It’s time. Staff vaccinations required for nursing homes as 10 RI facilities see new COVID cases

Published in Rhode Island News Today on August 24, 2021

With the COVID-19 Delta variant spiking across the country especially among the unvaccinated, last Wednesday, President Joe Biden announced at an afternoon address at the White House that the U.S. Department of Health and Human Services will require nursing homes to require all workers to be fully vaccinated against COVID-19 as a condition for those facilities to continue receiving federal Medicare and Medicaid funding.

According to federal data, of the 1.6 million nursing home workers across the  nation, about 540,000 — 40 percent of the work force — are unvaccinated.  

Since the spread of the Delta variant, there has been a rise in the number of COVID-19 cases, especially in those states that have low rates of vaccinated workers. Both the U.S. Centers for Disease Control and Prevention (CDC) and Centers for Medicare & Medicaid Services (CMS) data confirm a strong relationship between the increase of COVID-19 cases among nursing home residents and the rate of vaccination among nursing home workers.

These new emergency federal regulations, crafted  by CDC and CMS, would apply to nearly 15,000 nursing home facilities, which employ approximately 1.6 million workers and serve approximately 1.3 million nursing home residents.

Rhode Island Gov. Dan J. McKee, along with other states, has already taken a similar step to protect nursing home residents by requiring all staff to be vaccinated and the new federal mandate will ensure consistent and equitable standards throughout the country. 

At a COVID-19 update held at the state the state capitol in early August, McKee called for the new vaccine mandate (as a term of employment) to take effect on Oct. 1st.

On August 23rd, Pfizer’s vaccine was fully approved by the FDA. Approvals of Moderna, Johnson & Johnson and booster shots are expected to follow soon.

According to CMS, the new mandate is a key component of protecting the health and safety of nursing home residents and staff by ensuring that all nursing home staff receive COVID-19 vaccinations. Over the past several months, millions of vaccinations have been administered to nursing home residents and staff, and these vaccines have shown to help prevent COVID-19 and have proven to be effective against the Delta variant.

“Keeping nursing home residents and staff safe is our priority. The data are clear that higher levels of staff vaccination are linked to fewer outbreaks among residents, many of whom are at an increased risk of infection, hospitalization, or death,” said CMS Administrator Chiquita Brooks-LaSure in a statement announcing the new vaccine mandate.  “We will continue to work closely with our partners at the CDC, long-term care associations, unions, and other stakeholders to advance policies that keep residents and staff safe. As we advance these new requirements, we’ll work with nursing homes to address staff and resident concerns with compassion and by following the science,” she said.

CMS says that it’s requiring all nursing home staff to be vaccinated is in keeping with the federal agency’s authority to establish requirements to ensure the health and safety of individuals receiving care from all providers and suppliers participating in the Medicare and Medicaid programs. About 62% of nursing home staff are currently vaccinated as of August 8 nationally, and vaccination among staff at the state level ranges from a high of 88% to a low of 44%. The emergence of the Delta variant in the United States has driven a rise in cases among nursing home residents from a low of 319 cases on June 27, to 2,696 cases on August 8, with many of the recent outbreaks occurring in facilities located in areas of the United States with the lowest staff vaccination rates.

Last May, CMS issued new regulations that require Long-Term Care (LTC) facilities and Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICFs/IID) to educate residents, clients, and staff about COVID-19 vaccination and, when available, offer a COVID-19 vaccine to these individuals. These regulations also mandate that LTC facilities report weekly COVID-19 vaccination data for residents and staff to the CDC’s National Healthcare Safety Network (NHSN).

CMS will continue to analyze vaccination data for residents and staff from the CDC’s National Healthcare Safety Network (NHSN) data as an additional method of compliance monitoring and in keeping with current practice, as well as deploy the Quality Improvement Organizations (QIOs)—operated under the Medicare Quality Improvement Program—to educate and engage nursing homes with low rates of vaccinations.

CMS strongly encourages nursing home residents and staff members to get vaccinated as the Agency undergoes the necessary steps in the rule-making process over the course of the next several weeks. CMS expects nursing home operators to act in the best interest of residents and their staff by complying with these new rules, which the Agency expects to issue next month.  CMS also expects nursing home operators to use all available resources to support employees in getting vaccinated, including employee education and vaccination clinics, as they work to meet this staff vaccination requirement.

Rhode Island Long Term Care Facilities with new cases in the last 14 days (as of 8/14/2020):

These RI nursing homes are on the RI Dept. of Health list with increased cases –

Alpine – Coventry – 5-9 cases

Avalone – Warwick – less than 5

St. Antoine – North Smithfield – less than 5

Woonsocket Health – Woonsocket – less than 5

All America Assisted Living – Warwick – less than 5

Anchor Bay – Johnston – less than 5

Smithfield Woods – Smithfield – less than 5

Sunrise House – Providence – less than 5

Bridge at Cherry Hill – Johnston – 5-9

Tockwotton – Providence – less than 5

AARP Strongly Supports Biden’s Vaccine Mandate in Nursing Homes 

In response to the Biden Administration directing all nursing homes that receive Medicare or Medicaid funds to require vaccinations for all staff, Nancy A. LeaMond, AARP Executive Vice President and Chief Advocacy & Engagement Officer, stated:  

“The Administration’s announcement today requiring vaccinations for nursing home staff is a significant step in the fight against this pandemic. Around 30% of COVID deaths have been among residents and staff in nursing homes and other long-term care facilities, even though they represent less than 1% of the population. As the new variants are emerging, facilities cannot let preventable problems be repeated. Increasing vaccination rates in nursing homes is one of the most common sense and powerful actions we can take to protect the lives of vulnerable older adults.”

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.

Don’t Just Single Out Nursing Homes 

“We appreciate the Administration’s efforts to increase COVID-19 vaccinations in long term care. Unfortunately, this action does not go far enough. The government should not single out one provider group for mandatory vaccinations. Vaccination mandates for health care personnel should be applied to all health care settings. Without this, nursing homes face a disastrous workforce challenge,” warns Mark Parkinson, president and CEO of the American Health Care Association and National Center for Assisted Living (AHCA/NCAL) 

“Focusing only on nursing homes will cause vaccine hesitant workers to flee to other health care providers and leave many centers without adequate staff to care for residents. It will make an already difficult workforce shortage even worse. The net effect of this action will be the opposite of its intent and will affect the ability to provide quality care to our residents. We look forward to working with the Administration in the coming days to develop solutions to overcome this challenge,” says Parkinson.

The full Nursing Home COVID-19 Dashboard is available at www.aarp.org/nursinghomedashboard. For more information on how COVID is impacting nursing homes and AARP’s advocacy on this issue, visit www.aarp.org/nursinghomes.

A Call for House Dems to Bring Back House Aging Committee

Published in RINewsToday on August 16, 2021

Just days ago, Congressman David Cicilline, along with fellow lawmakers, Jan Schakowsky (D-IL), Doris Matsui (D-CA), who serve as co-chairs of the House Democratic Caucus Task Force  on Aging and Families, introduced H. Res. 583 to amend the rules of the House to establish a House Permanent Select Committee on Aging. This is the Rhode Island lawmaker’s fourth attempt, and it might well succeed with two co-chairs of the House Caucus Task Force on Aging and Families cosponsoring the resolution.

Getting Schakowsky and Matsui on board is “very significant,” says Cicilline.  He also has the support of the prestigious Washington, D.C.-based Leadership Council on Aging Organizations (LCAO), representing 69 national aging groups.

The original House Permanent Select Committee on Aging, which was active between 1974 and 1992, conducted investigations, hearings and issues reports to inform Congress on issues related to aging, putting a legislative spotlight on the challenges and issues facing the growing aging population in America. 

H. Res. 583 would reestablish the House Aging Committee without having legislative jurisdiction, this being no different than when the permanent committee previously existed. It would be authorized to conduct a continuing comprehensive study and review of aging issues, such as income maintenance, poverty, housing, health (including medical research), welfare, employment, education, recreation, and long-term care. These efforts impacted legislation taken up by standing committees. It has been referred to the House Rules Committee for consideration.

It’s relatively simple to create an ad hoc (temporary) select committee, says the Congressional Research Service. All it takes is a simple resolution that contains language establishing the committee—giving a purpose, defining membership, and detailing other issues that need to be address.  Salaries and expenses of standing committees, special and select, are authorized through the Legislative Branch Appropriations bill.

An Urgent Time Requires Passage of H. Res. 583  

“America’s seniors have spent a lifetime working hard and moving our country forward and they deserve the best in their retirement,” says Cicilline. “The pandemic has disproportionately impacted seniors and now with growing concerns about inflation, seniors on fixed incomes will bear the burden of the rising cost of prescription drugs, food, housing, and other essentials,” he says, noting there has never been a more urgent time for Congress to reauthorize the House Permanent Select Committee on Aging than right now. 

“The pandemic magnified gaps in U.S. policy that routinely forget about Older Americans and the need to nurture a culture that respects them. From the lack of a universal long-term care policy to barriers to vaccine access earlier in the pandemic, these are issues that need to be examined so that Congress can put forward strong solutions to support our aging population and the communities they live in,” says Schakowsky. 

“Older Americans today face many difficulties—including achieving retirement security and affording the rising costs in health care and prescription drugs—which have only been worsened by the COVID-19 pandemic,” said Matsui, stressing by creating a House Aging Committee Congress can continue to strengthen and support policies that are important to seniors throughout the country. 

Supporters Call on House Resolution’s Passage 

As the Leadership Council of Aging Organizations (LCAO), the preeminent national organization representing and focused on the well-being of older adults, noted in its letter of support for reestablished the House Permanent Select Committee on Aging, “now is the opportune time to reestablish the HPSCoA. Every day, 12,000 Americans turn 60. By 2030, nearly 75 million people in the U.S.—or 20% of the country—will be age 65 or older. As America grows older, the need for support and services provided under programs like Social Security, SSI, Medicare, Medicaid and the Older Americans Act also increases.”

“We strongly support Cicilline’s legislation to re-establish the House Permanent Select Committee on Aging. This committee did crucial work on behalf of American seniors between 1974 and 1992, including investigating nursing home abuse, promoting breast cancer screening for older women, improving elderly housing, and bringing attention to elder abuse, among other issues,” says Max Richtman, president and CEO, National Committee to Preserve Social Security and Medicare, warning that “we should not wait another day to re-establish a committee dedicated to protecting America’s seniors.” 

“Cicilline is 100% right that it is time to re-establish this vital committee, with ten thousand Americans turning 65 every day, amid a pandemic that has taken a disproportionate toll on seniors.  Today, there are a new set of issues that demand the attention of a dedicated House committee — prescription drug pricing, long-term care, soaring medical costs and the future of Social Security and Medicare,” adds Richtman.

Bob Blancato who had the longest tenure of any staff on the Committee said: “First I commend Cicilline for introducing the legislation.  The timing was especially good as the release yesterday of the 2020 Census data shows a continued sharp increase in the number of older Americans in our nation.” 

“While I support this legislation it does face considerable odds to gain passage,” warns Blancato, noting that two things could change that.  “The resolution must have backing from House Leadership especially from Speaker Pelosi and it must become bipartisan as the original Committee was.  In the end it is about how do advocates make this into a political issue.  This is an opportunity for the Leadership Council of Aging Organizations to show if it has clout,” he says.

Adds, CEO Sandy Markwood, of National Association of Area Agencies on Aging: “We are a rapidly aging nation: one in five Americans will be age 65 or older within this decade. This historic demographic shift requires policymakers and the public to factor in aging and how we can age well at home and in the community into every policy conversation. For this, the House of Representatives should have a special aging committee as the Senate does: to spotlight not only older Americans, but also the impact of this massive shift on all generations, our communities and society at large. COVID-19 shone a bright spotlight on what we need to do to help older adults age well at home, but local aging leaders like n4a’s members need the House’s leadership to give aging policy the focused attention it deserves…and our demographics demand.”

According to Robert S. Weiner, a close friend and confident of House Aging Committee Chair Claude Pepper (D-Florida) who served as his committee Chief of Staff, the Special Committee was and can  again be the protector of seniors.  “Among its most significant actions — all bipartisan– were advocating and causing enactment of  the law, passed 359-2 in the House and 89-10 in the Senate, barring age based “mandatory retirement and protecting people over 40 from age discrimination,” he remembers.

“The courts are now fudging with that clear intent, and the House Aging Committee would be a visible and influential protector. Transparency by nursing homes and congregate housing settings– as mandated by laws pressed by Pepper decades ago but now ignored —  would be another benefit,” states Weiner. “In housing, health care, nutrition, crime victimization, transportation, accessibility, and social services –in the whole array of actions stopping ageism by local, state, and federal agencies and the courts, including the Supreme Court — the House Aging Committee would again be an invaluable champion for seniors,” he adds. 

“During the 117th Congress, passing H Res. 583 is also necessary to protect against under-the-radar political invasions of Social Security’s surplus — a fund paid by seniors in the program– and attempts to use the money to pay for other programs including tax cuts for the wealthy,” warns Weiner.

As a long-time Washington insider, Weiner says the best way to pass H Res 583 to reestablish the House Aging Committee is for the chief congressional advocate, Cicilline, to talk directly with the top three House leaders, Speaker Nancy Pelosi (D-CA), Majority Leader Steny Hoyer (D-MD and Whip James E. Clyburn (D-SC) and makes the case on the merits and bill’s support while asking for quick endorsement. “Looking back, “that’s how Pepper always did it – he’d pull people to a place on the floor and talk with them there, or on the phone. 

Weiner recalled how Pepper, the fierce aging advocate from Florida, called Rosalyn Carter to ask her husband, President Jimmy Carter for a meeting to discuss the mandatory retirement Carter who ultimately endorsed the bill.  It passed the House 359-2 and the Senate 89-10, being considered by Congress. Ultimately, “the full House Aging Committee (40 members) met with and there was a glorious White House signing ceremony,” he says.

A Call for House Leadership Support 

Cicilline goes into the 117th Congress with the support of long-time Congressional senior advocates, Schakowsky and Matsui and the backing of a prestigious coalition aging organizations to bring back the House Aging Committee.  It will happen this Congress if House Speaker Pelosi along with Majority Leader Hoyer and Whip Clyburn can bring the moderates and progressives of the Democratic House Caucus together to support H. Res. 583.  

Politically it’s the smart thing to do.  It’s a winning policy issue for America’s seniors and this group has traditionally been the highest turnout age group in elections.  But, more important, it’s the right thing to do especially at a time when seniors have been a disproportionately impacted by the continuing COVID-19 pandemic.    

I say pass H. Res. 583. 

AARP concerned for working caregivers. Advice from Dr. Michael Fine

Published in RINewsToday on August 9, 2021

After the coronavirus (COVID-19) pandemic initially shuttered the nation’s businesses over a year ago and with Delta variant cases now surging among the 50 percent of the population not fully vaccinated, AARP releases a 17-page report exploring the concerns of working caregivers about returning to pre-pandemic business routines. 

AARP’s national survey, examining caregiver concerns during the COVID-19 pandemic, was conducted by phone and online panel on July 1-7, 2021, and included 800 U.S. residents 18 years or older who are currently providing unpaid care to an adult relative or friend and employed either full-time or part-time (but not self-employed).

Six in ten caregivers responding to the survey were paid hourly, while nearly four in ten are salaried workers. Almost seven in ten say that their job is “essential.” 

The researchers found that the COVID-19 pandemic impacted how working caregivers balanced their work and caregiving roles. Four in five caregivers expressed feeling stressed by juggling these dual responsibilities. More than three in five of the respondents say that they were spending more time caring for their loved one(s). When asked about the next 12 months, two-thirds of all working caregivers expect some, or a great deal of, difficulty balancing both job and caregiving roles. 

According to the AARP study, “Working Caregivers’ and Desires in a Post-Pandemic Workplace,” about half of working family caregivers were offered new benefits during the pandemic, including flexible hours (65%), paid leave (34%) and mental health or self-care resources (37%). About half of those surveyed were able to telework due to COVID 19; by early July, 22% were still working from home full time and 30% were working from home at least part-time. For those who could work from home, nearly nine in 10 said it helped them balance work and care responsibilities – and 75% are worried about how they will manage when their pre-pandemic schedules resume.

“Employers would be wise to consider how benefits like paid leave and flexible hours can help the one in six workers who are also caring for a loved one,” said Alison Bryant, Senior Vice President, AARP Research in an Aug. 4 statement released announcing the release of the report. “Living through the pandemic was challenging for working family caregivers – while some were helped by new workplace benefits and flexibility, the vast majority are worried about how to balance both roles going forward. Our research opens a window into how the pandemic changed the workplace and what working caregivers are concerned about in the coming year,” says Bryant.

As offices and other in-person workplaces begin to slowly re-open, many caregivers expressed concerns that they would bring the virus home to infect loved ones (63%) or contract COVID at work (53%). About three in five are worried about leaving the person they care for alone while they go to work. Among those who were able to work at home during the pandemic, almost nine in ten would like the option to continue doing so at least some of the time. And more than four in ten caregivers said they would consider looking for a new job if the benefits they were offered during the pandemic were rolled back.

AARP offers a range of free tools and resources to help employers retain working caregivers, including tip sheets, tool kits and online training for managers. The resources are available at www.aarp.org/employercaregivin

Dr. Michael Fine: The pandemic of the unvaccinated

Don’t let your guard down, even if you’re vaccinated, warns Dr. Michael Fine, the former Rhode Island Director of the Department of Health. As the COVID-19 Delta variant cases spike across the nation, “it’s the pandemic of the unvaccinated,” he says. “Now 97% of the hospitalized are unvaccinated. As community transmission rises, it is more likely that vaccinated people will get infected and spread the virus,” he says.

Dr. Fine further responded to requests about how we should approach this latest wave of COVID in Rhode Island:

“For most vaccinated people, Covid-19 will be a mild disease,” says Fine.  For those with chronic disease like high blood pressure, diabetes, heart disease, COPD and cancer, one study from Israel suggests that the risk of hospitalization and death is equal to the unvaccinated,” he says.  

“As community transition rises, I’m expecting some hospitalizations and death in vaccinated people with chronic disease. That group would do well to self-isolate — to stay home and let others shop for them, until community transmission falls to less than 35/100,000/week. We are now a place with high transmission, about 140/100,000/week,” states Fine.

Fine urges businesses to require all employees working together to be vaccinated, wear masks and get weekly Polymerase Chain Reaction (PCR) tests for the COVID-19 virus.

Teleconferencing technology should replace onsite or outside meetings, he says.  

Working caregivers can be protected from bringing COVID-19 home by being vaccinated and should get two PCR tests a week, and limit contact with other people by avoiding shopping at stores or going to restaurants.