Bill Seeks to Soften Impact of Medicare Cuts

Published in Pawtucket Times on September 23, 2002

One week to go before the new federal Medicare cuts go into effect – cuts that will slash $1.7 billion in 2003 funding for the developmentally disabled and frail seniors in nursing facilities.

According to the American Health Care Association (AHCA), over the next two year’s cumulative Medicare cuts, called the “Medicare Cliff,” will total a whopping $5.2 billion.

Meanwhile, AHCA, representing 12,000 nonprofit long-term care providers, has been lobbying Congress for federal relief from the draconian reductions.

A new ad appearing in the Capitol Hill newspaper, Roll Call, reminds lawmakers that the upcoming cuts could lead to reduced nurse staffing and puts residents at risk.

In the upcoming November elections, voters might just get riled up too, over Medicare being cut by 10 percent, says AHCA.

The Roll Call ad notes a recent national survey of 800 persons found that 84.6 percent of the respondents opposed cutting Medicare funding for nursing facility care by 10 percent.

Additionally, 64.1 percent were less likely to vote for a candidate running for Congress if they knew that the candidate “voted to cut Medicare funding for nursing facility for nursing facility care by billions.”

Charles H. Roadman, II, M.D., AHCA’s president and CEO noted that a recent study by the University of North Carolina School of Public Health confirms the devastating impact of the impending Medicare cuts.

The study says that cuts could lead to reduced numbers of staff caring for seniors in nursing facilities, thus jeopardizing quality of care.

“At a time when the Centers for Medicaid and Medicare Services (CMS) and nursing care providers are actively pursuing efforts to improve the quality of care in nursing facilities throughout the nation, new federal cuts to Medicare are inconsistent with achieving this important goal,” says Dr. Roadman.

Roberta Hawkins, executive director of the Alliance for Nursing Home Care and state ombudsman agree with Roadman’s assessment.

“Huge Medicare cuts pull the carpet from under the federal quality initiatives that take effect across the country in October,” she tells All About Seniors. “The right hand of the federal government does not seem to know what the left hand is doing.”

According to Hawkins, the staffing shortage in Rhode Island is having a drastic impact on the quality of care delivered to more than 10,000 residentes.

“The upcoming Medicare cuts combined with an outdated Medicaid payment system will only further compromise patient care in the Ocean State,” she says.

U.S. Rep. James Langevin and House colleagues today announced a legislative fix that would delay scheduled cuts for nursing facilities and assisted living facilities in Rhode Island.

Langevin is co-sponsoring the Medicare Skilled Nursing Beneficiary Protection Act, sponsored by Congressman Tom Allen (D-ME), that would extend Medicare reimbursement add-ons for three years, through 2005, to allow the Bush administration more time to implement an adequate reimbursement formula for skill nursing facilities.

Langevin and the other bill sponsors hope this new timetable will obviate the need for further cuts in Medicare reimbursement rates, which would place severe financial burdens on nursing facilities.

Langevin stated that unless Congress acts this year, Medicare funding for skilled nursing care will be cut by 10 percent in 2003 and 19 percent in 2004 – translating to cuts of nearly $ 35 per patient per day in 2003 and $68 in 2004.

The Rhode Island congressman believes that in the Ocean State, the Medicare cuts will be even greater than the national average totaling $ 38.81 in 2003 and $ 76.90 in 2004.

“Difficult decisions were made in 1997 with passage of the Balanced Budget Act, and some of the changes were not implemented as Congress intended,” Langevin said. “The Medicare Skilled Nursing Beneficiary Protection Act will postpone further cuts and ensure that critical funding remains available for thousands of Rhode Islanders who rely on skilled nursing services.”

According to Langevin in mid-1998, the new Medicare prospective payment system (PPS) was implemented for skilled nursing care, as mandated in the 1997 Balanced Budget Act (BBA).

He noted that the new system resulted in cuts far deeper than intended by Congress.

In 1999 and 2000, Congress temporarily restored some of the unintended cuts as part of the Balanced Budget Refinement Act (BBRA) and the Benefits Improvement and Protection Act (BIPA).

These temporary add-ons helped restore beneficiary access to care, but overall Medicare funding levels for skilled nursing facilities continue to be below BBA projections, Langevin said.

“I am wholly committed to making the restorations of 1999 and 2000 permanent,” he said.

“We cannot turn our backs on a generation who built and defended the very foundation of this nation. They answered the call of our nation -now we must answer theirs.”

Read Between the Lines of Political Campaign Literature

Published in Pawtucket Times on September 9, 2002

Tomorrow’s primary election means time has now run out for gubernatorial state legislative and congressional candidates.

For the past several months, these political candidates attended hundreds of public events scattered throughout the Ocean State, bearing gifts of political stickers, bumper stickers and campaign literature at every stop they make.

No doubt you will agree that this election cycle was no different than any other one. Older Rhode Islanders were bombarded with campaign literature outlining candidates’ positions on specific senior issues.

During this year’s campaign, seniors repeatedly told political candidates to fix the problem of rising pharmaceutical costs. It was no surprise that one Democratic candidate told me at a recent fundraiser in Pawtucket’s Slater Park that the hot topic for seniors this year was the issue of costly pharmaceuticals, concerns he’d heard over and over again at coffees and events. This would be a primary issue his campaign would address, he assured.

But with complicated senior issues, like how to pay for costly pharmaceutical drugs, how can you get beyond the smoke and mirrors of political campaigns?

Here’s my advice – seniors must not believe everything they read. They must become savvy shoppers when reading a candidate’s position papers and/or campaign literature about their solutions to aging policy issues.

One must listen closely to the candidates, and more importantly, read between the lines.

For instance, Myrth York, calls for Rhode Island to negotiate tough deals with the pharmaceutical industry to reduce prices, insisting these companies should provide Rhode Island with the same discounts that they provide government agencies and federal programs.

Furthermore, she goes on to say that Maine has created a similar program that other states across the country are starting to replicate.

“Good idea, but not applicable in the near future,” said Rep. Antonio Pires, who is running against the former state senator for governor in the Democratic primary.

“The pharmaceutical industry has tied that initiative up in the courts and the program is not in operation yet,” he told All About Seniors. While York’s idea may be a good one, can it get implemented quality?

Democrats gubernatorial candidates Pires, York and Attorney General Sheldon Whitehouse all call for the expansion of the state prescription drug program Rhode Island Pharmaceutical Assistance Program to Elders (RIPAE) to help older Rhode Islanders afford medication they need, via a Medicaid waiver to bring in federal dollars to pay for the expansion. This solution which everyone supports, sounds too good to be true.

Again, you must read between the lines.

Don’t expect this Medicaid waiver to materialize overnight, next week or even by next year. Some say that it will take some time to get this federal fix in place.

So, the quickest solution to lowering the cost of costly prescriptions drugs may well come at the federal rather than the state level, from Congress itself.

Political posturing about a particular party’s legislative proposal may look good in print, in a campaign ad or in a political commercial, but it won’t ultimately make prescription drugs cheaper in the near future.

The Democrat and Republican approach to providing seniors with prescription relief won’t gain the needed momentum for passage by Congress, so a bipartisan compromise is needed.

Now it’s on the shoulders of the Rhode Island delegation in Congress to work together to craft a meaningful compromise.

While the political candidates debate the pharmaceutical costs, they must not forget the other senior issues that must be addressed.

There is a need to being more assisted living facilities on line for moderate and low-income seniors. Don’t forget the need for affordable option for frail or low-income seniors.

Add to these housing issues the need to adequately fund a seamless continuum of long-term care services, from nursing facilities to community-based services. Adequate funding and resources must be allocated to state agencies to perform their legislative oversight responsibilities.

There must also be continued effort and energy directed by state policymakers to solve the state’s severe staffing shortage that continues to afflict both nursing facilities and home health agencies.

One lawmaker told me that the state budget deficit could well reach $ 250 billion. If true, this is not good news for those who want long-term solutions and not Band-Aid fixes to problems facing seniors.

Be a savvy shopper when you are reviewing the piles of campaign literature dropped at your door. It may look pleasing to the eye, but a severe budget deficit may ultimately make that promise just pie in the sky.

The Best Of…Music Reduces Alzheimer’s Patients’ Agitation

Published August 19, 2002, Pawtucket Times

After not being home for two years, I traveled to Dallas to visit my family and to celebrate my 88-year old father’s birthday party last week.

My trip was a bittersweet experience for me as I reconnected with my parents and siblings. It was great to spend time and catch up with everyone, but I saw firsthand how Alzheimer’s Disease had ravaged, both physically and mentally, my 80-year-old mother, and I saw the impact the disease had on my family.

My mother, who is in the mid-to-late stage of Alzheimer’s was largely unaware of recent events or even to who I was.

There was no recognition of my brother or sisters, and many times she did not even recognize my father, who has been her husband for the past 60 years.

My mother could not tell time on her watch,was not aware of what day it was or even where she lived.

Moreover, the staff warned me of my frequent mood swings and that she could get agitated very quickly.

However, some say “music calms the savage beast.”

That may be true, and it’s most certainly true for victims of Alzheimer’s disease — soothing music can reduce agitation. While Alzheimer’s robs a person of their memory or cognitive abilities, a timeless tune can reduce agitation and can have calming positive effects on Alzheimer’s patients, too. This point was driven home to me following my visit to my mother’s 28-bed Alzheimer’s unit at Dallas-base Marriott Brighton Gardens.

On Friday afternoons, Carrie A. Johns of Blue Rose Entertainment keeps things hopping in the Alzheimer’s unit’s television room with her music therapy program.

Popping CDs into a compact disc player, Johns plays a continuous string of popular tunes from the early 1900s to the 1960s. That day, about 20 songs were played, ranging from golden oldies to country and western and Broadway tuns.

Johns chooses from 8,000 songs in her CD collection, and she often selects songs during her one-and-a-half-hour program that reflect memorable happy periods in the residents’ lives.

Johns, who raises Arabian horses on a 12-acre ranch in Mabank, Teaxa, has a client list of more than 500 nursing facilities, assisted living facilities and senior centers in the Dallas-Fort Worth metroplex region.

Swaying, Johns sings the Andrews Sisters’ 1942 hit “The Boogie Woogie Bugle Boy of Company C” into her microphone, residents Rose Grimes, Helen Webb and Francis Donathan dance up a storm with Ashina Jackson, a personal care assistant, big smiles lighting up all of their faces.

“It is a joy to make these residents happy when their families are not here,” Jackson tells me. “I like to see their expressions when they remember the tunes. It’s like I’m going back to their time.”

To the beat of the 1920s tune “in’t She Sweet,” Activity Director Dave Mandt dances with my mother.

She belts out the song remembering all the words, not even missing a beat.

Jane Atobajeun, special care manager, says music helps to calm the residents down. While residents with Alzheimer’s disease don’t remember recent events — what they ate for lunch, for instance — they will remember songs that were once popular in distant eras, since they can retain long-term memory.

“Music makes them laugh,” adds Atobajeun, noting that it “touches their very being and also triggers me memories and emotions.”

According to Atobajeun, throughout the day residents can get frustrated if they can’t remember things.

But singing makes them very happy because they remember the words. Dancing can also get the residents up and moving, she adds, noting that even wheelchair-bound residents are assisted to stand and move.

Throughout the program my father and I traded off dancing with my mother. Several times, my smiling mother goes up to the microphone, and dances with Johns.

You guessed it — she automatically knows every word of the song. When the music ends, I say goodbye to my mother.

knowing the challenges she faces with Alzheimer’s, I at least know that there is a brief period of pleasure in her life — at least twice a week when she attends the Alzheimer’s unit’s music program.

Herb Weiss is a Pawtucket-based freelance writer covering aging, health care and medical issues. This article was published in the August 19, 2002 Pawtucket Times.