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.

The crafting of Rhode Island’s first State Plan on Caregiving

Published on February 28, 2022 in Rhode Island News Today

Rhode Island has the distinction of having one of the highest percentages of adults aged 85 and over in the country. In 2017, out of a population of 1,060,00 there are more than 136,000 caregivers providing 114 million hours of care, says AARP Rhode Island.  More Rhode Islanders will be thrust into caregiving roles in the coming years.

In response to the continued aging of Rhode Island’s population, the Rhode Island Office of Healthy Aging (OHA) and Family Caregiver Alliance of Rhode Island officially released Rhode Island’s first State Plan on Caregiving.  The state’s new Plan for Caregivers serves as the framework for the crafting and implementation of new policies, as well as the expansion of various existing programs and partnerships to assist caregivers. The Plan serves to strengthen and advance the shared mission of OHA and the Family Caregiver Alliance of Rhode Island at the United Way (FCARI)  to promote choice, independence, empowerment, and the overall well-being of older adults, individuals with disabilities, and their caregivers.  FCARI is supported with funds from OHA.

As an advocate for caregivers throughout the state, The FCARI serves as the administrator of the 29-page Plan which extends through Sept. 2023. 

A Call for Supporting Rhode Island’s Caregivers

“The COVID-19 crisis has exacerbated many of the challenges faced by our older adults and their caregivers, particularly social isolation,” said Interim Director Michelle Szylin announcing the release of this report on Sept 24, 2021. “Caregivers have a tough job and often receive little support. Through the development of this State Plan, we’re showing our commitment to strengthening resources available for our caregivers and better supporting the important work they do across our state,” she says.

Adds Maryam Attarpour, Program Manager, Family Caregiver Alliance of Rhode Island at the UWRI, “Caregiving has been and will always be a major part of the fabric of our society.” Attarpour says that the new State plan puts the needs of family caregivers first. “Our goal is to create a state that is equitable, inclusive, and supportive of our family caregivers, and the loved-ones they care for,” she says.

According to the statement, the State Plan on Caregiving also builds on the state’s existing efforts to meet the needs of Rhode Island caregivers of any age.  It provides an overview of the existing support network available for family caregivers to access as well as addresses the work that remains to ensure equitable access to resources and advocacy. 

One of the key areas of support that the plan focuses on is developing a comprehensive, robust website and social media presence for FCARI that will serve as a hub of information for resources and information for caregivers. It will also ensure diversity, equity, and inclusion for Rhode Island Caregivers and those for whom they care, too.

The State Plan will also ensure that the caregivers of Rhode Island seeking long term services and supports are identified and provided with information assistance and advance  opportunities for digital access (iPads, notebooks, computers and phones) to better serve and support Rhode Island Caregivers.

Over the years, the Rhode Island General Assembly has worked closely with aging advocates to enhance supports and resources for the state’s caregivers.  The State Plan calls on lawmakers to review existing laws to determine if they need to be refined or better funded.  It also suggests that legislation that has been submitted and not passed as well as laws and policies from other states be reviewed for “relevancy for supporting Rhode Island family caregivers.

Putting a Face on Family Caregivers

On Feb. 15th, Maureen Maigret, Chair of the state’s Long-Term Care Coordinating Council’s Aging in Community Subcommittee, told members of the Rhode Island House Oversight Subcommittee on Aging & Senior Services, the importance of hammering out sound policy to support the state’s growing number of caregivers.

Maigret painted a picture of the typical care recipient, citing the 2020 Report, Caregiving in the U.S., to the attending House lawmakers. “Eighty nine percent of the care recipients are a relative, with 50% being either a parent or parent-in-law, spouse/partner (12%), grandparent/grandparent-in-law (8%), sibling/sibling-in-law (7%), adult child (6%) or nonrelative (10%), she said, noting that the average care recipient’s age is 68.9.

While 61% of the caregivers are women, 39% are men, adds Maigret, noting that 61% are white, 14% African American and 17% Hispanic.  The age of most caregivers falls between ages 60-65, says Maigret, noting that younger adults also find themselves having to provide caregiving chores.  Twenty-four percent of persons ages 18-34 and 23% of person’s ages 35-49.

It’s not easy to be a caregiver, says Maigret. She warned that caregivers should be considered “the hidden patient” because they are at risk for becoming depressed, extremely fatigued, stressed, feeling overwhelmed, being socially isolated, losing income and having physical health problems.

Maigret’s presentation was followed by a panel led by Acting OHA Director, Michelle Szylin, and her staff who provided information on programs OHA offers to assist caregivers including subsidized respite, home care and adult day services and special pilots to support those caring persons with Alzheimer’s disease.

“Although our legislature and Governor have been supportive of funding programs to support caregivers, the growth of our older population means more persons will need to become caregivers,” said Maigret. “We need better state programs and services to provide physical, emotional and financial support, and enhanced access to information about available resources,” she said.

Maigret adds: “There is also an urgent need to address the direct care worker crisis by providing the workers with fair and competitive wages.  Many caregivers need to supplement the services they provide with paid caregivers if they are in the workforce, or need to take care of other family needs. Yet due to the low wages paid for personal care workers, it is not always possible to find such help.”

For a copy of the State Plan on Caregiving go to https://fcari.org/state-plan-on-caregiving/

RI State Budget must address long term care staffing crisis

Published in RINewsToday on February 21, 2022

As Rhode Island and states throughout the country loosen COVID-19 mask restrictions with the number of new coronavirus cases dropping by more than 75% since the highs in mid-January, and hospital admissions and death rates declining, AARP Rhode Island warns that now is the time to take steps to protect nursing facility residents from future COVID-19 surges in the state’s nursing facilities. 

In a statement released on Feb. 18, 2022, AARP Rhode Island, the state’s largest aging advocacy group for seniors, says that their “AARP’s Nursing Home COVID-19 Dashboard”, covering the four-week period ending January 23rd “paints a grim picture of the devastation caused by the surge of the Omicron variant in America’s nursing homes and underscores the need for booster shots to protect both residents and staff.”

A snapshot of COVID-19’s impact in nursing facilities

AARP Rhode Island’s statement notes that facility staff cases were more than 11 times as high nationwide as in last month’s Dashboard (covering the four weeks ending December 19), with resident cases nationwide more than eight times as high.

“Here in Rhode Island, staff cases increased nearly tenfold from the rate of 2.96 per 100 residents in December to 24.5 during the same time period in January. Resident cases spiked from a rate of 2.6 to 15.8. Nursing home resident deaths from COVID-19 increased from 0.18 per 100 residents in December to 0.30 in January,” says AARP Rhode Island.

AARP’s Nursing Home COVID-19 Dashboard also shows that as of January 23, 72% of nursing home residents in Rhode Island were fully vaccinated with a booster dose, an increase from mid-December’s 61.8%. Meanwhile, 35.6% of direct care staff had received a booster, an increase from 24.8% in mid-December.

“We know boosters save lives; we know they help prevent infections and severe illness,” said Catherine Taylor, State Director of AARP Rhode Island, which serves more than 130,000 members aged 50 and older in the Ocean State. “Even though the worst of the Omicron surge is hopefully behind us, the pandemic isn’t over. The delivery of booster doses to nursing home residents and staff must remain a high priority as these residents are among the most vulnerable to COVID-19 and its variants.,” she says, noting that the number of facilities in Rhode Island reporting a shortage of nurses or aides has also increased from 32.9% to 52.1%. in the four weeks ending January 23.

“The last two years have highlighted the chronic, ongoing issues that have long plagued nursing homes—such as the shortage of direct care workers, which is now a crisis; low pay that drives workers to take second and third jobs in multiple facilities; and shared rooms and bathrooms (for residents in facilities) – and that are chief contributors to poor infection control,” said Taylor.

John E. Gage, MBA, NHA, President & CEO, Rhode Island Health Care Association, says “AARP Rhode Island’s story is based mostly on national numbers, and RI’s situation is actually quite good” and its data recognizes the achievements of the state’s facilities as deserved. 

Nursing facilities continue to follow strict Covid-19 guidance provided by Rhode Island Department of Health (RIDOH) following CDC Guidance, says Gage, noting that residents and staff are among the highest vaccinated and boosted in the nation which has helped limit the impact of the latest Omicron surge.

“Numbers are dropping as quickly as they spiked, and we are hoping for a return of greater “normalcy” as we enter the Spring,” adds Gage as staff continue to utilize full PPE when providing care to residents, and masks are used at all times in nursing homes. They also continue to follow quarantine and isolation guidance for residents and staff as provided by the RIDOH – this guidance is updated frequently”, he says.

“Staff left early on in the pandemic because of fear of Covid. Remaining staff worked tirelessly throughout the first wave of the pandemic without vaccines and without the availability of sufficient PPE,” recalls Gage, stressing that “they are true heroes, but they are burned out, and many have chosen to leave for higher wages or less stress.” 

“Those who remain are working overtime – picking up shifts to help cover for the 20% vacancy rates in RI facilities,” he says, adding that facilities are paying higher wages, overtime, and bonuses to their existing staff, and they are forced to use temporary nurse staffing agencies at 4 times the pre-pandemic level.

The pandemic and RI’s staffing crisis

Now, in the midst of this crisis, facilities are expected to comply with the minimum staffing mandate passed during last year’s legislative session, says Gage, warning that it is impossible for the state’s 77 facilities to comply with the mandated staffing levels. “There are not enough willing applicants, Rhode Island Medicaid reimbursement does not allow facilities to make meaningful pay rate increases, and the staffing mandate is woefully underfunded,” he charges. In fact, when fully implemented, the unfunded mandate that is the minimum staffing statute will result in a $47 million/year reimbursement shortfall – that on top of the $50 million/year in pre-existing underfunding,” he says. 

“Then, when nursing homes are unable to meet impossible staffing thresholds in the midst of this workforce crisis, they will be fined millions of dollars for non-compliance (RIDOH estimated $8.3 million in fines in the first quarter alone). These fines will actually divert resources from nursing homes and further imperil the care and services our elder residents who reside in nursing homes so deserve. This is a true crisis in the making,” according to Gage.

“The intent of the minimum staffing statute was to provide more caregivers and better care but did not provide the resources to do so – the workforce or the appropriate reimbursement to pay that workforce. The state’s facilities have always had a reputation of providing among the best nursing home care in the country. That reputation is in peril now,” adds Gage.

“The pandemic will be with us for a while [and that] has highlighted the need to reimagine long term supports and services,” says  Maureen Maigret, state’s Long-Term Care Coordinating Council Aging (LTCCC) in Community Subcommittee.  “We need to provide incentives through low cost loans and reimbursement rates for nursing homes to convert to private rooms and bathrooms which would go a long way to prevent the spread of infections. We also need to enhance access to home and community-based services to give more persons the choice to get care at home.

And finally, we must urge our Governor and legislature to take immediate steps to address the workforce crisis by ensuring our direct care workers receive fair, competitive wages and opportunities for specialized training and advancement,” says Maigret, a former Director of the state’s Department of Elderly Affairs (renamed the Office of Healthy Aging).

Increasing Medicaid payments 

Last month, Gov. Dan McKee submitted a $12.8 billion state budget to address the pandemic, build more affordable housing, also providing increased funding to schools and small businesses.  In its statement, AARP Rhode Island called on the Rhode Island General Assembly to ” address the direct care workforce shortage through a combination of wage increases, paid training, professional development and enhanced benefits, and enact an enhanced rate for single rooms in nursing homes, retroactively.” Maigret said: “These are necessary for transforming how we provide nursing facility care. However, the Governor and lawmakers must address the immediate and urgent need to raise wages for direct care staff working in home and community programs as well,” she said, noting that the average wait time to get home care services paid by Medicaid is more than three months.”

Maigret adds: “It’s unacceptable that so many people wait so long to receive services due to the state’s failure to increase provider rates to allow them to pay our workers competitive and fair wages. It also inhibits reaching the state’s goals for providing people choice and receiving services in the least restrictive setting.”  

“The demographics are undeniable,” says Gage, noting that Rhode Island’s 85+ population will double in the next 15-20 years. “ Of course, we want everyone to have the option to live in the setting most appropriate for their needs.  However, this impending wave will overwhelm the state’s entire LTC continuum – home care, assisted living residences and nursing homes,” says Gage.

Gage calls on McKee and Rhode Island lawmakers to make sure that Rhode Island Medicaid ensures the long-term viability of the entire LTC continuum, including nursing facilities, to meet the needs of the most fragile Rhode Islanders today and in the coming years as demand will inevitably rise.

“The recently released AARP Nursing Home Dashboard data underscores the continued necessity of this advocacy, and the need for the legislature to pass these critical reforms this year,” says AARP’s Taylor.

Don’t forget the state’s most vulnerable

The AARP Nursing Home COVID-19 Dashboard  analyzes federally reported data in four-week periods going back to June 1, 2020. Using this data, the AARP Public Policy Institute, in collaboration with the Scripps Gerontology Center at Miami University in Ohio, created the dashboard to provide snapshots of the virus’ infiltration into nursing homes and impact on nursing home residents and staff, with the goal of identifying specific areas of concern at the national and state levels in a timely manner.

The full Nursing Home COVID-19 Dashboard is available at  www.aarp.org/nursinghomedashboard, and an AARP story about this month’s data is available here.

For more information on how coronavirus is impacting nursing homes and AARP’s advocacy on this issue,

visit www.aarp.org/nursinghomes. Medicare.gov’s Care Compare website now offers information about vaccination and booster rates within individual nursing homes and how they compare to state and national averages.