Watching over Nursing Homes once again – time for mandated Boosters

Published on December 20, 2021 in RINewsToday

Colder weather is keeping people more indoors now, and Thanksgiving and pre-Christmas gatherings are drawing people together in groups, small and large. Like other states across the country, Rhode Island is seeing a growing transmission of the COVID-19 Delta, and now Omicron variants. Some national sources say Rhode Island’s case rate is the highest.

According to WPRI’s COVID-19 tracking page, 73.7% of Rhode Island’s population, totaling 1,097,379 are fully vaccinated, 9.2 % are partially vaccinated, and 17 % have received no vaccination at all. “But some back-of-the-envelope math based on the state’s tally of daily doses shows nearly 251,000 people have received booster shots or third doses. And earlier this week, RI Gov. McKee publicly said the number is closer to 260,000 people,” says WPRI.

Taking a Snapshot of Vaccination Rates in Rhode Island’s Facilities

Just days ago, AARP Rhode Island called for increased boosters in the state’s nursing homes after releasing its new analysis of the latest data from AARP’s Nursing Home COVID-19 Dashboard.  The Dashboard revealed that only 54% of nursing home residents and 19% of staff in 79 Rhode Island nursing homes have received a COVID- 19 booster.

“With holiday gatherings on the horizon, these numbers are a cause for concern for state policy makers, as more than a year and a half into the pandemic, rates of COVID-19 cases in nursing homes are rising again nationally, along with increased community spread,” says AARP Rhode Island. While case rates declined slightly compared to the same time period last month, in AARP’s dashboard, looking week to week, the number of cases increased each week during the four weeks ending November 2, notes the state’s largest aging advocacy group serving more than 132,000 members aged 50 and older.

The Rhode Island-specific AARP Nursing Home Database says that resident cases grew from a rate of 0.64 per 100 residents in mid-October to 1.19 in mid-November. Staff cases decreased slightly from a rate of 0.96 to 0.82 during this same time period. Nursing home resident deaths from coronavirus rose slightly from a rate of 0.06 in mid-October to 0.11 in mid-November.

“COVID-19 continues to infiltrate America’s nursing homes with more than 1,500 new nursing home resident deaths nationally for the third consecutive month,” said AARP’s Rhode Island State Director Catherine Taylor. “Increasing vaccination rates—including boosters — among nursing home residents and staff is key to protecting our loved ones and getting the pandemic under control,” she says.

“AARP calls on nursing homes, state and federal authorities, and others to increase access to and receipt of COVID-19 boosters for both nursing home staff and residents,” Taylor added.

“As new variants emerge and vaccine immunity wanes, the low number of residents and staff who have received a booster creates an unacceptable level of risk since the disease spreads so easily in these environments,” says Tayler, urging Gov. Dan McKee “to prioritize the state’s most vulnerable population and take immediate action to addresses the relatively low percentage of nursing home residents and staff who have not received COVID-19 booster shots.”

According to AARP Rhode Island, while the percentage of residents and staff who have received boosters remain low, rates of those fully vaccinated—those who have received two COVID-19 shots—continue to slowly rise as of November 21. In Rhode Island, 99.10% of nursing home staff are fully vaccinated (the highest rate of any state in the nation) and 94.10% of nursing home residents.

The number of Rhode Island facilities reporting a shortage of nurses or aides rose sharply from 34.7% to 41.7% in the four weeks ending November 21, says the advocacy group. 

Rhode Island’s high vaccination rates can be tied to Rhode Island mandating all healthcare workers be vaccinated by Oct. 1, 2021, say John E. Gage, President and CEO of the Rhode Island Health Care Association. When the 30 day-compliance period ended, those who were unvaccinated were banned from entering the state’s healthcare facilities, he says, noting that termination resulted from failure to follow a reasonable policy set forth by their employer in compliance with Health Department’s emergency order. 

Yet, in at least one large nursing home facility, RINewsToday has learned, staff who refused to be vaccinated were either moved to non-patient-facing positions, or already worked in those positions, and allowed to keep working. An administrator said they are still working on encouraging 100% vaccination. Residents also have the right to refuse vaccination, and masks are required for patients outside of their rooms.

Families visiting had been restricted to the lobby, and at one time received a test in the parking lot prior to being able to enter. Today they are still screened for temperature, and they must wear a mask and complete a health symptom questionnaire. After a federal regulation went into effect several weeks ago easing access for families to visit, the screening also eased up and now tests are not required.

Any patient who is positive for COVID is moved to a quarantine area until fully recovered, and regular testing for patients and staff continues.

Some nursing homes are allowing families to take their loved one’s home for a Christmas holiday and then return after being with outside family and friends.

Gage notes that Rhode Island is ranked at No. 11 of states at a booster rate among residents of 54.1% compared to a national average of 38.4%.  Staff are boosted at 19.1% (#16) compared to a national average of 15.0%.  “Remember, individuals are not eligible for a booster until six months after their second dose of the vaccine series.  This will preclude some residents and staff, he says, stressing more credit should be given to the state’s health care facilities having the highest vaccine rates among staff and the second highest vaccination rate among residents.

According to Gage, the data released by the Centers for Medicare and Medicaid Services on Nov. 28, 2021 showed 99.38% of all workers in Rhode Island facilities are vaccinated – the highest (#1) vaccination rate for nursing homes in the country. Residents in Rhode Island nursing homes are 95.02% vaccinated – the second highest rate in the country.

To Booster or Not Booster, that is the Question

“With vaccines mandated in healthcare facilities and proof of vaccination being required to enter public places under the new Executive Order, it seems this would be a reasonable requirement for visitors to nursing homes,” says Gage, noting that this is not allowed according to the most recent guidance issued by the Centers for Med Centers for Medicare and Medicaid Services.

As to mandating booster shots for nursing facility staff, however, Gage warns, “staffing is at a crisis level already. We cannot afford to lose more staff with another mandate,” he says.

“The first rounds of vaccines were given most commonly by third-party sources such as CVS medical staff who came into the homes, similar as they do every year for flu shots”, said one nursing home administrator to RINewsToday – “For the boosters, we did them using our own staff, and ordering our supply from the RI Department of Health.”  Boosters were advised to be given 4-5 months from original vaccination completion – yet in the nursing homes most didn’t get them until 8 to 9 months – as late as the end of October.

However, Joseph Wendelken, Rhode Island’s Department of Health’s Public Information Officer, says that CVS and Walgreens are working to make COVID-19 vaccine booster doses available to all nursing facilities,. “If any facility is looking for additional support getting residents and workers vaccinated, we can provide that support,” he says.

Wendelken notes that there is a requirement for nursing home workers to complete a primary COVID-19 vaccine series, but there is no [federal or state] requirement for booster doses. “The data are becoming clearer and clearer that – especially with the Omicron variant – booster doses are absolutely critical,” says Wendelken.

“Residents [of nursing homes and assisted living facilities] were among the first to get vaccinated so that means their immunity has waned and boosters are needed to avert significant outbreaks and deaths,” says  Maureen Maigret, former director of the R.I. Department of Elderly Affairs and chair of the Aging in Community Subcommittee of the Long Term Care Coordinating Council. “It is critical that booster shots are offered to all nursing home and assisted living residents especially now that visitation has opened up and visitors do not have to show proof of vaccination,” she says.

As of December 15th, the RI Department of Health Department shows at least 114 new cases in nursing homes and assisted living facilities in the past seven days, says Maigret. “We must  remember that over 1,700 residents died as a result of COVID in these facilities and providing booster shots is our best defense against more fatalities for this vulnerable population.”  

Even though it is not a federal policy, a growing number of state officials across the country are calling for the definition for being fully vaccinated to now include the booster shot. With Rhode Island seeing a surge in COVID-19 cases and an increase in hospitalizations due to Delta and Omicron variants spreading throughout the state, many (including this writer) express it’s time for Governor Dan McKee to now mandate booster shots for nursing facility staff.  More important, it must become a priority for the Rhode Island Health Department to make sure that every consenting nursing facility resident receives a booster, too.

President Biden is set to address the country on Tuesday, at a time to be announced. There is speculation whether the term “fully vaccinated” will now include not just the two original vaccinations but the booster as well.

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. 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 rates within nursing homes and how they compare to state and national averages.

RI Nursing Homes with new cases (more than 5) in the past 14 days:

Berkshire Place, Providence – 10 to 15

Jeanne Juga Residence, Pawtucket – 5 to 9

Oak Hill Health Center, Pawtucket – 20 to 24

Pawtucket Falls Healthcare, Pawtucket – 10 to 14

Summit Commons, Providence – 5 to 9

West View Nursing, West Warwick – 10 to 14

The full Nursing Home COVID-19 Dashboard is available at  www.aarp.org/nursinghomedashboard. 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 rates within nursing homes and how they compare to state and national averages.

Social Security learns from remote experience, plans field office openings

Published on December 13, 2021 in RINewsToday

On March 17, 2020, as the COVID-19 pandemic rapidly spread throughout the nation, the Social Security Administration  (SSA) issued a press release announcing that its offices would only offer phone service and online services.

However, in-person appointments at SSA were scheduled for critical issues, specifically for those who were without food, medicine, shelter, or those needing to apply for benefits or to reinstate them. This decision allowed SSA to provide critical services while protecting its employees and older beneficiaries, many with underlying medial conditions. 

Congress Expresses Concern Over Closing of SSA Field Offices  

Almost four months later, House Ways and Means Social Security Subcommittee chairperson John B. Larson (D-CT) and Republican Leader Tom Reed (R-NY) sent two letters to the SSA Inspector General Gail S. Ennis asking for a review of SSA’s telephone service during the COVID-19 pandemic and SSA’s process for obtaining medical evidence for disability claims.

The correspondence to SSA’s Office of Inspector General (OIG) noted that as the COVID-19 pandemic continues, beneficiaries are relying on their Social Security now more than ever. Except in dire need, beneficiaries are unable to access in-person services and are relying instead on telephone services.

Members of Congress warned that beneficiaries, especially those from vulnerable populations who lack internet connection especially in rural areas or don’t have a reliable phone number or mailing addresses, are struggling to gain access SSA while field offices are closed.

“As highlighted in the OIG’s recent report, even before the current crisis the pubic relied heavily in SSA’s telephone services, but often could not access timely information or assistance. In fiscal year 2019, SSA’s national 1-800 number and field  offices received over 143 million calls – but handled fewer than to 3 of these calls. Callers who did not get a busy signal or give up while on hold waited to speak with an SSA employee for an average of 20 minutes on the 1-800 number and three minutes at field offices.

In addition, SSA requests millions of medical records each year from health care facilities and health professionals across the country to obtain evidence of an individual’s medical condition. The medical records request is an important part of the disability process, but the most recent report on this topic from the OIG is from 2001 and does not reflect changes to the process over the past nearly 20 years.

“Social Security benefits are earned by hard-working Americans, and we must do everything we can to ensure people are receiving the quality customer service they deserve.  These reports will provide important information to make sure Americans are receiving the service they expect and deserve from SSA,” said Larson and Reed.

SSA Responds to the Closing of Field Offices 

Almost two weeks ago, Ennis released a 58-page Congressional Response report, “The Social Security Telephone Service Performance,” detailing the impact on the closing of about 1,300 field offices.

The OIG found that in FY 2020, SSA received over 150 million calls, more than any other federal agency surveyed, and handled over half of those calls. Calls to field offices increased dramatically, from an average of 4.6 million calls per month leading up to the COVID-19 pandemic to an average of 7.5 million calls per month from April to Sept. 2020.

According to the OIG’s report, SSA’s telephone services shifted to more calls to field offices in FY 2020 when the agency closed its offices and provided the public with more field office telephone numbers. The increase in field office calls resulted in increased busy messages and wait-times toward the end of FY 2020. During the pandemic, SSA adjusted national 800 number operations to reduce wait times and the number of callers who received a busy message. National 800 number performance began to decline toward the end of the fiscal year, though it was still better then pre-pandemic performance.

When comparing SSA to 13 customer service call centers from 10 other federal agencies, SSA had a higher call volume in FY 2020 with similar or better performance.

To reduce wait times, improve caller experience, and ensure more calls are handled SSA hired additional 800-number staff, modified automated service options, and plans to implement a new telephone system.

“This [IOG] report highlights that SSA’s telephone services are vital to the American public. While I applaud the hard work of SSA employees, especially during the pandemic, the report also highlights actions that SSA is taking to reduce telephone wait times, handle more calls and improve caller experience, said Larson, noting that SSA will need more funding to do so and that is why he is supporting House Appropriations and Chair DeLauro’s proposal to give SSA an additional $1.1 billion in FY 2022.

Adds Reed, “This report provides clear evidence that with determined agency leadership and the hard work of dedicated staff, the SSA was able to respond to the largest management crisis in its history. With the almost 65 percent increase in phone calls during the pandemic the report also demonstrates the public’s clear and continued demand for access to the SSA’s vital services.” 

Opening the Doors

According to newly released 19-page SSA reentry plan, after more than 18 months working from home, senior SSA leadership are beginning to return to their offices, in early December. Employees are scheduled to return to their desks by Jan. 3. Along with in-person appointments, the agency will now also embrace telework. 

The agency will lift its current “work from home by quarantine” policy starting Jan. 2, at which point related collective bargaining agreements and pandemic policies will end as well. Reentry dates could change with the spread of the delta and omicron variant.

“We will use the evaluation period to develop, assess, and, if necessary, adjust any personnel or operational policies to provide public service and accomplish our mission as well as or better than, before the pandemic,” the SSA reentry plan reads. “Each [deputy commissioner] will evaluate their operations to identify ways to improve service, hire and retain the best employees and to operate efficiently including the consideration of potential space savings resulting from increased telework and information technology improvements.”

Over the next six months, the agency will review metrics on customer satisfaction, employee experience, service availability, workload, and environmental considerations.

“Throughout the pandemic, Social Security has helped many people through in-person appointments for certain situations in local offices nationwide and through options like online, telephone and video service,” Nicole Tiggemann, an SSA spokeswoman, said in an email to AARP, reported by Writer John Waggoner in his Nov. 11 blog posting, “Social Security Takes Steps to Reopen Field Offices.

“We know that those options do not work for everyone, says Tiggemann. “In order to improve service, especially for people who have had difficulty reaching us during the pandemic, Social Security will begin implementing the reentry process agencywide as soon as possible, including taking steps to increase in-person accessibility,” she said.

AARP applauds a return to normalcy at SSA. “Obviously, from our point of view, we’d like to see those offices open and staffed as soon as possible,” says Joel Eskovitz, director of Social Security and Savings at the AARP Public Policy Institute,” in Waggoner’s blog posting.

Senator Bob Dole’s legacy – putting nation over politics

Politician, War Hero, Senator Bob Dole Dies at 98

Published on December 7, 2021 in RINewsToday

Bob Dole a seriously wounded World War II hero, a Kansas politician who served in the House from 1961 to 1969 and the U.S. Senate from 1969 until 1996, who unsuccessfully ran as the Republican candidate against Bill Clinton for President in 1996, dies at age 98, after a long illness.  

According to the Elizabeth Dole Foundation, Senator Robert J. Dole died in his sleep on early Sunday morning.  While no cause of death was reported the former Senator was diagnosed with stage 4 lung cancer last February.  While funeral arrangements have not been announced, House Speaker Nancy Pelosi and Senate Majority Leader Chuck Schumer announced that Dole, one of the longest serving Republicans in the Senate’s history who served as Senate Majority leader from 1985 to 1987 and from 1995 to 1996, will lie in state in the United States Rotunda on Thursday, Dec. 9, 2021.  A formal arrival and departure ceremony will be held on Thursday morning.  Dole will join just 34 others, including government officials and military officers, who have had this honor in the U.S. Capitol since 1852.

“Putting his life on the line to defend our nation, he was awarded two Purple Hearts for his valor and sacrifice on the battlefield – and, when he came home, served as an inspiration to millions of Americans living with disabilities.  From the Well of the House to the Floor of the Senate, as a presidential candidate and as an elder statesman, he was one of the foremost advocates for our servicemembers, veterans and military families,” stated Pelosi, in a statement announcing Dole being given the nation’s highest honor to lie in state in the Capitol.   

“Senator Dole exemplified the Greatest Generation, and while I never had the pleasure of serving in the Senate with him, his reputation and his achievements, and most of all his character proceeded him, said Senate Majority Leader Chuck Schumer. “I always admired his steadfast advocacy for Americans with disabilities, and his love for this country,” he added.

Adds Senate Republican Leader Mitch McConnell, “Whatever their politics, anyone who saw Bob Dole in action had to admire his character and his profound patriotism. Those of us who were lucky to know Bob well ourselves admired him even more. A bright light of patriotic good cheer burned all the way from Bob’s teenage combat heroics, through his whole career in Washington, and through the years since.”

Fixing Social Security

Back in the late 1970s, President Ronald Reagan reacted to Social Security’s short-and long-term financing crisis funding crisis by charging the National Commission on Social Security Reform (NCSSR), chaired by Alan Greenspan, by making recommendations on strengthening the program’s financial viability to Congress.

There were NCSSR members of the bipartisan Commission who did not believe there was an impending fiscal crisis, believing that it was being politically blown out of proportion.  Like today, there were philosophical differences in how to keep Social Security solvent.  

The political polarization that resulted in hammering out recommendations kept the NCSSR from making its original deadline to issue its report. Reagan was forced to extend the life of the Commission, and this ultimately gave time for the 15 members to reach a compromise.

However, even with the NCSSR compromise, there was still political gridlock in Congress as to how to fix Social Security. But a chance reading of Dole’s article on Social Security published in the January 3, 1983 issue of the New York Times, brought Senator Patrick Moynihan (D-NY) together on the Senate floor with the Kansas Senator. Ultimately it was these two seasoned Senators who put political differences aside to draft a bipartisan compromise to allow the passage of NCSSR’s recommendations, including taxation of Social Security benefits and increasing the retirement age for receiving full benefits.

Dole and Moynihan’s “Gang of Seven”, including three NCSSR members and two Reagan advisors, came up with a politically acceptable time frame of payroll tax increases and spending reforms that both the Democrats and Republicans could accept. Meeting outside the halls of Congress, the so-called “Gang of Seven,” Dole, Moynihan, three other members of the Greenspan Commission and two Reagan advisors, came up with a timetable of payroll tax increases and spending reforms that legislators of both parties could accept. On April 20, 1983, President Reagan signed the Social Security reform into law. 

Reaching Across the Aisle

In a statement, President Joe Biden noted that even though he and Dole often disagreed on issues during his time in the Senate, “he never hesitated to work with me or other Democrats when it mattered most.”

“He and Ted Kennedy came together to turn Bob’s lifelong cause into the Americans with Disabilities Act — granting tens of millions of Americans lives of greater dignity,” said Biden.

“When he managed the bill to create a federal holiday in the name of Martin Luther King, Jr. — a bill that many in his own caucus opposed — I will never forget what he said to our colleagues: “No first-class democracy can treat people like second-class citizens,” noted Biden.

Finally, Biden noted Dole’s support of  another bipartisan effort, the McGovern-Dole International Food for Education and Child Nutrition Program. This initiative provided school meals and food for nursing mothers and young children. “It saved the lives of countless young people who would otherwise have died in infancy — and brought dignity to tens of millions of families at home and abroad. This work, for Bob, was about more than passing laws. It was written on his heart,” said Biden.

Known for his integrity and trustworthiness, this statesman, war veteran, patriot, knew how to work across the aisle to pass Senate bills that would help seniors, the disabled, and the needy, oftentimes in opposition to his caucus. He put the nation first above politics.

Hopefully, Congress can clearly see Dole’s political legacy of being bipartisan in legislating.  It’s not too late.