Bill would (re)create a RI Department of Healthy Aging

Published in Pawtucket Times on March 21, 2022

There are new efforts on Smith Hill to transform the state’s Office of Healthy Aging (OHA) into a department making it far more visible and effective as an advocate for the state’s growing senior population.  H. 7616, introduced by Rep. Lauren H. Carson (D-District 75, Newport), would expand the office in the Department of Human Services (DHS) into a full-fledged state department, expand its director’s authority, and appoint local senior centers as hubs for service delivery, with authority to bill Medicaid for transportation services.

The RI Department of Elderly Affairs (DEA) was created by law in 1977 and remained a department until 2011, when the legislature changed it to a division within the Department of Human Services (DHS). In 2019, the department was re-named the Office of Healthy Aging (OHA), shifting narratives and perceptions associated with growing older. At press time, the Office of Healthy Aging remains a division under the Department of Human Services. 

“Rhode Island should invest much more than we do in services that enable people to age in place and safely remain in their communities. Those services are far more cost-efficient overall, and encourage an active, more fulfilling lifestyle for people as they age”, says Carson in a statement announcing the introduction of the bill on March 2, 2022. “Considering that a quarter of our population consists of seniors, and that ratio is growing as the Baby Boomers join them, now is the time,” she adds.

At press time, the bill has been sent to the House Finance Committee, and its cost has not yet been determined and there is no companion measure introduced yet in the Senate.

“Working cooperatively with the senior centers operating around the state, we could make it much easier for people to access the support they need as they age, and really make the quality of life much better for the entire older population of our state,” says Carson expressing the importance of the state’s senior centers.

H. 7616 would authorize the new Department of Healthy Aging to protect and enable seniors to stay healthy and independent by providing meals, health programs, transportation, benefits counseling and more. Under the bill, the department would provide professional development to agencies and programs that provide services to seniors in the state and become a clearing house to help those agencies and businesses assist senior centers, which would serve as hubs for the delivery of services from the state.

In particular, H 7616 directs the new department to manage and develop a multi-tiered transportation system that works with the Department of Human Services, the Department of Transportation, senior centers and with all existing modes of public transportation to develop transportation plans that suit the elderly population of each municipality. The director would be enabled to authorize senior centers to bill Medicaid for transportation they provide.

The legislation also seeks to have the new department develop and submit to the General Assembly a funding formula to meet the requirements the new law sets forth, including input from seniors and the caregivers and allocating funding to each municipality based on its senior population, with restrictions that the funding be used only for senior programs.

Carson explains that this bill is intended to start important dialogue among state lawmakers, state officials and aging organizations about appropriately providing for Rhode Island’s aging population.

 “Whether or not we pass this bill this year, we have to address the needs of our growing older population. Leaving those needs unmet has a much greater price tag than decent locally administered basic programs would. Our whole state would be better served by investments that keep seniors safe with support in their community,” Carson said.

OHA and Aging Advocates Give Their Two Cents

Nicole Arias, a spokeswoman for OHA, says “we look forward to any future discussions and collaborations with community members, partners, and legislators.” When asked if the Rhode Island Advisory Commission on Aging, charged with advising the governor on aging policies and problems impacting older Rhode Islanders, Chair James Nyberg stated the commission also plans to review and discuss the bill at an upcoming meeting. 

“Our office looks forward to participating in dialogue that empowers and supports our aging residents and championing essential quality of life items such as healthy housing and reliable transportation. While our office is still unpacking H 7616, we appreciate Rep. Carson and the bill’s cosponsors for advocating on behalf of our senior residents,” says Lt. Gov. Sabina Matos, who over sees the state’s Long-Term Care Coordinating Council (LTCCC). The group works to preserve senior’s quality of life in all settings and coordinates state policy concerning all sectors of long-term care for seniors.

Bernard J. Beaudreau, Executive Director of the Senior Agenda Coalition of Rhode Island, says his group strongly supports any and all efforts that increase the state’s programs and services to address the growing needs of our aging population, especially those with low and moderate incomes.  The state-wide coalition calls for the reinstatement of OHA to a full department, but not without the commensurate expansion of funding and services that are needed for this important state government function.   

“When the Department of Elderly Affairs was reorganized to be a division of the Department of Human Services, we were concerned that it signified a diminishing of the importance of senior needs in the state budget.  While from a management perspective, the division within the larger Department of Human Services could streamline the delivery of services, there would still be the need to increase staffing and programs to meet the growing needs,” says Beaudreau. This did not happen in the ensuing years.

“Restoring the OHA to a department status will strengthen its position at the budget table and elevate the importance of programs supporting older residents of our state. We hope that will make a difference,” says Beaudreau.

“The legislation proposed by Rep. Carson elevates the conversation about the importance of age-friendly policies that enable Rhode Islanders to choose how we live as we age,” said AARP Rhode Island State Director Catherine Taylor. “AARP Rhode Island looks forward to being part of this conversation and continuing to advocate fiercely at both the state and local levels for enhanced home and community-based supportive services, accessible and affordable housing and transportation options, and full inclusion of people of all ages and abilities in community life,” she said. 

According to Maureen Maigret, policy consultant and chair of the Aging in Community Sub-committee of Rhode Island’s Long-Term Care Coordinating Council, H 7616 is a very significant bill that will help to stimulate a long due discussion as to how the state should fund senior programs and services in light of the state’s growing age 65 and older population. This age group is projected to represent at least one in five of  the state’s residents by 2040.

Maigret recalls that the state’s Department of Elderly Affairs was created by law in 1977 and remained a cabinet level department until 2011 when the Rhode Island General Assembly changed it to a division within the Department of Human Services as part of the enacted budget bill.  Eight years later, lawmakers would change the agency’s name from the division of elderly affairss the OHA. The enacted law placed OHA in the Department of Human Services for administrative purposes and called for the OHA Director to be appointed by and to report to the Governor with advice and consent of the Senate.

When Maigret left her position of Director of Elderly Affairs (serving from 1991 to 1994), its budget for FY1995 was $13.9 million (state funds) and it had at least 60 full-time employees. The state’s  FY2022  budget for OHA stands at $12 million (state funds) with 31 authorized employees, she said.

Maigret warns that the existing OHA is under-resourced both in state funding and human resources. She calculates that Rode Island spends about fifty dollars per older person (age 65 and older) when taking into account state funding for senior services and its population age 65 and over.

“We could do so much more to support our older adults by addressing service gaps especially for those not poor enough to meet our strict Medicaid income eligibility rules which require older adults to have income less than $13,600 and assets less than $4,000 single and $6,000 for a couple,” Maigret says. Funding for local senior centers and programs in Rhode Island municipalities should be calculated by at least $10 per person aged 65. 

Maigret urges state lawmakers to support local transit assistance efforts, to increase funding for caregiver support programs, and to expand information services to provide assistance to seniors to assist them to find subsidized home maintenance and chore service programs.  Better funding should be allocated to support volunteer programs that provide companionship and other services to reduce social isolation,“ she says.

“I suggest reverting the OHA to a full department as called for in H 7616 only if there is a concomitant increase funding and resources, says Maigret, noting that one source of funding could be available from  the Perry/Sullivan law (that the Governor’s budget proposes to defer for FY2023.),  These state funds could be used to allow OHA to truly provide the needed supports and services to older adults to live full and healthy lives as intended in the department’s creation,” she says.

“Older adults suffered greatly during the COVID pandemic – 90% of the deaths were individuals 60 and over, claims Vin Marzullo, a well-known aging advocate who served as a federal civil rights and and national service administrator. “We must provide greater attention and care for this vulnerable population,” he says. 

“Since the proposed legislation to elevate the OHA to department status was initiated by the Rhode Island House, I would hope that former House legislator, Marie Cimini, would welcome and embrace this legislation to become a premiere agency for the Governor, quips the West Warwick resident. He notes that Cimini was recently nominated by Gov. Dan McKee for the position of Director of the state’s Office of Healthy Aging.  This nomination requires Senate confirmation.

The other cosponsors of the H 7616 include Rep. Deborah Ruggiero (D-Dist. 74, Jamestown, Middletown), Rep. James N. McLaughlin (D-Dist. 57, Cumberland, Central Falls), Rep. Terri Cortvriend (D-Dist. 72, Portsmouth, Middletown), Rep. June S. Speakman (D-Dist. 68, Warren, Bristol), Rep. Edith H. Ajello (D-Dist. 1, Providence) and Rep. Brandon Potter (D-Dist. 16, Cranston).

Hopefully the upper chamber will see the wisdom in considering a companion measure to  H. 7616.  Let the debate begin. 

For more details about OHA, go to https://oha.ri.gov/

AARP Rhode Island calls on Congress to act on lowering high drug costs

Published on March 14, 2022 in Rhode Island News Today

On the day before the Washington, DC-based AARP’s March 8th launch of its new ad campaign showing the impact of Congress’s failure to act on prescription drug prices, AARP Rhode Island State Director Catherine Taylor, Volunteer State President Marcus Mitchell and Volunteer Lead Federal Liaison Dr. Phil Zarlengo joined Rhode Island US Senators Jack Reed and Sheldon Whitehouse for a virtual news conference highlighting the need for Congress to act now to slash rising prescription drug costs. 

During the 26 minute and 45 second event, AARP Rhode Island, representing 132,000 members, delivered a petition signed by more than 16,114 Rhode Islanders, calling for Congress to act now and stop unfair drug prices. AARP has called for fair drug prices for years and supports legislation that passed the House in November, which would allow Medicare to negotiate drug prices, put a cap on out-of-pocket costs that older adults pay for their prescription drugs and impose penalties on drug companies that raise prices faster than the rate of inflation.

“Americans are fed up with paying three times what people in other countries pay for the same drugs. More than four million people across the country, including more than 16,000 here in the Ocean State, are joining AARP to demand lower prices for prescription drugs,” said Taylor in a statement announcing the petition being delivered to Reed and Whitehouse. “There will never be a better time to lower drug prices than the historic opportunity in front of Congress. Now is the time to get it done!” Taylor says.

Big Pharma makes billions from high drug costs

“Big Pharma is making billions while seniors and taxpayers are suffering,” says AARP State President Mitchell, noting that just last month Big Pharma raised the prices of 800 prescription medications.” People are sick and tired of paying three times for prescription drugs what people in other countries are paying for these drugs, “It’s outrageous and unacceptable,” Mitchell said.

According to Mitchell, “if consumer prices had risen as fast as drug prices during the last 15 years, gas would cost $12.20 a gallon and milk would cost $13 a gallon.” This gives perspective to this issue, he said.

“Big Pharma is trying again to scare lawmakers and members of AARP and everyone else with misleading claims to stop Medicare to negotiate prices, charged Zarlengo. “We, at least, know the truth. The truth is by allowing Medicare negotiation [of prices], that process will help seniors during these times of inflation by lowing their prices of drugs and putting more money in their pocket,” he said.

Zarlengo gave the two Rhode Island Senators a message from Rhode Island seniors: “Don’t let Pharma win this time, lets lower drug prices now.”

“We hear you loud and clear,” said Senator Reed, responding to the over 16,000 signees of AARP’s petition. “Congress must address this issue of drug pricing. The system continues to force families into untenable choices between their health and other basic needs. One of the simplest things to do is to allow the federal government to negotiate drug prices for Medicare beneficiaries. I have been urging administrations, both Republican and Democratic for more than a decade to do this,” he noted.

“The VA already does this,” said Senator Whitehouse told his fellow panelists and those tuning in to the March 7 news conference. “And there is a big discrepancy in what the Veterans Administration (VA) pays for drugs and what Medicare pays for drugs. We have a reconciliation bill still in the Senate; it’s something Democrats can pass with only 50 votes. The bad news is that we need all 50 members to agree on the reconciliation measure and that has proven difficult. I hope we can agree on a package that all 50 of us can sign off on… and finally, finally, finally give Americans the drug pricing relief that they need. AARP is incredibly important in this fight. All your members make a difference. Thank you for stepping up yet again,” he said.

AARP fights Big Pharma on television and with digital advertising

In AARP’s new ad campaign, Larry Zarzecki, a retired law enforcement officer with Parkinson’s Disease who was forced to sell his home in order to afford his medications, returns to the airways as a spokesperson for AARP, illustrating the impact of the high cost of prescription drugs on seniors.  The retiree first shared his story in an AARP ad three years ago, but Congress’ failure to act means he has had no relief from the high cost of his treatments. As he says in the new ad, “I shouldn’t have to decide between my home or my medicine because Congress refuses to act. I’m tired of waiting for Congress.”

AARP’s seven-figure ad buy includes television and digital advertising in the DC area, and television in Arizona, Colorado, Georgia, New Hampshire, New York, Nevada, and Pennsylvania.

Responding to AARP’s new ad campaign, AARP Rhode Island’s Taylor said: “Larry Zarzecki was forced to sell his home in order to afford his medications.  He is but one example of Congress’ failure to act. No one should have to give up a home in order to pay for over-priced prescription medicines.  She called on Congress to put a stop to “spiraling price increases” by giving Medicare the authority to negotiate with pharmaceutical companies for lower prices.

“If the Veterans Administration can do so – paying roughly half as much for brand name prescription drugs as does Medicare Part D – then why can’t Medicare?” says Taylor.  “For a decade, Big Pharma has spent more on stock buybacks and dividends than on research and development; it’s outrageous that drug makers are charging Americans three times what people in other countries pay for the same drugs and justifying it with lies and scare tactics that simply don’t hold up,” she  added.

AARP has called for lower drug prices for years and is urging the Senate to pass legislation that would allow Medicare to negotiate drug prices, put a cap on out-of-pocket costs that older adults pay for their prescription drugs and impose penalties on drug companies that raise prices faster than the rate of inflation.

“Americans are sick and tired of Congress’ broken promises to bring down the price of prescription drugs,” said Nancy LeaMond, AARP Executive Vice President and Chief Advocacy & Engagement Officer announcing the launching of this ad campaign. “As Americans pay more and more for many consumer goods, Congress has an historic opportunity to lower drug prices and help seniors like Larry to afford their medications and other essentials,” she said.

It’s time to act NOW

According to AARP, without congressional action, pharmaceutical companies will continue to set high prices for prescription drugs and raise them without any warning or justification. The Washington, DC based advocacy group representing 38 million members recently released a report showing that 75 of the 100 brand name drugs with the highest total Medicare Part D spending have already increased their  list prices in the first month of 2022.

During the State of the Union, President Biden called for Congress to bring down the price of prescription drugs as a way to help consumers manage rising prices. The House of Representatives passed several prescription drug measures as part of the Build Back Better Act in November, but the Senate has yet to pass similar legislation.

It’s time for the Senate to put the welfare of the nation’s seniors first by passing legislation to put the brakes to spiraling prescription drug costs. This will be a hot campaign issue in the upcoming mid-term elections, just 230 days from now.

World issues pushed nursing home reform to the side in State of the Union. But it’s there

Published on March 7, 2022 in Rhode Island News Today

More than a week ago, President Joe Biden, with Vice President Kamala Harris and House Speaker Nancy Pelosi, sitting behind him in the House Chamber in the United States Capitol, delivered his first State of the Union Address. Harris and Pelosi made history marking the first time two women have been on the dais during a presidential address before the joint session and the American people

According to C-SPAN, Biden’s speech was the fourth-longest of the seven most recent presidents’ speeches, beating out Presidents George H.W. Bush, George H. Bush and Ronald Reagan. Amid frequent applause breaks, chanting from both sides of the aisle and heckling, Biden’s prepared remarks delivered Tuesday, March 1, 2022, totaled around 7,762 words, lasting over one hour and two minutes.

Biden spoke mostly on-script with his prepared remarks on a wide range of topics before lawmakers, Supreme Court Justices, guests, many waving small blue and yellow Ukraine flags or wearing the country’s colors to show solidarity with the people of Ukraine. While the first half touched on the Russian invasion of Ukraine and the need for a global coalition to respond, the second half addressed inflation, COVID-19 and the “new normal,” increasing domestic manufacturing, health care, prescription drugs, energy and taxes, voting rights legislation, and the nomination of Judge Ketanji Brown Jackson to the Supreme Court. 

Biden concluded his speech by proposing a “Unity agenda” calling for a fight against the opioid epidemic, pushing Congress to pass a mental health package, supporting Veterans returning from the battlegrounds of Iraq and Afghanistan and finding a cure for cancer.

The State of the Union and nursing homes

While Biden’s speech briefly touched on the quality of care in the nation’s nursing homes, his Administration is clearly making this a major domestic issue.  During the address, Biden expressed strong concerns about Wall Street firms that were taking over many nations’ nursing homes. “Quality in those homes has gone down and costs have gone up. That ends on my watch,” he told the packed chamber. “Medicare is going to set higher standards for nursing homes and make sure your loved ones get the care they deserve and expect and [they’ll be] looked at closely,” he said.

A day before the State of the Union address, the White house released a detailed document, entitled, “Fact Sheet: Protecting Seniors and People with Disabilities by Improving Safety and Quality of Care in the Nation’s Nursing Homes,” outlining dozens of proposed changes on how U.S. nursing homes are regulated and operate, including a vow to adopt federal minimum staffing requirements for facilities, step up enforcement of regulations and to eliminate overcrowded patient rooms.

Amid the ongoing COVID-19 pandemic that continues to wreak havoc on the nation’s nursing homes, where 200,000 residents and workers have died from COVID-19, nearly a quarter of all COVID-19 deaths in the United States, the Biden Administration says that staffing shortages are getting worse, reducing the quality of care provided to residents

Poorly performing facilities will be held accountable for improper and unsafe care and must immediately improve their services or will be cut off from tax payor dollars. Biden calls for better information to be provided to the public to assist them in better understanding the conditions they will find in each facility and to assist them in choosing the best care options available.  

Centers for Medicare & Medicaid Services (CMS) will begin to explore ways to reduce resident room crowding in nursing homes by phasing out rooms with three or more residents and promoting private, single occupancy rooms. Multi-occupancy rooms increase the risk of the spread of infectious diseases, including COVID-19.  The agency will also establish a minimum nursing home staffing requirement, the adequacy of staffing is closely linked to quality of care provided.

Meanwhile, CMS also plans to strengthen the Medicare Skilled Nursing Facility Value-Based Purchasing Program and base payment on staffing adequacy (including over weekends) and retention and the resident experience.  Although the nation has seen a dramatic decrease in the use of antipsychotic drugs in nursing homes in recent years, CMS will continue its efforts to identify problematic diagnoses and bring down “inappropriate use” of such drugs.

Enhancing accountability and oversight

The Biden Administration calls for the enhancing and accountability and oversight of the nation’s nursing homes by adequately funding inspection activities, beefing up scrutiny on more of the poorest facility performers, expanding financial penalties and other enforcement sanctions, and increasing the accountability for chain owners whose facilities provide substandard care. CMS will work with nursing homes to improve care by providing technical assistance.

To enhance transparency, CMS will create a new database that will track and identify owners and operators across states to highlight previous problems with promoting resident health and safety.  The agency will also collect and publicly report data on corporate nursing home ownership and will enhance the Nursing Home Care website. Finally, CMS will examine the role that private equity investors play in the nursing home sector.

Biden’s nursing home reforms will ensure that every nursing home has a sufficient number of adequately trained staff to provide care to the 1.4 million residents residing in over 15,500 Medicare and Medicaid facilities across the nation.  Nursing home staff turnover can be reduced by creating pathways to good-paying jobs along with ensuring staff to join a union.  CMS calls for lowering financial barriers to Nurse Assistant Training, adequate compensation and access to a realistic career ladder. The agency launches a National Nursing Career Pathways Campaign with partners including the Department of Labor.

Finally, Biden puts together his strategy to ensure emergency preparedness in nursing homes during the ongoing pandemic.  He calls for continued COVID-19 testing in nursing homes and continued COVID-19 vaccinations and boosters to be provided to residents and staff. CMS will strengthen requirements for on-site infection prevention, and make changes to its emergency preparedness requirements,   Finally, the agency will take what it has learned during the pandemic and integrate new lessons on standards of care into nursing home requirements around fire safety, infection control, and other areas, using an equity lens.

Point/Counter Point

In a released statement after Biden’s State of the Union address, AARP CEO Jo Ann Jenkins stated: “We were also encouraged to hear the President describe new actions to ensure that residents in nursing homes will receive the safe, high-quality care they deserve. For years, AARP and AARP Foundation have sounded the alarm about problems in America’s nursing homes. The COVID-19 pandemic exposed the chronic, ongoing issues with our long-term care system and emphasized the need for reform. It is a national disgrace that more than 200,000 residents and staff in nursing homes and other long-term care facilities died. AARP urges the federal government to act swiftly to ensure minimum staffing standards, increase transparency, and hold nursing homes accountable when they do not provide quality care.”

On the other hand, the nursing home industry had its views as to Biden’s call for nursing home reforms.  “The nursing home profession has always been committed to improving the quality of care our residents receive, and we appreciate the Biden Administration joining us in this ongoing effort. Over the last decade and prior to the pandemic, the sector made dramatic improvements. Fewer people were returning to the hospital, staff were providing more one-on-one care than ever before, and the unnecessary use of antipsychotic medications significantly declined,” said Mark Parkinson president and CEO of AHCA, in a released statement.

“Those who continue to criticize the nursing home sector are the same people who refuse to prioritize our residents and staff for resources that will help save and improve lives,” noted Parkinson, whose Washington, DC-based nonprofit organization represents more than 14,000 nursing homes and long-term care facilities across the nation. “Additional oversight without corresponding assistance will not improve resident care. To make real improvements, we need policymakers to prioritize investing in this chronically underfunded health care sector and support providers’ improvement on the metrics that matter for residents,” he said.

“It’s time to stop blaming nursing homes for a once-in-a-century pandemic that uniquely targeted our residents and vilifying the heroic caregivers who did everything they could to protect the residents they have come to know as family,” said Parkinson. ““Long term care was already dealing with a workforce shortage prior to COVID, and the pandemic exacerbated the crisis. We would love to hire more nurses and nurse aides to support the increasing needs of our residents. However, we cannot meet additional staffing requirements when we can’t find people to fill the open positions nor when we don’t have the resources to compete against other employers,” he said.  

To read the White House Fact Sheet to improving the quality of care in the nation’s nursing homes, go to:

https://www.whitehouse.gov/briefing-room/statements-releases/2022/02/28/fact-sheet-protecting-seniors-and-people-with-disabilities-by-improving-safety-and-quality-of-care-in-the-nations-nursing-homes/

On Monday, March 7th at 9am, AARP Rhode Island and US Senators Reed and Whitehouse will speak on the need for lower prescription drug prices in a virtual press conference.

AARP Rhode Island State Director Catherine Taylor, Volunteer State President Marcus Mitchell and Volunteer Lead Federal Liaison Dr. Phil Zarlengo will join Rhode Island US Senators Jack Reed and Sheldon Whitehouse for a virtual news conference highlighting the need for Congress to lower prescription drug prices. AARP Rhode Island will present the Senators with a petition signed by more than16,000 Rhode Islanders calling for Congress to act now and stop unfair drug prices.

You can listen in via ZOOM at:  

https://aarp-org.zoom.us/j/98668832992?pwd=bktuTjJBMUZhUDRaVDkvN2dCSXZqUT09

Passcode: 618357

Participants will respond to on-topic media questions posted in chat.

More information about AARP’s Fair Drug Prices campaign can be found at aarp.org/rx.