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.

Tennis and Your Later Years

Published in Pawtucket Times, July 25, 2014

Like bacon and eggs, AARP Rhode Island hopes to make tennis synonymous with AARP’s Life Reimagined initiative.  On Friday, July 11, Rhode Island’s largest aging advocacy group firmly tied its national initiative to the International Tennis Hall of Fame & Museum, seeing an immediate opportunity to be associated with one of the world’s most high-profile tennis events, one that matched its age 50 plus membership demographic.  The new relationship provided a unique opportunity for the Providence-based group to get the word out about its legislative advocacy and grassroots community work.

This July, AARP Rhode Island unveiled its sponsorship with the Hall of Fame Tennis Championships which drew 22,500 tennis fans from across the country to the International Tennis Hall of Fame & Museum in Newport, Rhode Island.  A live telecast of the tennis matches and the tennis organization’s Hall of Fame enshrinement ceremony, which honors the best of  the tennis world, was beamed to millions around the tennis world on The Tennis Channel.  AARP’s sponsorship include center-court signage at 30-second spots on this channel.

“When we heard that tennis is promoted as ‘the sport of a lifetime’ we knew we were on the same wavelength,” noted AARP State Director Kathleen Connell, who stressed “AARP is all about providing resources for a lifetime.”

Anne Marie McLaughlin, Director of Marketing at the International Tennis Hall of Fame & Museum, agrees with Connell’s keen assessment.  “Tennis is very much in sync with AARP’s Life Reimagined program.   Perhaps people are seeking new ways to connect with friends once they’ve  become empty nesters, or a new hobby to keep them active and healthy.  Tennis can provide so many benefits in these areas, and it’s a great activity for people who are looking to reimagine and explore their life.”

“We’re proud to partner with AARP Rhode Island to showcase the game’s many physical, social, and mental benefits to their members,” says McLaughlin who agrees with Connell’s take that tennis is a sport of a lifetime.  “It can be played and enjoyed by a 5-year-old or a 95-year-old and we are very excited to  partner with AARP Rhode Island to engage, and inspire their members,” she says.

“But, Connell warns that “You cannot generalize about the athletic abilities of people over 50, noting that demanding sports such as marathons, and distance swimming attract athletes in their 60s, 70s. 80s. and even older.  Tennis is a great sport for people over 50 because you can play at your own level with players of similar skill.  To live longer and remain healthy we know that being and staying active is critical.  AARP encourages people to find a sport or activity that can provide life-enhancing benefits, both physical and mental,” added the Middletown resident.

Creating New Opportunities in Your Later Years

As a sport, tennis is a great fit for people looking to reimagine their life after 40.  “Whether it’s a job transition, career change, starting a dream business, adapting to being an empty nester or making the switch to a retirement lifestyle, AARP Life Reimagined provides online assessment tools, guidance and resources to help people explore new opportunities, identify adaptable skills and set new goals,” Connell explained.

Connell says Life Reimagined.org is the go-to web address for feeling good about aging. “It’s about you and what you want to accomplish,” she says, noting that it helps put AARP’s “Real Possibilities” into action.

According to Connell, AARP is no longer an organization for older people, but one for all people who want the best out of life, regardless of their age.  Many AARP members are still working and do not plan to retire, others leave their jobs seeking new challenges or even establishing new businesses, she explains.

Over a year ago, AARP launched Life Reimaged, a free program designed to help 76 million Boomers easily navigate into new life experiences or reboot their professional lives into different directions.  For the sixties generation, continuing to work a full-time job, or even coasting into retirement is no longer an acceptable option.  But, AARP stressed that reinventing oneself is the way to go in your later stages of life.

The Life Reimaged website provides tools to help you make key decisions for your next direction and detailed resources to guide you through that journey, says Connell.  “Whether your career has hit an unexpected bump in your 50s, or you are looking to start your own business or head down a new path into retirement, AARP can help,” she said.

At the Hall of Fame Tennis Championships

AARP staff and over 50 volunteers were on hand at the Hall of Fame Tennis Championships from Monday, July 7 through the tournament finals on Sunday, July 13.  Being stationed at an AARP Life Reimagined booth, these individuals answered questions and distributed copies of AARP Magazine and other materials.  On Friday, July 11, (at AARP Day) Connell announced a new AARP membership benefit — a year-round discounted AARP member rate of $8 (instead of the standard $13 rate) for admission into the International Tennis Hall of Fame & Museum.  The organization’s museum is open daily and also offers special events including film and music.  Year-round tennis programming, including lessons and group play on the historic green courts are available, too.

Activities for AARP Day included a free 50+ tennis clinic led by legendary tennis coach and newly inducted Hall of Famer, Nick Bollettieri, followed by a book signing and Q&A session (see Bollettieri in action on AARP Rhode Island’s YouTube Channel, http://www.youtube.com/aarpri).  That day, over 70 people attended an-hour long panel discussion in air-conditioned comfort of the Casino Theatre at the Hall of Fame, about AARP’s Life Reimagined initiative.

At the Friday panel, Connell noted that “It was a real treat for fans to get a chance to hear Hall of Famers Nick Bollettieri, 82, (Class of 2014) and Owen Davidson, 71 (Class of 2010) talk about their careers.  AARP volunteer, Charles Dress, 76, of Warwick, also shared his thoughts about how tennis has played an important role in his later years, after retiring from a full-time career,”
said Connell.  The panelist all agreed that tennis was “a natural outlet for the life-long learners who want to work hard at improving their skills and staying mentally sharp.”

Meanwhile, at Friday’s tennis clinic Bollettieri, stressed to those attending, “age is only a number.”  Connell noted that this is in line with the messaging of AARP.  “His enshrinement into the Hall of Fame is fitting not only because of his place as the coach of some many tennis champions, but also because he is a magnificent ambassador for the game.  He inspires people with his energy and enthusiasm.  We were thrilled that he made his way to our tent to join AARP,” she says.

McLaughlin added that Bollettieri is “an amazing example of what Life Reimagined can represent.  At 82 years of age, Nick is still on court 6 days a wee for 10 hours a day…and likely on the golf course the 7th day.  He’s living proof that it’s possible and very positive, for someone to stay physically active in older years.  With this physical activity come great social and mental benefits as well.”

Before the Hall of Fame Enshrinement Ceremony, Bollettieri gave this columnist a few pointers on living life in your later years.  “Stay active and never, never, never, use the word retire,” he says, warning that once the word enters your vocabulary, you begin to decline.

Buying into AARP’s Life Reimagined initiative, Bollettieri advices, “Don’t retire, just change professions.”

Check This Out…

On September 4 and 5, AARP Rhode Island will host two free Life Reimagined “Checkups” at its Providence headquarters.  A Life Reimagined leader will facilitate the three-hour workshop that familiarizes people with the available Life Reimagined tools and resources.  These sessions include small-group exercise for people looking to make changes in their career direction or hoping to reinvent themselves in retirement.  The first session will be in the evening, the second session in the morning.  Register online at aarp.org/ri or call 401-248-2671.

For more information about the International Tennis Hall of Fame & Museum go to http://www.tennisfame. com.

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.