Rhode Island General Assembly Tackles Senior Issues

Published in Pawtucket Times, July 19, 2013

At the end of June, Rhode Island lawmakers passed the state’s $8.2-billion FY 2014 state budget bill, sending it to Governor Lincoln D. Chafee’s desk for his signature. Even with $ 30 million ultimately slashed from the state’s fiscal blueprint because of lower-than-anticipated revenues, cash strapped taxpayers were happy to learn that they will not see any state tax or fee increases.

            Political correspondents in print, electronic media and in web site blogs zeroed in on specific items in the state’s enacted budget plan, those that they judged as weighty and newsworthy to be detailed to their audience.  Like the phoenix rising from the ashes, the FY 2014 state budget brought back to life the state’s historic tax credit (through the efforts of Executive Director Scott Wolf, of Grow Smart and a broad based coalition of over 100 groups), also putting dollars into workforce development, even helping the Ocean State’s burgeoning artist community by enacting a state-wide sales tax exemption on specific types of art purchased.  With the budget now signed into law, Rhode Island liquor retailers are able to compete against competitors in nearby Massachusetts because of a new 16-month trial period for tax-free wine and liquor sales.  

            One of the more controversial items in the FY 2014 state budget that fueled heated discussions on WPRO and WHJJ radio talk shows was putting funds in the state budget to pay the first installment payment of $2.5 million on the bonds issued to the now bankrupt 38 Studios. 


Funding Programs and Services for Seniors

            Although not widely reported in many media outlets, Rhode Island lawmakers did not turn their back on aging baby boomers or seniors.   

            The FY 2014 budget provides $1.0 million in Community Service Grants to organizations serving the elderly, including $200,000 for meals on wheels, $25,000 for Home and Hospice Care and level funding for Senior Centers across the state.

            It also consolidates funding for care for the elderly, consistent with the Integrated Care Initiative.  This initiative will coordinate care of the elderly, many of whom are eligible for both Medicare and Medicaid and who navigate disjointed payment and delivery systems.  With the state’s enacted budget, there will be a single funding and delivery system that integrates long term, acute and primary care to dually-eligible individuals.

            Also, the state’s budget plan maintains the Rhode Island Pharmaceutical Assistance to the Elderly program (RIPAE), coordinating with benefits provided through the Affordable Care Act and ensuring no gaps in coverage for low income seniors.

            It also directs funding for programs and personnel within the state’s Office of Health and Human Services to combat waste, fraud and abuse, including the new Medicaid Fraud Control Unit, to ensure Medicaid dollars return as much value for participants as possible.

            The enacted budget also establishes $80,000 for the Emergency and Public Communications Access Fund to improve emergency communication and to support emergency responder training for the deaf and hard of hearing population in the State.

TDI Expansion Becomes Law

            Meanwhile, on July 3rd, Rhode Island lawmakers approved legislation (S 231 B, 5889A), sponsored by Sen. Gayle Goldin (D-District 3, Providence) and Rep. Elaine Coderre, (D-District 60, Pawtucket) to expand temporary disability insurance to employees who must take time out of work to care for a family member or bond with a new child in their home (see my May 17 issue of the Pawtucket Times, May 19 issue of Woonsocket Call).

            Women’s Fund of Rhode Island CEO Marcia Conė and the WE Care for RI coalition, consisting of over 40 groups, brought in national politico operative, Steve Gerencser, who consulted and developed the game plan and messaging needed to get the TDI legislation passed and onto the Governor’s desk for signature.  Rhode Island becomes the third state in the nation to pass a paid family leave law.

            Signed by Democratic Governor Chafee, the new law will increase the state’s TDI program to cover up to four weeks of wage replacement for workers who take time off to care for a seriously ill child, spouse, domestic partner, parent, parent-in-law or grandparent or to bond with a new child, whether through birth, adoption or foster care. Temporary caregiver benefits would be limited to those who are the caregiver of their sick or injured family member, and the program would require documentation from a licensed health care provider.

            “The most important reason for this legislation is to provide support to help families in times of need, but it has many good ripple effects for Rhode Islanders,” noted Coderre. This includes saving on avoidable medical costs for people who will be able to stay home with a family member instead of needing to admit their family member to an expensive medical facility. It can mean that someone keeps their job.

            Adds Senator Goldin, unpaid leave isn’t always an option, and it’s a very difficult option for most families. “Paid caregiver leave is a cost-effective way to keep people from losing their jobs, jeopardizing their financial security or risking their family’s well-being when a family member needs care,” she said.

            The expansion would be funded through employee contributions, just as the rest of the TDI program is currently funded. In order to support the expanded benefits, employees would contribute another 0.075 percent of their income to TDI. For a worker earning about $40,000 a year, this would mean he or she would pay an additional 64 cents a week for the expanded benefit.

Also Becoming Law…

            Governor Chafee has also signed the Family Caregivers Support Act of 2013 passed by the Rhode Island General Assembly.    

            Aiming to improve the quality of life for the elderly and the disabled in the comfort of their own homes, an approved  legislative proposal requires the Executive Office of Health and Human Services to develop evidence-based caregiver assessments and referral tools for family caregivers providing long-term care services.

            Sponsored by Rep. Eileen S. Naughton (D-Dist. 21, Warwick) and Senate Majority Whip Maryellen Goodwin (D-Dist.1, Providence), the legislation calls for an assessment that would identify specific problems caregivers or recipients might have, carefully evaluate how those situations should be handled and come up with effective solutions.

            The legislation defines “family caregiver” as “any relative, partner, friend or neighbor who has a significant relationship with, and who provides a broad range of assistance for, an older adult” or an adult or child “with chronic or disabling conditions.” Rep. Naughton said people should be aware that there are support systems and an abundance of resources available for home care before deciding to put an elderly person in a nursing home or an expensive facility.

            Senator Goodwin added that without the proper support, the current system can place an unnecessary burden on both facilities and caregivers.

            “We want fewer individuals going into nursing homes and similar facilities if we can help it,” says Rep. Naughton. “It’s upsetting for an elderly or disabled individual to have to trade the comfort of his or her home for an unfamiliar place. Family caregivers not only know the medical needs of these individuals, but are often aware of their emotional needs, too,” she said.

            The comprehensive assessment required as part of Medicaid long-term service reform is meant to provide assistance with activities of daily living needs and would serve as a basis for development and provision of an appropriate plan for caregiver information, referral and support services. Information about available respite programs, caregiver training, education programs, support groups and community support services is required to be included as part of the plan for each family caregiver.

Addressing Long Term Care Needs

            Other approved legislative proposals, supported by the state’s nursing facility industry, were also signed by Governor Chafee.  

            Lawmakers passed and the Governor signed legislation to permit pharmacies that sell medications to nursing homes to buy them back, with a “restocking” fee.  Under the new law, medications that are individually packaged, unopened, and meet other safety requirements as determined by a pharmacist can be used rather than being discarded.

            Also signed into law were measures that promote “aging in place” and direct the state’s Department of Health to review regulations to permit this.

            Finally, the Governor signed the Palliative Care and Quality of Life Act, which establishes an advisory council and program within the Department of Health. Also, beginning in 2015, every health care facility must establish a system for identifying patients or residents who would benefit from palliative care and provide information and assistance to access such care.

             Virginia Burke, CEO and President of the Rhode Island Health Care Association (RIHCA), observed that this year’s legislative session had mixed results for nursing home residents.  Most of the bills that the group supported did pass, which “should lead to enhanced care for our residents,” she says. 

            According to Burke, “Unfortunately, providers were anticipating an adjustment to their rates this fall to address price increases in things like insurance, food, and utilities and that was taken away due to the budget deficit.  We’re very lucky that Rhode Island providers are known throughout the nation for their delivery of quality care, but quality begins to suffer when providers don’t have adequate resources to do the job.”

            This year difficult budgetary choices were made to balance the state’s budget.  Although aging advocates did not get everything they pushed for, Governor Chafee and the Rhode Island General Assembly did fund programs and services that are sorely needed by the state’s growing senior population.  I urge lawmakers to continue these efforts in the next legislative session.  

            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


When its Time to Take Away Mom and Dad’s Car Keys

Published in Pawtucket Times, April 12, 2013

On May 2, 2003, Rhode Island State Rep. Mabel Anderson was looking to buy her husband George a surprise birthday present from one of his favorite stores, Home Depot. As she was walking and pushing a shopping carriage near the front entrance of the huge box store located in the Bristol Place Shopping Center in South Attleboro, Massachusetts, an 86-year old driver getting ready to exit his parking space, accidently shifted his vehicle into ‘reverse’ rather than ‘drive,’ stepped on the gas peddle. This jolted the vehicle in the wrong direction, running over Anderson. She was transported to the nearby hospital, where hours later, she would be pronounced dead. Anderson’s tragic death almost a decade ago continues to be played out today in communities across the nation.

Aging baby boomers, coping with a decline in their driving skills because of the aging process, keep driving well into their twilight years, when for safety’s sake, they should just retire the keys.

Driving Skills Decline in Later Years

According to the National Highway Safety Administration, in 2010, older individuals made up 17 percent of all traffic accidents and 8 percent of all people injured in crashes during that year. Compared to 2009, fatalities among this age group increased by 3 percent, 1 percent for these older persons being injured.

Meanwhile, John Paul, Manager of Public Affairs and Traffic Safety at AAA Southern New England, details research findings indicating that driving can be dangerous in your very later years. The report released by Carnegie Mellon University in Pittsburgh and the AAA Foundation for Traffic Safety, found the rate of deaths involving drivers 75 to 84 “is about three per million miles driven – on par with teen drivers,” says Paul. But, once they pass age 85, vehicular fatality rates jump to nearly four times that of teens, he says.

Older motorists lose their ability to drive when the aging process kicks in. For these individuals, driving skills lessen because of poor vision caused by cataracts, glaucoma and macular degeneration, compounded with poor hearing, lack of flexibility, limited range of motion and reduced reaction time make the complex tasks associated with driving more difficult. Oncoming cognitive impairments, such as Alzheimer’s Disease and dementias, can also impact one’s ability to drive safely.

As older driver fatalities increase and the death toll tied to older-driver accidents skyrocket, a growing number of states are looking at licensing restrictions as a way to delicately approach this complicated issue.

Like many aging advocates, Gerry Levesque, AARP’s State Coordinator for Driver Safety Program, states that not all seniors are equally affected as they age. “One may lose the necessary skills needed to drive safely at age 60, while another will not lose those skills until 90”, states the 66-year-old Coventry resident.

“For older adults, losing driving privileges can be translated as a loss of independence,” notes Levesque. If this occurs, family or public transportation may not be available to replace the lack of transportation. “Older people may feel stranded or abandoned when they give up their keys,” says Levesque, noting that driving allows an older adult to pick up their prescriptions, shop for groceries or get out to socialize at the bridge club, bingo parlor or simply to be with family and friends.

“One thing that seniors have that the younger generation does not is a lifetime of driving. While they are losing physical abilities, they do have a wealth of experience from their years of driving,” adds Levesque.

Coping with an Aging Population that Drives

Over the years, states have grappled with the age-charged issue of restricting licenses of seniors not wishing to stir up their wrath. Aging advocates oppose any “blanket” solution to this problem that calls for licensing restrictions, rather it be made on a case-by-case basis. They say age should not be used as a “predictor” of unsafe driving.

In Rhode Island, the Division of Motor Vehicles (DMV) prorates its license renewal cycle for person’s age 71 and older. If you are 75 years of age or older, you license will be valid for two years. At license renewal time, the older person is required to pass a vision test or provide a valid medical examination certificate. A person’s physical or mental fitness to operate a motor vehicle is reviewed by DMV’s Medical Advisory Board whenever a case is brought to its attention by law enforcement, a physician or a family member.

With a growing aging population, Rhode Island’s Department of Transportation (RIDOT) has moved to tackle senior driving issues head-on. Two years ago, this state agency began to install a series of reflective markers or “roadside delineators” installed on the sides of roads as well as mounted on small posts and on top of concrete barriers. Especially geared for older drivers, these improvements were made to assist in making night-time driving easier and safer, while also aided driving during adverse weather

In addition to these improvements, RIDOT has installed cable guard rails along narrow medians on the Interstate where none previously existed. This safety feature significantly reduces the occurrence of head-on impacts with opposing traffic. State transportation officials have also made improvements to rural roads, by adding rumble strips, signing and roadside reflectors to help reduce road departure crashes.

Sharpening Your Driving Skills

AARP along with the AAA Southern New England recognized the thorny issues surrounding restrictive licensing and have developed special training courses to help older motorists freshen their skills to help them drive more safety, thus reducing the their risk of having their licenses revoked by state authorities.

AAA’s Senior Defense Driving Program (www.seniordriving.aaa.com) provides information about the aging process and its impact on a person’s ability to drive. The program gives tips on how a person can compensate for these changes and drive safer for a longer period of time. Additionally, a self-administered program, called “Roadwise Review” provides confidential and instant feedback on performance in key areas, allowing individuals to see how changing visual, mental and physical conditions do impact driving. In addition, the Auto Club’s “Roadwise RX” allows older drivers to look at the interaction between medications and driving.

AARP’s Safe Driving Program, (http://www.aarp.org/home-garden/transportation/driver_safety) the nation’s first and largest refresher course for drivers age 50 and older, has helped millions of drivers sharpen their driving skills. The four-hour program teaches defensive driving techniques, new traffic laws and rules of the road, as well as (and more importantly) how to adjust your driving style to those age-related changes to vision, hearing and reaction time. After successfully completing the Aging Group’s Safe Driving Program held in Rhode Island, the attendee is awarded a certificate of completion. The state mandates that the insurance carrier give a discount on their liability coverage to the policy holder with this certificate.

Surrendering the Keys

Ultimately, the burden may well fall on the family or the older motorist’s physician who must take the keys away from the driving-challenged senior for not only the driver’s safety, but for the safety of those sharing the road as well.

In the late 1990s my mother began exhibiting signs of dementia, and yet my father could not stop my mother from driving. The only solution appeared to come from making a call to the Texas Department of Motor Vehicles (TDMV) for help.

Several times mother got lost driving around our neighborhood, a once familiar area for her, ultimately ending up on the dangerous LBJ Freeway, miles from home and confused. With her driving skills rapidly deteriorating, my siblings took on the task of making that hard decision of taking the car keys away from her. After several meetings with TDMV officials, the agency finally took away her driver’s license.

As difficult as this decision was for my family to make, ultimately for my mother who was in the mid-to-late stages of dementia, did not realize that she had lost her driving privileges and her precious keys.

Kristi Grigsby, Vice President of Content of AgingCare.com, agrees that taking the keys away from an elderly parent is one of the most difficult decisions that family caregivers must make. “The loss of independence can be traumatic for a senior,” she says, noting that some elderly parents can accept the life-altering change; others understandably can not.

Grigsby warns that the consequences of doing nothing far outweigh the wrath of an angry parent. “Stories of tragedies that could have been avoided had those keys been taken away are sometimes all the inspiration needed to stand firm and make a painful decision with confidence,” she says.

For more information about taking the keys away from an elderly parent go to http://www.agingcare.com/Articles/Taking-the-Keys-What-To-Do-If-Mom-or-Dad-Won-t-Give-Them-Up-112307.htm. Information on this web site, AgingCare.com,
connects people caring for their elderly parents with experts on aging issues and caregivers who visit this site help family members make the best care decisions for older loved ones.

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