Older adults still worried, coping with COVID-19 Delta, poll shows

Published October 11, 2021 in RINewsToday

With the COVID-19 Delta variant numbers having surged across the nation, Joe (70) and Joyce (66), residing across the Rhode Island border in Seekonk, Massachusetts, continue to keep their distance from others, only seeing vaccinated friends and spending time with their daughter and her husband and grandchildren. During the first year of the pandemic, my friends pre-ordered their groceries and picked up the filled bags outside the store, where an employee quickly put the bags in their trunk. Now, this includes a quick 15-minute trip into the store, if necessary. They continue to not eat their meals in restaurants but will pick up their order curbside or eat outside.

Like my longtime friends, many older adults age 50 and over still remained concerned about this virus and continue to isolate themselves from others (especially those unvaccinated) and practice social distancing and wear their masks.

Still Feeling Socially Isolated

According to a newly released survey on Sept. 29, 2021, by the Associated Press-NORC Center for Public Affairs Research and funded by The SCAN Foundation, while a majority of adults age 50 or older see their quality of life, mental health, and satisfaction with social activities and relationships positively, they rarely, or never, feel socially isolated. But still, 18 months into the pandemic,1 in 3 still feel socially isolated at least sometimes. And 1 in 4 feels that their social life and relationships have gotten worse over the past year.

The poll survey includes 1,015 interviews with a nationally representative sample of adults age 50 and older living in America. Interviews were conducted between Aug. 20 and 23, 2021, via internet and phone, in English.

The research findings indicate that those older adults most worried about themselves or a loved one being infected by COVID-19 are most likely to practice social distancing, by avoiding travel, staying away from large groups of people, and wearing a mask. They are the ones most often experiencing feelings of social isolation. The researchers say that these people rate their quality of life, mental and emotional health, and social activities and relationships as worse than those less concerned about the virus.

The study’s findings indicate that being vaccinated does not provide the older persons with relief. Those who are vaccinated are more worried about infection from the virus, are more likely to practice social distancing, and are more likely to describe their mental health as worse than last year compared to those who are not vaccinated.

Touching Others Thru Video Chat and Social Media

To cope with isolation, older adults are using video chat and social media more often since the beginning of the pandemic as the frequency of activities like visiting with friends and family in person, doing volunteer work, attending religious services, and talking with neighbors have declined, the study’s findings indicate. And despite struggles with mental health and isolation, more report that their use of mental health services has declined (34%) than increased (6%).

In addition to the increasing use of technology to socialize, more older adults are using video chat, email, and other technology to receive health care remotely, say the researchers, noting that 63% have used telehealth at some point during the pandemic, up from 56% who had used it as of March 2021. Fifty-1% users expect to continue using it once the pandemic is over, too.

Still, adults age 50 and older are more optimistic than pessimistic that they will be able to fully return to their pre-pandemic activities in the next year, though 17% have already done so.

The results of The Associated Press-NORC Center for Public Affairs Research can be found in “Long-Term Care in America: Coronavirus Worries and Social Isolation among Older Adults,” released on Sept. 2021.

Nursing facilities gear up for October vaccination deadline

Published in RI News Today on September 20, 2021

Over a month ago, the U.S. Centers for Disease Control and Prevention (Centers for Disease Control and Prevention) issued a Health Alert Network (HAN) Health Advisory to public health practitioners and clinicians about the urgent need to increase COVID-19 vaccination coverage across the United States to prevent surges in new infections that could increase COVID-19 related morbidity and mortality, overwhelm health care capacity, and widen existing COVID-19-related health disparities.

According to the July 27 Health Advisory, there is growing medical evidence that the Delta variant is at least twice as contagious as the original SARS-CoV-2 virus. It is reported that most cases of COVID-19 hospitalizations and death are in unvaccinated people; however, there are breakthrough infections in vaccinated people because of the surge of infections among the unvaccinated. This is a particular concern in nursing homes, where vaccinated residents are infected by unvaccinated staff.

The Biden Administration announced plans in August to require COVID-19 vaccinations for nursing home staff as a condition for those facilities to continue receiving federal Medicare and Medicaid funding. Rhode Island Governor Daniel J. McKee, along with other states’ leadership, took similar steps to protect nursing home residents by requiring all healthcare 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 capitol in early August, McKee called for the new vaccine mandate (as a term of employment) to take effect.

COVID Cases Rise in Rhode Island Nursing  Homes

Coronavirus continues to increase in nursing homes, warns AARP Rhode Island in a statement issued on September 17. According to the latest data from AARP’s Nursing Home COVID-19 Dashboard, in the four weeks ending August 22, resident cases increasing from 0.05 to 0.34 per 100 residents and staff cases increasing from 0.11 to 0.88 per 100 residents since the mid-July report.

Nationally, cases are concentrated among the unvaccinated, and those residents were three times as likely to contract COVID-19 last month compared to residents who are fully vaccinated.

The last eight months have shown vaccines to be the most effective tool in preventing COVID-19 related deaths, says AARP Rhode Island’s statement. There were modest increases in vaccination rates during this four-week period, with 92% of Rhode Island Nursing Home residents and 76% of staff fully vaccinated as of August 22.

“This month’s dashboard underscores why all staff and residents in long-term care facilities must be vaccinated as quickly as possible,” said AARP Rhode Island State Director, Catherine Taylor. “For unvaccinated nursing home residents, their risk of an infection is back up to the levels we saw a year ago. Too many people in Rhode Island who lived and worked in nursing facilities have died from COVID-19, and no one wants to see that tragedy repeated,” said Taylor.

The AARP Nursing Home COVID-19 Dashboard also found over a 300% increase in RI nursing homes reporting an urgent need for PPE in the period ending August 22, with almost 10% of facilities in Rhode Island reporting they did not have sufficient PPE.

Nursing Facilities Struggling to Maintain Adequate Staffing

While the Rhode Island Health Care Association supports Governor McKee’s decision to mandate COVID-19 vaccinations across the health care continuum, says John E. Gage, President and CEO of the Rhode Island Health Care Association, representing 64 of the 77 nursing facilities in the Ocean State, nursing homes are struggling to maintain their staffing levels to meet the state’s direct care requirements, but many are struggling to maintain that level, he says, noting that next month’s deadline requiring nursing facility staff will further strain the already “precarious staffing crisis in the state’s nursing facilities”.

Gage noted that the state’s Department of Health has surveyed facilities this week regarding the number of staff that will be unable to enter facilities in two weeks because they are unvaccinated. “It is reported that nursing facilities will lose 7% of their workforce – 706 staff of 10,137 in the workforce across all disciplines,” says Gage, noting that 495 out of the 706 are clinical staff members.

According to Gage, “Rhode Island nursing facilities are ranked the fourth best state for resident vaccinations and fifth best state for staff vaccination rates in the country. He notes, when taking a look at the Centers for Medicare and Medicaid Services data released last week, in Rhode Island 92.65% of residents are fully vaccinated compared to 84.1% nationwide. As to staff, 78.99% of Rhode Island’s nursing facility staff are fully vaccinated compared to 63.7% nationwide.

Gage says, “The vaccine mandate will further add to the challenge of staff retention and recruitment. We are facing the implementation of a minimum staffing mandate to take effect 1/1/22. There’s not adequate staff available to hire, and the legislature did not provide for adequate funding to achieve the upcoming mandate”. 

Finally, Gage notes that while visitation is currently open at Rhode Island nursing facilities there are many factors that make it difficult to stop the spread of COVID-19 from staff to residents. “Our staff are members of each and every community in Rhode Island  They interact with others outside of work who may or may not be vaccinated, and many have children under the age of 12 who are not eligible for vaccination. To further complicate matters, there are breakthrough cases among those who are fully vaccinated, especially now with the prevalence of the Delta variant,” says Gage.

“Rhode Island facilities will continue to take all steps necessary to mitigate the risks of COVID-19 infections,” says Gage, noting that vaccinations are the key to eradicating this pandemic, together with the proper use of personal protective equipment.  

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  www.AARP.org/nursinghomedashboard, and an AARP story about this month’s data is available here. For more information on how COVID is impacting nursing homes and AARP’s advocacy on this issue, visit www.aarp.org/nursinghomes.

Tracking legislation of interest to seniors as RI General Assembly wraps up – Herb Weiss

Published in RINewsToday on June 28, 2021

 In the waning days of the 2021 legislative session, RI House lawmakers approved a $13.1 billion state budget for the 2022 fiscal year (by a party-line vote of 64 Democrats to 10 Republicans) that boosts key supports for vulnerable Rhode Islanders — particularly affordable housing and social services— without imposing any broad-based tax increases.

The budget plan also fully funds K-12 education, boosts support for higher education, restores funding to Eleanor Slater Hospital and funds a first-of-its-kind statewide program for police body cameras.  

Additionally, the budget codifies the state’s existing Livable Home Grant Program to provide subsidies (up to 50%) for certain disability and accessibility home modifications, which will enable older people to remain in their homes. The budget includes $500,000 for the Livable Home Grant Program.

At press time, the state budget moves to the Senate for consideration. Once passed by the upper Chamber and signed into law by Gov. Dan McKee, the budget covers the new fiscal year, beginning July 1.

In the Waning Days…

According to Larry Berman, the House’s Communication Director, 1,470 bills were introduced in the House and 978 in the Senate. According to the RI General Assembly’s bill tracker, less than 30 are identified as directly related to seniors.

Here is a sampling of these bills:

The Nursing Home Staffing and Quality Care Act, sponsored by Senate Majority Whip Maryellen Goodwin (D- District 1, Providence) and Rep. Scott A. Slater (D-District 10, Providence), sets minimum staffing levels for Rhode Island nursing homes and was signed into law by Gov. McKee, two days after General Assembly passage. The legislation (S 0002A, H 5012Aaa) will establish a minimum standard of 3.58 hours of resident care per day, initially, and 3.81 hours of resident care per day beginning January 1, 2023. The bill also provides funding to raise wages for direct care staff to help recruit and retain a stable and qualified workforce.

With final votes in both chambers, the General Assembly approved The Elder Adult Financial Act sponsored by Sen. Cynthia A. Coyne (D-District 32, Barrington, Bristol and East Providence) and Rep. Joseph J. Solomon, Jr. (D-District 22, Warwick). The legislation requires financial institutions to report suspected financial exploitation of seniors to the Office of Healthy Aging and authorizing them to temporarily hold transactions they suspect as such. The legislation will be sent to the governor for signature. The legislation (S 0264A, H 5642A) would require financial institutions to train employees to recognize indicators of elderly financial exploitation, and on their obligation to properly report it and place a hold on suspicious transactions. The legislation was the result of recommendations made by the Special Task Force to Study Elderly Abuse and Financial Exploitation, a group led by Sen. Coyne that met in 2018 and 2019 to explore the facets of elder abuse and make policy recommendations to address them.

Rep. Gregg Amore (D-District 65, East Providence) and Sen. Valarie J. Lawson’s (D-District 14, East Providence) legislation, The Uniform Control Substance Act, would exclude chronic intractable pain from the definition of “acute pain management” for the purposes of prescribing opioid medication has been signed into law by Gov. McKee. The legislation (H 5247A, S 0384A) calls for new guidelines for treatment of chronic intractable pain based upon the consideration of the individualized needs of patients suffering from it. The legislation acknowledges that every patient and their needs are different, especially those suffering from chronic pain. Chronic intractable pain is defined as pain that is excruciating constant, incurable, and of such severity that it dominates virtually every constant, moment. It also produces mental and physical debilitation and may produce a desire to suicide for the sole purpose of stopping the pain.

The House passed legislation sponsored by Rep. June S. Speakman (D-District 68, Warren, Bristol) to allow visitation for nursing home residents by a designated family member or caregiver during a state of emergency. Under the Rights of Nursing Home Patients legislation, an essential caregiver would be an individual—whether a family member or friend of a resident of a nursing home or long-term care facility – who is designated to provide physical or emotional support to the resident during a declaration of disaster emergency. The legislation (H 5543aa) would require the Department of Health to create rules and regulations providing for the designation of essential caregivers to provide in-person physical or emotional support to a resident of a nursing home or long-term care facility during the period of 15 days after a declaration of disaster emergency and until 60 days after the termination of the declaration. The bill would require DOH to develop rules and regulations on designating an essential caregiver and the criteria to qualify. Those rules would include health and safety regulations as well as requirements allowing an essential caregiver to have regular and sustained in-person visitation and physical access to a resident of the nursing home or long-term care facility. The bill now goes to the Senate, which on June 1st passed companion legislation (S 0006A) sponsored by introduced by Sen. Frank S. Lombardi (D-District 26, Cranston).

As part of its ongoing efforts of addressing the cost of prescription drugs, the RI Senate passed legislation that requires pharmaceutical companies to disclose drug pricing information and legislation would prohibit an annual or lifetime dollar limit on drug benefits. The first legislative proposal (S 0494A), which was introduced by Senate President Dominick J. Ruggerio (D-District 4, North Providence, Providence) would require the pharmaceutical manufacturers disclose to the Office of the Health Insurance Commissioner the wholesale acquisition costs of drugs if this cost is at least $100 for a 30-day supply. It would also require the disclosure of pharmacy benefit management information to include rebates, price protection payments and other payments that are saved by the pharmacy, health plan issuer or enrollees at the point of the drug. The second one, (S 0381A), which was introduced by Senate Majority Leader Michael J. McCaffrey (D-District 29, Warwick), would require that health plans that provide prescription drug coverage not include an annual or lifetime dollar limit on drug benefits. It would also cap out-of-pocket expenses that some consumers would be required to pay for prescription drugs.  The measures now move to the House for consideration.

The Senate also approved legislation sponsored by Sen. Melissa A. Murray (D-District 27, Woonsocket, North Smithfield) limiting insured patients’ copays for insulin used to treat diabetes to $40 for a 30-day supply. The legislation (S 0170A), which is part of the Senate’s prescription drug affordability legislative package, would apply to all insurance plans that cover insulin. Under the legislation, insurers would be required to cap the total amount that any covered person is required to pay for covered insulin at $40 for a 30-day supply, regardless of the amount or type of insulin prescribed. It also forbids that coverage from being submit to any deductible. The bill does allow insurers to charge less if they choose. The cost of insulin has risen sharply over the years, and the cost is much higher in the United States than in other countries.  Millions of Americans depend on insulin for the management of diabetes. The legislation goes to the lower chamber, where House Speaker Pro Tempore Brian Patrick Kennedy (D-District. 38, Hopkinton, Westerly) is sponsoring a companion bill (H 5196A).

Finally, the passed legislation sponsored by Sen. Valarie J. Larson (D-District 14, East Providence) would increase temporary caregiver benefits for Rhode Islanders. The bill (S 0688) increases temporary caregiver benefits to six weeks in a benefit year starting Jan. 1, 2022, and would increase temporary caregiver benefits to eight weeks in a benefit year beginning Jan. 1, 2023.Rhode Island was the third state in the nation to pass a paid family leave programs when it enacted the Temporary Caregiver Insurance program in 2013.  It provides up to four weeks of partial (about 60%) wage replacement for workers who need to take time from their jobs to care for a serious ill family member or to bond with a newborn, adopted or foster child.  The worker’s job and seniority are protected while the worker is on leave.An amended companion measure (H 6090A), sponsored by House Majority Whip Katherine S. Kazarian (D-District 63, East Providence) passes the House and now heads to the Senate for consideration.

Deputy House Republican Minority Leader, George Nardone (R-Dist. 28, Coventry, Rep. Michael Chippendale (R-Dist. 40, Coventry, Foster, and Glocester and Rep. Raymond A. Hull (R-District 6, Providence) submitted H 5547 to ensure proper, safe, and personal contact with loved ones in congregate care facilities.  The legislation addresses the COVID-19 mandates that denied access to individuals in hospitals, group homes, nursing homes, assisted living facilities and Veterans homes. The purpose of this legislation is to entitle all residents of healthcare facilities and group homes the opportunity to designate a support person for regular, in-person visits. The policy is designed to balance disease transmission protocols with the benefits of having a loved one present during a lockdown. The House Health & Human Services Committee recommended the legislation be held for further study.

Senate Minority Whip Jessica de la Cruz (R-Dist. 23, Burrillville, Glocester, North Smithfield, introduced S 644 to provide medical assistance coverage for medical services provided qualifying eligible recipients for community-based care. The Senate Health & Human Services Committee has also recommended the legislation be held for further study.

Thoughts from the Sidelines at AARP

AARP Rhode Island says they “…are thrilled that the Livable Home Modification Grant Program, which provides matching funds for needed construction to ensure that Rhode Islanders with disabilities can remain safely and comfortably at home, was included in the FY22 budget,” said AARP Rhode Island State Director Catherine Taylor. “That was the highlight of the budget for us. Codifying this program has been a major priority.

“Another important win was enactment of the Elder Adult Financial Exploitation Prevention Act. This law is an important new tool to fight for the one-in-five older Rhode Islanders who is a victim of financial exploitation, with an average loss of $120,000. AARP-RI wrote to Governor McKee urging him to sign this critical legislation and they are delighted that he has done so.  This will be a game-changer in the effort to protect the life savings of older Rhode Islanders.

“Now we have our eye on the number of prescription drug bills that we’ve been working hard on, and we’re hopeful they will see passage before the end of the session. At this time, there are four Senate-approved Rx bills that need action in the House, and we are eagerly awaiting House passage of Rep. Brian Patrick Kennedy’s insulin cap bill.

The Legislative session is expected to end by the end of next week. Stay tuned to see what legislative proposals ultimately make it to the Governor’s desk for signature.

UPDATE:

‘According to Maureen Maigret, Vice Chair of Rhode Island’s Long-Term Care Coordinating Council, a former state representative and Director of Rhode Island’s Elderly Affairs, one of the biggest wins for older adults in the budget — the expansion of the Office of Healthy Aging @Home Cost Share program to increase income eligibility from 200% of the federal poverty level to 250% and to include persons under age 65 with Alzheimer’s/dementia. “Over $2Mil in all funds was added to the budget to do this. It was promoted by legislation sponsored by Sen. Walter Felag and Rep. Joseph Solomon. An estimated 500 persons will get subsidized home care and/or adult day services with this expansion. It was a priority of the Aging in Community Subcommittee for several years,” she says. 

Maigret also notes that the budget also includes Medicaid rate increases for a number of home and community care providers designed to increase access to these options for persons needing care. “These include assisted living, adult day services, shared living and home care. Importantly, with the cost of so many basic services such as rent and food increasing it raises the amount of money a person on home care can keep to pay for living expenses before they must pay a share of the cost of the services,”

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