Tag Archives for AARP Rhode Island

Rethinking Rhode Island’s LTC Delivery System

Published in the Woonsocket Call on April 12, 2015

AARP Rhode Island releases a state-specific analysis, of the 2014 edition of “Raising Expectations: A State Scorecard on Long-Term Services and Supports (LTSS) for Older Adults, People with Physical Disabilities, and Family Caregivers” that just might give state officials cause for concern, a low rating on its long-term care delivery system, when compared to other states.

The 2011 Scorecard was the first multidimensional assessment of state performance of LTSS. Like this earlier version, the release of the 109 page 2014 report, referred to as the LTSS Scorecard, and its state-specific analysis (prepared by policy consultant Maureen Maigret), measuring how well the nation and each of the states is doing in providing long-term care services, does not bode well for the nation’s littlest state. It finds the Ocean State ranks 38th nationally on 26 performance indicators, with it achieving the lowest rank of all New England States.

“Our analysis provides a closer look at where Rhode Island is keeping pace and where we fall short,” said AARP State Director Kathleen Connell. “The report indicates that, as the state with the highest percentage of persons 85 and older, we face exceptional challenges. It is our hope that the General Assembly and state policymakers find the analysis to be a valuable tool,” she says.

Failing Grades

The 2014 LTTS Scorecard indicates that Rhode Island:

• Ranks 4th highest among states in nursing home residents per 1,000 persons age 65 and over

• Has a high percent of low-care nursing home residents and spends a far higher percent of its LTSS dollars than the national average on nursing home care as opposed to home and community-based services.

• Has some of the highest long-term care cost burdens in the country making private pay long-term services unaffordable for the vast majority of older households.
But, on a positive note, the state-specific analysis noted that Rhode Island’s best progress was made in the Legal and System Supports dimension largely due to the 2013 passage of the Temporary Caregiver Insurance program and Caregiver Assessment requirements for Medicaid Home and Community Based Services (HCBS).

In addition, to revisiting the 19 recommendations made following the release of AARP’s 2011 Scorecard, the more recent 2014 analysis recommends five new major policy initiates to improve the littlest state’s LTSS. Among the recommendations: funding of an Aging and Disability Resource Center; the developing an online benefits screening tool to allow access to income-assistance benefits and conducting outreach programs to increase participation; reviewing the Rhode Island’s Nurse Practice Act to allow nurse delegation of certain health maintenance and nursing tasks to direct care workers; requiring hospitals to provide education and instruction to family caregivers regarding nursing care needs when a patient is being discharged; and exploring emerging medical technologies to better serve home and community based clients.

The current analysis finds that only four recommendations out of the 2011 recommendations have been implemented, most notably those to promote coordination of primary, acute and long-term care and to strengthen family caregiver supports.

Meanwhile, only six recommendations were partially implemented, including the expansion of the home and community co-pay program and authority (but not implementation) under the 1115 Medicaid waiver renewal to provide expedited eligibility for Medicaid HCBS and for a limited increase in the monthly maintenance allowance for persons on Medicaid HCBS who transition out of nursing homes. Finally, nine recommendations, although still relevant, have not been implemented.

Response and Comments

Responding to the release of AARP’s 2014 Scorecard and state-wide analysis, Governor Gina Raimondo says, “we need to ensure that we have a strong system of nursing home care for those who truly need those services, but we must invest our Medicaid dollars more wisely to support better outcomes. We cannot continue to have the fourth highest costs for nursing home care (as a percent of median income of older households) and also rank near the bottom of all states in investments in home and community-based care.”

According to Raimondo, the state’s Working Group to Reinvent Medicaid is looking closely at AARP’s Scorecard and state-specific analysis and Rhode Island’s spending on nursing home and long-term care. Health & Human Services Secretary Elizabeth Roberts has directed her staff to look directly at the proposals recommended by AARP Rhode Island.

“I expect the Working Group will include specific proposals stemming from these findings in their April budget recommendations and their long-term strategic report they will complete in July,” says the Governor.

AARP Rhode Island Executive Director Connell, representing over 130,000 Rhode Island members, was not at all surprised by the findings of the recently released 2014 Scorecard. “Based on benchmarks set in the 2011 Scorecard, it was apparent that there was much work to do,” she says, recognizing that there are “limited quick fixes.”

“Some steps in the right direction will not lead to an immediate shift in the data. This is a big ship we’re trying to steer on a better course. We were encouraged, however, by ‘improving’ grades for lower home-care costs and the percentage of adults with disabilities ‘usually or always’ getting needed support rising from 64 percent to 73 percent,” adds Connell.

Connell says that the Rhode Island General Assembly is considering legislation to improve the delivery of care, which might just improve the state’s future AARP ‘report’ cards.” “In this session, there is an opportunity to improve long-term supports and services with passage of several bills, including one that would provide population-based funding for senior centers,” she says, stressing that it’s a “responsible investment that will help cities and towns provide better services.”

Connell adds, “The proposed CARE Act gives caregivers better instruction and guidance when patients are discharged and returned to their homes. This can be a cost saver because it can reduce the number of patients returned for treatment or care.”

The larger mission for state leaders is the so-called ‘re-balancing’ of costs from nursing care to home to community-based care. That’s where real savings can occur and home is where most people would prefer to be anyway.”

Finally, Virginia Burke, Executive Director of the Rhode Island Health Care Association, a nursing facility advocacy groups, supports the implementation of the policy initiatives recommended by AARP’s state-specific analysis. But, “The primary driver of our state’s nursing facility use is the extremely advanced age of our elders,” Burke says, noting that the need for nursing facility care is more than triple for those aged 85 and older than for seniors just a decade younger. Due to the state’s demographics you probably won’t see a change of use even if you put more funding into community based home services, she adds.

Governor Gina Raimondo and the General Assembly leadership will most certainly find it challenging to show more improvement by the time the next Scorecard ranks the states. Older Rhode Islanders deserve to have access to a seamless system, taking care of your specific needs. Creative thinking, cutting waste and beefing up programs to keeping people in their homes as long as can happen might just be the first steps to be taken. But, the state must not turn its back on nursing facility care, especially for those who need that level of service.

Herb Weiss, LRI ’12 is a Pawtucket writer who covers aging, health care and medical issues. He can be reached at hweissri@aol.com.

Protecting Retirement Savings Should Be a Priority

Published on March 7, 2015 in the Pawtucket Times

Last month, President Obama used his presidential bully pulpit to publicly support a proposed U.S. Department of Labor (DOL) rule, endorsed by a coalition of aging, labor and consumer groups, that reportedly limits conflicts of interest, increases accountability, and strengthens protection for Americans receiving retirement investment advice.

At the February 23 press conference held at the Washington, D.C.-based AARP headquarters, attended by Obama, Save Our Retirement Coalition members and lawmakers, the President called for the issuing of the proposed rule, still awaiting Office of Management and Budget (OMB) review and final DOL action. The updating of DOL rules and requirements would require higher standards for financial advisors, requiring them to act solely in their client’s best interest when giving financial advice, said Obama.

The Save Our Retirement Coalition says that the final rule is “needed to help protect Americans’ hard earned retirement savings from advisers who recommend investments based on their own interest – such as those that pay generous commissions – not because they serve their clients’ best interest.”

Existing Rules Outdated

In his remarks at AARP, Obama called the rules governing retirement investments written over 40 years ago “outdated,” filled with “legal loopholes,” and just “fine print,” needing an overhaul.  The existing rules governing retirement investments were written “at a time when most workers with a retirement plan had traditional pensions, and IRAs were brand new, and 401ks didn’t even exist,” the President explained.

At the event, Secretary of Labor Thomas E. Perez., claimed that his agency has substantially reached out to “a wide range of stakeholders,” to craft the proposed rule that was sent to OMB.  “The input we have received to date has been invaluable, but we’re not even close to being done. We have a lot more listening to do, and once the Notice of Proposed Rule Making is published in the coming months, I look forward to hearing from as many stakeholders as I can. We’re going to get this right, because the strength of the middle class depends on a secure retirement,” he says.

“We know the people we represent have worked hard to save for retirement, and we believe that they deserve to have financial advisers who work just as hard to protect what they’ve earned,” said AARP CEO Jo Ann Jenkins, in her remarks.  AARP is a member of the Save Our Retirement Coalition.

“AARP, a major consumer advocate, has been fought for this consumer regulation for over five years to ensure that Americans of all ages get the best financial advice when planning for their retirement,” says Jenkins. “Recently AARP also found that 9 out of 10 employers who sponsor retirement savings plans support holding advice to such a ‘best interest’ standard,” she adds. .

“In today’s world, it’s hard enough to save for retirement and achieve your financial goals” added Jenkins. “We don’t need to make it more difficult by allowing some on Wall Street to take advantage of hard-working Americans. Bad financial advice is just wrong,” she says.

According to Save Our Retirement Coalition, “the need for the proposed rule was made starkly apparent in a White House report released showing that conflicts of interest are costing middle class families and billions of dollars annually. The 30 page report, released last month, details the current regulatory environment for financial planners, providing evidence on the negative financial impact of conflicted professional investment advice draining older American’s retirement saving accounts.

The White House report, issued by Council of Economic Advisors, cited evidence pulled from the literature, showing that “conflicted advice reduces investment returns by roughly 1 percentage point for savers receiving that advice” The report also found that “a retiree who receives conflicted advice when rolling over a 401 (k) balance to an IRA at retirement will lose an estimated 12 percent of the value of his or her savings if drawn down over 30 years.  For those receiving conflicted advice “takes withdrawals at the rate possible absent conflicted advice, his or her savings would run out more than 5 years earlier.”

Holding Wall Street Accountable

“Many investment professionals do what’s right,” said AARP Rhode Island State Director Kathleen Connell. ”But loopholes in the law are allowing some on Wall Street  to take advantage of hard-working Americans, recommending investments with higher fees, riskier investments, and lower returns to make even higher profits for themselves. Last year alone, hidden fees, unfair risk and bad investment advice robbed Americans of as much as $17 billion,” she states.

“AARP agrees that financial professionals of all types serve a valuable role in building the wealth and security of the investing public,” added Connell. “We simply want to achieve some consistency in the standards across the industry. Here is Rhode Island, many retirees are very concerned about their investment savings and they deserve protection. Our position is that retirement accounts managed by a broker should receive the same protections as regular investment accounts held with an advisor,” she says.

“Rhode Islanders have who have worked hard for their money and deserve a new standard that holds Wall Street genuinely accountable for helping them choose the best investments for themselves, their family and their future,” she adds.

Security Trade Group Concern

             The Securities Industry and Financial Markets Association (SIFMA), a trade group representing securities firms, banks and asset management companies, is waiting to see the details of the proposed rule.  SIFMA CEO Kenneth E. Bentsen, Jr., stated: “While we cannot comment on a proposal we have not yet seen, we have ongoing concerns that the DOL regulation could adversely affect retirement savers, particularly middle class workers.  The new regulation could limit investor choice, cause inconsistencies as different regulators would apply different standards to the same regulatory accounts, prohibit guidance, and raise the costs of savings for retirement.”

But, both Obama and the Save Our Retirement Coalition strongly disagree with SIFMA’s assessment of the potential impact of DOL’s proposed rule, which has not yet been issued and is ultimately subject to change after the public comment period.

A large majority of financial planners put their clients first when giving them investment advice. But, as you know a few bad apples can truly spoil the barrel.  If trade groups representing financial planners fail to act to rein in financial planners who give conflicted advice to pad their pockets, than federal regulations can quickly do that job by applying “simple, commonsense standards.”

It makes practical and political sense to me.

Here is a linked to President Obama’s comments at the AARP Press Conference: http://www.whitehouse.gov/photos-and-video/video/2015/02/23/president-obama-speaks-aarp.

Herb Weiss, LRI ’12 is a Pawtucket-based writer who covers aging, health care and medical issues.  He can be reached at hweissri@aol.com . Or call 401/ 742-5372.

Local Filmmaker Documents Innovative Hunger Project in Maine

Published in Pawtucket Times, January 3, 2015

Last July, long-time Rhode Island resident, John Martin, who filmed the 2013 web-based hunger documentary, “Hungry in the West End,” packed his bags and equipment to head off to rural Northern Maine. Martin, an AARP award-winning AARP filmmaker and AARP’s Communication’s Director, began filming a new short film to put a spotlight on the work of Dale Flewelling, to feed Maine’s hungry. The life-long resident of Houlton in Aroostook County, who founded the of Friends of Aroostock, a nonprofit agency, has worked for nearly seven years to provide fresh locally grown produce and emergency winter fire wood to low-income families throughout Aroostook County.

Maine AARP’s commissioned short film on Flewelling’s efforts, titled “With Friends Like These: Dale Flewelling & Friends of Aroostook,” profiles the retired businessman’s “passionate and charming crusade” to enlist friends, volunteers, leaders and businesses to help seniors in Aroostook and Washington Counties suffering daily from food insecurity.

After watching Martin’s short film (just over 11 minutes), it gives a simple message. By bringing together the community and working together we can put nutritious, fresh food on the tables of the nation’s needy. Creative ways of growing food, like at Aroostock’s farm, should be organized on farms throughout Rhode Island and the nation.

Yes, in hard times getting your hands dirty (by harvesting crops) rather than complaining may well be a simple solution to reducing hunger in America.

Stars Fall in Alignment

Looking back, Martin says, “Some things seem meant to be. There was a last-minute cancellation by a videographer who had been hired to shoot the film for our Maine State Office. In a bind, they turned to me, based on my, “Hungry in the West End,” he says.

Martin, a former Providence Journal reporter, says, “This was a dream assignment. The location was gorgeous. Overnight rained stopped right on cue. People were doing things more than talking about things, which is a lot better way of telling a story. I chose to follow Dale around during part of the day rather than sit him down for an interview. He is not big on sitting and, so, that may have been the best decision I made. And at the end of the day he insisted on loading me up with green beans, Maine potatoes dug that very afternoon, tomatoes and zucchini. How good is that?”

According to Martin, first impression of the town of Houlton was that of a community hit hard by the nation’s recent recession. “Last summer, no one was talking much about an economic recovery there,” he remembers. After an overnight stay at a trucker’s motel, Martin began his filming at Aroostook Farm at 5:30 a.m. “I was pretty shocked to see volunteers already at work picking string beans,” he says.

Martin notes that Flewelling is as charming in real life as he comes across in the film, observing that his work has added tremendous meaning to his retirement.

“It only occurred to me recently that I thought I was making a hunger film, but as far as AARP is concerned, it also is a great example of Life Reimagined – AARP’s resource for making life decisions, adapting to change and developing next-chapter careers,” says Martin, adding that Flewelling “personifies the benefits of identifying your “what next” opportunity and pursuing a dream.”
“He is so connected to the earth and growing food. You have to give him credit for finding a great place to focus his energy in his life after running a business,” states Marin.

“Also, for me the day at Aroostook revealed the great need the community faces,” Martin added. “In contrast to the urban poverty that frames the issue in the West End of Providence, here you find people who lived well for generations in rural Maine who are increasingly unable to meet their monthly expenses based on little or no personal savings and sometimes minimal Social Security benefits”.

But either way, these seniors are worried about outliving their resources, he says.

We Can Be Part of the Solution

“My conclusion after spending six months reporting in the West End [in Providence] was that government can do only so much; non-profits are helping as best they; but volunteers can make a huge difference. I hope that both Hungry in the West End and With Friends Like These sparks recognition that when you volunteer to help feed struggling seniors, the feeling you get back is a tremendous reward. We all can be part of the solution. And younger people, especially, need to pay it forward because some day they may be the ones needing help,” says Martin.

Dale Flewelling, executive director of the Friends of Aroostook, says “Generally speaking, a young organization such as Friends of Aroostook has to make a decision whether to utilize financial resources to build capacity or spend money on publicity and awareness. Like many, if not most, we choose to build capacity. To have John travel all the way from Rhode Island to Northern Maine and committing many hours and his talents to produce this film is almost overwhelming.“

“Words can’t describe the benefit this film brings to our programs. Friends of Aroostook and the hungry we serve own a heartfelt thank you to John, AARP Maine State Director Lori Parham and everyone at AARP who address the hunger needs within our less fortunate population, adds Flewelling, noting that this problem “is not going away. “But as you can see, people can make a big difference. So the film means a lot.”

Getting People Involved

“One of the results of Dale’s work at Aroostook Farm is that people see him in action out in the fields and better understand both the importance of the work and Dale’s ability to get people involved,” says Lori Parham, State Director, AARP Maine:

Parham says actually seeing people work the farm land makes it far “less intimidating” for those who might be reluctant to seek out or ask for help. “As the film shows, the neediest seniors are actually helping others – they pick a bag for themselves, and then pick a bag for someone else. We knew that capturing these images and sentiments in a short video would be a great way to illustrate Dale’s efforts to relieve hunger in Maine,” she says..

“John knows a lot about senior hunger and he is a great visual storyteller. We hope that the film inspires people from across Maine and other parts of the country to join in similar movements to engage entire communities and create a shared resource that, quite literally, can grow from season to season, notes Parham.

To watch, “With Friends Like These,” go to http://states.aarp.org/category/rhode-island/.

Herb Weiss, LRI ’12, is a Pawtucket-based writer covering Aging, Health Care and Medical issues. He can be reached at hweissri@aol.com.