authorizing payment for hospice care.

More than 40 years ago, the Special Committee on Aging, chaired by Moss, began to hold a series of hearing s on nursing homes. It became extremely clear to his committee through its hearings, generating 1,300 pages of testimony, that both nursing home standards and enforcement by state regulatory agencies varied drastically. Moss noted that these hearings helped to shape the Medicare and Medicaid programs, and that they also lead to series of reforms in 1967.

Ultimately, a series of 30 hearings held between 1969 and 1976 eventually lead to the publication of a 12-volume report, entitled “Nursing Home Care in the United States: Failure in Public Policy.”

In 1977, Moss, with coauthor Val Halmandaris (who at the time was responsible for research of the Subcommittee of Long-Term Care, but now serves as executive director of the National Association of Home Care) wrote “Too Old, Too Sick, Too Bad: Nursing Homes in America,” detailing the plight of America’s elderly.

More than 10 years later, in a 1998 speech to the National Council on Aging, Moss expressed his concerns that American’s elderly were losing ground from all the gains they had achieved in the late 1960s and 1970s. Congress has yet to enact a pharmaceutical drug program to put the brakes on spiraling drug costs. Elder abuse is still running rampant throughout the nation. Medicare expenditures are being slashed to nursing homes, home and hospice care.

It is now time for Congress to get serious about tackling the multitude of problems thrust upon the nation by an aging society. Moss’ advocacy comment to the nation’s elderly will be sorely missed, and his shoes will be hard to fill.

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

The Best Of…Many Opting to Pre-Plan, Pre-Pay for Funerals

Published on February 1, 2003

For me, it was stressful attempting to get my elderly father and my mother with dementia to enter into a pre-need agreement funeral arrangement. After all, my three siblings and I were only trying to give our parents the opportunity to have a say in their minute details of their final arrangements.

With my confused mother at his side, my father choose their caskets like he was purchasing a new car. He checked under the lid, throughly examined the lining and the wood. Ultimately, he would not buy the cheaper model, but he chose a nice one, a little higher on the price list.

Of course, my father told the funeral director their services would be held at Temple Emanuel with the family Rabbi presiding. But what type of music, vocal or instrumental did they want played? Or did they want a visitation or to name their pallbearers. Closed or open casket? All these decisions might have been made right there on the spot, but in the end my father backed out.

A little technicality over paper work derailed the process, causing my father to not sign on the dotted line and walking out of the funeral home in a huff.

My father’s experience was not the norm because most aging baby boomers make it through the most stressful process of pre-planning and pre-paying in advance.

According to a 1998 AARP survey, two in five people age 50 and older reported that they were contacted about the advance purchase of funerals.

About one-third of those responding said that they had prepaid, or were in the process of prepaying, for funerals or burials. Of this group, 86 percent had prepaid for cemetery plots, mausoleums, or niches, 58 percent had paid for other burial goods or services and 40 percent had prepaid for funeral services.

For those prepaying for funerals, 30 percent had funds in trust and 30 percent had funds in life insurance policies. Sixty percent held title to a cemetery plot, and 15 percent said they had that money in a life insurance policy.

Ted Wynne, funeral director of Pawtucket-based Manning-Heffern Funeral Home, sees a transient society where children are living in different states, fueling the demand for pre-planning and prepayment. “Seniors want to take the pressure off their children who live thousands of miles away from making the burial arrangement,” Wynne says. “Thus, they pay up front or set aside money for future funeral and burial payments.”

Bradford Bellows, funeral director of D.W. Bellows & Sons, Pawtucket and Bellows-Falso Funeral Chapel in Lincoln, says the seniors in nursing homes are also good candidates for prepaying a funeral.

“The family watches their parents’ funds dwindle to a point where they are forced to go on Medicaid.” Prior to being eligible for Medicaid, the senior or their children should prepay the funeral costs. Assets given the funeral home are allowed under Medicaid eligibility guidelines prior to going on Medicaid.

“Consumers must understand that pre-arranging a funeral is not the same as pre-paying one,” Bellows adds.

By pre-paying a funeral you are actually paying for a funeral at today’s prices, not tomorrow’s, Bellow says. “If the funeral occurs in the future, the funds will earn interest which will be used to pay for the cost of the funeral at the time of the death.”

Bellows offers these tips when pre-paying your funeral.

1. Make sure that your social security number is indicated on your savings account or insurance policy where the monies are placed to prepay your funeral. If the funeral home ever goes out of business or goes bankrupt, the funds are still yours and are safe, and can be easily be transferred to another funeral home.

2. When you enroll in the Medicaid program, all the funds in your prepayment account must be used. Any excess funds will be returned by the funeral home to the State of Rhode Island, to defray health costs incurred by the state of Rhode Island’s Medicaid program.

3. Once the funeral home opens the account or insurance policy, don’t forget to get a copy of the Irrevocable Funeral Trust Agreement, showing the bank or credit union account or the original insurance policy that was issued. This will give you proof that your advance payment has been set up for your funeral needs.

Herb Weiss is a Pawtucket-based freelance writer who covers, aging, health care and medical issues.