Time to resolve RI’s ongoing Nursing Home staffing crisis

Published in RINewsToday on April 18, 2021

The latest release of AARP’s Nursing Home COVID-19 Dashboard shows that both cases and deaths in nursing homes declined in the four weeks ending March 21. Although these rates are improving, chronic staffing problems in nursing homes—revealed during the COVID-19 pandemic—continue. In Rhode Island, 30% of nursing homes reported a shortage of nurses or aides, which is only fractionally better than the previous reporting period. 

AARP has come out swinging to fight for enhancing the quality of care in Rhode Island’s 104 nursing homes.

AARP Rhode Island, representing 131 members, calls for the General Assembly to ensure the quality of care for the state’s nursing home through minimum staffing standards, oversight, and access to in-person formal advocates, called long-term care Ombudsmen. The state’s the largest aging advocacy group has urged lawmakers to create a state task force on nursing home quality and safety and has pushed for rejecting immunity and holding facilities accountable when they fail to provide adequate care to residents.  It’s also crucial that Rhode Island ensures that increases in nursing homes’ reimbursement rates are spent on staff pay and to improve protections for residents, says AARP Rhode Island. 

Last December, AARP Rhode Island called on Governor Gina Raimondo to scrap Executive Order 20-21 and its subsequent reauthorizations to grant civil immunity related to COVID-19 for nursing homes and other long-term care facilities. The aging advocacy group warned that these facilities should be held responsible for providing the level of quality care that is required of them for which they are being compensated.

Rhode Island Lawmakers Attack Nursing Home Staffing Crisis

During the legislative session, the state’s nursing home staffing crisis caught the eye of Senate Majority Whip Maryellen Goodwin is a policy issue that needs to be addressed. They knew that Rhode Island ranked 41st in the nation in the number of the average hours of care nursing home residents receive, according to data from the Centers for Medicare and Medicaid Services.  The state also has the lowest average resident-care hours per day of any New England state.

On Feb. 2, the Rode Island Senate approved S 0002, “Nursing Home Staffing and Quality Care Act” sponsored by Goodwin and nine Democratic cosponsors to address an ongoing crisis in staffing nursing homes that has been exacerbated by the COVID-19 pandemic.  The bill had passed unanimously in the Health and Human Services Committee, and ultimately, the full Senate gave its thumbs up to the legislative proposal by a vote of 34 to 4.  Only one Republican senator crossed the aisle and voted with the Democratic senators.

“There is a resident care crisis in our state. Staffing shortages and low wages lead to seniors and people with disabilities not receiving the care they desperately need. The pandemic, of course, has exponentially increased the demands of the job and exacerbated patients’ needs. We must confront this problem head-on before our nursing home system collapses,” said Sponsor Senator Goodwin (D-Dist. 1, Providence).

The legislation would establish a minimum standard of 4.1 hours of resident care per day, the federal recommendation for quality care long endorsed by health care experts including the American Nurses Association, the Coalition of Geriatric Nursing Organizations, and the National Consumer Voice for Quality Long-Term Care. The bill, which the Senate also approved last year, has been backed by Raise the Bar on Resident Care, a coalition of advocates for patient care, and the Rhode Island’s Department of Health (RIDOH).

The bill would also secure funding to raise wages for caregivers to recruit and retain a stable and qualified workforce. Short staffing drives high turnover in nursing homes. Not only does high turnover create undue stress and burnout for remaining staff, but it also diverts valuable resources to recruit, orient, and train new employees and increases reliance on overtime and agency staff.  Low wages are a significant driver of the staffing crisis. The median wage for a CNA in Rhode Island is less than $15, and $1/hour lower than the median wage in both Massachusetts and Connecticut.

The legislation would also invest in needed training and skills enhancement for caregivers to provide care for patients with increasing acuity and complex health care needs.

At press time, the companion bill (2021-H-5012), sponsored by Reps. Scott A. Slater (D-Dist.10, Providence) and William W. O’Brien (D-Dist. 54) was considered by House Finance Committee and recommended for further study.

RIDOH’s Director Nicole Alexander-Scott, MD, MPH says the state agency “supports the thoughtfulness of the provisions included in the legislation and welcomes dialogue with its sponsors, advocates, and the nursing home facility industry regarding methods to sustain the necessary conditions associated with the intent of the bill.”

Alexander-Scott states that “RIDOH takes its charge seriously to keep nursing home residents and is supportive of efforts to update standards of care to better serve Rhode Islanders in nursing facilities, as well as increase resident and staff satisfaction within nursing facilities.”

Scott Fraser, President and CEO of the Rhode Island Health Care Association (RIHCA), a nonprofit group representing 80 percent of Rhode Island’s nursing homes, says that “staffing shortages are directly traceable to the chronic lack of Medicaid funding from past governors. Period.” 

According to Fraser, state law requires Medicaid to be funded at a national inflation index, usually averaging around 3%. “Up until this year, previous governors have slashed this amount resulting in millions of dollars in losses to our homes.  Thankfully, Governor McKee is proposing to fully fund the Medicaid Inflation Index this year,” he says.

RIHCA opposes the mandatory minimum staffing the legislation now being considered by the Rhode Island General Assembly, says Fraser, warning that its passage would result in facilities closing throughout the state. “No other state has adopted such a high standard,” he says, noting that the Washington, DC-based American Health Care Association estimates that this legislation would cost Rhode Island facilities at least $75 million to meet this standard and the need to hire more than 800 employees. 

Fraser calls for the “Nursing Home Staffing and Quality Care Act” to be defeated, noting that the legislation does not contain any provisions for funding.  “Medically, there is no proof that mandating a certain number of hours of direct care results in any better health outcomes.  This is an unfunded legislative mandate. If homes are forced to close, not only would residents be forced to find a new place for their care, but hundreds of workers would also be forced out of work,” he says.

Goodwin does not believe that mandating minimum staffing requirements in nursing homes will force nursing homes to close. She noted that the legislation is aimed at ensuring nursing home residents receive adequate care and that Rhode Island is the only state in the northeast without such a standard.

“There is an un-level playing field in nursing home staffing in Rhode Island,” charges Goodwin, noting that many facilities staff 4.1 hours per day, or close to it, while others only provide two hours of care per day. “In either case, the overwhelming majority of well-staffed and poorly-staffed nursing homes remain highly profitable,” she says. 

According to Goodwin, the lack of staffing and certified nursing assistants (CNAs) is due to unreasonable workloads and low pay. “RIDOH’s CAN registry makes it clear that retention of these workers is a big issue. This is in part because they can make as much money – or more – in a minimum wage profession with much less stress,” she adds, stressing that “The Nursing Home Staffing and Quality Care Act” directly addresses these staffing challenges.

One quick policy fix is to provide nursing home operators with adequate Medicaid reimbursement to pay for increased staffing.  Lawmakers must keep McKee’s proposed increase of nursing home rates pursuant to statute, requiring a market-based increase on Oct. 2021, in the state’s FY 2020 budget. The cost is estimated to be $9.6 million.

With the House panel recommending that Slater’s companion measure ((2021-H-5012) to be held for further study, Goodwin’s chances of seeing her legislation becoming law dwindles as the Rhode Island Assembly’s summer adjournment begins to loom ever closer. There’s probably no reason to insist that a bill be passed in order to have a study commission, so this could be appointed right away if there is serious intent to solve this problem.

Slater’s legislation may well be resurrected in the final days of the Rhode Island General Assembly, behind the closed doors when “horse-trading” takes place between House and Senate leadership.  If this doesn’t occur, either the House or Senate might consider creating a Task Force, bringing together nursing home operators, health care professionals and staff officials, to resolve the state’s nursing home staffing crisis. 

Seniors with student loans: AARP’s new online tool to manage debt

Published in RINewsToday on April 5, 2021

Over the years, AARP Public Policy Institute (PPI) has tracked the staggering amount of student loan debt that seniors are shouldering to help their children and grandchildren finance their higher education. Many people age 50 also take on student loan debt themselves, seeking more education at colleges and universities to sharpen up their skills to get a raise or a higher paying job.  

AARP national CEO, Ann Jenkins, in a July 3, 2019 blog posting, “Student Loan Debt is Crippling too Many Families,” urged Congress and state legislatures to increase public investment in colleges and universities. “The cost of attending a four-year college more than doubled, even after adjusting for inflation, as state and local funding for higher education per student has decreased,” she said, noting that family incomes haven’t come close to matching that increase.” 

Jenkins warned that the rising cost of student loan debt is “crippling too many families” and “threatens to crush the financial security of millions of Americans over age 50.” According to a PPI report, released May 2019, entitled “The Student Loan Debt Threat: An Intergenerational Problem,” cited by Jenkins in her blog article, Americans of all ages owed $1.5 trillion dollars in student loan debt as of Dec. 2018. Compare this to people ages 50 and older who owed 20 percent of this debt, or $289.5 billion of that total, up from $47.3 billion in 2004, she said, noting “that’s a fivefold increase since 2004.”

Most troubling, this 2019 PPI analysis, found that 25 percent of private student loan cosigners age 50 and older had to make a loan payment because the student borrower failed to do so.

The 2019 PPI analysis findings also indicated the obvious – that is, taking on student loan debt  can quickly deplete a senior’s retirement egg nest. The data revealed that many older student loan borrowers racked up debt by running a balance on a credit card (34 percent) and taking out a Parent PLUS loan, federal money borrowed by parents (26 percent). Other types of borrowing included taking out a home equity loan (12 percent), refinancing of their homes (10 percent), and taking out a loan against their retirement savings (8 percent).

Jenkins also noted that for seniors who defaulted in paying their monthly student loan payments, the federal government can recoup this money by taking a number of steps to collect, among them taking a portion of federal or state income tax refunds, withholding a percentage of Social Security retirement or disability benefits, or even garnishing some of the borrower’s wages.

Today, America’s seniors are still feeling the overwhelming financial weight of having to pay off student loan debt.  

Updated Student Loan Data Released 

Last week, AARP’s PPI released a new report updating data on older student loan borrowers. Like its 2019 analysis, the newly released data in the report, “Rising Student Loan Debt Continues to Burden Older Borrowers”, revealed that student loan debt is still a staggering problem across generations: Americans 50 and older held $336.1 billion, or 22 percent, of the $1.6 trillion in student loan debt in 2020. In 2004, older borrowers accounted for 10 percent of the $455.2 billion student loan debt.

“Student loan debt is becoming a burden for all generations, ensnaring more older adults and delaying or battering the retirement plans for many,” said Gary Koenig, AARP Vice President, Financial Security, in an AARP statement released on March 31, 2021. “Paying for higher education was never meant to last a lifetime.

That is why AARP is helping individuals take charge of their debt and financial security,” he said.

AARP’s newly released PPI analysis found that millions of borrowers – including as many as seven million individuals ages 50-plus – have had their payment suspension extended through September due to the pandemic. However, around a fifth of student loan debt – more than $300 billion – is not included in the current suspension.

Managing Your Student Loan Debt

To help individuals manage their student debt, AARP and Savi unveiled last week a new student loan repayment tool to help individuals identify the best payment options, with special features for the 50-plus population. The Savi Student Loan Repayment Tool provides a free, personalized assessment of student loan repayment options. It can also help individuals identify loan forgiveness opportunities based on employment, and assistance in preparing and filing paperwork.

“We’ve seen the generational impact of student loan debt, and we’re excited to work with AARP in helping older borrowers access immediate and long-term relief,” said Tobin Van Ostern, co-founder of Savi. “This is about changing the narrative and providing freedom from the burdens of student debt to those who need it most,” he notes.

“This new AARP resource provides a means for Rhode Islanders to form a clearer picture of student loan repayment that could help many clear up uncertainties and avoid potential additional costs,” said AARP Stated Director Kathleen Connell. “I urge older Rhode Islanders to get the Information they need, especially those whose retirement savings might be impacted.” 

Any adult with student loans may use the on-line tool at no cost, after registering at AARP.org/studentloans. AARP worked with Savi to customize the tool for older borrowers and includes: Options for dozens of national and state repayment and forgiveness programs; synchronized federal and private loans across all loan servicers easily with industry standard security; support from student loan experts; and access to free educational resources.

According to AARP’s statement announcing the new online tool, the Washington, DC – based aging advocacy group has worked with Savi to provide this resource to low-income older adults at no cost through the AARP Foundation. As older adults are the largest growing age group of student loan borrowers, AARP, and Savi are committed to helping them access the tools they need to begin tackling their student loan debt.

AARP’s statement makes it very clear that its collaboration with Savi does not involve or promote student loan refinancing of any.

“Georgia on My Mind”

Published by RINewsToday on March 29, 2021

Rewriting election rules has ramifications for voting accessibility of older adults. According to the National Conference of State Legislatures, Republicans now control 30 state houses with 18 being controlled by the Democrats, one legislature being nonpartisan. As the country looks at its election and voting rules, the background has been set for partisan politics of the highest order.

With this backdrop, legislation is being drafted to rewrite election laws. These steps could disproportionately impact minority communities. According to the New York City-based Brennan Center for Justice, as of Feb. 19, 2021, there are 253 bills with provisions that could restrict voting access pending in 43 states. More than a quarter of these voting and election bills address absentee voting procedures.

The legislation restricting voting includes creating stricter voter ID requirements, creating additional restrictions on voter registration, prohibiting the harvesting of ballots where a third party collects and delivers absentee ballots to the Board of Elections, reducing some opportunities to vote early, barring felons from voting, and reducing the number of polls. Some state legislatures are expected to re-draw legislative districts which could also have the effect of diluting voting power and representation of specific groups.

The Nation’s Long History of Absentee Voting

During the 2020 Presidential election, there were more than 50 challenges claiming electoral fraud and irregularities in absentee voting were made in various courts, but most not upheld. This method of voting has been around for hundreds of years, though it is more actively used today. In the past one had to attest to their physical inability to go to the poll or that they would be away from home on election day.

According to Becca Damanta, senior research associate of the Washington, DC-based Constitutional Accountability Center, a progressive think tank, the earliest record of absentee voting occurred in Dec. 1775 when a group of soldiers from the Continental Armory sent a letter to their town asking to absentee vote in a local election. At a meeting, the town agreed to count these votes “as if the men were present themselves,” says Damanta. Pennsylvania allowed soldiers to absentee vote during the War of 1812 but this law would be declared unconstitutional in 1862. She noted that New Jersey had a similar law dating back to 1815, but this law was repealed in 1820.

Damanta stated that the first major use of absentee ballots occurred during the Civil War when Wisconsin, before the 1862 midterm elections, enacted legislation to allow armory officers to conduct the vote in their camps and then forward the ballots to the governor and Secretary of State.

“By the 1864 presidential election, 19 Northern states had legislation allowing soldiers to vote away from home, either through polling places in the field or by mailing ballots home. Some soldiers were also allowed to vote by proxy whereby a soldier designated someone at home to cast his vote. By the time the election had concluded, about 150,000 of the 1 million Union soldiers voted absentee.

Damanta added: “After the Civil War ended, the states gradually passed new laws to expand absentee voting to civilians. Between 1911 and 1924, 45 of the 48 states adopted some kind of absentee voting. In some cases, these laws required voters to have a specific reason or excuse to vote absentee, such as travel or illness. Today, registered voters can vote absentee in all 50 states, though 16 states still required a documented ‘excuse’ to do so.”

The Importance of Casting a Vote by Absentee Ballot for Seniors

In a March 2021 issue brief, “The Importance of Mail-in Ballots to Seniors,” the Washington, DC-based National Committee to Preserve Social Security and Medicare (NCPSSM), noted that just before the COVID-19 pandemic, “five states were already holding entirely mail-in elections — Colorado, Hawaii, Oregon, Washington and Utah. Twenty-nine states and Washington, D.C., allowed ‘no excuse’ mail-in absentee voting. Sixteen states allowed voters to cast a ballot by mail if they had an excuse. In the 2016 presidential election, about one in four voters cast their votes via ballots mailed to them.”

According to NCPSSM, seniors like the ease and comfort of vote-by-mail. “Those who are immobile or sick can request mail ballots, as can those who cannot drive or lack access to mass transit. Mail ballots represent a way for those individuals to exercise their rights at election time in a convenient way, with over 60% of seniors age 65 and older living in states which currently use all mail-in voting systems support moving all elections to mail-in voting,” says NCPSSM’s issue brief. 41% of voters age 50-64 and 55% of voters over age 65 voted by mail in the 2020 election.

While some lawmakers alleged widespread absentee ballot fraud in the president 20020 election, NCPSSM cited studies that found vote-by-mail to be consistently free of fraud. “A Massachusetts Institute of Technology study says it found only 0.00006% of 250 million votes by mailed ballots nationwide were fraudulent. Additionally, scholars at Stanford University analyzing 1996-2018 data in California, Utah, Washington found vote-by-mail did not advantage one political party over another, noted NCPSSM.

In 2020, NCCPSM noted that many seniors took advantage of the easier voting when staying safe during the pandemic was a competing, if not greater concern. Voting-by-mail seemed destined to become a convenient choice liked by many, regardless of the inability to call close races on election night, with some races going to lengthy counts of ballots in boxes stored in a variety of locations. This election year was the most unusual ever, and standards were developed quickly in the year where a pandemic and presidential election were occurring simultaneously. It’s clear that if these practices are to become permanent, details should be shored up for security and confidence purposes.

At press time, while GOP-controlled state legislatures move to restrict voting on vote-by mail procedures, it becomes even more important now to be sure that while the security of the vote is shored up, the constitutional right to vote is not impeded – especially for the housebound, the frail, and the elderly.

Georgia Gov. Brian Kemp, signed S.B. 202, a 96-page bill that would shorten timelines, drop box restrictions, make it easier for state officials to have control of local election boards, ban third-party groups from sending absentee-ballot applications to voters, end the use of portable polling sites, and requiring a either a driver’s license or state ID or a photo copy of their identification to cast a mail in ballot. Water could still be available in a self-serve table, but no longer would be able to be given out by volunteers representing one candidate or another.  

After passage on March 25, Gov. Kemp stated, “I knew, like so many of you, that significant reforms to our elections were needed.”  He stated, “Georgia will take a step ensuring our elections are secure, accessible and fair. Republicans defend the law saying that it will preserve the state’s election integrity and root out election fraud. Some voting rights advocates view Georgia’s new law as a GOP attempt to influence an election by suppressing voter turnout, particularly from minorities. Stacey Abrams, founder of Fair Fight Action, stated, “Now, more than ever, Americans must demand federal action to protect voting rights as we continue to fight against these blatantly unconstitutional efforts that are nothing less than Jim Crow 2.0.” The Jim Crow comment has become a Democratic speaking point as it was later repeated by President Biden when referencing voter ballot changes.

Now, attention turns to Washington, DC to block GOP efforts to restrict voting in states by the passage of bills in state legislatures. The House recently passed H.R. 1, “For the People Act of 2021,” considered to be the largest overhaul of U.S. election law in a generation. The House proposal, now being considered by the Senate, can block state houses from taking steps seen as taking away the voting rights of their residents. Their legislative proposal contains a set of national mail-in voting standards, guaranteeing no-excuse mail-in voting. The act requires states to give every voter the option to vote by mail, calls for prepaid postage for all election materials and state-provided drop boxes for federal races.

Currently, 60 votes are needed to pass H.R.1’s Senate companion measure. President Joe Biden has indicated that he would support a change of current Senate rules to allow H.R.1 to pass by eliminating the filibuster that would reduce the number of votes for this legislation to pass. 

Stay tuned….