Tag Archives for AARP Rhode Island

Meals on Wheels Should Be Expanded

 Published in Pawtucket Times, October 25, 2013

            A warm, nutritious meal combined with social interaction can go a long way to putting the brakes to a state’s spiraling Medicaid costs.  According to new study findings detailed in this months issue of Health Affairs by Brown University public health researchers, expanding programs like Meals on Wheels, would save 26 of 48 states money in their Medicaid programs, just by allowing a person to stay in their own homes. 

            Kali Thomas, Assistant Professor of Research in the Brown University School of Public Health, says that if every U.S. state in the lower 48 expanded the number of seniors receiving meals by just 1 percent, 1,722 more Medicaid recipients avoid living in a nursing facility and most states would experience a net annual savings from implementing the expansion.

Put the Brakes to Medicaid Costs

            According to the study’s findings, Medicaid cost savings would be different in every state.  For instance, Pennsylvania would see the greatest net savings – $5.7 million – as Medicaid costs for nursing facility care decrease more than costs rose for delivering the additional meals.  Meanwhile, Florida would see a net cost of nearly $11.5 million instead. Overall, 26 states would stand to see a net savings according to the Brown University Public Health analysis, while 22 would end up spending more.

            Every state would enable more seniors, who could live independently except for meals, to remain in their homes regardless of whether they are on Medicaid.

            Thomas, the study’s lead author, believes the study’s findings can provide guidance for state lawmakers and state policymakers as they hammer out budget funding for home-delivered meals programs, which are conducted under the Older Americans Act.

            “We wanted to provide a roadmap for people,” Thomas said.

             To calculate Medicaid savings, Thomas and co-author Vincent Mor, Brown’s Florence Pirce Grant Professor of Community Health, examined data, including how many seniors in each state receive home-delivered meals and how much it costs each state to provide those meals. She and Mor also took a look at nursing facility and Medicaid data to estimate the number of seniors that Medicaid maintains in nursing facilities who are “low-care,” meaning they may have the functional capabilities to live at home. Finally they looked at the per diem Medicaid pays in each state for seniors to live in nursing facilities.

 Keeping Seniors at Home

             The study findings allowed them to estimate the incremental cost of providing meals to 1 percent more seniors in each state, the number of additional seniors on Medicaid who would no longer need to live in nursing facilities, and how much less Medicaid would have to pick up for the higher level of care in each state.

            The researchers found that the 1 percent expansion nationwide would bring meals to 392,594 more seniors at a cost of more than $117 million. Because 1,722 seniors would no longer have to live in costly nursing facilities paid for by Medicaid, total program savings would total $109 million.

            The reason why the study’s findings indicate that additional food delivery costs outstrip Medicaid savings nationwide, even though most states would save money on a net basis, is that in some very large states with relatively few low-care seniors or relatively low Medicaid per diems, food costs outweighed the resulting Medicaid savings on a relatively large scale.

            “In states like California and Florida where a 1-percent increase in the 65-plus population is a lot of people, it will cost those states a lot more to feed them,” Thomas said.

            But, as she and Mor wrote in Health Affairs, “Our analyses suggest that 26 states with high Medicaid nursing home per diem reimbursement rates, a large proportion of low-care [nursing home residents on Medicaid], and a relatively small population of older adults, could save money.”

            Thomas said states projected to lose money can opt to focus their efforts in ways that are more precise than an across-the-board expansion.

            “We’re not proposing that all states simply increase the proportion of age 65 plus receiving meals by 1 percent,” she said. “But if they were to target these vulnerable people who are at risk for nursing home placement they would likely see more savings. This is a program that has the potential to save states a lot of money if it’s done correctly.”

            Policymakers should consider not only the fiscal implications of providing home-delivered meals, which the study quantifies, but also the impact on individual seniors, said Thomas, who has seen the benefits anecdotally as a Meals on Wheels volunteer in both Florida and Rhode Island.

            Thomas’s research, detailed in this month’s issue of Health Affairs, which was completed last December, is featured in AARP Rhode Island’s award-winning documentary Hungry in the West End. Creator and director John Martin of the AARP

             Rhode Island state office screened the documentary in August at the Meals on Wheels Association of America National Conference in Boston. You can watch Hungry in the West End online at www.aarp.org/hungry.

             Although the quality of life argument is easy to see, other researchers, like Thomas, are closely looking at how the Meals on Wheels program can lower Medicaid costs.

             Based on a study by the Washington, D.C. based Center for Effective Government released in April 2013, every dollar invested in Meals on Wheels today could save taxpayers up to $50 in Medicaid costs down the road.

 Other Benefits of Meals on Wheels  

             Ellie Hollander, President and CEO of the Meals on Wheels Association of America, observes that both Brown University and the Center for Effective Government studies specifically focused on Medicaid savings attributable to nursing homes, but do not take into consideration significant savings that would be realized through reduced Medicare costs as well, through fewer visits to physicians and the emergency room and less hospitalization or reduced readmissions.

             Hollander says, “We have long known that the value of Meals on Wheels goes beyond the social and moral imperative of helping to address the epidemic of senior hunger in America.  “The friendly visit and a safety check are a lifeline enabling seniors to live more independently and healthy in their own homes, which in turn avoids far more costly health care alternatives often paid through Medicare and Medicaid,” she says.

             “The Brown University research proves what our work has long suggested to us: the Home Delivered Meals Program not only makes a positive impact for the senior, it is a good investment for the state as well,” says Executive Director Heather Amaral, Meals on Wheels of RI.

            Another study is in the works to support Thomas’ efforts to closely look at the impact of nutritious home delivered meals.  According to Hollander, a $350,000 grant from the AARP Foundation and the Meals on Wheels Association announced on Oct. 6 will enable Thomas to begin her randomized controlled trial of 600 seniors representing a cross-section of rural, urban, low income and minority populations across the country and a majority of the grant will be used to feed these seniors.            

            In this upcoming study, 200 seniors will receive meals daily, 200 more will receive a delivery of frozen meals once a week and then another 200 will continue on the waiting list as before as a control group. The study will compare quality of life, isolation, and health care utilization among individuals before and after they begin receiving meals and across the three groups.

             Holland says, “Through our generous grant from AARP Foundation, and with Dr. Thomas and Brown University’s help, we will seek to monetize the value add of the “more than a meal” component of Meals on Wheels.”

A Call for Support

            On AARP.org, Kathleen S. Connell, Rhode Island AARP State Director, calls on state lawmakers to take a very hard look at how they fund the state’s Meals on Wheels program.  Connell urges Congress not to put the Meals on Wheels program on the budgetary chopping block as a way to chop the huge federal budget deficit.

            Connell says that “Leaders need to be reminded that Meals on Wheels recipients aren’t unemployed workers waiting to return to jobs that will accompany an economic recovery. They are older retirees living on limited fixed incomes. With the cost of prescription medicines, healthcare and utilities going up, they sometimes can’t afford to eat. Many commonly sacrifice on food because of money worries – real or feared.”

            Connell notes, “Meals on Wheels is a big deal [to seniors]. No one should take it for granted.”

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

 

 

 

Gridlock Threatens Elder Programs, Services

Published in Pawtucket Times, October 11, 2013

At press time, this week continued heated partisan bickering on Capitol Hill that threatens to unravel a fragile economy, along with putting the brakes to an economic upturn that slowly was pushing the nation out of its financial doldrums. With this stand-off, a partial shutdown of the federal government continues. The Republican-controlled House, captured by the ultra-right Tea Party, has refused to budge, opposing the passage of a continuing resolution (CR) to fund government agencies past Sept. 30. House Republican leadership has demanded that passage of the CR must be tied to either the repeal or partially dismantling of President Obama’s signature achievement, the Affordable Care Act. The Democratic President along with a Senate Democratic leadership say no.

Meanwhile, the Democratic-controlled Senate passed a “clean” CR to provide funding through Nov. 15, not putting ACA on the GOP’s chopping block. Even if both legislative chambers sort out differences and hammer out a compromise agreement to open the doors of the federal government, this would not shield the nation from the disastrous impact of the impending second round of sequester cuts and a Oct. 17 deadline for the government to raise the debt ceiling. No action means a first-ever default on the nation’s debt that could send the stock market tumbling and push the nation’s and the world’s economy into a tailspin.

Treasury officials say that congressional deadlock and no action will result in the federal government running out of cash to pay its bills if Congress does not act to raise the nation’s debt ceiling this month.

Get Your House in Order

With the debt crisis looming, AARP Executive Vice President Nancy LeaMond called on Congressional lawmakers to settle the debt ceiling debate to avoiding default on the nation’s debt, specifically to protect the retirement of seniors and future generations.

In her letter, LeaMond expressed concern that any delay in raising the nation’s debt limit may unnecessarily increase borrowing costs, negatively impact retirement savings accounts and harm the nation’s fragile economy.

“Our members are worried that the benefits they have earned may be cut as part of a deal to reduce the deficit, fund government operations, or increase the debt ceiling, and they are increasingly worried that if there is no agreement very soon, they may not receive their Social Security checks and may lose access to their health care,” noted LeaMond.

Ten days ago, the nation entered a government shutdown, forcing furloughs of 800,000 workers, without pay, and suspending services. The last time this occurred was 17 years ago during the Clinton administration. The Congressional impasse has closed national parks and monuments, federally owned museums, such as the Smithsonian, offices overseas that give visas to foreigners hoping to visit the United States, and even many federal regulatory agencies.

So, how does this impact programs and services for older Americans? Simply put, impact on programs and benefits may vary throughout the federal bureaucracy.

The U.S. Department of Health & Human Services will furlough over 40,512 of its 78, 198 employees. The largest percentage of these employees comes from “grant-making and employee-intensive agencies,” such as the Administration for Community Living. This federal agency would not be able to fund the Senior Nutrition programs, Native American Nutrition and Supportive Services, Prevention of Elder Abuse and Neglect, the Long-Term Care Ombudsman program, and Protection and Advocacy for persons with developmental disabilities.

As reported, Social Security checks will be mailed, Medicare and Medicaid benefits will continue to be paid out, because these are considered mandatory programs, not discretionary ones. Benefits under the Supplemental Nutrition Assistance Program, commonly referred to as food Stamps, will continue in October, despite the federal shutdown.

Food Program Takes Budgetary Hit

Jenny Bertolette of the Meals on Wheels Association of America charges that the Federal Government shutdown “adds insult to injury as Senior Nutrition Programs are already dealing with devastating cuts due to sequestration, funding that has never kept up with inflation, increased food and transportation costs and increased need as significantly more seniors are aging and struggling with hunger than ever before.”

Bertolette says that should a shutdown persist for any considerable length of time, local Meals on Wheels programs that rely on government funding could experience a delay in reimbursements for meals and services delivered. Facing such funding uncertainty, programs could be forced to suspend meal services, create or expand waiting lists for meals, cut the number of meals or days they serve and reduce delivery days.

Jenny Bertolette of the Meals on Wheels Association of America charges that the Federal Government shutdown “adds insult to injury as Senior Nutrition Programs are already dealing with devastating cuts due to sequestration, funding that has never kept up with inflation, increased food and transportation costs and increased need as significantly more seniors are aging and struggling with hunger than ever before.”

Bertolette says that should a shutdown persist for any considerable length of time, local Meals on Wheels programs that rely on government funding could experience a delay in reimbursements for meals and services delivered. Facing such funding uncertainty, programs could be forced to suspend meal services, create or expand waiting lists for meals, cut the number of meals or days they serve and reduce delivery days.

Heather Amaral, Executive Director of Meals on Wheels of Rhode Island, agrees, noting that her Providence-based nonprofit program, has already lost $70,970 in 2013 federal funds due to last year’s sequestration cuts.

Amaral says that as a result of these cuts, to maintain meal delivery at the same numbers as last year (360,299 meals), she had to reduce menu items that were once offered. “Although the government shutdown doesn’t have an immediate impact on our program, I am concerned that it could lead to additional cuts,” she says, noting that should the shutdown continue until year end, the nonprofit agency will be forced to rely on donations and reserves to maintain service levels.

“We provide a safety check along with each home delivered meal and are often the only contact our client has that day, adds Amaral, who stresses that her program may be the only thing keeping a senior at home. “If we are forced to reduce the number of meals we serve, these people may be forced to live with a family member or enter a nursing home,” she warns.

Meanwhile, the U.S. Housing and Urban Development (HUD) agency will be unable to fund additional payments to public housing authorities, many providing shelter to older Americans. HUD expects the 3,300 Public Housing Authorities it funds to have enough funding to get through the month of October. But, if the shutdown continues, some public housing authorities will not be able to maintain normal operation.

Also, Quarterly formula grants will not go out for the Low-Income Home Energy Assistance Program (LIHEAP), the Social Services Block Grant (SSBG), or the Community Services Block Grant (CSBG).

Nutrition programs serving older adults face a double whammy with no FY14 appropriations and no reauthorization of the Farm Bill. The Senior Farmers’ Market Nutrition Program expired along with the Farm Bill on Sept. 30. The Commodity Supplemental Food Program (CSFP) requires appropriations to continue operating.

According to well-known Aging Advocate Susan Sweet, this is a partial shutdown that hasn’t really hit aging programs yet. There are funding reductions in programs for older people, but that is due to the sequester, which will have another round of cuts in October, she says.

Sweet predicts that the negative effects of the shutdown itself will become worse with every passing day. For example, there is doubt that veterans benefits and social security will be paid in or after October absent a funding bill. Death benefits, including burial subsidies, have not been paid to the survivors of fallen armed forces members, she notes. Because of the public outcry regarding this outrage, a private charity has stepped up to pay the benefits with the promise of reimbursement when the government re-opens.

“Reduced to its true absurdity, the United States of America has lost the ability to rationally govern,” states Sweet. “The sequester cuts, previously characterized as “cuts for dummies”, have been implemented, we are in a war yet cannot bury our dead from that war, can’t even agree on a temporary fix, and are arguing whether the US should pay its bills or default,” she adds.

“It is perplexing, and we have heard many, many concerns from Rhode Island members, “ said AARP State Director Kathleen Connell. “Since the U.S. government has never failed to meet its financial obligations, we don’t know what payments it could make if the President and Congress fail to reach an agreement.

“One cannot help but wonder what effects this uncertainty has on people – many of whom struggle enough with health and financial issues,” Connell added. “We’re doing whatever we can to urge Congress and the President to act responsibly.”

Herb Weiss, LRI ’12, is a Pawtucket-based writer covering aging, health care and medical issues. His weekly commentaries can be found on his blog, herbweiss.wordpress.com. He can be reached at hweissri@aol.com.

Rhode Island Families Can Benefit from Expanding State’s TDI Program

Published in Pawtucket Times, May 17, 2013

In the 2012 legislative session, it was very easy for Pawtucket Rep. Elaine A. Coderre to say yes to Sen. Rhoda E. Perry, when the Providence lawmaker came looking for a House sponsor of S 2734. Perry’s legislative proposal would amend the State’s existing Temporary Disability Insurance (TDI) program to include coverage for caregivers who care for loved ones during a health care emergency or to take time off to bond with a child.

Years before, unexpectedly being pushed into the role of caregiver would bring Coderre to become the primary sponsor of H 7862, the companion bill to S 2734. To the disappointment of the Pawtucket lawmaker and her Senate colleague, their legislative proposal would be held for further study, effectively killing it.
Understanding a Caregivers Needs

In 1997, taking care of her dying mother became time-consuming for Coderre, a part-time lawmaker who served full-time as Executive Director of the Emergency Shelter of Pawtucket. Before the onset of the terminal illness, Coderre’s 78-year-old mother had lived independently on the second floor of her daughter’s three floor tenement.

With her elderly mother quickly losing her ability to live independently, being diagnosed with fourth stage Alzheimer’s disease and fourth stage colon cancer, the fifty-year old Coderre instantly became a very stressed caregiver

For over ten months, Coderre skillfully juggled the responsibilities of working two very challenging jobs, meeting family demands, and becoming the primary caregiver to her frail mother. To provide care seven days a week, 24 hours a day, Coderre would rely on her husband, three adult children, sister and her husband, to assist.

“It was a scheduling nightmare, remembered Coderre, referring to the complexity of making sure each family member was inked in the schedule and were notified when to report for duty. “We were committed to making my mother, in her final days, feel safe, secure and to have a quality of life,” she said, noting that her family did work well together, making the care giving schedule work

Looking back, Coderre considers herself extremely fortunate because she had her immediate family and was able to hire a homemaker, to provide more of the physical care, from 9:00 a.m. to 4:00 p.m.
Supporting Temporary Caregiver Insurance

But, Coderre realized from this experience and calls from constituents that not everyone has a large network of family and friends, or adequate finances to take care of a very sick loved one, even to know where to find caregiver support services. Becoming a care giver to a frail family member, an experience that many Rhode Islanders will face during their adult life, pushed Coderre to again become the primary sponsor of House legislation to create a Temporary Caregiver Insurance Program (TCIP), for the second time around.

During the 2013 legislative session, Coderre has joined Sen. Gayle Goldin, who represents areas in Providence’s Eastside, to reintroduce companion measures in the Rhode Island General Assembly (H 5889 and S 231) to create a TCIP. The legislative proposal, modified to address opponent concerns from the last session over the length of the benefit, would expand TDI to employees who must take time out of work to care for a family member or bond with a new child in their home.

If enacted, employees would be eligible to receive up to 8 weeks of replacement income while providing care for a seriously ill family member or new child. The law would provide employees with job security by allowing them to return to work when their caregiver responsibilities have concluded. The average weekly benefit for an employee would be $408.

Like Coderre, Goldin, a first-term Senator, had her own life experience as a caregiver. Over the years she, as a family advocate, she has also talked with many parents who told her of their own children’s health needs and financial and emotional stress it created and how important this program was for them.

“Paid family leave is a cost-effective way to give employees the time to balance family and work responsibilities without jeopardizing their economic security,” said Goldin.

In the early 2000s, Goldin’s interest in research on TCIPs was piqued when the program was implemented in California. Last year, as a member of the Providence-based Women’s Fund of Rhode Island’s Policy Institute, she brought this knowledge to the table when working with seven women to get legislation introduced on Smith Hill.

At that time, out of five state’s nationwide that had TDI, like Rhode Island, identified two (California and New Jersey) allowed the program to be used by caregivers, not just those who are suffering the illness or injury themselves.

The research findings gathered from the Women’s Fund of Rhode Island’s Policy Institute would give ammunition to Sen. Perry and Coderre to push for the TDI program expansion in 2012. When Goldin took over Perry’s Senatorial seat when the long-time Providence Senator retired, she picked up the TDI cause, bringing Coderre back to the plate this legislative session, to assist her in the House.
Advocates Rally to Support

On April 11, eleven groups, including AARP Rhode
Island, the Senior Agenda coalition, Woman’s Fund of Rhode Island, the Economic Progress Institute, Rhode Island Kids Count, and the Rhode Island SEIU State Council, came before the House Finance Committee, to push for passage of H 5889.

Dr. Marcia Conè, Ph.D., CEO, of the Woman’s Fund of Rhode Island, told lawmakers that the TCIP is just an updated extension of the current TDI program that “best addresses the new health and lifestyle changes of today’s society, giving “everyone the flexibility of needed to balance the new realities of family and work responsibilities.”

To put the brakes to a “brain drain” out of the Ocean State, due to higher salaries available in bordering states, Dr. Conè stressed that H 5889 would offer what all employees need, time off to care of family business in a crisis. “The prestige of having the most family friendly work environment in New England is a very strong incentive for families to stay in the state to make Rhode Island their home,” she told the panel.

In her testimony, Executive Director Kate Brewster, of The Economic Progress Institute, stated that the state’s Parental and Family Medical Leave Act of 1987, and the Federal Family Medical Leave Act of 1993, give employees up to 13 weeks of “unpaid leave” to care for a family member or new child. “These laws protect employees’ jobs, but not their wages,” she said, observing that low-income Rhode Islanders can not afford to take unpaid time off from work, they need their wages.

Countering Brewster’s comments, submitted testimony by R. Kelly Sheridan, representing The Greater Providence Chamber of Commerce, warned that H 5889 would expand the State’s existing TDI program to allow employees time off to care for family members, when most states do not even have a TDI system. This expansion “would make Rhode Island’s business climate an outlier compared to our neighboring states and would send the wrong message to the business community regarding improving the business climate in our state,” he said.

While Matt Weldon, Assistant Director, of the State’s Department of Labor and Training, took no position on the TCIP legislative proposal, he came to answer questions. Weldon noted that there could be a .2 increase to the rate an employee is mandated to pay into TDI. Currently, the state program takes 1.2% of the first $61,400 out of an employee’s paycheck.

Maureen Maigret, Policy Consultant for the Senior Agenda Coalition of Rhode Island, told the House panel that nobody can predict when a family crisis will come, specifically “the critical illness of a child or spouse, an older person’s fall and subsequent need for care.”

Maigret estimated, for just pennies per week paid by workers – the cost of a cup of coffee — passage of H 5889, would allow workers to take temporary leave to deal with sudden critical family needs and still have some income.

With the Rhode Island General Assembly gearing up to finish the people’s legislative business by the middle of June, We Care for Rhode Island (WCRI), a grass roots coalition consisting of 32 organizations, including small business owners, workers, policy centers and family and health care advocates, was established at the end of April, to push for the passage of a Rhode Island TCIP.

Last Saturday, visiting local retail stores on Hope Street, Steve Gerencser, of WCRI, passed out literature, calling on owners to support his group’s attempts to create a TCIP in the Ocean State. “It can be a boon for businesses,” he says, citing a 2011 research study detailed on his Legislative Fact Sheet, supporting the passage of H 5889 and S 231. Gerencser notes that the findings estimate that program would save employers $89 million a year by improving employee retention and reducing turnover costs.

Goldin agrees with WCRI’s assessment a TCIP’s benefit to businesses. Moreover, she claims that there is really no impact on the State’s budget, to start up this new program. “It’s revenue-neutral and is solely funded by the employee, business owners and taxpayers do not contribute.”

With a negligible expense to implement, with no cost to the taxpayer or even the business community, it’s penny-wise and pound foolish for state lawmakers to not create a Temporary Care Giver Insurance Program, to financially assist Rhode Island employees when they take off time to help seriously ill family members or to care for newly adopted child.

Sound public policy, like this legislative proposal, can only send a clear message across the United States, that the Ocean State is finally taking steps to become more family-friendly, a great way to competitively attract large corporations and even smaller businesses into our borders.

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