One Year Later – Two Surveys Examine Impact of COVID-19

Published in RINewsToday on May24, 2021

Over the year the raging pandemic has impacted on the physical and mental health of Americans. With daily COVID case counts now the lowest since last year and hospitals seeing less coronavirus hospitalizations, most states, including Rhode Island, are now opening up.

According to the American Psychological Association’s (APA) latest Stress in AmericaTM poll (findings released on March 11, 2021), the nation’s health crisis is far from over. Just one year after the World Health Organization declared COVID-19 a global pandemic, many adults report increased negative behaviors, such as undesired changes to their weight and increased drinking, that may be related to their inability to cope with prolonged stress.

APA’s survey of U.S. adults, conducted in late February 2021 by The Harris Poll, shows that a majority of adults (61 percent) experienced undesired weight changes—weight gain or loss—since the pandemic started, with 42 percent reporting they gained more weight than they intended. Of these individuals, they gained an average of 29 pounds (the median amount gained was 15 pounds) and 10 percent stated they gained more than 50 pounds, noted the poll’s findings.

Gaining Weight Bad for Your Health

Weight changes come with significant health risks, including higher vulnerability to serious illness from COVID-19.  According to the National Institute of Health, people who gain more than 11 pounds are at higher risk of developing Type II diabetes mellitus and coronary heart disease, and people who gain more than 24 pounds are at higher risk of developing ischemic stroke. 

For the 18 percent of Americans who said they lost more weight than they wanted to, the average amount of weight lost was 26 pounds (median amount lost was 12 pounds). Adult respondents also reported unwanted changes in sleep patterns and increased alcohol consumption. Two in 3 (67 percent) said they have been sleeping more or less than desired since the pandemic started. Nearly 1 in 4 adults (or 23 percent) reported drinking more alcohol to cope with their stress.

“We’ve been concerned throughout this pandemic about the level of prolonged stress, exacerbated by the grief, trauma and isolation that Americans are experiencing. This survey reveals a secondary crisis that is likely to have persistent, serious mental and physical health consequences for years to come,” said Arthur C. Evans Jr, PhD, APA’s chief executive officer, in a March 21st statement announcing the results of the study’s findings. 

Evans calls on health and policy leaders to come together quickly to provide additional behavioral health supports as part of any national recovery plan.

The researchers found that the pandemic took a particularly heavy toll on parents of children under 18-years old. While slightly more than 3 in 10 adults (31 percent) reported their mental health has worsened compared with before the pandemic, nearly half of mothers who still have children home for remote learning (47 percent) say that their mental health has worsened; 30 percent of the fathers who still have children home said the same. 

APA’s study also found that parents were more likely than those without children to have received treatment from a mental health professional (32 percent vs. 12 percent) and to have been diagnosed with a mental health disorder since the coronavirus pandemic began (24 percent vs. 9 percent). More than half of fathers (55 percent) reported gaining weight, and nearly half (48 percent) said they are drinking more alcohol to cope with stress.

As to essential workers, (either persons working in health care or law enforcement), the majority said that they relied on a lot of unhealthy habits to get through the year-long pandemic. Nearly 3 in 10 (29 percent said their mental health has worsened, while 3 in 4 (75 percent) said they could have used more emotional support than they received since the pandemic began. Essential workers were more than twice as likely as adults who were not essential workers to have received treatment from a mental health professional (34 percent vs. 12 percent) and to have been diagnosed with a mental health disorder since the coronavirus pandemic started (25 percent vs. 9 percent).

Furthermore, people of color noted that unintended physical changes occurred during the pandemic. Hispanic adults were most likely to report undesired changes to sleep (78 percent Hispanic vs. 76 percent Black, 63 percent white and 61 percent Asian), physical activity levels (87 percent Hispanic vs. 84 percent Black, 81 percent Asian and 79 percent white) and weight (71 percent Hispanic vs. 64 percent Black, 58 percent white and 54 percent Asian) since the beginning of the pandemic.

Black Americans were most likely to report feelings of concern about the future, say the researchers, noting that more than half said they do not feel comfortable going back to living life like they used to before the pandemic (54 percent Black vs. 48 percent Hispanic, 45 percent Asian and 44 percent white).  They also feel uneasy about adjusting to in-person interaction once the pandemic ends (57 percent Black vs. 51 percent Asian, 50 percent Hispanic and 47 percent white).

“It’s clear that the pandemic is continuing to have a disproportionate effect on certain groups,” said APA President Jennifer Kelly, PhD. “We must do more to support communities of color, essential workers and parents as they continue to cope with the demands of the pandemic and start to show the physical consequences of prolonged stress,” says Kelly.

COVID-19’s Impact on Seniors

A newly released AARP study, released on May 10, 2021, has found that more than a year into the coronavirus pandemic, most adults age 50 and older say that it has had a negative impact on their mental health. Researchers found that seven in 10 older adults reported an increase in sadness or depression due to the COVID-19 pandemic, and nearly 8 in 10 said they had increased concern about the future, worry or anxiety. Half of adults 50 and older reported feelings of anxiety in the last two weeks, and 56% noted difficulties falling asleep or staying asleep, say the study’s findings.

“If you are feeling stressed and anxious after the last year, you are far from alone!” said Alison Bryant, Senior Vice President of Research at AARP in a statement announcing the survey results. “As our survey highlights, most older adults’ mental health and wellbeing was affected by the pandemic—and some of the ways we coped might not have been great for our health, either. With many communities returning to normal, we hope older adults will consider taking steps to reclaim their health this spring and summer,” she said.

Coping with the COVID-19 pandemic

According to the AARP study findings, seniors are responding to the increased stress in a variety of ways. About one in four of the respondents reported they are eating comfort foods or “unhealthy foods” like chips and candy more often than before the pandemic. And 27 percent of people 50 and over have increased the time they spend praying or meditating. One in 10 survey respondents reported seeking mental health care in the last year, a third of whom did so specifically because of the pandemic. Overall, 15 percent of older adults said that experiencing the pandemic made them more likely to seek help from a mental health provider if they had concerns.

AARP’s survey also highlighted how the pandemic increased loneliness and isolation among those age 50 and over.  Among older adults, 58 percent reported feeling increased loneliness, and 62 percent were less likely to socialize with friends and family compared to before the pandemic.

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.